2003 IFA Congress: Montreal, Canada

The Effects of Emotional Intelligence Training in Fluency Disorders Classes

Isabella K. Reichel1 and Kenneth O. St. Louis2
1Long Island University, Fluency Renaissance Center, University Plaza, Brooklyn, NY 11201, USA, Nova Southeastern University, 330] College Ave., Fort Lauderdale, FL 33314, USA
2Department of Speech Pathology and Audiology, West Virginia University, PO Box 6122, Morgantown, WV26506-6]22, USA

SUMMARY

Success of stuttering intervention may be compromised by speech-language pathologists’ negative stereotypes toward people who stutter. This study investigated the effect of emotional intelligence (El) training on attitudes of graduate students in fluency disorders courses in one New York City university, compared to attitudes of a control group at another New York City university without such training. An EI scale, a survey of attitudes toward stuttering, a bipolar adjective scale, and responses to an open-ended questionnaire regarding El training indicated modest expected changes in quantitative measures and very positive impressions regarding the value of El concepts in stuttering intervention.

  1. Introduction
Studies have consistently reported that not only members of the general public, but even speech-language pathologists (SLPs), tend to hold negative stereotypes toward people who stutter (e. g., Cooper & Cooper, 1996). Commentaries from people who stutter sometimes reveal beliefs that SLPs do not understand their clients’ feelings and experiences and are not aware of their own negative biases (Corcoran & Stewart, 1998; St. Louis, 2001). Not surprisingly, therefore, many SLPs are unable to manage affective aspects of stuttering or to address their own negative biases toward their clients (e. g., Manning, 2001; Shapiro, 1999). No matter how much substantive knowledge and training clinicians may have, their negative or ambivalent feelings about stuttering may affect their clinical decisions and motivation in some cases, potentially contributing to therapeutic failure.

Consequently, our field is challenged to identify and reduce negative stereotypes of SLPs toward people who stutter as well as to include in their training emotional competencies that foster better therapy outcomes. One potentially effective way to do this would be to provide specific training to graduate students in fluency disorders classes concerning emotional and related cognitive issues faced both by stuttering clients and their clinicians.

Emotional intelligence (E1) was defined by Mayer and Salovey (1997) as “the ability to perceive emotions, to access and generate emotions so as to assist thought, to understand emotions and emotional knowledge, and to reflectively regulate emotions so as to promote emotional and intellectual growth” (p. 5). This definition highlights the strong interaction between emotion and cognition. It also supports Izard’s (1993) notion of a “continually emotional mind” wherein goals, motives, and concerns always include an affective component. Some EI abilities include the perception and appraisal of emotion, the assimilation of emotional experiences into mental life, the understanding of and reasoning about emotion, and the management and regulation of emotions in oneself and others, a so-called “ability model.” Many psychologists have extended the concept of E1 to refer to motivational and interpersonal qualities similar to personality traits that are outside of the original definition of El, known as a “mixed model.” (Bar-On, 1997; Goleman, 1995). Nevertheless, Mayer et al. (2000) point out that “the mental ability model is probably the only one that is aptly called emotional intelligence” (p. 416).

We hypothesize that E1 is important in achieving successful outcomes in stuttering therapy and that graduate training could be an optimal opportunity to teach concepts and skills to students related to E1. The purpose of this study was to determine the effects of an El curriculum module in fluency disorders courses on (1) self-ratings of El, (2) attitudes toward people who stutter, and (3) perceptions of the value of El training.

  1. Method
An EI curriculum module was developed based primarily on the “ability model,” although the module (as well as the instrument used to measure El) also included some features of the “mixed model.” Among other topics, the module included: the neurophysiology and neurobiology of emotions; the role of the autonomic nervous system in emotions; cognitive-emotional interactions; relations between emotions and memory; development of empathy and sympathy; awareness of one’s own emotions; ability to discern others’ emotions; individual differences in emotions; cultural influences on emotions; theoretical perspectives on emotions; specific emotions and feelings of anxiety/fear, anger, hostility, embarrassment, guilt, and shyness and their management in stuttering intervention; the role of emotions in stereotyping and prejudice; and critical assessment of El constructs. Laboratories wherein students met groups of six or seven people who stutter provided a forum for sharing emotional experiences as well as opportunities for students to manage emotionally difficult situations, e.g., failures in communication and negative reactions of listeners. The module also included discussions of emotional competencies in SLPs, e.g., empathy, risk-taking, tolerance of diversity, flexibility, creativity, optimism, confidence, and persistence.

Quantitative measures for the study consisted of three questionnaires. The Emotional Intelligence Scale (EIS) (Schutte & Malouff, 1999) is a self-report instrument measuring the ability to identify, express, and regulate emotions in oneself and in others. It purports to correlate with such constructs as optimism, impulse control, strong attention to feelings, mood repair, and empathy. The Public Opinion Survey of Human Attributes - Experimental Edition (POSHA-E) (St. Louis et al., 2001) is a questionnaire under development that measures knowledge, beliefs, reactions, feelings, and comparative attitudes toward stuttering, and several other human conditions. The finished version of this instrument is intended to be a valid, reliable, and user-friendly instrument to measure attitudes in different languages and settings around the world. The 25 Bipolar Adjective Scale (BAS) (Woods & Williams, 1976) consists of 25 paired adjectives and was designed to describe perceived personality attributes of people who stutter. Qualitative measures consisted of open-ended written responses to a questionnaire about El.

Graduate students in fluency disorders courses from two universities in New York City (Univ A and Univ B) participated in the study. The El module was delivered to students in Univ A, but not to students in Univ B, who served as control subjects. The three quantitative instruments, the EIS, POSHA-E, and BAS, were administered at the beginning and at the end of the semester during the first and last sessions of each course. At Univ A, the El module was delivered to three different courses, in spring, summer, and fall terms, with 14, 19, and 14 students, respectively, (or 47 total) filling out the questionnaires. The qualitative questionnaire was distributed after the El module. One course was chosen from Univ B, with 30 students responding at the beginning and 29 at the end. The total number of participating students in both universities was 77 students. The number of respondents completing individual questionnaires was slightly discrepant among the three instruments and between pre- and post-testing, ranging from totals of 69 to 77.

  1. Results and Discussion
Table 1 shows means and percentages for selected variables from the POSHA demographic section for each of the classes and combined groups. The total student sample was composed of 96% females and 4% males, with a mean age of 27.5 years and 18.1 years of school completed.

All lived - and 80% were born - in New York City or its surrounding suburbs. About one-third of the students who identified their living arrangements were single, about half were married, and the rest listed other arrangements. Three-fourths were native English speakers, with the four individual classes showing considerable variability in profiles of respondents who also knew other languages, predominantly Hebrew, Yiddish, and/or Spanish. Over 60% were gainfully employed, and respondents reported liking their work.

TEE_t1.png

Table 1. Demographic data for three courses in Univ A, Univ A combined, Univ B, and Univ A and Univ B combined.

Most reported excellent physical and mental health as well as excellent ability to learn and speak. Of 67 individuals who identified their race: 79% were Caucasian, 12% were Hispanic or Latino, 6% were African American, and 3% were Asian. Of the 64 who identified their religion, 62% were Jewish, 22% Catholic, 6% Protestant, 4% Christian ‘(denomination unspecified), 2% Muslim, 2% Buddhist, and 2% Ausarian. None of the students regarded themselves as stutterers. At the beginning of the classes, 22% of the respondents reported knowing nobody who stuttered, compared to 45% reporting stuttering among acquaintances, 11% among close friends, and 14% among relatives.

Mean scores on the 33 items of the EIS are shown at the top of Table 2. These means were very similar. Pre- and post-test scores were compared statistically for Univ A, for Univ B, and for both universities combined. Pre-test scores between the two universities were also compared with each other. Multiple t tests between scores were corrected to minimize Type 1 errors using the Bonferroni procedure, i.e., the .05 alpha level was divided by 33 (the number of questionnaire items in the EIS) to yield a cutoff or statistical significance of .0015. None of the comparisons was statistically significant with this conservative procedure, although there was a trend in the direction of higher emotional intelligence post-test scores compared to pre-test scores. For Univ A, 94% of the mean differences favored higher emotional intelligence post-test scores. Post-test scores were higher in 61% of the pairs for Univ B, and in 70% of pairs for both universities combined.

Ninety-five POSHA-E pre- and post-test ratings were subjected to t test comparisons using the Bonferroni correction alpha level of p < .00053 (.05/95). Table 2 shows that the rating for “the amount I know about stuttering” increased significantly after the classes for Univ A respondents, no doubt because it was influenced heavily by the third Univ A class. Univ A respondents, and Univ A and B respondents combined, also rated the source of their knowledge in stuttering, i.e., from the Internet and from their schoolteachers, significantly higher in post-tests. None of the other ratings was significant. Nevertheless, to provide a sampling of the trend toward more positive attitude changes after the classes, 14 POSHA-E items are displayed wherein results can be interpreted as more or less positive attitudes toward stuttering. These items related to respondents’ concern about someone such as a neighbor, child’s teacher or friend, and so on being a stutterer; their perception of the likely effect of stuttering on such life activities as interacting socially, getting a job, and doing well at work; and their views of various intellectual or psychological characteristics of a stutterer. For these 14 items, 71% (10/14) post- versus pre-test comparisons favored improved attitudes for Univ A, 79% for Univ B, and 79% for both universities combined.

Respondents made forced choices between the 25 adjective pairs on the BAS. (A small number of pairs were not circled at all, and respondents circled both adjectives in 1% of total instances.) Based on the literature regarding stuttering stereotypes (e.g., Manning, 2001, Shapiro, 1999, St. Louis, 2001), for each pair, we selected one adjective that was more likely to characterize a “positive” response or less likely to confirm a stuttering stereotype (“negative” response). For example, “guarded” and “introverted” were judged less positive and/or more stereotypical than “open” and “extroverted,” respectively. Percentages of respondents selecting “positive” and “negative” choices are shown in Table 2, clearly indicating that the graduate students in this study manifested the typical “stuttering stereotype.” (There were notable exceptions, however, such as stutterers being perceived as more “friendly” than “unfriendly” and more “pleasant” than “unpleasant.”) Nonparametric Chi square tests for the independence of distributions of respondents circling “positive” vs. “negative” adjectives yielded a number of significant results (p .05): four pre- vs. post-test comparisons for Univ A, seven for Univ B, and seven for both universities combined. All were in the direction of more “positives” and fewer “negatives” after thecourse except in one case for Univ B wherein more post-test respondents regarded stutterers as being “unpleasant,” and fewer “pleasant,” than at the pre-test. (See Table 2.) These significant findings are bolstered by trends toward more “positive” attitudes at the end of the courses in the remainder of the items. Percentages of comparisons that contained more “positive” and fewer “negative” responses at the post-test than at the pre-test were observed in 84% of items for Univ A, 60% for Univ B, and 80% for both universities.

TEE_t21.png
TEE_t22.png

Table 2. Summary, statistically significant, and sample results from the Emotional Intelligence Scale (EIS) and for the Public Opinion Survey of Human Attributes - Experimental Edition (POSHA-E). Summary and statistically significant results are shown for the Bipolar Adjective Scale (BAS). On the BAS rows, data reflect the percentage of responses that were “positive” or less likely associated with a “negative” stuttering stereotype. ( F or all three measures, pairs in the first six data columns, representing three dijferent classes in Univ A, were not compared statistically.)

Following EI training at Univ A, a questionnaire was distributed containing open-ended questions regarding the extent and specific ways El constructs might or might not be useful in dealing with challenges students anticipated in future stuttering therapy. Written comments were categorized according to similar messages. Of the 47 Univ A students, 77% believed that the El constructs are crucial for success in stuttering intervention; 64% believed that El can help understand emotions of clients who stutter; 38% believed that El constructs would help clinicians manage emotions in their clients; 19% believed that El can help clinicians to understand their own emotions toward people who stutter; 9% believed that knowledge of the neurophysiology of emotion is important for the understanding of stuttering. Seventy percent believed that their emotional competencies improved as a result of El training; among emotional competencies listed were: empathy, confidence, optimism, flexibility, ability to establish trust, importance of the clinical relationship with the client, ability to motivate the client and the client’s family, and tolerance of diversity.

The foregoing does not capture the richness and enthusiasm of the students’ responses. Following are excerpts from participants’ written responses:
  • “lt is important to work through the client’s emotions in order to get to the heart of our work. It will help me to be a more effective clinician.”
  • “I anticipate that working with clients who stutter will be like riding an emotional roller coaster. The clinician will need to treat each client as an individual.”
  • “ln a therapy situation, the interaction between the therapist and the client is very intense. The ability to self-reflect, to understand the inner state of emotions is important.”
  • “We all are emotional individuals, and most of the time we make decisions based on how we feel.”
  • “An emotional intelligence construct will help me to be more aware of clients’ emotions, and to become in touch with their feelings as well.”
  • “Emotional intelligence provides knowledge and understanding to address clients’ emotional needs and to understand why they are experiencing these negative emotions.”
  • “Emotional intelligence provides a helpful tool to approach not only fluency disorders but also any communication disorder.”
  • “I learned that I would have to give a lot more time and energy to a stuttering person.”
  • “I usually only focus on what I think the client is feeling, but now I have gained insight regarding my emotions, and how they impact therapy.”
  • “I now know how important it is to take people’s emotional state into consideration. I am more empathetic to people who stutter.”
  • “I realize that it is very important to know that emotions play a crucial role in all situations - learning and life.”
  • “Therapy may be ineffective if a client’s emotions are not prioritized.”
  • “People who stutter carry more baggage within them than the actual stuttering disorder...
  • “Clinicians need to be empathetic and not sympathetic.”
  • “Emotional intelligence will help the clinician to deal with clients’ emotional [difficulties] and to change motivation, feelings, and attitudes.”
  1. Summary
An analysis of the responses to the questionnaires showed very few statistically significant results for the EIS and the POSHA-E that could be interpreted as suggesting that the El module had a noteworthy effect on E1 measures or on stuttering attitudes. EIS pre-test ratings were quite high, possibly creating a “ceiling effect” such that post-test scores could not show much improvement. By contrast, a number of significant differences were shown for the BAS, all but one in the expected direction. Comments from open-ended questionnaires distributed to students after El training indicated that a large majority of them were pleased with the El module. They considered EI training to be helpful to them personally and potentially helpful in their clinical interactions with people who stutter.

  1. A Vision for the Future
In the late 1990s the World Psychiatric Association (WPA) inaugurated an international program to combat stigma and discrimination due to schizophrenia, and expressed the hope that its program would eventually be emulated in programs dealing with other stigmatized conditions (Sartorius, 2001). We who deal with people who stutter should accept this challenge. The condition with which we deal is relatively unique - a neurological syndrome that is often misinterpreted as a psychological problem. It is our intention to examine key features of the program, which was launched at the XI World Congress of Psychiatry in 1999, and to propose ways and means to emulate it on behalf of people who stutter.

We envision the following idealistic scenario. Features of the WPA anti-stigma program would be modified for stuttering and involve: people who stutter, their family members, self-help groups, SLPs and other health care professionals, government and community organizations, businesses, and educational institutions. The initiative would be international; it would follow a planned sequence of goals but would allow for flexibility in their use; and all participants would benefit from the cumulative experiences of previous and present participants. Public attitudes would be measured objectively with carefully designed instruments, such as the POSHA. The public would be offered information about the nature and misperceptions of stuttering. SLPS would become not only more theoretically proficient and comfortable in treating people who stutter, but would also acquire emotional competencies, as described in the module above, such as creativity, optimism, persistence, and risk-taking. These competencies, in combination with El abilities, would enable SLPs to provide therapy that includes consideration of biological, experiential, cognitive, and cultural influences on the emotions of all who are involved in the therapeutic process: clients, clinicians, family members, and others. People who stutter would participate in activities designed to improve their self-image, quality of life, successes in social and vocational interactions, and ability to deal with negative stereotypes and stigma that often permeate their lives.

References
Bar-On, R. (1997). The Emotional Quotient Inventory (EQ-i): Technical Manual. Toronto: Multi- Health Systems.

Cooper, E. B., & Cooper, C. S. (1996). Clinician attitudes toward stuttering: Two decades of change. Journal ofFluency Disorders, 21, 119-135.

Corcoran, J. A., & Stewart, M. (1998). Stories of stuttering: A qualitative analysis of interview narratives._ Journal of Fluency Disorders, 23, 247-264.

Goleman, D. (1995). Emotional intelligence. New York: Bantam Books.

Izard, C. (1993). Four systems for emotion activation: Cognitive and noncognitive processes. Psychological Review, 100, 68-90.

Manning, W. H. (2001). Clinical decision making in fluency disorders. Vancouver: Singular Thomas Learning.

Mayer, J. D., & Salovey, P. (1997). What is emotional intelligence? In P. Salovey & D. J. Sluyter (Eds.). Emotional development and emotional intelligence: Educational implications (pp. 3- 34). New York: Basic Books.

Mayer, J. D., Salovey, P., & Caruso, D. R. (2000). Models of emotional intelligence. In R. J. Sternberg (Ed.). Handbook of intelligence. (pp. 396 - 420). New York: Cambridge University Press.

Sartorius, N. (2001). Some strategies to tackle stigmatization and discrimination: Part Four: Other campaigns. In A. H. Crisp (Ed.) Every Family in the Land: Understanding prejudice and discrimination against people with mental illness. The Editor and Robert Mond Memorial Trust. http://www.stigma.org/everyfamily.

Schutte, N. S., & Malouff, J. M. (1999). Measuring emotional intelligence and related constructs. Lewiston, NY: Edwin Mellen Press.

Shapiro, D. A. (1999). Stuttering intervention: A collaborative journey to fluency freedom. Austin, TX: Pro-Ed.

St. Louis, K. O. (2001). Living with stuttering: Stories, basics, resources, and hope. Morgantown, WV: Populore.

St. Louis, K. 0., Yaruss, J. S., Lubker, B. B., Pill, J., & Diggs, C. C. (2001). An international public opinion survey of stuttering: Pilot results. In H.-G. Bosshardt, J. S. Yaruss & H. F. M. Peters (Eds.). Fluency disorders: Theory, research, treatment and self-help. (pp, 581- 587). Proceedings of the Third World Congress on Fluency Disorders in Nyborg, Denmark. International Fluency Association.

Woods, C. L., & Williams, D. E. (1976). Traits attributed to stuttering and normally fluent males. Journal of Speech and Hearing Research, 19, 267-278.

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