Study Guide for Charles Van Riper's
The Treatment of Stuttering


Following are my study notes for pages 203 - 368 of The Treatment of Stuttering, by Dr. Charles Van Riper (1973). Englewood Cliffs: Prentice Hall. Although out of print, the contents of this book are still copyrighted. These notes are provided to assist students and to interest others in exploring this classic work, in the hope that it will one day be refurbished and republished. While steeped in mid-20th century behavior modification therapy, Van Riper's work truly indicates a holistic approach to therapy for stuttering, giving it continued relevance. - Darrell Dodge.


CONTENTS

The Design of Therapy | Diagnosis: Initial Evaluation | Motivation
Identification | Desensitization | Modification | Stabilization


THE DESIGN OF THERAPY

The Bases of Our Therapy

The Therapeutic Schedule

The Therapeutic Sequence

Identification Phase

Desensitization Phase

Modification Phase

Stabilization Phase

Provision for Individual Differences

Learning Theory

Stuttering Therapy as Unlearning and New Learning

The Targets of Learning and Unlearning

The Learning Process

Learning of stuttering behavior

Learning in Therapy

Servo therapy

Psychotherapy

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Diagnosis - Initial Examination

Obtain Speech Sample

Explore Client's Stuttering Behavior

Assess Client's Normal Speech

Anticipatory Characteristics

Explore PWS's Life History

Clinical Procedures

Trial Therapy

Provide Sum Up

Severity of Stuttering in Terms of Prospective Therapy (Prognosis)

 PFAGH  +  Sf Wf  +  Cs
Ss  =   ----------------------------------
              M  +  Fl

Where:

P = vulnerability to penalties of stuttering
F = frustration
A = anxiety
G = guilt or shame
H = hostility
Sf = situation fears
Wf = word fears
Cs = communication stress
M = morale or ego strength + motivation
Fl = fluency client already possesses

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MOTIVATION

The Stutterer's Motives

The Costs of Therapy

Varying Levels of Motivation During the Course of Therapy

Motivation Difficulties in Therapy

Goal-Setting Difficulties

The Aversiveness of Stuttering

Lack of Trust in the Therapist

Reluctance to Surrender Secondary Gains

Problem When Stuttering as Only a Minor Nuisance

Revealing the Therapist's Competence and Commitment

The Inevitable Challenge

Providing Hope that Stuttering is Modifiable

Motivational Arousal Through Planning

Subgoals and Motivation

Reinforcement

Therapist needs to constantly reinforce learning and behavior change

Available Reinforcers

Self Reinforcement

Approval for What?

Other Positive Reinforcers

Negative Reinforcement

Escape from punishment or unpleasant activities by changing behavior or accomplishing difficult tasks

Punishment

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IDENTIFICATION

Identification of overt and covert behaviors

Opportunity to establish client-therapist relationship

Therapist's Role

Role in Therapy course

Identification procedures

The Hierarchy of Identification Therapy

Provide guidance in addressing progressively more difficult behaviors

Identifying the Target Behaviors: The Fluent Stuttering

Identifying Avoidance Behaviors

Collecting Postponement Behaviors

Identifying Timing Behaviors

Modifying the Verbal Cues

Identifying the Situational Cues

Identifying the Core Behaviors

Use triads to show contrast between fluent and stuttered utterance

Begin proprioceptive training

Allow self corrections to happen

Encourage active exploration by PWS

Model and discuss tremors and loss of control

Identifying Foci of Tension

Identifying Repetitive Recoil Behavior

Identification of Post Stuttering Reactions

Identifying Feelings of Frustration

Identifying Feelings of Shame

Identifying Feelings of Hostility

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DESENSITIZATION:
THE REDUCTION OF NEGATIVE EMOTION

PWS fears are not irrational; they are based on the stigma of stuttering

Need to reduce strength of attendant emotional upheaval

Aimed at three targets:

  1. Confronting abnormality of stuttering
  2. Tolerating fixations and oscillations
  3. Communication stress & listener penalty

The Therapist's Role

How to Desensitize

Recognizing Negative Emotionality

Constructing Hierarchies

Targets of Desensitization Therapy

Confrontation of the Disorder (dealt with in Identification Phase)

Confronting Core Behaviors or moments of stuttering (fixations & oscillations)

Desensitization to Listener Reaction

Counterconditioning

Link an anxiety-inhibiting response to a stimulus that formerly evoked anxiety

The Therapist as a Counter conditioner

Assertive Responses

Disinhibition

Systematic Desensitization Using Relaxation

Pseudo stuttering in Desensitization

Pseudo stuttering as Self Disclosure

Misuses of Pseudo stuttering

Adaptation

"The Bath of Stuttering"

Nonreinforcement

Negative Suggestion and Flooding

Response Prevention

Adaptation with Negative Suggestion

Adaptation to Stress

Eliminating Other Sources of Anxiety

(Address other personality problems that may contribute to stuttering)

Reassurance

The Anxiety Reduction Effect of Modifying Stuttering

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MODIFICATION

Hold out vision it is possible to stutter fluently

Avoidance and escape behaviors do not extinguish easily

Stutterer must change as well as stuttering

Variation

The Exploration of Self

Varying Behaviors

Role Playing

Attitudinal Change

Varying the Stuttering Behaviors

Anticipatory Behaviors

Varying the Escape Behaviors

Modification: Teaching of Fluent Form of Stuttering

Goal is to modify and shape the form of stuttering

Sequence ordering produced - as close as possible to normal utterance

Change articulatory postures and speech habits in some way

Behavior inappropriate to normal sound/word/utterance production should be error signal for altering

Clarifying the Motor Model

Proprioceptive Monitoring: Masking

Enhancing Proprioceptive Awareness by DAF

Proprioceptive Monitoring Through Pantomiming

Program rewards to reinforce specified performances

Cancellation

Cancellation as a Preventative of Stuttering Reinforcement

The Pause

Resistance to Contingent Pausing

Necessity for Completing the Stuttered Word Before Canceling

Using the Pause for Calming

Filling the pause

Cybernetic Aspects of Canceling

Overt Cancellation

Shaping

Modification of Stuttering During Its Occurrence

Pull-Outs - Apply modifications during moment of stuttering

Pulling out of Fixations

Pulling out of Tremors

Release from Laryngeal Closures

Release from Clonic (Spastic Muscular) Behaviors

Getting Control of the Uncontrollable

Pull-Outs as the Consequence of Cancellation

Motor Planning and Preparatory Sets

Motor plan breaks down because articulators are in unnatural position for utterance

"Set" is plan to begin word in a more normal fashion

Plan includes slower sequencing, all sounds and transitions slowed proportionately

Need to raise awareness if PWS not conscious of motor activities

Motor Planning: Normal and Abnormal

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STABILIZATION

The Need for a Stabilization Stage in Therapy

Resist temptation to terminate therapy prematurely

Activities of the Stabilization Period

Reconfiguring Fluency

Shadowing in Stabilization

Prosody and Formulation

Continuous Speaking

Increasing the Rate

Reflecting

Automatization of Sets And Strategies

Generalized set creation by:

Preparing for Contingencies

Generalization

Extinguishing Fears

Nucleus Situation in Stabilization

Buffering

Resistance Therapy

Other Resistance Activities

Reintegrating the Self Concept

Terminating Therapy

Therapist should learn when to terminate therapy (read signs from client)

Therapist should learn how to terminate therapy

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