#70 Spontaneous Conversation with Dr. Chris Constantino
“Much of the stuttering experience really has little to do with dysfluency, but much to do with how the individual is coping. And the decisions they’re making under the surface can play a huge role in their quality of life.”
Listen to this episode on Apple Podcasts, Spotify, Google Podcasts or your favorite podcast platform. You can also watch the interview on YouTube.
BIO:
Christopher Constantino lives in Tallahassee with his wife, Megan, and son, Augustine. He is a speech-language pathologist at Florida State University. He works clinically with people who stutter, teaches classes on stuttering and counseling, and researches ways to improve the experience of stuttering. He co-edited Stammering Pride & Prejudice.
EPISODE HIGHLIGHTS
0:00 - 04:48 Intro
04:48 - 8:20 Spontaneity, Tension and Quality of life
8:20 - 12:20 Walt Manning - agency and autonomy in stuttering
12:20 - 18: 58 Spontaneity and fluency
18: 58 - 23:13 Producing fluency
23:13 - 31:56 Alternative path to stuttering treatment
31:56 - 36:42 Neurodiversity
36:42 - 42:05 Pride around identity, and Quality of Life
42:05 - 49:02 Ramp of Access and Models of Disability
49:02 - 56:05 treatment of school-aged children who stutter. Reframing goals and advocacy.
56:05 - 1:02:14 Stuttering Gain
1:02:14 - 01:04: 56 What I would tell my younger self…
01:04: 56 - 01:08:39 Outro
RESOURCE LIST
Stammering Pride & Prejudice.
MORE QUOTES
“The idea behind stuttering gain is that we have experienced because we stutter that we wouldn't have if we were fluent.” -Dr. Chris Constantino
“When I stutter, I'm allowing them to see something vulnerable, a conversation becomes much more intimate and there's an intimacy there that wouldn't be there had I not stuttered. “ - Dr. Chris Constantino
TRANSCRIPTION:
Uri Schneider: And we are, we are live. This is incredibly exciting. Uh, this is going to be a very special episode. I shared with Chris before we started to know each and every guest in each and every conversation is precious, but there are few people currently active who have influenced my thinking. And given me pause and also have been quoted for anyone who's been listening to this podcast, you've heard me reference or quote Dr.
Uri Schneider: Chris Constantino several times, probably more than anyone else. So I think that really speaks to my respect and appreciation for his work, for his examples, for his living example and for the thoughtfulness, with which he expresses himself. Um, I'm thinking of when I interviewed Chris, uh, the Mateo Rivera in Texas, and I complimented him.
Uri Schneider: on stuttering fluently. And he did a double-take and I said, yeah, look up, look up what Chris Constantino has to say about that and think about it. Every episode I just recorded with my friend, Dr. Joseph cornet and how one of the big turning points in his process was this moment where he was trying to figure out what's his goal.
Uri Schneider: His goal is to stop stuttering. And I said, well, maybe you're 20 something years old and stutters here. And maybe putting all this energy. And this time to stop stuttering is creating a tension and a struggle in and of itself. What if the goal could be spontaneity? And I was just channeling and referencing Chris Constantino, and then ending that recording.
Uri Schneider: I said, Joseph, you got to let me go. You'll never
Uri Schneider: guess who I'm recording with next.
Uri Schneider: So it is, it is truly a great honor and privilege, uh, to welcome Dr. Chris Constantino, I'll do a formerly. And then we'll, we'll roll into the good stuff. Um, but there's going, gonna be a wide-ranging conversation, touching on topics, including spontaneity.
Uri Schneider: One of Chris's great interests and contributions and studies, as well as talking about social model disability and how that can be useful in our understanding and treatment of stuttering. Uh, as well as some nuance that I think is, is really needs to be heard. And I really enjoyed hearing from Chris as recently as just a few weeks ago in Washington, DC at the ASHA convention.
Uri Schneider: So without further ado, let's jump into this episode of transcending stuttering. Uh, my name is Uri Schneider and this is Dr. Christopher Constantino. He lives in Tallahassee with his wife, Megan and his son. Augustine is a speech language pathologist at Florida state university works clinically with people who stutter teaches classes on stuttering and counseling.
Uri Schneider: And researches ways to improve the experience of stuttering. Most recently, he co-edited stammering pride and prejudice, which if you haven't gotten yet, what are you waiting for? So without further ado, welcome Chris.
Chris Constantino: Thank you. I'm excited to be talking to you today. I think this is going to be a lot of fun.
Uri Schneider: So the
Uri Schneider: first thing I always opened with is what's one thing you'd like people to know about you that doesn't show up on the formal bio.
Chris Constantino: Um, I love bicycles. I love riding my bike. Uh, I ride my bike to get around, uh, It's fun. It's healthy. I see the city in a way that I wouldn't see it from a car window.
Chris Constantino: And, um, my little, my son Augie is a two. He loves being on the back of the bike with me. And, uh, we just have a great time together.
Uri Schneider: Is he able to see past you? Cause you have pretty broad shoulders.
Chris Constantino: Uh, he can see side to side. Definitely. I think I'm, uh, Y Y when he gets a little taller, maybe he'll be able to see over me.
Uri Schneider: Well, I have fond memories of being in the kiddie seat behind my dad, biking in true trails and Newpaltz and places like that. That's great. So why don't
Chris Constantino: did you grow up in New Paltz
Uri Schneider: no, you interrupt me, please. I grew up downstate, uh, in the Bronx, in the beginning by Pelham Parkway and then in Riverdale, which is also part of the Bronx
Chris Constantino: um, I'm from Poughkeepsie, which is right across the river from new Paltz
Uri Schneider: so my
Uri Schneider: dad worked at Newpaltz for several years before he was at Queens college and he it's one of his favorite places. So he always would go for hikes there and Mohonk is imprinted in all of our mind's eyes and the beautiful, uh, beautiful spaces there.
Uri Schneider: And Poughkeepsie is also familiar to us. So another good connection. So we know where we want to go and how we get there is going to be a process in and of itself. But why don't you just kick off with whatever my introduction or what we talked about before we pressed record, whatever that was touching for you, as I shared about the impact of your work and in my thinking and clinically, how it's made such an impact in the journeys of people that I get to meet who stutter
Chris Constantino: yeah. So you mentioned, uh, one of the ideas that I've been trying to develop that I've been calling spontaneity. And so for listeners who are unfamiliar with that concept, um, the way I've been thinking about stuttering over the years, thinking about my own stuttering, I'm a person who stutters thinking about my clients, stuttering is, and this isn't a new observation.
Chris Constantino: I think lots of people have had this observation that it, I mean, from the earliest speech, language pathologists, like Wendell Johnson back in the thirties and forties, up through van riper and Joseph shin, it seems like the. More people think about stuttering. The more people try not to stutter the tenser, their stutters are the more effortful their stutters are.
Chris Constantino: Um, and there seems to be a cognitive dissonance between that repeated observation. And then a lot of what we do in therapy, which seems to be encouraging people to think about their speech more and try not to stutter more through, through techniques that we might teach them. And so I was thinking about how.
Chris Constantino: Pedagogically, how, how, how can we teach people to think about stuttering in a way that might resolve that paradox? What, how do we, how do we help people who stutter, uh, or regulate speaking to the back of the mind rather than bringing it to the forefront of their mind? And so I was trying to what my idea about spontaneity was to try to measure how salient speaking was to the speaker.
Chris Constantino: So in terms of how much was their attention on speaking like mentally, cognitively and how physically effortful was speaking, um,
Chris Constantino: and.
Chris Constantino: To see the effect of spontaneity on a person who stutter's quality of life overall. And, uh, the, the results of my work were pretty clear that the more spontaneous people felt the less of an impact stuttering had on their life, that they, they, uh, as, as, as measured by the Oasis, the overall assessment of the speaker's experience of stuttering, um, small changes in spontaneity contributed to big changes on the Oasis.
Chris Constantino: So it was, it was pretty clear that there was, um, something here. So I'll, I'll, I'll stop there. And, uh, maybe we can delve into some of the details about that.
Uri Schneider: Yeah.
Uri Schneider: So maybe just bringing us to that moment and you're training. Uh, I think your doctorate was with Walt Manning, right? So I think a lot of people, including myself, that was the textbook of choice that my father used.
Uri Schneider: Uh, and a lot of people have benefited from Walt's contributions in that textbook. Uh, what can you tell us about your training and studies under Walt and how that brought you to kind of the way you, what influence did it have on you, both in terms of the directions you took and some of the turns you might've taken?
Chris Constantino: Yeah. So Walt was a lot of fun to work with? Um, I would say as a mentor, he was, he was pretty non-directive he sort of just encouraged me to flow where I would and just try to support me wherever I ended up finding myself. Um, but I think what attracted me to working with. Is, he had some really one is, if you look at his really interesting work, a lot of it is with prior PhD students.
Chris Constantino: And so he seems to have this ability to nurture the creativity of others. And so I, I, I wanted some of that nurturing. Um, but he also, as what was also is still a person who starters, um, he, I think he had a very deep understanding of some of the issues with agency and autonomy, uh, that, uh, affect stuttering.
Chris Constantino: So.
Chris Constantino: How much do people who stutter feel like they're in charge of the choices that they're making, right. How, how, how trapped do they feel by their stuttering and how can they regain some of the ability to make the choices that they want to make? Whether that's like big picture choices, like what you want to be for your career?
Chris Constantino: Uh, can you, can you speak to the people you want to speak to, whether that's small level choices? Like, can you say the sound of the word you want to say without avoiding it? And these are all choices that stuttering might affect. And that was an interest of waltz for decades is trying and trying to measure that.
Chris Constantino: And so this idea that, uh, much of the stuttering experience really has, has little to do with this fluency, but much to do with how the individual is coping. And w w the decisions they're making under, uh, under the surface, um, and that those decisions can play a huge role in their quality of life. And so, um, I think something, I was really trying to tease apart, as I was thinking about spontaneity was I had done my, my pre-discertation work, looking at, uh, people who pass as fluent.
Chris Constantino: So people who are able to hide their stuttering to such an extent that most of the people don't know that they stutter, that they sort of go through life presenting as a fluent speaker and.
Chris Constantino: These participants had very fluent speech, right? If, I mean, uh, from the listener's perspective, right? Their speech sounded fluent. But if you look in the literature about any definition of fluency, it has to do with the ease with which that speech is produced as well. Right? So these, these speakers sounded fluent, but they clearly weren't fluent, right?
Chris Constantino: That they were doing a lot of stuff under the surface to hide their stuttering. They were avoiding moments of suffering. They were doing things that typically fluent speakers do not do. And so while their speech may have sounded fluent, it wasn't experienced as fluent by them. And that was, that was clear in the interviews, but it's also clear like definitionally, if they're having to do that stuff or they're not by definition, fluent speakers.
Chris Constantino: Um, and it struck me that. That's also a similar experience to somebody who might be speaking fluently using fluency shaping techniques, right. That, although they're not stuttering, they're not producing disfluencies right there. There's not a discreet moments of disfluency their speech overall while it might sound fluent is still not experienced as fluent because it's still requiring that additional level of effort and attention that typically fluent speakers do not experience.
Chris Constantino: Right. And this isn't a, uh, this isn't a, a criticism of fluency shaping. It's just an observation that as long as the speaker is thinking about speaking and using effort to speak, they're not actually speaking to them. And so I wanted a way to think about stuttering and speaking that would distinguish those nuanced experiences, right.
Chris Constantino: That would, that would be able to quantitatively recognize that fluency shapes speech, the speech of somebody passing as fluent is different from the speech of a typical fluence of, of a typically fluent speaker. Um, and so I was attempting to measure both presence or absence of disfluencies like what we would typically do in stuttering in this, in the stuttering world and call that fluency, but then also measure the subjective experience of how much effort and attention does speaking require.
Chris Constantino: And so you have this sort of a dual set of constructs and on which speaking can vary. Right? So a typically fluent speaker might be both highly fluent and highly spontaneous, right? Um, they're not necessarily thinking about speech production, whereas somebody who's stuttering, who's really struggling with their speech.
Chris Constantino: They're getting blocked. They're getting stuck. They're wrestling with, it might be both low fluency and low spontaneity. Whereas somebody who's passing might be, um, highly fluent as, as measured by the listener, but have low spontaneity. But then what was really interesting is that opens up this fourth category right of then is it, is it possible to have disfluencies but still be spontaneous?
Chris Constantino: And, uh, I think that's the most fun category because it opens up this, um, perhaps alternative way of viewing therapy of, uh, can we, can we help people who stutter to speak more spontaneously regardless of their fluency and not the fluency's bad, but when I was mentioning those things, fluency had no effect on a Oases, right?
Chris Constantino: It, it, it, it didn't necessarily improve quality of life, but spontan spontaneity did. Um, and so I think the long-term, it, it behooves both therapists and people who started to think about the long-term goal of therapy as an increase in spontaneity.
Chris Constantino: Oh, yeah.
Uri Schneider: I just pulled up an image. Uh, so Chris, maybe it might help people who are listening to that, uh, visualize it because I found this visual incredibly helpful. So do you want to just walk through those two images that we're looking at here? Yeah.
Chris Constantino: So this is a image from a study I published last year, the references below the images, uh, Constantina at all 2020.
Chris Constantino: And I think we can link to that in the show notes. Um, so on the left-hand side, on the left hand side, well first let me orient you to the, the S two coordinate systems. Um, so I was just describing these two experiences of speaking, right? The presence or absence of disfluency and then. Degree of attention and effort on speaking.
Chris Constantino: And so you can see that I have disfluency influencing mapped on the X axis. Thank you. And, uh, spontaneity and effort fullness mapped on the Y axis. And then
Uri Schneider: I always dreamed
Uri Schneider: of being your TA.
Chris Constantino: Well, you're, you're doing a beautiful job. And then, um, you see that, that produces these four categories, right? The spontaneous fluency, which might be the typical experience of a typical speaker effortful fluence disfluency, which might be the, uh, effortful disfluency.
Chris Constantino: Yeah. Which might be the experience of a person who stutters who's who's very much struggling with their speech effortful, fluent. Which might be the experience of somebody using fluency, shaping strategies or passing as fluent, and then spontaneous disfluency, which would be somebody who has moments of stuttering, but they're not requiring much attention and not requiring much effort.
Chris Constantino: Uh, there, they might not even be accompanied by that feeling of losing control that we always talk about in, um, stuttering therapy. And for those of you who don't always talk about that, what I mean by that is, uh, that, that feeling of being stuck and unable to proceed forward in speech, that is what we, who start a wrestle with, right.
Chris Constantino: That, uh, when we're stuttering and we are trying to unstuck ourselves that, that, that feeling of not being in control of our mouth and lips and tongue. And so. I think the next slide we can go to. What I have on the left here is I think how maybe not, they might not explicitly realize that they're doing this, but I think this is how many therapists conceive of the therapeutic process, right?
Chris Constantino: That most people are walking into our therapy offices with speech that is effortfully disfluent right. There's noticeable stuttering, and they're struggling with it. They're having trouble regaining control of those moments. They're having trouble proceeding forward in speech and a intuitive thing to do.
Chris Constantino: It's to teach them how to produce fluency, using some sort of strategy, uh, whether that's prolong speech or, um, slower speech or easy onsets. Uh, we, we have pretty, we have pretty effective ways of making people fairly fluent fairly quickly. And so that would move them from the number one to the number two, where they go from effortful disfluency to effortful fluency.
Chris Constantino: And I, I think the hope from there is that then through practice and maybe some neuro-plasticity, uh, that over time that effortful fluency will turn to spontaneous fluency number three. And I think that's, that's reasonable, but. The support from the literature is lacking, uh, that these, these strategies are, I think very good at producing effortful fluency but poor at producing spontaneous fluency that you tend to have relapse Once the speaking techniques become automatic, right? You see this a lot from people who go to intensive clinics, where they might learn some strategies over the course of a couple of weeks and they leave very, very fluent. And then a couple of weeks later, a day later, a year later, uh, they're they're, they're stuttering like they used to, and these.
Chris Constantino: Even when they interview people who are still using the techniques years later and they, they, they might continue to sound very fluent, but they will say, uh, I still think about my speech all the time. Like I have to think about my speech all the time to produce this fluency. So I'm not suggesting this is bad, right?
Chris Constantino: This isn't a ethical argument or a moral argument. I'm just asking that we be, we be honest that we may be leaving a lot of our clients in the effortful fluency phase. And what my research showed was that going from disfluency to fluency wasn't as important as going from effortful to spontaneous. And so if we leave.
Chris Constantino: Our clients that effortful fluency we've changed how their speech sounds. I, it, it no longer sounds different to the listener, but we haven't changed how speech feels so much because it's still feels ever full and attention demanding maybe in a different way than stuttering felt. Right. And the client might prefer that way to the old way, but it's still not spontaneous.
Uri Schneider: There's a deception of liberation and a inattention of perhaps what tax or what price is being paid for that external fluency. I think that's how I've heard you.
Chris Constantino: Yeah, yeah, yeah. That, that, that fluency is ex is expensive. Right? It's it's it's attention demanding. Um, and so the graph on the right. Shows, perhaps an alternative path to, uh, stuttering treatment, which focuses on spontaneity first and foremost and allows fluency to happen as it's, as it might, or it might not.
Chris Constantino: And I think our, our literature on, um, people who stutters ability to stutter easier, shorter with less effort. Um, I'm thinking about a lot of the stuttering modification literature, uh, van van Ripers work Shane's work, um, is, is, is pretty clear that stuttering modification is possible. And if the literature looking at people.
Chris Constantino: Claimed has successfully managed their stuttering. I'm thinking specifically of, of a study by, uh, Laura lexicon, where, where, where she interviewed, uh, I think five people who stutter who've become very fluent over the years. And like, how did you manage that? Uh, what, what, what were you doing? And this, the stories are remarkably similar, right?
Chris Constantino: That people were reducing their reactions to stuttering, uh, reacting less and less giving less and less attention to their stuttering and that as their stuttering got shorter and shorter, some of them, some of them became highly fluent. Uh, Walt, my mentor is an example of that. I think I'm perhaps. Of that also, but not everybody does some, some people continue to stutter just as much as they used to.
Chris Constantino: They're just shorter, easier, more pleasant stutters. Right. And, and, and they see that as a wonderful outcome, right. That they, they don't want their old stuttering. And so this idea that if we can, if we can decrease the amount of attention effort that speaking takes, we've already done the important change.
Chris Constantino: Some people, for reasons we don't yet understand might then continue to get more and more fluent over time. And, but that's, that's less important. Moving from two to three is less important than moving from one to two.
Uri Schneider: I think it's so important. I'm so grateful that you're a bit of walk us through that because I think that image is that.
Uri Schneider: Very poignant way to have that conversation. And without the visual, it's hard to really conceptualize it. But the point is we've been so focused on and we don't have to dive into all the different nuances and all the great research that's being done on. Where is the locus of stuttering? And is it in the moment of the physical tension or is it in the anticipation of the speaker anticipating it.
Uri Schneider: And is it even just limited to a moment of being verbal and vocal or is it also impacting all those other moments of choices of what I choose to show up for what I choose to run away from or substitute other folks in, but just the concept of if we stop and think, well, what's stuttering, what's the impact and what are we looking to help people with?
Uri Schneider: And if we just start to see this, it becomes a very practical to me, very practical and salient way to recognize at least the value of this conversation. I've not just looking at the plain of the axis of disfluency to fluency, but also the access of effort to spontaneity or perhaps effort to effortless and to just kind of be able to go with the flow.
Uri Schneider: And as Chris was saying, if, and stop me, if I'm saying something that you wouldn't say, or you want to add to, but the value of fluency is certainly not an absolute, and while it can be something that someone can absolutely have the right to work on to shoot for, to wish for, and to want. It's important that we not set up this absolute expectation, that that's the be all and end all, uh, at all costs because at some point at the beginning of the journey, young kids, teens, adults can reasonably say that that's what they want
Uri Schneider: but it's
Chris Constantino: important for those of us, with some perspective that serve as a guide to recognize, well, is it the be all and end all because what about effortless and effort fullness and you know, what price and cost are you ready to pay? You know, as, as Chris said, if it's expensive, if you can be fluent, but you have to feel like you're walking a tight rope of strategies between two towers, it's still worth it.
Chris Constantino: You know? And like the trade off the idea of cost benefit and conceptualizing it as these two axes can be incredibly helpful. I think to frame it both from the research and conceptual, but I think it also dribbles into very practically how do we assess where someone's at and assess them over time and get a sense of being able to talk with someone where they're at and also set up goals and exercises that are going to bring them to.
Chris Constantino: Their personal promised land, uh, whatever that's gonna look like, but just broadening it from a one-dimensional to a two dimensional and recognizing the play between
Chris Constantino: the two.
Chris Constantino: Yeah. Yeah. I think that's really important. And I also, I just want to make clear to the listeners that it's not, it's not the is bad.
Chris Constantino: Right. I, as I alluded to earlier, my, my speech has gotten much more fluent over the years and I, I don't regret that. I like it's it's I don't, um, it's not that fluency is bad. It's that it's less important. It seems than ease of speech. And I think, I suspect I don't have the data to, to flesh this out, but I would imagine that the reason, uh, fluency did not predict changes in a wasted score was that.
Chris Constantino: Sometimes fluency is achieved at the expense of spontaneity that somebody is able to be fluent by, uh, thinking about speaking, by using strategies, by putting extra attention on their speech. And in those cases, uh, stuttering is still impacting them very much. And so it's not so much that fluency is bad.
Chris Constantino: It's, it's fluency achieved at the expense of spontaneity that seems to, to lessen the effectiveness of, of our therapies. And so I think there's there there's that point, but there's also the point that, uh, I don't know that all people who stutter can become fluent, I think there's very little data to suggest that they can.
Chris Constantino: And so there's an issue of realistic goals for people. Um, clearly some people who stutter get more fluent, but it doesn't seem like everybody does. And we don't quite understand why, if that's different genetic loading, different personality types, uh, different, we don't know the factors that, that, that influence that.
Chris Constantino: Um, but it does seem that, uh, most people who stutter have the ability to stutter are differently than they currently are. Right. I don't see a reason why they couldn't. And so to, to, to increase spontaneity is available to everybody, right. And we know whoever walks through our office, we can help you with that, but we have no way of knowing you know that I can make you fluent. And so, because that's, that seems to be the, the less important of the two. Anyway, I think it makes sense to, to focus on what we can change and then let that fluency do what it does.
Uri Schneider: Amazing. So with that, as a backdrop, maybe you want to touch on the topic of that talk neurodiversity, and that's really, you know, hot, important, valuable for us all to really understand what that means and, and bring in that perspective into the way we meet people and meet the world and embrace and engage people around us.
Uri Schneider: And I think there's a lot of value in the way it can inform the work that we do in stuttering, uh, both for people who stutter and what they're looking for and how they advocate for themselves as well as for those of us that are guides we're parents or teachers, or. Uh, for people who stutter, and I know that you added some nuance as to ways it could be helpful and then ways that we also need to be thoughtful to kind of couch that if you want to just reflect on that and I can bring up those slides, if you want,
Uri Schneider: let me, that's a big topic, so let me, um,
Uri Schneider: yeah, however you want to go with it.
Uri Schneider: It is, it is a massive topic, but there's no one better suited
Chris Constantino: ramble.
Uri Schneider: You do what you do best and we will listen, please. Don't, uh, don't, self-regulate too much. I'll take care of the time management. We're here to listen and to learn to your wisdom.
Chris Constantino: And so. Neuro-diversity was first talked about by, uh, Judy singer, who is an Australian sociologist.
Chris Constantino: I don't think she thought it was going to turn into the massive movement that it ended up turning into. She was working on her degree in sociology, in Australia, and wrote about this idea of thinking about different types of people, different neurotypes people with different brains, different, different, uh, ways of experiencing the world in the same way that we talk about biodiversity or, um, ethnic diversity that perhaps rather than trying to make.
Chris Constantino: People the same through medical interventions and therapeutic interventions, it might be healthy for society to have people who perceive the world and think about the world differently. And she, she, she called this idea neurodiversity. And at the time she was really thinking about especially autism, um, but also things like dyslexia and ADHD in a day.
Chris Constantino: But it's, it's the autism community that, that, that really grabbed hold of this idea and ran with it. And it became very popular on internet circles and, um, has had a pretty profound effect on the autistic community as a whole. Um, and the, I think a bit. A big piece of it was the idea that especially for somebody with autism, because autism is such a pervasive part of who they are.
Chris Constantino: And I, and I don't mean pervasive in a negative way, but just in a holistic way that autism affects how you perceive the world. It affects how you think about the world. It, uh, it affects many, many aspects of who you are as a person that it might not even make sense to talk about who that person is without autism, because that might be an entirely different person than the person with autism that you, you, you, you see this embrace of identity first language amongst this community calling themselves autistic rather than person with autism, because they insisted.
Chris Constantino: You can't separate my autism from who I am. And so to try and take away, my autism would be in a way to, to, to replace me with a different person. I think this idea was very powerful for a lot of people. It was a way to cultivate pride around an identity that was normally stigmatized. It was a, it was a way to begin to try to find value in being different.
Chris Constantino: Um, and so before long, you had lots of different other disabled communities trying to see if they could also make meaning, meaning from these eye gears and how it might apply to their circumstances.
Uri Schneider: And so with regards to that and how it informs stuttering community thinking about neurodiversity, and so looking at stuttering as. Another accent or another cadence or another, you know, if we look at a spectrum of different ways and cadence of speaking. So if we plug stuttering into a neurodiversity model, we'd kind of think of stuttering as just another, another notch on that spectrum of different ways that speech is presented.
Uri Schneider: And some people would find that extremely, uh, welcoming and refreshing, and some people would look at that and say, well, wait, hold on a second. It doesn't seem like that's the way the world sees me with my stutter or a parent might say, well, we'll hold up. Like none of the other kids in the class are, are repeating sounds with, with thoughts of time intention.
Uri Schneider: Uh, so I think there's something valuable there. And I just wonder if you want it to reflect on that. Cause I think you have some thoughts. Yeah.
Chris Constantino: Yeah. I think it, I think it actually dovetails nicely into what we were talking about earlier in terms of spontaneity influences. I think a big insight and important insight from the neuro-diversity movement was that trying to make somebody normal, doesn't always improve their life.
Chris Constantino: Right? So, um, something in the autism community has been very vocal about is that some of the things we do in treatment seem to not be geared at improving the quality of life of the person with autism, but making them appear more normal, right. Making them appear less autistic. And I think, uh, I think a really concrete example could be, if you take somebody maybe with cerebral palsy, who's having trouble walking and, um,
Chris Constantino: they might benefit greatly from a. wheelchair, right. You could give them a wheel chair and they could get around very, very well assuming their arms are functional. Um, but rolling around isn't as normal as walking around. And so they could probably also take crutches. Right. But that might actually be a less efficient way for them to move around.
Chris Constantino: Um, and so the, the solution that was less normal might actually be the better solution. And so I think in terms of autism, Uh, autistic authors have written about how, you know, uh, why, why do I need to make eye contact with people? I, I just don't like making eye contact and like, I can do it for the, because my therapist had been trying to get me to, but I don't understand why I need to do this normal thing that everybody else does just to make my listener more comfortable.
Chris Constantino: If it makes me uncomfortable. Why am I sacrificing my comfort for the comfort of the other or a self stimming behaviors? Right. If, if I want to flap my arms and it's not bothering anybody, why can't I flat my arms? Just because it's weird. And so this, this idea that perhaps the best way to help people, isn't always to make them like everybody else.
Chris Constantino: Uh, I don't mean like, as in be fond of everybody else, but, but to act the same as everybody else. And if we think that in our company similar to, yes. Thank you. Yeah. So when you think back about our conversation with stuttering, um, like we actually have empirical evidence that, that this holds right, that making Sutter is fluent.
Chris Constantino: Doesn't always help them if that fluency comes at the expense of spontaneity. And so it can be really intuitive to think about disabilities in terms of what's normal and what's abnormal, and to try to make the abnormal thing more normal. Hey, that's that makes intuitive sense. If people who don't start or don't have trouble physically speaking, then maybe if we make people who stutter are more like people who don't stutter her, it'll help them.
Chris Constantino: But it's not that easy and we don't actually have the power to do that usually. Right. And so just like giving that person with cerebral palsy, a wheelchair might be a better option than giving them the ability to walk from crutches, helping a person who stutters to speak spontaneously, but still stutter might be a better way to help them then, um, having them use effortful strategies to speak fluently.
Chris Constantino: And so the idea being that, uh, we should, we should focus our, our treatment strategies on improving their quality of life, improving their subjective experience before focusing on normalization or reducing the appearance of what makes them different.
Uri Schneider: So this is an excellent way to back into topic of disability.
Uri Schneider: Um, and where it is located, what we, how we conceptualize it. Um, one of my favorite classes in undergrad was the sociology of disability taught by Dr. Chris Rosa, not Chris Constantino. I was at Queens college and it was one of my favorite classes in Chris. Rosa was someone who was involved in the Clinton administration.
Uri Schneider: He was an advocate. He was, he's a legend in his own. Right. And he's also a person who was getting around the campus in a wheelchair. And you opened up my eyes to what it would be like to live life in the position of a wheelchair, both in terms of your stature, in terms of your way, you engage people at different Heights in the way that you enter a building and navigate the entrance of a building or the access of a place that just didn't have.
Uri Schneider: A ramp of access. And the concept of creating ramps of access was just a profound game changer for me. And I know that you, Chris, in advance of our conversation and I think dovetailing and on the heels of this conversation about neurodiversity at the topic of disability, the location of disability, as it relates to a person themselves, as it relates to the way the person engages the world around them in society, would you like to share some thoughts as it relates to stuttering in that sense?
Chris Constantino: I really like how you set that question up talking about location of disability, because I think, I think that's the right way to think about it. And I think that's how a lot of work in disability studies is thinking about it. And so it's not so much, is this person. Disabled or not disabled abstractly, but what is disabling this person, right?
Chris Constantino: Where does, where does the disability come from? And, uh, often we talk about models of disability in terms of ultimately where we think the disability originates. And so if we think it originates in the body, we usually call that the medical model and the way to then intuitively um, ameliorate that disability would be to do work on the body, to give medication, do surgery, do therapy, to, to help the individual, um, Alternatively, uh, another prevalent models called the social model, which sees disability as a systemic societal issue, that society is, is built to accommodate certain types of bodies.
Chris Constantino: And if you have a body that is sufficiently different from the norm, society might not accommodate you. And so to think about your professor, um, if all buildings on campus are built under the assumption that you are a Walker and he is a ruler, uh, he cannot access those buildings. Not because he uses a wheelchair, but because he was not taking into account in the construction of those buildings, uh, or at least the entranceway, some of those buildings.
Chris Constantino: And so this is often called a social model of disability. And these are, I think it's important for listeners to understand that. We can get bogged down in, in arguments here. And I, I, I very much am uninterested in those arguments and
Uri Schneider: as am I, and that's why this conversation can only happen with Chris Constantino.
Uri Schneider: So we're going to go right for the, for the practical, meaningful parts of this without getting into camps and arguments over minutia or taking
Uri Schneider: sides.
Uri Schneider: Yeah. So I, I think, I think models are useful for thinking about a problem, but they, but they're clearly simplifications of the truth. Right? And so I think the medical model is useful for thinking about, um, bodily change.
Uri Schneider: Whereas a social model is useful for thinking about societal change. And I think you need both from mobile. Most disabilities. I think stuttering is no exception to that. That very clearly from the literature, much of what people who stutter struggle with is social and origin. And that there's, it's, well-documented that, uh, as children, people who stutter are bullied and teased as adults, they have, uh, educational penalties.
Uri Schneider: They have vocational penalties, they have trouble forming relationships because of stigma around stuttering. And so if these sort of attitudinal barriers are removed, the experience of stuttering should improve dramatically at the same time. I think it would be naive to suggest that if society understood stuttering completely.
Uri Schneider: All people who stutter would be completely happy stuttering. And I think I, I, I say that because I remember how I used to stutter and I remember how hard it was to speak, regardless of who I was talking to, whether I was talking to my grandmother who loved me very much and was not bullying me or whether I was at the national stuttering association, talking to other people who stutter and I was experiencing no stigma.
Uri Schneider: Speaking was still very, very hard. And I would say that, uh, disability can be multi-faceted right. It can be located both in society and in the individual. And so, um, in addition to. Lessening societal prejudice. Um, I think many people who stutter, I'm not saying they have to, people stutter don't have to do anything.
Uri Schneider: They don't need to go to therapy, but I think many people who stutter benefit from learning to speak more spontaneously and wanting to speak easier. Um, and so I, I, I think there's room for both of those ideas.
Uri Schneider: What would you say about, um, stuttering gain fluency costs, reasons to stutter the benefit of no eating a school aged kid? I think I asked you this at the asha conference. Um, you know, it's easier in some ways when I'm engaging in adult, who's been through the ringer, frankly, who's been through all sorts of experiences, some, uh, more meaningful and useful.
Uri Schneider: Left bruises. And, uh, there's a lot of resentment towards the people that delivered those experiences or the experiences themselves or family members or peers who said something, peers, who didn't say something, teachers who were oblivious, teachers who were too much attending, you know, people have all sorts of experience.
Uri Schneider: When you have an adult, you can get in there and you can kind of reframe and revisit and kind of engage them where they're at and provide all the context and options in the world and see where they want to go. I think it's a little trickier given all the knowledge and understanding that we now have.
Uri Schneider: How does a therapist engage that young school aged kid to create options and choices without pushing too hard in one direction or the other? I was wondering if you had any thoughts on that, because I think we know one thing is clear. It's not fluency or bust, right? And so I think a lot of therapists, more therapists, not enough, but spread the word.
Uri Schneider: It's not all about fluency. Um, at the same time, a lot of people are then left with like, well then what you know, and what am I trying to do? So I think we're doing a really good job of getting the word out there. It's not all about fluency, but as you said, it doesn't mean that fluency can't be a piece of it.
Uri Schneider: Uh, it's just important that the effort effortlessness spontaneity is a piece of the equation. So what thoughts do you have about, you know, how do we meet that school aged kid who stutters in a way that's wholesome and allows them to find their way?
Chris Constantino: Yeah, so I, I think you're right that by the time, like, if, if you have an adult client usually they've for better or for worse, they've tried for.
Chris Constantino: Right. And they've done the techniques and it hasn't worked out for them. They're, you know, they want to try something different or they were thinking about maybe trying that again. But our, our easy to, uh, are, are open to trying other strategies just because they they've had experiences in that end, that that just didn't pan out for them, depending on the age of the child, it might not be much different.
Chris Constantino: I know with parents, the children of parents, the children of parents, the parents of children that, uh, oftentimes there's a sense of guilt that my child is still struggling to speak. Um, they've been in therapy from a young age. I've tried to do all the things that therapist told me to do, and they're still stuttering.
Chris Constantino: And maybe we just didn't practice enough. Maybe we just didn't do this or that enough. And when I, when I started my career as a therapist, I was really worried about taking sort of a stuttering positive position with parents of children. I thought they would, they would be, uh, you know, they would insist on fluency and say, you know, I need this to be fixed.
Chris Constantino: My child's really suffering. Um, but what I have found, something that happens more frequently is the mother or the father is relieved that, uh, it's not their fault that their kid is still stuttering and stuttering does not represent failure on their part as a parent. And that. That doesn't mean the child is doing to be miserable, right?
Chris Constantino: They can, they can speak how they speak and be happy and successful. And so, um, I guess the, I think reframing the goals even for, even for some kids have gone through the whole fluency thing and an, our doubt and they're willing to try something different. Um, I haven't met many, I haven't met any like young school-aged children who have the metacognitive skills to use fluency, shaving all the time.
Chris Constantino: I met many that can do it in the therapy room and will be a hundred percent fluent, but then you take them out of the door to bring them back to class. It's like they weren't even in therapy. Right. What did we just do for the past hour? And th th those metacognitive skills are not there for them yet.
Chris Constantino: Right. That's, that's hard. That's, that's an adult level skill. Um, and so I think the idea that what we're going to work on is trying to stutter as openly and easily and joyfully as we can. And we're going to think about what we're doing when we stutter. And are we, are we preventing our stuttering anyway, are we trying to hide our stuttering?
Chris Constantino: Are we, are we actually making it harder than it has to be? And let's try to, let's try to figure out how we can let ourselves stutter as much as possible that that's often. Welcome. It's like, oh, I, I can stop fighting this. I don't have to. I, you know, I don't have to speak a certain way. I just have to learn to let myself speak how I do.
Chris Constantino: And I think therapy with children is often simultaneously reducing those reactions to stuttering and preventing kind of event, new reactions from forming, right? You're almost, you're almost trying to play defense that you, you know, stuttering's hard, you know, that they're gonna receive, uh, teasing and bullying.
Chris Constantino: And so how do we, how do we stay on top of all those ways they might try not to stutter that all those ways they might make their speech pattern, more struggled and more effortful. And, um, Continue to make sure that they're equipped to stutter as openly and easily as they can. Um, how do we help them advocate for themselves?
Chris Constantino: How do we teach them to talk to their teachers, talk to their peers about stuttering, respond to teasing and bullying, um, and do what they need to do so that they can start her. Well, you, you, you mentioned stuttering gain earlier and the, the idea there is I didn't, I didn't
Uri Schneider: originate with that idea. I just want to give credit where credit's
Chris Constantino: due.
Chris Constantino: That's fine. Yeah, no, I think the, the, the, the idea there is that, uh, I think sometimes I talk about this and people will say, you know, but I would still rather be fluent and. I'm not suggesting would stuttering with the idea of stuttering gain. I know I haven't explained the concept yet, but, and I will, I just want to preface it with this thought, the idea that I'm about to talk about isn't that stuttering is better than foot's fluency.
Chris Constantino: It's that the stuttering is a normal human attribute. And by that, I mean, it has a nuance there's it's not just monolithically negative and it doesn't, it doesn't matter whether it's better or worse than fluency. What, what, what matters is that there's there's texture to this experience and the way that we've been taught to relate to our stuttering smooths it out, right?
Chris Constantino: It, it removes the texture because we only see the next. It's like, uh, we're not able to, to, to fully experience all the nuances of it because we're, we're so zoomed in on, on those, those bad experiences. And so the idea behind stuttering gain is that we have experiences because we stutter that we wouldn't have.
Chris Constantino: If we were fluent, some of those experiences, we wish we didn't have, I understand that, but some of those experiences are good and some of those experiences we would miss had, we never stuttered. And so I can't tell people what they gained from stuttering, but I think it's, it's important for people to explore that because if we can, if we can figure that out, if we can figure out what we gain from stuttering, um, the way I usually put this.
Chris Constantino: is If we it's easier to stutter, if we have a reason to stutter and that we can react less, avoid less. If the experience isn't totally negative, if there's, if there's something good that comes from this experience. Um, and so I, I said a moment ago that I can't tell people what the gain, is I think this is highly individual, but I, I like to give an example of something that helped me a lot, uh, of what I think I gained from my stuttering.
Chris Constantino: And that was this, this feeling that stuttering stuttering was, is it was an, is this incredibly vulnerable experience that when I stutter, I'm stuck trying to communicate with this person in, in a, in a very raw way. And they're, they're witnessing this. And the more I can allow them to witness it, not try to hide it, not try to obscure it and not try to convince them.
Chris Constantino: I was just thinking, but if I can allow them to witness me really be stuck, that they've just seen something vulnerable. And by allowing them to see something vulnerable, a conversation becomes much more intimate and there's an intimacy there that wouldn't be there. Had I not stuttered. And I can say, as my speech has become more fluent that that's, I miss that.
Chris Constantino: I, I miss those moments of, uh, eye contact while I'm stuttering. And the person is almost gently catching me. Right. It's almost like they're ho they're holding me as I'm, as I'm trying to speak. And then it comes out and we carry on and we just shared something. We wouldn't have shared. Otherwise, those people who stutter always talk about the, the hand shake that never ends, right.
Chris Constantino: Where you go to introduce yourself and, you know, you're always going to stutter on your name. And so you're trying to shake their hand and say their name and the handshake might extend for a minute or two. There's something nice about that. Right? You're you're, you're holding somebody's hand, um, pre COVID pre pre pre pre COVID.
Chris Constantino: Now it's a fist bump, so it doesn't take very long.
Uri Schneider: Um, nobody give you a long, give you a long extended, extended elbow to elbow rev.
Chris Constantino: Yeah. So there's, there's, there's something there that, uh, and I think this maybe even dovetails back to the neuro-diversity thing, it's not normal. It's not normal to hold somebody's hand for a minute when you're introducing yourself, but that doesn't make it
Uri Schneider: bad.
Uri Schneider: Right? Yeah. Chris, I hate to interrupt you, but I just want to say so many people come in. They say,
Chris Constantino: I just want to be normal. I just want to talk normal.
Uri Schneider: And one way of reframing, that could be like, well, what's normal, right? And another way would be like, dude, you're too good for normal, normal, boring, normal.
Uri Schneider: Doesn't excite me. I'm not attracted women. Men, people are not attracted to normal. They liked the extraordinary cause something extraordinary. There's something outstanding. I think of Catherine Preston talking about, you know, networking her stutter was at once of sources. Tremendous shame became a very memorable way to network.
Uri Schneider: You remember that person? And if they showcased it with creating these intimate moments and creating a very open, vulnerable moment, that was really. And not filled with unease. Um, could you get personal and share with us as a 20 year old guy and maybe compared to today, something that you would have wished you didn't have to deal with something that was uncomfortable with stuttering and, and then something that was a gain because like today, obviously Dr.
Uri Schneider: Chris Constantino and Dr. Walt Manning, I find it really interesting looking at the longitudinal picture of how we evolve. Is there something you can think back to some touch point and maybe even share that with us, if that's not too personal or too too
Uri Schneider: much?
Chris Constantino: Um,
Uri Schneider: something that was difficult, something that was an annoyance that was cumbersome.
Chris Constantino: My, my stuttering was very difficult. Um, there was a, there was a lot I could talk about, but I think like bird's eye view. My experience of speaking was like I was going into battle all the time. I, I, I was never, I wa I never passed as fluent. My stuttering was very much present all the time and very struggled.
Chris Constantino: And so my, I think, I think it affected my attitude a lot. I think I was just, uh, not open to experience, not, not open to intimacy because it was like I had shields up. I was expecting to be battered all the time, and I had this sort of, uh, I just have to keep my head down and keep moving. You know, uh, not really like a woe is me attitude, but more like a if I don't toughen up I'm not going to get through this, right. That it's just, I have to keep my skin as thick and hard as I possibly can. And, um, I think it prevented me from forming relationships with those around me, because I was it's like I was consumed with myself, you know, I was consumed with just surviving and, uh, was unable to accommodate others in a way that would, that, that, that would have been attractive to them.
Chris Constantino: Right. I, I don't know that I was able to form some of the friendships I would have liked you not that I didn't have friends. I wasn't lonely, but I was, uh, I was sort of, I was really rough around the edges.
Uri Schneider: Well to honor the time. I just want to thank you for this broad ranging wide ranging conversation, a spontaneous conversation.
Uri Schneider: Um, it was delightful for comments coming in from around the world. Uh, and so a lot of people have enjoyed this conversation, live, check it out on the podcast, transcending stuttering, it'll come out soon and, uh, look forward to another round. I'd like to finish with one question always. And that is one word of wisdom, either thinking of what you could say to your younger self, that 12 year old Chris, what you wish he would have heard, or you could say to him, knowing what you know now, maybe that would be, that would be a powerful message or a message for the world.
Uri Schneider: If you want to go less personal, you could just kind of say like what you wish the world would, would take away and, and be considerate of as we leave this conversation.
Uri Schneider: Yeah, I'm trying to. I know the thought I'm trying to convey to young Chris I'm having trouble making it pithy and clever. Um, so I'm going to make it on
Uri Schneider: clever, go into amendment
Chris Constantino: uncover.
Chris Constantino: Uh, I think something that I, I didn't realize that I had any control over how I was stuttering. Right. I thought that when I stuttered all these things happen, I look at the ceiling, I clenched my fists. I, I, uh, spit, I get blocked up. I do all these things. And like, in my head, that was just part of stuttering.
Chris Constantino: Right. That was just my cross to bear. And I'll just go out and do that. And it is what it is, but the idea that, uh, nothing. Or very few things about what happens when I stutter where necessary, right? The, that they were, they were things, I were doing things I was, I was struggling. They were just ways I was struggling.
Chris Constantino: And that like, there's no reason I couldn't make eye contact. There's no reason I had to push so hard. There was no reason other than habit, other than force of habit. Um, that, uh, actually, uh, most of the things I was doing or because I didn't value my speech and I was trying to speak, I was trying to speak like everybody else.
Chris Constantino: And as a person who stutters that was impossible. And so, um, what I would tell my younger self is, um, speak in a way that values your stuttering, speak in a way where. You're not holding yourself up to other people's standards that your stutter stutter in a way how you would stutter. If you liked it.
Chris Constantino: If, if you liked to stutter, would you, would you still be doing all those things that you're doing? If you wanted to stutter.
Uri Schneider: Profound, thought-provoking raw and, uh, always the way I leave listening to you, Chris. Oh, I want to thank you. The way we started you, uh, did not fail to provide much thoughts and, uh, things to consider people that have commented as such. And I want to thank you for taking the time. If you feel this was a conversation that you got something from, we'd love to hear your takeaways.
Uri Schneider: Chris will provide some resources. We'll post those, uh, on the. In the show notes. So you can access some of the research that was mentioned in some of Chris's work that he feels would be relevant. And, uh, we'd love to hear from you what resonated for you, uh, what was provocative for you. And, uh, without further ado, please share this with your friends, drop a like and comments, subscribe, and we wish you a wonderful day and talk in a way that values you and talk in a way that values your speech, whoever you are.
Uri Schneider: And however you talk, because what you have to say is worth it. So thank you everybody. I'll hit
Chris Constantino: pause here.