BIO

Vivian Sisskin is a Clinical Professor in the Dept. of Hearing and Speech Sciences. She is an ASHA Fellow and a Board Certified Specialist in Fluency Disorders. Sisskin was awarded the Excellence in Teaching Award by the College of Behavioral and Social Sciences. She served as Coordinator for ASHA’s Special Interest Group 4, Fluency and Fluency Disorders, and received the ASHA Media Champion Award for promoting an improved understanding of communication disorders through her appearances on local and national television, radio, internet and print. She has presented her work on the treatment of stuttering both nationally and internationally. In addition, her articles and workshops include principles for effective group therapy and communication strategies for children with autism spectrum disorders. Sisskin served on the Board of Directors of the National Stuttering Association and as  Vice-Chair of the American Board of Fluency and Fluency Disorders. She was honored as the 2014 Speech-Language Pathologist of the Year by the National Stuttering Association. Sisskin served as Chair for ASHA's Council for Clinical Certification in Audiology and Speech-Language Pathology (CFCC). She is a faculty member for the Stuttering Foundation of America’s Mid-Atlantic Workshop, as well as the Workshop for University Faculty and Doctoral Students. She is affiliated with the University of Maryland Autism Research Consortium (UMARC) and the Maryland Cochlear Implant Center of Excellence (MCICE).

Listen to this episode on Apple Podcasts, Spotify, Google Podcasts or your favorite podcast platform. You can also watch the interview on YouTube.

EPISODE HIGHLIGHTS

0:00 - 14:06 Intro 

14:06 - 19:24 Parent Involvement

19:24 - 25:27 Ivar lovas

25:27 - 28:35 Genetic Predisposition to Stuttering

28:35 - 45:29 Differentiating Struggle from Disfluency

45:29 - 45:57 Confidence

45:57 - 50:05 Spontaneity

50:05 - 1:11:59 Giving Yourself Permission 

1:11:59 - 1:17:07 Secondary Behavior

1:17:07 - 1:20:25 Take an Inventory of their Own Behavior

1:20:25 - 1:22:38 Where Can People Contact You?

RESOURCE LIST

Sisskin Stuttering Center

Vivian Sisskin- Use Your Tools And Other Ineffective Nagging Podcast Episode 

Contact Vivian Sisskin

Upcoming events

MORE QUOTES

“ It [stuttering] is a thing in itself and it does not grow out of normal disfluency. But when you have someone who stutters, who begins to develop what we call tension responses early on reactivity to the moment of stuttering, that's when the stuttering struggle begins. - Vivian Sisskin

TRANSCRIPTION:

uri: Good morning. Good morning. And there she is. There she is. She didn't want to hear the intro. She didn't want to hear the intro. So we are alive. I popped on because 200 people were knocking down the doors, Vivian. Good morning.

vivian: Okay. Good morning. Can you hear me okay, or is it too loud? I can adjust it. Is

uri: it fair to say?

uri: I mean, you're all miked up. You look great. Everything's

vivian: fantastic. How does it sound? Can we do a

uri: sound check?

vivian: Um, well, how does it, I don't know. Can you

uri: sing, can you sing maybe a little piece of opera for us?

vivian: Um, I don't know if I can sing a little piece of opera

uri: happy birthday or the, the rainbow passage.

vivian: Hear me speak. Okay. I'm not going to sing. I'm terrible at singing. Okay.

uri: I was going to say, you know, this would be a much nicer conversation if we were sitting, uh, at the evening after some workshops, over a glass of wine in the lobby, but it's too early for that.

vivian: Yeah, but I do have my coffee though. I have my coffee.

uri: Well, I'm going with some lemon ginger tea, the double double TV. But your, your headset. I mean, that headset just says one thing. You're talking to someone who's Ted talk level, we're talking the greatest spokesperson currently for stuttering. Uh, and so without further ado, let me just do a quick intro here.

uri: Great to see everybody. Good morning. It's already Schneider. Uh, I have the privilege to lead, uh, at Schneider speech with my father, Dr. Phil Schneider. And we've got some exciting things going on, but the most exciting thing, and I'll share the other things towards the end. So hang in, uh, I'll talk about the AirPods we're giving away and if you pay attention, if you find something Vivian says that's awesome.

uri: Write it down and notice when she says it, because you can send that to us. And that gets you into the raffle to win the free AirPods. We're trying to create a highlight reel for the end of the year episode. So if you help us grab a piece, cause I can't. Possibly relisten to all the gems. There's like a, it's like a mountain of wisdom.

uri: And if everybody could help us, we'll all pick out what was meaningful to them.

vivian: That's a lot of pressure. That's a lot of pressure. Yeah.

uri: There's no pressure. Listen, I pulled out some gems. I really listened to so many of your talks, Vivian in the past week. I have you coming out of, I have you coming out of my ears?

uri: No, no, no, no, no. I thought though, maybe you were avoiding coming on this morning, but uh, I'm glad you did.

vivian: The actual truth was I could not find the invitation in the, I know

uri: I have to get better at like locking things in with that.

vivian: Well, maybe a reminder the night before, but sure. Yeah.

uri: A hundred percent, a hundred percent.

uri: Uh, listen. It's a work in progress. This is all like an accident. So yeah, it's not like we had to schedule this, I think four months ago. I think like you were the, one of the first people I was like, okay. So it was nice doing this with the first person. I'd love to talk to Vivian. She's like, Oh, that'd be lovely.

uri: Um, my calendar's a little full. I think I could squeeze you in, in 2020. Let's see what we can do. So

vivian: it's a privilege. Well, yeah,

uri: we're gonna, we're going to finish strong. Uh, so I'll finish, I'll finish the nice things, but, uh, yeah, so we're giving away the AirPods because we want to just put together this highlight reel.

uri: We're giving away the online course, just as like a spirit of giving the season of the year for people to see what they can do if they choose, uh, whether you're a speech therapist or a teen or adult to kind of dive into the transcending stuttering online course, we'll give the details later in the comments, but.

uri: You're not here to listen about that. You're here because Vivian Siskin is someone who most of us know, and to know her as to lover, uh, she stands out besides all of her boring intro accomplishments, uh, which are not unremarkable, uh, both at university of Maryland. Also the Siskin center, stuttering, what she does with the avoidance reduction therapy.

uri: For stuttering, her work with the stuttering foundation, her work with the national stuttering association travels around the world. She's just a walking masterclass. I don't know if there's a feminine form of the goat. That's an expression for the greatest of all time. So, um, That's it. So we're in the presence of greatness.

uri: It's so good to see you. There are so many

vivian: questions. It's good to talk to you. Yeah. Sorta we're talking. Yeah. Sort of in person. Yeah. I think we're talking, I

uri: love your headset.

vivian: I love your head. You'll have to thank my son for that. Okay.

uri: Good. Well, we'll deal with that offline, offline. It definitely sounds great.

uri: So tell us besides that boring intro, what do you think are some things you would like people to know about you that don't show up on your, on your bio that shows up everywhere?

vivian: Um, I love Contra dancing. It's one of the things that I really miss during pandemic. I'm a Contra dancer and I travel around going to Contra dance weekends, and that's something I really, really miss.

vivian: Um, the other thing that I think that many people listening might already know about me, but, um, I'm the parent of a, um, adult disabled young man and, um, with autism and intellectual disability. And so most of my life is really surrounding, um, being in the world of disability. We have a special needs family.

vivian: And, um, so that's what I'm really all about. Although it looks to people, it looks like I'm about. Voidance reduction therapy, but I'm really about my family and, um, making sure that, um, my son is taken care of and, um, he lives at home with us. Um, I do have another son who's fabulous. Um, but right now our younger son with autism, uh, is living with us.

vivian: And so, um, that's what we do. That's what we're about.

uri: I take the Liberty to share that, but I do think that's something that is a big piece of what makes you so exceptional. Would you say that there's something about being a mom of a child with difference that contributes to the way you show up, obviously as a mom, but also to the work that you do, do you feel that adds a dimension that is unique?

vivian: Um, well, I kind of, I understand parents a little bit more than maybe I would've, um, I don't take anything for granted. I know how hard it is when, um, you're trying to sometimes have careers sometimes just manage. Um, I think that many people know about the research in, you know, A lot of divorce rate, high divorce rate among them.

vivian: Um, people with special needs in their family, there's stressors on the family. There's financial stresses on the family. There's emotional social. Um, and so, um, there's a lot that goes into it. I'm not saying that parents of neuro-typical kids are having it easy because they're not especially right now, but, um, it's just another layer.

vivian: It's a little different. Um, yeah.

uri: I think it's also, it's helpful to humanize people that we admire. And I think a lot of people admire you. And I think to know that you're a mom and a mom at that level, and that sometimes it's hard just acknowledging that really normalizes it for the rest of us and for all people.

uri: So certainly I, I can resonate with that. I always tell parents when we're in the session. Don't mistaken me for the, you know, I have all the answers. I am one fantastically imperfect parent. Um, and if you want to hear it straight from an imperfect parent to another imperfect parent, then I'm happy to share it.

uri: But

vivian: I used to always say to my older son who, um, we always say he's on the other end of the bell shaped curve. I always say, you know what, save it for the couch. You know, when you get older, go to the psychiatrist, say it for the couch. Um, but. Look, we, you know, in any particular moment you problem solve, you do things that you think are the best or what I go back and do things differently.

vivian: Of course, wouldn't we all. Um, but there's always tomorrow to do what you, you know, you feel as right tomorrow. So, um, And the other thing I want to say about being a parent, it never ends it doesn't ever end, you know, um, that reminds me of times that I used to, um, go to conferences and, um, spend time with your dad.

vivian: Um, yeah. And we used to, uh, your dad used to invite me to his room in the hotel and we'd have lunch together and cause he'd bring his food and we'd have these wonderful talks. So we go on walks together and guess what? We talked about Erie. Our kids,

uri: which my bro, he talked about my brother all the time. Right.

uri: That's awesome. Yeah, I left that out. Another intro would be what I could say about what my dad wrote about Vivian, but we'd be here all day. Um, the, the mutual respect, admiration and affinity that, that Vivian and my father share. It goes both ways. It's very deep. It's very long lasting and transcends.

uri: Everything, but, uh, very, very powerful and, and it's very much a privilege. So I feel that I have my connection to you through that, but also on our own. And it's, uh, it's always a treat and a pleasure kind of bouncing ideas with you and, and, and being challenged, uh, by different things that you'll push me on.

uri: I really, those are some of the things I look forward to most that I miss most. So I'm glad we're talking. You gave me a tough job. You, you know, you're when you posted it, you said you're going to, there are lots of people there trying to find time to talk to you. And they're going to have to suffice, listening to me being like their agent, a chatterbox, but

vivian: sort of my excuse for not keeping up with my friends when I really want to so, and missing everybody.

vivian: Um, totally just think about, you know, when we go to conferences, we go to professional events. That's our time to connect with our friends. I mean, our colleagues, our friends, especially in the stuttering community and, um, having the, the, the one-to-one time with people and the hugging, the hugging, I'm a big hugger.

uri: Uh, that is what I miss most, you know, distance is one thing you get within proximity people. If we. I haven't had like a good hug besides my plane. Thankfully, I have a wife, thankfully I have kids. And I don't say that lightly, but, uh, for people that don't, and that are really distanced, but for grandparents of grandchildren and for so many people yeah.

uri: To greet each other once a year with a hug. And you know, for me, due to religious reasons, it's a little bit easier because I don't try to have physical contact with people other than my wife. So it sometimes gets awkward when people want to have a really tight embrace, but I. Try to limit that a little bit, but for sure, like the embraces that is very much miss.

uri: So let's be a conduit for that. And if you have comments or questions, I will try to monitor Facebook to the best of my ability. So Vivian can just be Vivian flowing, doing her thing. I'm sure she's doing a thousand screening as, at the same time also, but I'll try to weave your stuff in. So if you drop a comment, a like a share, you'll help this conversation, reach more people.

uri: And without further ado, Vivian Siskin. So, you know, here we are. It's COVID what, um, what can you say about what's shifted in your practice in terms of how you're able to deliver care? Are you able to, people are always asking me, is, is zoom. Eh, should we wait until this is over, you know, is zoom really doable?

uri: Um, how do you respond to that? And how's your practice kind of doing that, handling that.

vivian: Certainly things have changed, but, um, we're having pretty good sessions on zoom. We've adapted quite a bit. And I think that, um, just to give you an example, one of why we have several groups going, but my Saturday morning group, which is a staple, it's a had Saturday morning group and the composition has changed over the years, but my Saturday morning group has been more consistent.

vivian: Um, ever than ever before, because you can get up and put your slippers on and maybe change your shirt and. Come to group and, um, they don't want to go back in person after this is over. I find that so interesting. They said, no, we're staying in virtual because we don't want to lose anybody in the group.

vivian: And, um, we know that even though we lost some people, when we went virtual, If we go back to being face-to-face, we'll lose some people too. Um, people who can't drive the distances here we are in the Washington area. The traffic is rough. Um, getting from one place to another. I always live in places that are very, very difficult to get around.

vivian: And I'm from Los Angeles, always had a traffic problem. Back to traffic problems here too. So we're making

uri: do thank God I live in New York city. So

vivian: yeah. Yeah. It's a little harder with the little ones. Um, um, but the, the silver lining to that is that we're able to work with the families. The families are online a hundred percent and, um, not that our family, we always worked with the families in the room and that that's our model, but, um, Well, they would rush in and say, you know, I I'm just gonna run over to the grocery store and get one thing and get right back, you know, here or there the whole time.

vivian: And we have opportunities to really sit and talk with them. If the kids, um, you know, get tired because they can't sit for that long in front of a screen. Um, so yeah, there are some good things to say

uri: too. Yeah. I think my, my big point, whenever I talked to people is if the need is there, don't put it off because we're going to be living with COVID.

uri: At least for the next couple of days, right. It's going to be just this much time and that, that it's this much time, but it's here. And if you have a present need, I think good professionals that could help before most of us have adapted. Uh, certainly there are certain ages that are tougher, but with the little ones.

uri: Something, I would say that's, that's become reinforced similar to some of the things you said is the parent involvement. And for parents to realize, look, you're already the, the teacher at home, the physical ed instructor to, you know, the counselor. So being a change agent for your child, really being a parent.

uri: But learning how you can be a part of this process and be a hero in your kid's journey is that much easier to put across because you're clearly not going to be putting it on the therapist to tube in 40 minutes with a magic wand. And the other good thing is getting videos from home. We've always done that, but more so now.

uri: So getting video clips, then you really see the child in their natural environment as opposed to something more artificial in the office.

vivian: Yeah. And in another area of my life, which is teaching, which I do quite a bit of. Um, when we were sort of thrown online last spring, the idea of doing it all online was, Oh, how are we going to handle this?

vivian: You know, how are we going to do? I redesigned all my courses to be online courses. And so I'm actually, I didn't, I, I can't believe I'm actually saying this. I'm actually actually enjoying teaching my courses right now, because I'm not struggling with throwing something that was meant to be face-to-face in an online format.

vivian: So now it's organically meant to be that way with a variety of different activities. I've changed the assignments, I've changed the, um, the lecture format. And so, um, that's worked out too, um, to my surprise. Yeah.

uri: I was speaking with rod Gable and talking about teaching. He's starting up the program with university and then the work he does with in Africa.

uri: And we were talking about how they would have these zoom meetings before COVID trying to empower people. To be able to become helpers for other people who stutter. And he was talking about the effectiveness and what they did and how time consuming it was. And, and then, then he stumbled upon what, what I've been doing.

uri: And you're talking about it, make the presentation material available offline or asynchronous. And then the meeting time can be much richer discussion around the content that's already been processed or digested or presented. And then you can really have much richer time. There's no need to get on zoom to hear a presentation.

vivian: Yeah, interaction and also the ability to bring in guests. Um, I love that opportunity, you know, we did before too, but most of our guests came in in person and sat in the classroom. Um, now we're able to bring in guests from all over the world. Um, and it enriches the learning environment tremendously.

uri: Yeah.

uri: Well, hopefully in many ways we'll. Hopefully it'd be back to something that resembles life before much more than not, but there definitely are some things that we should hold dear, that we shouldn't go back to the way things were. Just turn back the clock as if we're just going back to the way it was.

uri: There's a lot of things we've learned along the way, and there's also things we've come to appreciate. And different strengths that we've uncovered things we used to avoid perhaps responsibilities. So that's a nice segue.

vivian: Yeah. Yeah. I I've stepped out of my comfort zone a bit, so I, I don't think I've ever really swam in my adult life and I'm swimming every morning now, which is my husband.

vivian: And I look at me at each other and say, Is this real, are you really doing this? And I'm talking to my friends and they go, okay, first of all, let me get beyond the idea that you're actually putting a swimsuit on, because I think 10 years ago, you might've said, um, I don't need to do this ever again. Um, and here I am going in a pool every morning, um, because my son lost his day program and he has his love of his swimming.

vivian: And so we managed to get to, um, a socially distanced pool situation with lap lanes. And so I go swimming with him every morning. Actually our whole family goes swimming every morning. And so that's really facing a fear. That's really stretching my comfort zone.

uri: And I think also that says a lot for those people.

uri: When you talk to the people that are the greats, you talk to the Vivians and others, they tend to be people that push themselves too. Right. They're not just preaching. They're also practicing, you know? So as, as they're helping others get out of their comfort zone, they're also doing things to push themselves for that.

uri: I love that. So avoidance reduction therapy, do you want to go there and talk about kind of like. Where did it all begin and, and your original learning with Joshi Han and, and the influence, and kind of like the evolution of you from, I dunno, undergrad and like how you kind of actually chose to dive into stuttering and then the evolution of how you kind of

vivian: came to that.

vivian: Yeah. So I can talk a little bit about that. I had, um, I was rather forte. I was rather fortunate when I was an undergrad, um, at UCLA and I was, um, mentored by two. Very well known people in the psychology department. One was Joe Sheehan. Um, and he was, of course in the psychology department. Um, there was no speech program, no speech, no communication disorders program at UCLA.

vivian: Um, but he was in the psychology program and he did teach a course called psychology of speech disorders or something that he called it that fit into the department. And the other person who influenced me quite a bit was Eve R Lovaza. Who was also in the psychology department. Um, if those of you who don't know who that is, because as I'm getting older, I'm finding people don't know who that is.

vivian: He's the father of ABA therapy for autism. And I did work with him at, um, cameo state hospital at the time that hospital no longer exists with young children with autism. And at the same time got involved in the UCLA speech psychology clinic. So, um, I was heavily involved in both the behavioral movement and also.

vivian: Um, uh, for autism, but also being absolutely fascinated with stuttering at the same time. Um, and becoming involved in that clinic. And, um, the, I had a little bit of a schizophrenia, um, uh, experience at that time because even our low Vos always saw, he liked to put. Exam questions that were about stuttering on his exams.

vivian: I think it was to poke at Joe Sheehan. And so you always had to answer them in a behavioral way and operant way, and then Joshi and would say he doesn't follow the law of effect. So I was like this undergraduate going, what do I do? Um, and so that was sort of an experience that has an undergraduate. Um, uh, I knew that I wanted, at that time, I, um, Uh, we're thinking of actually going and living in France.

vivian: Um, and so I got a teaching credential to go, um, live in France, uh, and teach English in France. Um, but then I ended up making a decision back and forth between, um, going into psychology. Joe wanted me to go into the psychology department to get my PhD in psychology at UCLA and his wife, Vivian. Shin, um, sending in a, you'll be a great speech pathologist.

vivian: And the two of them would fight over that. I don't know. No people understand, knew that they would argue over what I should be doing. And, um, Vivian went out, I really wanted to do clinical work. Um, in speech, language pathology. Um, and I worked with him there. Um, met my husband there, my husband of 40. How many years is it now?

vivian: 43 years. Um,

uri: got married when you were 15.

vivian: Well, the younger, younger, I you're making me a little older than I am. Very, you know. Um, so, um, and, uh, And until his death in 1983, I worked with him there along with Vivian and I remained friends in close contact with Vivian, um, until she died, um, in her nineties.

vivian: Um, and I'm currently, I'm still friendly with, um, one of their daughters. So still have a big Shane connection. It's like

uri: the Schneider connection transgenerational.

vivian: Huh?

uri: That's amazing. What would you say is something people don't appreciate or don't know about, about Joe Sheehan? And I think one of the things that's interesting for people like yourself that we're really proud of GA's of, of the greats they evolved over time.

uri: Didn't they? Right? Like people sometimes encapsulate people at one point in time with one thing they said. And at another point in their career earlier or later, they may have said something very different. So. Is there something you feel is under appreciated? Something that you could just highlight that people don't get just right about Toshi.

vivian: I dunno if it's under appreciated. Well, I think people don't know how funny he was. I mean, that's what I'm going to start out with. He was hysterical and he told jokes at every single staff meeting. We'd have a staff meeting before clinic began. At the, you know, on when the Wednesday night clinic and he would tell jokes, he would also tell stuttering jokes.

vivian: He would tell all kinds of jokes. He was very, very funny. Um, and that's one of the things that I remember. He, I also was, um, Other hard. I mean, he was hard on me. Um, the expectations he had, he would throw things sort of on my desk as a TA right before the weekend and expect them to be done by the end of the weekend.

vivian: Um, so, you know, he had, uh, he had what he called high demand, high support. And I resonate with that. You know, you think about demand being higher, low, and support being higher, low, the best combination could be high Samantha high demand, high support. The worst would be low demand, low support or high D high demand.

vivian: Low support would be the absolute worst because we have high expectations, but get no support, but you had very high expectations, but he was also very supportive. Um, and, um, I think that in terms of his work, um, he didn't write enough. Um, here I take, after him in that way,

uri: I was going to say, if you're reflecting on that, I'm wondering how you've incorporated that, but you're following in that, in that path,

vivian: he didn't write enough.

vivian: It's, you know, it's a long line of great people who don't write enough. Dean Williams, Joe Shyanne just didn't write enough. And so a lot of what I remember. About his, um, his understanding of stuttering, his living of stuttering is what he talked about, what he told me. And so sometimes I'll have a quote and people say, well, where is that from?

vivian: Can you point me to the reference and I'll go, no, he just said that he said that all the time. So there's a lot of just. W w verbal, uh, you know, folklore of things that, you know, even today, um, when I talked to his daughter, Marianne, um, we laugh about things. He used to say all the time because, um, it was just, you know, they weren't written down.

vivian: Um, the other thing, um, I think people think that his, his. His therapy and his ideas about stuttering were that stuttering was a learned behavior. And he said very clearly, even then, even back when he was writing about this in the sixties and what certainly when I was with him in the seventies, um, um, he said that.

vivian: Um, stuttering, there's a genetic predisposition to stuttering and that what we're seeing in sputtering is, you know, reactivity is learned. Um, and a lot of people think he saw it as. The nature of stuttering is learned as an approach avoiding conflict. And he never said stuttering was caused by an approach, avoidance conflict.

vivian: He always used the approach avoidance conflict to describe what happens in the moment of stuttering. And that's something that people don't understand. Um,

uri: I want to, I want to dig in on that just for a moment, cause I think it's. It's a really subtle, significant point. I listened, as I said, I love Peter and I love stutter talk and you can listen to Vivian there.

uri: And so many other 600, I don't know if they're up to 700 amazing podcasts, uh, as stutter talk.com. But. I am very honestly, I loved listening and I always enjoy listening. You have a very matter of fact way of saying it, but you explained things very well and you make certain distinctions that I think peers through some of the fog that people have.

uri: So can you just, you were saying Joseph Shyanne is thought of as someone who talked a lot about, you know, and you talk about choice and the idea of the behavioral side or the learned behavior side, and then you're trying to also distinguish there's a part of stuttering. That's an experience that's, you know, Biophysical and, uh, right.

uri: Um, neurophysiological and its nature. And then there's a part that's a learned behavior. I think it would be helpful to some people, even those of us that have heard you talk about it, just to hear how you could kind of tease that apart, those two pieces.

vivian: Yeah. Um, and I think that I'll, I'll say though, I'll talk about the way I can.

vivian: Can conceptualize it right now. That really, um, is not exactly the way Josie she end does, but I'll, I'll talk about the way I conceptualize it.

uri: Go here. Yeah. We have used, so we'll take, we'll be Vivian

vivian: for me. I think that there's, there are breaks in, in influency. Um, whether those breaks and fluency are in themselves neurological, or they come from the loss of control or what, there, there are breaks in fluency that occur, uh, bumps along the way in the way we talk that are part of a continuum of fluent.

vivian: Speech and disfluent speech in the normal population with stuttering probably be being on the more frequent side,

uri: um, of spectrum.

vivian: Spectrum. Yeah.

uri: The normal range within the normal range, bell curve you'd have people displaying some kinds of disfluencies and then there's somewhere along that range where it's more than the typical.

uri: Yeah.

vivian: But I don't want to confuse the idea that stuttering Rose out of normal. Disfluency I don't want it. Stuttering is a thing. It is a thing in itself and it does not grow out of normal disfluency. But when you have someone who stutters, who begins to develop what we call tension responses early on reactivity to the moment of stuttering, that's when the stuttering.

vivian: Struggle begins. And I differentiate struggle from disfluency and that's the hallmark of the arts program is differentiating struggle from disfluency dysfluency is the part that maybe neurological, you know, the reactivity to loss of control, whatever that is at that moment, that doesn't have to be struggled.

vivian: And when people are talking about wanting to. Um, either reduce their stuttering change, their stuttering managers time. I, we can talk about all of that. We're going to get there with the lenders. I'm interested in that. Yeah. Um, they're really mostly talking about their struggle, not the fact that there are breaks in their fluency in the forward flow of speech could because most people who live very, very well with a lot of disfluency in their life.

vivian: It's because the reactivity in the struggle is not there. And when I talk about struggle, I don't only mean physical struggle, but I'm also talking about emotional and cognitive struggle that goes along with, um, that frustration of having the break, the break in disfluency. Let me

uri: get, let me tell you a quick story that happened to a half hour ago.

uri: And tell me if I got, if this is a good illustration for people to just bring it into there's a boy, I actually mentioned last week with Gareth. Um, he's a lacrosse player. He's a high school kid and we just started working together on zoom. And this week we had a meeting today and he says to me, uh, yeah, this week I participated on a skit in school.

uri: It was on zoom and we all had to read our parts and it went, it went really well. And I said, that's awesome. I said, you know, how'd it feel? He's like, like a seven out of 10. I said, that's great. That's great. It's like, yeah, there was some stuttering there. I said, what it feel like you said. It

vivian: felt

uri: really good to participate and to do it and not worry about it.

uri: I said, that's awesome. What would it have been like, you know, like two months ago he says, Oh, it would have been like a four, like I would have been fretting and anticipating and kind of like having all this kind of managing effort going on. And his mom reported that she was listening to them, do this on zoom from the kitchen.

uri: And I said to her, how was it for you? She said, It's hard to describe. It was both calm and exciting. I said, Oh, can you tell me more about that? She said it was just so nice to hear him participating fully and freely. And then to see afterwards on his face, the shine of delight there wasn't like a feeling of like he slipped by, he survived.

uri: It was a shine of delight and flow. Does that capture kind of what you're talking about?

vivian: Yeah. Um, I think that, um,

vivian: How would you look at that?

uri: Or how would you bring your, what you were talking about that prism? How would I was wondering if that example could kind of be unpaid?

vivian: Yeah. I mean, I think that when you talk about the seven out of 10 rating that and good day, bad day, you know, I, my, my hope is that eventually they, they move beyond having to rate their communication in terms of.

vivian: They're stuttering that they're stuttering is not something that is going to

uri: go, we'll get to that. Cause actually he wasn't reading his stuttering. He was, he was rating his ease in the moment. His flow in the moment had nothing, not unrelated to the speech. We disconnected it from the speech, but we can.

uri: So the idea of rating the speech is something that we try to pass

vivian: eventually what we want to happen, you know, to me, the outcome would be. That it's not, it's not a thing. There's no life impact. Right. Sort of my husband's stuttering is sort of like that there's no life impact to the point where, um, he he's not rating his ability to be spontaneous anymore.

vivian: He's not rating his enjoyment. There is enjoyment. There is joy of communication there, spontaneity there's confidence, um, and it no longer becomes something that has to be looked at separately from any other identity. He has. Of course, you're going to look at other identities, um, when they're appropriate, you know, I'm going to look at my identity as mother, you know, as, as a Jewish woman, I'm going to look at my identity.

vivian: As you know, a sister, you look at your identities all the time, but if one is on your mind and always has to be evaluated, then there's still some life impact there that you might want to move past.

uri: Amazing. So that speaks to, and there's some comments here, a lot of friends, and I mentioned some of them in a bit, but the question about the social model.

uri: Versus the medical model.

vivian: Yeah. Yeah. Um,

do

uri: you want to just reflect on that a little bit, wherever

vivian: we want to go with that and how you,

uri: how you incorporate that and how you, what are some of the things that you also want to point out as places where things could go in a direction that actually complicate or, or inhibit the ability to move things forward, but the importance of incorporating that in certain ways, for sure, as we go ahead,

vivian: Yeah.

vivian: So, um, my, my, um, my evolution is still going in this area from the medical model to the social model. And I have to thank a couple of people that have really helped me in this way. And I've put in a shout out to, um, the authors of. Stammering pride and prejudice, you know, Patrick Campbell and Sam Simpson and Chris Constantino.

vivian: Um, and also a lot of my colleagues and friends and the disability movement, um, in the area of autism, um, Kristin Gillespie Lynch, um, um, Joshua St. Pierre. There are some people who, um, I've had some wonderful conversations with and. Helped me realize that I've always been in the social model, but never use the terminology because we use terminology that we're used to using.

vivian: And if we grow up in the medical model, you know, so those people listening don't know what I'm talking about. The medical model basically is where you see, um, stuttering as. Um, a problem of the individual, it has to be fixed or changed. Um, it's the responsibility of the individual to get therapy or rehabilitation.

vivian: Um, in the, in the social model, we look more to society and stigma discrimination, barriers, challenges, um, that, um, that often lead to limitations for the person who stutters, um, I'm going to, I'm going to go back to the, my, my evolution, my thinking about this, because I've been thinking about it a lot lately.

vivian: Um, the autism movement has. Is way ahead of us on this. And we're kind of shadowing that. In fact, this, the area of stuttering has always, um, shadowed the, the, the field of psychology a bit. When we were, when they were doing Freudian psychology, we were doing, um, psych, we were doing, um, analysis for stuttering.

vivian: When the behavior movement was big for psychology, we were doing behavioral therapy. So we kind of mirrored the psychology movement. When it comes to the autism movement. Yeah. A couple of decades ago we were searching for the cure, that little puzzle piece that everybody was wearing that little ribbon, which I refuse to put on my car aware because I wasn't trying to unlock the cure.

vivian: I even, when my son was very, very tiny, I diagnosed him because I was, you know, a speech pathologist who did a lot of pre-verbal assessments that those in those days. And, um, I was never looking to. Search for the cure, but the autism movement has had a great grassroots group roots movement to move away from finding the cure, making it, you know, fixing the person who is, who is autistic.

vivian: And instead looking at it in the form in the area of neurodiversity. And it's. Heartwarming relief. It's such, it's freeing to me to see the stuttering stuttering movement move in that direction. Um, we're behind the autism community in doing that, but there are some really. Great leaders. Um, young SLPs who stutter, um, people who stutter, who have joined in, um, um, and partnered with speech language pathologists to change the way that we think about stuttering and our outcomes for therapy.

vivian: And I think it all comes down to outcomes for therapy.

uri: So what do you say about that? I was actually leading a lot of conversations on this very topic and it was, it was surprising. Just raising that topic, meaning talking about outcomes and how the outcomes and goals we set, you know, so let's say the goal was to cure the stutter and the person at the end of therapy or at time they decide to stop or we decide to stop it.

uri: If that's the way that model is working, they're still stuttering. So then someone failed. And someone didn't do their job and their responsibility to fix it. It's still kind of dangling out there. And I was talking about that as like collateral damage. We talk in medicine about side-effects. We talk about quality of life.

uri: You know, if you have God forbid a loved one, dealing with cancer and you have the best cancer hospital in the world, you don't necessarily want them to go in with the heaviest dosages of, of chemo. And radiation does zap the cancer because there are other impacts to that. And I think in speech therapy, we don't think about it.

uri: The other side. In other words, if speech therapy is a powerful tool for the positive, powerful contribution, it must also have certain risks. And I think as practitioners, we need to think about that. So when I opened the conversation about that, it was amazing how certain people push back so hard. How could you be so critical?

uri: And so I just want to hear what your thoughts are on that outcome, how it all comes down to that.

vivian: And when you, when you talk about pushback, I think it's, I think it's interesting because it depends on how you ask the question. So if you ask a new client, you know, what they want out of therapy. Yeah, very often.

vivian: They'll say they want to be fluent. Um, it, you know, that's what they understand, but what does that mean to them? So you have to ask the second question and when you're fluent, What will be different or what would that mean to you or, uh, what will you be doing that you're not doing now? And it always comes down to, I want to feel confident.

vivian: I want to feel spontaneous. I want to participate. I want to not think about my speech. I don't want to be exhausted every time I talk. Um, and so when you think about all of those outcomes, from my perspective, those are outcomes that are really possible. Those are all about struggle. And those are all about ways that you can change.

vivian: And I I'm, I'm one of those people who thinks that change and acceptance are compatible. And so, um, I very much in favor of self acceptance as a person who stutters, but it's acceptance of identity and role, and that's what, believe it or not arts is all about arts is about identity and role more than it is about how you stutter or.

vivian: Even avoidance itself, it's about role. And I think you asked me a few minutes ago, what people didn't know about Joshi and is that they see it as yeah. Avoidance reduction therapy is reducing avoidance and removing, um, escape behaviors, van riper strategies and, and voluntary stuttering. No, no, that's not what arts is about.

vivian: It's about. Changing the, your relationship to your stuttering and becoming a role congruent so that when you go out in the world as a person who stutters and you do stutter, your role congruent, it's when you go out in the world as a person who's hiding or suppressing or managing or minimizing stuttering, and you do stutter, that's when you have the role conflict.

uri: What's the quote, what's the quote about suppression is the condition.

vivian: Um, successful suppression of stuttering is what maintains and perpetuates it.

uri: Just say it again so people can just chew on it. It's a mouthful

vivian: last full suppression of stuttering. So hiding it well is what maintains and perpetuates it.

uri: And could you unpack that back into the frame you shared about what's the physical component and then what's the reactive component and how that ties.

vivian: Yeah. Um, so if you think about, um, what, when people start in process of therapy, if analyzing their stuttering pattern, because many people have a kind of therapy where you start looking at your stuttering patterns, start observing yourself and seeing what you do, the first thing.

vivian: People would look at is how efficient they are. Okay. Now, if you have little bumps in your speech and every once in a while you have a, disfluency like I'm having right now, I'm not interfering with my E efficiency at all. Okay. So I'm fairly efficient. Nothing is really getting me to, you know, get, get off track.

vivian: However, when you start using escape behaviors, you start adding in word, you start starting over, you start putting in interjections, you pause you, uh, beat around the Bush. You substitute words. All of the things that we consider, escape behaviors. And avoidance behaviors escaping and avoiding the moment of stuttering.

vivian: Those are the things that lead to the inefficiency. Okay. So for me, all the inefficiency is reactive. And one of the outcomes of arts is efficiency of communication. So those are that's one thing I think you can change is efficiency in the speech direction. I'll go through, um, since I'm on it, I'll, I'll talk about the outcomes of arts because people maybe want to know that and how, why it fits into the social model.

vivian: And I just

uri: want to, I just want to highlight, first of all, I resonate personally and our approach is so resonant. Certainly we have different, you know, Vernacular and we do things slightly differently, but everything Vivian saying, I just want to say on a personal and professional level, listen carefully.

uri: I think, you know, you're listening to the goat and, um, and again, her ability to articulate this and pull it apart is incredible. I also just dropped a comment, keep your questions coming. I'm going to find a way to weave them in. There's a bunch of people here, maybe just for the moment, just acknowledge a couple of people that I know.

uri: You'd be happy to hear it. This is really not about. Me. And it's not about Vivian, even. It's about connecting people and keeping our conversations going Gareth welcome. Uh, Tricia, uh, Lynn Remsen and Amy Dickson. Erin, Tom Sharfstein hope Gurlack. Yeah, I hope. Uh, Matt Phillips, Adam, uh, Mark Anita, Jen.

uri: she's looking forward to, and again, it's with you. She says it changed her life. Um, there's so many wonderful people here. So keep your comments coming also regards from Chile and, uh, other parts of the world. Yeah. Tons of great people. So keep your comments and questions, but yeah, great opportunity to hear it straight from the source in terms of the outcomes and what we can learn more to understand arts better.

uri: As we learned about Jo, she has certain things that are misunderstood or underappreciated, but.

vivian: So efficiency, I think is an important one because I feel that, um, the frustration that comes from stuttering, um, comes from inefficiency. Also a lot of, um, um, a lot of the stigma. Comes from observing people, being inefficient and uncomfortable with their stuttering pattern, um, and not understanding it.

vivian: And then as we talk about, you know, the, the internalization of that self stigma is, uh, is one of the things that we deal a lot with in, in, in therapy. But the second outcome is comfort in the stuttering pattern. And so. What we're trying to do at that point is, um, take away the things that are making it hard to communicate.

vivian: It's not only effort from pushing through a sound or physical effort from stuttering, but it's the effort in energy in your head, mostly in your head worrying about what people are thinking, worry about what you're thinking about, what people are thinking and emotionally, the effort that it feels to endure.

vivian: You know, shame and embarrassment and feeling less than, um, there's a lot of discomfort in the moment of stuttering. That's not only from the stuttering pattern, it's from feeling different and feeling awkward. And so we, we definitely want to work on improving, you know, reducing discomfort and making the stuttering can be much more comfortable and.

vivian: I think that when people come for therapy, it's not that they don't want to stutter. They don't want to feel uncomfortable. You know, that's one of the things that they want, they want to feel. The other big one is, is confidence. And that's our third outcome. So confidence in communication really comes from, um, um, feeling that you're a good communicator feeling that when you are actually.

vivian: Communicating with others. Um, you're a leader and you're a follower. You're connecting. You have this confidence that you can communicate well. And, um, so that's another one. And then the third one, the fourth one, which I think is the most important one for arts is spontaneity. And so that's where we are.

vivian: And this is the big differences. We're anti strategies, anti technique. We're anti management. We don't manage stuttering. We don't manage and it's not something to be. We

uri: don't manage it. We control it. Oh,

vivian: we don't control it. We don't suppress it. We don't minimize it. We don't have techniques because I feel that when you're doing all of those things, you have to be doing something.

vivian: And when you're doing something, you're telling yourself that this is not good enough. I have to change it. And the idea is when you stop fighting, Stuttering when you stop fighting the actual disfluency, all of that settles down. All a lot of the struggle comes from trying so hard to be fluent.

uri: I was, I met a guy yesterday for the first time.

uri: I just want to, what you just said speaks to me just a quick analogy, that a guy, his story, he was so full of story. And he was so full of thoughts about what other people are thinking about what he's thinking about, what they're thinking. If only we were so good about thinking about what other people are thinking about, what we're thinking about, what they're thinking, then it would be efficient, but it's a big waste because we're not very good at reading people's minds.

uri: If you're the average human being. Um, I was thinking about it like, like a competitive cyclist, you know, you try to minimize drag and then you work on your technique or your performance and you get it to be very efficient, but it's not only by training to pedal harder. It's by minimizing the drag. And so like over time, most of us, and I think this speaks in my language to the layers of psychological behavioral, reactivity and coping mechanisms, we pick up a lot of drag.

uri: We pick up a lot of weight and part of the process of therapy can be most efficiently done to work on that efficiency by dropping the drag. It's not necessarily learning something new, but letting go. I've suffered the mental load and the emotional load and the physical load that you might be trying to manage, which is draining, you know, a certain amount of mental effort, physical effort, and it just creates drag.

uri: So when you drop that, It sounds dramatic what Vivian saying, but the way I'm thinking about it is like you, you try to optimize efficiency by dropping the drag. You know? I think it's an interesting analogy.

vivian: Yeah. Yeah. And I love analogies. I use them a lot in therapy too, so that's, and I love when my clients come up with analogies as well are the

uri: last say about the analogy I'm picking you didn't, you didn't resonate fully with it.

uri: I'd love to hear you take

vivian: your take on it. I know my I'm just going pro my husband is a cyclist and, um, and, um, so I was just, I was going in too deep in my head. Don't worry about it. What is swimming?

uri: It's similar to swimming. I was going to, I was doing do swimming, but I'm too hairy. So it's slowing me down a little too much drag.

uri: So I was going to get a full one piece, but then my wife said, everyone's going to laugh at me. So I just said, you know what, I'll just go running and I can keep my clothes on for the most part. So I get into the trails.

vivian: Yeah. I mean, I think that we could, we could stop, um, trying to think about what other people are thinking, but I think the way I look at it in the context of the therapy I do is go ahead.

vivian: You're, you know, go ahead and think, whatever you think and give them permission to think what they think. And it's about giving permission. That the, that it ends up being, um, um, less of a life impact for you. If you, if you, anything you say you don't want to do, don't do that. Don't do that. No, feel the shame, um, allow other people to think you're stupid, allow other people to think anything they're thinking they have a right to think that.

vivian: And if we predict that someone is thinking that we're incompetent because we stutter. They have a right to think that, and it's giving them permission to do that and giving yourself permission to stutter, which I think is the way we go in, in, in arts. It's it's, it's all about that permission.

uri: I think that right there, if anyone's looking for it, giving yourself permission, we had a team meeting in November, 2019 before this whole thing happened.

uri: And Julie Jackson said that line about, or was it true? Julie said something else. Excuse me. She was talking about agency. And Tiffany Marino on our team shared this idea of giving ourselves permission, giving parents permission, giving our clients permission, whomever. They are just that concept. If you just sit on that for a moment that right there has taken our team through this entire year, that's been a theme of what we've done to kind of take our work to the next level.

uri: I think giving people permission just opens everything up and then going otherwise you're suppressing, right? Otherwise you're pushing, you're pushing back against something.

vivian: I was meeting. I was meeting with a group of my grad students, um, clinic students, and there's a whole big group of them. And, um, they were stressed, of course, you know, grad students are always stressed about their clinical work.

vivian: Um, and at one point I said to one of them, I said to the whole group, I said, you know, you have permission to be graduate students. They're not going to know what to do in your sessions. And one of them said to me, No one's ever said that it's almost like you have permission to stutter. No, one's ever said that to me.

vivian: He looked at me and he said, no one in the program has ever said, we have permission to be grad students. Wow. That really changes things. So I think it's, it goes across a lot of areas.

uri: And I'm hearing it in the way that Joseph Shyanne was, was training you with the high demands on the one hand, it's tough, but it also says he believes that you could do it.

uri: And I think when we believe in our clients, when we believe in parents, when we believe in ourselves, that's a very important thing. People rise to the occasion and then providing the support, providing the support to really says, I know that it might be more than you can handle. That's why I'm here. And that's where we can position ourselves to be there as needed.

uri: And that allows people to get the bigger play, bigger, live more, go for things out of their comfort zone. There's a bunch of questions when you're ready. I want to, yeah.

vivian: I wanted to just skip back to this model for one minute, because I know we had a question on the Facebook page about where I think the field is going with the, with the social model and stuttering.

vivian: So we have. I don't know, 500 plus programs in the United States and training speech, language pathologists. We have many, many training programs at the MBA level. And I would say, and you probably would agree with me when you meet someone. We have, you know, we know who the specialists are in stuttering and people who resonate with working with people who start or whether they're specialists or not.

vivian: They had a mentor who taught them about stuttering, who got them interested in stuttering. We all can go to that mentor. And, um, the problem is that most people, these mentors are someone they met in their graduate program, or shortly thereafter. Most of the people teaching stuttering courses in these graduate programs are not people who love stuttering, who understand it.

vivian: And so they're teaching it as if it's a disorder to remediate. Um, and so. All those graduate students are graduating, graduating out of those programs with this idea that you need to fix stuttering. And, um, it's hard to change that once they go into the field that way. So I think that without. My feeling is that we need to go in that direction.

vivian: We need to look at the training programs and help people and teach stuttering within the social model of disability, not just go for the clinicians and having them treat that way. We have, I think that has to be more basic in terms of learning about stuttering within the culture model, when it's taught to the graduate students.

uri: What would the one smart, what would be one small step in that direction? So you have many grad schools where the instructor is not a specialist. They're teaching it as one of many courses. They teach. Sometimes it's a short seminar, half the semester, even. Um, what would be one thing you'd. Like to see baked into that experience that might make that shift in terms of how that clinician comes out,

vivian: thinking about they have to be, they have to be a member of the stuttering community.

vivian: There has to be participatory research. There has to be, um, involvement with, um, people who stutter. They have to understand, um, the experience of stuttering and many of them who are teaching the course maybe have never. Met someone who stutters, who wasn't their client, that's big.

uri: What are your thoughts in terms of we had this conversation publicly and privately last year in Fort Lauderdale, um, where you really hosted and brought this to the forefront for the entire, you know, research symposium before the NSA conference, do you see. Do you see kind of throwing the medical model out with yesterday's garbage, throwing the baby out with the bath water.

uri: And there's no baby there. Uh, and just totally leaning all the way in to the social model, because there are those, and there were those there that raised that voice, which would say that any form of treatment or a parent choosing to treat a child who stutters is making a decision that is, uh, unjust and is not with the permission of the child.

uri: There are those voices. And I'm curious, you know, that's taking this maybe the social model and then some, um, and then on the other hand, there's a way to incorporate those values in, in a nuanced way. I think there's no one better to address that than you. What

vivian: would you say? So I think the way we have to look at it is when you said treat stuttering.

vivian: Um, it's very clear when I teach my autism course that I say right from the beginning, we're not treating autism here. We're learning how to treat people with autism who have communication needs, speech, language, voice, whatever it might be fluency in the same way. I don't think we're treating stuttering.

vivian: We're treating reactivity and life impact that is making it hard for that individual to live a fulfilling, happy, connected life. Where there's joy of communication and connection and communication. So, yes, there's a combination of things. We are. Are we treating certain things? Sure. We're treating certain things, but we're not treating stuttering in its basic

uri: form.

uri: I would say we're not even treating the thing. Treating. We're helping people. Like you said, we're helping people. Communicate and enjoy communicating. That was something that came out, not surprisingly from Rubin chef the conversation with Ruben, always so insightful. And obviously you've had a big part in his journey.

uri: Um, he in his own right is extraordinary, but he quoted you many times. What would you say I've got this cough. If you notice, I keep muting myself. I find that my work with people who stutter is helping me deal with this cough it's helped me deal with different challenges through COVID it's it's being a father of kids with different needs and different strengths has informed my work and helping people in the work I do with people has been so informative for me as a father.

uri: I'm thinking about my cough. It's a physical thing. Now I could have canceled our conversation. And frankly, the past week, two weeks, three weeks, I said, I'll, I'll, I'll just wipe everything clear and wait until it goes away. That'd be one option. I'm seeing a pulmonologist to check it out, but it's been an allergy allergic type thing and it's hanging out with me.

uri: So it's a physical thing. So I feel in some ways there is a certain similarity to the physical experience of stuttering and there's the behaviors around it. Like I keep muting myself. That's a way that I'm. Thinking about how to manage this conversation, how to, uh, choose to have this conversation. But at the same time, have the least distractability for me, for you and upload anyone else's ears off on the other hand.

uri: Uh, maybe why am I even muting myself? So I'm just thinking about stuttering, where you don't have the option to mute those moments. Let's say. From an arts point of view, from your point of view, could you kind of bring the arts model to my cloth? What would be some things you would be thinking about not to give me therapy, but to kind of bring it into around that people that don't set or maybe you could even get it a little bit?

vivian: Yeah. I mean, the first thing I would say is what you're doing is to look at it and try to figure out if, if that cough is something that's interfering with something, if it's interfering with your comfort in, in communication, Yeah, do something about it. So my feeling is that when I see the, and this is what it's going to be, this is a little bit of more controversy.

vivian: When I see people who have choices to make their stuttering pattern more comfortable, more efficient so that they have less frustration. They have less exhaustion. This is, this is about comfort and, and, and, and they, and they're more willing to connect with people. I can't see the downside of that. So being against therapy for the sake of being against therapy, for some theoretical reason, it makes no sense to me.

vivian: Um, I think

uri: that's the controversial part or that's where you're saying. Okay.

vivian: No. When you were mentioning some people who say no therapy at all, in other words, if you're very much into the social model, it's really, but you know, there's also this idea that, um, And I asked this question to Joshua St.

vivian: Pierre when we were online for something else. I said, what is the individual's responsibility and what is society's responsibility? So there's responsibilities from both sides. So society has to become more knowledgeable, more accepting and live with people who are diverse, even, you know, many minor neuro diversities, these different.

vivian: These different communities. On the other hand, the individual can also change to make that connection more comfortable and easier as well. And so I think there's a connection. There's something on both sides in terms of your cough. Yeah. Certainly reactivity, you know, I'll

uri: just show you what I'm doing.

uri: I'm just gonna show you behind the scenes to be totally transparent. I've got this 20 ounce tumbler. I've got two. To ginger lemon, tea's going in there with fresh raw honey. Uh, then I've got a Ricola. I just popped in. Um, I've also got this clear fluid hydration and I have, um, an inhaler, a Serotide disc.

uri: And I also did a, um, what's it called the mist, right? The mist with the Buder court and the Ventalin. And I'm doing all those things and I'm taking a very aggressive anti-histamine. And yet I'm getting pain in my chest and it's exhausting. And it bothers me. It interesting in the middle of the sentences, I'm giving workshops where I have to do this for two hours and I have to keep muting myself.

uri: And I have meetings all day and I'm minimizing and making some adaptations. It generally hasn't bothered me, but it's starting to bother me, but I think I'm just illustrating to me. It's a good, it's a good thing where you're what you're saying. And I think it's nuanced and I think. Don't you feel it's easier, uh, to take, uh, like a absolute position and what you're describing?

uri: I, I, so identify with, I think for the earlier stage clinician is, is a more nuanced, tricky position, right? That acceptance and change are not mutually exclusive. That's what you said earlier. I think that's a very subtle, um, rope to walk for the earlier. Stage audition.

vivian: Yeah. There are lots of very similar little things.

vivian: Um, you know, I think the most, the biggest contradiction that I see in, in clinicians, not necessarily early clinicians or young clinicians are, is the contradiction between it's okay to stutter. And here use this management tool. Um, so it's okay. But manage it. Um, and I think that is a, that's a, a big double message from my perspective.

vivian: Um, if I'm the double message perspective from your reactivity and your cough links, something different right now, because you're talking to me than you would do alone. If you weren't on zoom. See, so you're not doing anything because of somebody's listener reaction. You're taking care of yourself in both contexts.

vivian: So

uri: there, therefore the way that I'm caring for myself and adapting is not some kind of, uh, extra load. It's a reasonable. Healthy thing. Is that what you were saying? I'm just trying to tease out. Can grew it. Whereas if I was putting on a different identity or different behavior to suppress the cough differently with you than I would, once we closed the screen, that would be,

vivian: yeah.

vivian: Yeah. And there is a nervous cough condition from, that comes from suppression

uri: today. I was very nervous. You make me very nervous.

vivian: I

uri: get nervous every time I come on and then to speak with you and to know everybody's listening and I got so many quit. I was a wreck.

vivian: Yeah. So I'm not nervous. I, you know, that's what I, that's what happens when you get old, you don't care anymore.

uri: Well, then I'm getting old that and losing my hair, but I'm like, yeah, I could get 10 years on me or something like that. Let's see. Do you have another moment? Can we throw in, I'll try to give you like a couple of quick

vivian: other questions going.

uri: Yeah. Cause, uh, there a lot of people here. A lot of comments, you can keep them coming if he is going to get through all of them.

uri: Um, if not now she'll try later or whatever. Um, let's see. Yeah. We talked about the changing of education. Um, that's a really good one. Uh, Oh, this is a good one. Vivian. I want to hear your take on this Anita from Sweden, how can the international SLP help the, the, the stuttering community to get the frauds?

uri: Uh, those people who leave behind a trail of devastated people with debt and, uh, and a lot of hurts. So like you said, those promises of outcomes and unmet expectations are not only unhelpful, but they leave people. Um, not only poor, but really often shattered their hopes were shattered. And every time your hopes are shattered like that, you're, you're elevated.

uri: You're blown up and then it doesn't manifest it. It just. Collapses. And sometimes people don't get up from that and sometimes they do, but it's, it's very hurtful. So there's a lot of charlatans out there. What the question was, what could the SLP community do about that?

vivian: I think this is even more serious in the autism community because, um, you'll do anything, um, that, uh, national or vulnerable

uri: or vulnerable.

uri: Exactly.

vivian: Yeah. Very, yeah, very susceptible to crack years and things to try. And I'll be honest that I've done somethings, um, gone through some programs just to do it. So that professionals isn't insane.

uri: Oh,

vivian: feeding each parent as a parent,

uri: as a parent in the autism community,

vivian: meaning as a I've done some therapies and was sort of when I said, when I, when I met with the clinician, I said, you know, I know this is going to do anything, but I don't mind spending blank thousand dollars just to check it off and say did it.

vivian: And, um, it was sort of a joke between me and the practitioner. Um, does your husband wear

uri: that you were just blowing that money?

vivian: What.

uri: Was your husband in on this? This was, what was the purpose of that you were doing it?

vivian: I did not want to look back and say, gee, I wish I did that.

uri: So you're saying even Vivian Siskin, I'm saying as a sophisticated professional, there was a feeling as a parent.

uri: I don't want to leave any stone unturned. And even if I, my rational voice says, this is not the direction to go. How could I not try it? Like I've got to try everything. Right. And I think.

vivian: Or I had to experience what that does. In other words, if somebody, let me defend the other side of it, first of all, to Anita, I think that, um, education about, um, about what we can change, you know, education is the most important thing and.

vivian: Stopping people from doing things that are not helpful is going to be a problem in all areas. I mean, it's, it's not just in stuttering, it's across the board, but, um, I lost where I was going with that. What was I saying,

uri: saying about that? You did something just to kind of check

vivian: it off

uri: and then, uh, yeah, yeah,

vivian: yeah.

vivian: So I think that sometimes, um, Something sometimes works for some people. We know this, um, even in the stuttering world, I'm not going to say that, you know, strict fluency shaping is not going to be helpful for some people. It is, and you can bring these people together and they can talk about how helpful it was for them.

vivian: We can't ignore that. So because we're individuals and everybody's different if. One per person is helped by look, take a look at facilitated communication or, um, you know, spelled to talk those kinds of things. It helps some people, will it help everybody? No. So as a parent, you might think, well, my child might be the one that could be helped by this.

vivian: And why should I,

uri: are you incorporating and including, cause I think there's different. There are people that are professionals with different approaches. There are people that are pseudo professionals from related professions that are. Pitching something that at least has some professional veneer and sense to it.

uri: And then there are people that are saying, Hey, I cured myself or, Hey, I found it was revealed to me, send me $10,000 to an offshore account and a no guarantee, meaning I guarantee it until you pay me and it doesn't work after two days. And then you can't get your money back. I think though, and more, some more subtle than that would be.

uri: And I'll highlight something that I'm concerned about, curious what you would say within the community, within the stuttering community, people who find success and, and, and really fulfillment and find the freedom and the efficiency that they're looking for in their life. And then they turn it into a for-profit coaching practice.

uri: Yeah, and start selling their experience to others. I'm all for self-help and I'm all for coaching and mentoring and helping each other. But what are your thoughts on that and how should that be held accountable and maybe who can do more of that? Yeah.

vivian: Yeah. Luckily in the United States we have licensing laws, you know, so we're happy.

vivian: And I, and I understand that she's talking about an international perspective and I know many of the cases that she's talking about, those are true, but. What do we do about the person who says, I made myself a millionaire through this strategy and come take my workshop and you will become a millionaire too.

vivian: Or what about I lost weight this way? Give me your money and you'll lose weight this way too. There's a lot of that going on in every realm of. You know, help

uri: burden is on the consumer. The burden is on the consumer.

vivian: I think that we need maybe to have written materials out saying which of these are, have some kind of, you know, expert behind them. Um, I think that in, in, I don't know how other countries necessarily work it, but they need to, they need to fight for lasting laws.

uri: But Vivian, even in the States, there are people that are working within the 50 States doing this kind of stuff.

uri: There's no influence

vivian: they need to be, they need to be taken up on, on, on charges of practicing without a license. Is

uri: Ashley doing that or that something, an individual bring up with

vivian: us. This is the state. This is the state. If someone's practicing without a license. Um, the state does that. What if a medical doctor did that?

vivian: Wouldn't the state do something. What if I opened up my, my surgery practice tomorrow,

uri: if, if you or I were to just call one of these state licensing agencies and there's a prison practicing and selling a cure and they're operating out of whatever state, I won't even say a name to suggest anything. And we called, have you seen any, uh, any.

uri: Precedent where there was something that was actually enforced.

vivian: And I haven't, I don't know about that. I'll be honest. I don't know enough about it, but it would be the state complaint. Yes, they do take complaints. And, um, and there would be probably depending upon the state, I don't know. There would probably be some kinds of investigations.

vivian: So

uri: I guess what one could do if one had that concern is they could take it upon themselves. If they feel there's a valid complaint to bring it up to the state licensing committee and play that course of action.

vivian: Yeah, there and there is something we can do in the States, but internationally, I just don't know enough

uri: about it.

uri: Yeah. Yeah. That's definitely true. Okay. Let's say one more question. Let me see. I think Mark. Uh, yeah. So someone here asking, I think it's important to also take these like very, uh, concrete and direct. A lot of people are familiar with the term secondary behaviors. And so someone's asking what's your approach with secondary behaviors.

uri: And I kind of can imagine where you're going to go with it, but I think for someone asking it. It deserves to hear it straight from Vivian.

vivian: Yeah. Yeah.

uri: Secondary behaviors.

vivian: Yeah. Yeah. Yeah. Um, secondary behaviors are of multiple kinds. There are physical concomitant behaviors, you know, where you would do something with your hand or your face or lose eye contact during the moment of disfluency or approaching the moment of disfluency there's linguistic ones, word substitution, restarting phrases, restarting words.

vivian: Um, there are role. Escape behaviors pretending to be fluent, pretending to be confident, depending to be a clown, pretending to have a foreign accent there. These are distractions and escape behaviors that allow you to escape the moment of stuttering and they work. They work initially and because they work initially.

vivian: And, um, they are very, they, they become habitual. So what happens is that they allow you to escape the moment of stuttering you go, wow. Like my name is Vivian. Next time. My name is, uh, uh, uh, pretty soon, ah, is a part of my stuttering pattern and Joshi. And used to say that you become a walking museum of all the things that you've learned to, to escape from the moment of stuttering.

vivian: This to me is struggle. This is not efficient communication and it's learned behavior it's learned. Um, and it's habituated very quickly because it goes onto an intermittent reinforcement schedule and intermittent reinforcement schedules become very, very strong. And so something that was once used to escape, the moment of stuttering.

vivian: Because you didn't want to show it at that moment now becomes a habitual part of the stuttering pattern that even though you don't want to escape anymore, you're still using it. So in the arts program, we're all about eliminating it. We want to get back to what we call open stuttering, stuttering directly on the intended sound, stuttering, openly, and honestly, And then once you start doing that, it's at the beginning.

vivian: It's not going to be, um, real comfortable, um, because you were spending all of your time trying to hide that, try to avoid that. So when you first start open stuttering, it's not going to be pretty. It's not going to be comfortable and forward moving. It's probably in our therapy. It's the mild toward moving into facing stuttering when you're at.

vivian: Actually saying the word that you want to say and stuttering directly on it. So we take care of it in an our therapy approach in two different ways. One, we take notice of them and start reducing them by watching them, monitoring them and they reduce on their own. And then we've tried to replace it with true stuttering.

vivian: Getting on the sound and saying the word you want to say, putting the stuttering where it belongs on the sound that's feared. And so that's basically our attitude toward secondary behaviors. Um, they were, they were learned. Young. Sometimes they were learned, honestly, they were learned from escape. They were learned sometimes from management.

vivian: So speech pathologists often give children advice. Um, I call it advice because it's not therapy from my perspective. They give them advice to take a pause, to start over,

uri: take a deep breath,

vivian: take a deep breath. Think about where you're going to say I get it. I can tell you what secondary behaviors each of those lead to, right?

uri: Yeah. When the, when the person comes in and you say, okay, Let's see, you know, especially young kids, someone, someone must've told this kid X, because that doesn't yeah,

vivian: yeah, yeah, yeah. That inhalation pattern comes from taking a deep breath and

uri: it's not a respiratory problem. So like one doesn't need to learn now in all seriousness, a lot is how many people in the stuttering community, either through therapy or were believed that therapy is about learning how to breathe properly and speak on exhalation.

uri: Now, if anyone would try to, to speak on inhalation, you would discover what stridor is that we all speak on exhalation. Right? So what would you say just about that? I can't ignore that question. Isn't stuttering a dysfunction of

vivian: breath. No, I don't think it's, I don't. I, as I say to my clients, if you weren't breathing correctly, you probably would be dead by now.

vivian: So,

uri: or, or you can come with me to the pulmonologist.

vivian: No. What happens is that because of trying to avoid stuttering, some people interfere with their. Typical breathing patterns that are very automatic. So eating problems don't cause stuttering, stuttering leads to maladaptive rest support. And that's

uri: a beautiful word, maladaptive.

uri: So there's adaptive stuff. That's healthy. And I'm thinking of David Shapiro patients and then there's stuff that's maladaptive. And the permission going back to what you said, the permission for people to choose how they want to adapt. Right. But with a mindful. Deliberate idea of what's possible what's necessary.

uri: What's efficient. So one of the things we do and I'll close with this, I think is a nice exercise. I wonder if, if you end with like it, we help people explore and take an inventory of their own stuttering. What are all the different things that happen? What are the things that are visible? What are the things that are audible what's going on inside just the full inventory.

uri: And then you can sort that inventory pile out into which of these are actually stuttering. Which are the actual physical experience of studying, which of them are that reactive adaptation side of things again, without judgment. And then what I find is powerful in the subtle there is you start to identify, wow, these might be things I have no agency over.

uri: They're just part of me and these things. I can make some choices, you know, these have become reinforced behaviors. And with some, with some time I can do some things that could. Have a different first nature, second nature of them. Would that be right?

vivian: Yeah. The only thing I would say about that is when you first meet somebody who stutters, um, you won't find their, their stuttering yet.

vivian: Um, and so, um, it's very likely that you won't find the things to put in the category of, this is something that I can't change because it's so hard to find that until you peel away the layers of the onion, so much of the stuttering pattern. In the beginning of therapy, it's all things that they've learned in response to their, it's hard to find nothing in a marriage.

uri: You're seeing the, the behaviors you're seeing the reactivity. You're not seeing the stutter.

vivian: Yeah. Yeah. And especially someone who's covert, you see nothing. Um, you know what I mean? Th there's, it's very rare to see. Um, when I see somebody who I see, um, some real, um, stuttering, we want to keep. It's usually because they've already had some therapy and the color,

uri: you know, rah, rah, rah, you're stuttering,

vivian: or just stuttering on intended sound, um, without trying to fix it without trying to manage it without trying to control it.

vivian: Um, and even those who are in therapy with me for a long time and we see. Control in their open stuttering, or we see PR prolongations in their speech, it's all control. So is that something we want to keep, let's see the open stutter, let's see the stuttering, you know, in its raw form. And then let's keep that.

vivian: So, um, when we, when we do our stuttering inventories at the beginning of therapy, um, we often separated into the piles of helpful and not helpful, um, rather than inside, outside those kinds of things. Um, because they can put in a thought, you know, that any thought that they write down how helpful is that?

vivian: And so we can, we look at helpful and unhelpful, um, in terms of. Effective communication.

uri: Yeah. Yeah. Awesome. Well, Vivian, this has been awesome. I just want to share with everybody. If you had one highlight, there's like a whole, I could think of probably 20 that I'm going to go back and relisten to. This has been an absolute treasure trove and a treat.

uri: Thank you for taking the extra time. Thank you for everyone watching and listening. Share this comments and Vivian, Vivian, where can people contact you if they want to find you or reach out to you?

vivian: They can contact me@myemailaddressatvsiskinatumd.edu easiest place to find me I'm on email all the time.

uri: Yeah. And I'll post this up to Schneider speech.com/our blog with all the other 30 something conversations. And I'll include all of Vivian's bio and links to her clinic and to her practice. Um, if you're interested in getting those free iPod, uh, AirPods. You just go to the blog page. There's a, there's a raffle there.

uri: Very simple. Just send us the timestamp of which was your favorite talk and what was that highlight? We're going to put it together for an episode at the end of 2020 together, we can squeeze out something nice, something sweet. And then if you want to check out the online course that we have, there's a coupon code.

uri: Give. And that's available and you can get, uh, three weeks to just run through the course and explore it to your heart's delight and see what's possible for teens and adults who stutter. This has been amazing. Thank you, Vivian. Next week we have. Really exciting Dr. Derek Daniels and also just, just on my good friend, Justin, Matt Lee, who helped us produce the movie transcending, stuttering, and going with the flow and also the online course.

uri: So I'm super excited. That'll be on. Wednesday and Derek's on Thursday, but Vivian, nobody has brought out 200 people. So, um, you are loved and, uh, many miss you and appreciate that little kiss and I miss you. And I'm really glad we were able to do this.

vivian: And the only thing I, I regret from this is that I'm not able to see everybody.

vivian: So I wish I could see all of you. That's the one thing that I miss. Yeah.

uri: So we'll do like a virtual, everyone send a Vivian, uh, a picture. Collage of this morning. Yeah, it would have been nice. The problem is there wasn't enough screen space. Um, you would need, I would need to get like a full, like, I don't know what the whole wall would need to be a screen, but thank you for this.

uri: And yet it would be nice to see everybody, but at least to know that you're there and to feel connected and to keep the conversations going, we all benefit and appreciate that.

vivian: Yeah, it was great chatting with you.

uri: Thank you so much. This has been great.