Understanding Stuttering Therapy Through A Trauma-informed Lens
“I don’t understand. I was ready. Truly ready. But when I opened my mouth to speak I blocked so hard and couldn't get any sounds out. It felt like a thousand bricks lodged in my throat. When I finally did get the sounds moving, I stuttered so hard. Every syllable I uttered felt like a broken engine hitting the ground. It hurt. Things started to go dark. I didn’t want to be there. I wished the floor would open up and swallow me whole.”
Alexandra looked at me with sorrowful eyes and lowered her head again.
“It felt like an eternity. The room started to feel small and far away. I felt myself feeling distant from my body. I could hear some muffled voices from my teacher, but couldn’t hear anything she was saying. I couldn’t see my classmates anymore. I knew I was reciting my poem but I don’t remember saying any of the words. I have no idea how I finished or got back to my seat. I physically was there, but every part of me wasn’t there. Chaya, does any of this make sense?”
I looked back at Alexandra with a compassionate gaze and nodded reassuringly.
“Yes, this all makes sense. And if you want, I can help you understand more.”
“Yes.” Alexandra nodded and looked at me with relief.
I explained ‘freeze’, the most primitive of the fight-flight or freeze response, a response that has been around since the beginning of time to protect mammals from real or perceived threats. I explained to Alexandra how the fear of showing stuttering to her class stirred up extreme stress in her body and moved her into the freeze state. Being present in the moment would have felt unbearable, so her body protected her by shutting down. She was able to survive the moment by going through “la petite mort’, a little bit of death, known today in the trauma literature as ‘dissociation’. Dissociation, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), is a “disruption, interruption, and/or discontinuity of the normal, subjective integration of behavior, memory, identity, consciousness, emotion, perception, body representation, and motor control”. Dissociation, disconnecting from the body, helped Alexandra navigate the extreme stress until it felt safe again to re engage with her body and the environment.
I could see Alexandra’s face soften, as she made sense of what happened to her. She felt relieved and looked at me with hope in her eyes.
“Do you think there is something we can do about this so I don’t go into shutdown again?”
“Yes. I replied. “There absolutely is.”
For the rest of the session we deepened our understanding of the neurophysiology of the body during stressful stuttering moments. We looked at what was needed to regulate the body before, during and after stressful events. We tested and applied self-regulation strategies that felt good. Alexandra was able to thank her body for doing its best to protect her during the moment of the stutter and feel compassion and appreciation for its otherwise confusing response. By the end of the session Alexandra had a deeper understanding of her nervous system. She felt a renewed sense of safety in her body, and a renewed sense of trust in herself.
This is one example of what a trauma informed stuttering therapy session might look like. Deep listening, making meaning out of madness through education, narrative integration, creative vision, and therapeutic interventions. These are some starting points to help clients feel more at peace with themselves and their stutters. It’s the start of moving toward positive change and growth in a practical way.
What is the relationship between stuttering, trauma and trauma informed therapy?
“Trauma is not what happens to you, it’s what happens inside you as a result of what happened to you.”
—Dr. Gabor Mate, The Wisdom of Trauma
“Trauma arises from an inescapable stressful event that overwhelms people’s coping mechanisms.”
— van der Kolk, Fisler, Dissociation and the Fragmentary Nature of Traumatic Memories: Overview and Exploratory Study
“We have learned that trauma is not just an event that took place sometime in the past; it is also the imprint left by that experience on mind, brain, and body. This imprint has ongoing consequences for how the human organism manages to survive in the present. Trauma results in a fundamental reorganization of the way the mind and brain manage perceptions. It changes not only how we think and what we think about, but also our very capacity to think.”
― Bessel A. van der Kolk, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
These quotes, and others like them, point to the experience of stuttering as a trauma. At the core of the stuttering trauma is the repeated disconnect from ones’ core sense of self, body, and others. Traumatic stuttering events impact a sense of safety and belonging. It corrodes trust in ones’ self. The consequences run deep.
Without understanding the relationship between stuttering and trauma people who stutter and therapists alike are often left baffled by some of the experiences people who stutter have, and grasping for ways to be impactful in therapy.
With understanding the relationship between stuttering and trauma the doorway to healing and transformation opens. Stuttering therapy is approached with a trauma informed lens and sessions are structured around the principles of trauma informed care. Connection with self and others during the moments of stuttering increases. A sense of safety and trust is built.
Healing starts to happen.
Communication becomes more joyful and stuttering becomes just another part of a much larger, beautiful dynamic human being.
With a trauma informed lens and trauma informed care, stuttering trauma has the capacity to be transformed into triumph.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.)
van der Kolk, B.A., Fisler, R. Dissociation and the fragmentary nature of traumatic memories: Overview and exploratory study. J Trauma Stress 8, 505–525 (1995)
van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.