Perspectives on the effects of stuttering on the formation and maintenance of intimate relationships.

Consumers who stutter can experience difficulty communicating and one major functional impact of the disability is in the area of social interaction. Stuttering affects a person in many ways, but one of the most critical social activities an adult individual undertakes is that of finding a partner and maintaining an intimate relationship. Rehabilitation professionals are often reluctant to focus on such personal issues, but for the person who stutters, developing and maintaining intimate (and supportive) relationships is critical to functioning up to potential as well as quality of life issues. Shears and Jensema (1969) reported that people who stutter severely were rated as acceptable marriage partners by only 7% of the participants. A review of the literature reveals that little is written specifically on this topic, although a variety of sources have examined issues relating to disability, stuttering, and intimacy.

The present writers will use these sources to both provide a review of what is researched and to interpret previously published findings using a coping and succumbing framework. In addition, specific suggestions are provided to aid rehabilitation professionals in counseling consumers who stutter. These suggestions are designed to facilitate the consumers' ability to improve social interactions and develop intimate relations, thus enhancing the quality of life.

Stuttering is a particular type of disfluency(1) that is often characterized by repeated or prolonged sounds/syllables within a word. This disorder affects 1% of American adults, with its incidence reported to be three or four times greater in males than females (Bloodstein, 1995). Onset of stuttering begins for most individuals between their second to fourth year of life (Conture, 1990). Treatment programs with young children who stutter are quite effective if initiated close to the onset of the problem. However, if stuttering is not successfully treated by adolescence, the individual is at high risk for maintaining stuttering throughout adulthood (Van Riper, 1973). [When an adult has experienced lifelong stuttering, it often influences the person's attitude toward speaking in general. His/her abilities to communicate and his/her self-identification as a "stutterer," rather than as a "speaker" often influences the individual's attitude about speaking in general, his/her abilities to communicate, and his/her self-identification as a "stutterer" rather that as a "speaker".] It has frequently been reported that adults who stutter view the act of speaking as negative, stressful, and even threatening. Moreover, given a long history of stuttering, it is likely that many adults have or will develop negative ideas (Conture, 1990). For example, it is not uncommon, based upon our clinical observations, that adults who stutter develop the belief that speech is hard work, I'm not good at speech, and speech is something I should avoid. Speaking/communication plays a major role in the development of interpersonal relationships and adults who stutter may experience greater difficulty in such relationships as compared to their fluent counterparts.

Wright (1983) constructed a conceptual framework at the macrosystem level from which to analyze the positive and negative behaviors, attitudes, and structures that shape how a disability affects a person's life. In a coping framework, the emphasis is on what an individual with a disability can do. Value is placed on the specific assets and functions which the individual with a disability is able to do, and not on comparing the individual with a disability to a functional level of individuals without disabilities. Conversely, the succumbing framework emphasizes what an individual cannot do. Similarly, the individual with a disability (and the family) can approach the concept of a person having a disability using either comparative values or asset values (Dembo, Leviton, Wright, 1956). Murphy (1987), an anthropologist, states in The Body Silent that "Shame and guilt are one in that both lower self-esteem and undercut the facade of dignity we present to the world. Moreover, in our culture they tend to stimulate each other" (p. 93). Shame and guilt, especially when they are connected to disability, are examples of the succumbing framework at the cultural level and of using comparative values at the personal level. The differences involved in the coping versus succumbing frameworks are useful in analyzing the psychosocial impact of stuttering on intimate relationships from the macrosystem level of analysis. Studying an individual's and/or families values from the perspective of comparative values or asset values allows the writers to discuss negative and positive views of how stuttering affects the formation and maintenance of an intimate relationship.

Macrosystem

Intimate relationships happen within a cultural and societal context, which may foster a framework of a coping or a succumbing response or set of responses. The individual who stutters and his/her partner or potential partner operate within a cultural and social context. Doody, Kalinowski, Armson, and Stuart (1993) examined the stereotyping of people who stutter in three rural towns in Newfoundland, Canada. The researchers asked respondents to identify the traits associated with a fluent male speaker and a male speaker who stutters. Despite the cohesiveness of these three communities and the high percentage of respondents reporting that they either knew someone who stuttered or had a family member who stuttered, their perceptions of the male stutterer were significantly more negative than the adult male nonstutterer. These perceptions of apparent normative values of speech and resultant spread within the family and community setting support succumbing framework. Spread "refers to the power of single characteristics to evoke inferences about a person" (Dembo et al., 1956). Comparing the disfluent speech of people who stutter to the fluent speech of nonstuttering2 individuals fosters an environment in which people who stutter are devalued. Within this succumbing framework, people who stutter are socialized to view themselves or other people who stutter as less valued than fluent speakers (Kalinowski, Lerman and Watt, 1987).

Formation of Intimate Relationships

Courtship. The first step in the formation of an intimate relationship is exposure to and acquaintance with potential significant others. Boberg and Boberg (1990) in discussing relationships of persons who stutter noted that "two thirds of the courtships were conducted by means of dates as couples, rather than in a larger social group" (p.64). Through avoiding group social activities, an individual who stutters limits not only social experiences and activities, but also his/her chances for finding compatible partners for an intimate relationship. Boberg and Boberg's qualitative study of wives of husbands who stutter report that slightly over half of the spouses interviewed stated they noticed no stuttering the first time they met. The absence of disfluency from the individual who stutters on the first meeting was likely due to the couple meeting alone, the person who stutters hiding his disability, or because the individual was in a fluent period due to speech fluency therapy (Boberg and Boberg, 1990).

Collins and Blood (1990) document the efficacy of acknowledging being a person who stutters. These authors investigated fluent females' perceptions of four males who stutter (two who were severe, and two that were mild). One individual in each group (mild and severe) of men who stutter disclosed that he is person who stutters. Collins and Blood reported that individuals who disclose their stuttering, regardless of severity level, can limit negative spread in nonstuttering females' perceptions of their "intelligence, personality, and appearance" (1990, p.76). The use of asset values may encourage an individual who stutters to disclose to his/her companion or companions that s/he stutters, during the formation stage of an intimate relationship, thereby controlling to some degree the potential "negative spread."

Perception of Partner. Another position from which to view the effects of stuttering on the formation and courtship stage of an intimate relationship is from the perspective of the partner. Boberg and Boberg (1990) asked wives of husbands who stutter questions regarding their relationship during the formation stage. Providing insight into perceptions of the nonstuttering female partner, they stated, "Most of the wives said the prospect of such a curtailed social life did not bother them" (Boberg and Boberg, 1990 p.64). Many of the women interviewed in the Boberg and Boberg study expected to have a limited social life, due to loving and/or living with a man who stutters.

Carlisle (1985) notes that the spouses of people who stutter decide to marry a person who stutters even though they realize that their spouse's disability limits social participation and may decrease vocational opportunities that will affect his/her own life. Both Carlisle's and Boberg and Boberg's analyses suggest that the partner of the person who stutters contemplates the effect of his/her partner's disability on his/her own life. The partner's contemplation on the impact of stuttering on his/her own life does not inherently fall into analysis of whether s/he is using comparative or asset values. The Boberg and Boberg (1990) study suggests that in the English speaking, North American cultures, the impact of stuttering is significant enough to encourage the nonstuttering spouse to assist and compensate his/her partner who stutters in some verbal situations, even when the person who stutters and his/her partner elect to use asset values and thus operate within a coping framework. Rehabilitation professionals should be aware that observing the fluent spouse's assistance in some situations is appropriate, such as facilitating social introductions for the couple.

Maintenance: Children. In the task of raising children, the influence of stuttering upon family life and interactions becomes apparent. The Boberg and Boberg (1990) study points out the efficacy of not attempting to hide the fact that a parent stutters. The children could be included as participants in a parent's speech therapy fluency maintenance program as illustrated in the Boberg and Boberg study. Revelation of stuttering encourages both the intimate relationships and family to function in a positive manner. Open discussion concerning stuttering between the spouse who stutters, the spouse who does not stutter, and their children would help to prevent the "conspiracy of silence" (Boberg & Boberg, 1990). The conspiracy of silence, as used by Boberg & Boberg, is an unspoken agreement between the couple to pretend that stuttering does not affect their lives; thus, stuttering should not be discussed.

Daily living. Frustration on the part of the partner who does not stutter arises when stuttering affects his/her partner's daily life, and thus, becomes a focal point for unrelated tensions. Glen Dickson (1994) explores his feelings and reactions surrounding being part of an intimate relationship with Chris, his partner who stutters. "I feel frustrated at her stuttering. But then, almost invariably, I realize that I am actually not frustrated at her stuttering; I am frustrated at me, at one part of my life or experience (a bad day, a need to take a walk, problem to solve). The stuttering was just a lightening rod for my frustration, which sprang from other sources, sources within me" (Dickson, 1994 p.202). Dickson's awareness of his reaction to his partner's disability is positive, because his insight allows him to address these feelings and thus provides an avenue for positive expression of the root of his frustration.

Rolland's concept of a chronic disorder becoming a third member of an intimate relationship can be applied to the effects of stuttering. Rolland (1994) notes the danger of the person with a disability using the symptoms to lessen daily activities. An example of this scenario was reported by Boberg and Boberg (1990) in which the wife of the husband who stuttered was taking almost all phone calls. The concern with using a disability as an argument for changing the daily living activities of a couple is that the change is directly respondent to the person's stuttering and may hinder recovery (Rolland, 1994). This use of stuttering on an intimate relationship would need to be addressed, perhaps through family counseling.

Long Term Relationships. In discussing issues concerning disability, particularly stuttering, a couple's relationship becomes stronger through communication, understanding and the building of trust. Boberg and Boberg (1990) provide an example of a woman who says that she and her husband (who stutters) went 20 years without ever seriously discussing stuttering and how it affected their lives. This illustrates how the conspiracy of silence can be a major concern even in long term, stable relationships. This woman reported that the relationship became more fulfilling and close after they openly discussed issues concerning how the disability affected the spouse who stutters and the partner. Rolland (1994) states that conflict avoidance takes a heavy toll on a relationship over time and discusses the importance of helping couples develop ways to express and resolve their disagreements. Through more open communication, couples can learn to become more at ease with discussing issues of how stuttering is affecting their daily living activities. Open communication between both partners concerning the feelings, cognitions and behaviors involved in a relationship in which daily living activities are affected by stuttering reduces feelings of shame and guilt, and promotes the use of asset values.

Implications for Rehabilitation Counselors and Consumers

Stuttering can limit a person's ability to engage and participate in social activities and intimate relationships. Two reasons for this appear to stand out: (1) individuals who stutter tend to avoid group social activities, (Boberg and Boberg, 1990); and (2) the listeners' reaction, influenced by unfavorable stereotypes of people who stutter, reduce the opportunities of people who stutter to form intimate relationships (Doody et al., 1993; Kalinowski et al., 1987). In addition, stuttering negatively affects the chances of an individual who stutters to form intimate relationships due to shame and guilt, which significantly limits his/her ability to cope effectively with difficult speaking environments and specific situations. If the consumer who stutters has formed an intimate relationship, the rehabilitation counselor can play a positive role by encouraging the consumer to discuss ideas and feelings regarding stuttering and its influence on all aspects of life, including the intimate relationship with his/her partner. Rehabilitation counselors can promote asset values and consumer control over his/her life. It is recommended that rehabilitation professionals provide explicit and concrete suggestions regarding the use of asset values as a basis for behavior and change, as well as enhancing self-esteem for their consumers.

One way the rehabilitation counselor can promote consumer growth is discussing with the consumer and the fluency clinician the option to disclose his/her disability to manage listeners' perceptions toward the speaker. The decision to disclose one's disability will depend upon the specifics of each speaking situation, and other factors unique to each consumer (e.g., cultural beliefs about self-disclosure and/or impairment (Wright, 1983). While it may seem unnecessary to disclose a disability that many listeners can hear, it is not uncommon for many listeners to draw inaccurate conclusions about the cause of (e.g., mental retardation) or the reason for (e.g., high anxiety or negative personality traits) stuttering. The rehabilitation counselor should teach consumers ways in which to effectively disclose if they decide to do so. The disclosure should be brief so as not to deter from the original topic for communicating and minimize the chance of the topic switching to a discussion of the disability.

Rehabilitation counselors can introduce the consumer to asset values in order to improve general self-confidence and self-esteem. Self-confidence and self-esteem can be encouraged by the rehabilitation counselor who facilitates the consumer's awareness of what they are thankful for regarding current speaking ability, speech communication in general, and social interactions. Once the consumer has identified positive aspects of speaking, he/she should be encouraged to apply asset values to daily living, and thus build confidence regarding verbal communication. The rehabilitation counselor is encouraging consumers who stutter to operate within the coping, rather than succumbing, framework through using asset values which de-emphasize comparisons of their speech abilities to those of fluent speakers and highlighting what s/he can do.

A consumer should be encouraged to consider how stuttering affects his/her life, whether it is vocational issues, social activities, or forming and/or maintaining an intimate relationship. Consumers who stutter may have only a rough or implicit idea of the effect of stuttering on his/her life. For consumers who stutter and have another disability, the psychosocial experience and impact of stuttering may interact and require integration.

The rehabilitation counselor should refer the consumer who stutters to a speech language pathologist who is experienced in the assessment and treatment of fluency disorders. If the consumer is receiving fluency therapy, the rehabilitation counselor should develop a collaborative relationship with the fluency clinician. In essence, the rehabilitation counselor should provide the fluency clinician with important information regarding various aspects of the consumer's life, including the demands for verbal communication at the job site (e.g., talking with a supervisor), the consumer's activities of daily living (e.g., phone activities), and willingness to initiate social interactions and relationships (e.g., greetings and conversation). Furthermore, the rehabilitation counselor and the fluency clinician should both work with the consumer to minimize, if not eliminate, the avoidance of social and vocational speaking situations. The rehabilitation counselor should understand the long and short-term goals of the fluency therapy, and work with the speech-language pathologist in transferring the client's newly acquired speaking skills from the clinic to the "real world."

The rehabilitation counselor should also encourage consumers to convey their goals for participation in social activities, dating, and/or the maintenance of an intimate relationship to the speech-language pathologist. An important role of the rehabilitation counselor is to provide assistance to the consumer in identification of the motivating factors for speech therapy. This is an important role because it will: (a) enable the fluency clinician to design more appropriate treatments, and (b) increase consumers satisfaction that fluency therapy is designed for and meets their needs.

Summary and Conclusion

In conclusion, rehabilitation professionals should be aware of the impact of stuttering on both social and work interactions and relationships. Work provides money to be able to participate in many social activities, such as being able to afford to date, development of social status, and the ability to form a household. Thus, work and social activities in general and intimacy specifically are interrelated. However, if an individual is avoiding social activities and, hence, does not have a sense of efficacy involving participation in social activities, then life satisfaction, including interest in work, is significantly limited.

In a healthy partnership, the partner of the individual who stutters can provide essential support and function as a sounding board for job hunting stress and the stress of being a person who stutters in a competitive employment setting. Life satisfaction is dependent upon social relationships as well a vocational endeavors. Persons who stutter have the potential for full and satisfying intimate relationships. A shift to asset values as a basis for self-esteem and social behaviors is likely to enhance this very important life experience.

Acknowledgements

The first author thanks and appreciates Lisa Beisel-Linn, his spouse, for support and understanding in the process involved in writing this paper. Finally, the encouragement of a former teacher, who wishes to remain anonymous, is appreciated.

(1) Disfluent/disfluency are general terms that refer to the lack of a smooth forward flow from sound-to-sound or word-to-word during speech production.

(2) Nonstuttering is a term that is widely utilized in the communication disorders literature. This term is used to describe the speaking skills of individuals who do not stutter. However, nonstuttering speakers may or may not have other aspects of communication (e.g., articulation, language and voice) that are outside of normal limits.

References

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Gerard W. Linn, 2365 Norhtland Avenue, Lakewood, OH 44107 Email: [e-mail]