10.13 Alalia scales the stairs out of the pit of doom: a de-escalation.
An equally easy to understand map is that of Alalia, a young stutterer who is climbing a stair, or rather she climbs up two ladders at the same time. With the right foot she attempts a higher rung in the hierarchy of increasing fluency, by decreasing the speech rate, using soft onset, legato speech etc. That procedure is called gradual approximation of a desired goal, a more fluent way of speaking. The learning principle involved is that of instrumental or operant learning of speech-motor abilities or habits.
With her left foot she will gain a higher level for tolerating emotional stress. The procedure is that of desensitisation by classical conditioning (respondent learning). It trains her not to be distracted by negative anticipations, to "believe in herself" when confronted by a dominant person, and to be less apprehensive of speech-failures.
A map such as this is a "figure of speech". Every stutterer dreams of a free ride by escalator to free, uninhibited speech. The best he can hope for, however, is a steep and unstable ladder, and he will need a lot of courage to climb it and so to free himself. The ladder is a metaphor that helps the student understand that:
(1) during therapy there are two learning principles at play. Type I: therapy and training of the individual changes emotions, cognitions, motivation, beliefs and attitudes. Type II: practising speech modifying techniques (instrumental learning) shapes the voluntary, partly automatic senso-motor control of the speech-act.
(2) for a stutterer, participating in therapy is an arduous task. The force of habit and the resistance to change are like the force of gravity. You have to work long and hard in order to obtain easy communication that remains easy under stressful circumstances. You have to work at two levels: at the involuntary level of emotions and attitudes, and at the voluntary level of senso-motor control of speech.
It is one of life's paradoxes that, in order to bring down highly strung emotions and tense habits its one has to make the effort of climbing up the ladder towards increased self-reliance and mental composure in order to let go of irrational fear and unnecessary tension. When the stutterer has discovered one or more conditions under which he can speak fluently this can be a point from which to start treatment. Suppose this is reading aloud slowly in a relaxed state of mind. It is certainly an encouraging experience to be fluent in the presence of somebody else. The surprise of experiencing this has made stutterers expect that they will soon overcome their stuttering. However: the greater the unrealistic expectation, the greater the fall when it appears that in other situations such as speaking under time-pressure their dragon is still undefeated. The margin for voluntarily changing conditioned behaviour is narrow, and numerous rungs of the ladder are needed to reach the avenue of freedom. Involuntary responses cannot be changed on short notice. Take for example the nervousness and tension, which is accompanied by moist hands, dilation of the pupils of the eye and rapid heart rate. Such a combination of autonomic reactions is provoked by certain circumstances and by the expectations associated with them. Unlearning emotionally conditioned responses can be achieved by body-oriented practice and other behaviour therapy procedures combined with cognitive therapy.
Between voluntary and involuntary behaviour there are gradations of partly (in)voluntary behaviours. You can move your fingers at will, but you cannot change your handwriting at will, because it is partly automatic. A stutterer cannot prevent at will that tension and moist hands occur under certain circumstances. He is however free to do his treatment assignments to gradually overcome the interference of involuntary and unwanted responses. It is a limited freedom, because the new behaviour has to compete with strong inclinations to stick to the habitual patterns of avoidance and flight reactions. Prolonging a sound, pushing against the vocal cords, pressing the tongue to avoid the dreaded repetitions, these habitual stuttering symptoms have had an avoidance function when they first established themselves.
The degree of voluntariness of behaviour decreases in the following order:
feedback controlled sensomotor behaviour
automatic programmed sensomotor behaviour
emotionally determined autonomous functions
constitutionally determined autonomous functions
The response-times increase when we go from the sensomotor to the autonomous system. Changes in the lifestyle or life script at the cognitive level can only be implemented when certain conditions have been met: the patient should be sufficiently self-reliant, courageous and secure. The stutterer and his therapist face a great challenge when practising response modification and altering social relationships, mental attitudes and self-concept. Insight in behaviour associated with one's life-style opens the possibility to change it.