Thursday, September 29, 2005

BUKO - first day - continuation

I am now back home. After BUKO, I attended another conference, in Frankfurt and on hedge funds: you know those people who make millions on the stock market! :-) Let me talk a bit more about the first day at BUKO.

In the afternoon, there was a discussion panel and presentations. First, representatives from different therapies answered questions on stuttering and described their respective therapies. There was a representative from the self-groups, Andreas Starke advocating van Riper approach, Alex von Gudenberg advocating a fluency shaping therapy, and a speech and language therapy advocating "Individual Psychology" (IP). IP has certainly provoked the strongest reaction from both panel members and audience. So let me talk about it.

I found a description on "Individual psychology":
Stottern ist aus individualpsychologischer Sicht eine Neurose. Dabei wird davon ausgegangen, dass die Diagnose Neurose dann berechtigt ist, wenn Krankheiten und Krankheitssymptome als Alibi verwendet werden, um soziale Mängel zu entschuldigen. Der Titel „Ja ..., aber“ steht deshalb für eine neurotische Formel, deren Antwort immer „Nein“ lautet, z.B.: „Ja, ich würde noch ein neues Studium anfangen, aber mit diesem Stottern ist das unmöglich.“
Die Ätiopathogenese des Stotterns ist weiterhin unklar. Es ist auch nicht eindeutig erwiesen, ob Stottersymptome immer primär auf der Basis einer neurotischen Fehlentwicklung entstehen. Unbestreitbar ist jedoch, dass jeder stotternde Patient psychosomatische Persönlichkeitsstörungen hat und Stottersymptome oftmals unbewusst oder bewusst eingesetzt werden, um einen sekundären Krankheitsgewinn zu erzielen. Dies führt dann zwangsläufig zu einer kontinuierlichen Fixierung der Symptomatik. Hier sind individualpsychologische Therapieansätze, insbesondere bei Erwachsenen, äußerst hilfreich. Grundlage der individualpsychologischen Sichtweise ist dabei, dass Stottern als Ausdruck frühkindlicher Entmutigung in den ersten fünf bis sechs Lebensjahren entsteht und so ein bestimmter Lebensstil entwickelt wird, der das Verhalten des Menschen im Verlauf seines Lebensweitgehend bestimmt. Wenn es daher gelingt, den Patienten in die Lage zu versetzen, seine individuelle Problematik zu erkennen und seinen Lebensstil zu analysieren, ergibt sich daraus auch die Möglichkeit, Verhaltensmodifikationen zu erreichen und so auch die Stottersymptomatik günstig zu beeinflussen.

Here is a quick translation:

In the IP framework, stuttering is a neurosis. A diagnosis of a neurosis is justified whenever illness and symptoms of illness is used as an alibi to cover for social defficiences. The title "Yes,.. but" stands for a typical sign of neurosis, e.g. "Yes I would like to go to university but it is impossible due to my stuttering". The mechanisms and causes of stuttering are still unclear. It is not clearly proven that stuttering symptoms always start out as neurotic developments. However, unquestionably every stuttering patient has psychosomatic personality troubles and that stuttering symptoms are often unconsciously or consciously used to obtain secondary gains. This leads to a obsessively continuous fixation on symptoms. In this respect, IP therapy approaches prove to be very sucessful. According to IP, stuttering in childhood is a symptom of early disencouragement in the first 5 to 6 first years which leads to a specific lifestyle that determines a human's life. If the patient is able to acknowledge its individual problems and lifestyle, a possibility opens up to change his behaviour and reduce the stuttering symptoms.

This approach did not prove very popular with the audience or panel members. Especially Andreas Starke dismissed it strongly and came examples. Also, a woman stood up and was visibly upset by what she thought was a completely ridiculous theory. She said that she stuttered not because of any deeper psychological problems or of problems bigger than that of the average person, she was just unable to translate her thoughts into speech. And that she was not deriving any open or hidden advantages from stuttering. But there was another member of the audience who said that he is convinced that stuttering is due to fear in the first place.

So what does Tom think? I actually spoke with two therapists doing IP during lunch. I really had the impression that they felt a bit on the defensive. I explained to them that I think that one must separate between therapy and theory. The troubling thing about IP is really that it makes clear statements about the nature of stuttering, which I can honestly not support. In fact there is much evidence against it like genetic predisposition, brain imaging studies showing structural problems, good results of the Lidcombe problem, etc. Having said this, I am NOT saying that IP is a useless therapy, on the contrary. Many aspects, including reviewing one's constructs and how stuttering affects them, are useful to reduce the handicap that stuttering brings with it. As I said many times before, the biggest handicap does not come from disfluency but from the social and pyschological SECONDARY effect. And IP does deal with them. So in my view, the therapy is OK but based on a wrong and outdated theory.


Einar said...

I agree mostly with you, however I cannot accept the idea of a "good therapy" based on "an outdated theory"... garbage in garbage out... Just imagine of the damage you can do to a child if you explain to him/her that he/she stutters in order to get favours from other people... But yes, if the right theory is applied, a lot of important work can be done on the psychological level

Tom Weidig said...

My argument was that success is the most important argument in favour of a therapy. So if it is sucessful to some degree, that's it, even if it is based on an oudated theory.

But I also say that a sucessful therapy does not prove the theory behind it.

In fact it is part of the therapy not to tell the child about the theory! Parents are instructed to avoid any negative feedback, and encourage their natural development.

Anyway, I am not a supporter of IP.

Anonymous said...

Hope you know "Individualpsychologie" is the name of the psychoanalytical theory of Alfred Adler, which is outdated indeed. I'm not a specialist on Adler but one of the main constructs he uses to explain psychological disorders are inferiority feelings. Stuttering, AFAIK, was one of his favourite theoretical subjects.

One of my most successful stuttering therapies I did with an Adlerian. We didn't do any Adlerian therapy, though, I hope. So, occasionally, even those can help.

Thinking of stuttering as a neurosis doesn't work anymore since it has been shown that there are virtually no personality differences between stutterers and non-stutterers.

Tom Weidig said...

Yes, I am aware this. But I didnt want to go into details.

Here is a intro to Adler's work: