Stuttering or Disfluent Speech: Our Interview with Clinician Elizabeth Kapstein
Elizabeth Kapstein was introduced to us by one of our favorite guests on Mental Health News Radio, Steven Welch. We wanted to speak with a clinician that specializes in working with clients where stuttering is part of their lives. While she has many specialities, today we focus on stuttering and as Elizabeth is a stutterer herself, she brings that unique perspective to her experience as a trained and licensed behavioral health provider.
Join us in welcoming Elizabeth to Mental Health News Radio!
Why are you a therapist and why this topic?
Well, why am I a therapist? I like it, I have worked in a variety of professions (in chronological order): community organizing, food service, business development, information technology, and clinical social work. Here’s the funny thing. I never really understood that I was acting like a social worker years and years before I decided to go to school for Social Work. I didn’t get it, but over the years all of my work has been to work with people to “go from one place to another through either community organizing, education, activism, or clinical work.”
I started community based volunteer work as a teenager. I volunteered for almost two decades with people living through terminal illnesses. I learned that I was able to sit with people during difficult passages of life. “Sit with” is a funny term, but it’s a way of being with and connecting with people. It was there that I developed a sense of “patient rights” and “the right to self-determination.”
After graduation from undergraduate college I divided my work hours between “paid day work” and “non-paid evening work.” I started working in the food business in my hometown, Washington, D.C. I spent several years developing a catering company, volunteering for “Food and Friends” & the DC Gray Panthers , and part-time administrative work. It was the late 1980’s at the beginning of the HIV/AIDS epidemic.
My focus was on developing my business and community justice. I had not conceptualized my own identity as a social worker or had considered attending graduate school. I was also not connected to the “stuttering community,” nor did I know anything about it. In the early 1990’s I learned about the National Stuttering Association. I attended my first support group and met fellow stutterers. It was a crazy experience.
For years I had dealt with stuttering on my own. I understood and shared very little about what stuttering was and its impact in my life. Once I joined the DC Chapter of the NSA my world changed. It was a crazy shock to meet and listen to other stutterers. I learned all about “voluntary stuttering”, acceptance of my stutter, and being part of a larger stuttering community.
In the 1990’s I moved to New York City to continue my food career. I attended the Natural Gourmet Institute. For the next seven years I worked as a chef, educator, and business development consultant. Here’s the funny thing; during that time I realized that my identity as a stuttering person was so strong, that I needed to have a community of stutterers around me. The trouble was that there was no developed stuttering community. So, I started the Manhattan Stuttering Group (MSG) in my apartment with my new found friends (Jeff Shames and Joseph Tegtmier). This group spanned the creative support for many people to develop their own ventures e.g. www.stuttertalk.com and www.say.org.
Eventually I found that in developing food programs and businesses that I loved working in technology. So I trained and moved into working in technology. I spent five years working in information technology solutions for corporations, while continuing my work in the stuttering community.
This was a very rich part of my own career development. In the stuttering world I was still in the MSG and even co-founded with Barry Yeoman “Passing Twice” (www.passingtwice.org) and deepened my identify as a presenter and educator in stuttering self-help conferences. On the technology side I ran through the “start-up” technology boom.
Yet, still no sign of becoming a Social Worker. I had accomplished a strong identify in community organizing, food service, business development, and information technology, but something was amiss. Through some careful work I decided to pull all my avocational and vocational work together and become a Clinical Social Worker. I realized that all this work led to my next path of working with people to move from one place to another through the venue as a therapist.
So, I attended New York University School of Social Worker with my fellow stutterer Jeff Shames. I graduated in 2006 with a Masters of Social Work. Since my graduation I worked for over eight years as a Clinical Social Worker at Harlem United (www.harlemunited.org) in supportive housing and mental health programming within a community health center. During this time I continued my post graduate studies in Cognitive Behavioral Therapy, Psychodynamic Therapy, Eye Movement Desensitization Reprocessing, and Psychodrama. I am no in full-time private practice as a “Trauma Informed” Psychotherapist. I work with adults moving through life transitions, healing through life traumas, living with disabilities, living in alternative communities.
It is now with this lens as a Psychotherapist who Stutters that I oversee the “Connecting with Others: The Role of Mental Health Professionals who Stutter” in the On-line Conference for International Stuttering Awareness from October 1 to 22.
Stuttering is a complex set of behaviors that interfere with the production of fluent speech. It is often referred to as “dysfluent speech.” Generally there is an interruption or break in the flow of speech (a.k.a. a dysfluency).
Now and then, everyone has trouble getting words out. It’s a normal part of language development during childhood. When it continues past the usual childhood development and takes up over 10% of speech, well then it’s looked at as speech dysfluency. There are as many different patterns of stuttering behavior as there are people who stutter. A good place for information is I like to look to Friends Who Stutter for a description of stuttering.
What does Stuttering sound like?
Well, it’s generally described by what others see or by what you hear. So you might see someone speaking with multiple repetitions (r-r-r-r-petitions), prolongations (rrrrepetition), blocks (—-repetitions). You might see a person struggle in the face, head, and neck movements.
What Causes Stuttering?
I don’t know. It’s very a very complex communication disorder. It’s said that approximately 1% of the population (over 68 million people) and 3 million Americans are stutterers. Many children go through a period of stuttering but then outgrow it, so approximately 5% of children stutter at some point in their lives.
Stuttering is a variable disorder that can be confusing and potentially frustrating at times. Stuttering frequency can change from word to word, sentence to sentence, hour to hour, month to month, or even year to year.
Because stuttering is a multi-dimensional disorder, it is often defined in three parts:
- Affective: The way one feels about stuttering, such as: feeling ashamed, embarrassed, anxious, etc.
- Behavioral: The observable characteristics, such as repetitions (c-c-car), prolongations (mmmine), blocks (—-book), physical struggle, avoidance behaviors, etc.
- Cognitive: The way one thinks about stuttering and themselves, such as: thinking people don’t like them, thinking they are stupid, thinking they are less of a person, etc.
I like to think of stuttering as something that we do. It’s an organic part of us. However, stuttering is more than just the way someone speaks. Stuttering affects every aspect of our internal process and lives. It is often the aftershock of the experience that impacts our affect, the way we feel, see ourselves in the world and how we respond to how others respond to us that becomes the difficulty. Stuttering is just what we do. The work is how to do it in a way that is organic and comfortable. Often the reaction of others who don’t understand what we do becomes the difficult part of living with a stutter.
People laugh at us and often we don’t learn how to deal with that from a very young age. Okay, so let’s back up:
- Approximately 1% of the population stutters (over 68 million) and about 3 million Americans
- Stuttering is generally not caused by psychological or physical trauma
- Stuttering is not related to intelligence
- Approximately 3 males stutter to every 1 female
- Many preschoolers who show early signs of stuttering will outgrow it. However, we cannot predict who will recover spontaneously. Speech therapy at an early age can increase the likelihood that the child will recover.
- There are no cures for stuttering. Speech therapy can help a person manage his/her speech and make long-term changes over time.
- Approximately 5% of all children go through a period of stuttering that lasts six months or more. Three-quarters of those will recover by late childhood.
Myths and Beliefs
I will outgrow my stuttering.
I am alone.
I stutter because I am a nervous person.
Stuttering is my fault. I cause it.
I am just not trying hard enough.
I need to hide my stuttering.
Just breathe, slow down and it will go away.
I must speak without stuttering to be successful and accepted in life.
I shouldn’t talk about stuttering. It’s embarrassing.
Stuttering will hold me back in life.
What to do when someone stutters: Stuttering is misunderstood. Sometimes the listener feels anxious and doesn’t know what to do. Here are some ideas:
- Stay connected. Maintain eye contact with each person. Look at the eyes and/or forehead to keep connection.
- Be patient. Slow down your reaction to finish sentences or fill in words for the person, and stay away from making remarks like: “slow down,” “take a breath,” or “relax.”
- We know we stutter, if you wonder what it is then go ahead and ask.
- Sometimes you may not understand what is said to you, do not be afraid to say, “I’m sorry, I didn’t understand what you just said.”
- Show connection to the person by your body language, manner and actions. Be yourself. Be a good listener.
- Remember, people who stutter are normal except it just might take a bit longer to talk.
What are the different types of therapies for people who stutter? There are a multitude of options:
Speech Language Therapy: The Stuttering Foundation
Therapy/Counseling: Start with any of us for referrals at http://isad.isastutter.org/isad-2015/papers-presented-by-2015/mental-health-and-stuttering/connecting-to-others-the-role-of-mental-health-professionals-in-the-stuttering-community/
So, wrapping this up, there are multiple paths to understanding stuttering and the role in our lives. My path has been a long one to where I am today. As a therapist I continue focusing on providing education, connection, and community for stutterers to deal with their true clear stuttering selves.
Elizabeth is a licensed clinical social worker (LCSW) and Certified Alcoholism and Substance Abuse Counselor (CASAC), practicing psychotherapy since 2006. In addition to her private psychotherapy practice, she has worked at Harlem United, Guidance Center for Mental Health, Post Graduation Center for Mental Health, Henry Street Settlement House, and TRI Center, The Recovery Center. She is also an alumni and mentor in the National Health Service Corp.
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Tags: clinical social work, Cognitive Behavioral Therapy, dysfluency, EMDR, food and friends, Harlem United, Kristin Sunanta Walker, Kristin Walker, Manhattan Stuttering Group, Mental Health Is Real, mental health news radio, MHNR, Not Changing the Name, passing twice, Psychodrama, Psychodynamic, stuttering, stuttertalk, What is Mental Health?