CHAPTER 13

PREVENTING RELAPSE

Ironically, one of the greatest advantages of the use of the Passive Air Flow Technique - the speed with which it often brings total fluency - can, with some patients, also be one of its greatest setbacks. A patient who on Monday had been a severe stutterer, will on Tuesday, speak effortlessly everywhere without a trace of his former problem. He, his friends, and family would be delighted; his therapist, on the other hand, would be deeply concerned.

For the immediate, total success produced by the Air Flow Technique for some patients can be reversed as quickly as it was learned, if careful maintenance is ignored. The patient is highly suggestible, having just overcome a major lifelong difficulty, and if he lets down his defenses and relaxes his attention to technique, he runs the risk of having his stuttering return at the slightest provocation. He also open himself up to another, more subtle complication - a condition that I have come to call "the assault of the subconscious."

The assault of the subconscious only occurs in individuals with a moderate or severe stutter who quickly become fluent. Shortly after attaining fluency the patient reports experiencing an anxiety attack which may range from nervousness to a deeper sense of dread. The anxiety continues unabated for days and they begin to feel that if only they were to start stuttering again, their anxieties would decrease. For a small percentage of patients the stress is so great they succumb to the temptation. The stress does indeed stop after the resumption of stuttering and the patient vows "never to go near that fluency again."

The theoretical explanation for the assault of the subconscious is as follows: The subconscious plays a critical role in a person's identity, and in producing and maintaining change. In a person who stutters, the subconscious sees itself as a stutterer. For years the individual has been telling his subconscious that he cannot say certain sounds, certain words, or speak in certain situations - and the subconscious believes it. The subconscious does not place a value judgement on stuttering, it simply says that's the way it is. Value judgements came from the conscious mind.

When a person abruptly stops stuttering, the subconscious becomes disoriented. Fluency is not the normal state of affairs; it violates the self concept of the subconscious. The subconscious becomes "concerned" that the well-being of the individual is being threatened, and and its only mode of response is to "sound the alarm" by raising the person's level of anxiety.

It is well known in learning psychology that all newly learned behaviors, including the Passive Air Flow Technique, are lost under conditions of stress. The elevated state of anxiety is an attempt on the part of the subconscious to restore its self concept as a stutterer by causing the individual to give up his newly-learned fluency. I have encountered this problem time and again, in totally different situations, and have come to recognize it as the precipitating cause of relapse in patients who attain total fluency quickly!

During my early experiences with stutterers I found that fully a third of those who became totally fluent quickly reported the assault of the subconscious. Some would "hang tough" and after a week or two it would be gone; others would succumb to the temptation to resume stuttering and would be lost to the Program. The Bathtub Technique is a treatment that has been developed by the National Center for Stuttering to deal with this problem. At first it may seem unusual, but it has been used with over 4,000 patients and it successfully eliminates the assault of the subconscious.

Three things are required: a bathtub filled with warm water, a candle in a candle holder, and a mirror. The candle is lit, placed in the holder, and put on the ledge of the tub. The mirror is placed next to it. The patient then turns out the light, enters the tub reclines in the water so that his torso is completely submerged, breathes calmly in and out through his nose, keeps his eyes open and stares at a spot on the wall directly in front of him. Each time the air calmly comes out of his nose, he thinks the word one. As he does this, he may find his mind starting to drift, starting to think other thoughts. Each time this happens, he is to bring his mind gently back to thinking the word one. Since the mind is an undisciplined thing, he may find himself frequently having to bring it back to the thought. But he is to persevere for at least five minutes and steep there in the tub like a pot of tea.

Here's how the first phase of this technique works: First, the warm water mechanically relaxes the muscles of the patient's body. Second, the subdued light from the candle prevents any bright light from tensing his eyes. Third, fixing his eyes on a spot on the wall prevents eye-scanning movements, which is important to this exercise since eye-scanning movements have been shown to stimulate muscle tension. Fourth, thinking the word one over and over again renders the word meaningless. Like repeating a Hindu mantra, and this prevents the patient from thinking about what he should have done yesterday and what he has to do tomorrow. Such thoughts stimulate tension.

In those five minutes, we are attempting to strip away as much muscle tension as we can, to create as much of an intra-uterine experience as we can, our mother's uterus being the safest place we've ever known - warm, moist, dark, supportive, thoughtless, relaxed. We are using an intra-uterine model as the physiological rationale for this first phase of The Bathtub Technique.

We now move to the second phase. The patient sits up in the tub, picks up the mirror, and positions it so that he can see his eyes. Using perfect Air Flow Technique, he begins to repeat the word "relax" slowly, using an extremely soft voice. He does this for about three minutes (usually about fifty repetitions are produced during this time). These first two phases are designed to reduce muscle tension to a level where we can access the subconscious.

We are now ready for the third and most important phase of the program. In it, the patient is literally going to brainwash himself; he is going to change the self-concept of the subconscious..

The patient reads a specially-prepared series of positive statements called affirmations. The affirmations are prepared individually for each patient. They are read three times using the Air Flow Technique. One of these affirmations is designed to provide subconscious motivation to practice. It is naive to rely solely on conscious desire, when the subconscious is free and accessible.

Subconscious motivation is powerful but gentle. An example of this is brushing the teeth. Think of brushing the teeth as practice we do every morning and every evening. Somehow we feel obliged to do it, as if the day would be uncomfortable or incomplete if we didn't. There is no question about our doing it. It is something we all have to do and we never call it practice. It is our subconscious at work, telling us to do it. We are almost never too tired to brush our teeth. So too does airflow practice become almost involuntary as the bathtub technique affects the subconscious.

Each patient is provided with a post-hypnotic cue word to say silently before entering a stressful speaking situation. Many stutterers, when they say the word, experience a profound drop in Base Level Stress - to the point where they seem to be alone, even if they are in the middle of a large group. Their fluency is then assured. 


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