Self-esteem has been referred to in the literature as an important component of change for individuals who stutter (e.g., Bloodstein, 1995; Manning, 2001; Starkweather & Givens-Ackerman, 1997; Van Riper, 1982). These authors describe how a sense of self-esteem will very often increase as a client progresses in therapy. Manning (2001) states that people who stutter "Šare able to redefine themselves and create an altered paradigm of their lives" (p.407). Starkweather & Givens-Ackerman (1997) refer to self-esteem as a "personal sense of worth". This personal sense of worth is the subject of this paper. We will review the case history of a 41 year old person who stutters and view how his sense of self-worth has lead him to the brink of success in dealing with his stuttering. Most of the literature in self-esteem and stuttering explains how self-esteem or self-concept can be achieved in therapy, or as a result of therapy (e.g., Manning, 2001; Van Riper 1982). At least one study used a standard scale to compare self-esteem of PWS versus a normative sample (Yovetich, Leschied, & Flicht, 2000), however, their subjects were all children below the age of 11.9 years. Many stories of success in therapy document change at a later period in life, and often how it is associated with success in other aspects of life (see St.Louis, 2001). The many testimonials documented by St. Louis show the different paths to success by people who stutter, and emphasizes the strength that is gathered from "telling one's own story". This paper follows that basic theme. The second author of this paper, Michael, is about to tell you his story, and how it lead him to where he is today. Michael is not "cured" yet. He is not even sure what "cured" means. However, he is clearly on the road to success, and much of it came through an improvement in self-esteem. Here is his story (in his words).

SUBJECT

Client's view:

My name is Michael Kevin Latulas. I am 41 years old and was born in New Iberia, Louisiana, a small, historic city located about 35 miles outside of Lafayette, Louisiana. I am the youngest of six children born to my parents and consider myself blessed to have my parents living only five miles away from me. I have been married for four years to a wonderful wife, Tracy, and have two children, Kelly, 3 years old and Michael, 10 months old. I am currently living on Avery Island, Louisiana, which is home to the world famous McIlhenny Co., producers of Tabasco Pepper Sauce, where I have been employed for twenty-three years. My family and I live quietly and happily just going about our daily rituals of life. But my life is not as picture perfect as I have made it seemŠ.I am a stutterer.

My stuttering began when I was eight years old. I was told that my speech was fluent until I began attending third grade. My third grade teacher had everyone in my class afraid of her because she was a stern disciplinarian. I remember shaking when she spoke and the fear that I felt just being in the same room with her was very real. After attending class for a few days, she called on me to speak or read. I could not speak. I began to stutter on every word. I remember everyone laughing at me and all I wanted to do was hide or run away. I was extremely embarrassed. As a third grader, I really cared about what my peers thought of me but I stuttered on everything, especially the telephone. This was the beginning of "my problem."

As I reflect on my early years, I do have many regrets. One is that there was not anyone whom I felt could help me out of this terrible situation. Believe it or not, teachers were highly respected and to disagree with a teacher or "talk against" a teacher's tactics were frowned upon when I was a kid. I do, however, wish that someone would have recognized my fear and helped me to overcome it at that time and by doing so, maybe I would not have this problem today.

My mom and I are best friends. She has always encouraged me to move forward and has always let me know that she loved me, regardless of how I was speaking. My mom wanted me to get help for my stuttering problem, but the school system did not offer any help at the particular school I was attending. Therefore, I avoided any situation where I would have to speak. At the end of that school year, I was a severe stutterer. You can imagine how this felt. I did not receive any therapy until I was a sophomore in high school. The type of stuttering I had was called "stoppage". I feel that the technique my therapist used on me did not help me at all.

As I moved into my adolescent years I had become a very shy, withdrawn and distant teenager. My self-esteem was very low. The only thing that made me feel good about myself was sports. I never dated or went to any proms or dances when I was in high school. I let my stuttering keep me from having fun when I was in school. I also let stuttering keep me from going to college. My ambitions were high, but because of my stuttering, I felt I had to accept what not having to speak or express myself in large groups could give me at that time. Sports made me feel good because no one knew that I stuttered. So, after I graduated, I started taking martial arts classes. This began to help my self-esteem. After a few years in martial arts, I received a "Second Degree Black Belt". As my self-esteem grew, so did my desire to become fluent. I received some therapy and a major milestone happened in my life, I overcame my fear of the telephone. So many people take for granted the ability to talk on the telephone, but for me this was MAJOR! I learned some techniques to become more fluent, but I still stuttered. It wasn't as bad as when I was in high school. But I still was not totally satisfied.

A few years later I became interested in bodybuilding. I won two "Mr. Louisiana" championships, I won second place in the "United States Bodybuilding" championship, and first place in the "Mr. Universe" championship. My self-esteem was getting better and better and I began taking a few chances of speaking publicly. I still stuttered because I did not have the training or a strategy to speak more fluently, however, I WAS getting better!

I had a small circle of friends who accepted me for who I was on the inside and I did not try to leave out of my small world. Then I got married. My wife totally accepts me for who I am and I am deeply in love with her. I often tell her that I never expected to get married and find the kind of love that we share. After my kids were born, my life was almost complete. . . but I was still not satisfied.

When my daughter Kelly was 2 1/2, I noticed that she was showing signs of stuttering. I told my wife that I wanted to get her therapy as soon as possible so she would not have to go through life being a stutterer. We checked into it and found that some of the best therapy in our area was at the University of Louisiana at Lafayette. We went to the University and met Dr. John Tetnowski. My life has changed.

Clinician's view:

Most of the skilled clinician's of the world reading this paper probably see Mike as the ideal client (I know I did). He is motivated, sincere, hard working, and honest. However, you may have noticed that our relationship began only because he was concerned for his daughter. I (John, the first author of this paper) was supervising the evaluation of Mike's daughter (Kelly) that was being completed by a current doctoral student (Jennifer, the third author of this paper). Jennifer noted that there was a family history of stuttering, and I immediately went to have a conversation with mom and dad, who were also observing the evaluation. Kelly's mother did most of the talking, but when I asked why they were interested in getting an evaluation of Kelly's speech at such a young age Mike quickly said "because I don't want her to go through the same things that I went through". Mike stuttered severely through this utterance. When I asked if he had ever received therapy, or if he was interested in therapy, he admitted that he had received some, but didn't know if it could help him anymore. I encouraged Mike to start attending our local support group, and within two months, he proclaimed that he was ready to begin therapy himself.

What made Mike ready for therapy now? I believe that it is a combination of issues, almost all related to his status in life and his self-esteem. Mike is:

- happy with himself and his self-concept
- happy with his life
- knows the value of hard work and change

Here is an example of a comment made by Mike during a support group.

Group member: "When you were young did other kids laugh at you and tease you?"
Mike : "Yeah, but they don't tease me any more"

And believe me, if you saw Mike, you wouldn't tease him either! I think that Mike's body image and self-esteem (developed through improved self-concept) make him ready for therapy now. At the time of his evaluation, Mike clearly falls into the severe category of stuttering. His stuttering rates are as high as 40% during structured clinical tasks, an average of 21 stuttered syllables per minute during out of clinic conversation tasks, and a severity rating of "severe" on the Stuttering Severity Instrument-3 (Riley, 1994). An unskilled clinician might think that with his degree of severity, and the number of years that he has been stuttering give him a poor prognosis for efficacious therapy. However, the confidence and high self-esteem shown by Mike made us (John & Jennifer) believe that he was ready for therapy now. Our feelings were reinforced by Mike's responses on the Wright and Ayers Stuttering Self-Perception (WASSP) Scale (Wright & Ayers, 2000). His responses included 7 (very severe) for physical struggle during stutters, 7 (very severe) for frustration about stuttering, 7 (very severe) for social disadvantage due to stuttering, but 1 (none) of admitting problem to yourself. Our evaluation of Mike's self-rating of stuttering is that he sees stuttering as a severe problem, but one that he can openly admit and accept.

RESULTS

We think we were correct in getting Mike into therapy at this time. Initial sessions began with an educational and counseling component of therapy. Following this, Mike was introduced to the fluency enhancing conditions of "easy onset" and slightly "prolonged speech".

Current status:

Mike has been attending weekly therapy sessions for almost two months. Within this time, he has developed an understanding of his stuttering, including the physiology of normal talking. In addition he has attained significant success at reducing stuttering. Presently he has lowered stuttering in clinical setting to 0% (reduced from 40% at the time of evaluation). Mike is the "lead talker" at support groups. He has been asked in the past whether he talks that much at home and in other situations, and he states that he feels more comfortable with the group because we understand stuttering. Reports from others indicate that he is talking more in other situations as well. The support group has noted a significant decrease in Mike's stuttering and an increase in self-awareness and willingness to talk on any subject.

As stated earlier, Mike is certainly on the road to recovery. Several factors have led him to this level, but we believe one of the biggest is the degree of self-esteem that Mike currently has achieved. We, as speech-language pathologists did little to improve his self-esteem, but we recognize how martial arts and body-building have set the stage for Mike to be successful now. Without this self-esteem, Mike has avoided situations, words, and has even made career choices based upon levels of self-esteem. We feel that many times clients can help themselves in finding the road to success. Mike will get there -- or maybe he already is there!

REFERENCES

Bloodstein, O. (1995). A Handbook on Stuttering. San Diego, CA: Singular.

Manning, W.H. (2001). Clinical Decision Making in Fluency Disorders. San Diego, CA: Singular.

Riley, G.A. (1994). Stuttering Severity Instrument for Children and Adults-Third Edition. Austin TX: Pro-Ed.

St. Louis, K.O. (2001). Living with Stuttering: Stories, Basics, Resources, and Hope. Morgantown, WV: Populore Publishing.

Starkweather, C.W., & Givens-Ackerman, J. (1997). Stuttering. Austin, TX: Pro-Ed.

Van Riper, C. (1982). The Nature of Stuttering. Englewood Cliffs, NJ: Prentice-Hall.

Wright, L. & Ayre, A. (2000). Wright & Ayre Stuttering Self-Rating Profile. Bicester, Oxon: Winslow Press.

Yovetich, W.S., Leschied, A.W., & Flicht, J. (2000). Self-esteem of school-age children who stutter. Journal of Fluency Disorders, 25, 143-153.

-Discussion-