In 2003 I wrote an ISAD paper based on Joseph Sheehan's original concept of the Iceberg of Stuttering. The fundamental concept is that stuttering involves a LOT more than just blocks and sound repetitions. The top of the iceberg does indeed represent those audible disfluencies, and in "the olden days," that was almost all people were aware of, both people who stutter plus speech-language pathologists.

But Joe Sheehan postulated that the whole picture of stuttering looked like an iceberg, with the audible stuttering on the top and an ENORMOUS amount of emotional baggage beneath the waterline. If you addressed only the top part of the iceberg, you were missing a critically important part of the stuttering puzzle.

I strongly suggest you read my paper, The Iceberg Analogy of Stuttering, before you continue (http://www.mnsu.edu/comdis/isad6/papers/hicks6.html). That paper is not long or complicated, but it forms the basis for this paper.

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I'm an engineer and we think differently than "normal" people. A "matrix" is simply an X-Y chart, plotting one variable against another. The resulting matrix can reveal some extremely interesting pictures that make categories snap into focus. For example if we compare the height and weight of a population of people, we might produce a matrix that looks like this...

You can see that there are various categories of people, little, big, tall, short, skinny, fat - and of course average. You can find yourself in a specific area of this matrix. If you are 7 feet tall and weigh 100 pounds, you'll be a "tall skinny" person. See how that works?

If you were a doctor and a skinny person came to you for help, would you put him (or her) on an 800 calorie a day diet? NO!! If a fat person came to you, would you recommend four chocolate milkshakes a day? NO!! Different categories of people require different treatments. That's obvious.

And so it is with stuttering...!

Here is the basic stuttering matrix. We are comparing is the top versus the bottom of the iceberg.

The horizontal X axis is the bottom of the iceberg and reflects the emotional baggage of stuttering. I use the label "Fear" to represent all the emotions below the waterline. You'd get similar results if you used Shame, Guilt, Anxiety, etc. On the far left of this axis, you have no fear of speaking. On the far right, you are absolutely terrified of speaking. Most of us are somewhere in the middle of those two extremes.

The vertical Y axis is the top of the iceberg and represents the traditional "stuttering severity" measurements. If you speak very fluently, you are down at the bottom of this axis. If you have obvious severe disfluencies, you are nearer the top. Again, most of us - we people who stutter - are somewhere in between.

Now the plot thickens...

We now begin to see the various CATEGORIES of people who stutter. A person who has a high FEAR of stuttering (to right on the X axis) plus relatively FLUENT speech (low on the Y axis) is generally a "covert" stutterer. If we can bring the fear down, that person can become a "mild" stutterer. (Easier said than done, of course!)

A person who has significant disfluencies (high on the Y axis) with little fear of speaking (to the left on the X axis) - and I generally fall into this category - is called a "comfortable" stutterer. I struggled with that label, but that's the best word I found. If you're familiar with iceberg density, the term "Styrofoam stutterer" might also work. A fairly light iceberg with more on the top than on the bottom.

A person with both high fear AND high disfluencies (high on BOTH X and Y axis) can be called a "very serious" stutterer.

Again, most people who stutter will fall somewhere in the middle of this overall matrix. They might be called "typical" stutterers.

You can also see that down in the lower left corner of the matrix we have an area where normally fluent people reside. Little fear (under normal circumstances) and very few disfluencies.

How we wish it were this simple! A person can be defined on a single point on the matrix. If we had numeric scales from 1 to 10 - and that's the subject for another paper - a person might be on matrix point X=6, Y=4. But as human beings, nothing is ever that simple.

Average "Joe" may start out the day at one point on the matrix and slide all over the map during the day. At noon he may be eating lunch with his buddies talking about the football game last night and be low on both the X and Y scales. The next hour he may be in an important meeting with his boss and be scared to death - and rise dramatically on both scales. And all during the day he may slide from one point to another as circumstances arise. We've all seen this phenomenon and we call it "the infuriating variability of stuttering." Such is life, and we need to recognize that. The main contention here, however, is that typically Joe will have a "home base" from which his daily variations can be shown to be relative. And as therapists, the SLP needs to concentrate on that home base as well as recognize the short term variability which makes their jobs "more interesting."

If you are a person who stutters, you can generally locate your own home base point on the matrix. The names on the following chart have been "changed to protect the innocent" - with one exception. "Russ" is me and you can see where my home base is. I stutter quite significantly but it's an easy, open stutter with almost no secondaries. I do a lot of public speaking so my fear of speaking is very low. Low on the X axis, moderate to high on the Y axis. I'm a "comfortable" stutterer.

Where are YOU on this matrix?

We all know Cheryl. Totally fearless but it takes her a while to get the words out. She's amazing.

Lew is a very mild stutterer. He does a lot of public speaking and he loves it. Most people hardly know he stutters.

Bill is almost completely fluent, but he sweats blood every time he has to open his mouth. He uses every trick in the book to keep from stuttering. His conscious mind is nearly overwhelmed with ways to keep from having even the slightest disfluency. He's absolutely covert.

Susie is nearly the same way. To her horror, people DO notice she has some unusual speech patterns, but very few people would say she - gasp! - stutters. She lives in constant fear of isolation from everyone around her. What if people found out about her dirty little secret? Oh, the horror of it! She is the poster child of a covert stutterer.

Peter may be recovering from covert stuttering. His disfluencies are more noticeable than they used to be, but his fear of speaking - and of stuttering - is coming down. He may very well be a man on the move. Hooray!

Charles is in desperate trouble. He has an enormous iceberg, both above and below the waterline. His stuttering is extremely severe and he lives his life in continual fear of failure to do almost anything. He may well have become a hermit, avoiding contact with people unless absolutely necessary. (I knew Charles several years ago. He committed suicide. Don't tell me stuttering isn't fatal. It certainly was in his case. Very sad...)

And as with the other cases, our "Average Joe" is near the middle of the chart.

Being good friends with several covert stutterers over the past several years, I noticed a phenomenon which I believe is unique to covert stutterers. I call it the Great White Shark Syndrome.

In my initial contact with a couple of covert stutters - a story in itself - my first reaction was "What the heck are you afraid of? You don't even stutter!" It took me at least a year to understand that they are afraid of the Great White Shark - that monster that lurks beneath the waves and seemingly strikes from out of nowhere!

The Great White Shark is that HORRIBLE block that really does cause terrible problems. He may not come around but once every five years - or longer - but when he does, he will stop you dead in your tracks and it will be totally obvious to everyone present - much to your horror - that you really DO have a stuttering problem. I've seen this happen and it's absolutely real. And the fear of the Great White Shark is pervasive in the minds of most covert stutterers. To think that a covert stutterer is really mild is to not understand the fear that comes from the Great White Shark.

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Okay, now that we understand the theory of the Stuttering Matrix and can see the various categories of stutterers that it shows, what's next? What is the appropriate therapy for the various categories of stutterers?

The overall objective of responsible stuttering therapy is to help the person who stutters move his home base down toward the origin of the matrix, the 0,0 point, the part of the matrix where both fear and disfluencies are low. That's the "normally fluent speakers" area. You may never get there, but that's the direction you want to go anyway.

The direction arrow (the "force vector" in mathematical terms) is on a DIAGONAL line pointing down and to the left, always pointing to the 0,0 origin of the matrix. To move in that direction, you need to push both DOWN using traditional fluency skills and TO THE LEFT using psychological counseling and support groups. Relying on only one approach is destined for failure. (I can personally vouch for that! Been there, done that, did NOT work!) That combination force vector is typically called "stuttering modification."

Depending on the location of the "home base" of the client, different amounts of fluency and psychology are suggested. In Joe's case he needs significant amounts of both fluency and psychological therapy. Russ needs a lot more fluency help than he does psychological help. (Well duh!) Susie needs a lot more psychological help than she does fluency help. Do you see how that works? The combination force vector should always point to the origin of the chart, but they point in different directions depending on where they are on the chart. That's the essence of what the matrix teaches us. Just like you wouldn't give milkshakes to fat people or put a skinny person on a strict diet, you need to understand the general category of where a person who stutters is on the matrix before developing good strategies for treatment.

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Does this make sense? As we are all so different from one another, it takes different approaches for everyone. That's what makes the SLP's job so challenging. But if an SLP has a general understanding of the matrix, that will give her (or him) a general starting point for what combination of strategies will probably work best for specific categories of stutterers.

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An extra credit puzzle for students who are really turned on by this sort of stuff...

Be careful for what you ask for - because you MAY get it! What would happen if the strategies you devise work TOO well? That is, the client develops super fluency (goes BELOW the X axis) and/or is becomes soooooo enchanted by the sound of his own voice that he loses ALL fear of speaking and aggressively pursues every opportunity to speak or preach his sermon to anyone and everyone he can get to listen (goes to the LEFT of the Y axis)? These are rare instances, but I've seen it happen. The person's home base is pushed into the NEGATIVE values on both the X and Y axes. What would you call a person like that?

What do you think? How would the matrix look for those rare people? What would be a good category name for those people? What would their icebergs look like?

-Discussion-