Rapid Cure of Stuttering in a Three-Year-Old as a Result of Psychodynamic Treatment
By Martin A. Silverman, M.D.
The telephone rang one morning. The caller identified himself as an internist in a distant, southwestern state. He asked me if I could help him find a good speech therapist for his three-and-a-quarter year old nephew, who lived near the town in which I had my practice. His nephew had begun to stutter two or three months earlier, and it was getting more and more severe. The doctor calling me was startled when I suggested that I see his nephew for evaluation before arranging for speech therapy.
I explained how emotional factors can contribute to the sudden onset of stuttering. I promised that, after a brief assessment, I would do everything in my power to help his nephew, including arranging for competent speech therapy if it proved to be indicated. He agreed, albeit somewhat reluctantly, to recommend to his distraught sister that she bring her son to me for evaluation.
A few days later, Danny’s mother informed me that he had always been a healthy, happy, affectionate, bright, lively, energetic youngster. He began to speak at about a year of age, and did so clearly and without impediment until shortly after his parents returned from a week in California. During his parents’ absence, he stayed with his grandparents, who reported that they had had a good time together and that nothing occurred to mar the experience. Danny’s parents called him every day during their absence, and he appeared to enjoy the telephone calls, although he did say toward the end of the week that he missed them.
When I met Danny the day after I spoke with his mother, he presented as sturdy, bright-eyed, and inquisitive about me and about the items in the playroom. His mother repeated what she had told him about my being someone who liked children, knew a lot about them, and had been able to help a number of children and their parents when things were troubling them. She said that she was sad that he had begun to stutter and that it bothered him so much to do so. Indeed, Danny did stutter very badly. His efforts at communicating orally were greatly hampered by staccato-like stuttering that seemed to me to affect vowels even more than consonants. He agreed with his mother that the stuttering bothered him very much, and he indicated that he would appreciate being relieved of it.
Danny dove into exploration of the toys and play materials that were in my playroom. The plastic soldiers, animals, and dinosaurs delighted him, as did the little cars and trucks. After a while, his mother expressed pleasure in his interest in playing with the toys and asked if she could leave for a little while to run an errand. He hesitated for a moment, with a serious look on his face, but then told her she could leave. Danny continued to play with the toys after his mother left. He was particularly pleased when he found a toy rifle in the playroom with which he could become a hunter and shoot at the wild animals that were set up in one section of a set of shelves that contained play items.
Danny and I chatted amiably about his interests, his nursery school experience, his family, and so on, while he played with the toys. It was evident that it bothered Danny that the stuttering impeded him from expressing himself easily. When I noted this to him, he looked sad. He said that he wished the stuttering would go away. I told him that I had learned from his mother that he had not always stuttered and that it had begun a little while after his parents had been away on a trip. Danny darkened, got up from the floor, where he had been playing with toy cars and planes (about which I thought of his parents leaving him to fly to California a little before the onset of his speech problem), and went over to the dollhouse corner, which was as far away from me and the toys with which he had been occupying himself as he could possibly go in the room. He stood with his back to me, picked up a number of the items of furniture and the family figures and looked at them in a desultory fashion.
I informed Danny that I was told that he stayed with his grandparents while his parents were away. He turned around so that he faced me again. He did not look happy. He just stood there without speaking. “Did something happen while you were with your grandparents that bothered you?” I asked. He clouded over and furrowed his brow. “Gramma and Grampa told me not to tell,” he said. “I promised.” I replied that I appreciated his believing in people keeping promises, but I added that people do not always do so and that sometimes people cannot keep a promise, because it isn’t a good promise to keep. Danny looked angry. He said: “Gramma and Grampa promised me and Mommy they wouldn’t go out and leave me with a babysitter while Mommy and Daddy were away.” (I noticed that Danny hardly stammered while he angrily told me this.)
“Did they break their promise?” I asked. Danny looked even angrier. “One night,” he said, “they went to the movies and left me with a babysitter.” “How did you feel?” I asked. Danny said nothing, but then he suddenly wet his pants! “You must have felt like crying,” I said. “I was sad,” Danny replied. “I cried.” I had heard Danny’s mother returning and going into the waiting room. I told Danny that I would ask her to come in and help him change his clothes. I also told him that I thought he needed to talk with her and tell her what happened while he was with his grandparents. I said that she would want to know about it and that I would help him tell her about it.
When his mother came into the playroom, at my request, she expressed surprise that Danny had wet himself, because he had been completely dry for some time. I told her that wetting and crying at times can be related. She went out to her car, brought back the extra set of clothes she kept there at the request of the teachers at Danny’s nursery school, and she changed him into them in the bathroom. Then I helped Danny share with his mother what happened while Danny was with his grandparents. She became angry, but with a bit of help from me, she calmed down. Then she assured Danny that he would not be in any trouble, but she was going to talk to his grandparents about what they had done. The three of us agreed to meet again two days later.
When I saw Danny again, he accepted his mother’s offer to stay in the waiting room while he came into the playroom with me—but he asked that the doors be left open. I acceded to his request, and he dove into playing with the toys. He looked at the various toys which he had ignored during his first visit with me, and he explored the drawing and construction materials, the games, the balls, and the expressive play materials that were in the toy cabinet. Then he returned to playing with the things that had interested him during our first meeting. I told Danny that his mother and I had spoken on the telephone and that that she had informed me that she had a talk with his grandparents about what had happened. They apologized for what they had done and said that they had made a mistake and would never do it again. Danny told me that they also spoke to him and that they said they were very sorry that they had made him feel bad.
“How did that make you feel?” I asked. Danny, still stuttering badly, said that he felt better, but the look on his face indicated otherwise. “Are you sure you feel better?” I asked. “You look angry.” Danny took two steps forward, picked up the toy gun, aimed it at the animals, and began firing at them as he made a staccato, machine-gun-like noise—“uh-uh-uh-uh-uh-uh-uh.” “Danny,” I said, as I raised the volume and tone of my voice so that I was speaking emphatically, “that sounds just like it sounds when you’re stuttering! I think when you stutter, you’re very angry at your Grandma and Grandpa and you’re shooting them down!” Danny turned to me and, in a clear and loud voice, without any stuttering, said: “I’m very angry at them. They did a bad thing! They made me scared. They made me cry. They shouldn’t have done that.” “Danny,” I said, “you didn’t stutter just now! I think you should tell your grandparents how you feel about what they did. They’ll understand. And then maybe you won’t have to stutter any more.”
I looked up and saw that Danny’s mother, who had been on her way to the bathroom, was standing outside the playroom, looking at us, with her mouth open and her eyes open wide. She had observed what had just occurred and was flabbergasted. She proceeded to use the bathroom, after which I invited her in to join us. She reiterated to Danny what I had said about speaking up to his grandparents and assured him that she would help him do it and that it would be okay. They left soon after this.
When I met with Danny for the third time, alone and then together with his mother, we spoke together about the confrontation the two of them had had with Danny’s grandparents. Danny and I spoke about all that had occurred. He spoke with intensity and with emotion—and he did not stutter! In fact, he never stuttered again! When we met for a couple of follow-up visits during the couple of months that followed the third visit, he appeared to be a happy, cheerful, well-adjusted little boy. I had an opportunity to follow Danny’s progress for a long time. For the next 15 years, until Danny went off to college, his mother would not make a significant decision involving her children without consulting with me first, because, as she put it, I was “a wizard” whose counsel she would not do without. Her brother, the doctor in the southwest who had called me to begin with, in search of a speech therapist for Danny, called again, this time to warmly thank me for helping his nephew—as well as for helping him learn something about psychosomatic medicine and about stuttering in particular.
This vignette illustrates dramatically how effective and efficient psychodynamic psychotherapy can be in helping people overcome a neurotic disorder. Behavior modification techniques often can reduce or even eliminate the surface manifestations of an emotional disease, but the internal engine that has created the symptoms remains inside, ready to create further problems. I think, for example, of a twenty-two year old soldier, whom I treated in group therapy while I was an army psychiatrist overseas, who overcame the severe stuttering that had developed when he was given responsibilities that involved speaking to people on the telephone -- after he recalled beginning to stutter at the age of four when he was forced by his grandfather to speak with his parents although he was angry at them for traveling two thousand miles away from him for a vacation. A speech therapist helped him stop stuttering, but the pain, anguish, and rage at his parents and grandparents lay dormant thereafter until circumstances rekindled the fire smoldering within him eighteen years later. That, however, is another clinical story. The important thing is that behavior modification can “antiseptically manipulate surface behavior,” as Fritz Redl put it many years ago, while psychodynamic psychotherapy or psychoanalysis can lead to real cure.