راهکارهای درمانی خاص در درمان لکنت زبان کلینیک تخصصی لکنت کرج بلوار ۳۸ متری نبوت (ضلع جنوبی)
attempting to do so. These opposing forces can occur at many different levels, both linguistic (for example, in word avoidance) and affective (e.g., interpersonal relationship level). In every case, the conflict will result in increased anxiety, and it is this anxiety which helps maintain the stutter. Sheehan’s indirect therapeutic approach, based on this model of stuttering is described in chapter 12.
Stuttering as anticipatory struggle behaviour
The anticipatory struggle hypothesis (Bloodstein, 1987) has at its basis the idea that stuttering develops when a child becomes frustrated with speech and believes the act of speaking to be difficult. These feelings may initially arise for a variety of reasons, which may not have anything to do with stuttering, but involve factors such as articulation or language difficulties. Bloodstein argues that these, together with environmental influences such as negative listener reaction, may then lead to increased anxiety, which can translate as features such as facial muscle tension. Speech may subsequently become more blocked and disfluent, and stuttering can quickly develop
from the typical easy repetitions seen at onset to the increasingly tense blocks and avoidance of an established stutter. A key feature in the antici¬patory struggle conception is the child’s personality. The individual may set very high standards, which can exacerbate feelings of anxiety, frustration and even inadequacy and shame as the speech problem persists. The family too may set often unrealistically high standards for verbal acuity, and may either knowingly or unknowingly respond negatively when the child does not reach these high goals, both with regard to speech and language and elsewhere.
The idea that the onset of stuttering is characterized by excessive pressure, whether internal or environmental, seems attractive, and many clinicians will be able to identify young clients they have seen whose background is consis¬tent with this pattern. The theory also offers an explanation as to why some children, experiencing nonfluency as is common in preschool speech, go on to develop a