One way fears are expressed is through avoidance. A client who is fearful of and anticipates stuttering will often try to avoid specific sounds or words, or try to circumvent the situation altogether.

Avoidances are revealed in several ways, and clinicians should be able to interpret certain behaviors as a client's reaction to their fear of stuttering and consequent embarrassment. Ham (1999) defines an avoidance as "any behavior designed to avoid, reduce, or escape stuttering on a specific word". He lists common avoidance behaviors include:

	Circumlocution/Substitution - using a synonym or other words to replace the feared word, originally targeted.
	Interjection - a sound, not part of the intended message, inserted into the utterance, intended to avoiding, postponing or releasing from a stutter.
	Postponement - a behavior that purposefully delays a speech attempt, in order to enhance the likelihood of saying it fluently.
	Release - a movement, gesture, or sound used to break out of a stutter; an escape.
	Retrial - when an attempt to say a word is terminated is followed by a pause, and a new attempt is made.
	Starter - a behavior that coincides with and supports an attempt to say a feared word.

Avoidances are often very subtle as clients are trying to conceal their stuttering by using avoidances. From time to time, clinicians will be uncertain whether some behaviors are truly avoidances or natural revisions. The result of an avoidance is often a very unnatural utterance (in terms of the overall flow or word selection) or a confusing or ambiguous message. Be mindful of the frequency avoidances and patterns of avoidance behaviors. It is common practice to ask the client if he or she used the word(s) they intended or an avoidance behavior.

Avoidance behaviors are detrimental for several reasons. Using avoidances is a failure; a loss. The client's fear has won out, and next time the fear will be stronger as a result. An avoidance is a response to fear; a response that reflects a client's feeling he or she lacks the skill and ability to attack feared words with their stuttering techniques. Yielding to fear results in the client being "out of control"; unable to response volitionally or as otherwise desired.

Avoidance behaviors are patterned habits, accentuated and strengthened by the fear of stuttering; they can be difficult to change. Some suggested approaches are offered below:

	Awareness - make your client aware each time you suspect they have used an avoidance and discuss the reason why they felt they needed to resort to avoiding. Have the client watch a video or listen to an audiotape recording of themselves and identify their own avoidance behaviors.
	Modification - to help break the pattern, have the client use a different form of avoidance than the one they typically would use.
	Substitution - have the client consistently substitute a socially "less acceptable" avoidance. For example, have them substitute "duh" for every interjection they normally use. (This is beneficial for speakers who don't stutter as well, as it draws unwanted attention to their interjections and usually quickly motivates the speaker to discontinue their use of "ah" or "um" interjections.)
	Targets - the best strategy is for the client to use a speech target to fight their fear, instead of using an avoidance. No matter which approach is initially taken, clients should work toward implementing their targets as the best strategy in overcoming speaking fears.

 

 

© Rentschler, 2001