THE IMPORTANCE OF GROUP THERAPY USED IN THE TREATMENT OF STUTTERING

1 Завод за психофизиолошки пореметувања и говорна патологија ,,Проф. др. Цветко Брајовиќ“ – Београд, Србија 2 Факултет за специјална едукација и рехабилитација, Универзитет во Белград – Белград, Србија 3 Завод за рехабилитација на слух говор и глас – Скопје, Македонија 4 Институт за дефектологија, Филозофски факултет – Скопје, Македонија 5 Завод за рехабилитација на слух, говор и глас – Битола, Македонија THE IMPORTANCE OF GROUP THERAPY USED IN THE TREATMENT OF STUTTERING


Introduction:
Stuttering is not a problem of individuals, but it's a problem in the verbal communication with others.Individual and group treatment is equally important to use while working with people who stutter.
Purpose: Group treatment is used to allow the patient adequate adjustment in all problematic situations (situations increasing stuttering) in the environment and to gradually inhibit negative emotions.

Предмет и цел на истражувањето
The object and purpose of the research  Reading in front of a person, 11.

Материјал и методи Material and methods
Reading for a familiar group, 12.
Reading for an unfamiliar group, 13.
Narration in front of a familiar group 14.
Narration in front of an un familiar group, 15.
Handling a dialog with the therapist.The therapeutic program that is implemented in the stationary includes: 1. method of "Conscious synthesis of development" (from the author Brajovich) Cognitive-behavioural part for the reduction of anxiety, containing relaxation and imagination of vocal critical situations.

Резултати Results
Табела  1 shows the number of patients who used the scores between 100 and10 SUD units in 18 speaking situations at the beginning of the first stationary treatment.From the table can be seen that the patients give the highest mark of 100 SUD units in the following situations: -verbal reasoning at school and on examination (situation No1, 8 examinees) -phone (situation No.5, 1 respondent) -reading in front of a person (situation No. 10, 1 respondent) -reading for a familiar group (situation No11, 3 examinees) -reading for an unfamiliar group (situation No. 12, 1 respondent) -narration in front of a familiar group (situation No.13, 3 examinees) -handling a dialog with the therapist (situation No. 18, 1 examinee).From the table we can see that most of the patients usually evaluated the speech situations using the rate from 50-100 SUD units at the beginning of the treatment.The patients' anxiety ranged from moderate to maximum anxiety in almost all 18 speech situations.Table 3 shows the number of patients who used the scores between 100-10 SUD units in 18 speaking situations at the beginning of the second stationary treatment.From the table can be seen that most speech situations are evaluated from 60-10 SUD units or this second stationary treatment has began on the existence of moderate anxiety.From the table it may also be noted that patients rated with high mark of 100 SUD units in these following situations:
На табелата 4 е прикажан бројот на пациентите кои ги користеле оценките од 100 до 10 СУД единици за 18 говорни ситуации на крајот од вториот стационарен третман.Од табелата може да се забележи дека пациентите поголемиот број на говорни ситуации ги оцениле со оценки кои го означуваат нај-In Table 4 is shown the number of patients who used the scores between 100 and 10 SUD units in 18 speaking situations at the end of the second stationary treatment.From the table can be seen that the patients most of the speaking situations evaluated with grades representing In figure 1 the graphic shows the summary assessment of anxiety expressed in SUD units at the beginning of the first and at the end of the second stationary treatment.From the graph can be seen that there is a significant anxiety reduction for all speech situations on a tolerable level.If we look at individual situations, we'll notice that anxiety is notably reduced in the speech situations 1, 2, 3, 5, 11, 13 and 18 that at the beginning of the first treatment were assessed with the highest score for presence of anxiety.

Дискусија Discussion
Резултатите The results of the examination showed that patients at the beginning of the first group stationary treatment had evaluated almost all speaking situations with high SUD units.Speech situations such as verbal reasoning at school and on examination, talking on the phone, reading in front of a person, reading for a familiar group and reading for an unfamiliar group were marked as situations where the anxiety is highly present.The scores at the end of the first stationary treatment showed the presence of moderate anxiety, meaning that the anxiety decreased to moderate level, while at the end of the second treatment, looking separately at all speech situations, can be concluded that in all speech situations there was a significant reduction of anxiety.The group stationary treatment and modulation create favourable conditions of rapid and efficient de-conditioning of the interpersonal anxiety and the acquisition of socially acceptable forms of behaviour through therapist's and other patients' feedback.Dell offers the stutterer to talk about a topic very difficult for him i.e. to talk in a certain type of vocal environment.Talking with clarity in that environment, his face tells more and more.If anxiety should occurred in that situation, changing the complexity of speaking is mostly recommended; i.e. it is required a different type of communication that is naturally easier (18).In the U.S. and Canada mostly used is Boberg's method (1994) named "transfer".The "transfer" includes some successes in various situations.Different communicative exercises are often различни ситуации.Во третманот на пелтечењето најчесто се одредуваат вежби во разни комуникативни ситуации поврзани со реалната опкружувачка средина (19).Меѓу програмите кои главно се засновани на примената на когнитивно-бихејвиоралната терапија, а се спроведуваат групно и индивидуално, амбулантно и/или стационарно и опфаќаат следење на говорот после третманот се: SSMP (програмата за успешно управување со петелчењето) во САД, PATMAR, (20) (21).The general attitude in the last decades that prevails among the experts in the field of stuttering is that considering group work in the treatment of stuttering is very important tool.In some cases this is achieved through working with a group in the clinic for 2-4 hours, while in most cases it is managed through a stationary treatment.Depending on the therapeutic access and/or the country in which the stationary treatment is implemented (the health insurance, the material conditions, etc.) has duration from 4 days to 3 weeks.Most of them last between 8 and 15 days and include from 4 to 15 hours intensive daily treatment.

Figure 1 .
Figure 1.Preview of the patients' speech situations evaluation at the beginning of the first and the end of the second stationary treatment

Table 1 .
Preview of the patients' speech situations evaluation at the beginning of the first stationary treatment

Table 2 .
Preview of the patients' speech situations evaluation at the end of the first stationary treatment

Table 3 .
Preview of the patients' speech situations evaluation at the beginning of the second stationary treatment Сето ова многу потешко се постигнува во амбулантни услови, а неопходно е за добивање на долготрајни позитивни ефекти во терапијата на пелтечење кај адолесцентите.-The modified behaviour which is one of the group treatment goals led to significant reduction of the anxiety tolerance level and the evasion of critical speech situations that can be monitored in the stationary conditions was reduced to a minimum.-The intended synthesis of the development and cognitive-behavioural components in the program in the group stationary treatment gives positive effects in the treatment and reduction of anxiety in specific provocative speech situations.Despite these conclusions directly referring to the research, based on a long experience and feedback obtained from patients can be concluded that: -The CSD method with cognitivebehavioural component in the program provides solid basis for the treatment of stuttering in adolescents.-The group stationary treatment is necessary and indispensable part of the treatment of adolescents who stutter, since it reduces the frequency and severity of speech difficulties up to 84%.-During the stationary treatment can be achieved significant reduction of speech anxiety related to critical speech situations and reduction of anxiety related to specific provocative speech situations, which is accompanied by improvement of the attitudes related to stuttering.-In most cases it is achieved establishment of emotional stability and development of social competence, promotion of selfexpression and understanding.Patients during the treatment learn to use the techniques and to successfully apply them in the social environment.All this is very difficult to achieve in clinical conditions, but in the same time it is necessary for obtaining long-lasting positive effects in the treatment of stuttering among adolescents.