Why is it so difficult to transfer speech fluency outside of the therapy room? This is a question that has troubled SLP’s and clients alike to this day. However, the answer is actually so simple that it can be summed up in one sentence: Fluency cannot be purposefully transferred, because consciously trying to speak fluently goes against the principles of normal speech production. It goes against nature. I don’t mean just the nature of people who stutter. I mean against my nature, yours, and everyone’s. In fact, anyone who stutters knows that the more you try to be fluent, the more you stutter.
Does this mean that if people who stutter can’t transfer fluency, they can’t speak fluently? No, this is obviously not at all the case. There are countless examples of people who stuttered in the past who have later spoken fluently in their daily life. There are also examples of people who spoke fluently who later began to stutter. Speech fluency can change and we as clinicians can do a lot to facilitate this change. I will spend the remaining time of my talk explaining why people who stutter have difficulty achieving fluent speech and what we can do to improve the situation.
Facilitating real-life improvements in our clients’ speech fluency depends on the following factors:
- Laws of Neuroplasticity
- Mind and body connection
Our and our clients’ perspective of stuttering is critical to their ability to speak fluently in their real life. As the field of stuttering therapy developed, the perspective has traditionally been focused on what we can see and hear, and mostly on the speech itself. Emphasis is placed on the type of disfluencies, the rhythm of speech, the presence of involuntary movements, breathing, etc. I call this the external perspective.
There is a different perspective from which to view stuttering. I call this the internal system perspective. We can see stuttering as a malfunction of the speech generating system. Instead of focusing on the stuttering, we can focus on what we know about speech science, the anatomy, physiology, neurobiology and psychology of speech production. We can also consider what brain imaging studies have been telling us. Research has shown that, for reasons not yet understood, people who stutter, when speaking, have differences in their brain function from people who speak fluently. Today I will not describe all that is known about these differences, I will just make this simple comparison that to me sums it up:
Fluent speakers: All the components of speech production function automatically in parallel.
Stuttering Speakers: They actively TRY to GET OUT WORDS.
If we analyze these differences, we can see that fluent speakers don’t do much of anything to speak. There are processes that develop from pre-birth through the late teens that function automatically when there is intent to speak. People who stutter, on the other hand, work at speaking. They also have processes that have been developed and reinforced, but their processes require much more consciousness. At least some of the time, they are involved in TRYING to talk. Unlike normally fluent speakers, they know what words they want to say and are putting thought and effort in trying to get them out. I know it appears that people who stutter have involuntary movements, and they do. However, these movements occur when the overall process is conscious and there are attempts to control speaking. Exactly how this happens is the subject for another talk.