Stuttering Online Therapy

Many people who stutter believe that they stutter because of their feelings about themselves and being too concerned with what other people think of them. It cannot be denied that people who stutter often stutter more when they are concerned over how they present themselves or how their speech sounds to others. However, it is important to differentiate between what causes stuttering and what increases stuttering. Making this difference is essential for understanding what stuttering is and for the self-esteem of many people who are sincerely trying to not let their stuttering affect their lives.

I want to make this point, because I have heard many people who stutter say that if they could make themselves care less about stuttering, they would not stutter. The fact that they are still stuttering seems to them to be a failure in their ability to cope emotionally. This is not the case. A person can be the most centered, emotionally intelligent and socially well-adjusted person and still stutter. This is true, because stuttering is a condition that involves so much more than the person’s feelings.

Today researchers are coming up with more and more evidence that the place where speech is created, the brain, is the source of stuttering. Recently new genetic research lead by Dennis Drayna at the National Institute on Deafness and Other Communication Disorders (NIDCD), part of the National Institutes of Health, has shown that at least some people (thought to be 9% of the people who stutter) have a gene mutation, not found in fluent speakers. It turns out that these particular genes are responsible for the production of two enzymes necessary for a metabolic process required by all cells, but that especially affect a group of cells in the brain responsible for speech. Other researchers studying other families have also found indications of mutations in genes of those members of the family who stutter. The relationship of these genes to speaking is not yet clear. However, what we are seeing is that stuttering isn’t simply a question of how the person feels.

For those people who have tried to stop stuttering by changing only their attitude and feelings, it is important to know that stuttering is not only about what you feel inside. Advertising stuttering is good and helpful. Learning to be self-accepting of yourself whether or not you stutter is essential for your personal wellbeing. Being disappointment in yourself and thinking you have failed because you still stutter is self-defeating and misplaced.

An almost universal aspect of stuttering is that people who stutter don’t always stutter. There is a small number of people who do stutter more or less the same way and to the same degree whenever they talk. However, they are by far in the minority. Most of the people who I have met who stutter (in the thousands!) tell me that they stutter more when… The ending might refer to people, places, words or letters, eating and sleeping, or even the weather, but most often to “tension, pressure and anxiety.”

In an effort to speak fluently, people who stutter, their family and friends are busy trying to find out what outside factors make them stutter. Their hope is to eliminate, change, or learn how to deal with these factors. The emphasis is on external factors. This search is ineffectual because the external factor is not the problem.

The role of external factors is that they may lead the speaker to use a more, or less, controlled process for speaking. It is the individual’s reaction to outside factors and the way their brain functions when these factors are present that actually causes the fluctuations of stuttered speech. Therefore, it is the individual’s reactions, not the catalyst leading to the reactions, that need to change.

Brain functions are not carved in stone. They fluctuate for the better and worse as a result of experience, learning, practice, self-talk and imagination. When an activity has been done in a certain way over and over again, it becomes automatic and consequently more efficient and less subject to influence by outside circumstances.

Taking control over normally automatic processes will always have a negative effect. We see this when we give too much thought to our body movements when we walk or dance. Controlled action makes us clumsier and less flowing in our movement. The same thing happens with our speech.

Stuttering comes and goes according to the degree that controlled processes function to produce speech. By learning how to produce speech automatically, and by accepting the need to speak without control, people who stutter can develop a stable system that generates fluent speech.

The inconsistent nature of stuttering often causes people who stutter to feel confused as they wonder whether the next word, sentence or conversation will go smoothly. People who stutter covertly have an additional frustration. They feel the stuttering, work hard to speak, and also live in fear of being found out.

Part of the frustration of covert stuttering is the result of the lack of understanding by the people around them. Parents, friends and teachers may not be aware of the feelings or the difficulty that the speaker is experiencing. Unfortunately, even when they try to explain, people who stutter covertly are too often told that they really don’t have a problem or that it is a psychological problem.

Some people believe that covert stuttering is different than overt stuttering. Speech pathologists have been known to turn covert stutterers away from speech therapy. After all, it’s difficult to use speech modification or fluency shaping techniques to change the speech when no stuttering is heard.

Even people who stutter overtly sometimes fail to understand covert stuttering. They may minimize the problems that the covert stutterer feels, and claim that if stuttering is not heard, it isn’t really stuttering. This only adds to the torment that people who stutter covertly experience.

I want to say unequivocally that covert stuttering is as real a condition as overt stuttering. In both conditions the speaker is not generating speech easily and automatically. Even when stuttering is not audible, there is very real pressure that can be felt in the head, chest, vocal tract, or abdomen. The person who stutters covertly may be very good at changing words quickly so that planned words are not actually forced out, or they may use more pausing so that blocks are not actually heard. However, what is going internally is not very different in overt and covert stuttering. In fact, some speech techniques for controlling overt stuttering, actually lead to covert stuttering, i.e. they result in less stuttered speech produced by a still mal-functioning speech production system.

Effective treatment for covet stuttering usually involves reducing the effort to hide stuttering, but people who stutter covertly do not have to try to stutter overtly on purpose, because this puts the focus on the stuttered speech instead of on the process of speaking. Learning how to process speech is as important for people who stutter covertly as it is for people who stutter overtly. They can learn to produce speech automatically and without effort. Since this is the goal of Dynamic Stuttering Therapy, treatment is just as effective for people who stutter covertly as for people who stutter overtly.

I’ve been talking a lot about control lately. It’s a really important subject when it comes to treating stuttering. Learning how to speak without control is really not very difficult to do. The process of speaking automatically is not complicated. There is so much less to do and think about than when creating stuttered speech. The speech is flowing and expressive. But the hardest thing for clients to do is to accept that speaking fluently requires giving up control.

For some people who stutter control has become so intertwined with talking that to give it up seems very strange. They believe that it is normal to think of what words you are going to say and how to form the sounds. They can’t imagine not doing that when they talk (even though they don’t do it when they are talking to themselves). Other people use control as a crutch. They know how to speak without control, but they are afraid to let go.

Actually the more people try not to stutter, the more control they exert over their speech. That is why chasing fluency has always been a no win battle. When people who stutter give up their fear of stuttering and any negative feelings that they have toward themselves because they stutter, they are often more open to giving up control. Speaking fluently requires using the normal automatic processes of producing speech. Giving up control is essential.

As I have stated in previous posts, it seems very clear that people who stutter generate speech, at least some of the time, with too much control over language planning and motor programming. This is the problem; we need to consider the solution.

We know that the goal of modern stuttering therapy is usually to learn to use speech tools. People who stutter are guided to think about what they want to say and how to say it. They are asked to:

• Change the rhythm of speech or speak slowly.
• Reduce struggle behavior with pullouts and cancellations, preparatory sets.
• Remember to stutter on purpose
• Control how the mouth and breath forms various classes of speech sounds
• Control breathing and pause after short phrases

Although these “tools” may reduce the strength or frequency of stuttering blocks, they are really asking the speaker to add more control over speech. People are meant to be produced speech automatically, but speech tools support controlled speech. It is no wonder, therefore, that the use of these tools causes frustration and takes away from the joy and freedom of speaking naturally. Speech tools also interfere with the natural quality of speech and make it harder to express mood and the speaker’s real personality through normal patterns of intonation.

People often give up on speech tools and resign themselves to believing that their only other option is to continue to stutter. As much as they want to find ways to be more fluent, they are locked into their belief that their only choice is speech tools or stuttering. They can’t accept what there is now another option that guides people who stutter to speak fluently by learning to give up control.

Dynamic Stuttering Therapy is what both clinicians and clients have hoped for. It shows people who stutter how to speak without effort, thought or control over words or speech muscles. The speech produced is natural and expresses the speaker’s feelings. People who stutter can learn to speak fluently without having to use speech tools.

For those who have hoped for something better than speech tools, Dynamic Stuttering Therapy is the answer.

In my next few blog posts, I want to talk about the issue of control. People who stutter sometimes feel a loss of control when they are speaking. Their tongue or lips may go to places where they are not meant to be; their larynx may tighten uncontrollably; they feel like they cannot breathe and experience involuntary blocks. This certainly seems like a lack of control, because all these symptoms of stuttering occur without the speaker’s control. However, this does not mean that the speaker does not have control. I will argue that these unwanted symptoms occur because the speaker is exerting too much control in the central processing of speech.

Those of you, who have followed my writings, have heard me say that, according to psycholinguistic experts, speaking must be an automatic process. Automaticity is the requirement for fluent speech. The development of language happens automatically without thinking about the words. Controlling the choice of words, preplanning and scanning ahead is not part of normal speech production.

If you are a person who stutters, when do you stutter most? Is it when you forget that you are speaking or when you try to control your speech so that you will not stutter? We know that many people stutter less when they are alone, caring less about stuttering and taking less control over speaking.

Thinking about words is one form of control. Another is trying to control how you say the words. This involves using a controlled motor program. Sometimes the control of muscle movements is conscious, but at other times the control is subconscious. Many motor programs can be carried out on either a controlled mode or in an automatic mode. Automatic programming is always more efficient, more stable and faster than controlled programming.

Let’s take a minute to experience the difference between controlled and automatic programming. For an example, we can use the movement of the eyelids. Purposefully open and close your eyelids. When you do this you are using a controlled movement program. Do the movements feel heavier, more labored and slower than those automatic movements of your lids that occur throughout the day?

The same difference can occur regarding the speech muscles. We know that in order to speak theses muscles must also move with light, extremely rapid and miniscule movements. This requires the automatic mode. When control is used, muscle movement becomes more labored and, often, muscle groups not normally used to speak are activated. The fluid movement of speaking is compromised and the stuttering symptoms so often associated with lack of control happen because the program used to process speech is one that involves too much control.

I have recently heard people who stutter saying that they felt that a person who no longer stutters should not be a spokesperson for the stuttering community. They believe that if they speak without stuttering, the public gets the impression that everyone who stutters can speak fluently if they would only try, and people who stutter are given false hope that they can also speak fluently.

I was very bothered by this discussion because I believe these opinions reinforce the belief that people who stutter can at best learn to live with stuttering. It is my belief that the truth requires looking at stuttering from a different perspective. It was once true that we did not know exactly how to guide people who stutter develop the ability to speak naturally in all the different situations that they encounter in their lives. Therapy was a trial and error endeavor. Very often clients tried very hard to develop techniques and control their speech, but to no avail. On the other hand, there have always been people, who once stuttered, who no longer stutter. Since we didn’t know how that happened, it was chalked up to “good luck” or perhaps no longer chasing fluency god.

Times have changed. In my work with people who stutter I see on a regular basis that that there is a clear, explainable, and doable process that people who stutter can use that results in naturally fluent speech. It does not require chasing fluency, an activity that does usually result either in stuttering or effortful fluency. It does not require developing speech controls, the antithesis of automatic, normally produced speech. What it does involve is understanding how a person who stutters process speech and what changes need to be made to make speaking a much easier and dependable activity. I am fully part of the group who believes that there is no magic cure for stuttering. However, as a result of practical experience, I know that people of all ages and severities of stuttering are capable adopting and getting used to a process that results in comfortable easily produced fluent speech.

I believe that the stuttering community should welcome the input of people who have overcome stuttering. People who still stutter can learn from them that change is possible. For those who believe that it is not possible for people who stutter to develop a way of speaking fluently, it is time to gain a deeper understanding of stuttering. Instead of sticking to beliefs based on yesterday’s knowledge, they should listen carefully to the positive experiences of people who have overcome stuttering and to all the new research and clinical knowledge about stuttering. The time for negativity has past. The time for being open to a new perspective on stuttering has come.

We have had many clients who have tried various other therapy approaches before participating in Dynamic Stuttering Therapy. From what I have observed, these clients fall mainly into 3 categories:

1.      Those who had stuttering modification therapy, but were not convinced that this was all they could do to help themselves. They come to Dynamic Stuttering Therapy, because they have decided that, while accepting that they stutter and learning to stutter with a bit less struggle is beneficial, they have not been be able to improve the quality of their communication to the extent they desire. In their heart, they really do want to speak fluently.

2.     Those who were in fluency shaping programs and have tried to do what they had been taught, but became frustrated because it did not work for them. Due to the high hopes they had, they are often skeptical of yet another therapy and fear being disappointed by another unsuccessful therapy experience. Having been dedicated and serious clients, they may also be reluctant to give up the control techniques that they were taught even though they have really not produced the desired results. When these clients come to Dynamic Stuttering Therapy, they are amazed that the experience of speaking can be easier, more comfortable and, of course,  fluent.

3.    Those who did not like the therapy approach they had tried and, therefore, never made a habit of using additional speech or stuttering controls to speaking. When they come to Dynamic Stuttering Therapy, they are relieved that the therapy goals are so logical and uncomplicated. They are no longer reluctant to go along with the therapy process, because it makes sense and feels good.

Some of our clients did not let stuttering affect their lives even before beginning treatment. However, the majority of our clients come to therapy with years of negative experiences, thoughts and feelings related to stuttering. These clients work as much on cognitive processing as on neurological processing. Some of our clients need to make substantial cognitive changes in order to begin to enjoy speaking. My experience as a clinician has shown me the power of individuals to make changes. When the there is a direct relationship between change and desired results, the experience is rewarding.

I am often asked to explain how Dynamic Stuttering Therapy differs from other therapies. The short answer is in almost every way. The more complete answer is that our focus is not on how to, or not to stutter. Dynamic Stuttering Therapy shows clients how to produce speech in the same way that normally fluent speakers produce speech. Naturally, if the process for producing speech is the same, the results are also the same – normally fluent speech. This is logical. People who stutter are capable of changing the way they process speech, so it is also possible. There is a clinically proven cause and effect between speech processing and fluency. That is why Dynamic Stuttering Therapy is the most effective approach for treating stuttering.

For some strange reason, until now people have thought of stuttering as if it were a condition that has little to do with the process of speaking. This is unlike almost any other speech condition in the field of Speech Therapy. If a person has poor vocal quality, the goal of therapy is to change the way the voice functions. If a child has language development problems, we search for the weakness in language processing and work to strengthen it, and so forth. However, with stuttering the goal is either on directly changing the speech itself or, alternatively, accepting that “once a stutterer, always a stutterer”.

There are therapies that do try to manipulate aspects of speaking, such as controlling the rhythm of speech, slowing it down, or controlling breathing. However, while in some cases these approaches might inadvertently cause the speaker to change the interactive neural process of producing speech, they do not actually deal directly with normal speech production. Dynamic Stuttering Therapy directly treats the neural network involved in creating speech.

The normal process for producing speech is essentially automatic. Controlling what you will say or how to say it is the antithesis of normal processing. We do not tell our clients to speak slowly, control their breathing, use gentle onsets or other techniques that require control. We guide them to give up control and show them how to speak automatically and without effort.

Dynamic Stuttering Therapy is an exciting experience, because people who stutter see that within themselves, they have the basic ability to produce speech normally. In some cases they even use this ability some of the time. However, because their focus is so much on the outcome, fluency/stuttering, they are not aware of the inner workings of speaking. Dynamic Stuttering Therapy is a process of self-discovery and change. There is no pressure on our clients to be fluent speakers. However, as they develop greater awareness of their way of producing speech their attitudes and behaviors gradually change. Speaking becomes effortless, comfortable and enjoyable.