controversy | Stuttering Online Therapy

Controversy at the convention

July 26, 2010 By Barbara Dahm View Comments

The National Stuttering Association Convention in Cleveland, Ohio is over. Approximately 600 people attended. Most of the participants were adults and children who stutter and their families. There were also clinicians who stutter and a few like me – clinicians who were there because we specialize in treating people who stutter. It was really a wonderful gathering, a tribute to the NSA and all the wonderful people who made it happen.

The NSA convention is fun, interesting, and a place for both people who stutter and clinicians to meet and make friends with others who don’t want stuttering to negatively affect the lives of people who stutter. At this year’s convention there were also tones of that old controversy between those who think fluent speech should be the goal of people who stutter and those who believe that the goal of people who stutter should be to be open about their stuttering and avoid avoiding speaking.

The controversy was stimulated when Sander Flaum, a person who stutters and the CEO of Flaum Partners addressed the 1^st general session. Sander Flaum has many credits to his name including books and numerous articles on marketing, management and leadership, as well as a podcast on leadership that can be found at the itunes store. In short, Sander is a man with a highly successful career who has achieved so much.

Today Sander virtually does not stutter when he speaks, but it was not always that way. He described the effects that stuttering had on him as a youth and how it affected his career. The message that he wanted to get across is that a person can make great achievements both career wise and in speaking fluently through determination and hard work. The intent was clearly motivational. However, many people took offense with his belief that people who stutter can speak fluently, albeit as the result of hard work and continued practice.

I believe that the reason that so many people who still stutter, and clinicians were upset by Mr. Flaum’s message is that their experience in achieving fluency has been unsuccessful. In fact, one clinician commented that only “treatment virgins” believe that fluency is possible.

This argument between the stuttering modification and fluency shaping camps seems never ending. However, it will no longer be relevant when people stop looking at stuttering as a speech disorder characterized by the blocks, repetitions, etc. Instead they will see that stuttering is the result of the way that the brain functions during speech production. When this happens, the frustration felt when trying to get speech out fluently by using artificial techniques that have nothing to do with the principles of normal speech production will no longer be experienced. The belief that the only alternative to chasing fluency is to accept stuttering as a lifelong condition will be unnecessary. The alternative perspective that fluency is the natural outcome of a normally functioning speech production system will be universally understood. It will be known that people who stutter can make internal changes that lead to effortless fluent speech. I know from experience that this is possible. It is the message that I went to the NSA to make heard.

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Filed Under: controversy, fluent speech, therapy approach

Petition aims for ethical stuttering therapy practices

June 17, 2010 By Barbara Dahm View Comments

Recently a petition has been circulated asking the American Speech and Hearing and Language Association to enforce its own, self imposed, Code of Ethics so that consumers of stuttering treatment and their families are better protected from unethical and misleading advertisements. Peter Reitzes and Dr. Philip Schneider, who are justifiably concerned about misleading advertising particularly as related to stuttering treatment, initiated the petition. I signed the petition, because I am against false advertisement and I believe that as professionals we need to do our best to explain the realistic and possible outcomes of treatment to clients.

However, aside from the issue of promising too good results, there is another ethical issue that needs to be addressed. This is the issue of promising that the best realistic outcome of treatment is to become a better and happier communicator who continues to stutter. I have heard many clinicians send out the message to people who stutter that nothing can be done that will enable them to become a normally fluent speaker. In fact, many highly regarded clinicians who are leaders in the field of stuttering say that you should be suspicious of anyone who claims to have high levels of success in the treatment of stuttering.

My experience in treating over 2000 people who stutter, has lead me to believe that there are no quick fixes or magic technique that you can learn about that will suddenly make the stuttering go away. More importantly, however, I have seen over and over again that people who stutter can become normally fluent speakers by going through a process that includes learning, awareness, the right kind of repetitive practice, intention, and conscious mind change. This is not a fanciful claim. It is a fact, according Dr. Joe Dispenza, who explains that when something happens once it’s an incident; when it happens twice it’s a coincidence and when it happens again and again, it’s a fact.

When professionals in the field of stuttering block their minds and their clients’ minds to the possibility of change, they are taking away the individual’s hope for growth and change. They are doing a disservice that I believe borders on being unethical. While it is noble to try to protect clients from disappointment when they do not achieve promised results, it is the highest standard of professionalism to find ways for our clients who want to speak fluently to achieve their desired results.

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Filed Under: controversy, therapy approach Tagged With: asha, petition, stuttering therapy

A new concept of stuttering

June 9, 2010 By Barbara Dahm View Comments

For the past 60-70 years treatments for stuttering have been based on the concept that stuttering is an uncontrollable thing that happens to people. This “thing” is often described as repetitions, prolongations and blocks that stop the forward flow of speech. Not knowing why and how this happens, the focus has been on the stuttered speech and the consensus for treatment is to accept, control, tame or get rid of it by trying to identify and change the external conditions that are assumed to disrupt speech.

Some conditions that tend to disrupt speech:

Rate or rhythm of speech
Fear of stuttering, speaking, or words
Shame
Pressure to speak
Anxiety
Physical and mental tension
Lack of control
Faulty breathing

Over the years this concept of stuttering has become deeply ingrained in the psyche of most people who do and do not stutter. Today it is the basis for most treatments, coping strategies, and advice for people who stutter. In fact it has become so ingrained that ideas that do not fit into this concept are often rejected or not considered serious enough to be investigated.

Over the past 20 years, while treating people who stutter, a different concept became apparent to me. I realized that there was more to stuttering than meets the eye or ear. The “how” stuttering is created started to emerge. I’d like to share this concept with you.

Within each speaker there is a speech production system and, as in all systems, the way it functions determines the outcome. I came to see stuttering as a breakdown in the way the speech system functions. The result of this breakdown is the variety of symptoms that people who stutter may exhibit.

Symptoms of a breakdown in the speech production system:

Repetitions, prolongations and blocks in speech

Facial tension
Eye blinks
Loss of eye contact
Body tension
Emotional tension
Low self-esteem
Uncontrollable movements of body and speech muscles
Poor vocal quality
Unclear speech
Unusual pausing
And many others

Fortunately, many people have helped me understand stuttering. First and foremost, I have learned so much from listening to and closely observing my clients, and other people who stutter, stuttered and never stuttered. I have also learned a lot from studies on the brain functions of people who stutter, neuroplasticity, and from researchers such as Levelt (1989) who describes how normally fluent speech is developed, as well as Smith & Kelly (1996); Watson, et. al. (1997) who through their research have also come to look at stuttering from the perspective of system function.

It is difficult to change ingrained concepts, because it is human nature to stick with the way we see things. I believe this is the reason that therapy for stuttering has not changed much in 60 years. The focus of therapy then and now is on stuttering as speech, rather than on the process of producing speech. Over and over again we hear that there are two basic treatment approaches – stuttering modification and fluency shaping. You either learn to live with stuttering or learn how to control or modify stuttering/fluency/speech.

There is an alternative stuttering therapy that doesn’t try to solve the problem by treating the symptoms. It focuses on how all of the processes of speech production interact, as well as on all the factors that influence the way the brain functions. I call this a speech processing approach. In this approach the focus is on changing brain functions so that speaking is virtually effortless and automatic. The treatment guides people who stutter to use their system according to Levelt’s model of a normal speech production. Stuttering disappears when the processes function naturally.

The process of normal speaking:

Attending to the nonverbal idea that the person is expressing
The brain automatically transforming ideas into language
The brain simultaneously sending a signal to the speech motor system so that a natural voice that contains intonation is produced
The mouth simultaneously moving subconsciously and automatically

In normal speech production there is no conscious word awareness, no control over motor activity, and no such thing as trying to “get words out”. People who stutter may produce speech in this way some of the time, but it is not their exclusive way of speaking. If it were their speech would not be stuttered.

Changing how the brain creates speech is the goal of the treatment program Dynamic Stuttering Therapy. The treatment process involves exploration and self-discovery, identifying what changes need to be made and learning how to make them. It involves making a commitment to effect neurological, cognitive, and behavioral change, and reinforcing these changes until they become habitual.

The specific goals of therapy that relate to neurological functions are not techniques for controlling speech. They are simply processes normally used by speakers to produce speech.

Specific goals of Dynamic Stuttering Therapy:

Learning to develop internal (sub vocal speech) naturally without any attempt to get it out
Allowing the speech muscles to work on an automatic mode
Generating your voice naturally in a way that allows for the expression of mood and meaning

Many people who have learned to use techniques for controlling their stuttering balk at the idea of not using these controls. They say, “Sure I would like to produce speech more automatically, but I need a way to get out of blocks and to control my stutter”. It is hard to grasp that the point of learning to produce speech naturally is that when you do it, stuttering doesn’t happen. Most people are so locked into their way of thinking that they cannot fathom speaking without effort and thought. They do not realize that there can be a scenario where there is no need for speech controls. Training yourself to function in a new way requires awareness and repetitive use of the brain function. It is moving away from thought about how to say words and control speech, toward the automatic expression of thought.

Speaking naturally is different; it is possible; it is not physically hard to do and requires no special skills, but changing long held concepts and being open to a new approach is a great human challenge.

Sources:

Levelt, W.J.M. (1989). Speaking: From intention to articulation. Cambridge, MA: The MIT Press.
Smith, A. and Kelly, E. 1996). Stuttering: A dynamic multifactorial model. In Curlee, R. and Siegel, G. (Ed.)Nature and treatment of stuttering: new directions, (2^nd ed.) (p.204-217) Needham Heigts, MA: Allyn & Bacon.
Watson, B.C. & Freeman, F.J., (1997) Neurophysiologic behavioral evidence for a fluency-generating system. In W. Hulstijn, Pascal H.H.M. van Lieshout, & H.F.M. Peters, (Eds.), Speech production: motor control, brain research and fluency disorders. (pp. 341-349) Amsterdam, Netherlands: Elsevier.

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Filed Under: controversy, dynamic stuttering therapy, fluent speech, general information, nature of stuttering, therapy approach Tagged With: approach, change, dynamic, effective, fluent, fluent speech, natural speech, stuttering, treatment

Stuttering and brain plasticity – how learning changes your brain

March 17, 2010 By Barbara Dahm View Comments

As we learn more about stuttering, we are seeing increasing evidence that stuttering is related to the workings of the brain. If stuttering proves to be a genetic disorder or a neurological problem related to how the brain processes speech production, many people question what the point is of having therapy?

Once it was believed that the brain was hard wired. People thought that once the brain developed, there was no possibility of making changes. Today neuroscientists believe that this is not true. There have been many studies on brain plasticity, the capacity of the brain to change by developing new connections between neurons resulting in changes of the internal structure of the existing synapses.

We are all born with a specific genetic makeup that determines our tendencies. Musical tendencies, language abilities, handedness, and mathematical ability, among countless others are influenced by our genetic make up. However, when we engage in a specific activity to the point of becoming expert, the areas in your brain that deal with this type of skill have been shown to change.

Other evidence that the processes that produce stuttered speech are not so hard wired that they cannot be changed comes from a lot anecdotal evidence in which people who have once stuttered appear to be naturally fluent speakers and from our clients who report that stuttering is no longer an issue in their life. This is proof that the same person can produce speech differently at different times in his life.

During Dynamic Stuttering Therapy people who stutter learn to use the normal processes of producing speech. They begin therapy thinking that what they do is the only thing they can do, but soon see that it is indeed possible to produce speech in a way that is so very different. If it weren’t possible to change their way of producing speech, we would not see this happen. No matter what the cause of stuttering proves to be, change is possible and treatment can help people who stutter to make the necessary changes.

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Filed Under: controversy, dynamic stuttering therapy, therapy approach Tagged With: brain plasticity, fluent, genetic, learning, neurological, speech, stuttering, therapy, treatment approach

My thoughts after the ASHA Division Conference

February 8, 2010 By Barbara Dahm View Comments

The ASHA Special Interest Division in Fluency Disorders 2010 Leadership and Clinical Conference is now over. I think it was one of the best of our Division conferences that I have been to. I was very heartened by the content of the conference. The talks were informative and stimulating and certainly gave us direction for advancing our field.

As I listened to many of the talks, I realized that as research progresses and clinicians share their treatment experiences and observations, the speech-processing model of stuttering is gaining greater validity.

This model, as Dr. Edward Conture suggested, is based on process. It is aligned with Willem Levelt’s model of speech production that is so often mentioned by Dr. Conture, Dr. Luc DeNil and other experts in our field. The speech-processing model considers stuttering in relation to brain functions, attention, neuro-motor programming, neurological functioning, language formulation, working memory, and the automaticity of speaking. All of these topics were subjects that were discussed as possible links to stuttering.

Dynamic Stuttering Therapy, the therapeutic correlate to this theory, seeks to make changes in the neurological functions that relate to speech and language planning and production, as well as the cognitive and behavioral changes that so many of you see as an important component of therapy. It also incorporates Prochaska, DiClemente and Norcross’s Stages of Change model that Dr. Walter Manning mentioned in his keynote speech.

Unfortunately, I only had 5 minutes on Saturday to talk to most of the conference participants about this approach. I think that because of the overlap of Dynamic Stuttering Therapy theory/therapy with what we discussed at the conference, there is a need to investigate this model to see whether it is a worthwhile direction for advancing the effectiveness of the treatment of stuttering.

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The Connection Between Speech Anxiety and Stuttering

January 19, 2010 By Barbara Dahm View Comments

Most people who stutter believe that anxiety causes stuttering or increases stuttering severity. There is an obvious link between anxiety and stuttering, but, as with most aspects of the condition of stuttering, there is more to it than meets the eye.

Many years ago, I presented a research study at The Third International Congress of Fluency Disorders in which I asked both normally fluent and stuttering speakers to develop language in whole word units instead of syllables while producing only a voice or while talking silently (as if the mute button had been turned on). I then asked them to describe the feeling. Both groups answered that they felt choked, tense, and uncomfortable. The people who stutter said that this way of speaking reminded them of stuttering. The fluent speakers reported that this is not at all the way they speak.

This experiment lends support to what I have observed so often in the clinic. Processing speech in the way that people who stutter do, not only makes speech stuttered, it also leads to feelings of tension and anxiety. People tend to believe that anxiety causes stuttering, or stuttering causes anxiety. However, both anxiety and stuttering are the natural outcomes of faulty speech processing. Over time these two conditions become so linked in the speaker’s mind that any feeling of anxiety will exacerbate faulty processing and, therefore, increase stuttering. In turn, a stuttering incident increases anxiety. This leads to increased faulty processing and, therefore, increased stuttering.

Many people believe that the goal of therapy for stuttering is to reduce anxiety. They believe that if the person who stutters could just relax the stuttering would disappear. While it is true that giving up the effort of trying to get words out fluently, may lead to more automatic processing and thus reduce both stuttering and anxiety, it is asking the impossible to try to feel relaxed when you are still trying to control speech.

One of the big frustrations that people who stutter often encounter is being told to relax so that they won’t stutter. Trying to follow this impossible, though seemingly good advice, only increases anxiety. I have treated yoga experts and people who meditate daily. They are great at relaxing, but the second they try to control their words, relaxation evaporates.

When clients learn to produce speech automatically, without thinking about words and how to say them, the result is not only flowing speech, it is a feeling of comfort and relaxation. Trying to reduce anxiety may inadvertently lead to better speech processing, but there is a more direct approach. Learning to produce speech automatically and without control directly leads to a decrease in anxiety and stuttering.

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Filed Under: controversy, nature of stuttering, speech control, therapy approach Tagged With: anxiety, fluent, frustration, processing, speech, stammer, stutter

Fluency Without Speech Tools

December 14, 2009 By Barbara Dahm View Comments

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.

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Filed Under: clients, controversy, dynamic stuttering therapy, speech control, treatment results Tagged With: effective, fluency, natural speech, solution, speaking freely, speech control, speech tools

The Issue of Control

December 10, 2009 By Barbara Dahm View Comments

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.

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Filed Under: clients, controversy, dynamic stuttering therapy, speech control, therapy approach Tagged With: automatic speech, natural speech, speaking freely, speech control, speech muscles, stuttering, therapy

There Is Hope For Overcoming Stuttering

November 22, 2009 By Barbara Dahm View Comments

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.

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Filed Under: clients, controversy, dynamic stuttering therapy, general information, therapy approach, treatment results Tagged With: effective, fluency, stuttering community, treatment

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