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Whose Fault, part II

September 19, 2010 By 1 Comment

In part 1 of Whose Fault, I said that a major cause for the failure of stuttering treatment is a lack of knowledge of how to treat it. That is pretty amazing in the 21st century when so many advances have been made in the treatment of very complicated diseases, and innovative behavioral programs are abundant and often very successful. Our knowledge of biology, physiology, neurology, genetics, physics, and even human behavior has taken giant steps. However, mainstream stuttering therapy has remained pretty much the same, albeit with some refinements, for the past 80 years. We have learned a lot about the nature of stuttering from clinical observations and research, but this knowledge has not been incorporated in how stuttering is treated.

This leads me to what I believe is another major cause for the failure of treatment. There is a tendency on the part of professionals to become so rooted in a treatment approach or a theoretical belief about stuttering that they do not apply research findings and knowledge to treatment. Their prejudices and emotional investment in their work block them from being open to new ideas.

I recently searched for a title for a seminar that I will be presenting to clinicians. I chose Treating Stuttering With Confidence: A New and Logical Approach. “New” that word should no longer be appropriate. It has been almost 20 years since I gave my 1st presentation in Oxford, England in which I said that stuttering can be explained and treated through an understanding of the process of speaking. The presentation was well accepted, even though we still had so much to learn about the differences in brain function and motor processing of people who speak fluently and those who stutter. In spite of the initial enthusiasm of my colleagues, as the research backed my theories and as the clear-cut cause and effect relationship between internal processes used to produce speech and the fluency of the speech became apparent, I saw a growing resistance from my colleagues.

Interestingly, I found a correlation between clients, including young children, telling me this approach to therapy “rocks” and that Dynamic Stuttering Therapy is the most logical therapy they have ever had, and professionals telling me they don’t understand what I’m getting at or just being too busy to review my materials. I do not take this resistance personally, because I don’t think that it is related specifically to the approach or to me. I do think that the inability to change perspective stems from a very human condition – resistance to change.

While understandable, professionals are at fault for not overcoming this resistance. We ask our clients to put their feelings and beliefs into perspective and overcome their fear of the unknown. It is also our responsibility to do this. The time has come to let go of the arguments of whether clients should work on fluency or accept stuttering. Calling fluency the “f-word” as I have heard fluency experts do is not helpful. It is demagogic. The affiliation by professionals with a theoretical camp should to be abandoned. All voices should be heard and minds should be open. Professionals need to work together. We need to brainstorm. We need to put our heads together to make sense of stuttering and to insure that clients do not suffer disappointment from our efforts to treat them.

Some people who stutter that have had disappointing and frustrating therapy experiences are angry with clinicians in general. They think that clinicians are taking advantage of them and don’t care about them. In all my contacts with my colleagues, I have not seen that this is the case. I see that clinicians are concerned with their clients’ wellbeing and believe they are helping people by sticking to their belief. Nevertheless, the lack of progress and being closed to new ideas is hurting these clients who we care about. We, as professionals, owe it to our clients to make therapy the most rewarding experience possible. If not, it is our fault.

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Whose fault is it?

August 22, 2010 By 2 Comments

Have you been through a therapy program hoping to improve your speech fluency and in the end didn’t see much change? If you have, you are not alone. This is too often the case, even after years of treatment. Why? Who is at fault? Is it you, the client? Is it the clinician? Is it that fluency in real life is not possible? Or is the treatment approach that is not adequate? In my next few blogs I will discuss where I think the fault lies from the all these angels.

Before I begin, however, I want to say that looking for the responsible source i.e. “fault” is not the same as placing blame. There is a big difference between where the responsibility lies and the need for blame or guilt. For instance, once most people died from pneumonia. Was the doctor or patient guilty? No. Was the treatment at fault? Yes, and the reason was the lack of knowledge about bacteria and how to kill it. Therefore, at that time we could not blame or place guilt on the part of the people involved. Today, we have the knowledge of how to treat most cases of pneumonia, so a doctor could be blamed for not recognizing the signs of pneumonia (as my doctor failed to do 3 years ago when I had it); a patient could be blamed for not going to a doctor when feeling sick, or not demanding better tests and treatment when the condition is not improving (as I did when I wasn’t getting better), or not taking the medicine that was prescribed. Nevertheless, I would prefer to search for source, because blame and guilt are not constructive in a search for solutions.

So let’s get back to stuttering. If we are going to look for whose fault it is that so many people do not achieve the long-term ability to speak fluently, I think that the first place to look is the treatment approaches being used. Simply stated, I believe that the major cause for the failure of treatment is a lack of knowledge of how to treat it. Most treatment approaches focus on fluency or try to modify the moment of stuttering. However, it is obvious to anyone who has tried it that you don’t become a fluent speaker by treating the stuttered speech and trying to make your speech non-stuttered.

Speaking is a neurological activity in the brain of a person who has thoughts, feelings, intentions, genetic tendencies and memories. We have seen through various types of brain scans that the brain works differently in people who stutter. Therefore, changes in the brain need to be made in order to create fluent speech.

Not only is speaking is an activity of the brain but for the most part it is an unconscious activity. People are not meant to think about how to speak; how to get words out; which words should be said. People are not meant to preplan their speech before speaking. Why then should stuttering therapy train people to monitor and control how they breathe, how to hold or relax the muscles of the mouth, how to say sounds more gently and smoothly, how to change the way you stutter? Stuttering represents control of a system that is meant to function subconsciously, so why ask people who stutter to develop speech controls and “tools”? Tools and controls are not part of normally fluent speech.

Managing stuttering by way of speech controls has been the long-standing method of choice. It’s time to try a different approach, one that has eluded too many clinicians and clients for too long. We have to keep our minds open to a new perspective that incorporates research findings and clinical observations. This is the 21st century. Strides are being made in the understanding and treatment of human conditions that only a short time ago were not understood or treatable. The old paradigms that have been the driving force of stuttering treatment until now do not fall in line with current research and do not explain all that is known about the nature of stuttering. Until stuttering therapy helps people use their brain the way it is meant to function in order to produce speech, the ability to produce normally fluent speech will continue to elude clients and clinicians alike. Change is a reality of life. Now is the time to rid ourselves of the concepts that have not lead people who stutter in the direction that will give them a successful treatment experience. Now is the time for developing a treatment approach that will lead clients to speak with ease and freedom from control.

Filed Under: controversy, dynamic stuttering therapy, fluent speech, therapy approach, treatment results

Acceptance or Speech Techniques

August 1, 2010 By Leave a Comment

At the recent National Stuttering Association convention, there were many conversations revolving around the conflict that people who stutter often experience. It is whether to use “speech tools” or accept oneself as a person who will always stutter. When I hear people struggling to decide which path to follow, I so want to tell them that there is an entirely different way, a way of self-acceptance and the ability to speak with easy and natural fluency.

The speech tools and techniques that people falsely believe are their only hope for improving fluency fall under the classification of fluency shaping techniques and ways of modifying stuttering. At best, some of these techniques may reduce the incidence of stuttering at times to some degree. However, even when this happens, most do not lead directly to normal brain function for the production of speech. They require effort, thinking about how to say words, speaking at a measured rate or remembering to stutter purposefully in conversations, just to name a few. It is no wonder that many people who stutter tire of using these artificial techniques in order to control their speech, that they may not realize is already being produced with too much control.

The brain is meant to produce speech automatically, while we concentrate on the ideas that we want to communicate to the listener. Controlling words and trying to get them out interferes with automatically producing speech and leads to the feeling of being out of control as you stutter without being able to prevent it. Using speech tools in addition further reduces the automatic production of speech. Even if stuttering is reduced, the brain is not functioning naturally.

Some people who stutter are so used to using an ineffective neural (brain) network for speaking that they use it even when not consciously controlling their speech. They can learn and experience the neural network that is aligned to the principles of normal speech production. It requires attention, a different intent and repetitive activity. The result is normally fluent speech.

There are options for people who stutter. One option is to accept stuttering and to live a full life as a person who stutters. Another option is to stutter internally with or without stuttered speech as you use tools and techniques not used by normally fluent speakers. The third option is to change the way your brain functions when speaking so that you are speaking normally, naturally, and without effort or control. This change is possible, because it is now known is that even adult brains can change in function and even in structure.

Filed Under: controversy, dynamic stuttering therapy, Emmotions, fluent speech, therapy approach, treatment results

Controversy at the convention

July 26, 2010 By Leave a Comment

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 1st 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.

Filed Under: controversy, fluent speech, therapy approach

Petition aims for ethical stuttering therapy practices

June 17, 2010 By Leave a Comment

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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A new concept of stuttering

June 9, 2010 By Leave a Comment

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:

  1. Learning to develop internal (sub vocal speech) naturally without any attempt to get it out
  2. Allowing the speech muscles to work on an automatic mode
  3. 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, (2nd 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.
Filed Under: controversy, dynamic stuttering therapy, fluent speech, general information, nature of stuttering, therapy approach Tagged With: , , , , , , , ,

Stuttering and brain plasticity – how learning changes your brain

March 17, 2010 By Leave a Comment

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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My thoughts after the ASHA Division Conference

February 8, 2010 By Leave a Comment

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 Leave a Comment

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.

Filed Under: controversy, nature of stuttering, speech control, therapy approach Tagged With: , , , , , ,

Fluency Without Speech Tools

December 14, 2009 By Leave a Comment

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.

Filed Under: clients, controversy, dynamic stuttering therapy, speech control, treatment results Tagged With: , , , , , ,
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