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.

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.

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.

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, (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.

11 years after treatment with Stuttering Online Therapy, Shmulik, who once stuttered severely, explains that stuttering is no longer an issue in his life.

Over and above the general difficulties of maintaining change, stuttering is a condition that presents special difficulties for the maintenance of change. One of these is that there is most likely an innate tendency for the brain to use an ineffective way for processing speech. Another is that most people who stutter are usually trying to change the wrong thing. I would like to address these two issues.

Research has shown that there are functional and possibly structural difference in the brains of fluent speakers and people who stutter when speaking. These findings are overlooked in most treatment programs. When working on speech tools, the goal is usually to change speech without any consideration of how the speech is being produced. Tools include smooth, slow speech, gentle onsets, pullouts, cancellations and voluntary stuttering. Working on using these techniques is like trying to change how the cake looks when it is finished instead of changing the ingredients and how they are put together. They deal with the result of speaking, the speech, instead of working on how to make it.

In Dynamic Stuttering Therapy we relate to the neuro-physiological process of speaking. During therapy one of the biggest challenges is to get clients to report on how they process speech both in practice and conversations between therapy sessions, instead of on whether or not they stuttered. I find that the clients who succeed in making this switch in perspective are the ones who maintain the new process and enhance their ability to speak fluently. This makes sense. If you are trying to be fluent, who knows what you are doing. It’s all a matter of chance. If you have a way of making speech that results in natural fluency, as happens when you use the processes you have used during therapy, you can make certain you use it.

Once we accept that there is a correct and incorrect process for making speech, there is still a need to cope with the innate tendency of the brain to function the way it is used to functioning. We have a clearly defined process for producing fluent speech, but that does not mean that just because you know the process and have used it, the brain will always function this way. People who stutter have to decide to use the process. The process doesn’t happen to them. They make it happen. Brain processes become stable only when they are repeated over and over again with awareness for at least 6 months to a year. This requires carrying out the process with awareness for a long time after knowing what and how to do it.

When the goal of therapy is to process speech normally, the issue of regression changes. Stuttering doesn’t come and go. You do not have to hope that you will maintain results.  There is a direct connection between what you do and the fluency of speech. Regression does not happen, although the speaker might not use the effective process all the time. In this case stuttering may occur. Nevertheless, if you know the processes for producing fluent speech, you know how to return to it. Being able to do this is not a matter of chance. It is an empowering experience.

Nevertheless, people who stutter can go through a process of helping themselves to become fluent speakers. This process starts with discovering how fluent speech is produced and comparing this to what you do to produce speech. So for those of you who want to take an active role in this process, I thought that it would be a good idea to give you an activity to do.

The activity I am describing here is meant to show you that speaking does not involve thinking about what you want to say and then trying to get it out. So let’s explore….

Activity: Discovering how language develops in the brain i.e. developing internal (sub vocal) speech

Step 1: Write an email to some one. While you are doing this, become aware of how language automatically develops in your head. This is your internal or sub vocal speech.

Internal speech automatically develops in your head when you are writing, figuring out a math problem or simply talking silently to yourself. Language is meant to develop in the exact same way when you are talking to all people in all situations. Developing internal speech is speaking and there is really nothing else that you need to do. Doing anything less, or anything more, will very likely lead to speech blocks. I suggest you look at these fascinating link related to sub vocal speech. It will help you understand the power of this inner speech.

Step 2: Speak silently as you become aware of how language develops automatically when you are not thinking about the words that you are saying or planning to say.

For most of you, this will be natural under the condition of silent speech, but for others, you might find that even in silent speech you have a tendency to preplan your thoughts or choose your words. If this is the case, you can try giving up all control by experiencing automatic internal speech while counting or saying the ABCs. Later you can move on move on to spontaneous speech.

Step 3: Once you are speaking naturally in your head, continue to do this as your mouth simultaneously moves as you develop internal speech.

Some of you might have been doing this already in steps 1 & 2. If not, do it now. If you are using automatic articulation, you will hardly feel that your mouth is moving, even though it is. Also you will be able to speak without any effort.

Step 4: Talk silently and then talk aloud. See if there is any difference at all in the way your internal speech develops and the way your mouth moves.

Being aware of whether the process of speaking silently and aloud is the same, or even slightly different, is the prerequisite for changing how the system works.

There are a few examples of famous people who for the most part have become fluent speakers. Carly Simon, who once struggled with stuttering, set her speech to a rhythm. In an interview she gave with Tavis Smiley, she showed an example of how she made herself speak with what she describes as syncopation. To me it looked like her speech progressed in syllables, as she was no longer trying to get words out. In the same interview, Smiley, who also once stuttered, says he began speaking fluently by imitating the cadence of Dr. Martin Luther King’s speech. This is an example of achieving a normal pattern of intonation.

Vice President Joe Biden tells of his efforts to overcome stuttering by practicing reading aloud in front of a mirror and trying to eliminate the contortions of his face.

My clients changed their neurophysiologic processes by learning to develop speech internally without any effort to get it out and by letting their voice reflect normal patterns of intonation while giving up all control over forming words or speech sounds.

Whether the change was made by self-help or within a treatment program, we can learn a few things from people who as older children and adults do change how they speak I am listing a few of them here:

1. They investigate how people who do not stutter speak.
2. They learn from watching and listening to themselves when they speak.
3. They become aware of the act of speaking, instead of trying not to stutter.
4. They are persistent in looking for solutions, instead of focusing on problems.
5. Whether or not it is their conscious goal, they change the intonation pattern of their speech.
6. They take responsibility for the recovery process.
7. They are willing to do repetitive practice on a daily basis.
8. They believe they are capable of making changes.
9. They focus more on what they do rather than blaming external situations for their stuttering.
10. They realize making change requires patience and time.

If you want to help yourself to speak with greater fluency, the first step is to develop as many of these qualities and behaviors as you can. It will make the process of change easier and so much more rewarding.

Reason for continuing to stutter: Trying to become fluent

So many people who stutter go to therapy to fulfill their desire to become a fluent speaker, only to be disappointed when it doesn’t happen. They try and they try, and the more they try, the more they become frustrated. The consequence is either giving up on their hope of ever speaking without stuttering or continuing to search in vain for the magic cure that will get rid of their stuttering.

I don’t believe there are any magic cures, but I do know that people who stutter can speak fluently. I also know that people who stutter will never speak with normal fluency by trying to speak fluently. As a matter of fact, trying to be fluent is very counterproductive, because it usually makes the person more aware of words (a good way to make stuttering happen), and putting in more effort to try to get them out (adding control to what must be an automatic process).

It’s hard for people who stutter to grasp that there is a way that they can create fluent speech without chasing after fluency. Perhaps that is why the hardest challenge of Dynamic Stuttering Therapy is to keep clients focused on the internal processes of creating speech when all the really want is the outcome-fluent speech. In Dynamic Stuttering Therapy, fluency is never the criteria of success. Nevertheless, when the person creates speech in the normal way, the effortless outcome is fluent speech.

As I write this, I am watching the Winter Olympics. I see sportsman after sportswoman focused on their process for their sport as they go for the gold. I think this is a good example of how to achieve success in therapy.

Desire of people who stutter: Becoming fluent

Reason speech is fluent: Focus is on the inner processes of creating speech