Here we see that trying to transfer fluency is an impossible and debilitating task that results in frustration. Taking steps that allow the process of normal speech production to seep into the mind, brain and body is possible. It requires changes in neurophysiological processes and the thoughts, perspective, and behaviors of our clients. This can be challenging not only for our clients, but also for clinicians. We must challenge our perspective, our beliefs, our thoughts and orientations. We all know that as much as they try and perhaps because they try, clients cannot transfer fluency into their lives. It doesn’t work. We also know that it is not necessary to accept stuttering as a life decree. There are ways to help our clients make the necessary changes so that the speaking experience is easy and automatic in the therapy room and outside.

One of the false expectations that is almost universal is the thought “I spoke fluently in therapy so now I want to see if it will work all the time.” This one expectation contains so much of the answer as to why what is done in the therapy session is not done outside the therapy room even when the goal of treatment is to speak naturally.

“I spoke fluently in therapy so now I want to see if it will work all the time.” contains these problems:

1. I’m still focused on fluency.
2. I’m looking for results not focusing on process.
3. I’m trying to do something before I have internalized it.
4. I’m testing to see if it works, because I don’t trust what I’m doing.
5. I’m expecting perfection.
6. I want to use a new neural network before it is hard wired.

During therapy we need to help the client remain focused on process rather than looking for the false reward of succeeding to get a word out in any way possible. If the client “tries to use” the new process in their life too quickly, they might work for the false reward. Most clients do not come to therapy with a lot of patience. They want a quick fix. This is why I actually tell my clients that they are not supposed to use the process until it seems so natural and logical that they are excited, happy and confident about using it in life. The surest way to lose the client’s motivation and perspective is to tell them to use the process in their life before they show me that their focused awareness is in the right place and that they are mentally prepared to use the process.

Goals that are logical and that lead to automatic natural speech production can be transferred from the therapy room to real life are goals. They include doing all that we know that normally fluent speakers do to produce speech. In normal speech production we develop speech automatically in our brain as a progression of syllables. The execution of speech requires activating the vocal folds to produce phonation that expresses intonation. The voice is shaped into speech sounds by uncontrolled movements of the articulators.

In this case, fluency or stuttering is not the goal of therapy. The goal is to change the way the brain is functioning to create speech. A brain that is functioning in a normal way for speaking will, of course, result in normally fluent speech. The speech will sound normal and it will be produced with the same ease and comfort that normally fluent speakers experience. The good news is that according to the laws of neuroplasticity, the brain can change itself. New neural networks can be created at any age. Hebb’s Law states that neurons that fire together wire together. This means that the more the client uses the new way of processing speech, the more hard wired it becomes. Alternatively, if you don’t use it, you lose it. Therefore, as the new process is used, the strength of the old process is reduced. This means that repetitive use of the new process makes it easier, more dependable and possible to use even when under conditions of stress.

However, time put into practice is not the key to successfully rewiring brain function. Rewiring the brain requires focused awareness. We need to understand that the brain wants to function the way it has always functioned so keeping awareness is not so simple when the brain is wired to focus on the speech and the fluency. As a matter of fact, getting the clients to see what they need to focus on is not at all easy. The criterion for success is never non-stuttered speech. Maybe this is why I have found that it isn’t easy to get clients to achieve goals in therapy. When clients are not doing the process in the natural automatic way, the stuttering is there. The clients feel it and I may also hear it, although perceived stuttering is not required. Stuttering can be covert as well as perceived by the listener. I have seen that beyond doubt, there is a direct relationship between internal processes and the ease, comfort, and fluency of the speech produced.

This brings us to the subject of goals. What are the goals that will lead to our clients’ ability to speak fluently in their daily life? Before I tell you about the goals that I have found allow this to happen, I want to emphasize that there are some goals that can result in less stuttered therapy-room speech, but that make transfer outside next to impossible. These goals include any techniques that do not lead to speaking naturally and automatically. When clients are asked to do things that are not related to normal speech production, they will, of course, still have difficulty speaking. The speech won’t sound natural, and the whole activity will be mentally and physically taxing. Making the situation even worse, if the clinician tells clients to practice these artificial techniques for hours a day, the client will reinforce unnatural processes that still make it hard or harder for them to talk.

Sometimes clinicians ask clients to use a special abnormal way of speaking, such as speaking slowly, taking a deep breath, etc., during therapy and advise that once they get used to using the technique they will automatically speak in a more or less normal way in life. This makes no sense to me. If they practice and reinforce big breaths, that ‘s what the clients will do, or, alternatively, the clients will drop the big breaths outside the therapy and go back to their old way of talking. In this case clients justifiably are not motivated to transfer what they have done in therapy to the outside world.

If the goal of therapy is to learn a way of speaking that sounds unnatural such as slow, monotone, or rhythmic speech, the client will also be unwilling to speak this way in their daily life. In this case there is,  of course, no carryover into everyday life. Unfortunately, the blame is sometimes placed on the client for not working hard enough.

Does this mean that if people who stutter can’t transfer fluency, they can’t speak fluently? No, this is obviously not at all the case. There are countless examples of people who stuttered in the past who have later spoken fluently in their daily life. There are also examples of people who spoke fluently who later began to stutter. Speech fluency can change and we as clinicians can do a lot to facilitate this change. I will spend the remaining time of my talk explaining why people who stutter have difficulty achieving fluent speech and what we can do to improve the situation.

Facilitating real-life improvements in our clients’ speech fluency depends on the following factors:

• Perspective
• Goals
• Laws of Neuroplasticity
• Expectations
• Mind and body connection

Our and our clients’ perspective of stuttering is critical to their ability to speak fluently in their real life. As the field of stuttering therapy developed, the perspective has traditionally been focused on what we can see and hear, and mostly on the speech itself. Emphasis is placed on the type of disfluencies, the rhythm of speech, the presence of involuntary movements, breathing, etc. I call this the external perspective.

There is a different perspective from which to view stuttering. I call this the internal system perspective. We can see stuttering as a malfunction of the speech generating system. Instead of focusing on the stuttering, we can focus on what we know about speech science, the anatomy, physiology, neurobiology and psychology of speech production. We can also consider what brain imaging studies have been telling us. Research has shown that, for reasons not yet understood, people who stutter, when speaking, have differences in their brain function from people who speak fluently. Today I will not describe all that is known about these differences, I will just make this simple comparison that to me sums it up:

Fluent speakers: All the components of speech production function automatically in parallel.

Stuttering Speakers: They actively TRY to GET OUT WORDS.

If we analyze these differences, we can see that fluent speakers don’t do much of anything to speak. There are processes that develop from pre-birth through the late teens that function automatically when there is intent to speak. People who stutter, on the other hand, work at speaking. They also have processes that have been developed and reinforced, but their processes require much more consciousness. At least some of the time, they are involved in TRYING to talk. Unlike normally fluent speakers, they know what words they want to say and are putting thought and effort in trying to get them out. I know it appears that people who stutter have involuntary movements, and they do. However, these movements occur when the overall process is conscious and there are attempts to control speaking. Exactly how this happens is the subject for another talk.

An acceptable theory of stuttering has to account for this phenomenon. Therefore, I am going to explain from the perspective of my theory why people who stutter don’t stutter when they sing and what the difference is between speaking and singing.

When singing, the subconscious intent is to produce a voice that contains a sequence of varied vocal tones. This sequence makes up the melody of the song. The melody of a song is developed in the brain. As this is done, the motor area of the brain sends signals to the muscles of the larynx so that they will vibrate with the right pitch and rhythm. If you want to see this for yourself, sing a song silently. If you become aware of what happens in your throat, you will sense that your vocal folds are prepared to vibrate, even though you want to remain silent. The brain sends these signals automatically whether you are singing silently or aloud. Singing is all about voice and melody. When the song contains lyrics, nothing changes. The speech sounds are formed automatically without any thought or effort. Singing works this way for almost all people.

For the fluent speaker, speaking and singing are created in a similar way from the same exact anatomical structures. The same signals to vibrate the same vocal folds are subconsciously sent from the brain. This creates intonation, the speech equivalent to melody. Intonation becomes speech sounds as the mouth moves automatically. This can happen because fluent speakers are not aware of the words they are saying. For people who stutter speaking and singing are done differently. When speaking, the focus of attention for people who stutter is the words. In one way or another, they are concerned with saying words and “getting them out”. Intonation takes a backseat as the brain tries to control word formation. Subconsciously, the brain is busy sending signals to lips, tongue, jaw, etc. Instead of the mouth automatically shaping the voice (intonation) into speech sounds, the voice becomes a vehicle for pushing out already formed speech sounds and words. For people who stutter the processes of speaking and singing are done very differently. For people who speak fluently, they are almost identical. During Dynamic Stuttering Therapy, clients begin to understand this difference between these 2 ways of speaking and they report a big difference in the ease of speaking when they do it in the way that it is don by normally fluent speakers.

Now the question is can this hypothesis be validated through research? Not being a researcher myself, I was very excited to attend a lecture at the NSA Applied Research Symposium by Dr. Jennifer Kleinow of LaSalle University. Kleinow’ et al.’s research related to Smith and Kelly’s Multi-factorial Model of Stuttering, a model that I have referenced many times. The study she presented was designed to see if something in the internal monitoring system of people who stutter is different than in people who speak fluently. What Dr. Kleinow and her colleagues found is that stutterers showed heightened peaks in looking for errors, regardless of whether an error was actually committed. This supports the vicious cycle hypothesis that says stuttering results from over-monitoring the speech plan.

In addition, Kleinow explained that the part of the brain that tells you to stop and start all over might be the anterior cingulate caudate (ACC). This area is a kind of switchboard between the premotor, linguistic, cognitive, limbic system. It is active during speech production, apparently overactive in some people who stutter.

So here we have some support that stuttering is not just a linear problem of blocks, rate of speech, breathing or voice production. It is most likely a problem of system function and is effected, at least in part, by over control of speech planning. There may be other areas of control as well, but this study related to the monitoring of phonological errors before they happen. It is my hope that learning about this connection might encourage those of you who stutter to be aware that planning what you are going to say gets in the way of what you want – the ability to speak without effort.

According to my theory both stuttered and fluent speech is the outcome of the way the brain functions when speaking. Brains are dynamic. Therefore, while there is a preferred neural network for carrying out a specific task, different neural networks can kick in at different times according to the circumstance, health, thoughts and feelings of the person, or environmental cues. Let’s take the task of writing. The letters we see on the paper are the outcome of a neural network that we develop as we learn to form letters to express language, and do this repeatedly. After a while our handwriting becomes automatic and individualized. However, over time it changes. It also changes if we are relaxed/excited, happy/sad, distracted/concentrated, and, according to graphologists, as our personality develops. The same is true of speech. Fluent or stuttered speech is the outcome of a neural network that we develop as we learn to verbally express language, and do this repeatedly.

One of the factors that I believe affects the way the brain functions is the degree of conscious control that the speaker exerts over how to move the mouth to form words. More control equals more stuttering and less control results in better fluency. If you are speaking to myself, to an animal or small child, you are probably not at all concerned about speaking. In fact you might even be oblivious of the fact that you are speaking. What you are doing is simply giving expression to your inner thoughts. You are not thinking at all about talking, let alone trying to be fluent. Here is a situation that will not trigger the control mode of speaking, the mode that helps to create stuttering. Different situations can be linked to different modes of speech production. In later blog, I will explain the neurophysiological speech control network and why it creates stuttering.

Of course, there are people who also stutter in the situations that I’ve mentioned. Maybe they stutter less than when speaking before an audience or telling a joke, but they do report that their speech is not completely fluent. According to my theory, the network may have become so hardwired that even when not trying to control fluency, it is the default program. You might say it is basically the way the brain functions.

I invite all of you who stutter to see if there is a connection between your trying to speak fluently, articulately, or just trying to talk and the degree to which you stutter. When you totally forget that you are speaking, as in swearing or making asides, such as “I-I-I b-b-built a mmmm-mmmm-mmmm (aside: ‘This word is not coming out’) mmmmodel airplane,” do you have some spontaneous fluency? After you look into  this, I invite you to share your experiences. You might just find out why “chasing fluency” is so very unhelpful.

Today people who stutter are confused. If you stutter, you have probably asked yourself, “What made me stutter this time?” or “Why can I speak in one situation, but not in another?” Wouldn’t it be great if there were a theory that would explain the why and how of stuttering, and how people who stutter can speak with ease and comfort?

So far there is no widely accepted comprehensive theory of stuttering. Furthermore, there never will be one, if we keep thinking about stuttering from the same perspective. By opening our minds and realizing that there is more to know and many different ways of looking at stuttering, we may be able to put crystal clarity on a condition that has until now been surrounded by a cloud of confusion.

For the past quarter of a century, I have been asking myself what is it about stuttering that I don’t know. Trying to find the answer to that question lead to observations that lead to another question. Through this process, I eventually found myself with the beginnings of a theory of stuttering. In this blog I want to check out this theory, but I will need your help. You see, if my theory can be proven to be true, it has to be able to explain all of what you know now about the characteristics, and nature of stuttering and fluency inducing factors. It also has to explain the speech behaviors, attitudes and feelings of people who stutter and how stuttering begins and develops. If my theory is valid it has to be testable and applicable to all people who stutter. It also has to be able answer all your questions or at least generate questions for research that can answer your questions. This is where you can help. In the weeks to come, I am going to explain my theory and see if it is plausible. So please post your questions below and let’s get a dialogue going. Let’s see if together we can get to know what we don’t know.

To get started, I will give you a basic overview of what I think stuttering is. As I comment on your questions and comments, I will explain it in more detail, but for now, it goes like this:

Stuttering is a condition in which the normally automatic way the brain transforms thoughts into language while producing a voice that is automatically shaped into speech sounds comes under too much control. Instead of all the elements of speaking working simultaneously, the speaker pays attention to words and then tries to get them out.

All the symptoms we see in people who stutter, such as blocks, repetitions facial and body tension, a lack of breath, fear of speaking, discomfort and so much more are the result of the malfunctioning neurological system that involves speech planning and production. Genetics, learned behavior, misconceptions about speaking, attitudes, reactions to outside stimuli and emotions can affect and may be affected by the way the system functions.

I look forward to explaining this theory further and to being stimulated by your questions.

One problem in “transfer” is, of course, that people want to transfer fluency. Anyone who has been following my blog knows that I don’t believe that fluency comes and goes by itself.  It is how the person’s brain functions that results in either stuttering or fluent speech. So if you are trying to be fluent and disregarding process, the results will be very disappointing.

Another problem is that people jump too quickly from being able to process speech in a way that results in fluent speech to wanting to use this way of speaking all the time. When I was a young and inexperienced clinician, I used to be happy when clients would say, “This is a wonderful way of speaking, I’m going to speak this way from now on”. Today, I realize that this is unrealistic. It takes time for the brain to accept a new way of functioning. This acceptance happens only after a period repetitive focused intention that enables the network of neurons in the brain that is now firing together to become wired together. When this happens the way of speaking becomes part of the self.

My advice to clients who have learned to process speech normally during our sessions is not to expect that because you know what to do it will happen automatically. Also, I do not want them to go and try to use this process when they are feeling anxiety and trepidation. Instead of going off into life and “trying” to speak this way, I encourage them to use the process alone and in non-threatening situations again and again and again. I want them to use this process of speaking for their own fun and enjoyment. I want them to see the relationship between process and results and I want them to get the sense of how peasant and easy it is to speak this way. As a matter of fact, I tell them not to even think of using it in any situation until they can’t wait to start using it, until it feels like the preferred thing to do. When that happens they will not be trying to do something they fear they cannot do. They will be confidently doing something they love to do. Under this circumstance, transfer will not be a threat it will be a pleasure.