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Results Are the Problem with Stuttering Therapy

February 3, 2011 By Leave a Comment

People who stutter can become fluent speakers. However, this will never happen by trying to speak fluently.

This might seem like just one more of the many paradoxes related to stuttering, but it is actually common sense. That is, it is common sense if you are talking about playing tennis, dancing, skateboarding, writing, cooking, constructing a chair, or even a sand castle. In all these activities people understand that there is a way to carry out these activities effectively. They know that results depend upon the process that goes into doing them. When results are not as they want them to be, the natural tendency is to think, “Hmmm… What do I need to do differently?” i.e. feel the music, hold my body differently, add more flavors, cut the wood straighter, etc.

For some reason stuttering doesn’t cause people who stutter and those who would like to help them think with that same kind of logic. Perhaps this is part of human nature because it has been going on for centuries. People seem to want to change speech fluency without considering the process of speaking. They want the speech to be smooth by trying to make the speech smooth. They want to get words out fluently, even though words are not a thing to get out, even if you want to get them out gently. They wonder why a person who stutters can speak fluently when alone, but not in front of a crowd. However, they don’t come to grips with how thoughts directly affect speech production, and they don’t focus on how to change both.

The belief that stuttering is a thing, not the result of a process, is so firmly and indelibly planted in peoples’ minds, that it is hard to accept that stuttering doesn’t come and go. It is not a thing that happens to you. It is a challenge for people to accept that stuttering is the brain using an ineffective network for the activity of producing speech. We know from the latest research that people who stutter use a different brain process for producing speech, but in treating stuttering this fact is so often ignored. People still think that you can change stuttering by changing the speech, i.e. speaking rate, number of pauses, levels of tension, etc. The result is frustration, because these techniques only occasionally and only inadvertently cause changes where changes need to be made – in brain processing.

I know many people will not agree with me when I say that people who stutter can become fluent speakers. This is because these people are focused on results (fluency and stuttering). I have seen again and again that people who stutter can change the way their brain functions to produce speech. It takes time, repetition, changing thoughts and awareness. It is not a quick and easy change, but people who stutter can do it, and when they do, naturally fluent speech is the natural outcome.

The greatest breakthrough for people who stutter comes when they say, “Hmmm.. I blocked on my name today. What was I doing that I can change? What were my thoughts and how can I change them?”

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

Whose Fault Is It? Part Three

January 4, 2011 By Leave a Comment

Several weeks ago I started a 3 part series in which I talked about whose fault it is that so many people who stutter are disappointed and dissatisfied with their treatment experiences. In part 1, I discussed that the approaches for treating stuttering need to be revised. In part 2, I talked about the inability of professionals to change the paradigms that they were taught and trained to believe are the best that can be. Today I am focusing on the people who are being treated, the people who stutter.

First I want to say that I strongly believe that everyone who comes to therapy wants to “get rid of the stuttering”. Furthermore, I think that most clients put their trust in their clinician and are willing to work hard to become fluent speakers. To some extent, while they are doing their absolute best to do what the clinician asks of them, it is this trust that is part of the problem. I believe that there are some clients who need to take a more proactive role in the therapy process. When they are asked to use a technique, they need to question how it is meant to help. Also, if they have honestly tried to do what was asked of them and found it to effortful or difficult to do, they have the responsibility to say that the technique is not working for them and, together with the clinician, explore where the problem lies.

Speech is one of the neurophysiologic systems of the human body that is meant to work automatically. It should not be an effort to speak. If it is an effort, something is wrong. Clients should not accept directives and goals that add layers of cumbersome controls. Clients who come to therapy without questioning what is being asked of them are at fault when they don’t get what they want.

It is very understandable that clients need to be encouraged to investigate the logic behind what they are being asked to do. This is why Dynamic Stuttering Therapy explains the process of normal speech production and is so centered on self exploration. I don’t want clients to do something because I say so; I want them to do what makes sense to them. Some clients do begin therapy thinking that I can make them fluent without their help. They do not want to be bothered with the details. Explanations and discussions are of little interest. During the initial intake it is normal to want to know results of therapy. However, during therapy clients who continue to believe that change comes by osmosis do not make the change that is necessary for a successful therapy experience.

Clients who expect that therapy is a quick fix cause their own disappointment. Therapy is a process of self-change. To be honest, speaking naturally is not a difficult process to learn. However, learning the process is only part of what therapy entails. I sometimes see clients who after 3-4 hours of treatment begin speaking with a degree of ease and fluency that is unfamiliar to them, even during their more fluent moments. In their joy, they expect to go off into their lives and their speech will remain fluent. This expectation is unrealistic. Developing a normal speech production system requires developing or at least strengthening the specific neurological network that results in fluent speech. This can only be done, with intention, mindfulness and repetitive experience.

I have discussed the three factors that are at fault for the failure of therapy to bring the understandably desired results. At the same time, I have touched on how these three factors can improve the situation. The poor outcomes that are traditionally associated with stuttering therapy need not be allowed to perpetuate. Open minds on the part of clinicians and clients will enable more people who stutter experience effective treatment and the ability to speak with ease and fluency.

Filed Under: controversy, dynamic stuttering therapy, fluent speech, nature of stuttering, therapy approach

New Year Wishes

December 24, 2010 By Leave a Comment

During this special time of year, I want to wish all of you who are celebrating Christmas a very Happy Holiday. I hope Christmas will be a meaningful day for you and that you will have the opportunity to celebrate with family and friends.

While you are celebrating, I want to wish you the opportunity to speak freely and to resist the all too natural tendency that people who stutter have to avoid speaking. We all know that effort to avoid stuttering increases the frequency and severity of stuttering. For this reason it is far better to speak without concern of whether or not you will be able to say this word or that one.

Giving up trying to avoid stuttering is not easy.  However, a good 1st step toward doing this is to start talking more openly about the subject of stuttering. This helps, because once the subject is out in the open, the fear of having your stuttered speech heard is somewhat reduced.

This Christmas holiday as you are sitting around the table or visiting with friends and relatives, it will be easier than ever to bring up the subject of stuttering. All you have to do is mention having seen, or not having seen yet the new movie, “The King’s Speech”.  For anyone who has not yet heard about or seen this movie, it focuses on the effect of stuttering on the life of King George VI of England and his speech therapy.  What a wonderful icebreaker for the subject of stuttering!

As the New Year approaches, this is also be a good time for new beginnings, for looking at stuttering in a new way, for making 2011 the year that you make the changes that make it easier for you to speak. During the coming year I am planning to continue sharing my thoughts about stuttering, my knowledge about how to treat stuttering effectively and some of the experiences of my clients as they actually make these changes.

I wish you all a very Happy New Year!

Filed Under: fluent speech, general information, therapy approach Tagged With: , , ,

A sample activity to supplement treatment – sub vocal speech

August 22, 2010 By Leave a Comment

I often get emails from people who want me to give them a quick tip on how they can become fluent speakers. I certainly understand their desire. However, I’m also certain that no one really believes that there is a simple trick or one piece of advice that will instantly transform a person who stutters into a fluent speaker.

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 links 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 along with the 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 you 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.

Filed Under: dynamic stuttering therapy, fluent speech, speech control, therapy approach

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

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: , , , , , , , ,

Ariel’s story – a client before and after stuttering therapy

May 31, 2010 By 1 Comment

Filed Under: clients, dynamic stuttering therapy, fluent speech, therapy approach, treatment results Tagged With: , , , , , , ,

Shmulik’s story – stuttering “no longer an issue”

May 31, 2010 By 1 Comment

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

Filed Under: clients, dynamic stuttering therapy, fluent speech, therapy approach, treatment results Tagged With: , , , , , , ,
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