Stuttering Online Therapy

An almost universal aspect of stuttering is that people who stutter don’t always stutter. There is a small number of people who do stutter more or less the same way and to the same degree whenever they talk. However, they are by far in the minority. Most of the people who I have met who stutter (in the thousands!) tell me that they stutter more when… The ending might refer to people, places, words or letters, eating and sleeping, or even the weather, but most often to “tension, pressure and anxiety.”

In an effort to speak fluently, people who stutter, their family and friends are busy trying to find out what outside factors make them stutter. Their hope is to eliminate, change, or learn how to deal with these factors. The emphasis is on external factors. This search is ineffectual because the external factor is not the problem.

The role of external factors is that they may lead the speaker to use a more, or less, controlled process for speaking. It is the individual’s reaction to outside factors and the way their brain functions when these factors are present that actually causes the fluctuations of stuttered speech. Therefore, it is the individual’s reactions, not the catalyst leading to the reactions, that need to change.

Brain functions are not carved in stone. They fluctuate for the better and worse as a result of experience, learning, practice, self-talk and imagination. When an activity has been done in a certain way over and over again, it becomes automatic and consequently more efficient and less subject to influence by outside circumstances.

Taking control over normally automatic processes will always have a negative effect. We see this when we give too much thought to our body movements when we walk or dance. Controlled action makes us clumsier and less flowing in our movement. The same thing happens with our speech.

Stuttering comes and goes according to the degree that controlled processes function to produce speech. By learning how to produce speech automatically, and by accepting the need to speak without control, people who stutter can develop a stable system that generates fluent speech.

Barbara Dahm will be available for therapy sessions and initial consultations beginning in February at The Ridgewood Speech and Language Center in Midland Park and Tender Touch Therapy in Lakewood, New Jersey. Clients beginning therapy will be able to continue treatment via the web.

In addition, Barbara will be available to work with clinicians looking to expand their expertise in stuttering treatment.

For an appointment, please contact us at barbdahm@gmail.com or by phone, please call us at 201-378-0089 until Jan. 28 and 201-873-2093 after Jan. 28.

Barbara will also be part of a roundtable discussion at the American Speech-Language Hearing Association Conference on Unique Challenges and Common Themes in Stuttering Assessment, Treatment, and Research, which begins on Jan. 29 in Tampa, Fla.

The inconsistent nature of stuttering often causes people who stutter to feel confused as they wonder whether the next word, sentence or conversation will go smoothly. People who stutter covertly have an additional frustration. They feel the stuttering, work hard to speak, and also live in fear of being found out.

Part of the frustration of covert stuttering is the result of the lack of understanding by the people around them. Parents, friends and teachers may not be aware of the feelings or the difficulty that the speaker is experiencing. Unfortunately, even when they try to explain, people who stutter covertly are too often told that they really don’t have a problem or that it is a psychological problem.

Some people believe that covert stuttering is different than overt stuttering. Speech pathologists have been known to turn covert stutterers away from speech therapy. After all, it’s difficult to use speech modification or fluency shaping techniques to change the speech when no stuttering is heard.

Even people who stutter overtly sometimes fail to understand covert stuttering. They may minimize the problems that the covert stutterer feels, and claim that if stuttering is not heard, it isn’t really stuttering. This only adds to the torment that people who stutter covertly experience.

I want to say unequivocally that covert stuttering is as real a condition as overt stuttering. In both conditions the speaker is not generating speech easily and automatically. Even when stuttering is not audible, there is very real pressure that can be felt in the head, chest, vocal tract, or abdomen. The person who stutters covertly may be very good at changing words quickly so that planned words are not actually forced out, or they may use more pausing so that blocks are not actually heard. However, what is going internally is not very different in overt and covert stuttering. In fact, some speech techniques for controlling overt stuttering, actually lead to covert stuttering, i.e. they result in less stuttered speech produced by a still mal-functioning speech production system.

Effective treatment for covet stuttering usually involves reducing the effort to hide stuttering, but people who stutter covertly do not have to try to stutter overtly on purpose, because this puts the focus on the stuttered speech instead of on the process of speaking. Learning how to process speech is as important for people who stutter covertly as it is for people who stutter overtly. They can learn to produce speech automatically and without effort. Since this is the goal of Dynamic Stuttering Therapy, treatment is just as effective for people who stutter covertly as for people who stutter overtly.

I have recently heard people who stutter saying that they felt that a person who no longer stutters should not be a spokesperson for the stuttering community. They believe that if they speak without stuttering, the public gets the impression that everyone who stutters can speak fluently if they would only try, and people who stutter are given false hope that they can also speak fluently.

I was very bothered by this discussion because I believe these opinions reinforce the belief that people who stutter can at best learn to live with stuttering. It is my belief that the truth requires looking at stuttering from a different perspective. It was once true that we did not know exactly how to guide people who stutter develop the ability to speak naturally in all the different situations that they encounter in their lives. Therapy was a trial and error endeavor. Very often clients tried very hard to develop techniques and control their speech, but to no avail. On the other hand, there have always been people, who once stuttered, who no longer stutter. Since we didn’t know how that happened, it was chalked up to “good luck” or perhaps no longer chasing fluency god.

Times have changed. In my work with people who stutter I see on a regular basis that that there is a clear, explainable, and doable process that people who stutter can use that results in naturally fluent speech. It does not require chasing fluency, an activity that does usually result either in stuttering or effortful fluency. It does not require developing speech controls, the antithesis of automatic, normally produced speech. What it does involve is understanding how a person who stutters process speech and what changes need to be made to make speaking a much easier and dependable activity. I am fully part of the group who believes that there is no magic cure for stuttering. However, as a result of practical experience, I know that people of all ages and severities of stuttering are capable adopting and getting used to a process that results in comfortable easily produced fluent speech.

I believe that the stuttering community should welcome the input of people who have overcome stuttering. People who still stutter can learn from them that change is possible. For those who believe that it is not possible for people who stutter to develop a way of speaking fluently, it is time to gain a deeper understanding of stuttering. Instead of sticking to beliefs based on yesterday’s knowledge, they should listen carefully to the positive experiences of people who have overcome stuttering and to all the new research and clinical knowledge about stuttering. The time for negativity has past. The time for being open to a new perspective on stuttering has come.

I am often asked to explain how Dynamic Stuttering Therapy differs from other therapies. The short answer is in almost every way. The more complete answer is that our focus is not on how to, or not to stutter. Dynamic Stuttering Therapy shows clients how to produce speech in the same way that normally fluent speakers produce speech. Naturally, if the process for producing speech is the same, the results are also the same – normally fluent speech. This is logical. People who stutter are capable of changing the way they process speech, so it is also possible. There is a clinically proven cause and effect between speech processing and fluency. That is why Dynamic Stuttering Therapy is the most effective approach for treating stuttering.

For some strange reason, until now people have thought of stuttering as if it were a condition that has little to do with the process of speaking. This is unlike almost any other speech condition in the field of Speech Therapy. If a person has poor vocal quality, the goal of therapy is to change the way the voice functions. If a child has language development problems, we search for the weakness in language processing and work to strengthen it, and so forth. However, with stuttering the goal is either on directly changing the speech itself or, alternatively, accepting that “once a stutterer, always a stutterer”.

There are therapies that do try to manipulate aspects of speaking, such as controlling the rhythm of speech, slowing it down, or controlling breathing. However, while in some cases these approaches might inadvertently cause the speaker to change the interactive neural process of producing speech, they do not actually deal directly with normal speech production. Dynamic Stuttering Therapy directly treats the neural network involved in creating speech.

The normal process for producing speech is essentially automatic. Controlling what you will say or how to say it is the antithesis of normal processing. We do not tell our clients to speak slowly, control their breathing, use gentle onsets or other techniques that require control. We guide them to give up control and show them how to speak automatically and without effort.

Dynamic Stuttering Therapy is an exciting experience, because people who stutter see that within themselves, they have the basic ability to produce speech normally. In some cases they even use this ability some of the time. However, because their focus is so much on the outcome, fluency/stuttering, they are not aware of the inner workings of speaking. Dynamic Stuttering Therapy is a process of self-discovery and change. There is no pressure on our clients to be fluent speakers. However, as they develop greater awareness of their way of producing speech their attitudes and behaviors gradually change. Speaking becomes effortless, comfortable and enjoyable.

The people who come to CTI for treatment reflect the character of the stuttering community. They are of all ages, cultures, economic status, professions, levels of intelligence or any other criteria you could think of. We do have more male than female clients. This would be expected, because there are about 4-5 times more males than females who stutter. There is, however, a common denominator among all our clients. They all are processing speech with too much control and effort, and they all have the potential to change the way they speak.

When CTI began over 20 years ago, we treated only older children and adults, but as we gained a greater understanding of the speech production system, we were able to adjust the therapy procedures so that the therapy was also suitable to very young children. Now in our mortar and brick clinic, we have treated people from ages 3 to over 70.

At stuttering online, we treat people from the age of 14 – adult. Although the therapy goals would benefit anyone who stutters, we do not yet have the computer software that would be appropriate for younger children. During online therapy we use the Dynamic Stuttering Therapy Workbook. This book was written for teens and adults.

Although we do not actually treat children online, we do consult with parents so that they can help their child develop the normal processes for speaking. We also offer consultations to SLPs who would like to use the speech processing approach with their clients.

Stuttering severity is not a consideration for determining suitability for Dynamic Stuttering Therapy. We treat people who are in the 99^th percentile for stuttering severity, people who stutter very mildly and at all levels of severity in between. Dynamic Stuttering Therapy is also highly recommended for people who have been described as “covert stutterers”. By this, we mean that their struggle to speak is internal and not usually perceived by listeners. The person who stutters covertly is not using the normal processes for producing speech and often has a great fear of being “found out”. Since Dynamic Stuttering Therapy does not focus on the stuttered speech, treating people who stutter covertly is in essence the same as treating those who stutter overtly and every bit as beneficial.

Stuttering has been a puzzling condition to people throughout time. There are so many conflicting theories that seem to contradict one another and every so often someone claims to have found the magic bullet for its cure. During the early years of my career, I was as puzzled as everyone else about how to best treat stuttering. Knowing that every problem has its solution and stuttering is no different, I was determined to find the solution that my stuttering clients were searching for. What they asked from me was to give them the ability to speak with fluent ease, like everyone else. I endeavored to find a way to do this.

Determination, resolve, and not a small amount of stubbornness forced me to look out of the box to find the best way to treat my clients who stutter. I never intended to come up with a whole new theory about stuttering and a new treatment approach. However, when I took into consideration all that is known about stuttering, including the thoughts, beliefs, reactions and behaviors of all my clients and the many thousands of people I have met and spoken to in the stuttering community, it begged to happen. It became so clear to me that stuttering is not simply a problem of the rhythm or forward flow of speech. These were just characteristics of the speech produced. I realized that stuttered speech was the product of a malfunctioning interactive system, so I studied this system from all angles both in the clinic and by learning from researchers and experts in all related fields. It all began to make sense. In the clinic I saw an obvious direct relationship between the way the specific production processes functioned and the fluency of speech. The proof that the speech processing perspective is the right perspective is in the results.

I have never touted Dynamic Stuttering Therapy as the magic cure for stuttering. It is just that I have found it to be the most effective therapy approach. I have a number of clients who have contacted me more than a decade after completing therapy. Some of them are in the videos on my website. They have told me that the treatment they received in my clinic changed their lives. Not all the clients that I have treated over the years have reached the same level of success, but, as the program was refined over the years, there are more and more clients who feel this way.

I have gotten used to seeing the astounding changes that so many clients have made, but sometimes, when I look back on videos to they way the client spoke only a month or so earlier, the enormous difference amazes even me. Not only is the person’s speech so much more fluent, there is also a change in the person’s overall demeanor. Their facial expression, posture and body language is more relaxed and natural and they have a new found ability to relate stories, argue, tell jokes and anecdotes, read before an audience and lead prayers. I have heard many a client say that Dynamic Stuttering Therapy is the most logical and effective way to treat stuttering, but I had to smile when a 13 year old client said, “This therapy rocks!”

October is a special month for people who stutter. October 22nd is International Stuttering Awareness Day and all month long there is an online conference. The theme of his year’s twelfth annual conference is “Stuttering: More Than a Tangled Tongue”. The International Stuttering Awareness Day online conference, hosted by Judith Kuster , Minnesota State University, Mankato , will open October 1. It can be found by going to The Stuttering Home Page  (www.stutteringhomepage.com).

The online conference features several papers written by well-known professionals and consumers (people who stutter/clutter) from around the world.  Participants can read papers and interact with the presenters on easy-to-use threaded discussions attached to each paper, during the three weeks the conference is “live” — from October 1-22. The ISAD online conference is freely available or can be taken for Continuing Education (1.5/15 hours) or one university credit (either graduate or undergraduate). Instructions and requirements for CEU or credit are online at

http://www.mnsu.edu/comdis/kuster/isadarchive/requirements.html

Papers remain available online after the conference has ended and all past conferences are archived and available at

http://www.mnsu.edu/comdis/kuster/isadarchive/onlineconference.html

There are also posters and a brochure for ISAD that you can download from near the top of the Stuttering Home Page - http://www.stutteringhomepage.com/
now.