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.

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.

Barbara will also be giving a workshop at the National Stuttering Association Convention in Cleveland between July 7-11, 2010.  She will be talking about the disparity between research and treatment for stuttering and explaining how this can be overcome. It looks like it will be a great convention. It’s an opportunity for people who stutter and their families to meet and discuss all aspects of stuttering and to have lots of fun with a great group of people.

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.

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.

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.

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 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.

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.

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.