nature of stuttering | Stuttering Online Therapy

A new concept of stuttering

June 9, 2010 By Barbara Dahm View Comments

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:

Learning to develop internal (sub vocal speech) naturally without any attempt to get it out
Allowing the speech muscles to work on an automatic mode
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.

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Filed Under: controversy, dynamic stuttering therapy, fluent speech, general information, nature of stuttering, therapy approach Tagged With: approach, change, dynamic, effective, fluent, fluent speech, natural speech, stuttering, treatment

Relapse After Stuttering Therapy

May 20, 2010 By Barbara Dahm View Comments

A common complaint of people who have undergone stuttering treatment is that the results don’t last. This complaint relates to many other conditions, such as weight loss, anger management, addictions and so forth, and is discussed in a wonderful book, Changing For Good, by Prochaska, Norcross, & Diclemente. The authors discuss the reasons that people who come to treatment wanting to achieve certain goals do not maintain their accomplishments, and they outline a program to overcome this problem. I believe it is a must read for people who want to help themselves to make long-term changes in their behaviors and attitudes. In fact, I have incorporated the principles of this program in the Dynamic Stuttering Therapy Workbook.

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.

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Filed Under: fluent speech, nature of stuttering, therapy approach, treatment results Tagged With: approach, change, overcoming stuttering, relapse, results, speech tools, stuttering, therapy goal

A sample activity to supplement treatment – sub vocal speech

April 19, 2010 By Barbara Dahm View Comments

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 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.

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Filed Under: clients, dynamic stuttering therapy, fluent speech, nature of stuttering, sample activity, therapy approach Tagged With: automatic speech, fluent speech, natural speech, practice, stuttering, subvocal-speech, therapy for stuttering, tips for fluent speech

Stuttering- More Than Feelings

March 2, 2010 By Barbara Dahm View Comments

Many people who stutter believe that they stutter because of their feelings about themselves and being too concerned with what other people think of them. It cannot be denied that people who stutter often stutter more when they are concerned over how they present themselves or how their speech sounds to others. However, it is important to differentiate between what causes stuttering and what increases stuttering. Making this difference is essential for understanding what stuttering is and for the self-esteem of many people who are sincerely trying to not let their stuttering affect their lives.

I want to make this point, because I have heard many people who stutter say that if they could make themselves care less about stuttering, they would not stutter. The fact that they are still stuttering seems to them to be a failure in their ability to cope emotionally. This is not the case. A person can be the most centered, emotionally intelligent and socially well-adjusted person and still stutter. This is true, because stuttering is a condition that involves so much more than the person’s feelings.

Today researchers are coming up with more and more evidence that the place where speech is created, the brain, is the source of stuttering. Recently new genetic research lead by Dennis Drayna at the National Institute on Deafness and Other Communication Disorders (NIDCD), part of the National Institutes of Health, has shown that at least some people (thought to be 9% of the people who stutter) have a gene mutation, not found in fluent speakers. It turns out that these particular genes are responsible for the production of two enzymes necessary for a metabolic process required by all cells, but that especially affect a group of cells in the brain responsible for speech. Other researchers studying other families have also found indications of mutations in genes of those members of the family who stutter. The relationship of these genes to speaking is not yet clear. However, what we are seeing is that stuttering isn’t simply a question of how the person feels.

For those people who have tried to stop stuttering by changing only their attitude and feelings, it is important to know that stuttering is not only about what you feel inside. Advertising stuttering is good and helpful. Learning to be self-accepting of yourself whether or not you stutter is essential for your personal wellbeing. Being disappointment in yourself and thinking you have failed because you still stutter is self-defeating and misplaced.

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Filed Under: Emmotions, clients, nature of stuttering Tagged With: fluency, genes, overcoming stuttering, self-esteem, treatment

The Connection Between Speech Anxiety and Stuttering

January 19, 2010 By Barbara Dahm View Comments

Most people who stutter believe that anxiety causes stuttering or increases stuttering severity. There is an obvious link between anxiety and stuttering, but, as with most aspects of the condition of stuttering, there is more to it than meets the eye.

Many years ago, I presented a research study at The Third International Congress of Fluency Disorders in which I asked both normally fluent and stuttering speakers to develop language in whole word units instead of syllables while producing only a voice or while talking silently (as if the mute button had been turned on). I then asked them to describe the feeling. Both groups answered that they felt choked, tense, and uncomfortable. The people who stutter said that this way of speaking reminded them of stuttering. The fluent speakers reported that this is not at all the way they speak.

This experiment lends support to what I have observed so often in the clinic. Processing speech in the way that people who stutter do, not only makes speech stuttered, it also leads to feelings of tension and anxiety. People tend to believe that anxiety causes stuttering, or stuttering causes anxiety. However, both anxiety and stuttering are the natural outcomes of faulty speech processing. Over time these two conditions become so linked in the speaker’s mind that any feeling of anxiety will exacerbate faulty processing and, therefore, increase stuttering. In turn, a stuttering incident increases anxiety. This leads to increased faulty processing and, therefore, increased stuttering.

Many people believe that the goal of therapy for stuttering is to reduce anxiety. They believe that if the person who stutters could just relax the stuttering would disappear. While it is true that giving up the effort of trying to get words out fluently, may lead to more automatic processing and thus reduce both stuttering and anxiety, it is asking the impossible to try to feel relaxed when you are still trying to control speech.

One of the big frustrations that people who stutter often encounter is being told to relax so that they won’t stutter. Trying to follow this impossible, though seemingly good advice, only increases anxiety. I have treated yoga experts and people who meditate daily. They are great at relaxing, but the second they try to control their words, relaxation evaporates.

When clients learn to produce speech automatically, without thinking about words and how to say them, the result is not only flowing speech, it is a feeling of comfort and relaxation. Trying to reduce anxiety may inadvertently lead to better speech processing, but there is a more direct approach. Learning to produce speech automatically and without control directly leads to a decrease in anxiety and stuttering.

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Filed Under: controversy, nature of stuttering, speech control, therapy approach Tagged With: anxiety, fluent, frustration, processing, speech, stammer, stutter

The Fluctuations In Stuttering

January 13, 2010 By Barbara Dahm View Comments

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.

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Filed Under: clients, dynamic stuttering therapy, general information, nature of stuttering, speech control, therapy approach Tagged With: automation, cause, change, control, factor, fluent speech, pressure, problem, stutter, tension

A new concept of stuttering

Relapse After Stuttering Therapy

A sample activity to supplement treatment – sub vocal speech

Stuttering- More Than Feelings

The Connection Between Speech Anxiety and Stuttering

The Fluctuations In Stuttering

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