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Taking Stuttering Therapy Beyond the Clinic Setting – All About Transfer

February 16, 2011 By Leave a Comment

People who stutter often say that they are able to speak fluently in the clinic, but find that their fluency disappears when they leave. This is a serious problem and I believe the solution lies in rethinking the issue of “transfer.”

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

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

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

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

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

Chasing Fluency

February 21, 2010 By 1 Comment

Desire of people who stutter: Becoming fluent

Reason for continuing to stutter: Trying to become fluent

So many people who stutter go to therapy to fulfill their desire to become a fluent speaker, only to be disappointed when it doesn’t happen. They try and they try, and the more they try, the more they become frustrated. The consequence is either giving up on their hope of ever speaking without stuttering or continuing to search in vain for the magic cure that will get rid of their stuttering.

I don’t believe there are any magic cures, but I do know that people who stutter can speak fluently. I also know that people who stutter will never speak with normal fluency by trying to speak fluently. As a matter of fact, trying to be fluent is very counterproductive, because it usually makes the person more aware of words (a good way to make stuttering happen), and putting in more effort to try to get them out (adding control to what must be an automatic process).

It’s hard for people who stutter to grasp that there is a way that they can create fluent speech without chasing after fluency. Perhaps that is why the hardest challenge of Dynamic Stuttering Therapy is to keep clients focused on the internal processes of creating speech when all the really want is the outcome-fluent speech. In Dynamic Stuttering Therapy, fluency is never the criteria of success. Nevertheless, when the person creates speech in the normal way, the effortless outcome is fluent speech.

As I write this, I am watching the Winter Olympics. I see sportsman after sportswoman focused on their process for their sport as they go for the gold. I think this is a good example of how to achieve success in therapy.

Desire of people who stutter: Becoming fluent

Reason speech is fluent: Focus is on the inner processes of creating speech

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The Connection Between Speech Anxiety and Stuttering

January 19, 2010 By Leave a Comment

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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The Fluctuations In Stuttering

January 13, 2010 By Leave a Comment

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.

Filed Under: clients, dynamic stuttering therapy, general information, nature of stuttering, speech control, therapy approach Tagged With: , , , , , , , , ,

Covert Stuttering

January 5, 2010 By Leave a Comment

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.

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Letting Go Is Essential

December 21, 2009 By Leave a Comment

I’ve been talking a lot about control lately. It’s a really important subject when it comes to treating stuttering. Learning how to speak without control is really not very difficult to do. The process of speaking automatically is not complicated. There is so much less to do and think about than when creating stuttered speech. The speech is flowing and expressive. But the hardest thing for clients to do is to accept that speaking fluently requires giving up control.

For some people who stutter control has become so intertwined with talking that to give it up seems very strange. They believe that it is normal to think of what words you are going to say and how to form the sounds. They can’t imagine not doing that when they talk (even though they don’t do it when they are talking to themselves). Other people use control as a crutch. They know how to speak without control, but they are afraid to let go.

Actually the more people try not to stutter, the more control they exert over their speech. That is why chasing fluency has always been a no win battle. When people who stutter give up their fear of stuttering and any negative feelings that they have toward themselves because they stutter, they are often more open to giving up control. Speaking fluently requires using the normal automatic processes of producing speech. Giving up control is essential.

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Fluency Without Speech Tools

December 14, 2009 By Leave a Comment

As I have stated in previous posts, it seems very clear that people who stutter generate speech, at least some of the time, with too much control over language planning and motor programming. This is the problem; we need to consider the solution.

We know that the goal of modern stuttering therapy is usually to learn to use speech tools. People who stutter are guided to think about what they want to say and how to say it. They are asked to:

  • Change the rhythm of speech or speak slowly.
  • Reduce struggle behavior with pullouts and cancellations, preparatory sets.
  • Remember to stutter on purpose
  • Control how the mouth and breath forms various classes of speech sounds
  • Control breathing and pause after short phrases

Although these “tools” may reduce the strength or frequency of stuttering blocks, they are really asking the speaker to add more control over speech. People are meant to be produced speech automatically, but speech tools support controlled speech. It is no wonder, therefore, that the use of these tools causes frustration and takes away from the joy and freedom of speaking naturally. Speech tools also interfere with the natural quality of speech and make it harder to express mood and the speaker’s real personality through normal patterns of intonation.

People often give up on speech tools and resign themselves to believing that their only other option is to continue to stutter. As much as they want to find ways to be more fluent, they are locked into their belief that their only choice is speech tools or stuttering. They can’t accept what there is now another option that guides people who stutter to speak fluently by learning to give up control.

Dynamic Stuttering Therapy is what both clinicians and clients have hoped for. It shows people who stutter how to speak without effort, thought or control over words or speech muscles. The speech produced is natural and expresses the speaker’s feelings. People who stutter can learn to speak fluently without having to use speech tools.

For those who have hoped for something better than speech tools, Dynamic Stuttering Therapy is the answer.

Filed Under: clients, controversy, dynamic stuttering therapy, speech control, treatment results Tagged With: , , , , , ,

The Issue of Control

December 10, 2009 By Leave a Comment

In my next few blog posts, I want to talk about the issue of control. People who stutter sometimes feel a loss of control when they are speaking. Their tongue or lips may go to places where they are not meant to be; their larynx may tighten uncontrollably; they feel like they cannot breathe and experience involuntary blocks. This certainly seems like a lack of control, because all these symptoms of stuttering occur without the speaker’s control. However, this does not mean that the speaker does not have control. I will argue that these unwanted symptoms occur because the speaker is exerting too much control in the central processing of speech.

Those of you, who have followed my writings, have heard me say that, according to psycholinguistic experts, speaking must be an automatic process. Automaticity is the requirement for fluent speech. The development of language happens automatically without thinking about the words. Controlling the choice of words, preplanning and scanning ahead is not part of normal speech production.

If you are a person who stutters, when do you stutter most? Is it when you forget that you are speaking or when you try to control your speech so that you will not stutter? We know that many people stutter less when they are alone, caring less about stuttering and taking less control over speaking.

Thinking about words is one form of control. Another is trying to control how you say the words. This involves using a controlled motor program. Sometimes the control of muscle movements is conscious, but at other times the control is subconscious. Many motor programs can be carried out on either a controlled mode or in an automatic mode. Automatic programming is always more efficient, more stable and faster than controlled programming.

Let’s take a minute to experience the difference between controlled and automatic programming. For an example, we can use the movement of the eyelids. Purposefully open and close your eyelids. When you do this you are using a controlled movement program. Do the movements feel heavier, more labored and slower than those automatic movements of your lids that occur throughout the day?

The same difference can occur regarding the speech muscles. We know that in order to speak theses muscles must also move with light, extremely rapid and miniscule movements. This requires the automatic mode. When control is used, muscle movement becomes more labored and, often, muscle groups not normally used to speak are activated. The fluid movement of speaking is compromised and the stuttering symptoms so often associated with lack of control happen because the program used to process speech is one that involves too much control.

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