Stuttering Online Therapy

What is stuttering?

Stuttering, also known as stammering, is usually defined as a speech disorder in which the flow of speech is disrupted by involuntary repetitions and prolongations of sounds, syllables, words or phrases, and involuntary silent pauses or blocks in which the speaker is unable to produce sounds. However, we define stuttering as a condition in which the dynamic speech production system malfunctions. Stuttering involves the use of different brain processes when speaking, even when the speech sounds relatively fluent. The normally automatic process of speaking becomes a more controlled process in which the speaker has some degree of word awareness, either before speaking or while trying to get words out, that is not present in normal speech production. The way the system functions makes speaking effortful and results in a variety of involuntary behaviors. These include a disturbance in the forward flow of speech, facial tension and body tension, unintended movement of the limbs and head, a lack of breath support during speaking, involuntary eye blinks and lack of eye contact. It is not known why the speech system functions differently in some people. However, genetics, learned behavior, misconceptions about speaking, attitudes, reactions to outside stimuli and emotions can affect and may be affected by the way the system functions.

The term “stuttering”, as popularly used, covers a wide spectrum of severity: from stuttering that is felt by the speaker, but barely perceptible to extremely severe symptoms that prevent most oral communication.
Stuttering may affect the quality of a person’s life. The impact of stuttering on a person’s functioning and emotional state also ranges from minimal to severe. Some people do not let stuttering stop them from speaking in almost all situations, while others feel devastated by their speech difficulty. To some degree, stuttering causes frustration, fears of not being able to enunciate specific vowels or consonants, fears of being caught stuttering in social situations, self-imposed isolation, anxiety, stress, shame, or a feeling of “loss of control” during speech. Stuttering can keep a person from achieving his potential academically and socially. People who stutter have been held back from job advancement either by their own fear of speaking or by employers who do not see the real ability of a person who does not speak fluently. Without the ability to communicate effectively, many people avoid speaking in public places, in front of large groups of people and even with friends.

Stuttering is sometimes popularly associated with anxiety or low intelligence, but there is actually no such correlation (though as mentioned social anxiety may actually result in individuals as a result of their stuttering). Despite popular perceptions to the contrary , stuttering does not affect and has no bearing on intelligence.

The brain’s role in disorder

It is widely accepted that people who stutter use different neurological processes when speaking than normally fluent speakers. Differences in the planning and execution of internal speech distort the natural flow of speaking, and result in stuttered speech.

In addition, there appears to be a chain reaction in which difficulty in speaking causes the speaker to exert more conscious control over speech production. Negative behaviors may be developed and reinforced, exacerbating the deviant neurological processing. The more control that is exerted, the more pronounced stuttering becomes.

The speech production model of Willem Levelt explains that a necessary condition for fluent speech is that the basic elements of the speech production system must function automatically and in parallel. Dynamic Stuttering Therapy guides people who stutter to meet this condition. Dynamic Stuttering Therapy does not try to manipulate the rate, rhythm or smoothness of the speech, nor does it teach techniques for controlling speech. It focuses on all the elements of the dynamic speech production system that are shown in the diagram below. During the therapy experience, clients develop and accept the natural and automatic planning and execution of speech that is used by normally fluent speakers.

What is Dynamic Stuttering Therapy?

Dynamic Stuttering Therapy programs your brain to create speech normally and naturally. Although most people who stutter appear to have the ability to produce the basic elements of speech normally, this aptitude is hidden because all the elements do not come together to form the normal circuitry for speaking. This is especially true when the person is conscious of speaking and trying to control speech.

The goal of Dynamic Stuttering Therapy is to help you develop the same subconscious and automatic brain circuits found in fluent speakers. Scientific studies have shown that there are functional and possibly structural differences in the brains of fluent speakers and people who stutter. These differences are related to the planning, execution, and the coordination of the various elements of speech production. The interruptions of the natural flow of speaking, the feelings of physical and mental tension, and involuntary movement of the head and body are the result of the faulty brain circuits that are present in people who stutter.

There is often a chain reaction in which the difficulty in speaking causes people who stutter to exert even more control over their speech. Negative behaviors may be developed and reinforced, exacerbating the problem and increasing the severity of the stuttered speech. Dynamic Stuttering Therapy addresses the cognitive issues and emotions related to stuttering so that they will not interfere with adopting the natural way of speaking. Clients gradually develop a different way of thinking about stuttering and themselves as communicators. They develop the confidence that comes with the experience of producing speech with ease.

Scientists have shown that changing thoughts, learning, and acting in new ways can shape brain anatomy and perfect brain circuits. This in turn leads to new behavior. Dynamic Stuttering Therapy is designed to help you make these changes. As you progress through the numerous, well-defined activities, you will become aware of your ability to use all of the elements of speech production without effort or control. The end result is automatic and natural sounding speech.

Changes you make during therapy:

• You give up controlling how to say words.
• You become aware of how you inadvertently interfere with normally automatic speech production.
• You develop language automatically.
• You use your voice naturally with ease and comfort.
• You let your mouth articulate sounds automatically.
• You develop attitudes and behaviors that are consistent with long-term change.

How is Dynamic Stuttering Therapy different from other therapies?

The most common therapies today focus on either shaping the fluency of the speech or modifying the stuttering in an effort to struggle less to get words out. While these methods sometimes reduce the degree of stuttering, they teach strategies that require effort, thought and consciousness about stuttering and speech. They do not directly target the root of the problem, the brain processes that are responsible for generating speech.

Dynamic Stuttering Therapy focuses only on your inner ability to speak naturally, at a normal rate with normal vocal inflection. It does not require you to use any strategy that is not part of normal speech production. You are free to focus on communicating your thoughts, instead of thinking about how to speak or trying to be fluent. Changing the way the brain functions does require a measure of awareness, but the manner in which speech is produced is effortless.

What are the treatment results?

• The ability to speak automatically, without effort or control
• Greater self-confidence
• Natural, fluent speech

When you achieve the goals of Generating Fluent Speech, you will speak normally and as a result your speech will be normally fluent. Many clients establish this new way of speaking as their default program. These people speak with normal fluency in all situations.

A study carried out in 2005 of 80 clients showed an 82% average increase of speech fluency after treatment. The rate of speech also increased. Measured by syllables per minute, after therapy, the average rate of spontaneous speech was 57% faster and reading was 40% faster. In addition, clients reported that subjectively the experience of speaking was much more satisfying. A study conducted in 2003 showed a 58% increase in speech satisfaction 5-6 months after the completion of therapy.

A study conducted in 2000 of speech naturalness after treatment showed that the mean difference of speech naturalness ratings of our clients after treatment and non-stuttering speakers is 0.44. This is the lowest difference compared to 5 other similar studies of people who had participated in other programs.

How long is the therapy program?

The preferred framework for administering Dynamic Stuttering Therapy is an individualized intensive program of approximately 24-30 hours administered within 3-5 weeks. The length of the sessions may vary from 1 hour for young children to 3 hours for adults. Some clients require occasional follow-up sessions after the completion of intensive treatment.

How long will it take to get rid of my stuttering?

Your speech will be fluent as soon as you use the process of speech production that is the goal of treatment. The length of time that it takes to do this varies according to the individual. Most clients are able to use this process within the first 15 hours of treatment. However, it will take much longer to establish the habit of speaking this way. Nevertheless, your speech will be fluent whenever you use this mode of speaking. Throughout the treatment program and when you are continuing to maintain what you have learned, you will see that there is a direct cause and effect relationship between the achievement of the goals of therapy and the fluency of your speech. Long-term fluency requires establishing strong connections in the brain for speech production. Therefore, you will need to continue to be aware that you are using the new way of generating speech. Many clients establish this new way of speaking as their default program. These people speak with normal fluency in all situations.

How much effort does it require to speak in the new way?

Clients report that it is easier to speak in the new way than in their old way. This is because speech production becomes more subconscious and automatic. A certain degree of present awareness is required for using the new process. However, it does not require thought or consciousness of the words you are saying.

Will I be able to speak fluently in all situations?

You will be able to use your new way of producing speech whenever you choose to use it. Since your fear of stuttering might influence you to react in your habitual way, you will have to become proactive instead of reactive. It may take you time to adjust to your new way of speaking before you begin using it in your more feared situations. Clients who develop positive attitudes report being able to speak fluently in all situations.

Does Dynamic Stuttering Therapy suit all people who stutter?

Any person who is not using the normal processes for the production of
 speech in such a way that the result is covert or overt stuttering would benefit from this approach. It should be noted, however, that therapy is a partnership between the clinician and the client. People who are looking for a “magic cure” will not be satisfied with this program. An experienced clinician knowledgeable in the principles of this approach and clients who are active participants in the therapy process are the requirements for success.

What are the treatment hours?

Therapy hours for the complete program will be schedule before you begin treatment. The clinic in the USA is open from Monday through Friday and in Israel from Sunday through Thursday. An attempt will be made to schedule treatment at the times that are most convenient for you.

Who developed this treatment approach?

Dynamic Stuttering Therapy was developed by Barbara Dahm SLP-CCC as a direct result of her extensive clinical experience in treating people who stutter. Barbara received her degrees from Boston University and has 40 years of experience as a speech pathologist. In 2002 she was among the original cadre of Board Recognized Specialists in Fluency Disorders. Since 1987, Barbara has served as Director of Communication Therapy Institute in Israel, a clinic that specializes in the treatment of stuttering. In 1993 Barbara presented the speech processing approach for the treatment of stuttering to her colleagues in Oxford, England. This approach was published in 1997 as Generating Fluent Speech: A Comprehensive speech processing approach. The treatment program was further refined and in 2007 the Dynamic Stuttering Therapy workbook was published.

Barbara is a certified member of the American Speech Language and Hearing Association (ASHA) and licensed by the State of New Jersey and Israel. She is a member of the ASHA Special Interest Division in Fluency Disorders, a member of the Israel Association of Communications Clinicians and a founding member of the International Fluency Association. She is active in several self-help groups for people who stutter both in Israel and the USA. She has received enthusiastic feedback after presenting her approach to professionals and people who stutter in The Netherlands, England, Germany, Denmark, Canada, Israel and the USA.