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, (2nd 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.
