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A new concept of stuttering

June 9, 2010 By Leave a Comment

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:

  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, (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.
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It’s time for a new theory on stuttering therapy

February 1, 2010 By Leave a Comment

This week I am traveling to Tampa, Fla., to the ASHA Special Interest Division in Fluency Disorders 2010 Leadership and Clinical Conference. The title of the conference is “Unique Challenges and Common Themes in Stuttering Assessment, Treatment, and Research”. I am very much looking forward to this conference, because I believe that the time has come for everyone interested in advancing the treatment for stuttering to work together at developing a unified scientific theory.

This conference will be a gathering of clinicians who are concerned with delivering effective therapy to their clients, researchers who want to find answers to the many questions about stuttering, and professors who want to pass on correct knowledge to their students. The Stuttering Foundation of America and National Stuttering Association, two organizations that represent consumers who want and deserve improved treatment will also be lending their support. It should be an ideal forum for exploring new ideas, observations, and findings. A realistic outcome will be the ability of all to look beyond the same ideas and treatment approaches that have been discussed over and over in the past and to find the best direction for advancing the field.

I am planning to do my part as part of a roundtable discussion. As all my readers know, I will be presenting a theory and treatment approach that is different from what most of my colleagues follow. This is not the 1st conference in which I will be sharing my views. I first presented my seminal theory at a conference in Oxford England in 1993. The reaction I received there and at seminars and conferences that followed was extremely positive. However, my clients who tell me that Dynamic Stuttering Therapy is the most logical therapy that they have experienced don’t understand why other clinicians do not use this treatment approach. Perhaps the late Hugo Gregory was correct in 1993 when he told me that my ideas would not be accepted in our lifetime. Apparently new ideas do trickle slowly into the collective consciousness. That is why I am pleased for the opportunity to share my experiences, learn more about the latest research findings and insights from my colleagues as we brainstorm together with an open mind. By doing this, we should be able to make this a successful conference. I’ll give you my impressions when I return.

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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.

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There Is Hope For Overcoming Stuttering

November 22, 2009 By Leave a Comment

I have recently heard people who stutter saying that they felt that a person who no longer stutters should not be a spokesperson for the stuttering community. They believe that if they speak without stuttering, the public gets the impression that everyone who stutters can speak fluently if they would only try, and people who stutter are given false hope that they can also speak fluently.

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.

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Yet Another Therapy

November 15, 2009 By Leave a Comment

We have had many clients who have tried various other therapy approaches before participating in Dynamic Stuttering Therapy. From what I have observed, these clients fall mainly into 3 categories:

1.      Those who had stuttering modification therapy, but were not convinced that this was all they could do to help themselves. They come to Dynamic Stuttering Therapy, because they have decided that, while accepting that they stutter and learning to stutter with a bit less struggle is beneficial, they have not been be able to improve the quality of their communication to the extent they desire. In their heart, they really do want to speak fluently.

2.     Those who were in fluency shaping programs and have tried to do what they had been taught, but became frustrated because it did not work for them. Due to the high hopes they had, they are often skeptical of yet another therapy and fear being disappointed by another unsuccessful therapy experience. Having been dedicated and serious clients, they may also be reluctant to give up the control techniques that they were taught even though they have really not produced the desired results. When these clients come to Dynamic Stuttering Therapy, they are amazed that the experience of speaking can be easier, more comfortable and, of course,  fluent.

3.    Those who did not like the therapy approach they had tried and, therefore, never made a habit of using additional speech or stuttering controls to speaking. When they come to Dynamic Stuttering Therapy, they are relieved that the therapy goals are so logical and uncomplicated. They are no longer reluctant to go along with the therapy process, because it makes sense and feels good.

Some of our clients did not let stuttering affect their lives even before beginning treatment. However, the majority of our clients come to therapy with years of negative experiences, thoughts and feelings related to stuttering. These clients work as much on cognitive processing as on neurological processing. Some of our clients need to make substantial cognitive changes in order to begin to enjoy speaking. My experience as a clinician has shown me the power of individuals to make changes. When the there is a direct relationship between change and desired results, the experience is rewarding.

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Why DST Is So Effective

November 10, 2009 By Leave a Comment

I am often asked to explain how Dynamic Stuttering Therapy differs from other therapies. The short answer is in almost every way. The more complete answer is that our focus is not on how to, or not to stutter. Dynamic Stuttering Therapy shows clients how to produce speech in the same way that normally fluent speakers produce speech. Naturally, if the process for producing speech is the same, the results are also the same – normally fluent speech. This is logical. People who stutter are capable of changing the way they process speech, so it is also possible. There is a clinically proven cause and effect between speech processing and fluency. That is why Dynamic Stuttering Therapy is the most effective approach for treating stuttering.

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.

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Not a Cure, Just Effective Treatment

October 11, 2009 By Leave a Comment

Stuttering has been a puzzling condition to people throughout time. There are so many conflicting theories that seem to contradict one another and every so often someone claims to have found the magic bullet for its cure. During the early years of my career, I was as puzzled as everyone else about how to best treat stuttering. Knowing that every problem has its solution and stuttering is no different, I was determined to find the solution that my stuttering clients were searching for. What they asked from me was to give them the ability to speak with fluent ease, like everyone else. I endeavored to find a way to do this.

Determination, resolve, and not a small amount of stubbornness forced me to look out of the box to find the best way to treat my clients who stutter. I never intended to come up with a whole new theory about stuttering and a new treatment approach. However, when I took into consideration all that is known about stuttering, including the thoughts, beliefs, reactions and behaviors of all my clients and the many thousands of people I have met and spoken to in the stuttering community, it begged to happen. It became so clear to me that stuttering is not simply a problem of the rhythm or forward flow of speech. These were just characteristics of the speech produced. I realized that stuttered speech was the product of a malfunctioning interactive system, so I studied this system from all angles both in the clinic and by learning from researchers and experts in all related fields. It all began to make sense. In the clinic I saw an obvious direct relationship between the way the specific production processes functioned and the fluency of speech. The proof that the speech processing perspective is the right perspective is in the results.

I have never touted Dynamic Stuttering Therapy as the magic cure for stuttering. It is just that I have found it to be the most effective therapy approach. I have a number of clients who have contacted me more than a decade after completing therapy. Some of them are in the videos on my website. They have told me that the treatment they received in my clinic changed their lives. Not all the clients that I have treated over the years have reached the same level of success, but, as the program was refined over the years, there are more and more clients who feel this way.

I have gotten used to seeing the astounding changes that so many clients have made, but sometimes, when I look back on videos to they way the client spoke only a month or so earlier, the enormous difference amazes even me. Not only is the person’s speech so much more fluent, there is also a change in the person’s overall demeanor. Their facial expression, posture and body language is more relaxed and natural and they have a new found ability to relate stories, argue, tell jokes and anecdotes, read before an audience and lead prayers. I have heard many a client say that Dynamic Stuttering Therapy is the most logical and effective way to treat stuttering, but I had to smile when a 13 year old client said, “This therapy rocks!”

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Clients Enjoy Speaking Naturally

September 10, 2009 By Leave a Comment

Spencer is an outgoing and sociable boy who had learned to live with stuttering. He has lots of friends and is active in school activities. Nonetheless, his speech did hold him back from meeting new people and he hoped to be able to speak fluently. Spencer received speech therapy both in elementary and middle schools, but he didn’t feel that these therapy experiences were very helpful to him. After hearing about Dynamic Stuttering Therapy, Spencer was not convinced that therapy would really help, but he was ready to give therapy another try.

After 18 hours of treatment with Barbara Dahm, Spencer explains how he learned  to speak naturally. For the first time he realized that there was no need force words out. He learned to produce speech easily and without effort . He was pleased not to have to learn, memorize and practice techniques.

Spencer’s ability to speak fluently was in no sense of the word a magic cure. In therapy he experienced a natural way of producing speech. During the therapy process, Spencer saw that his new way of speaking was more effective than his previous way. That motivated him to do the practice activities between sessions and to gradually begin to incorporate this way of speaking in his daily life. Spencer was never told that he had to speak in the new way all the time. However, he soon realized that there is a cause and effect condition. When he tried to force words out, he stuttered. When he produced speech by generating his natural voice without trying to control what he was saying, his speech flowed naturally. For the first time he felt that therapy had a positive effect on his life.

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