Stuttering Online Therapy

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 1^st 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.

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.

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.

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.

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.

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.

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.

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!”

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.

Over 20 years ago, I decided to devote all my time and effort as a Speech Clinician to one specific communication disorder – stuttering. It was then that I resigned as a public school speech therapist and opened Communication Therapy Institute. In the early years, I administered a fluency-shaping program in an intensive 3-week group format. At the time this was considered to be the most successful stuttering program available and I intended to do this kind of therapy for years to come. However, after about 4 years of trying to stick to the procedures and goals of fluency shaping as I had learned them, I began to realize that this approach did not take into account many of the aspects of stuttering that I was discovering. So, with care, I gradually made small changes that grew into big changes and evolved into an entirely different way of looking at and treating stuttering.

In 1993, the idea that stuttering was the result of a malfunctioning speech generating system was clear enough to me to write about it and to present it to my colleagues at The 3rd International Dysfluency Conference in Oxford, England. I also decided to write my program in the form of a Workbook and Clinician’s Guide. It was published in 1997 under the name Generating Fluent Speech: A Comprehensive Speech Processing Approach.

During the ensuing years my staff and I continued to treat clients while carefully observing what they did when speaking, how they felt, what they thought and how they were able to speak in the short and long term. Just when I thought I really understood how stuttering and fluent speech was created, the whole process of speaking became even clearer. As this happened, I made changes in therapy procedures. Instructions, activities and even the delivery model were changed. Sticking to my goal of making therapy as simple and effective as possible, I rewrote the workbook that was published in 2007 as Dynamic Stuttering Therapy.

Today we treat people who stutter of all ages. We still believe that the best delivery model when possible is intensive treatment, at least until the person is able to use and reinforce the process between therapy sessions. From then on some clients are able to continue independently, while others require more direct support from the clinician. We no longer do group therapy as we have decided that we prefer to give each client our undivided attention during the learning process. We do, however, recommend group practice and participation in support groups for clients who would benefit from a group atmosphere.

Our mortar and brick clinic continues to receive clients in New Jersey, USA and in Israel. In addition, we are making the same outstanding and effective treatment approach available to people all over the world via video conferencing.

All clients are treated according to the principles of the speech processing approach, the process of change, and the principles of developing new networks for neurological functions on which Dynamic Stuttering Therapy is based. We do not administer this therapy approach because we are loyal to the program. We administer this therapy approach because we are dedicated to our clients and we have seen that beyond doubt Dynamic Stuttering Therapy is the most up to date, most logical, practical and effective treatment for stuttering.