Natural Speech | Stuttering Online Therapy

A new concept of stuttering

June 9, 2010 By Barbara Dahm View Comments

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, (2^nd 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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A sample activity to supplement treatment – sub vocal speech

April 19, 2010 By Barbara Dahm View Comments

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 link 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 as you develop 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 your 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.

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Chasing Fluency

February 21, 2010 By Barbara Dahm View Comments

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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It’s time for a new theory on stuttering therapy

February 1, 2010 By Barbara Dahm View Comments

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.

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Letting Go Is Essential

December 21, 2009 By Barbara Dahm View Comments

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 Barbara Dahm View Comments

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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The Issue of Control

December 10, 2009 By Barbara Dahm View Comments

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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Yet Another Therapy

November 15, 2009 By Barbara Dahm View Comments

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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Clients Enjoy Speaking Naturally

September 10, 2009 By Barbara Dahm View Comments

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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