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.

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.

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.

The people who come to CTI for treatment reflect the character of the stuttering community. They are of all ages, cultures, economic status, professions, levels of intelligence or any other criteria you could think of. We do have more male than female clients. This would be expected, because there are about 4-5 times more males than females who stutter. There is, however, a common denominator among all our clients. They all are processing speech with too much control and effort, and they all have the potential to change the way they speak.

When CTI began over 20 years ago, we treated only older children and adults, but as we gained a greater understanding of the speech production system, we were able to adjust the therapy procedures so that the therapy was also suitable to very young children. Now in our mortar and brick clinic, we have treated people from ages 3 to over 70.

At stuttering online, we treat people from the age of 14 – adult. Although the therapy goals would benefit anyone who stutters, we do not yet have the computer software that would be appropriate for younger children. During online therapy we use the Dynamic Stuttering Therapy Workbook. This book was written for teens and adults.

Although we do not actually treat children online, we do consult with parents so that they can help their child develop the normal processes for speaking. We also offer consultations to SLPs who would like to use the speech processing approach with their clients.

Stuttering severity is not a consideration for determining suitability for Dynamic Stuttering Therapy. We treat people who are in the 99^th percentile for stuttering severity, people who stutter very mildly and at all levels of severity in between. Dynamic Stuttering Therapy is also highly recommended for people who have been described as “covert stutterers”. By this, we mean that their struggle to speak is internal and not usually perceived by listeners. The person who stutters covertly is not using the normal processes for producing speech and often has a great fear of being “found out”. Since Dynamic Stuttering Therapy does not focus on the stuttered speech, treating people who stutter covertly is in essence the same as treating those who stutter overtly and every bit as beneficial.

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!”

October is a special month for people who stutter. October 22nd is International Stuttering Awareness Day and all month long there is an online conference. The theme of his year’s twelfth annual conference is “Stuttering: More Than a Tangled Tongue”. The International Stuttering Awareness Day online conference, hosted by Judith Kuster , Minnesota State University, Mankato , will open October 1. It can be found by going to The Stuttering Home Page  (www.stutteringhomepage.com).

The online conference features several papers written by well-known professionals and consumers (people who stutter/clutter) from around the world.  Participants can read papers and interact with the presenters on easy-to-use threaded discussions attached to each paper, during the three weeks the conference is “live” — from October 1-22. The ISAD online conference is freely available or can be taken for Continuing Education (1.5/15 hours) or one university credit (either graduate or undergraduate). Instructions and requirements for CEU or credit are online at

http://www.mnsu.edu/comdis/kuster/isadarchive/requirements.html

Papers remain available online after the conference has ended and all past conferences are archived and available at

http://www.mnsu.edu/comdis/kuster/isadarchive/onlineconference.html

There are also posters and a brochure for ISAD that you can download from near the top of the Stuttering Home Page - http://www.stutteringhomepage.com/
now.

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.