Stuttering | 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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Filed Under: controversy, dynamic stuttering therapy, fluent speech, general information, nature of stuttering, therapy approach Tagged With: approach, change, dynamic, effective, fluent, fluent speech, natural speech, stuttering, treatment

Upcoming events for the summer

May 24, 2010 By Barbara Dahm View Comments

For those of you in the greater New York/New Jersey area, Barbara Dahm will be available for therapy sessions and initial consultations this summer at The Ridgewood Speech and Language Center in Midland Park, and Tender Touch Therapy in Lakewood, New Jersey. Clients beginning face-to-face therapy will also have the option of continuing treatment via the web.

In addition, Barbara will be available to work with clinicians looking to expand their expertise in stuttering treatment.

For an appointment, please contact us at barbdahm@gmail.com or by phone, please call us at 201-378-0089.

Barbara will also be giving a workshop at the National Stuttering Association Convention in Cleveland between July 7-11, 2010. She will be talking about the disparity between research and treatment for stuttering and explaining how this can be overcome. It looks like it will be a great convention. It’s an opportunity for people who stutter and their families to meet and discuss all aspects of stuttering and to have lots of fun with a great group of people.

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Relapse After Stuttering Therapy

May 20, 2010 By Barbara Dahm View Comments

A common complaint of people who have undergone stuttering treatment is that the results don’t last. This complaint relates to many other conditions, such as weight loss, anger management, addictions and so forth, and is discussed in a wonderful book, Changing For Good, by Prochaska, Norcross, & Diclemente. The authors discuss the reasons that people who come to treatment wanting to achieve certain goals do not maintain their accomplishments, and they outline a program to overcome this problem. I believe it is a must read for people who want to help themselves to make long-term changes in their behaviors and attitudes. In fact, I have incorporated the principles of this program in the Dynamic Stuttering Therapy Workbook.

Over and above the general difficulties of maintaining change, stuttering is a condition that presents special difficulties for the maintenance of change. One of these is that there is most likely an innate tendency for the brain to use an ineffective way for processing speech. Another is that most people who stutter are usually trying to change the wrong thing. I would like to address these two issues.

Research has shown that there are functional and possibly structural difference in the brains of fluent speakers and people who stutter when speaking. These findings are overlooked in most treatment programs. When working on speech tools, the goal is usually to change speech without any consideration of how the speech is being produced. Tools include smooth, slow speech, gentle onsets, pullouts, cancellations and voluntary stuttering. Working on using these techniques is like trying to change how the cake looks when it is finished instead of changing the ingredients and how they are put together. They deal with the result of speaking, the speech, instead of working on how to make it.

In Dynamic Stuttering Therapy we relate to the neuro-physiological process of speaking. During therapy one of the biggest challenges is to get clients to report on how they process speech both in practice and conversations between therapy sessions, instead of on whether or not they stuttered. I find that the clients who succeed in making this switch in perspective are the ones who maintain the new process and enhance their ability to speak fluently. This makes sense. If you are trying to be fluent, who knows what you are doing. It’s all a matter of chance. If you have a way of making speech that results in natural fluency, as happens when you use the processes you have used during therapy, you can make certain you use it.

Once we accept that there is a correct and incorrect process for making speech, there is still a need to cope with the innate tendency of the brain to function the way it is used to functioning. We have a clearly defined process for producing fluent speech, but that does not mean that just because you know the process and have used it, the brain will always function this way. People who stutter have to decide to use the process. The process doesn’t happen to them. They make it happen. Brain processes become stable only when they are repeated over and over again with awareness for at least 6 months to a year. This requires carrying out the process with awareness for a long time after knowing what and how to do it.

When the goal of therapy is to process speech normally, the issue of regression changes. Stuttering doesn’t come and go. You do not have to hope that you will maintain results. There is a direct connection between what you do and the fluency of speech. Regression does not happen, although the speaker might not use the effective process all the time. In this case stuttering may occur. Nevertheless, if you know the processes for producing fluent speech, you know how to return to it. Being able to do this is not a matter of chance. It is an empowering experience.

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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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Leading to Recovery From Stuttering

March 31, 2010 By Barbara Dahm View Comments

My experience in treating a few thousand people who stutter has shown me that while it may not always be easy, it is possible for most people who stutter to develop the ability to produce normally fluent speech. We do not yet understand why some people do use different neurophysiologic processes for producing speech, but we see so many examples of people who have apparently changed these processes. These are the people who once stuttered and no longer feel the same difficulty when speaking.

There are a few examples of famous people who for the most part have become fluent speakers. Carly Simon, who once struggled with stuttering, set her speech to a rhythm. In an interview she gave with Tavis Smiley, she showed an example of how she made herself speak with what she describes as syncopation. To me it looked like her speech progressed in syllables, as she was no longer trying to get words out. In the same interview, Smiley, who also once stuttered, says he began speaking fluently by imitating the cadence of Dr. Martin Luther King’s speech. This is an example of achieving a normal pattern of intonation.

Vice President Joe Biden tells of his efforts to overcome stuttering by practicing reading aloud in front of a mirror and trying to eliminate the contortions of his face.

My clients changed their neurophysiologic processes by learning to develop speech internally without any effort to get it out and by letting their voice reflect normal patterns of intonation while giving up all control over forming words or speech sounds.

Whether the change was made by self-help or within a treatment program, we can learn a few things from people who as older children and adults do change how they speak I am listing a few of them here:

They investigate how people who do not stutter speak.
They learn from watching and listening to themselves when they speak.
They become aware of the act of speaking, instead of trying not to stutter.
They are persistent in looking for solutions, instead of focusing on problems.
Whether or not it is their conscious goal, they change the intonation pattern of their speech.
They take responsibility for the recovery process.
They are willing to do repetitive practice on a daily basis.
They believe they are capable of making changes.
They focus more on what they do rather than blaming external situations for their stuttering.
They realize making change requires patience and time.

If you want to help yourself to speak with greater fluency, the first step is to develop as many of these qualities and behaviors as you can. It will make the process of change easier and so much more rewarding.

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Stuttering and brain plasticity – how learning changes your brain

March 17, 2010 By Barbara Dahm View Comments

As we learn more about stuttering, we are seeing increasing evidence that stuttering is related to the workings of the brain. If stuttering proves to be a genetic disorder or a neurological problem related to how the brain processes speech production, many people question what the point is of having therapy?

Once it was believed that the brain was hard wired. People thought that once the brain developed, there was no possibility of making changes. Today neuroscientists believe that this is not true. There have been many studies on brain plasticity, the capacity of the brain to change by developing new connections between neurons resulting in changes of the internal structure of the existing synapses.

We are all born with a specific genetic makeup that determines our tendencies. Musical tendencies, language abilities, handedness, and mathematical ability, among countless others are influenced by our genetic make up. However, when we engage in a specific activity to the point of becoming expert, the areas in your brain that deal with this type of skill have been shown to change.

Other evidence that the processes that produce stuttered speech are not so hard wired that they cannot be changed comes from a lot anecdotal evidence in which people who have once stuttered appear to be naturally fluent speakers and from our clients who report that stuttering is no longer an issue in their life. This is proof that the same person can produce speech differently at different times in his life.

During Dynamic Stuttering Therapy people who stutter learn to use the normal processes of producing speech. They begin therapy thinking that what they do is the only thing they can do, but soon see that it is indeed possible to produce speech in a way that is so very different. If it weren’t possible to change their way of producing speech, we would not see this happen. No matter what the cause of stuttering proves to be, change is possible and treatment can help people who stutter to make the necessary changes.

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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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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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Why DST Is So Effective

November 10, 2009 By Barbara Dahm View Comments

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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These Are Our Clients

October 27, 2009 By Barbara Dahm View Comments

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.

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