This leads me to what I believe is another major cause for the failure of treatment. There is a tendency on the part of professionals to become so rooted in a treatment approach or a theoretical belief about stuttering that they do not apply research findings and knowledge to treatment. Their prejudices and emotional investment in their work block them from being open to new ideas.

I recently searched for a title for a seminar that I will be presenting to clinicians. I chose Treating Stuttering With Confidence: A New and Logical Approach. “New” that word should no longer be appropriate. It has been almost 20 years since I gave my 1^st presentation in Oxford, England in which I said that stuttering can be explained and treated through an understanding of the process of speaking. The presentation was well accepted, even though we still had so much to learn about the differences in brain function and motor processing of people who speak fluently and those who stutter. In spite of the initial enthusiasm of my colleagues, as the research backed my theories and as the clear-cut cause and effect relationship between internal processes used to produce speech and the fluency of the speech became apparent, I saw a growing resistance from my colleagues.

Interestingly, I found a correlation between clients, including young children, telling me this approach to therapy “rocks” and that Dynamic Stuttering Therapy is the most logical therapy they have ever had, and professionals telling me they don’t understand what I’m getting at or just being too busy to review my materials. I do not take this resistance personally, because I don’t think that it is related specifically to the approach or to me. I do think that the inability to change perspective stems from a very human condition – resistance to change.

While understandable, professionals are at fault for not overcoming this resistance. We ask our clients to put their feelings and beliefs into perspective and overcome their fear of the unknown. It is also our responsibility to do this. The time has come to let go of the arguments of whether clients should work on fluency or accept stuttering. Calling fluency the “f-word” as I have heard fluency experts do is not helpful. It is demagogic. The affiliation by professionals with a theoretical camp should to be abandoned. All voices should be heard and minds should be open. Professionals need to work together. We need to brainstorm. We need to put our heads together to make sense of stuttering and to insure that clients do not suffer disappointment from our efforts to treat them.

Some people who stutter that have had disappointing and frustrating therapy experiences are angry with clinicians in general. They think that clinicians are taking advantage of them and don’t care about them. In all my contacts with my colleagues, I have not seen that this is the case. I see that clinicians are concerned with their clients’ wellbeing and believe they are helping people by sticking to their belief. Nevertheless, the lack of progress and being closed to new ideas is hurting these clients who we care about. We, as professionals, owe it to our clients to make therapy the most rewarding experience possible. If not, it is our fault.

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.

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

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.