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‘Your patience and knowledge was just a miracle for our son!’

We’ve added some recent testimonials to the site – we hope you’ll enjoy reading the successes patients and participants in Dynamic Stuttering Therapy have achieved. We’re very proud of each of them and what they have accomplished.

Hi Barbara,

Since we the last session, I must say that there has been a definite change in the way Josh speaks.  I can’t tell you the change that has occurred.  It seems like he really has just GOT IT.  He has control of his speech and it has lasted well over a week.  This is the longest that a notable change has been observed. Last night, he had 30 minute telephone conversation with his friend – absoultely beautiful speech.

I suppose I was waiting for the fall before emailing you again for another session.  Maybe we won’t need any more – a very unusual concept in this household as Josh has needed speech therapy since he was 6 and he has just turned 14 years old.

We have really not needed to remind him to use any technique, he self corrects – this approach to his speech works.  At times, I can see Josh working at using the strategies he has learnt from you – it works  …. IT WORKS.  He practices the strategies all the time – using it at all times – he has control – he feels in control.

Last December, I searched for an approach to Josh’s speech that would work for him – he had all the ingredients for success – interest, focus and dedication – but he needed a brilliant therapist and approach.  You are unique – the long search for an approach to fluent speech that worked was worth it.

Barbara, apart from the approach to speech, it was the discussions you had with Josh about the way he feels, linking this with his speech and ability to take a different perspective on board that was also integral to the improvement.

And can I also say that Josh not only enjoyed the skype sessions, but felt respected and liked by you – so thank you for the whole package.

Forever grateful,

Ellen

 

Dear Barbara,

This letter is past due.  I’m sorry it took so long but my husband and I, wanted to personally thank-you for the unbelievable work you put into our son, Avromie.  Before we started treatments with you, we thought it would be just another try, and another large sum of money, going to waste.  At our first visit, we were able to see how your idea and way of treatment just made so much sense!!  Your patience and KNOWLEDGE was just a miracle for our son!!  When our son does practice your techniques, it’s like, (as my husband put it), as if he swallowed some sort of pill!!  Thanks again of everything.

 

Hi Barbara,

Here’s as promised, a review of the therapy:

I have been trough the online stutter therapy,

I had my first sessions for some months ago.

I chose the online therapy because, first of all it was avialable for me - it is available for everyone who has internet.

And the online stutter therapy is very diiferent from other therapies.

What I learned was that my “stutter” (we are thought in the therapy to not use the word stutter) was affected from the major areas: 1) positive thinking and feelings towards my language

2) Fosucing on my vocal chords

3) Speeking in syllables

And also, I learned that my stutter is an old habit, from producing controlled language, in the wrong way.

The goal with the online stutter therapy is a fluent, enjoyable way of speaking.

And after 5 months of therapy I feel that being very much more the case than before, and I recommend this therapy to everyone. Just make sure you have the time for it first. If it is your goal to become fluent, and you have time for it, then I suggest this approach.

Friendly regards,

Oliver

 

Dear Barbara,

I need to tell you how valuable the Dynamic Stuttering Therapy program is to my students. Your approach gives students a “new” way of speaking which they can embrace and share with their families. Being in the public schools it’s often difficult scheduling students but I find my students seek out additional time to work on their speech, because of the program’s “user friendly” units/ goals. Thank you for clearly stating the goals and objectives and providing so many appropriate techniques.  Your program has been extremely helpful to not only the stutterer but to families. Thank you.

Susan Abrahamson CCC/SLP

 

(translated from the original Hebrew testimonial)

Hi Barbara,

First of all, thank you for the online session we had. I really enjoyed talking to you and of course reviewing the natural and normal way of speaking that disappeared from me for some time. The session was very successful and I got a lot out of it. I learned a lot about myself and about the way to speak.

I understand the (treatment) approach at CTI. I know that this approach is the right one and most important the natural method of speaking.

I’m happy to share with you and help you understand the person who stutters. Even though I have always stuttered mildly, I suffered from a lack of confidence in some situations when I had to talk or express my opinions. That was certainly very frustrating and caused me discomfort and not a few times bitter disappointment.

It is absurd to say that the normal way of speaking is the natural and easy way that little children speak, without any control or “filter”. It is just speaking without thinking about how to speak; speaking the way nature meant for us to speak. As a person who stutters mildly, I absolutely know that most people who stutter monitor their speech and plan what they are going to say. This is what disrupts the speech and makes it sound unnatural, causes prolongations, ends in blocks and causes certain words and sounds to get stuck. And it’s terribly, terribly frustrating for some one who has stuttered that unfortunately people who stutter still carry have a negative stigma. The secret is to speak without any monitoring, without filters, without preparing. Simply… talk automatically so that there is a natural coordination between the brain and the whole speech system!

I still think that it is not so easy to get rid of the habit of focusing on words and doing all sorts of preparations to speak, such as changing words, prolonging words. It is really difficult for someone who has used the wrong process for speaking for many years to give up old habits and get used to speaking naturally. Making this change is not easy or simple for everyone, but it is possible and it is the only way to speak naturally without stuttering!! Practicing internal speech (speaking silently in the head) is really worthwhile. (That was what was missing for me all these years!!)

So thank you very much for helping me get back my confidence in speaking. Already, during the past few days since our session, I have felt an improvement. This is the right approach!! A great approach!!! It is the approach that gets to the source of the problem instead of the syndrome and shaping the speech.

If you would like, I would be happy to send you heartfelt recommendations so that everyone will see and will learn the importance of realizing that this is the approach that can save everyone from the problem of stuttering.

 

Hi Mrs. Dahm,

That hope that you have been well. I’m afraid that I have the bad habit that when I don’t respond to an e-mail right away I get busy with other things and manage to forget about it completely… Anyways, here’s my update. I have overall been relatively pleased with the progress that I have made toward consistently speaking correctly. I would say that one particularly positive point has been my attitude toward speaking situations in general.

I have gotten to the point where I really don’t worry about any speaking situations any more. I gave an approximately 10 minute speech at my brother’s wedding, in front of a few hundred people, and I was not nervous about stuttering beforehand. No doubt related to that fact, I spoke correctly pretty much the whole time and therefore was able to speak fluently. There was a long time when I would have probably declined that opportunity to speak for fear of stuttering, and if I had done it I would have worried so much and tried so hard to speak fluently that I would have spoken incorrectly and therefore stuttered a lot.

In general, I have been making progress toward speaking correctly more of the time. I still sometimes slip back into my old way of speaking, trying to use my mouth too much to shape and force out my words. I think that I’m usually pretty good about noticing when I’m doing that and then going back to speaking correctly. I’m still working on making the correct way of speaking more habitual. I hope that you have been well. I’ll keep you posted about how things go in the future.

All the best,

Daniel

Whose Fault, part II

In part 1 of Whose Fault, I said that a major cause for the failure of stuttering treatment is a lack of knowledge of how to treat it. That is pretty amazing in the 21st century when so many advances have been made in the treatment of very complicated diseases, and innovative behavioral programs are abundant and often very successful. Our knowledge of biology, physiology, neurology, genetics, physics, and even human behavior has taken giant steps. However, mainstream stuttering therapy has remained pretty much the same, albeit with some refinements, for the past 80 years. We have learned a lot about the nature of stuttering from clinical observations and research, but this knowledge has not been incorporated in how stuttering is treated.

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 1st 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.

A new concept of stuttering

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:

  1. Learning to develop internal (sub vocal speech) naturally without any attempt to get it out
  2. Allowing the speech muscles to work on an automatic mode
  3. 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, (2nd 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.

Ariel’s story – a client before and after stuttering therapy

Shmulik’s story – stuttering “no longer an issue”

11 years after treatment with Stuttering Online Therapy, Shmulik, who once stuttered severely, explains that stuttering is no longer an issue in his life.

Gil’s story – before and after stuttering therapy with a client

At Stuttering Online Therapy, we see firsthand the progress our clients make, but we love it when our clients are happy to speak for themselves.

During Gil’s first therapy session:

Gil: Let’s say, there are times when I realize that my stuttering slightly bothers me. It happens when I’m a bit tired or if I go out to a pub and drink. Then my thoughts are not organized; they are free and not in my control. I noticed at these times that I have a tendency to stutter more. Or I have problems with the flow of speech, so in these situations I have more stuttering…

After 15 hours of treatment:

Gil: First, I got a new way of expressing myself. (Before) the words were always in my head, but the way to get them out was a bit of a problem.  (Now) the ideas simply flow in a very free way.  Suddenly, after a long time of not doing this and not being used to doing it, you feel a real relief. Suddenly everything goes smoothly like it’s supposed to. Speech is something so basic. It’s your way of communicating with the outside world. Suddenly, something that was so difficult and not right goes smoothly and, in short, that gives you an excellent feeling.

(In this therapy), you have goals that are A,B,C,D and you know you have to focus on them. These are the basics and you go according to them. This makes the therapy very focused.  It doesn’t say to you, “Well, you have to loose 50 kilo in a half a year.” It’s not like that. It’s not something abstract like that. There are specific goals that go with you all the way. The therapy is very focused.

Barbara: Have you changed your perspective about what speech is?

Gil: Yes, of course. Before (treatment) I didn’t know at all what it was – how you develop ideas, how it gets out of your mouth, how everything happens in your brain. Suddenly you actually realize that it (speaking) is really about not doing anything.

Barbara: What is your feeling today as you complete the formal stage of therapy?

Gil: Humm. First there is still more to do. I am not yet 100% there, so that I can’t say, “Great, after 15 hours of this treatment course, I can do everything that I want.”  But first of all, it really contributed a lot to my self-confidence. If once, you were afraid or hesitant to open your mouth because of how people might react or because you couldn’t speak fluently, then it’s already normal not to be that way. That helps a lot. I don’t know, it’s just that everything is so much freer. The thoughts that you always had that were such a bother are reduced. They suddenly just aren’t there. So you have the time, freedom and energy to think about a million and one other things. Once the energy was directed to another place. Now you have the energy to use freely for whatever you want. You have peace of mind.

The therapy on skype is something that I had heard of for the first time and had never thought of doing it. I had never heard of such an option. At the beginning I was a bit skeptical.  I said, “What? Via skype?” I am used to using skype just to talk to my friends abroad. It seemed strange to get therapy via skype. But, honestly, it is a great development. It’s not the conventional way of coming (to a clinic). It cuts out a lot of the bureaucracy of traveling, parking and sitting face to face. The therapy was much more comfortable and pleasant.  It’s so much nicer. You go home to your own home and open up your computer for a 1-2 hour session, and that’s it. You’re finished. You also have all your home practice on your computer. It’s not the regular therapy and I really liked it a lot.

Upcoming events for the summer

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.

Stuttering- More Than Feelings

Many people who stutter believe that they stutter because of their feelings about themselves and being too concerned with what other people think of them. It cannot be denied that people who stutter often stutter more when they are concerned over how they present themselves or how their speech sounds to others. However, it is important to differentiate between what causes stuttering and what increases stuttering. Making this difference is essential for understanding what stuttering is and for the self-esteem of many people who are sincerely trying to not let their stuttering affect their lives.

I want to make this point, because I have heard many people who stutter say that if they could make themselves care less about stuttering, they would not stutter. The fact that they are still stuttering seems to them to be a failure in their ability to cope emotionally. This is not the case. A person can be the most centered, emotionally intelligent and socially well-adjusted person and still stutter. This is true, because stuttering is a condition that involves so much more than the person’s feelings.

Today researchers are coming up with more and more evidence that the place where speech is created, the brain, is the source of stuttering. Recently new genetic research lead by Dennis Drayna at the National Institute on Deafness and Other Communication Disorders (NIDCD), part of the National Institutes of Health, has shown that at least some people (thought to be 9% of the people who stutter) have a gene mutation, not found in fluent speakers. It turns out that these particular genes are responsible for the production of two enzymes necessary for a metabolic process required by all cells, but that especially affect a group of cells in the brain responsible for speech. Other researchers studying other families have also found indications of mutations in genes of those members of the family who stutter. The relationship of these genes to speaking is not yet clear. However, what we are seeing is that stuttering isn’t simply a question of how the person feels.

For those people who have tried to stop stuttering by changing only their attitude and feelings, it is important to know that stuttering is not only about what you feel inside. Advertising stuttering is good and helpful. Learning to be self-accepting of yourself whether or not you stutter is essential for your personal wellbeing. Being disappointment in yourself and thinking you have failed because you still stutter is self-defeating and misplaced.

Chasing Fluency

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

There Is Hope For Overcoming Stuttering

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.