What is meant by ‘manage’? Increasingly we find people who are so successful at managing their speech that the disorder is no longer the big problem it once was. They have replaced many or most of their speech fears with ‘speaking confidence’ – the previously feared situations or words no longer cause tension. As a result their speech tension no longer reaches their threshold. Or else they may have lowered their base-level tension sufficiently to prevent their speech tension from reaching their threshold. (See the chapter ‘A possible cause of stuttering’ for explanations of these important concepts printed in bold).
These people may not all be ‘cured’ in the sense that they will never stutter. They may still have the potential to stutter, and on occasion they may be tripped up. They have, however, stress-desensitised themselves in many previously problematic speaking situations; and they have the tools for tackling and stress-desensitising areas that still cause tension.
One such person is Dr Grady Carter, co-author of Martin Schwartz’s second book, Stop Stuttering. In this book Dr Carter describes how he gradually got the better of his stuttering. In the course of time his stuttering 'atrophied from disuse and died a silent death', as he put it.
Success stories such as these are the result of hard work, perseverance, motivation and perhaps other factors (see below) in favour of progress; but cases have also been reported where a cure apparently was the result of little or no effort. There is the case of the man who was cured after watching a TV programme on stuttering; and cases where a combination of stress-reducing vitamins and minerals resulted in a cure. The reason for these cures seems obvious: a dramatic and huge drop in base-level tension, so that the stuttering was no longer activated. In the case of the TV watcher, the psychological effect of the programme was so immense that the watcher's base-level tension dropped significantly; in the case of the vitamin drinker the drop in base-level tension was physiological.
Easy cures such as these, however, are unfortunately few and far between - though cases such as these should be studied as they contain pointers for future breakthroughs in therapy. People differ in their psychological and physiological make-up, particularly with regard to their stress levels. For the majority of us, the road to success is more complex.
Sadly it also needs to be said that, at the other end of the spectrum, a minority of chronic stutterers do not seem to respond to any type of currently available treatment. For these unfortunates, acceptance of and psychological adjustment to the defect seem the best option.
The adult stutterer who really wishes to take on the challenge of improving his speech has to understand that treatments are usually long-term and require a lot of work and effort. In addition progress may also depend on several other factors.
A second point is that it may be inappropriate to speak of a 100% cure for stuttering. Stuttering is, at least partly, behaviour which is to some extent stress-related and partly learned. Though many stutterers anxiously await a miracle cure, usually in the form of a new medicine being tested and showing some promise, a quick cure does not yet seem to be on the cards for the foreseeable future - for most of us anyway.
This raises another issue which is frequently raised on stuttering discussion websites: Does therapy for an adult stutterer serve any purpose at all?
This is a valid question, bearing in mind that effective treatment can be a difficult and long-term procedure, usually requiring effort on the part of the adult stutterer. Most of all it’s a question the individual will have to answer for himself. He should know what he’s letting himself in for before actively trying to improve his speech. He needs to realise that he has been suffering from the defect for many years, that the condition is firmly established and that therapy may, among other things, demand a personality adjustment and a change in lifestyle. For instance, issues such as stress and stress management may have to be addressed.
A stuttering teen or adult’s decision to undergo speech therapy (whether self-help or therapist-led) should also partly depend on the extent to which his stuttering is (or may become) a major problem. Some stutterers have managed to pursue a successful career, are satisfied with their social life and have adjusted well to their dysfluency. They may argue that it is not worthwhile for them to expend lots of time and energy on improving their fluency - they would rather spend that energy on their careers, hobbies etc. Surely their circumstances differ from those of stutterers whose speech hampers their career prospects, forces them to live in isolation and submits them to daily psychological torture. This last group has nothing to lose and may benefit from therapy.
Another consideration is the possibility of limited, well-defined goals. Instead of a complete cure, it may be more realistic to aim at success in a particular problem area, such as telephone conversations. After all, most people have no need to master advanced communication skills such as public speaking – in fact most normal speakers are loath to deliver speeches and the like.
Realistic goals such as stuttering management can be attained for many stutterers. The stutterer may therefore decide to aim for a particular level of control and/or a degree of psychological acceptance of and adjustment to the defect. This may not be the ideal solution, but is preferable to an endless and frustrating search for an elusive dream.
Some factors that may affect the success of stuttering therapy
1. Type of treatment
This is a controversial issue, and may be related to the theory of the cause of stuttering favoured by the therapist.
In this respect the person who stutters should ask the following questions before undergoing therapy:
- Is the programme in which you are interested limited to psychological counselling, or does it also include learning a fluency technique? Both could be of benefit.
- Is the treatment short-term or long-term? Don’t trust a programme promising a quick and permanent cure. Does it offer an adequate follow-up programme, a support system (eg. a telephone hotline and local support or self-help groups) and frequent refresher courses? Is intensive group therapy available for those who prefer this to individual therapy? Does the treatment aim to transfer the fluency acquired in the consulting room to real-life situations?
- Establish the importance accorded to stress and base-level tension. Programmes neglecting these crucial issues are hopelessly outdated.
- Try to find a therapist who specialises in stuttering. Ask to be put in touch with former patients to establish if the treatment really helped them.
2. The patient
- Stutterers should realise that their personal impression of the therapy and the therapist plays a role in treatment. Therapy contains an element of subjectivity – the stutterer may respond to suggestion. The patient who strongly believes in the therapy or the healer may benefit from the treatment even if the healer is a charlatan. Such a patient becomes so convinced of his progress that his self-confidence increases, his stress levels decrease and his speech improves, even if only temporarily. Unfortunately the opposite can also apply: the patient may not benefit from the treatment if the therapist fails to make a positive impression – no matter how effective and logical the treatment may be. In much the same way few audiences will be impressed by a Beethoven symphony performed by an uninspired orchestra, and a Shakespeare play will fall flat if the actors cannot do it justice.
- Much will depend on you and your personality. Are you prepared to do your homework? Do you have the necessary self-discipline and determination? Are you really motivated? Are you prepared to work on your speech and related problems such as stress and self-image? Are you prepared to increase your knowledge of the defect so that you can apply the different strategies in a flexible way that applies to your circumstances and needs? And most important of all: do you have the ability and courage to change? In the next chapter I will discuss some ways in which your life may need to change.
Experts have given a great deal of thought to factors that may favour a patient at the onset of therapy. I name a few:
2. Weak vocal cord spasms.
3. Speech fears and learned stuttering behaviour which have not yet become well established. The older the patient, the more deep-seated the fears and the stuttering tend to be.
4. A good self-image. The shy, withdrawn and sensitive person may be less able to resist tension and stress.
5. Openness about stuttering as opposed to regarding the disorder as a private and secret matter. Social skills may also play a role. A person with many social skills may find interacting with others easier and less stressful.
6. Emotional self-control. The tension levels of an excessively emotional person tend to rise very rapidly.
7. Time, energy, motivation and perseverance.
There are numerous different treatments for stuttering, and although I briefly discuss a few in a later chapter, I have not attempted to treat all of them comprehensively – that would require a separate book, and qualified speech experts would do it more justice than I ever could. I would prefer to focus on the Passive Airflow approach of Dr Martin Schwartz, of the Medical Centre of New York University. Many people including myself have benefited from this approach. I am convinced that Schwartz’s work in this area is a breakthrough and an example of a modem, sophisticated and comprehensive treatment procedure.
It is a fact that the Passive Airflow approach have already helped many people. I include a few of the comments made in an opinion poll amongst members of the self-help groups I was involved with for many years:
Everything has improved. I don’t have as many feared words as I used to and I don’t avoid them either. My first thought in conversation used to be: ‘Will I get stuck?’ Now it’s: ‘Did I use the airflow to help me speak?’ I used to find ordering food in restaurants very difficult. Nowadays I don’t even think that I could stutter. I order for everybody. Life is much easier.
It was different eighteen months ago. I couldn’t read aloud from a book. I couldn’t tell strangers my first name. I managed, but only because I word-substituted all the time and used all kinds of mannerisms ... I’m more relaxed than before. I feel at ease with people. I’m not one hundred per cent, but I’m improving ... It’s a situational improvement. I speak in far more situations than before. Recently I waited in a post office queue and started talking to someone behind me, and later even to the desk clerk – while others stood by and listened. I would never have done something like that before. (Robin, 44, a sales manager)
The airflow technique has all the answers - except one: It’s not a quick fix. People want a pill for every ache and pain, and we want one for stuttering. Practising to speak correctly takes a lot of time and effort - you get nothing for free. I don’t practise, but I know that I can get out of a block with the airflow technique. You have more control over your speech. (Dieuwke, 38, pharmacist and mother of four)
The airflow approach is very logical and provides a long-term strategy to confront stuttering. It addresses both the psychological and physiological components. It gives you an understanding of stuttering, and on this basis you can confront it. Speaking on the telephone and going to the doctor are no more feared situations. (Ed, 20, student)
I learned to use the airflow technique in 1986, and since then my speech has improved by sixty to seventy per cent ... Telephones don’t scare me anymore. Of all the methods I’ve tried, this is the only one for adult stutterers. It provides a physical foothold, a starting point from where you can gradually improve your speech. (Johnnie, 59, superintendent in the public service)
Now, two and a half years after the workshop, my speech is much better and my speaking confidence has improved ... I am much better off now than I ever was before ... (Bruce, 40, computer programmer)
I went down the same road as any other stutterer – always looking for but never finding the miracle cure that would break my chains. But in His wonderful way God answered my prayers. He didn’t cure my speech disability, but guided me to a technique I could use to speak fluently. I will always be a stutterer, but with hard work I have managed to control the laryngospasm and the accompanying struggle behaviour.
After practising for hundreds of hours, going to numerous self-help meetings and almost giving up hope, I have become quite fluent. I still have difficult days when my tension is too high even for the airflow, but I’m much better than before. (Frank, a public servant)
It is important to keep in mind that these results were obtained in spite of the virtual absence of proper treatment and follow-up facilities – in fact some of the above comments are from people who haven’t attended any airflow workshop; they were taught within our self-help group.
A criticism which has been levelled against fluency techniques such as airflow is that they tend to neglect the psychological aspects of stuttering. I have tried to rectify this by adding a few chapters on psychological aids such as positive thinking and self-assertion. Conversations with stutterers have indicated time and again that these aids have helped many people.
Before we focus on the airflow approach, however, we have to consider the problem (or rather the challenge) of change.
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