Some Other Techniques and Approaches

The correction of stuttering is a do-it-yourself project. Stuttering is YOUR problem. The expert can tell you what to do and how to do it, but YOU are the one who has to do it. --- Harold Starbuck, retired professor of speech pathology, New York


This book emphasises vocal cord tension management for the control of stuttering, but other techniques and approaches may also benefit those who stutter. Like all stuttering approaches they all have their particular limitations. Consult a speech and language clinician or other relevant expert if you feel that you may benefit from one or more of these approaches. Some aspects of these approaches have already been incorporated in previous chapters of this book.

The treatment of stuttering comprises a vast and continually changing area of knowledge. What follows can therefore only be a lay summary, with a bias toward the view that stuttering is caused by tension-sensitive vocal cords.

First we have to look at the different structures that constitute therapy.

1. The structure of therapy

a. 'Speak more fluently' approaches 

Many experts argue that modem stuttering therapy should consist of three phases: 1) establishing fluency in the speech clinic, eg by learning a fluency technique, 2) transferring this new fluency to actual situations in everyday life and 3) maintaining fluency to make it permanent.

This is also the structure used throughout this book, and many stuttering clinics, particularly those who favour fluency techniques, have adopted this phased approach.

Being taught a fluency technique is usually part of what is known as a ‘speak more fluently’ approach, also known as fluency-shaping. A ‘speak more fluently’ approach focuses on trying to get the PWS fluent – in contrast with the ‘stutter more fluently’ approach where the focus is on the stutter rather than on fluency. The ‘stutter more fluently’ approach is more psychological in nature, and the PWS is taught to stutter in a more relaxed and manageable manner.

b. 'Stutter more fluently' approaches


In contrast with the structured 3-phase treatment of stuttering mentioned above, other clinicians – particularly those who favour a more psychological or a ‘stutter more fluently’ approach – prefer not to have a definite therapeutic structure. They rather emphasise counselling and the interpersonal clinician-client relationship.

Both of these contrasting approaches have merit, depending on the client’s particular stutter and personality. For instance, some PWSs may just be interested in learning a speak-more-fluently technique to speak better, and may not need any psychological ‘adjusting’; for others, stuttering may entail a huge emotional load to bear which aggravates stress, so contributing to the stutter. Obviously this would require a greater focus on counselling.


2. Breathing therapies

Breathing is a major part of speaking, and breathing techniques have been part of stuttering therapy for many years.

Costal breathing, also known as deep breathing, belly breathing or diaphragmatic breathing, is generally regarded as a healthier way to ingest oxygen. It is often used as part of therapy not only for stuttering, but also in the treatment of certain anxiety disorders. Costal breathing means breathing deeply by flexing one's diaphragm and expanding the stomach rather than the chest. It is also used in some yoga and meditation traditions. With practice it can become a standard way of breathing.

This type of breathing can reduce stress, the reason being that when we are stressed or angry, we tend to inhale and hold our breath as part of the 'fight or flight' response. Exhaling, however, signals to the body that the danger is past and that it can relax.

In stuttering circles, costal breathing has in recent times become identified with two fluency institutes, the McGuire Programme and The Starfish Project.   

The McGuire Programme offers intensive courses for adults, run by people who themselves stutter or have stuttered. It was founded in 1994 and is active in several countries. Costal breathing as a fluency technique is a major part of their therapy, and the emphasis is also on hard and dedicated work on one's speech. It has been called a 'boot camp' for people who stutter, as the exercises are compared with sports training, the aim being to become accomplished at 'the sport of speaking'.

Other features of the course are mental disciplines such as self-acceptance, assertiveness, non-avoidance and how to handle relapses. Post-course support is excellent, with attendees welcomed back as often as they wish in order to continue working on their speech, and they are encouraged to get involved in helping new attendees.

The Starfish Project originated as an offshoot of the McGuire Programme and is based in the UK. It is in many aspects similar to McGuire and offers a 2,5-day intensive course for adults, focusing on costal breathing, desensitation, avoidance reduction, phone work, positive thinking and transferring fluency from the workshop to the outside world.

As with McGuire, much emphasis is placed on post-course support via free follow-up courses, support meetings and a phone list of ex-course members who are willing to be phoned at any time to share problems and reinforce the costal breathing technique.

According to Starfish, they differ from McGuire in that their approach is non-invasive, i.e. without the element of coercion inherent in the McGuire 'boot camp' approach. So there is no obligatory speech-making and the like. This is therefore a 'softer' approach compared to McGuire, though it should be noted that both the 'hard' and 'soft' approach could be of benefit, depending on the individual. Even so both courses are by their nature demanding, as adult stuttering can be a difficult nut to crack. Starfish, however, is less expensive than McGuire.

There can be no doubt that both these programmes have brought success and improved fluency for many stutterers, and this could be ascribed to the focus on hard and regular work, excellent post-course support, group intensive therapy and psychological assistance such as assertiveness training, etc.


3. Slow/prolonged speech

More popular in the UK than the US, this ‘speak more fluently’ approach has some features in common with the Passive Airflow technique. The emphasis is on slow speech, until fluency is achieved. The PWS may also be taught to pause during speech, as many PWSs tend to fear pauses, and tend to rush their speech.

An additional feature of this approach is its emphasis on prolonging sounds, especially vowels. Prolonging vowels reduces stuttering, the reason being that your vocal cords vibrate when saying vowels – and, as has been stated before in this book, the vocal cord spasm will usually not occur when the cords are already in a vibrating state.

When fluency is obtained in the clinic via the slow and/or prolonged speech, the speech tempo is gradually increased to that of normal speech. In a step-by-step manner the client is exposed to different degrees of difficulty. He may, for example, start with reading and once he can read fluently, progress to a more difficult level such as monologues and eventually dialogues. The final objective is to transfer this fluency to the world outside the speech clinic.

Benefits:


Slow speech can help the PWS in many ways – it reduces speed stress and provides more time during which one can formulate one’s thoughts and apply speaking techniques.

Disadvantages:


Though slow speech is generally beneficial, exaggerated slow speech and too long pausing may have the result that the vocal cords cease to vibrate. Lack of vibration makes it easier for the vocal cords to lock. The end result, in a worst-case scenario, is a slow speaker experiencing a block after every pause.

4. Distraction treatments

Many PWSs are more fluent when they don't THINK about what they are going to say. This phenomenon has given rise to various therapies that use some form of DISTRACTION, to take the PWS's focus temporarily away from what he wants to say.

Distraction is in fact part and parcel of many techniques and approaches that are not usually classified as distraction techniques. For instance, the 'artificial stuttering' approach of Van Riper (see further down in this chapter) includes an element of distraction - when you stutter intentionally, the mind is momentarily distracted.

Disadvantage: 


The problem with therapies based purely on distraction is that many clients, after experiencing some temporary, initial fluency due to the distraction, gradually become used to the distracting stimuli – so that they can once again concentrate fully on their stuttering!

Distraction devices of the past

For centuries PWSs have been using distraction techniques to improve their speech. According to tradition, one of the ways in which the great Greek orator Demosthenes rid himself of a speech defect which may have been stuttering was by speaking with pebbles in his mouth. The pebbles probably distracted his attention from stuttering, and / or forced him to speak slowly. Much of the later equipment used to treat stuttering is based on this age-old principle.

Strange oral devices such as a mouth-plate or other mouthpiece were sold to PWSs in the nineteenth century. These devices deliberately made it difficult to speak, and distracted the wearer to such an extent that they simply forgot to stutter. As can be expected these devices were impractical.

It has been known for some time that some people will not stutter if they cannot hear themselves speak. Masking devices such as the so-called ‘Edinburgh masker’ were based on this principle. This device consists of earphones attached to a small, portable electronic control unit. When activated manually, the device produces white noise in the earphones that prevents the speaker from hearing himself. An automatic version produces noise when the user begins to speak, and stops when the user stops speaking.

This device probably works through distraction, and / or by preventing you from hearing your own (poor) speech, in this way reducing the negative emotions (and increased tension) generated by stuttered speech.

Delayed auditory feedback (DAF) and frequency altered feedback (FAF) appliances

Interest in electronic appliances to manage stuttering has increased by leaps and bounds in recent decades, partly because modern technology has enabled these appliances to become very compact so that they can be worn on the person, very much like a hearing aid.

Bulky DAF / FAF devices have been used for many years by clinicians to treat PWSs. Newer, portable versions are now so small that they can be worn in or around the ear. They alter sound, so that you hear your voice at a slight time delay (DAF) and / or at a different pitch (FAF).

Of these gadgets, the SpeechEasy (click here for the website) has generated much publicity. The appliance changes the sound (including your speech) through DAF and / or FAF, creating a choral effect – in other words, it will sound as if you speak in unison with others. SpeechEasy is based on the principle that a PWS’s speech usually improves when speaking in unison with other people. The SpeechEasy is expensive – in May 2010 the cost ranged from $4100 to $5100.

Other appliances include:

The CasaFuturatech devices - click here for the website 

CasaFuturatech’s Pocket Speech Lab (PSL) is of special interest in the context of this book, which focuses on the vocal cords as the core root of stuttering. The PSL provides, inter alia, feedback on the tension in your vocal cords. The appliance analyses your voice's pitch and volume and shows a red light on the control unit to indicate tense vocal folds.

Defstut - click here for the website

VoiceAmp - click here for the website

Benefits of these appliances:

  •  Some people do benefit from these devices to a lesser or greater degree.
  • Apart from the distraction effect, these devices may also hold other benefits. Because of the delaying effect of DAF, the user tends to speak slower, which reduces speed stress on the vocal cords. There could also be psychological benefits – the user may feel more relaxed and confident wearing the device.
 Disadvantages of these appliances:

  •  For many people, distractions have a temporary effect. After a while the wearer tends to get used to the distracting stimuli.
  •  These are not cures, but speech aids. 
  •  They tend to be expensive.
  •   Silent blocks can be a problem, because you won’t hear any sound to distract you. However, some of these devices have a masking function (white noise such as a hiss or buzz) which you can turn on manually to overcome the silent block.
  •  Noisy situations may make it hard to hear your voice, though some devices offer a noise reduction function.
  •  The field of stuttering management through electronic aids is wide-ranging and continually developing. For more info, go to the British Stammering Association’s website which you will find HERE.
 DAF and FAF software

The devices discussed in the above section are, as mentioned, expensive. A cheaper option is to purchase DAF and FAF software which can be used on your PC, portable computer or cell phone:

ArtefactSofthttp://www.artefactsoft.com/   Products include:

DAF software for the iPhone and iPod Touch

DAF/FAF for the iPAQ Pocket PC

DAF/FAF for handheld computers running Windows Mobile 5.0

 DAF/FAF for Windows desktop PCs.

SpeechGym – click HERE for their website   Offers DAF for desktop and pocket PCs.

FluencyPalclick HERE for their website   Offers DAF for many types of cell phones.

5. Syllabic or rhythmic speech

Very popular during the 1960s, this fluency technique is now regarded by many clinicians as obsolete. Interestingly, however, Prof Mark Onslow of the Australian Stuttering Research Centre argued in 2007 that a subtle version thereof may still be of value for some PWSs.

For centuries it has been known that rhythmic speaking greatly improves the PWS’s speech, eg ‘I’m-go-ing-home-now-to-watch-T-V.’

In normal speech, only some syllables are emphasised. In the word ‘MissisSIPpi’, for example, only the uppercase, underlined section is stressed. This therapy teaches the PWS to stress EVERY single syllable. Sometimes he is also taught to accompany himself by tapping out the rhythm with a finger or foot. The unnatural rhythm distracts attention from feared words, and furthermore linguistic tension is reduced by eliminating the natural accents in words and sentences.

The danger inherent in providing rhythmic accompaniment with a finger etc is that these movements may become involuntary, and incorporated into stuttering behaviour through conditioning. Rhythmic speech also sounds unnatural.

Clinicians of this school of thought sometimes used a metronome to help the PWS learn rhythmic speaking. Some PWSs also used an electronic PORTABLE metronome, resembling a hearing aid and emitting rhythmic signals. The user was supposed to speak in time with this rhythm. The signals served as a distraction device. The metronome was usually set at a slow tempo, which trained the user to reduce his speaking tempo, thereby eliminating speed stress.

Once the client managed to speak fluently with this technique, the clinician helped him to gradually increase his speaking tempo and to make use of normal accentuation.

6. Singing, tone and whisper therapy

Why do singing, whispering, or speaking with a strange accent or in a different tone sometimes improve a PWS’s speech? According to Prof Martin Schwartz, the vocal cords open partially just before a person sings, whispers, etc. This reduces the likelihood that the vocal cords will lock. Under conditions of severe stress, however, the vocal cords may not open sufficiently, so that they lock.

Singing, whispering or a change of tone may also serve to distract the speaker’s attention.

Some therapists provide tone therapy – the client learns to vary his tone of voice during speaking. The disadvantage of this technique is that it sounds unnatural – as if you are singing to your listener! Speaking in a whisper is equally unnatural and impractical.

7. Conditioning

Operant conditioning

Many treatments include the principles of conditioning. Conditioning in stuttering therapy is based on the theory that stuttering is learned behaviour, and that it can therefore be unlearned. According to this approach, fluent speech can be reinforced by rewarding it in some way (eg through praise or encouragement), while stuttering behaviour can be weakened by disapproval or some form of ‘punishment’. This form of conditioning is known as operant conditioning.

Operant conditioning in stuttering therapy – in other words, rewarding fluency and discouraging nonfluency – has generally had disappointing results where it was used as the main therapy, which is not surprising if you agree with the point of view advocated by Prof Martin Schwartz. According to Schwartz, the claim that stuttering is learned is only true up to a point. In his view the locking of the vocal cords itself is a non-learned, inherited sensitivity to stress, though this stress is often the result of learned tension and complicated by learned struggle behaviour. The non-learned component will not respond to conditioning – the learned components will.

Of greater value is INDIRECT reward and punishment. Undertaking a ‘contract’ with others to pay them every time you fail to use your speech technique (see the ‘Maintenance’ chapter) is an example of this.

Classical conditioning

Classical conditioning is a different form of conditioning. Classical conditioning makes use of ASSOCIATION to teach new behaviour. The well-known experiment of the physiologist Pavlov is a prime example. Over a period of some days he fed a dog and simultaneously rang a bell. Eventually he found that the dog started salivating as soon as the bell rang, even if he did not give him any food. The dog responded to the bell as if it were food. He started associating the bell with food.

It would seem that both types of conditioning play an important role in much of stuttering behaviour (see the chapter ‘A Possible Cause of Stuttering’ where the role of conditioning in the development of the disorder is discussed).

In this context I cannot resist repeating an odd story I heard from an acquaintance who stutters. In his youth he was treated for his stuttering by a psychiatrist. The psychiatrist decided that the client needed to have something done about his poor speaking confidence. Subsequently the shrink identified an area in which the client had an abundance of confidence – his maleness and sexuality. He was in fact very fond of the opposite sex and never stuttered in the company of girls. A strategy was devised in which the client repeatedly had to read aloud, simultaneously and unobtrusively holding his penis via a trouser pocket – the idea was that he would learn to associate his positive feelings about his sexuality with his speech. The client was then instructed to unobtrusively hold his sexual organ every time he found himself in a difficult speaking situation! This treatment was unsuccessful ...

An example of classical conditioning as an aid is found in the chapter ‘Learning the Technique’, where the reader is encouraged to practise his fluency technique as far as possible within the place where he usually has difficulty speaking, eg. in the empty classroom after school. In this way he will begin to associate the technique with the classroom.

Unlearning secondary behaviours

It would appear that learned secondary struggle behaviour such as facial contortions, involuntary arm movements etc can indeed be unlearned (though this would not necessarily have an effect on the vocal-cord lock). Experts recommend the following procedure for overcoming learned secondary behaviour:

1. Identify the exact nature of the automatic behaviour and divide it into smaller components. This will make it easier to eliminate.

2. Start by changing and thus weakening the behaviour, rather than attempting to eliminate it all at once. For example, a person who cannot speak without first involuntarily moving his head towards the left, should try moving it to the right, or backwards or forwards.

It may also be possible to unlearn a learned stress response. A person who automatically becomes tense in shops, for instance, can weaken this learned stress response and gradually eliminate it by DELAYING the reaction – ie postponing for as long as possible the moment when his tension will rise. He could tell himself: ‘Yes, I know I’ll become tense, but not right away – only after the count of ten.’ (Compare this with the traditional advice of counting to ten before losing your temper.) This type of treatment can be of great use for PWSs.

It can be very difficult, however, to overcome learned, deep-seated speech fears. These fears may have a still-valid source: the punishing effect of the social embarrassment caused by stuttering. These fears feed on the PWS’s everyday experiences. For this reason it may be of help to use a fluency technique to attack these fears at their very origin – the stuttering itself.

8. Charles van Riper’s approach

Van Riper (1906-1994) was a very influential American stuttering expert, and a PWS himself. His is one of the so-called ‘stutter more fluently’ approaches, also known as block modification. The client learns how to better control his stuttering rather than to be fluent. The emphasis is on stuttering, rather than fluent speech. Four phases can be distinguished:

1. Identification. Client and clinician make a detailed study of the actual stuttering behaviour: the precise nature of the struggling, avoidances and distractions. This demystifies the disorder and places it in a less emotional context. Van Riper rightly argued that the PWS has to know as much as possible about his own stuttering behaviour before he can do something about it.

2. Desensitisation. The aim in this phase is to reduce the PWS’s speech fears and other negative feelings such as guilt and shame. The client is also encouraged to see the disorder in perspective, to be less hypersensitive about his speech and to accept his stuttering to some extent. He is trained to stay calm while stuttering, to maintain eye contact and to be open about his problem. He is also advised to stutter artificially on non-feared words – this allows him to be in control even as he stutters. This feeling of control can go a long way towards reducing speech fears.

3. Modification. The stuttering itself is treated in this stage. The PWS is taught to stutter more ‘fluently’. Instead of developing insurmountable blocks that render all speech impossible, you are taught to stutter in an artificial and light way – to return to the easy, struggle-free stuttering typical of stuttering children. You may for example be taught to say ‘c-c-cat’, repeating the ‘c’ twice, instead of getting completely stuck on the ‘c’. You are also taught ways to get rid of your unnatural starters, distractions and avoidances. For example, the habit to delay feared sounds by repeating an ‘eh’ sound, can be weakened and eventually eliminated by repeating sounds such as ‘ooo’ or ‘ah’.

Additional aspects covered in this phase include preparatory sets (ie preparing yourself for speech), ‘pull-outs’ (getting out of a block) and cancellations (what to do after having blocked) (read the book Self-therapy for the Stutterer mentioned in the ‘Bibliography’ chapter for a comprehensive discussion of these concepts).

4. Stabilisation. The aim in this phase is to make these new habits a permanent feature of the PWS’s speech.

Disadvantages:

There is no doubt that many PWSs have benefited from Van Riper and his insistence on artificial stuttering – but it’s not for everyone. Critics leaning toward the ‘conditioning and learned behaviour’ explanation of stuttering have in fact pointed out that artificial stuttering could reinforce the stuttering.

9. Joseph Sheehan’s approach

Sheehan was another well-known American speech expert. Like Van Riper he also stuttered. He emphasised the psychological component of stuttering, and focused on the tendency PWSs have to hide their disorder. He argued that PWSs have to be open about their problem, confronting and accepting instead of denying it. For him, the main objective of therapy must be to reduce the PWS’s numerous fears – fear of the way others will react to his speech, fear of stuttering and fear of silences occurring in his speech.

Sheehan compared stuttering to an iceberg. The visible and audible aspect of stuttering is like the part of the iceberg exposed above the water. Then there is the invisible, hidden part that poses the more dangerous threat: fears, feelings of shame, etc. The ‘icebergs’ of PWSs differ – some are more hidden than others.

Stuttering children often have highly visible icebergs, ie there is a lot of external stuttering, but little psychological harm. Years go by, the iceberg sinks down deeper into the sea, and it seems as if the child stutters less. This is an illusion. Much of the stuttering has merely disappeared beneath the surface, where the real damage is being done. According to Sheehan part of the aim of stuttering therapy should be to expose the hidden part of the iceberg so that it can melt, as it were, in the heat of the sun.

Sheehan represents the most extreme form of the ‘stutter more fluently’ approach. The client is encouraged to stutter as much as possible in other people’s company, even in situations where he would not normally stutter.

Disadvantages:

As in the case of Van Riper’s approach, some PWSs benefit from Sheehan’s artificial stuttering, but again some PWSs find artificial stuttering to be unpleasant. The social embarrassment caused by excessive public stuttering could be an additional source of stress for some PWSs, thereby contributing to the stutter. Also the artificial stuttering may reinforce the problem.

10. Hypnotherapy

Clinical hypnosis is a state of deep relaxation and concentration brought about by suggestion. It should not be confused with what stage hypnotists do.

In clinical hypnotherapy, the client is awake and in control. A skilled hypnotherapist can use this state of relaxation to access the subconscious and ‘reprogramme’ issues such as, for example, shyness, stress, lack of confidence etc. via VISUALISATION (see also the chapter ‘The Power of Visualisation’). At the end of therapy the hypnotherapist may teach the client self-hypnosis as a self-help technique in order to build on the progress made.

There can be no doubt that INDIRECT anti-stuttering hypnosis of this nature can assist PWSs, as it can address the underlying stressors that contribute to stuttering. I have myself experienced clinical hypnotherapy focusing on stress reduction, and have as a result definitely improved my ability to manage stress.

Some PWSs speak more fluently while under hypnosis, probably due to lowered tension. This phenomenon has served as encouragement for opportunistic hypnotists to use DIRECT anti-stuttering hypnosis (eg ‘As of now your speech will be fluent’) to improve speech. Hypnotic suggestions of this nature usually have a temporary effect. Beware of hypnotists who claim to be able to cure stuttering!

In short, hypnotherapy can be a useful adjunct to stuttering therapy, but is for the great majority of stutterers not a cure (though a very few lucky individuals may perhaps experience a real cure because of greatly and permanently reduced stress levels through hypnosis).  

11. Relaxation, yoga, meditation, biofeedback

It is a well-known fact that a PWS’s speech improves when he is relaxed – though it is very difficult to rely on relaxation alone to control stuttering. For this reason clinicians usually use relaxation as an aid, and not as the main treatment. Yoga and meditation can also lower tension levels (see the ‘Stress Management’ chapter for more information).

Clinicians sometimes use biofeedback machines to train their clients to relax before and during speaking. These machines measure the degree of tension in specific parts of the body. In this way a person can learn to relax specific sets of muscles, eg the muscles of the jaw and face, even if other muscles remain tense. Once again treatment of this nature may be of benefit in lowering tension and stress, thus reducing the severity of the stutter even though it may not eliminate the problem.

12. Medication

Some PWSs use tranquillisers to reduce their tension levels, for example before delivering a speech. This practice has many disadvantages: tranquillisers can affect the ability to concentrate; as a chemically-induced form of stress control the effect only lasts for as long as the medication is taken; there is a real risk of addiction. Vitamin and other supplements are relatively harmless and therefore preferable (see the ‘Stress Management’ chapter).

Any chemical substance having an anaesthetic effect on the nervous system can improve a person’s speech temporarily. I have often found that eg. certain analgesics and flu medication reduce my tension and improve my speech. These medications slow one’s mental processes, thereby reducing speech fears and anaesthetising the PWS’s mental ‘scanner’. The use of these substances to control stuttering is nevertheless impractical and unhealthy.

These days, the focus in stuttering research is very much on the brain, with many theories being expounded. According to some neurological theories, the disorder is the result of chemical imbalances in the brain. To correct this, drugs such as haloperidol have been prescribed for some PWSs. The results have been inconclusive. In addition a variety of side-effects have been observed. In more recent times there have also been experiments with clomipramine; and the latest tests with Pagoclone have resulted in much speculation. Don’t hold your breath, however, while waiting for another miracle pill to solve all your stuttering problems ... a shortcut to fluency does not yet exist.

13. Psychotherapy

As far as SEVERE psychological disorders are concerned, PWSs as a whole do not suffer from these more than fluent speakers.

Many PWSs do, however, suffer from feelings of inferiority, bad self-image, lack of confidence, depression, neuroses, stress, anxiety, etc. This is usually the RESULT and not the main cause of their speech problems.

Fact is that anxiety, bad self-image, inferiority feelings etc. result in stress, which again leads to more stuttering, which results in more anxiety etc. So this is a vicious circle – see the chapter ‘A Possible Cause of Stuttering’ for more on the vicious circle of stuttering.

If the psychological side of stuttering results in more stuttering, it follows that the PWS can be helped not only by working on the stuttering itself, but also by addressing feelings of anxiety, inferiority, bad self-image etc. In other words, a holistic approach should be followed by working on all the aspects of stuttering, including the psychological side. That’s why I’ve included chapters on self-image etc.

Note that a small percentage of PWSs, in addition to their stuttering problem, have UNDERLYING psychological problems unrelated to stuttering, just like non-PWSs. Due to these underlying problems their base-level tension may remain exceedingly high, thus maintaining the stutter. Common sense dictates that these people should first have their psychological problems attended to before tackling their speech problem. Example:

The case of the shell-shocked soldier

A Dutch speech therapist discussed a case soon after World War Two when he treated a young soldier who had begun to stutter after a battle against the Germans. The soldier had previously consulted a female therapist and had several times felt the urge to talk about his combat experiences, but she would interrupt him, saying: "That is not what you are here for. Take the mirror and look into it. Now, with a round mouth say: ‘Oh no don’t go’ and then, with a wide mouth: ‘She is drinking tea’." The fact is that the young man had been devastated by the horrors he had witnessed. If ever there was an inappropriate treatment, this was it. Instead of being treated for his speech, the patient should have been given a chance to vent his feelings.

(P Faber, Achtergronden van stotteren en spreekangst, 1979).

Counselling

Psychological counselling may help to lower stress levels, for example by working on the client’s self-image, social skills and ability to cope with specific life problems. The client is also granted opportunities to verbalise his feelings and gain new insight into his speech problem. With counselling he can also improve his adjustment to and acceptance of his disorder.

Counselling may, however, have limitations. In the past some treatments tended to rely exclusively on psychological counselling. Many experts now realise that such an approach could be inadequate and should be combined with teaching the client a fluency technique.

Psychoanalysis

Psychoanalysis is a type of psychotherapy that uses dream interpretation, hypnosis, free association and the like in an attempt to expose any traumatic experiences in the client’s past. Research has found that most PWSs do not really benefit from this, though those who are indeed traumatised might find it beneficial.

Personal Construct therapy

This is a modern approach in psychological stuttering therapy based on the theories of the American psychologist George Kelly. This treatment derives from the view that many PWSs find fluency to be a strange and unfamiliar experience. The theory is that many PWSs fail to maintain their fluency after being treated because they are socially and psychologically not equipped to cope with the new experiences that accompany fluency. They may want to be fluent, but they also fear the unfamiliar and even threatening world of fluency.

The aim of this approach is to initiate the PWS into the world of fluency and help him accept himself as a more fluent speaker.

14. Intensive courses

Nowadays many experts maintain that this is the best vehicle for offering therapy. Clients are treated as a group and exposed to intensive therapy on a continuous basis for a period ranging from days to weeks.

The interaction with other PWSs and the continuous attention to speech may have a dramatic effect, often resulting in a drastic drop in base-level tension, greatly improved fluency and euphoria. In many cases PWSs achieve fluency to such an extent during the course that they are able to make public speeches in front of large audiences and to participate in radio and TV discussions.

This effect tends to be temporary – as the client, having completed the course, again finds himself in the ‘real’ world and is exposed to all the usual pressures, his base-level tension rises and the stutter returns.

But this is not to say that the temporary ‘high’ has been of no benefit. It has demonstrated to him that fluency can be achieved, and that there is hope. The intensive course can serve as a basis from which the PWS can gradually work his way towards better speech via the methods which he has learned during the course, aided by follow-up treatment and support groups.

15. Support/self-help groups

These groups have certainly been of enormous help for many PWSs. In fact many people say that they would not have been able to make the progress they did had it not been for the support received from their group. I have found them of enormous value, as it is very difficult to work on your own in trying to do something about your stuttering.

Groups can take various forms. A support group provides an understanding environment in which PWSs can discuss their speech-related problems, thereby verbalising their difficulties and helping them to adapt to the disorder. This type of group usually does not attempt to deal with the stuttering directly.

A self-help group can also provide support, but here the emphasis is on actually working on one’s speech by testing and practising speech techniques and approaches, in the process learning from others and helping new members. These groups work best when seen as a supplement to practising at home and/or formal speech therapy.

Groups can either be therapist-led or independent. Both types have their pros and cons – the format of the group should meet the particular needs of the participants.

Disadvantages:

The group approach to stuttering is nevertheless not an easy road to fluency. Much will depend on practical issues and the personalities of the members. A group is only as good as the people involved. Domineering members can undermine the democratic running of the group. Another problem is that member turnover tends to be high – after the initial enthusiasm many people soon realise the amount of work and time involved, and they drop out. As a result, groups in towns and small cities tend to have a short lifespan.

On the other hand groups in large cities have, in many countries, grown and succeeded to such an extent that they have evolved into national associations, such as the wonderful British Stammering Association (BSA). For stammerers in the UK the BSA website should surely be the first port of call.

*  *  *  *

Some clinicians focus on a single approach or technique; others combine different approaches or use an eclectic approach in which they tailor the treatment to suit the client’s specific needs and problems. Regardless of the approach favoured, all responsible clinicians seem to agree that there is currently no single instant and complete cure for stuttering that will help everybody. The struggle therefore continues ... hopefully with the promise of new breakthroughs in the future!

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4 comments:

anna lee said...

Thank you for the blog on the stuttering and disability and to share the your own experience with all of us , it's really motivated blog for the stutter. help people who stutter and need to be patient, kind, understanding with them. We need to show we care too. for more help and treatment anyone can visit the site http://www.naturaltherapyforstuttering.com/

john smith said...

Hold each tongue exercise for three to five seconds, and do five repetitions of each. Speech therapy

Ali said...

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