The outcome of stuttering therapy has not been encouraging. Even when the standard of success is downgraded from recovery to progress, Walt Manning reports that one-third of clients will make good progress; one-third moderate progress; one-third little or no progress. As a clinician who exclusively treats people who stutter, I think these findings are unacceptable. This is the reason that I did not stick with the traditional stuttering modification and fluency shaping approaches that were being used when I began to treat people who stutter.
At first I tried using these approaches, then I tried to improve the way I carried them out. I began to discover what really helped and didn’t help my clients. I realized that the treatment perspective was part of the reason clients were having such a difficult and frustrating therapy experience. Stuttering modification focuses on moments of stuttering and fluency shaping focuses on trying to make the speech fluent by using some artificial and hard to use control techniques. These are actually two sides of the same continuum, speech. Neither approach relates to the system within every person that functions to create speech. I realized that we need to look at how this system is doing its job. Using the model of how fluent speech is produced, I explored how the system works to create stuttered speech. Here is an equation that I think summarizes a lot of what I’ve found:
S = (T + W + GO) +/- PEART
S, of course, stands for STUTTERING (stammering). I define stuttering, not as the problem that people who stutter face, but as the result of the problem. In essence, the problem is that the brain does not function in a way that allows for the production of comfortable, easy to produce flowing speech. That brings us to the other side of the equation, the side that includes brain processes and the person’s state of mind.
T stands for TRYING. People who stutter TRY to speak. People who speak fluently do not try to speak anymore than people in general “try” to write, walk, eat, etc. These are activities that we learn how to do at an early age and continue to do them automatically without thought or effort. Speaking is also meant to be an automatic process. This is a requirement for producing normally fluent speech. The automatic mode does not involve pre-editing what you will say, listening to what you have said, or using the control mode to move your mouth to form the sounds.
W stands for words. People who stutter are in some way word conscious. In fact, words are not the unit of speech production. However, to some degree, at least some of the time, people who stutter use the whole word as the unit of speaking. The more aware you are of the words you are saying or want to say, the harder it is to speak.
GO stands for GET OUT. We all use this term when we refer to talking, as in the idiom, “He didn’t let me get a word out”. However, people who stutter literally use a motor process that attempts to get out what they want to say. Normally fluent speakers do not do this. They develop language in the brain as a progression of speech sounds. When they want people to hear this inner language, they activate the voice in the throat in an easy effortless way. At the same time, the mouth subconsciously shapes the voice so that the end result is an audible progression of sounds that make up syllables that make up words that make up language.
PEART relates to PERSPECTIVE, EMMOTIONS, ATTITUDE, REACTIONS and THOUGHTS.
In addition to what might be innate developmental tendencies, the degree and way the speaker TRIES TO GET OUT WORDS may be affected by some or all of PEART. There is PEART that supports trying to control how you can get the words out, and there is PEART that supports change and using an automatic mode for speaking. This is an important aspect of treatment. The individual cannot change the way the brain creates speech when thoughts and feelings are working against change.
If S = (T + W + GO) +/- PEART, therapy needs show people how speech can be generated without TRYING TO GET OUT WORDS. Dynamic Stuttering Therapy does this. Clients carry out activities that achieves these goals:
1. Let the brain automatically develop language as a sequence of syllables
2. Activate the voice in an effortless way that allows for the normal intonation of speech
3. Allow the mouth to function on an automatic mode
4. Completely give up monitoring speech, pre-editing, listening to how the speech sounds, visualizing words and other forms of control,
5. PEART changes, according to individual needs, so as to support the new way of processing speech. This is done through discussion, meditation, cognitive therapy and experience.
None of the goals for changing the way you speak include working on TRYING to make the speech fluent. If there is one thing that almost everyone who knows anything about stuttering and its nature agrees upon, it is that the more you TRY to be fluent, the more you stutter. Some people might also agree with me that more you TRY to monitor your speech, the more effortful it will be too talk, even if there are less or no actual perceived blocks, repetitions and prolongations.
Dynamic Stuttering Therapy shares some common elements with stuttering modification therapy, cognitive behavioral therapies, and mindfulness training. However, what makes Dynamic Stuttering Therapy unique is that at the same time that people who stutter work at changing their state of mind, they are also working directly to train their brain to use the same natural automatic process of speech production that is used by fluent speakers.
Changing both your state of mind and the neurological process of speaking is a winning combination. Using the new process gives you a new experience. Awareness of the experience stimulates new feelings. At the same time thinking in a different way alters your reactions and lets you use the new process. Therapy becomes an evolution of the self. The end result is an easier and more enjoyable way of speaking. Clients report that they feel greater physical and mental comfort when they achieve the treatment goals. Instead of being concerned about how to get the words out, they are able to communicate their thoughts. This is, of course, the reason we speak.
References:
Dahm, B. (2007) Dynamic Stuttering Therapy. Glen Rock, NJ: CTI Publications
Doidge, N. (2007). The Brain That Changes Itself, New York, NY: Penguin Books.
Levelt, W. (2001). Speaking: From intention to articulation. Cambridge, Mass: M.I.T. Press.
Manning, W.H., (1996). Clinical decision making in the diagnosis and treatment of fluency disorders, New York: Delmar Publishers (p. 203).
Watson, B and Freeman, F.J. (1997). Brain Imaging Contributions. In R. Curlee, & G.Siegel, (Ed.)Nature and treatment of stuttering: new directions, (2nd ed.) (pp.204-217) Needham Heights, MA: Allyn & Bacon.