Prolonged Speech – In previous posts, I have spoken a lot about the difficulties that people who stutter tend to face, when they are trying to learn and maintain a fluency shaping technique. I have also spoken extensively about the psychological and spiritual sides of approaching the problem. There are a number of mainstream approaches to treating the physical symptoms of stuttering, but one of the most effective approaches that has been developed, is generally known as the Prolonged Speech method. I would like to talk about this approach in the next couple of blog posts.

The Prolonged Speech method, is the basis of most fluency shaping treatment programs that are taught around the world these days in various forms. The name comes from the fact that in using this method, the person who stutters is initially taught to say words broken down into their syllables, and the utterance of these syllables is “prolonged” to varying degrees for certain reasons that I will talk about below.

Prolonged Speech is relatively easy to learn, but like most stuttering treatment methods, it can be difficult to transfer into the outside world, unless the individual has a solid grounding in using it in a clinical environment. The practitioner responsible for teaching the method to people who stutter, aims to replace the client’s faltering way of speaking, with a more smooth and controlled way of speaking where the client becomes more aware of all aspects of the speaking process. As such the technique is best and most effectively taught in an intensive course, and the most effective courses have been shown to have a duration of at least 3 weeks. It is a well know understanding in psychology, that it takes 21 days to change a habit, and although stuttering is more than a habit, this understanding is certainly not lost on the effective treatment of stuttering as a behaviour based phenomenon.

Approaches to the teaching of the Prolonged Speech method vary from clinic to clinic, but the most effective format is to have a highly trained psychologist or speech pathologist, to work with a group of no more than 6 adults who stutter. The group sits around a table, and while speaking in their new way, are constantly monitored and observed by the clinician to ensure that they are continuously and effectively using the various aspects of Prolonged Speech, in a perfect manner and at the speech rate set for the various speaking sessions. The first week of the intensive is taken up by the process of learning to use Prolonged Speech, and at the same time being highly aware of monitoring the process as speaking is taking place. In the early stage of the first week the client is taught to break words down into syllables and these syllables are uttered with exaggerated prolongations at the beginning. This prolongation rate gradually increases over the week until the client is speaking at what would be an acceptably normal rate or speed. Typically these daily sessions, in the first week, are 10 – 12 hours in length.  The second and third weeks of the intensive are used, to have the person who stutters, start to transfer the skills learned in the clinic, into the “outside of clinic” environment. In the second week speech “assignments” are standard assignments set by the clinic, like talking to strangers, using the telephone etc., while in the third week assignments are set by the individuals themselves taking into account where they have had specific difficulties in their daily life. e.g work, home, education environment etc. If the course has been conducted in the correct way by an experienced professional, the result is that all individuals are able to speak fluently in all “outside of clinic” situations at the end of the course, however, unfortunately this is not the result from all clinics purporting to conduct a prolonged speech intensive, but that is a subject to be covered in a subsequent post.

While the immediate post-treatment results from a well run Prolonged Speech intensive are very impressive, like any learned skill, the new method of speaking and associated speech monitoring needs to be constantly used. This can be a very demanding task for most people, when they are faced with pressure in the outside world, to speak faster and more spontaneously, with less focus on all the skills that make up the Prolonged Speech method. For this reason, success in maintaining the level of fluency, achieved during the intensive course, is best facilitated by joining a stuttering support group, where others who are also working on perfecting fluency, gained from the use of Prolonged Speech, are also members.

So what are the “skills” that make up the Prolonged Speech method of controlling stuttering? There are basically 9 parts to this method as follows:

1)     The pre-vocalisation out-breath.
2)     Gentle onsets.
3)     Continuous vocalisation.
4)     Control of tongue and lip movements.
5)     Prolongation of syllables.
6)     Regular controlled pausing.
7)     Interesting intonation.
8)     Good eye contact.
9)     Slow controlled in-breath.

1) The pre-vocalisation out-breath.
In simple terms, stuttering is caused by a locking of the vocal chords or vocal folds situated in the throat. When these folds are closed, air is not able to flow out to create speech. When stuttering occurs, these folds are closed. It is also a common occurrence that these folds are locked closed when speech is about to be initiated. In addition, a problem can occur when one is breathing in instead of out when the individual goes to start to speak. In order to speak, breath needs to be flowing out to first ensure that the vocal folds are open, and then to keep them open and vibrating during speech. The breath needs to continue to flow out while the person is speaking.

2) Gentle onsets.
When the breath is flowing out, the individual must then begin to vocalise sound, but with a gentle onset there is a slow and graduated transition from no sound and no audible speech, to audible speech. If the onset of speech utterance is not slow and gentle, it is possible that the articulators will lock up. It will assist the individual if the onset of all sentence or phrase beginnings is a gentle onset. It is akin to initiating movement of a manual motor vehicle where the clutch needs to be slowly released, for the vehicle to begin moving without a faltering and jerky start.

3) Continuous vocalisation.
When the breath is flowing out, and the vocal folds are vibrating, and speech is being created using the speech articulators (tongue & lips), it is imperative that the underlying vocalisation is continuous. By continuous, I mean that there are no breaks in continuity of sound from when speech commences to when the phrase or utterance finishes. Continuous vocalisation is achieved by the constant out-breath vibrating the vocal folds. You can experience continuous vocalisation by just saying “aaaahhhhhhhhh” for say 5 seconds. It is a continuous sound with no breaks. Continuous vocalisation is important while uttering a phrase or sentence because when sound stops, the vocal folds of a person who stutters are likely to lock closed again, creating a speech block. During the intensive, the clinician ensures that continuous vocalisation is achieved by discouraging the client from using any “uhms”, “ahs” or any other fillers, which are a sign that focus on continuous vocalisation, is not being monitored by the client.

4) Control of tongue and lip movements.
When a person who stutters has a speech block, it is often that the closing and locking of the vocal folds is facilitated by, or given leverage by, pushing the tongue hard against the top of the palette when making the t, d, n and l sounds. Similarly the closing and locking of the vocal folds is facilitated by, or given leverage by, pushing the lips hard together when making b, m and p sounds. As mentioned above, it is imperative that the breath continues to flow out during speech, and this can be facilitated if the person who stutters, is able to control the tongue in such a way that it does not actually touch the top of the mouth during speech, and similarly controlling the movement of the lips, so that they do not actually touch during speech when sounds that would normally require such touching are made.

5) Prolongation of syllables.
As the name implies, the Prolonged Speech technique for controlling stuttering, is given its name because the syllables that make up words, are prolonged when they are uttered. Syllables are prolonged for various reasons. Firstly the syllables are prolonged when this stuttering treatment method is being learned, so that the speech delivery is slowed down so that the various aspects of the method can be learned and mastered. Secondly the process of concentrating on prolonging syllables does certain things in the brain to take awareness while speaking, away from the listener or audience, and onto the processes being used to speak. Finally it has been shown that prolonging of the syllables, when a stuttering moment is encountered, can assist in getting the words out more fluently. As Prolonged Speech is being mastered the prolongation rate is gradually reduced so that speech gets faster, until it reaches the “normal” range of 180 – 200 syllables per minute.

6) Regular controlled pausing.
Breath control is critical for the person who stutters, to be able to control stuttering and produce free flowing stutter-free speech. When a person who stutters begins to utter a phrase or sentence, and what he/she wants to say is coming out fluently, there is a tendency for the person to continue to go on speaking as long as possible, without pausing to take another breath. While a logical reason for this behaviour can be argued, such behaviour can quickly lead to dysfluent speech. The reason for this is that the individual will eventually run out of breath, and the feeling of being out of breath, can trigger stuttering behaviour, like rushed breathing. It is recommended that the person who stutters speaks in shorter, rather than longer, breath lengths and preferably aims to speak in a constant rhythm of breathing, speaking and pausing. This will facilitate the control of the speaking process.

7) Interesting intonation.
When a person who stutters is using continuous vocalisation, combined with prolongation of syllables, there is an initial tendency for the person to develop a somewhat monotone and robotic sort of a sound. This is due to the underlying continuous vocalisation, being made on a limited range of intonation or voice melody. It is imperative that the person learning to master Prolonged Speech, learns to vary the intonation of the vocalisation, in such a way that it takes away any level of monotony in the sound of the speech delivery, and sounds as “normal” as possible.

8 ) Good eye contact.
Good eye contact with the person that one is speaking to, is a good trait for anyone to have, and no more so than for a person who stutters. People who stutter generally tend to look away from the listener, when they are in a stuttering situation. This makes it difficult for both the listener and the person who stutters. When the person who stutters looks away, the listener has a tendency to become embarrassed, and also wants to look away, while the person who stutters tends to lose his power and confidence in the speaking situation.

9) Slow controlled in-breath.
When a phrase or sentence has been uttered, and the vocalisation comes to a temporary halt, it will help to release all residual air in the lungs. At that point it is time to breathe air into the lungs, in order to prepare to start of new “cycle” of speech, for the next phrase or sentence to be uttered. While some stuttering control techniques teach that a fast and full breath should be taken, in this method the in-breath is slow and controlled, and should ideally take 1 – 2 seconds which facilitates the pause, and also formulation of the next phrase or sentence. We do not rush the breath in. At the top of the breath we do not begin to speak, as mentioned in point one above. We must start the whole cycle again, which is to begin by breathing a small amount of air out to open the vocal folds before the vocalisation commences again.

When a proficient exponent of the Prolonged Speech method is speaking, using this stuttering control method, he would be speaking more fluently than most “normal” speakers would be speaking, and the average listener would not be able to detect that he is speaking in any way other than a perfectly fluent normal speaker.

For Prolonged Speech to be effective in all situations, it needs to be used constantly, as it is more a technique to use to stop getting into stuttering behaviour rather than to get out of it. It is not for everyone, and most people other than severe and chronic stutterers, who are highly motivated to achieve total fluency, are unlikely in the long run to give up spontaneous speech, and to put the constant effort and awareness in that is required for this method to control stuttering in all situations. Having said that, it is still the best method available to treat the chronic stutterer and the highly motivated for whom the quest for fluent speech is not negotiable.

This describes the basics of Prolonged Speech. In the next post I will talk further about the more advanced aspects of ensuring that Prolonged Speech really gives the results that every person who stutters is seeking. In the meantime, I again urge you to subscribe to my RSS feed or email notification, so that you do not miss posts about subjects and content that you will not read anywhere else. If you found this post useful or thought-provoking in any way, please make a comment.

Cognitive Behaviour Therapy, (CBT), is a behavioural approach to addressing thoughts and feelings that lead to anxiety, and, in the case of the person who stutters/stammers, social phobia. CBT is increasingly being used as a tool to treat stuttering/stammering, based on the premise that stuttering/stammering is aggravated by anxiety, and in many cases this anxiety level can be managed, especially if the anxiety is related purely to the belief, that the person might stutter/stammer, and what that will mean to them.

Having said all that, I do not believe that CBT is a viable approach for ALL people who stutter especially those who have severe speech blocking. I believe it is better suited to those people who I would rate as a mild stutterer (1,5 or 1,4 on the Stuttering Jack Scale of severity). That is, people who are low on the actual physical scale, but high on the psychological scale of severity. This includes what we would refer to as covert stutterers. So a person who has mild and irregular speech dysfluencies, but high psychological reactions to incidences of dysfluency, is more likely to benefit from CBT, than a person with severe and constant dysfluencies. This is an example of how it is most important, that we have some form of scale, when talking about stuttering. For to say that CBT will definitely help “stutterers”, is a misleading statement. You might be interested in reading my first two post on this subject.

Research has shown that the parts of the brain that control anxiety, are linked closely to the areas that control speech, so it is not unusual that anxiety levels effect speech fluency. Anxious thoughts that a person has about how they might be being judged by the listener, will invariably contribute to a degree of stuttering, as the focus is taken off the conversation and put onto anxiety provoking thoughts. It goes without saying, that if we can take the focus off these distracting thoughts, then they will no longer have the anxiety producing effect that they are currently having.

It must be understood, that our thoughts and feelings are so important in determining our emotional state, and the way that we see the world around us. If we want to change our behaviour, we must first look at how we are thinking. By changing the way we think about a speaking situation, we can change the experience that we have in that speaking situation. Recognising this can be a break through for some people.

CBT therapy, teaches the person who stutters to look at the thoughts that they are having and attempts to have the person see, that those toxic thoughts, invariably have no basis in fact, logic or experience, so should be negated in moving forward into the speaking situation. If thoughts can’t be negated, the aim is to learn to challenge those thoughts with a view to altering them to less anxiety provoking thoughts, when facing a particular speaking situation. Once again this is more easily achieved for mild or covert stutterers than chronic overt blockers.

The CBT practitioner, talks about the different types of thought groups that can create increased levels of anxiety. These thought groups include, unrealistic standards of social performance, unrealistic beliefs about the consequences of poor performance, and, unrealistic negative beliefs about oneself. These thoughts lead to a level of perceived negative evaluation from the listener, and, lead on to social phobia, which can be a more difficult extension of anxiety to address.

After the individual begins to understand the role that thoughts and emotions play on our feelings, and, how that effects our anxiety level, which in turn effects our degree of stuttering, he then moves onto identifying the specific thoughts, that are causing the problems to do with his own individual speech.

When a problem thought is identified like, “if I stutter people will laugh at me”, or, “if I stutter no one will employ me”, or, “if I stutter they will think I am incompetent”, or, “if I stutter they will think I am weird”, the individual is taught to challenge that thought, by asking the following eight standard CBT questions about the thought:

1) What evidence do I have that the thought is correct?

2) What evidence do I have that the thought is wrong?

3) What would I tell a friend, if they had the same thought, that would help them?

4) What would a very understanding and supportive friend say, to help me eliminate this thought?

5) Do I think I am worrying unnecessarily about something, that I have no control over?

6) How does the thought make me feel – good or bad?

7) Would there be benefits to me giving up thinking this thought?

8 )  What is the worst outcome that could occur, if this thought were true?

The individual is quite often encouraged to carry a notepad with them, and when a negative thought enters his mind, that is causing anxiety, he is encouraged to ask these questions about the thought, until he is able to consciously replace the thought, with a more resourceful thought based on evidence, and the anxious behaviour is diminished.

A CBT program generally continues to talk about how we tend to use “safety behaviours”, like avoidance, so that our feared situations do not actually occur. Through such behaviour, we are continually reinforcing our feelings about the feared situation, by instantly gratifying ourselves with reduced anxiety, from applying our own individual form of safety behaviour. CBT theory argues that unless we face our fears, we will never give ourselves the chance of seeing that our assumed outcomes of the situation, are invariably wrong, illogical and even abnormally catastrophised.

There is a natural response to the fear stimulus, that is often referred to as the “fight or flight” response. Whenever we are faced with a feeling of fear, the brain throws the body into an automatic, almost reflex response, and the natural reaction to this is invariably avoidance. This can, over time, lead to a level of social anxiety in the person who stutters. When faced with the thought that we will be judged negatively by others, it is not unusual to choose avoidance, as the easiest option. Having said that, if avoidance is not giving you the outcome that you truly desire, the best strategy to adopt, is to face your fears in these speaking situations, to discover the real outcome, rather than your imagined outcome. For it is only through facing fears, by moving outside your individual comfort zone, that fear and anxiety can ever have a chance of being reduced. It is often said in CBT that, “thoughts or predictions are NOT facts”.

Frequently, CBT involves self imagery or visualisation, where the individual is required to imagine that he is in a feared speaking situation. While in such a situation, he is asked to become aware of the images that he is producing in his head and describe what he sees, both in his own behaviour, and the behaviour of the listener. If the image is what would best be described as, “negative”, then the individual is encouraged to re-imagine the situation, in a more positive, or less negative way in an effort to override the negative experience.

CBT also seeks to address the perceptions that we have about the opinions of others. The main perception that is addressed is the perception of approval, or, disapproval. Invariably the person who stutters believes that the listener will disapprove of his stuttering. The CBT practitioner will explain that, only your thoughts can create the emotional disturbance that make you feel uneasy, as a result of a social rejection, or negative evaluation. Perceptions are within your own power to alter, and your own perceived negative evaluation only gives the listener power over you, that you have given them. If there is any actual negative evaluation, it is generally not about “you”, but more about the person doing the evaluation.  The concept of “predicting”, is also addressed as we tend to predict the worst, with quite often no justification further adding to our anxiety level.

The typical CBT program then goes onto address the common issue of social perfectionism, as another form of social fear. Aiming for perfection, invariably leads to procrastination and avoidance. We can often become overly worried about what other people think of us, if we make a mistake or if we stutter, and this, once again, leads to avoidance, procrastination and excessive use of safety behaviours. Having a perfectionist approach to speech fluency, will increase anxiety and stuttering, as it makes the speaking environment very stressful. It is a useful exercise, to pretend that you are writing a letter to yourself or a friend, explaining why it doesn’t matter what other people think of you.

Social perfectionism, is addressed in CBT by encouraging the individual to deliberately make a mistake. In addressing stuttering, the mistake would be to deliberately stutter. This can be very difficult for the social perfectionist, but continuing to avoid certain speaking situations, only gives strength to the avoidance, and only by facing the situations that one avoids, without safety behaviours, will one understand that their behaviour itself, is invariably reinforcing the fears.

Another area generally addressed as part of a CBT program, is our perception of how things “should be” in our concept of the world. Are your individual perceptions resourceful to you, or not resourceful to you? Are they creating a situation where failure is inevitable, where you feel shame and frustration? As part of this process, post event analysis is quite often discussed. Are you continually going over in your mind the failures that you experience? Continually reliving your failures, only seeks to reinforce them as part of your future thoughts. Rescripting these events, to more resourceful imaging in your mind, will facilitate the brain, in remembering the preferred outcome you were really seeking.

As mentioned earlier, CBT has the possibility of being helpful for the mild or covert stutterer, who tends to catastrophise the possibility that they, “might”, have some infrequent experiences of dysfluent speech, and what that means to them. But, I believe, it will prove to be less helpful for the overt and chronic stutterer, with years of “experience”, that confirms his beliefs, about the effect of severe stuttering on himself, and his listener. This person “knows”, what will happen, and, “when” it happens, and, “how bad” it happens, and, what the outcome generally is. This is not imagined or catastrophised. It is no good telling the chronic stutterer, that his stuttering will not make a negative impression on the listener, when his life’s experience confirms his belief. It is no good telling the severe stutterer, that people will not treat him differently, if he has severe and repetitive speech blocks, when his experience confirms this belief. It is no good telling the severe stutterer, not to worry what others think, when he is really concerned more about his own judgement of himself. This is especially true if he is fluent in many situations and is able to experience the world as both a fluent and dysfluent speaker. Sometimes avoidance and other safety behaviours are a more peaceful way for the severe stutterer to live than continually putting her hand into the fire to see if she still experiences pain. CBT practitioners, working with severe stutterers, need to be reminded that stuttering is more about neural deficits in the brain, and less about cognitive processing. Having made that comment, it is fair to say that CBT is more about altering the pychological experience of stuttering, not the physical experience of speech dysfluencies, and in that regard anything that can make the experience of stuttering less painful for the stutterer, is worth giving a try.

One final comment. I do believe that CBT can be used successfully in treating severe stutterers, if it is implemented as a fluency shaping program add-on, to assist the individual, not to accept their stuttered speech, but to accept their new way of speaking, which for some, can be as hard to accept as the stuttered speech. I will talk more about this in a future post on the key aspects of conducting a successful fluency shaping program.

In the next post I will talk about NLP and Neuro-Semantics, and how they can have an equal or greater impact on the psyche of the person who stutters. In the meantime, I again urge you to subscribe to my RSS feed or email notification, so that you do not miss posts about subjects and content that you will not read anywhere else. If you found this post useful or thought provoking in any way, please make a comment.

In my last couple of posts, I have spoken about the psychological side of stuttering/stammering, and how our fear of speaking anxiety, is largely as a result of the perceived consequence of speaking with dysfluent speech. I spoke about some of the typical destructive and fear of speaking anxiety provoking consequences, that we can conjure up in our mind. This type of thinking has been referred to by some as “stinking thinking”.

Thinking this way is not resourceful to us. It is guaranteed to make us stutter worse, because of the consequence that we place on being dysfluent, in these situations. For example, “if I stutter in this job interview I will definitely not get the job because everyone hates stuttering people”. If you layer that with further negative thinking like, “ if I cannot get a job I will have no income”, and then continue to add to that further layers like, “if I have no income I might become homeless”, “if I am homeless I may not have any food”, “if I have no food I will die”. Now obviously we are not conscious of layering these thoughts onto thoughts, but we certainly do it subconsciously, and in a fraction of a second. If we do not recognise, and accept, that many of our fears, subconsciously layer themselves back to the “fear of death”, we will not understand why there is such fear and anxiety, associated with having some trouble in getting words out of our mouth, and into the other person’s head. We are born with an innate belief, which is often confirmed through our childhood experiences, that those who are “obviously flawed” in some way, are often singled out and marginalised, or “sacrificed” in some way by the group. So there is a deep fear there within every human being, of being seen to be “different” when we know we are otherwise. Such thoughts, if allowed to run rampant in your head, can lead to panic attacks, or at the least, a constant high level of anxiety, and can totally control the direction in which your life progresses. Can all fear be traced back to the fear of death? At the deepest layered level “YES”. This is a key understanding that you must have, if you are to alter your innate and reflex thinking, about situations where you are allowing the consequence of your dysfluent speech, to determine your anxiety level. You must learn to intervene at the base thought, so that increasingly toxic thoughts, do not escalate the consequences of dysfluent speech to the point where they send your speech spiralling out of control and into uncontrolled avoidance, shame, embarrassment and panic, which ultimately leads to ever increasing levels of stuttering.

If we accept that creating negative consequences, of dysfluent speech, are leading to higher anxiety, and that these consequences, are as a result of our own thoughts and feelings, and that we can change these thoughts and feelings, then we can start to look for ways to make these changes.

So how can this be achieved? There are various methods that have been, and are used, to train people, not only people who stutter, to look at the validity of their thoughts and feelings.

The first of these is a process known as Cognitive Behaviour Therapy, also know as CBT. CBT teaches the individual to look into and analyse the negative thoughts, and the negative consequences, that they see a particular action will have, and look for the real validity in those perceptions. Ideally the CBT practitioner helps the individual to see that there is no validity in the analysed perception and that the thoughts were in fact illogical to varying degrees and lack substantiation. In this case the thoughts revolve around stuttering. For instance if the individual may have the perception that if he blocks and stutters, the listener will think he is “retarded in some way”, or, “of lesser intelligence”, or, “not telling the truth”, (see the list of general consequences in my last post). Closer analysis of these thoughts are aimed at revealing that there is no evidence to support them as truth. By getting the person who stutters, to see how unfounded or illogical these thoughts are, by constantly asking what evidence they have for these perceptions, one can learn to replace these thoughts with more logical, and more personally useful thoughts, and so lower the speaking anxiety level.

The second and less known process, is known as Neuro-Semantics, which is an offshoot of a process known as Neuro Linguistic Programming, also known as NLP. This method works on the premise, that if you can speak fluently in any particular situation, you can learn to speak fluently in all situations. To do this, you need to learn to identify the “state of mind” that you are in when you are fluent, and the different states that you are in when you are blocking and stuttering, and then learn to step into that fluent state of mind, at will. It works on the premise that stuttering is a “thinking problem”, that manifests in a “speaking problem”. Neuro-semantics seeks to change the meanings that you have given to certain events, in your life experiences, from being fear based to being more resourceful to you. The premise is that blocking and stuttering is panic and anxiety expressing itself in the muscles that control speech. Just like a panic attack, a speech block is triggered psychologically. This work has been pioneered by Dr Bob Bodenhamer, in consultation with Michael Hall, both master practitioners in NLP and Neuro-Semantics. The theory and practice involved in mastering these methods of reducing speaking anxiety, are not simple to understand and put into practice, so guidance from a master practitioner in this method is advisable, but hard to find. Thankfully Dr Bodenhamer, has published a book on how to understand and apply this process, which for the cost of a weeks supply of Pagoclone, would be a very worth addition to your “toolkit” to attack speaking anxiety and stuttering. The book is called, “Mastering Blocking and Stuttering”. I personally believe that Neuro-Semantics starts off where CBT leaves off and is a more powerful process.

There are other methods of addressing the psychological side of the personality, that has developed wrapped in the “vines of stuttering”, and one of those is Personal Construct Therapy, also know as Narrative Therapy. In simple terms, that method looks at the way that the person, has constructed their whole persona as a person who stutters, and endeavours to address the difficulties that the person faces in developing the persona of a fluent or more fluent speaker.

Other methods include visualisation, meditation and modalities that seek to remove the emotions and trauma trapped in the energy fields of the body, as a result of stuttering experiences and other personally disturbing experiences, that contribute to your reflex fear and anxiety levels. These methods include such emerging modalities as, “pranic healing”, and, “emotional freedom therapy”, also known as EFT. But once again, these are all topics for coming posts, so I again urge you to subscribe to my RSS feed or email notification, so that you do not miss posts about subjects and content that you will not read anywhere else. If you found this post thought provoking in any way, please make a comment.

In my last post, I spoke about my belief that speech therapy for stuttering or stammering is not always a necessary stuttering treatment approach for all people who wish to remove a stuttering problem from their life, especially those who have what would best be described as a mild to moderate form of stuttering problem, as determined by the Stuttering Jack Scale, as the speech outcome from speech therapy for stuttering/stammering is unlikely to be sustainable for most of them. I urge you to read that article before reading this one. That article was not to deter an individual from stuttering therapy. It was just to say that it might not be as helpful and as long lasting as working more on applying methods aimed at achieving an initial level of acceptance of the stuttering problem, while working on the psychological side of the issue, by facing and conquering the fear of speaking dysfluently. Many people with a mild to moderate stutter, have been more successful with dealing with their speech dysfluency, by adopting the approaches that I briefly mentioned in that previous post. I concluded that post by saying, “if however, one is in the higher levels of the scale for physical and psychological symptoms of stuttering on the Stuttering Jack Scale, then speech therapy will be a must if the individual is to have any chance of achieving the fluency level that is desired”.

If the individual is going to seek some form of speech therapy, one must first decide if totally fluent speech is to be the goal, or a more fluent and acceptable form of speech dysfluency that is currently being experienced. Having said that, it is only natural that the ultimate aim of any person with a speech dysfluency is to speak totally fluently, but that is unlikely to be a realistic goal for most people. If total fluency is the goal of the severe stutterer, then the only way to achieve that is to take the process of speech production from auto to manual. This is achieved by becoming totally aware of the breathing patterns, movement of the tongue and lips, the rhythm of the speech, the continuity of the words, the speed of delivery at the start of utterances as well as during the delivery, and also the intonation or melody in the voice. As mentioned, for the individual with a severe stutter total fluency in all speaking situations can only be achieved with total concentration and awareness of the process of speech delivery.

Speech therapy that is designed to achieve this goal is know as a fluency shaping method and must be taught in an intensive clinical environment, with gradual and controlled exposure to all outside speaking situations, when the skills required for the correct delivery of speech, using this method, have been acquired. There are only a handful of clinics around the world that offer this form of treatment, which ideally needs to be in the form of a three week intensive to get the desired results. Courses teaching this method that run for less than that period of time, are less effective in that they have to rush the process of teaching and “embedding” the required skills, and then fall into the trap of sending the client back into the outside world much too early, and the skills are quickly eroded for reasons that include those mentioned in my last post.

If an individual has a severe stutter, and is successful with a fluency shaping method of treating their stuttering, they will always benefit greatly from joining a support group, especially if the support group is made up of other people who have done the same program and are also working on achieving a high level of fluent speech, in all situations. The group environment gives the much needed support required to maintain the skills and move forward.

Fluency shaping, if taught properly, will allow the individual to speak totally fluently if used as it has been taught to them, but when the demands on the individual are increased and everyday stress levels are escalated, the skill level can fall, and as a result the stuttering level can increase, and quite often return to its former level of severity. Fluency can be hard to regain when the individual begins to lose confidence in their ability to apply the technique in all situations. This can be exacerbated by the fact that fluent speech, in all situations, is not always predictable. Skills can however be reinstated without returning to the speech clinic, but it does require undertaking a period of using the skills in an exaggerated form to reinstate the level of focus and awareness in the brain, and this is best facilitated through the use of the “speech buddy system”, and support group organised “booster sessions”.

The skilled practitioner of a fluency shaping method can become more fluent than most normal speakers, yet total fluency, in ALL situations, can be illusive if the psychological side of the problem is not equally addressed, but this is the subject of a future post.

As you can see, if you are a 5,5 Stutterer or close to it, with high levels of speech dysfluency and associated anxiety surrounding speaking, it can be an “all consuming” pastime to achieve total fluency and freedom from speaking anxiety in all situations, but it is possible, if that is needed to fulfill your life goals.

Once again, this is extremely hard to achieve unless one has a burning reason to be totally fluent, matched by a high motivation level, combined with a belief that speech fluency is a “no compromise” issue in life.

Having said that, if the individual is a mild, :2,2 Stutterer”, or close to it, and still wishes to undertake a fluency shaping technique course, and try to adopt the skills taught whenever possible and needed, a high level of fluency can be achieved relatively easily in most situations but, as mentioned in my previous article, it is unlikely that a person with a mild stutter will persist with the level of awareness and concentration needed to consistently apply these methods.

The fact of the matter is, that by far the majority of people who have an obvious speech dysfluency, are going to be unable to achieve these ultimate levels of fluency that some stutterers have been able to achieve. For the average person, the best answer for speech therapy is more likely to be a method known as “stuttering modification treatment”, or, “a stutter more fluently program”, rather than a fluency shaping program. In a stuttering modification program, the individual is taught to not resist or mask the urges to be dysfluent on certain words and sounds, but to go ahead and be dysfluent, but in a more fluent way. This may sound a little strange or counterproductive at first, but it is a highly successful form of treatment where the individual aims to remove major, and out of control, blocking behaviour and replace it with a form of “voluntary stuttering”, that is more repetitive, yet free flowing in the direction that the speech utterance is moving, rather than halted dysfluency in the form of severe blocking. The individual must, however, come to terms with the fact that a form of speech dysfluency is an inevitable, yet acceptable, behaviour for them to have, and learn to accept the new form of free flowing stuttering as a desirable outcome.

In both forms of treatment, which are designed to eliminate or modify the overt speech dysfluency, the level of outcome is always dependent on how well the individual is able to also change or modify the psychological side of their stuttering problem, and that is the topic of my next post, and in that regard, I invite you to subscribe to the blog RSS feed or email notification so that you do not miss the next and future interesting articles.

As you are aware, there are many different forms of speech dysfluency that we seek speech therapy for stuttering/stuttering therapy, and in my last post I attempted to come up with a simple, “rough and ready” way to differentiate between them that I called the Stuttering Jack Scale. The reason that we need to differentiate between them, is that it is very important to know the degrees of the stuttering problem if we are to give constructive advice about potential stuttering treatment strategies for stuttering problems.

What we must understand is that, as an adult, your personal communication style has become hard wired into your system, and unless you consciously try to alter it, that communication style is going to stay with you. This is not just the stuttering pattern but also includes such aspects as the speed of delivery, the enthusiasm of delivery, the response time, the number of words uttered on a single breath, the pause lengths within speech etc. In addition, most of the psychological responses to visual triggers have also become almost a reflex action by the time you are an adult. So in response to a certain visual or auditory stimulus, you will generally react in the same way, as far as your psychological response, and your resultant speech pattern in that situation. So you must understand that, it is going to be extremely difficult to change, over the long term, those innate responses by undertaking a short speech retraining course.

There are many methods of fluency reshaping that can change your thinking and speaking behaviour in a clinical situation. Some will reduce your level of speech dysfluency a little, and some will completely eliminate it in that environment. A few are even capable of having you speak totally fluently in all, “outside the clinic”, situations for a period of time, but your innate communicating style eventually overrides the new style that you have been taught, and the stuttering will return to varying degrees, if not totally unless you can maintain your awareness and consciousness on your new speaking technique, while speaking in every situation.

As mentioned, it is not difficult to teach a person a method to eliminate their stuttering in a clinical environment, or outside the clinical environment, if the treatment is done in an intensive form, and taught by a highly trained and experienced clinician. In the intensive course, the individual is taken out of their normal environment and subjected to an exaggerated form of the new speaking method. This exaggeration method, is designed to get the brain to focus on a certain way of breathing and speaking, that eliminates dysfluent speech. If this is taught in a rigid fashion, over an extended period of time, fluent speech can be achieved, however, the innate or old form of communication style, speech pattern, and focus of attention while speaking, will eventually return. This is known as relapse. The length of time before this relapse tends to occur will include, but is not limited to, these factors:

1) The length of time that the fluency reshaping process was consistently applied in the clinical environment, be it a day, a week, or three weeks.

2) The degree of difference between the old innate speaking pattern and the new learned speaking pattern.

3) The personality of the individual.

4) The motivation of the individual.

5) The degree to which consistent fluent speech plays an important part in the life of the individual.

6) The severity of the dysfluency problem.

7) The environment that the individual will return to in employment, social, and family life.

8 ) The support given to the individual in the change process, following treatment.

There are so many factors conspiring against the individual to alter the behaviour patterns that are holding their speech dysfluency in place, that it is almost impossible to achieve the results from therapy that one is ultimately seeking, and a level of acceptance, of something less than ideal, is inevitable. That level of acceptance of speech dysfluency, generally settles at a level that is not greatly different to the level of physical stuttering prior to the speech treatment, for most mild to medium forms of stuttering in individuals.

So one must ask, is seeking treatment for the physical symptoms of stuttering a must for most stutterers? I believe that it is a debatable issue, if relapse is almost a certainty, and avoidance of an extreme emotional roller-coaster ride is to be avoided by most individuals. If we are to make such a bold statement, we must ask ourselves, why most of the stuttering treatment programs claim that 70 to 90% of clients are happy that they did the treatment program. Well, apart from the likely fact that these statistics may not always be correct, the fact remains that most people, with what would be best described as a mild speech dysfluency, are happier after having attended treatment, but not because their physical speech dysfluency has changed dramatically, but because their psychological reaction to it has altered for the better.

This has come about through:

1) An admission to themselves, that they have a problem.

2) An admission to others, that they have a problem.

3) A meeting of other normal, successful, and well adjusted people, like themselves who share their problem, and a realisation that they are not alone.

4) An introduction to the concept of voluntary stuttering and the benefits of its use.

5) An introduction to the concept of advertising, or self disclosure, to strangers that they have a speech dysfluency.

6) A learning of an alternate method of speaking, to reduce or control the dysfluent speech.

7) Arriving at an altered psychological state, where it is believed that the dysfluent speech is no longer a psychological issue.

8 ) A realisation that nothing in their life has greatly changed, as a result of more fluent speech, that has come at a cost.

Now as you can see, there is only one aspect, above, that involves the actual learning of a fluency enhancing method, and that is the learning of a physical method to control the speech dysfluency. The others can all be undertaken outside of a speech therapy environment, as they involve reshaping the concept of the world that the individual has created in their mind, and their place in it. Reshaping what it means to the individual to have a degree of dysfluent speech. That is within the individual’s own powers to change, and it is as a result of this, non-speech related process of change, that real treatment for dysfluent speech can be achieved. Simple solutions such as joining a local Toastmasters Club, regularly attending a stuttering support group, reading  John Harrison’s and Bob Bodenhamer’s books, (sold here), are all ways of learning to reduce the negative experience of mild to medium speech dysfluency.

So in conclusion, I can summarise by saying that if the person who stutters is low on the Stuttering Jack Scale, as far as physical speech dysfluency, yet in the average to higher range on the psychological scale, then speech therapy, in its many traditional forms, is unlikely, in the long term, to bring freedom from stuttering. Greater results can be achieved by accepting that the mild and infrequent (in terms of % syllables stuttered) dysfluency, that is being experienced, is “something that you do, not something that you are”, and then working on bringing down the rating on the psychological side of the Stuttering Jack Scale. Undertaking a long and costly process, to hopefully achieve reduced dysfluency through speech therapy, should really be given careful consideration, as you are unlikely to adopt the new way of speaking, that you will be taught. This is not because you do not want to adopt it, but because it will be so different to your innate and accepted speech pattern, that it will be almost impossible for you to maintain. On the other hand, if you are in the higher levels of the scale for physical and psychological symptoms of stuttering on the Stuttering Jack Scale, then speech therapy will be a must if you are to have any chance of achieving the fluency level that you seek, and that will be the subject of my next post, and in that regard I invite you to subscribe to this blog above to ensure that you do not miss the next post. In the meantime I also invite you to make a comment about what I have had to say here.