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.