Hi, my name is Abi and I am a second-year speech pathology graduate student. I understand that different therapy approaches work best for each individual, and I am curious about what your experience has been with using different strategies.
Do you feel like you have found one approach/strategy that feels most comfortable for you in terms of speaking with a stutter? If so, do you feel like it was challenging to discover which strategies are most comfortable for you, and do you feel like this is something that has changed over time? In other words, do you think your approach to stuttering has been consistent, or do you feel as if you have approached it differently based on different contexts or periods of time?
Hello Abi,
Thank you for your question.
I did not receive formal therapy per se in my instance, save for informal counsel on occasions from an SLT because I interacted with her frequently. (Well, you could call it speech therapy). The first thing she taught me was to 1. Accept my stammer. 2. Stammer confidently.
Tell you what, if any strategies have worked best for me, these are the two best ones I’ve found to date. Have I followed through on these strategies? Yes, I will say! My primary problem with stammering was that I didn’t accept it and was too embarrassed to see myself stammer in front of others. However, after I accepted myself as a PWS and that I may not be able to speak as fluently as others (even though this does not interfere with my effective communication), I felt less nervous about my stammer, which actually lessened the intensity and frequency of my stammer. Now that I’ve accepted myself as a PWS, I self-disclose anytime I have to, and that has motivated me to talk openly even though stammering.
So for me, being consistent with my approach or strategy has worked well for me. I hope this helps.
Best,
Elias.
.
Thank you for this well thought out question – and I have quite an answer for you!
From about age 4 to age 23 (late 1950’s to late 1970’s), I had at least some therapy at each age. Then again, I had fluency shaping therapy and refreshers periodically through most of my 30’s (mid-1980’s to early 1990’s).
I estimate I saw about 35 therapists for stuttering during the periods above. Of that number, I count 7 as being significantly helpful. And of those 7, there were 4 who were very helpful.
It’s quite a long story, since there were so many different programs, approaches, and clinicians – but I’ll try to summarize.
All the therapy I had during my childhood, before age 17, was totally useless. To be fair, knowledge and therapeutic understanding of stuttering back then (50-65 years ago) was much less than it is today. Most of my childhood stuttering therapy consisted of either talking about various aspects of my life, or practicing articulation (which was not my problem at all – stuttering is a fluency disorder, not an articulation disorder). The therapists really did not understand the problem of stuttering.
At the age of 17, I had the first helpful therapy of my life, in which I learned pullout techniques – and those very much reduced the length of my blocks (which had been measured up to 45 seconds), though not the frequency of blocking (which occurred on most words).
During my first three years of college, I had therapy from a speech pathology professor who stuttered himself. He tried traditional approaches with me – reducing avoidances and secondary symptoms, and trying to reduce my speech anxieties. This didn’t help my speech at all.
BUT this therapy did very much improve my social life, as under his guidance, I began talking with many fellow students on my college campus, regardless of how severe my stuttering happened to be. I quickly made many friends who – to my great surprise – didn’t care at all how disfluent I was.
Because of how he helped me develop my social life, I count him as one of my very helpful therapists.
My next therapy was a mysterious one, based on an experimental approach of successfully responding to commands to be fluent – beginning with single words, then advancing to sentences, paragraphs, and increasing periods of time (for example, “for the remainder of this therapy session”). Soon I was fluent for entire therapy sessions, and this expanded into my everyday life, as I learned to give myself commands to be fluent.
I began to experience a sensation of being enclosed into fluency bubbles (“fluency feelings”, I called them), perhaps a form of self-hypnosis. I was experiencing the first fluency of my entire life at age 21 (I remember my first fluent phone call, for example, in November 1975.) During a “fluency feeling”, I felt completely immune to disfluency.
Soon I reached a point of fluency in about a third of all my situations, and improved speech in another third of my situations.
For the first time in my life, I learned that I could indeed sometimes talk fluently.
But eventually that all collapsed. About a half-year after it began, there were no more fluency feelings, and I could no longer get fluency by self-command.
I next tried a behavioral therapy program at the University of Chicago, run by the psychology department, and developed by Dr. I.G.(now deceased). The premise behind this program was that one stutters because one “gets something out of it”, i.e., that one receives some hidden advantages from stuttering. The idea seemed like total nonsense to me; but since they claimed a 98% cure rate and I was desperate for help, I tried it. They taught a simple technique inside the clinic (based on breathing and phrasing), and I managed to speak fluently inside the clinic. But I could not apply it in the outside world. My clinician (a psychology grad student – I never actually met Dr. G.) spent hours with me, trying to figure out what (alleged) hidden advantages I was receiving from (allegedly) “not choosing” to use their technique in the outside world.
Total BS. I knew I wasn’t “choosing” to be disfluent, and wasn’t receiving any advantages from stuttering. I just couldn’t apply their simple technique, that’s all – my speech stresses were too great.
In the end, they told me I was among the 2% who had failed their program. (In retrospect, I don’t believe their statistics.) That damn program cost a huge amount of money, a total waste.
My next therapy was the famous airflow program of Dr. M.S., a speech scientist who had offices in Manhattan. (He’s retired now.)
His therapy was a relaxing airflow, with thoughts only on the flow while inhaling; then a little sigh at the top of the exhalation, followed by speech and a stretch of the first syllable. There were two others taking the week-long therapy at the same time I was (back in 1977 when I was 23). I was quite severe in my stuttering, and one of the other clients was even more severe than I was. But within a few minutes, we were all speaking fluently using Dr. S.’s technique.
I could use the technique inside the clinic. The other two also found success with using the technique in talking with strangers, store clerks, and waiters in Manhattan. But not me. I could only use the technique inside the clinic.
After returning home to Massachusetts, I practiced intensively, an hour or more each day. Finally the technique started to come together for me, and soon I could use the technique successfully in more and more situations.
I soon resumed grad study in Chicago, and continued to make progress. Pretty soon I was fluent in about a third of my situations.
Then speech disaster struck. A young uncle of mine passed away from cancer, and I rushed back to Massachusetts for the funeral. My speech completely fell to pieces, worse than it had been before I began S. therapy.
Despite many efforts over the coming months, I could not get back my previous successes with Schwartz airflow.
Frustrated with the whole therapy scene, I didn’t have any therapy at all for the next seven years – until age 30.
Then in 1984, I became involved with the program in which I found the most success, the Precision Fluency Shaping Program (PFSP – later called the Hollins Fluency System), devised by Dr. R.W. at the Hollins Communications Research Institute (HCRI) in Roanoke, Virginia.
It was a three-week intensive program (later shortened to 12 days), which trained clients in the use of a relaxing diaphragmatic breathing technique, gentle onsets, a loudness contour through syllables, and stabilizing articulators through slight stretching of the first vocalized sound in each syllable. The technique is complex, and is learned in stages – first with 2-second-long syllables, then with speech gradually speeded up until one is speaking at a slow-normal rate (or in Hollins terminology, slow-normal syllable durations).
I learned the technique very well, and could apply it successfully inside the clinic. Most of the others taking the program at the same time I did went home after three weeks speaking fluently in all situations.
Not me. As in several previous therapies, I couldn’t immediately apply the technique in the outside world.
But after coming home, I practiced really intensively, an hour or more each day. And there was gradual improvement. I was speaking fluently in more and more situations.
Finally – after three months of intensive practice – I reached my ultimate goal!
I WAS FLUENT EVERYWHERE!
It was a dream come true!!
I thought I was totally cured! WOW!!
I remained fluent for many months. I reduced my daily practice, thinking it wasn’t as necessary as it had been before. Four months after reaching total fluency everywhere, I attended a reunion at Hollins. My former clinician warned me that, even though I was speaking fluently, my techniques (called “targets”) were weakening. Sure enough, a few months later, I began to experience disfluencies again. A month after that, my speech fell apart totally.
I went back to Hollins for a week-long refresher, and my total fluency returned. I maintained fluency again for quite a few weeks. But it required a great deal of practice to maintain (an hour or more daily), and I didn’t always have the time to practice. Eventually my speech fell apart again.
In 1988, four years after first attending the Hollins program, I tried therapy somewhere else – also a Precision Fluency Shaping program, run by R.B. (a speech pathologist who stutters, who is a master of the Precision Fluency targets he learned at Hollins). This program took place at the Eastern Virginia Medical Center in Roanoke.
R. has an advantage over the fluent clinicians at Hollins – he uses the fluency targets himself, and has additional insight from his own personal experiences with stuttering and the Hollins techniques. Therefore, his program was a slight bit different from Hollins.
I started to periodically take one-week refreshers from R., one or two a year. I found his therapy to be really excellent, and his personal insights very helpful. During every refresher with R., I returned to complete fluency within a matter of hours. Then after a week, I maintained my fluency for weeks or for months, with intensive daily practice.
But still my speech eventually fell apart each time, and I kept returning to R. for more refreshers.
Meanwhile I went back to graduate school to study speech-language pathology (very different from my previous graduate program, music composition).
Afterwards, I became my own therapist, and conducted Precision Fluency refreshers for myself and others in Massachusetts and nearby states.
I continued the same pattern – reaching total fluency, and maintaining it for quite a while with continued intensive practice. But eventually, my speech always relapsed, and then it was back to conduct another refresher. This occurred many times throughout the 1990’s.
Up and down, up and down, up and down.
I eventually got tired of this yo-yo effect.
A little over 20 years ago, after moving to Norway, I decided to pull the plug on Precision Fluency. I now simply, peacefully, and calmly accept the fact that I happen to be a person who stutters.
And life became much simpler, less stressful, less pressured.
Yes, I still stutter severely. But it’s okay. I accept it. My speech is a difference. I no longer have the fluency I enjoyed for many long periods with fluency shaping techniques – but I no longer have the wild relapses either. I stutter severely, but I don’t have the really wild swings in both directions that I used to have.
And it’s all right. My life is happy, even though I’m not the most fluent person in the world. I accept myself as I am.
Hi Abi
Therapy is not one option. It should be a full smörgåsbord with different things to try, of which some are maybe completely different than speech therapy. F ex ACT, Mindfulness, yoga, singing, theatre, public speaking, art. Meeting other PWS. And should be adjusted as we go along. As we change along the way, physically, mentally, our place in life, goals, dreams, job options, partners, etc. What didn’t work at first might work later on, and vice versa. While to others, consistency is the key. And that’s why your job is challenging, but also creative! So keep listening, asking questions and stay creative. And work together. As you have the tools, but your client can give you the information you need to find new “recipees” for your smörgåsbord. 🙂
Keep them talking
Anita