Hello! I am currently a graduate student studying speech-language pathology and I would like to know more about how to be a better clinician when it comes to stuttering. I have heard some stories regarding terrible speech therapy experiences the PWS have had in the past. I was wondering, what are good experiences you have had with speech therapy or with a speech therapist and what did you find most helpful? Also, if you did have a speech therapist, did they provide you with any resources that you thought were helpful? Any insight would be greatly appreciated! Thank you!
Hello!
I have had a few experiences with speech therapy, and I now judge them by the impact they have had on my life…. Or rather, by how they have changed the impact that stuttering has on my life. I will give you two tips that have been very helpful for me, as a patient.
We know that stuttering itself is neither something positive nor something negative. And that at the same time there is a lot of prejudice and a lot of stigma (and self-stigma), which can have a devastating impact on people’s lives. So having a therapist who makes this distinction clear to you is very important, because it helps you understand where the problem is (and spolier alert, it’s not inside you).
Another key thing, would be to advise the patient to be part of the community. Sharing one’s experiences with another pws can help so much.
I know, it’s nothing outstanding but I hope they will still help you! 🙂
Andrea
Hi, and thank you for these most interesting questions!
I had many different types of therapy for my speech, and many different therapists, from age 4 to almost age 40. I estimate I saw about 35 different therapists for stuttering, the large majority of whom provided no help at all.
In retrospect, I count only seven who provided me with significant help; and of those seven, there were five who helped me substantially.
I will list those five here chronologically by initials, with years, my ages, and how they helped me:
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R.G. (1971-1972, ages 17-18)
I had many childhood speech therapists before her, but none seemed to understand stuttering or how to help me. When I came to R., I had very long struggled blockages, and they were on most words (usually lasting between 10 and 45 seconds). She was a fluent speech pathologist knowledgeable in Charles Van Riper’s writings, and taught me the essence of the pullout technique. She also introduced me to real knowledge about stuttering. Under her guidance, my block lengths went way down, even though I still stuttered on most words. This was the first helpful therapy of my life.
J.M. (1972-1975, ages 18-21)
J. was a speech pathologist who also stuttered himself. We spent three years together, mainly talking about stuttering and how it was affecting my life (and how stuttering had affected his). My speech itself did not improve while I was seeing J. BUT – through his guidance, I learned to become very social, to seek out and not avoid social situations, and develop a great social life (which I lacked before his therapy). I’ll always be grateful for how he helped turn my life around.
J. also introduced me to the concept of “person who stutters” (rather than “stutterer”). He was one of the very earliest to advocate this shift of terminology.
P.R. (1975-1976, ages 21-22)
P. was the first therapist to introduce me to the world of fluency. She was a fluent speech pathologist who decided to try out with me a very new experimental approach – following a series of commands for fluent speech (from single words to phrases to sentences to longer periods of speaking).
[Years later, I discovered this was based on Bruce Ryan’s “Gradual Increase in Length and Complexity of Utterances” or GILCU.]
This worked WONDERS with me – and I was so absolutely amazed!
I didn’t understand how or why this particular therapy worked, but it did. I still remember the joyous feeling of being able to speak fluently in the therapy room, and soon afterwards I was very fluent in a phone conversation with a friend – my very first fluency experience outside of a therapy room! Fluency then started spreading through my situations. Within a few months, a third of my situations were totally fluent, and another third of my situations were greatly improved. To me the experience was a mysterious “fluency feeling”, a feeling of being totally immune to stuttering, like being enclosed in a bubble – perhaps a form of self-hypnosis.
P. tried to explain to me that during what I called “fluency feelings”, I was consciously controlling my speech, being aware of my articulators, voicing, etc. No, I wasn’t – not at all. I wasn’t consciously controlling anything; it just was something mysteriously happening to me. P. didn’t accept this explanation, but I knew it was the truth.
Eventually, the whole thing collapsed. Within a half-year, all my fluency was gone – and these mysterious “fluency feelings” never returned. P. didn’t understand the relapse, and of course neither did I.
Although the benefits of P.’s therapy were temporary, I consider this experience to have been really valuable, in showing me that speaking fluently was indeed a possibility for me.
A.W. (1984-1988, ages 30-34)
A. for many years was a clinician of the Precision Fluency Shaping Program (PFSP), at the Hollins Communications Research Institute (HCRI), Roanoke, Virginia. [PFSP is no longer around, and the Hollins Institute closed up in 2023 after 51 years in business.]
She was my first Precision Fluency clinician (at that time, a psychologist; later she became a speech-language pathologist), and she understood stuttering more deeply than any fluent clinician I ever had therapy from. I first had therapy with her for three weeks at Hollins in 1984; later she moved to my old home state of Massachusetts, and I continued therapy with her for a while during subsequent years.
Precision Fluency was a very intensive program, developed by Dr. Ronald Webster, in which people who stutter retrained their speaking with carefully defined “targets” (muscle movement patterns). The primary targets were Full Breath (a slow smooth relaxing form of comfortably full diaphragmatic breathing), Loudness Contour (or Amplitude Contour or Vibrational Contour; a method of contouring dynamics of syllables, so that each one is initiated with a soft Gentle Onset, and reaches natural loudness levels), and Stretched Syllable (or Stretched Sounds or Stabilized Articulation; each initial voiced stretchable sound is slightly stretched and stabilized). These targets were initially learned at two-second syllable durations, with syllable durations gradually decreasing to one second, half-second, and “slow normal” (about quarter-second durations).
Most participants reached fluency in all situations by the end of the three weeks. It took me a lot longer – three months of intensive daily practice after returning from Hollins.
But finally, I reached what I regarded as the pinnacle of success – FLUENCY EVERYWHERE for the first time in my life.
It was a dream come true!!
I had total fluency for months!
But – it didn’t last, and I found that the intensity of daily practicing and conversational monitoring necessary to maintain fluency were just overwhelming.
About a half-year after reaching the “pinnacle of success”, my speech completely deteriorated, and I was back to very severe stuttering.
I had more therapy sessions with A. after she moved to Massachusetts, and those helped to a certain extent.
But I came to realize I was faced with the choice of either practicing and monitoring daily and intensively, or being disfluent.
R.B. (1988-1992, ages 34-38)
I had tried one week-long Precision Fluency refresher at Hollins, but found it disappointing.
At Hollins reunions, I had learned about R., a speech-language pathologist who stutters, who had gone through the Hollins program, and was considered a master at using Precision Fluency targets. He had established his own Precision Fluency clinic in Norfolk, Virginia.
R.’s approach was slightly different from Hollins, and was largely based on his own personal experiences of stuttering and using the fluency targets. He emphasized focusing on the totality of target use, rather than zeroing in on tiny details as had been the Hollins approach. Unlike Hollins, he included natural expression of speech and meaningful speech content as important goals, so his approach was somewhat more holistic. He also considered Full Breath to be the most important target (as do I), unlike Hollins (the Institute considered Gentle Onset to be the most important). And he also was realistic – Hollins told clients they must monitor their targets 100% of the time; R. knew this was too much, and told clients 90% would be fine. R., unlike most Precision Fluency clinicians, knew firsthand what stuttering was like, and about the special challenges that people who stutter face. So he was very helpful to clients in that way as well.
I had quite a few refreshers with R. over a four-year period, and each time managed to regain consistent fluency which lasted for quite a while.
R. was the last speech therapist I had (other than myself). Each period of fluency eventually ended. (I must have been “cured” over 20 different times in my life!)
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(A little conclusion appears below.)
During the late 1990’s, I conducted my own fluency refreshers with others who desired them in the New England area. (By that time I had a graduate education in speech-language pathology.)
Eventually I came to the conclusion that enough was enough.
I now simply, peacefully, and calmly accept myself as a person who happens to stutter.
And life is much less pressured – and indeed happier – that way!