I totally agree with you that there is a gap between the desired and real outcome, especially when adults are concerned. I think a broader definition of improvement when it comes to stuttering treatment is needed, and improvement of acceptance is an important issue. In my clinical practice, I experience that many adults benefit from a mixture of behavioural and emotional-/cognitive-/mindfulness-based approaches, and what I focus on, is mostly related to what kind of goals and aspects which are of importance for the person himself. I see that the level of acceptance often is associated with the person’s ability to cope with his stuttering in his daily life. How the SLP is combining the elements in treatment, and how the elements are integrated in real life is usually more interesting/important rather than what kind of specific method or resources the SLP is introducing. Another important point is that I usually focus on how the person is making speech and communication less effortful rather than focusing on speech fluency in itself. In the same time, I do understand that some PWS want to improve their speech fluency, because for several stuttering might be associated with struggle and loss of energy, regardless if the stuttering is mainly based on components of covert or overt stuttering, or a combination of those components. To be confident in communication is usually a meaningful issue to focus on, even though we stutter or not.