How has stuttering therapy changed over time?
Hello,
I am a current speech-language pathology student, and something I am curious about the change in stuttering therapy over time. I know that in the past that there was a large focus on fluency, but it has shifted to have more of a focus on other behaviors and that the goals that PWS have instead.
-For professionals, in your career, have you shifted techniques from when you first started until now?
-For PWS, has your therapy changed over time if you have been in therapy for a long time or with a break in-between? -Around the world, how has it changed for you across where you live (is it newer or what have the focuses been for you)?
Thank you all in advance for the insight and information! I truly appreciate have many different perspectives.
Hello, and thanks so much for posting to the professional panel- do make sure that your question for PWS got posted to the PWS panel as well. First, I wish you the best in your continued graduate studies, and going forward! SLP is such a fun profession. This is a really good question. For me, my graduate school experience was largely based on fluency, and fluency counts within assessment. My graduate-level research project was even on comparing types and frequency of disfluencies across two languages in PWS. I don’t think that the covert and lived-experience of stuttering was completely discounted in my graduate studies, but even the definition of stuttering has shifted some since I was in undergraduate school to include the WHO ICF framing. I have shifted very much in my practice over the past 16 years, not just in stuttering but in other areas that we treat as well (aphasia is also shifting of recent to more often recognize a lived-experience approach and we are also seeing this in goal writing practices in neuro treatment).I have learned so much since I began to practice, and while this may sound odd and make me sound like a horrible person… I had to learn that I am treating a human being in front of me- not the case I read on paper before the person came in (or the child I read about in paperwork, etc). When I learned that I am a human treating a fellow human- I was a lot less intimidated by what I read and learned about the client that I was about to see- and I read their case histories with a more compassionate and humanistic lens. Now within practice, I really love holding paramount client autonomy. If you think of speech therapy like a ship… the clinician is the ship but the client is the steering wheel. We involve the client in goal writing, and in the treatment process as much as possible, while utilizing our skills sets and knowledge to provide a template and guidance for the client- while making sure we are holding paramount their own goals for themselves and not what we think they want. In terms of growth and learning-I always tell folks that I am learning every day, and with every client, because every client is treated differently in terms of personal therapy experience. As science evolves and grows, we shift out practices, and we are tasked with keeping up with best practices in our given areas of treatment by taking CEUs- so this helps to keep up with changes. I hope that helps give you some insight to your question, and I am looking forward to hear about my colleagues journeys as well!
Hi, and thank you for these most interesting questions!
I estimate that I saw about 35 different therapists for my severe stuttering between the ages of 4 and 40. All of this was many years ago, from the late 1950’s to the mid-1990’s.
The tyoe of therapy that I personally benefited the most from was fluency shaping. I tried four different fluency shaping programs from the mid-1970’s to the mid-1980’s (during ages 21-30), and found the most success with Precision Fluency Shaping. I experienced much success with Precision Fluency Shaping, off-and-on, for about 16 years (1984-2000). The reason why I say “off-and-on” is that I discovered I could only maintain those fluency techniques if I spent enormous daily practice time (an hour or more), combined with careful monitoring of all conversations with the techniques I had learned.
This was all too much for me, and eventually I simply decided on an entirely new strategy – self-acceptance. About 25 years ago, I came around to the idea of simply and calmly accepting myself as a person who happens to stutter, a person with a speech difference. And I found life to be much more satisfying, and so much less pressured, once I shifted my perspective. I stopped trying to transform myself into a fluent person, and simply accepted myself as I am, a person with a difference in speech.
Before all my fluency shaping programs, my therapies mostly dealt with the psychological aspects of stuttering, with some use of stuttering modification methods based on the writings of Charles Van Riper.
I never had actual therapy that focused on self-acceptance, the life philosophy of stuttering I now adhere to. This was something that I came around to, based on my own life experiences as a person who stutters. But I guess acceptance therapy was virtually non-existent during the years that I was seeing clinicians.
In this context it would be useful to mention that I have a graduate education in speech-language pathology (one of a number of fields I’ve studied). During my years of study in the field (late 1980’s and early 1990’s), I don’t think I encountered the self-acceptance approach at any time – either in my fluency disorders courses, or in any other speech/language disorders courses. The idea just wasn’t around back then, among professionals (or professors) in the field.
I realize that self-acceptance, for people who stutter, has been rapidly gaining adherents within the speech-language pathology field – and I am very glad that it has.
Hello, thank you for this important question, and for the truly fascinating insights shared by the previous contributors.
My situation, as a therapist from Europe, from Poland, has been quite different. When I graduated in speech-language pathology at the end of the last century, almost nothing was known in Poland about stuttering modification. At university, we were taught only fluency shaping.
Coming from a family with a history of both stuttering and cluttering, I have been deeply interested in these topics from the very beginning of my professional career and have tried to specialize in this field. For nearly ten years, I participated in intensive therapy camps for individuals who stutter. While the short-term results of these programs were often satisfying for participants, the long-term outcomes rarely met their expectations.
Over time, I grew increasingly frustrated, mainly because I was in regular contact with adults who had participated in various therapy programs in Poland and attended a therapy and self-help group I coordinated at my university. This experience pushed me to seek training abroad.
I attended a course organized by the Stuttering Foundation, and later in several programs offered by the Michael Palin Centre for Stammering Children in London. I completed the European Stuttering Specialization (which at that time was still called the European Clinical Specialization in Fluency Disorders). In 2023, I also visited the Arthur M. Blank Center for Stuttering Education and Research at the University of Texas at Austin, and I now maintain ongoing collaboration with both centers.
The change that has taken place within me, and which I now promote alongside my team in Poland, has been profound.
Acceptance is now at the heart of everything we do. The client and their individual needs always come first, and everything we do is based on this philosophy.
And I want to admit that this approach is incredibly liberating. For some time now, both my team and I have felt that what we do truly makes sense; we are genuinely improving the quality of life for the people we serve.
Thank you again for this inspiring question!
I wish you all the best with your future career, Katarzyna Węsierska
Thank you for your question.
Yes, fluency was the goal. And the sad part is that the word fluency is still used in many places. F ex we’ve seen many SLP students talking about them doing a Fluency course.
For a PWS, fluency can be as hard as for a person with a physical disability to climb the Mt Everest. Sure, some will succeed, which is amazing. But for others, when you don’t succeed to what everyone is telling and expecting you to do, you could feel (and sometimes are told) you’re a failure. it can lead to PWS becoming covert, silent or even worse (as in my case…).
Thank you for your question, hcb0325. When I was young SLPs didn’t really know how to treat stuttering. I was told to say the days of the week in one breath. (I played the saxophone, so air wasn’t the issue.) I’ve had SLPs telling me to breath properly. (Again breathing.) I’ve had an SLP who became my psychologist, but when I told her my story, she threw it back in my face. All of this made me feel less, incapable, a failure. Today most SLPs understand that fluency is not the one and only goal, but for a client to say what s/he wants to say, the way s/he feels comfortable with. Whether that’s with some help to get out of a block, to gain more self-esteem, to expend comfort zones or even to help explain stuttering to others or to find the answers to raise awareness. A good SLP works together with the client, listens, asks questions, and together find a way to set up baby step goals, while stepping out of the box and see what this very client wants and needs. S/he is maybe asking for something that’s not in your textbook, and you may have a suggestion that your client never heard of. So work together. As you have the tools, but we have the experience. 😉
I’ve tried most things out there. Even hypnosis, carrying pyrit (stone) in my pocket, whispering, you name it. 😉 But what suits me the most is what comes as close to my regular speech, and my personality. So for me that’s pausing and making shorter sentences, a slightly slower speech, slightly more articulating, a slightly lower pitch. But also using body language, courses in presentation techniques, singing, Mindfulness and NLP, self-worth exercises and affirmations, challenging myself (f ex public speaking) and standing up for myself. And also to keep calm and stutter on. As it’s up to me how I chose to speak, and this can vary from moment to moment. And the most important tool for me is acceptance. It’s my safety net. As it’s hard to use techniques all the time. (Try yourself and speak in 3-4 word sentences for 24 hrs.) So to know I’m OK no matter what, and that stuttering doesn’t define me, is a strong base to build upon. Acceptance and Act go nicely together.
I also gave some advice in my paper in this conference, so please have a read.
Keep them talking
Anita
Hi,
Thanks so much for your great question and for being interested! It’s been really lovely to read the responses from my colleagues, above too!
Due to a relationship as a teenager, I’ve always been interested in listener responses to stammering and how they impact upon the person who stammers. I saw at first hand the negative, cruel responses and how this drove a need to conceal stammering at all costs. Consequently, the focus of my dissertation (many moons ago) was on the listener responses to stammering and communication attitudes of teens who stammer.
I have been working for over 20 years and feel fortunate to perhaps be one of the very few older therapists to have never really focussed on fluency! This, in the most part, is due to the amazing university lecturer who taught me. She was hugely passionate about stuttering and always instilled in us that techniques which promoted fluency were not helpful – they were hard to use in the real world, particularly over time, and that they don’t reduce the fear of stammering, since there is no cure and they don’t always work. She always encouraged us to support the person to feel more comfortable and confident in stammering; to help them move towards acceptance of stammering and to do the things in life they wished regardless of stammering….. and then, if the client was wanting more fluency, they would be ready to work on it more effectively. We learned about the stammer more fluently approach and block modification. That isn’t to say we weren’t taught about techniques – we were, and a lot of the interventions, even if this wasn’t explicitly stated, had the goal of reducing stammering. Even the work around acceptance – if people cared less about stammering, become more accepting of it, they were likely to stutter less. Therapy, was often sold to people in this way.
What my university course didn’t cover, however, were the risks that fluency techniques may pose: making a person feel that the way they speak isn’t acceptable, isn’t okay, and essentially encouraging them to hide their stammer. We never spoke about the fact that techniques contradict the message that a person’s natural and authentic voice is acceptable, welcomed, and valuable just as it is. What I discovered after working with people who stammer – was that if we work on people feeling ok about stammering, rather than fluency, people never wanted the techniques. They felt happy with their speech as it was.
Over the last 10 years or so, I’ve been more connected with the stammering community and listening to voices within it. I’ve learnt about the social model of disability and am indebted to the work of Sam Simpson. I was privileged to be a part of some social model supervision led by Sam back in 2020. I found something which had previously just been a feeling in my gut. It led me to being committed to therapy based on my integrity and beliefs about stammering as a valuable way of speaking, a way of speaking that adds something to communication, and to the world. I can honour and see the beauty in stammering and I know this shapes my work. Joshua St Pierre recently used the phrase ‘care for dysfluency’ and I feel like this is such a tender and nurturing idea which I’m keen to let ripple through my work. I feel at peace with how I’m working. That’s not to say I’m not changing. I feel like I’m continually evolving, continually learning and there is so much new and exciting research being done, along with conceptual models of thinking about stammering and stammering culture. I’m enjoying looking at the Stuttering Commons handbook at the moment, which you can access here: https://www.stutteringcommons.org/handbook.
I hope you enjoy reading all the responses and wish you well for your future in speech therapy (and hopefully working with people who stammer),
Nic