About the Author: Hanan Hurwitz is an electronics engineer by training, and currently self-employed as a Quality and Regulatory Management Consultant. He is also a person who stutters, and former Chair and Executive Director of AMBI, the Israeli Stuttering Association. Hanan lectures extensively on stuttering. His volunteering activity these days is with an association that runs projects designed to close equity gaps in Israeli society. His primary interests – at present – are Buddhist and Stoic philosophy, Blues music, and reading.

Abstract

“We have the power to hold no opinion about a thing,” Marcus Aurelius wrote, “and to not let it upset our state of mind—for things have no natural power to shape our judgments.” – Ryan Holiday, quoting Marcus Auerlius

With this in mind, I am nevertheless mindfully choosing to express my opinion about this year’s ISAD theme. Even if I feel strongly about my opinion, and even if I come across strongly, I know that what I write are only my opinions.

It is proposed in this ISAD conference that “One Size Does NOT Fit All” when it comes to therapy for stuttering, meaning that “a single solution or approach is not suitable for everyone, as different people have different needs and circumstances.”.

Indeed, over the past few years there seems to have been more discussion on and emphasis about “client-centered” therapy, that is therapy that is geared towards the needs and wants of each person. When introducing different types of therapies offered at the Michael Palin Center, they write that “Therapy can focus on communication skills, speech skills, psychological or skills or a combination of these, depending on what you are interested in.”. In my opinion client-centered therapy is always necessary, in any therapeutic context.

However, the claim that “one size does not fit all” needs to be qualified. We have a responsibility to identify therapeutic approaches – and practitioners – that are potentially harmful.

Is Therapy Necessary?

I think that is firstly necessary to consider that one option in “one size does not fit all” is No Therapy. Sometimes, perhaps too often, we are subject to the part of the stigma of stuttering that implies that therapy is necessary. We always need to ask “Why is therapy desired or necessary?”. Just the fact of stuttering does not make therapy necessary, and this attitude can take us a long way towards disassociating ourselves from the stigma of stuttering and the perceived opinions and judgements about others about our stuttering. In my many talks to teachers, to speech therapists and to parents of children who stutter, I have attempted to convey the message that if stuttering is not impeding the person from living their life they way that they want to, then therapy is both unnecessary and potentially harmful. It’s amazing to see how the folks in the audience get this message, and how it frees them from the belief that therapy is inherently necessary for a person who stutters.

The Potential for Harm in Fluency Shaping Therapy

“Successful suppression of stuttering is what maintains and perpetuates the problem.” – Joseph Sheehan

I have been thinking about this for a long time, and thankfully I am able of late to just come out and say it: In my opinion, Fluency Shaping Therapy is one of those approaches that are potentially harmful. It seems that in many parts of the world this remains the main therapeutic approach, and, in my opinion only, it is past time to say Stop: This approach has the potential to cause more harm than good. Moreover, the approach should be banned as it is abusive. It is most abusive when the therapist sends the conflicting message of “it’s ok to stutter, but try to use your tools”, when those tools are fluency-shaping methods.

Fluency-shaping, easy onset, whatever they call it perpetuates the stigma of stuttering by prioritizing fluency over communication and placing value on fluency over a multitude of things that we can choose as our true values. Fluency-shaping perpetuates self-stigma in the forms of shame, anxiety, guilt and fear, which can all arise as a direct result of this therapy.

• Fear: In the moment of speaking, I feel fear that I will not be able to use the tools, as well as feeling fear of stuttering itself and fear of the response of The Other to my stuttering and to my fluency-shaped speech that sounds weird to me. Fear results in our natural mechanisms of self-preservation to kick in, and our cognitive brain takes a back seat while we “fight, flight or freeze” as we face this threat. The cognitive brain is the part that we need in order to do the fluency shaping. And so, we are stuck. And, possibly, this causes us to block more than we would have done otherwise.
• Anxiety: In anticipation of speaking, we are anxious as to whether we will be able to use the tools
• Guilt: Since we will stutter sooner or later unless we choose not to speak, we then feel guilty about stuttering. After all, we or our parents paid significant sums of money for a treatment meant to cure/suppress/hide our stuttering and yet we still stutter.
• Shame: While guilt means that I feel bad about doing something, shame means that “I am bad”. Many people who stutter know this feeling. Shame is an intense and destructive emotion. It guides our life and our decisions. It grows since we might be ashamed to speak about our shame.

When these feelings and emotions arise, they can make us withdraw from life.

Fluency shaping can also be exhausting. For me personally: after my three-week intensive fluency-shaping course, I soon became exhausted from the effort of consciously controlling my speech, and from the effort of having to both think about what I was saying and about how I was saying it, while all the time fearing that I would stutter. I soon chose to speak less.

One of the traps that I bought into for a while was that fluency shaping is valuable in showing the person who stutters who states that they cannot speak that they can, in fact, speak. So why is that statement wrong (in my opinion)? Well, it’s because many people who stutter are so (understandably) desperate for a cure that we latch onto anything that gives us hope. Once we have experienced speaking with an easy onset, it is really hard to give it up. And so we are trapped in the fluency focussed treatment model with all its pitfalls.

Identifying the Real Problem (if there even is one)

“The problem is not the problem; the problem is your attitude about the problem.” – Captain Jack Sparrow

Before engaging in any therapy, we need to be able to identify for ourselves what the problem is for which we want resolution, and what that resolution, or outcome, looks like.

In society in general there are many imaginary problems that, when we believe them, cause untold suffering. Stuttering is one of those imaginary problems. “Not True”, you might say, “I stutter and I cannot get a word out and it’s killing me.”. I understand. Truly. However, the problem is not the stuttering. The problem is (a) our attitude towards stuttering and (b) the struggle that we have with and against my stuttering.  I am forever indebted to Vivian Sisskin for teaching me to differentiate between Stuttering and Struggle. Accept the Stuttering, she teaches, but not the Struggle.

I have learned that I suffered, and sometimes still suffer, due to my attitude towards stuttering (including deep-seated shame that I am still working on understanding) and the struggle behaviour that I added to my stuttering. The most difficult lesson for me to learn in my Journey with stuttering was that a lot of my stuttering was due to behaviours that I added to the native stuttering.

The fluency shaping therapy that I went through reinforced my belief that my stuttering was a problem, it created additional struggle behaviour, and my speech was more difficult for me than before. So, after this therapy I was still struggling to control and conceal my stuttering. I cannot emphasise enough how abusive this treatment was. I used to think that I was the only one who “failed” fluency shaping therapy, but then I met more folks like me. Many more.

On the other hand, my journey to learn about and accept stuttering has been liberating, full of meaning that I never had before, and, frankly, life-saving. A few of us who attended that fluency shaping course (not at the same time, but the same course) refer to ourselves as “survivors” of that therapy. We are traumatized, we are angry, but we are also more fulfilled now that we have found a different way to live with our stutter. Survivors, no less.

Other Abusive Therapeutic Approaches

“… sometimes I’ve believed as many as six impossible things before breakfast.” – The Queen in Alice in Wonderland

There are other abusive treatment options that need to be spoken about. In Israel there is a person who claims that he will fix your stuttering by teaching you how to adopt a different persona. In fact, he says, he will teach you a number of personas and that you can choose at any time which one to adopt. Great. I will get up in the morning and decide which face to put on. I will live my life in complete unauthenticity while still fearing my stutter. Wonderful. While it still remains to find one person who has been helped by this approach, we see many who claim to have been victims of fraud.

And what about the folks that claim, without any evidence, that hyperbaric oxygen therapy will cure stuttering, or that hypnosis will cure it? Hyperbaric and hypnotic treatments have their place, but certainly not in the “curing” of stuttering.

Take a look at this clinical trial and decide for yourselves if this is abusive or not. Look at the Inclusive and the Exclusion criteria. In my opinion this trial is hyper-barbaric.

https://classic.clinicaltrials.gov/ct2/show/NCT05291572

Conclusions

“We must keep an open mind, but not so open that our brains fall out” – Walter Kotschnig and others.

“One Size Does Not Fit All” makes sense, but it is perhaps worth maintaining a critical attitude to therapy and to explicitly call out and oppose therapeutic practices that, even if they have been around for years, are abusive.

There are therapeutic practices that focus on helping us identify and let go of our struggle behaviours, on overcoming our self-limiting thoughts and beliefs, and on enabling us to find meaning and purpose and to pursue that purpose without letting our stuttering get in the way. There are life-enhancing therapies out there.

Sure, it’s challenging to live with stuttering. However, for better or worse it is what it is and we can find a way through it, and we should preferably do this within a framework of community support. People with a variety of physiological differences do so, and we people who stutter can do so, too. Freedom lies on the other side of that discovery.