Speech therapy guidance
Hi, my name is Meghan and I am a speech-language pathology graduate student in Texas. I would like to hear from people who stutter, how has speech therapy helped or not helped you? One of my biggest concerns when working with a client who stutters is making them feel as though they must speak fluently or that it is not okay to stutter. I never want my clients, or anyone who stutters, to feel this way. So, what have your speech therapists done in therapy that has made a positive and/or negative impact on your life? Thank you for sharing!
Hello Meghan
The judgement of stuttering as something wrong was THE biggest problem in my years (and years) of therapy. So, I am pleased to read that you do not intend to make clients feel this way.
I never went to therapy that was helpful, since I went to so much unhelpful therapy. I taught myself about stuttering, and about acceptance of stuttering.
A therapist can have a positive impact in therapy by:
1) Listening to what the PWS is saying, as opposed to focusing on how they are speaking
2) Explaing why we stutter
3) Explain the difference between primary and secondary characteristics of stuttering
4) Ask the client where they have difficulty, where they suffer.
5) Never promise fluency. You can help the client identify the stuttering and the struggle, and you can teach avoidance reduction techniques – avoidance of the avoidance of stuttering.
6) Introduce the client and the family to the National Stuttering Association and to FRIEND of young people who stutter. Break the isolation that the PWS might feel. They, and the parents, need to knwo that they are not alone.
Wishing you success.
Hanan
Hi, Meghan, and thank you for your important 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!
Thank you for your important question, Meghan.
Your concern is correct. Speech therapy had focused on fluency for way too many years. It’s like saying “here’s a pair of shows and a rope, now climb the Mt Everest. And if you don’t succeed, there’s something you’re doing wrong. This is not only not helping, it can add so much to the iceberg that’s even harder to treat.
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. 😉
There are some things I wish SLPs would do:
1. Listen and ask questions. Don’t just listen to the stuttered syllables, but listen to the story. The background. The goals. The culture, religion, anything that makes the person the way s/he is. As stuttering is so much more than what comes out of the mouth. Also listen to the parents and maybe even a friend, a partner. If a PWS doesn’t feel heard or safe, s/he will not give you the information you need.
2. Think out of the book, or box. One size does NOT fit all. One client (or the parent) might want to be fluent. Tell them fluency might not be for all. That climbing the Mount Everest is too hard for most people. So to set up reachable goals. Maybe tools to get out of a block. Maybe working on acceptance and self-worth. Maybe by giving them the knowledge to learn more about stuttering and explain to others. Maybe by suggesting something else but speech therapy. F ex presentation techniques, yoga, a choir. Or all of the above!
By listening, asking questions and providing a smörgåsbord of things to try, TOGETHER you might find something that fits that very client to reach acchievable goals.
As we’re all different, want and need different approaches. Some might want total fluency. If so, make sure they understand that this might not be an obtainable goal, but that there are many steps in between. Some might want help to accept and live with stuttering. Some might simply want some techniques to get out of a block. Some might want to know more about stuttering. Some might want help to get family members to understand. And therapy can be a full smörgåsbord with different things to try, of which some are maybe completely different than speech therapy. F ex yoga, singing, art. Also bring your clients to support groups, camps and online places where PWS meet. This has been life changing for me.
I also gave some advice in my paper in this conference, so feel free to have a read. 🙂
Keep them talking
Anita