The future of fluency
After participating in this conference and reading several essays, both personal and academic, I find myself thinking about the future of fluency treatment. Some people spoke about the history of fluency treatment, while others spoke of newer approaches to fluency, and some simply reflected on their own experience and how stuttering had both negative and positive affects on their lives.
I read about some people who use technical meditation, others used yoga, and some people found that just being around other people who stutter helped them gain a sense of belonging and acceptance about their experience with stuttering.
There seems to be so many new and exciting approaches out there to treat stuttering (or general disfluencies). As an SLP graduate student, I find the history of this field very interesting, but I am also always curious about the future. Where do you think the future of fluency treatment is going? Could the increase in technology have positive effects in fluency treatment (therapies such as technical meditation)? On the flip side, I know technology and the constant interruptions caused by being “plugged in” can be a hinderance to fluency treatment.
What are the newest, (perhaps even controversial) treatments of stuttering? Are there treatment approaches in the works or being studied that you believe could change how we view treatment?
This is not a question with one answer, just a curious brain wondering what could be next!
You ask a very important question. The research is going in many directions. There are brain studies, genetic research, pharmaceutical trials, experimentation with vitamin supplements, a lot of trials with cognitive behavioral psychology and mindfulness. Stuttering is like an octopus with many arms, but they are all attached to the same speech production system. Many researchers are relating to stuttering as malfunctioning speech production system. Hopefully in the near future they will learn the causes. In the meantime, I, for one, hope that the treatment for stuttering will follow the research and also relate to the multifactorial system. That means that there will be value to cognitive behavioral approaches, with meditation, with neurophysiological changes in the way speech is produced. I would imagine technology will add to the effectiveness of therapy in ways we are not yet familiar with. It would be nice to find some chemical imbalance in the brain that could be corrected by supplements or medication, but I am more pessimistic about that. Still though it something to be explored. As an SLP beginning your career, you are starting at an exciting time. I think the new technology will certainly help us understand stuttering and possibly be used to enhance fluent communication.
Thank you for this thorough response! It sounds like there is a lot of exciting research being done. The brain is so fascinating and I’m sure as we learn more about the brain, we will learn more about stuttering and perhaps even discover the causes. I agree that we cannot really know what kind of benefits technology will bring to treatment and that is what makes it so exciting!
Thanks again for your response!
Great question! I think the Challenge will remain the same also in the future; How to tailor the right approach for each person’s individual needs? For some, it may be a reduction in stuttering, for others a reduction in struggle, and for still others, improvement may be related to changes in approach- and avoidance-related behaviour. All of these issues are depending on the person itself: his personality and speech/stuttering pattern, as well as the goals and aims defined by the person himself. Stuttering may incorporate motor speech difficulties, for many individuals, stuttering may create additional social and psychological challenges in daily life. Flexible approaches are therefore needed to deal with this complexity and variabilities also in the future. I don’t think the treatment approaches is changing into a “new” direction. I rather think that the approaches are just defined differently, or they are defined into other terms/names. I do not like that we make a big gap between cognitive/fluency/affective approaches. This gap is only a theoretical gap. In most of the collaborative situations in my practice, the treatment is having a synergy effect on each of the factors mentioned above and it is often a combined appraoch. I do hope you understand my English. I wish I could explain in Norwegian because this issue is very interesting and of high importance for many, including me;) Best wishes, Hilda Sønsterud
Thank you for this great response! Your english is wonderful! This is a fantastic answer and I think touches at the heart of stuttering treatment. When dealing with a person who stutters, there is not one approach that works for every client. Each client is unique and SLP’s must be informed on a wide variety of approaches. Technology will not change that part of fluency treatment and that is a good thing. Synergy is a good word to use when speaking of fluency treatment, all the components from client to SLP to environment to the approach must work together for beneficial fluency treatment.
Thanks again for your comments!
Dear Lysandra,
I can almost envy your enthusiasm for the future of stuttering treatment. More than 50 years ago, after a dramatic (but temporary) cure of my stuttering in my first treatment during my high school years, I decided that I would enter the field and do what I could to “solve the problem of stuttering.” I was extremely enthusiastic myself at the time. I would not say that I am unusually jaded or cynical at this point, but I certainly know well that such a goal is probably as unattainable, just as the goal of being able to successfully treat every stutterer whom we see. That does not mean we cannot do great and wonderful things with children and adults who can’t seem to get their words out fluently. We can and we do! But my experience has taught me again and again that stuttering treatment now is really not much different than it has been for 100 years. The terminology has changed. The packaging has changed. The delivery systems have changed. But aside from a few approaches that I will mention momentarily, the basic approaches are very similar to what we do now. Bryngelson, Van Riper, and their predecessors (e.g., Bluemel) in the 1920s to 1950s) developed the basics of what we now package as stuttering modification. Although fluency shaping was not popularized until the 1970s, Cooper pointed out that most of the “targets” could have been discovered in the late 1800s in the library. Of course, even Freud wrote a bit about the psychological aspects of stuttering and as number of Neo-Freudians, clinicians, and others have written eloquently about reducing anxiety, fear, avoidance, and other negative feelings associated with stuttering. Johnson wrote about society’s reactions to stuttering and how those reactions affected people who stutter.
Since then, we have learned about the use of artificially delaying the speech signal (beginning with Lee in 1950) or filtering it (more recently). These beneficial effects (in some stutterers) are now packaged in a small, ear-level device known as the SpeechEasy. Drugs have been used for a long time as well, but until recently, the side effects have almost always been worse than the benefits achieved. Recent drugs (that Scott Yaruss mentioned in another post) have shown much greater promise; however, drug treatment has not yet been shown to be highly effective in most cases of stuttering. Learning approaches have been around for a long time as well, but reached their heyday in the 1960s and 1970s. Of course any behavioral therapy must deal with habits, old and new.
The newest approaches in my mind which have been shown to be especially useful include (a) treating stuttering children while they are very young and while their brains are still plastic, (b) combining clinical treatment with self-help from committed persons in the stuttering community, (c) and pharmacological advances. I’ve probably forgotten about a few others.
What about the future? A few researchers are looking at brain stimulation to see if that might help stuttering as well, but that will not be in the clinical realm for some time even if it turns out to be effective. I heard Travis talk shortly before he died that he believed neurochemical approaches would likely occasion the most significant future advances in understanding stuttering and improving treatment. Researchers are making headway in these realms as well. Genetic treatment might become part of the overall management of stuttering, but since most good genetic studies have found that stuttering can be associated with numerous different combinations of genetic defects, we’ll have to wait a long time to find out if this might be effective as well.
Do I think that we’ll solve the problem of stuttering such that almost every case can be treated? No. Bloodstein said it well. To paraphrase his point very loosely, when we understand why people do most everything that they do, then we’ll probably know enough to think about understanding stuttering.
I hope this addresses at least some of your curiosity.
Ken St. Louis
Thank you for such a well thought out response! You make so many good points and have a perspective that can only come for working in the field a long time. It’s interesting to look at my question from the opposite angle, not what is changing about treatment, but what has remained the same. From your response, it seems that a lot of treatment has varied some, but many of the core concepts have stayed the same. That is another good way of looking at evolution, not just where we are going, but where we have been and how that still informs treatment every day.
You absolutely addressed my curiosity and then some. Thank you again for such a thought-provoking response!
You’re welcome. It’s always gratifying when the questioner replies. Best to you and stay curious!
Ken