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Therapy and Self-Therapy for Stuttering
Personality & Therapy | Selecting a Therapist | Self-Therapy | How it Works

'm an advocate and provider of individualized therapy for people who stutter, integrating fluency shaping and stuttering modification approaches, and consider this to be "best practice."  Some of the group "therapy" approaches now being touted are nothing more than a support group with some "talk differently" practice (for example, breathing violently and talking forcefully, speaking in a monotone, or singing) thrown in to create instant situational fluency. Some of these programs employ invented "technical" terms that may sound good but are essentially meaningless (like "costal breathing.")  Intensive one-weekend programs -- no matter what the approach -- don't last long enough to make a lasting difference, though they may help people feel and speak better for a few days or weeks. This means that continued intensive support from the group running the program is required and that the client (you) needs to consider the educational, professional, and clinical qualifications of the group therapists. 

Before choosing a therapist, it's a good idea to do some research about therapy approaches. I encourage any parent with a child of any age who has noticeable dysfluencies (more than 2-3 sequential part-word repetitions and prolongations of more than 1 second) to have these evaluated by a qualified speech-language pathologist who specializes in stuttering as soon as possible.

If you've come here for "one size fits all" therapy tricks, you won't find any. It's not appropriate to dispense specific therapeutic advice to people who stutter on a Web site. Even seemingly constructive advice like "avoid avoiding" may not be the best thing for some people at some times. For those searching for strategies for coping with stuttering and troublesome listeners, there are helpful ideas provided in the links on the last page of this Web site. 

Many speech therapy approaches have been shown to work for stuttering, including fluency shaping (various approaches), stuttering modification, and various combinations of these and other approaches. None of these will have a lasting impact, however, unless the client is motivated and willing to make some actual changes in behavior. Of course, once a person makes it into therapy, it is also the therapist's job to help that person maintain his motivation! Follow-up over many months (and working through several periods of difficulty or partial relapse) appears to be an important contributor to success. Sometimes, people who stutter just seem to need to go through several cycles of therapy before lasting changes begin to be made.

It's my personal view that the process of selecting a specific therapy approach can benefit from consideration of the stutterer's personality. My article on the Enneagram and stuttering therapy explores this idea. The basic concept here is to use the personality as an ally, not fight against it. For example, a person who has a difficult time concentrating and who tends to have a lot of fear of speaking and stuttering may not do as well at fluency shaping (which requires considerable discipline to produce "correct" and fluent speech in every situation) as at stuttering modification, which helps the stutterer confront the fear component more directly and provides techniques for confronting stuttering when it occurs. On the other hand, some people who have an extreme fear of stuttering may also do well at fluency shaping, while they would have difficulty going through with voluntary stuttering, an important element of stuttering modification.  Again, it is impossible to generalize about such matters. One size doesn't fit all.

Therapies that require clients to assume an accepted personality (for example, being an "eloquent speaker" or an "outgoing performer") should be scrutinized closely for evidence of psychological manipulation.

By the way, for those under the impression that people who stutter have identical personalities, consider the two people shown above: Lewis Carroll (the author of Alice in Wonderland) and Bill Walton (former basketball great and now sportscaster.)

Selecting a Speech Therapist

There's quite a bit of contradictory information on stuttering available on the Internet. For that reason, I've decided to list some guidelines (based on my personal experience with many therapy approaches and communication with other stutterers) on what to look for when interviewing or selecting a speech therapist or counselor. 

Select a speech therapist who:

• Realizes you may need to work for at least one to two years together (if the stutterer is an adult)
• Demonstrates a sincere interest in you as a human being
• Is encouraging and supportive, but doesn't promise a "cure," and acknowledges that lasting changes will not be made overnight.
• Does more than just talk about stuttering; i.e., actually works with your speech in a clinical setting.
• Encourages (but does not require) you to participate in a stuttering support group
• Doesn't attribute stuttering to one cause or "cardinal fault," whether physical or psychological
• Is able to watch you stutter without a negative reaction and encourages you to stutter in the clinic
• Plans to give you his or her personal attention
• Only uses electronic devices (such as delayed auditory feedback (DAF) devices) for therapy purposes or to inhibit stuttering, not as a "cure."
• Views you as a client, not as a research subject or an academic project
• Tells you that speech therapy is really self-therapy and that you will learn to be your own therapist
• Is open to the idea of appropriate psychological or personal/spiritual counseling as a part of therapy
• Doesn't say or imply that you must stop or avoid stuttering "at all costs"
• Doesn't try to argue with you or convince you of anything
• Doesn't say that they can "talk you out of" stuttering or that you can talk or think yourself out of stuttering.

Things you should ask questions about include statements by a potential therapist that developmental ("garden variety") stuttering is "caused" by one of the following, each of which is partially or totally erroneous in most cases:

• Things your parents told you, did to you, or made you do
• A childhood trauma of any kind that is not related to speaking
• Tightness or tension in one location, such as the larynx or tongue
• A neurosis or psychosis of any type
• Environmental factors (exclusively)
• Genetic factors (exclusively)
• Thoughts that are completely under your control or completely out of your control
• Depression, low self-esteem, or other psychological conditions
• A spiritual lack of some kind
• An addiction to dysfluency or to stuttering
• An obsession with stuttering
• A chemical or neurotransmitter deficiency or imbalance for which there is a curative drug

Providing therapy for people who stutter is difficult. And it can be frustrating for many non-stutterers (and even for stutterers) to interact for long periods with other people who stutter severely. An increasing (and troubling) tendency is to automate therapy as much as possible and/or to simplify therapy into a standardized, "one-size-fits-all" training or "coaching" procedure. Several ways of doing this are correspondence courses, intensive two or three-day therapy sessions, speech evaluations or follow-up using tape recordings, and the sale of electronic devices as "cures" for stuttering (as opposed to therapy or fluency aids.) Some so-called stuttering therapy "certificates" are even awarded by mail following correspondence training courses or by so-called "institutes" after 10-hour training sessions. The problem is that there are still no standards for stuttering therapy. The American Speech-Language and Hearing Association (ASHA) Special Interest Division 4 (SID-4) has developed a clinical specialty recognition for such therapy, obtaining input from experts and organizations like the National Stuttering Association and the Stuttering Foundation of America. However, there is still no way to quickly evaluate the legitimacy of a therapy program based on the therapist's credentials alone. Membership in ASHA or even ASHA certification does not guarantee that a therapist is competent to treat stuttering.

Charles Van Riper developed the "stuttering modification" therapy approach based partly on his personal experience with voluntary stuttering.

Self Therapy for Stuttering

There is a rich tradition of self-therapy for stuttering. That such therapy can be effective is shown by the success of many people using their own techniques to improve their fluency. In a very real sense, the PWS is never really helped in therapy without healing him/herself. Some self-therapy approaches, disciplined and enriched by study, research, and many years of clinical practice, have become successful in treating other stutterers. This is the case with Charles Van Riper's therapy and others.

Another useful approach is that taken in the book Self Therapy for the Stutterer, published by the Stuttering Foundation of America. This book provides contributions from therapists who give general and specific guidance for PWS who want usable near-term techniques to help increase their fluency or who are happy enough to live with managed stuttering.

Other more "programmed" or "canned" approaches are offered on the Internet by some individuals who stutter. I don't recommend any of these approaches over good, personalized, professional stuttering therapy. Such so-called "self-therapy" programs tend to focus on a pet theory of stuttering causation. While the theory of causation may be suspect, this does not necessarily invalidate the program. (Indeed, all therapy programs offered today by professionals are at least partly based on hypotheses about stuttering causation that are not explicitly proven.) But programs developed by individuals who are not trained in providing therapy often contain a key flaw. For example, they may unintentionally incorporate an element of lost awareness or reactivity that has not been "worked through" or even discovered by the person who created the program. 

More importantly, approaches based on personal self-therapy may not include a key therapeutic element from which the person benefited, but of which they were unaware when he or she engaged in the original self-therapy activities. Such errors commonly result from confabulation. For example, one writer who has increasingly touted the primary role of "psychology" in stuttering and downplayed the importance of speech practice has mentioned in some of his articles how he used to "play" with modifying his speech during presentations to groups -- which is a pretty fair description of so-called "traditional" stuttering modification practice and transfer. 

Such omissions can even be found in some professional programs. For example, most intensive 3-week "fluency shaping" programs deny the importance of emotions (physiological reactivity) in stuttering, but may actually be obtaining some of their success by using the positive emotional effects of the ad hoc "support groups" of people who stutter created during attendance in the programs.

One can learn things from virtually any therapy approach and an attitude of curiosity is probably the best way to investigate self therapy approaches. But it helps to have an understanding of what works for you and of the possible pitfalls of therapy approaches, such as fluency addiction, the conscious manifestation of which is popularly called "Worshipping the Fluency God."

How Does Speech Therapy for 
Stuttering Work?

Despite the common (and understandable) impression that stuttering therapy works by helping the person learn how to consciously control stuttering, the recovery process is essentially mysterious, and won't be fully understood until the physical basis of stuttering is revealed.

Speech therapy using several approaches seems to be effective when it begins by demonstrating 1) an ability to modify speech motor movements during the stuttering moment and 2) lack of negative consequences of stuttering during situations when stuttering would normally be elicited.

As in all human healing, there is a natural process ready and waiting to take over to promote fluency. In the case of stuttering, there are two major approaches to facilitating this natural process: eliminating cues that precipitate stuttering (with fluency shaping) and extinguishing reactivity to stuttering (with stuttering modification techniques.) The combination of these two approaches seems to be the most effective because it facilitates an increased conscious and subconscious awareness of all elements of stuttering behavior, resulting in an experience of increased self-efficacy.

At some point in a process of continually increased awareness and conscious drill, recovery then proceeds to a more subtle process through which the person begins to "let go" of control while maintaining the intention to speak. The process is difficult to put into words. This is possibly because many elements of the brain that are involved in initiating and maintaining stuttering don't even understand language. They can't be "talked into" fluency or "out of" stuttering because these mechanisms don't encode words and can't be consciously controlled. (If they did, humans probably would have disappeared long ago, but that's another story.) The "language" they do understand is mostly physical and non-verbal. That's why all successful stuttering therapies invariably involve actual manipulation of speech in some intentional, physically monitored way.

My own hypothesis -- based on my interpretation of recent research findings in stuttering and related areas -- is that greater fluency results from increased inhibition of unconscious, reactive, inhibitory responses by physical and mental processes and systems that have been made persistent by neuro-psychological conditioning.

The stutterer cannot make this happen. Fluency is the result of de-conditioning and counter-conditioning, the process of which is unknown to the stutterer, except by its gradual results.

Based on the success of several therapy approaches, this "inhibition of inhibitions" can be accomplished in two major ways: 1) by extinguishing auditory and tactile cues for stuttering reactivity through fluency shaping or airflow and 2) by de-conditioning stuttering reactivity through stuttering modification therapy. I hypothesize that the reactivity of stuttering originates in subcortical brain circuits that mediate survival reactions, threat responses, fear, and other basic conditioned responses. (See the Reactive Inhibition Model of Stuttering Behavior.) Such reactivity is notoriously difficult to extinguish and has been shown experimentally to be indelible at the level of the affected neurons. However, extinction of unhelpful conditioned responses through reinforced cortical inhibition is also a well known phenomenon and can acquire its own permanence over time. I don't think that we will really understand stuttering or how stuttering therapy works until the neurological factors are revealed in exquisite detail at the microscopic level. This detail would probably also reveal quite a bit about the variability of stuttering and the recovery process in different individuals.

This hypothesis is also based on the observation that another thing that is effective (in adulthood at least) is to repeatedly demonstrate to one's self that open stuttering (including openness about the feelings associated with uncontrolled stuttering) will not result in dire or life-threatening negative consequences. In fact, open stuttering alone can cause incredible temporary improvements in fluency. I would advise people who stutter to seek assistance and/or support in doing this. And to beware of therapists who use this powerful effect in the clinic as their sole therapeutic technique. 

Why Does Stuttering Persist?

One of the distinctive characteristics of stuttering, when it is present beyond the pre-school years, is its persistence and the tendency for relapse, even following years of therapy. The most common reaction when hearing about this characteristic and/or having to deal with it is to blame someone. This may be true even if (as is often the case), the person's residual stuttering is much less disruptive of communication that it once was -- often dramatically so.

Two likely answers are:

1. For stuttering to develop in the first place requires that the person have a genetic predisposition to stutter, most likely involving neurological, physiological, personality and other factors. Changing some of these characteristics would require something akin to changing the person's hair color.
    
2. Years of stuttering behavior (particularly in the important early childhood years) result in the physiological and emotional reactivity associated with stuttering becoming classically conditioned. Recent research (discussed here) indicates that such conditioning can be extinguished to a greater or lesser extent, but not totally erased.

It is the stuttering therapist's job to persist in spite of these characteristics of stuttering, and to help people who stutter persevere in improving their ability to communicate freely and without fear.

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© 1994 - 2007 Darrell M. Dodge

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Last Updated: Wednesday, October 17, 2007