Success in speech therapy for stuttering

First off, how do you define success in speech therapy for stuttering?

And yes, the answer comes down to three key elements I’m about to share. Once you start working on these three elements with your clients, that’s already a success. But what’s the result? What’s the destination? Where are we going?

You want to be able to distill that result, that destination, into a single phrase—or even just one word. So, how would you define success in one phrase or one word? I’d love to hear your thoughts—it will be great if you could leave a comment!

At first glance, the answer to this question might seem obvious: to reduce stuttering and increase fluency. That seems to make total sense. However, I don’t believe that’s the right focus.
Let’s take a closer look at the stuttering cycle.

There is a predisposition, insecurity in the speaking structure, speech impediments, helplessness, feeling bad about it, stuttering anxiety, and tension. However, the key element is what I call 'refusal.'

The refusal or withdrawal means that some part of the brain simply refuses to cooperate. I try to speak fluently, but it doesn’t happen the way I want. And it doesn’t feel great. Why would I want to continue? Consciously, of course, I want to continue, but the brain has its own view. It creates its own automated reaction. We could even say that it’s a very logical and natural reaction of the brain and body. They instinctively try to help us avoid and escape a negative experience through this non-cooperation. They’d rather not, but that’s what we have. That’s what we need to deal with.

That refusal—that’s what we want to change as a result of speech therapy. The opposite of that refusal is not quite fluency or not just fluency, if you would.

The opposite of that refusal is presence. When a person truly enjoys speaking and social interactions.

Some people might say here that we don’t necessarily need fluency to enjoy the interaction. And yes, there’s another concept which is aiming at effective communication as a goal rather than fluency. A person can effectively communicate while still stuttering. And it goes in line with acceptance, being open about stuttering, being not ashamed of it, being OK with it. I love this concept, but at the same time, I’ve never heard a PWS say “I truly enjoy this stuttering moment.” The stuttering moment itself is not a pleasant experience.

So, if there’s a way to combine fluency and presence, to create fuller alignment and fuller presence, and of course if a PWS is willing to go for it, I would suggest that we view that as a goal, we see that as the destination.

Element # 1

Critical amount of new muscle and emotional memory

Let’s turn to a physics analogy. As you know, the Moon goes around the Earth, completing a full cycle in about a month. The Earth, in turn, orbits the Sun, taking approximately one year for a full cycle. Meanwhile, the Sun and the solar system orbit the center of our galaxy, the Milky Way, completing one cycle roughly every 250 million years.

I don't want you to remember all this, I just want you to understand how critical mass matters when it comes to creating gravity. This gravity ensures stability in the system by pulling all the objects together and not letting them go.

Returning to the stuttering cycle, we can see that it’s a very stable system that reproduces itself over and over again. It has a lot of gravity in it. Predisposition, insecurity in the speaking structure, tension, anxiety, refusal as an automated reaction of our brain and the body. They strongly reinforce and support each other. It may seem that it’s just the way it is. It’s just the way I am.

If we want to create a new system where a person feels great about speaking and social interactions, a new stable emotional state that starts to reproduce itself over and over again, we need to generate enough new muscle and emotional memory. So that a person’s behavior, feelings, automated responses and reactions start revolving around a new center of gravity that keeps it all together.

How do we create new muscle and emotional memory? Through creating speaking experiences.

And that already might feel frightening when you say that to a person who stutters. That’s why a lot of PWS look for other ways. Magic ways. Learning about stuttering and its causes (maybe I need to realize something and everything suddenly falls into place!) or looking for medications, devices or hypnosis or some magic stuttering technique. Probably I just don’t know something! Tell me the secret!

That’s why I started with physics - there are no fairy tales here. No stuttering cure. No magic trick. But boring physics can become a fairy tale. It can feel like magic. We’ll get there in element 2 as we’re going to talk about the tools. For now, let’s come back to generating a critical amount of muscle and emotional memory. How do we do that?

Intensive part

Stuttering programs and specialized stuttering therapies often start with an intensive part. That was my experience as well, when I took a speech therapy program back in the day as a person who stutters. So for several days I immersed myself into learning a new way of speaking.

The idea of the intensive part is to learn the tools, the training speech (element #2) and generate initial muscle and emotional memory to take off the ground. To overcome gravity.

It’s not just mechanical muscle memory (learning in a therapy room) but creating new emotional memory. That's how memory works - we remember something really well and it goes deep into the core when there is a strong emotion attached to it.

I don't remember what the weather was like yesterday, I don't remember how I practiced the training speech all by myself, I even don't quite remember how I did it in the therapy room. But I vividly remember how we went to some college and presented in front of a class, in front of a group of people. I don't remember what my presentation was about but I do remember how I spoke and how I felt. I remember that it was a playful and joyful experience. That felt magic. That felt like I just learned to fly.

That's already where I see some traditional speech therapy is going a different way offering just evaluation and then some sessions maybe weekly, maybe from time to time. Without a certain amount of initial intensity it’s like an airplane which wants to take off but instead of taking off we’re just taxiing around the runway. And of course we cannot fly to the desired destination without first taking off.

Again, there's a lot of gravity in the stuttering cycle. We need quite some intensity to overcome this gravity and take off. And at that first moment the determination of your clients are at the highest. We want to use that determination when a person is most willing and ready to put in the work.

And you can test, you can experiment, there could be different formats of this initial intensive part. In my own speech therapy back in the day it was several days of in-person everyday practice. In the Free From Stutter Program that I run for my students I extended this intensive part for 8 weeks. Testing different numbers of calls, starting from 4-3, I found that 2 calls per week can do perfectly fine. So, it's 16 calls in 8 weeks. The first four weeks are for learning the training speech, and beginning to speak this new way with key speaking contacts and in new environments. And the next four weeks are about creating more challenging experiences, like public speaking environments, making phone calls, asking directions, recording everyday interactions.

By the end of this intensive part a person can speak in a new way. It's not just a conceptual understanding of some technique or techniques. We create a strong momentum to move forward.

System

There are many stories where people after the Intensive part say “I was fluent for several weeks (or several months) and then came back to stuttering again.”

At the initial stage, taking boxing analogy, stuttering gets a strong punch in the face. Stuttering cycle is destabilized, like “what’s going on?” But it’s not a knock down though. A more peaceful analogy - it’s just a seed that we’ve planted and now we have a little spout we want to water and grow. It’s a snowball. We can leave it, you can throw it, or you can roll it so that it grows into a new reality.

The key part of the system moving forward is to consistently create speaking experiences where a person doesn’t have to speak.

And I see your role at this stage is encouragement, accountability and providing your clients with practical steps on how to do that.

Basically, there are two types of speaking experiences. The first is more or less what we usually do—what we have to or need to do. People who stutter naturally tend to limit this type of speaking to the bare minimum. The second type involves situations where we don’t have to speak, but we choose to. This is where your clients proactively create those experiences.

And even though the percentage of using the training speech in everyday life matters for sure, I see this second type as the most impactful piece of the system. Because when a person creates a new speaking experience this in and of itself is the opposite of avoidance, escaping, withdrawal and refusal. This is the act of presence. This is the act of belonging. This is saying “I’m not going to run away. I belong here. This is my land.”

And for each individual there could be more challenging experiences and less challenging experiences. Typical mistakes people are making are picking only challenging or only comfort zone experiences. We want to have both.

For my students, for example, I suggest combining 3 types of activities:

1) small Facebook group - it's a private group where where they do the assignments and after doing a couple assignments it feels like comfort zone;

2) big Facebook group - it’s still a private group, but it feels more like public speaking environment, we also have our speaking club - a group environment, so it’s somewhere in the middle;

3) real-life recordings - using the training speech in real life settings - it depends on the environment, but it obviously tends to be more challenging.

We’re talking about developmental stuttering. Which means stuttering takes some time to develop into a stable cycle. Similarly, it takes some time to create a critical amount of new muscle and emotional memory for PWS. I would aim at 2-3 years to develop a new emotional state associated with the act of speaking, a new automated reaction to glitches. A “no worries” reaction non-stuttering people have when glitches happen in their speaking.

Performance

I like to use one word—'performance'—to describe all the new experiences mentioned above.

You can take a look at actors who stuttered - Emily Blunt, James Jones, Bruce Willis, Samuel Jackson. Or Steve Harvey who even gives advice on how to overcome stuttering. All the way to public figures like Tomas Jefferson, Joe Biden, Winston Churchill. What do they do or did they do? They show up to speak / perform. They create a public speaking environment.

Perhaps the best book about stuttering is written by John Harrison, titled Redefining Stuttering. Do you know what the initial idea behind it was? Public speaking exercises for the National Stuttering Project (now NSA).

I talk about public speaking as a separate technique in my 17 stuttering techniques video. I talk about starting a YouTube channel in my video about Stuttering cure. All the same idea behind all those examples - that’s how we create a critical amount of new muscle and emotional memory.

So, creating public speaking environment or performance as I call it, is the # 1 exercise. Because as we practice it, eventually, any interaction, be that a phone call or work presentation, it’s ultimately you taking the mic and feeling that the stage is yours, it’s your turn, and you feel great because you have nothing to hide, you’re open, active and positive, you’re ready to speak on your terms. Not just conceptually, but you’re actually doing it.

Now, let’s see how tools can help with performance / creating speaking experiences.

Element # 2

New tools (hand technique)

The tool I used in my own speech therapy back in the day, and the one I now use with my students, is the so-called 'hand stuttering technique.' I labeled it the 'hand stuttering technique,' even though it’s not quite a technique. We'd better call it a method of synchronizing speech with pressing fingers on the thigh.

So, what's the major problem with pretty much all other techniques, including, of course, the traditional speech therapy stuttering techniques?

The problem is that these techniques don’t affect your clients’ speaking as a whole. Typically, a technique is simply a way to respond or react to stuttering. By default, it’s reactive—just like stuttering itself—and that’s why many people say these techniques don’t work. I agree when we apply techniques with the intention of escaping or avoiding stuttering (we might call this managing or controlling stuttering), it’s still protective and defensive. We remain in the realm of stuttering—we’re just escaping it a bit more effectively. But this is still stuttering.

So, with traditional speech therapy tools, since we’re not targeting speaking as a whole, we’re not addressing the insecure speaking structure your clients have in their speech.

Imagine your client wants to say “Excuse me, do you have a minute?” And “excuse me do you have a” go fine and on “minute” there’s a difficulty. Only at that point your client starts thinking about using a technique. So, it means that we’re not addressing the biggest part of your clients’ speaking. We’re not addressing the speaking structure as such. And insecurity accumulates, it still perfectly lives there.

By synchronizing speaking with pressing fingers on the thigh we cover speaking as a whole. From the first sound to the end of the phrase. At the beginning, it’s a bit slower, as we use more fingers, closer to one finger - one syllable. In the video, I demonstrate how the phrase “Excuse me, do you have a minute?” sounds with the hand technique at the beginner stage, and at a later stage where we use fingers only for the stressed syllables.

It's not some artificial prolongation or imposing some artificial external rhythm or distracting our attention. We're bringing security and alignment to each and every syllable in the phrase. It's just feeling a bit better the natural rhythmical structure of that particular phrase. We’re restoring the natural rhythmical structure.

All my students were quite surprised and even shocked when they realized how simple and yet how powerful it is.

At this point, I'm sure there are quite some people who stutter who would say, “I don't need the techniques!” There are even speech therapists who also don’t like any techniques. There are well known individuals we mentioned above who overcame stuttering, maybe not using any techniques or tools. And yes, public speaking and acting is in and of itself quite a tool, quite a technique. So, this option is always open, the stage is yours!

It depends on the individual for sure, but if we assume that stuttering develops - if we talk about developmental stuttering, not neurogenic stuttering as a result of a severe brain injury or other structural damage - so if it develops over some time, it means that it doesn’t come out of the blue, there’s a ground for the insecure speaking structure. We can assume that this ground is a discrepancy in auditory feedback, a mismatch in how people who stutter perceive their own speech.

That’s why citing poetry and singing songs are in most cases much easier for people who stutter compared to regular speaking. And that’s first of all because there’s a clear repetitive rhythmical pattern that’s easy for our ear to identify.

In regular speaking there’s no pattern. The stressed syllables are different in each phrase. The brain, given this discrepancy in auditory feedback, might feel a bit lost and this insecurity, this mismatch can accumulate to the point where a glitch happens.

Imagine a train arriving at the station. There are people on the platform ready to board, everything seems fine, but let’s say one door doesn’t open. What happens? People rush to the next open door, and a bit of a crowd forms there. Either the wagon becomes overcrowded, or some people end up staying on the platform because there’s no space left. Now, imagine several doors fail to open on the train, or this happens with every train arriving at the platform repeatedly. That creates even more rush, jam, and can lead to quite a mess.

I also can share my own experience as a person who stutters, and the experience of my students. I often ask them how they felt when they used the training speech in our sessions when they do some practices, when they made a real life phone call for example. And they always say that they think and they feel that they spoke much slower than their regular pace. Then we listen to the recording. And the person says, “Wow, it sounds awesome.” So at the moment of the actual experience the speaking feels slower than it actually is.

This simple example shows there’s a mismatch in how we perceive speech. That's why you can notice that PWS may increase their speaking pace and speed up compared to our normal pace. Partially, it's because people who stutter tend to try to squeeze into that fluent space as much as they can until they face the next difficulty (like in our train analogy). But partially it's because of this mismatch in the auditory feedback loop.

That’s why most popular devices for PWS are DAF (delayed auditory feedback) devices that slightly delay the sensory feedback, auditory feedback to the ear of a speaker. The devices don’t change the speaking structure though. They can help when you use them, but they don’t remove the discrepancy as such. It’s like glasses that don’t improve the eye-sight.

Synchronizing speaking with pressing fingers on the thigh works differently. The hand technique introduces another channel of sensory feedback. It brings very tangible and physical presence in the sound, starting on a syllable level. It works like dental braces - reshaping and giving enough space for each tooth - providing enough space for each syllable in this case. Removing this mismatch, this discrepancy, and removing insecurity in overall speaking structure as a result.

Again, some people who stutter might say, “I don't need the techniques! I can speak fluently when I’m alone!” or “I don’t like this training speech!” But the brain, the body, the emotional system - they have their own view. They are going to be very thankful if we could help them. They respond with great feelings when people who stutter can finally be themselves, when they can be open, active, and positive and speak on their terms.

And here we’re getting to the third element of a successful speech therapy for stuttering which is embracing the difference, developing a new identity in how your clients see themselves.

Element # 3

Identity shift (new identity)

People who stutter mostly fall into one of two categories. One pursues fluency (in fact, I’m fluent, it’s just…) and the other preaches acceptance (I stutter, it’s OK to stutter). Yet, even though it seems like these are the opposite sides of the spectrum (I’m fluent vs I stutter), in fact these are the two sides of the same coin. Both categories try to speak fluently, regularly and normally and it’s not happening.

There’s another, third option: the path of speech therapy—or, more broadly, working on your speaking skills and self-expression. This path involves using the training speech. What I call 'stuttering on your terms' or 'speaking on your terms'—they're actually the same thing.

But, as I already mentioned, there’s ego standing in the way.

People who pursue fluency tend to say “No, I don’t want to stutter on my terms, I just want to be fluent, I just want to be regular”. “In fact, I am fluent when I’m alone” or “I’m much more fluent in some settings” or “I can say a word fluently, then why can’t I speak fluently?” and “Come on! Everything is fine with me in principle!” etc. Ironically, embracing the difference and speaking on your terms makes us feel normal and regular. There’s nothing to hide! There’s no need to escape, avoid and pretend. That is freedom! Holding on to that ego makes us very different, makes us feel like I don’t belong.

People who claim “It’s OK to stutter” tend to say, “No, I don’t need the training speech because stuttering is not a problem.” Yet, technically they’re still trying to say it fluently, normally and it’s not happening. Technically they’re not quite accepting it. Some part of you doesn't like this experience. Ironically, by stepping on the path of working on your speaking we can truly accept stuttering and feel with our whole being that it’s OK to stutter, it’s truly not a problem.

So, the relationship with the training speech becomes a great litmus test and the essence of a person’s true relationship with stuttering.

There’s this dominating ego and there’s a tiny little kid who is suffering. It feels like there’s nothing I can do about it. Once your clients realize there’s something they can do about it, there’s a way they can help this kid, once they realize there’s a choice - staying inactive, staying helpless is no longer an option.

So the new identity becomes the heart of the system, the invisible center of a new system, of a new emotional state your clients are developing. Of course, the identity determines how active a person is, how much a person creates new speaking experiences, uses the training speech, generate new muscle and emotional memory. And eventually - how they get to the destination, how successful speech therapy is.

I believe this identity work and identity shift should be one of the key components of speech therapy. The number one exercise for this element of speech therapy is active positive disclosure. And it’s one of the hardest one things to do as we, people who stutter, tend to hide it as much as we can.

It’s like a muscle - we need to train in different settings and role-plays. Over and over again. To feel truly comfortable in this new identity. “I’m in speech therapy for stuttering. So I might speak a bit slower, don’t be surprised.” Maybe it’s not slower at all. Maybe it’s pretty regular. But working on this ego and conformity (we want to be like everyone) is a big focus. This is a muscle we can develop, this is a skill we can train. As a by-product, this is a very valuable leadership skill.

And we’re talking here about a broader path - working on your speaking skills, working on a skill of self-expression. Personal development path. That’s why we can see quite some people who achieved very clear and visible improvement without any speech therapy tools at all.

A person becomes a speaker (performance, the mic if yours), a leader (creating speaking experiences and speaking on your terms), a great team player (you enjoy being around people and being in the spotlight, enjoy contributing, not escaping and avoiding and hiding, you smile and look in the yes, you open, active and positive about yourself, people around and the interaction).

I like an analogy with archery. If we aim at the target we’ll probably miss because of the gravity (again!) that pulls the arrow down. So we need to aim a bit higher.

Same with speech therapy for stuttering: aim at fluency and there’s a big chance you miss. Aim higher and you will hit your goal of consistent and permanent fluency. Aim at “I’m OK with stutter” and there’s a big chance there’s still part of you that is not OK with stuttering. If you aim higher - that’s where you get to the destination - you hit your goal of feeling truly OK with stuttering.

I believe speech therapists hold a huge responsibility for meeting the hopes and desires of people who stutter. Once I saw an advertisement of some program and the girl who was thinking about participating in that program said something along the lines, “This is my last chance. I’ve tried everything and if it doesn’t work I don’t know what to do.” It shows that the determination and desire to change is not endless.

Some of my students went through a number of stuttering programs and speech therapies before joining the FFS Program. But for most people that determination is a limited resource. They try this and that and if it doesn’t work - they stop. Your goal as a speech therapist is to use this precious resource very carefully as fuel for your clients to reach the desired destination.

If there’s anything you can improve in your process and make it more effective, if there’s anything you can do to make it more structured and streamlined, more playful, enjoyable and fun - I invite you to do so! And if I could be of any help - I’d be happy to help! 🙂

So, to recap:

1) The path to the desired destination for your clients is all about creating speaking activities where they don’t have to speak. Performance, creating public speaking environment is the #1 priority and measure of their progress.

2) We can provide help to our brain and the body so that they feel great. Sinchronizing speaking with pressing fingers on the thigh or the hand technique is a very powerful and natural tool. There’s nothing artificial about it. It’s very simple, no need for fancy devices or anything like that.

3) Building a healthy relationship with stuttering comes down to developing a new identity. Where I’m not ashamed of stuttering and working on my speech. Where I can proactively disclose. And as a result of this new identity shift I’m not afraid of speaking, I truly enjoy being in the spotlight, I feel open, active and positive about this experience by giving myself permission to speak on my terms. I can truly and fully express myself.