A Peek Into Therapy

In the survey conducted for this project 86% of respondents stated that if they had a peek into what therapy would be like it could help them feel like therapy could be successful. 80% of those who already had therapy either weren't sure or didn't think it would work at the onset. 36% of those who had never been to therapy had a moderate to severe anxiety level at the thought of going. We have to change these numbers.

If you think about it, we all know from movies, books, and TV shows how a psychologist's office looks like. We know the types of questions that are asked. We also have seen how a physical therapist works, especially if you watch sports. We all pretty much know what a regular doctor's office looks likeā€¦but for some reason, the doors are closed into the therapy room. To a person who stutters that infamous treatment room becomes a chamber of torture. It is where a therapist asks us to confront our greatest fear and stare it down. And that is no easy task knowing what stuttering has done to us. [32]

My hope is to alleviate this stumbling block by explaining some of the therapies that might be used when going to speech therapy. Please know that this look into therapy should guide you right into that therapy room. Think of it as a sports training camp. And think of your therapist as a coach where they will encourage you, stretch you, and be there for you when you fall. Because the best results come with the help of a professional just like with a psychologist, a specialist, or a physical therapist.

Stuttering is one of those disabilities that has individual variability. This variability shows the importance of creating individually tailored therapy plans. [33] Many therapists will combine therapies and other treatments to uniquely help a particular individuals needs.

These plans can include the following therapies:

  • Stuttering Modification
  • Fluency Shaping

Other treatments include:

  • Appliances
  • The Valsalva Hypothesis
  • Medication

Stuttering Modification, or "a stutter more fluently program", is where people who stutter are taught to modify their stuttering so that it is less severe. [34]

Stuttering modification has four stages:

  1. In the first stage, called identification, the person who stutters and clinician identify the core behaviors, secondary behaviors, and feelings and attitudes that characterize your stuttering.
  2. In the second stage, called desensitization, the individual tells people that he is a stutterer, freezes core behaviors, and intentionally stutters ("voluntary stuttering").
  3. In the third stage, called modification, the individual learns easy stuttering. This is done by cancellations (stopping in a disfluency, pausing a few moments, and saying the word again); pull-outs,; or pulling out of a disfluency into fluent speech; and preparatory sets, or looking ahead for words you're going to stutter on, and using easy stuttering on those words.
  4. In the fourth stage, called stabilization, the stutterer prepares practice assignments, makes preparatory sets and pull-outs automatic, and changes his self-concept from being a person who stutters to being a person who speaks fluently most of the time but who occasionally stutters mildly. (From The Official Stuttering FAQ) [35]

Fluency shaping therapy trains stutterers to speak fluently with relaxed breathing, vocal folds, and articulation (lips, jaw, and tongue).

Those who stutter are usually trained to breathe with their diaphragms and understand how to breath (airflow techniques), gently increase vocal fold tension at the beginning of words (gentle onsets), slow their speaking rate by stretching vowels, and reduce articulatory pressure. They are taught to use softness when approaching a word they know they will stutter on (Light Contact). The use of a singing or chant like continuous tone when speaking will teach continuous flow (Continuous Phonation). [36] The result is slow, monotonic, but fluent speech. This abnormal-sounding speech is used only in the speech clinic. After the stutterer masters these target speech behaviors, speaking rate and prosody (emotional intonation) are increased, until the stutterer sounds normal. This normal-sounding, fluent speech is then transferred to daily life outside the speech clinic. (From The Official Stuttering FAQ) [37]

Appliances (Anti-Stuttering Devices)

Speaking in unison with another person can produce a reduced rate of stuttering, if not, fluency. This is the underlying theory on how these stuttering appliances work. They change how an individual hears their voice, therefore hopefully improving fluency.

According to the Casa Futura Technologies, official stuttering FAQ: The altered auditory feedback effect can be produced by speaking in chorus with another person. However, this effect is usually produced with electronic devices.

The three most common types of altered auditory feedback are:

  • Auditory feedback (DAF), which delays the user's voice to his ear a fraction of a second.
  • Frequency-shifted auditory feedback (FAF), which changes the pitch of the user's voice in his ear.
  • Masking auditory feedback (MAF), which produces a synthesized sine wave in the user's ear at the frequency at which the user's vocal folds are vibrating. [38]

The results of this treatment is mixed. Speak to your therapist to see if this treatment could be an option for you.

The Valsalva Hypothesis

William D. Parry, a stutterer, lawyer, and speech language pathologist, has found that many people who stutter activate the Valsalva mechanism when forcing words out. This increase pressure in the lungs and upper airways create excessive forceful closures of the mouth or larynx and delays in phonation. This mechanism used by body builders to aide them in building up physical strength [39] and those in the Air Force to help equalize the pressure between the ears and sinuses when ambient pressure changes in aviation. [40]

The hypothesis states that those who stutter and have learned to involuntarily activate the Valsalva mechanism while speaking should learn how to control it so fluent speech can be possible. [41] Learn more at this website: http://www.valsalva.org/valsalva.htm.

There is no approved medication for stuttering. But researchers have been and are still trying to develop new pharmaceutical treatments. With the discovery of the stuttering genes, more treatments are sure to come.

Used with permission. | Odelia Mirzadeh, M.S., CCC-SLP | www.innovativeslp.com

[32] Logan, The Three Dimensions of Stuttering: Neurology, Behaviour and Emotion, 99.
[33] Nan Bernstein Ratner and E. Charles Healey, Stuttering Research and Practice: Bridging the Gap (New Jersey: Lawernce Erlbaum Associates, 1999), 237, http://www.netlibrary.com/.
[34] Stuttering Therapy - Is It for Everyone? (Part 2)," Stuttering Jack, n.d., http://stutteringjack.com/speech-therapy-for-stuttering-treatment-adults-part2/.
[35] "Official Stuttering FAQ", n.d., http://www.casafuturatech.com/Book/faq.html#stutteringmodification.
[36] Gary Rentschler, "Therapy Tip: Using the Continuous Phonation Technique", n.d., http://www.slp.duq.edu/rentschler/STUTTERING/therapy_skills/Tip_Continuous_Phonation.htm; Gary Rentschler, "Therapy Tip: Using the Light Articulatory Contact Technique", n.d., http://www.slp.duq.edu/rentschler/STUTTERING/therapy_skills/Tip_Light_Artic_Contact.htm; ibid.
[37] "Official Stuttering FAQ." http://www.casafuturatech.com/Book/faq.html.
[38] "Official Stuttering FAQ", n.d., http://www.casafuturatech.com/Book/faq.html#core.
[39] "Valsalva Stuttering Network - Introduction", n.d., http://www.valsalva.org/introduction.htm.
[40] "Valsalva Maneuver - Wikipedia, the Free Encyclopedia", n.d., http://en.wikipedia.org/wiki/Valsalva_maneuver.
[41] "Valsalva Stuttering Network - Introduction."

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