Treatment of stuttering requires attention to several critical issues which include establishing a meaningful explanation of stuttering, developing fluency enhancing speaking skills, and modifying the thoughts, perceptions and beliefs of the person who stutters. These components form the basis of a comprehensive approach to stuttering therapy and establish a solid foundation from which to coping skills can develop.
By adolescence and adulthood stuttering is unlikely to disappear. For most, it becomes a matter of how best to cope with the adversities of the problem. People often develop ways of coping that actually serve to maintain or aggravate their stuttering. Helping clients learn to cope with their stuttering in productive ways is an essential part of the overall therapeutic process. Clients need to understand their stuttering and to have a framework from which to explain the disorder to others. Providing the general concept that their stuttering results from a imperfect speaking system that is unable to sustain fluency when challenged by cognitive, behavioral, or affective stimulation, is a step toward building a base of understanding for the client.
Developing fluency enhancing speaking skills teaches the client that the imperfections of his or her speaking system need not result in disfluency and that he of she can effect control over their stuttering. Using speech therapy techniques, the client can gain control of stuttering and begin to realize that he or she has recourse in acting upon disfluencies. Most clients initially comment that it requires too much concentration to split their attention between using the techniques and thinking about what they are saying. But the important part of the lesson is that the responsibility to effect fluency is now theirs. It is often necessary at first to reduce the speed and natural continuity of speaking in challenging circumstances. But like any newly acquired skill, continued practice results in more satisfactory results.
By progressing gradually through speaking situations of increasing challenge, the patient manages their fluency skills in a range of circumstances. The successes experienced help to reduce the fears, avoidances, and negative self-perceptions. The process provides the basis for positive cognitive change as well.
Stuttering consists of two major components: the stuttering behaviors and the feelings that arise from it. Both the feelings and the overt stuttering behaviors must be treated. If only the feelings are treated, the client is likely to relapse as disfluent moments inevitably return periodically following treatment. When they occur, the patient is likely to react to them in the same way as before. This experience may re-sensitize the client, weakening their ability to utilize their targets. If the fear of being disfluent is still present, normal disfluencies can provoke the old reactions of struggle and avoidance and the re-emergence of the old stuttering behaviors. Thus, if old fears are left intact, minor setbacks, that is, transient stuttering, can lead to a total breakdown of fluency.
Changes in the speech and cognitive systems are important and complementary factors in effecting long-term treatment outcomes. Counseling is most successful with persons who are inclined to be introspective and reflective regarding their thoughts and subjective experiences. Therefore, such discussions in therapy are usually fruitful.
Long-term prognosis may be poorer for clients who begin treatment with highly negative attitudes about speaking or with external locus of control. Negative attitudes do not cause stuttering, but the attitudinal consequences of stuttering may interfere with treatment.
© Rentschler, 2001