Therapy Techniques

There is a core group of speech therapy techniques (targets) which is used in the vast majority of treatment programs for stuttering. These speech targets are described in this section.

Generally clients focus on one or two (and sometimes as many as three) speech targets in their therapy. Occasionally the targets are used consecutively in the course of therapy, but most commonly they are used concurrently. When techniques are employed concurrently, the transition from one target to practicing another target needs to be clearly delineated for the client.

Targets are generally selected based upon the treatment philosophy of the clinician, the target's applicability to the specific symptoms of the stuttering, a client's willingness to use the target, and the effectiveness of the target to enhance speech fluency. Further explanation is provided below.

	Philosophical Considerations. Some clinicians operate from a specific ideology or theory of how stuttering behaves. Other clinicians are more eclectic, and their selection of targets is more strongly influenced by other factors. In either case, the clinician needs to be able to explain their rationale for their selection of techniques used in therapy to the client.
	Symptomatic Considerations. Targets are usually selected because they address a specific stuttering symptom evident in the client's stuttering. For example, when a client demonstrates excessive force in articulating plosive sounds, a 'light articulatory contact' may be chosen to correct this characteristic of the client's stuttering. If a client has many symptoms, only one or two targets are selected for use for an extended period in therapy to enable mastery of each target.
	Effectiveness Considerations. Effectiveness is usually a function of selecting a technique that remedies the symptoms of stuttering. However, it is also dependent upon the client's ability to master and utilize a technique effectively. Generalization is a related consideration. One or sometimes two targets often emerge that have a "spillover" effect. That is, one technique may prove beneficial to other symptoms or aspects of disfluency, beyond the specific symptoms of the target addresses. This "keystone target" usually becomes the primary focus of later therapy.

Description: A deep breath is slowly inhaled. Passive release of air (exhalation) is begun just prior to adducting the vocal folds to initiate phonation.

Benefits: Promotes relaxed breathing, tension reduction and easy onset of vocalization.

Description: Emphasis is focused on a placing only minimal pressure at the point of contact made be the lips, tongue, teeth and palate during articulation.

Symptom Relief: Reduces excessive muscular effort used while articulating phonemes: often most pronounced on plosives or other blockages of airflow in the oral cavity. May also be effective in managing repetitions.

Benefits: Promotes appropriate amount of muscular effort while articulating, builds proprioceptive feedback of the speaking process, develops oral-motor awareness, and slows rate of speaking.

Description: Words are articulated by stretching (prolonging) the vowel sounds by up to two full seconds.

Symptom Relief: Reduces rate, focuses on articulatory aspects of speaking, increases the amount of vocalization in words.

Benefits: Improves concentration on the motor act of the speaking process, promotes volitional control of speech, reduces articulatory effort, slows rate of speaking.

Description: Voice is initiated very softly with a gradual increase in intensity. There is often a very brief puff of exhalated air that precedes the gentle adduction of the vocal folds. As phonation begins, intensity is gradually increased in a controlled manner.

Symptom Relief: Reduces excessive muscular effort initiating phonation, thus diminishing laryngeal blocks.

Benefits: Diminishes laryngeal blocks, builds volitional control and awareness of phonatory onset and modulation.

Description: There are several approaches in rate control therapy. The goal is to speak at a steady, reduced rate. Approaches may include using pacing (syllable or word tapping) techniques, targeting a rate modeled by the clinician, using a delayed auditory feedback device, or any technique which increases the volitional control of the act of speaking. The goal is to establish a new kinesthetic and acoustic model for speaking.

Symptom Relief: Most people who stutter experience dramatic improvement in most aspects of their fluency just by speaking more slowly. It is almost as if their speaking system (the ability to generate sentences, retrieve words, coordinate phonation with articulation, etc., etc.) was designed to perform optimally at this slower rate, and that breakdown occurs when the system is pushed to go too rapidly.

Benefits: Promotes better control of the process of speaking, reduction of anxiety (a sense of being more relaxed), and a reduction in many types of disfluent behaviors.

For some it is a matter of (mis)perception. Listening to a recording of themselves speaking at a "slow-normal" sometimes leads them to realize that it doesn't "sound as slow as it feels"; they will use the technique effectively to their benefit. Rate is very difficult to change; clinicians should try to slow their own rate in a conversation with a friend to develop an understanding of the difficulty involved. Nonetheless, rate control is a "key target" which is most often used in specific situations by speakers in stressful situations, such as giving a presentation.

Description: In the middle of a stuttering block, the client "stretches" the sound they are "stuck" on, "sliding" the stuttered sound and blending it into the next sound.

Symptom Relief: Intervenes in the stuttering habit patterns of blocks and repetitions.

Benefits: Builds volitional control of releasing from a stuttered moment; develops a sense of empowerment in which the client may no longer feel the victim of his or her stuttering because they can now manipulate (modify) their stuttering.

Description: In normal speaking, the voice is used in producing some sounds, while not used for others (voiced vs. voiceless sounds). In a sense, fluency for some who stutter may be disrupted by the process of constantly switching between voice on to voice off. With continuous phonation, the voice remains on as much as is feasible. Singing or chanting may be considered variations of this technique.

Symptom Relief: There is usually a primary reduction of laryngeal blocks and often a secondary reduction of oral stuttering blocks.

Benefits: The client experiences a sense of the flow of continuous uninterrupted speaking. For many, the benefit is mitigated by the noticeably different sounds of their speech.

Speech targets are tools (or techniques) for a client to master in a series of graded situations of increasing stress-provoking circumstances. These therapeutic tools may be used on a "as needed" basis in specific situations, or preferably, to change the general manner in which the person who stutters speaks, making it more compatible with fluency. For example, slow rate is a technique that might be used situationally. When giving an oral presentation for example, slow rate benefits not only fluency, but also it makes it easier for an audience to follow and process what is being said. The speaker also sounds and appears relaxed, which often make them feel relaxed too.

As a client becomes more capable of managing their stuttering using their targets, their speaking confidence increases while their fears and anxieties decrease; this is a true turning point in their therapy.