“I bet you can’t stutter better than me!”
by Dan Fitch
My training in stuttering therapy has led me to value the emotions and perceptions that surround stuttering. While it is incredibly important to have the technical skills in place to help a person who stutters (PWS), it is equally important to have a knowledge base about therapeutic styles and “how” to reach different individuals.
In their article, Yaruss, Coleman, and Quesal (2012) discuss a comprehensive approach to treatment for school-age children who stutter. Through keeping a balanced approach which targets skills and acceptance regarding stuttering, speech-language pathologists can work towards the best outcomes for their students.
One of my go-to techniques for both students in school and clients in private practice has been voluntary stuttering. This approach allows me to target both the technical and non-technical parts of stuttering treatment.
We know that many PWS experience challenges that go far beyond dysfluent speech. For example, not talking in social situations and avoidance of speaking situations are challenges that many PWS experience.
Voluntary stuttering helps to reduce negative feelings associated with stuttering. In my practice, I have used it so successfully to desensitize students that they begin to look at voluntary stuttering as being “fun.” When we have moved from negative feelings such as avoiding speaking to working through stuttering moments in a “fun” way, we have found success in breaking down the walls around communication for PWS.
Voluntary stuttering should incorporate the following characteristics (adapted from Byrd, Gkalitisou, Donaher, and Stergiou, 2016). These characteristics are not in a progression or sequence and can be adapted as needed.
The PWS attempts to imitate their own stuttering
The PWS produces effortless prolongations or repetitions (ba-ba-ba-ball; hhhhhhhello)
The PWS will produce dysfluency with increased tension and then work to decrease the tension over time.
Additionally, Byrd et al. note that voluntary stuttering that is most closely related to the clients form of stuttering is the most effective (2016). Voluntary stuttering that focuses on easy repetitions or prolongations was not found to not have the same effect as imitating the clients way of stuttering.
Clinical experience has led me to find increased tension to be the most salient technique. When working with my clients, I will ask them to exaggerate their production of stuttering (“I bet you can’t stutter like me!”). When we work through these discussions, visual supports have been helpful for me to gauge a client’s understanding. Click here for a little freebie that I have used, that you can use right away! http://bit.ly/2ofFalO
This is where the balance between desensitization and fun comes in; many of my clients have gotten enjoyment out of this technique. While we work through these productions, I like to talk about how impressed I am with the control that is evident (both in exaggeration of the stutter and in reducing tension).
You might be thinking… is this the right strategy? Am I bringing awareness that is negative to my client’s stuttering? While there might be concern over implementing a strategy such as this with your clients, research from Byrd et al. has shown that after some initial apprehension these perceptions were cut in half after using the strategy for a few sessions (2016).
Another consideration for voluntary stuttering has to do with ancillary aspects. While it is important to desensitize, we can move beyond desensitization to building skills around more control of stuttering. For instance, Leiman (2013) describes voluntary stuttering as allowing a “more forward moving form of stuttering.”
In my sessions, I have asked students to try blocking strongly or repeating frequently so that they get the feeling of controlling intensity. With that feeling of control we can work to not only make stuttering something that is not a “big deal,” but also something that can be “played” with or controlled more readily. Leiman (2013) goes on to talk about the power of being able to adapt timing to stutter “more comfortably.”
We also need to consider the long-term effects of this therapeutic modality. Byrd et al. (2016) cite research showing that the use of voluntary stuttering outside of the therapy room also has a positive effect. Through exposure to voluntary stuttering, clients decreased the need to “hide” their stuttering and increased their comfort overall.
If we think about this perspective through the lens of best practices, it is clear that voluntary stuttering can help in a number of ways. The following are just a few:
reducing negative emotions around stuttering
exposing stuttering to ease negative emotions
reducing tension in speaking
increasing confidence in speaking situations
increased perception of control
What you need to know now: (Takeaways)
voluntary stuttering is a valid therapeutic technique for PWS
voluntary stuttering is most successful when it imitates the clients form of stuttering
reduced tension, increased confidence, and decreased negative emotions around stuttering are all positive effects
adjusting intensity of voluntary stutters can be a helpful way of establishing perceived control of speech fluency
Stuttering behaviors can be challenging due to the need to work through both the tangible and intangible effects of stuttering. A comprehensive approach which targets both acceptance and fluency skills will benefit your client in the long run. Voluntary stuttering is a therapeutic tool that has both efficacy that is research based and supported by clinical experience.
Byrd, C., Gkalitisiou, Z., Donaher, J., & Stergiou, E. (2016). The Client’s Perspective on Voluntary Stuttering. American Journal of Speech-Language Pathology, 25, 290–305.
Leiman, B. (2013, September 21st) The 411 on Voluntary Stuttering [blog post] Retrieved from: http://www.stutteringsource.com/blog/the-411-on-voluntary-stuttering#.WjKk6EpKtPb
Yaruss, J. S., Coleman, C., & Quesal, R. (2012) Stuttering in School-Age Children: A Comprehensive Approach to Treatment. Language, Speech, and Hearing Services in Schools, 43, 536–548.
Dan Fitch, M.A. CCC-SLP, works in schools and private practice. When not being a Dad or husband, Dan is intensely interested in finding ways to help his students communicate better. He writes at Everything is Language and Medium- he also tweets at @itsalllanguage!