Speech Therapy

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Speech Therapy

joshualane
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Is it possible to have speech therapy that doesn't also teach there is something wrong with your voice that needs to be fixed? What has your experience with speech therapy been?
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Re: Speech Therapy

Brooke Leiman
To the question- is it possible to receive speech therapy that doesn't instill the idea that something is wrong with your voice and need to be "fixed"?  

I am not a person who stutters, however as a speech pathologist working predominantly with the stuttering community, I find this question one that I struggle with as I develop a treatment plan for each incoming client.  I thought I'd share an interview I conducted with an employee of mine and a person who stutters, which discusses Avoidance Reduction therapy.  If a therapist truly subscribes to the ideas behind Avoidance Reduction, I would hope that the person receiving the therapy would NOT get the message that they need to be "fixed" but rather the message that there are changes that can be made to ensure that stuttering does not need to impact their ability to effectively communicate or limit/restrict their participation in life.  Surprisingly enough, these "changes" do not necessarily and actually rarely begin with altering their speech, but instead focus on some of the unhelpful thoughts and feelings about stuttering that are having a negative impact on them. Here is the link to the full interview:  http://www.stutteringsource.com/blog/avoiding-avoidance

I'd love to hear people's thoughts or experiences with Avoidance Reduction therapy.
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Re: Speech Therapy

joshualane
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Brooke,

Thanks so much for your comment. I, also, would love to hear what other people have to say on this issue. Speech therapy is a really complicated thing for me, which I am still sorting through. We want to make space for those who desire speech therapy while at the same time being able to stand back and question some taken-for-granted assumptions.

The interview with Ben was very interesting, and Avoidance Reduction therapy seems incredibly positive. If speech therapy is to be done, focusing on reducing anxiety (etc.) rather than fluency is definitely advantageous. Here is my question about speech therapy in general that, I think, applies even to Avoidance Reduction.

One of the results of entering into a client/therapist relation is that the stutterer is left with the belief that (1) stuttering is something that only I can manage (whether it be through fluency reduction or reducing avoidance, fear, etc.), (2) being able to communicate is solely my responsibility, and (3) these are not political and social, but psychological and physiological issues.  

Even done in the very best way and with the very best intentions, I am unsure how speech therapy can avoid these problems, since they are built into the very idea of the patient/client relationship. I agree with the general method of Avoidance Reduction—so much so that I am not sure why speech pathology is needed for it. Thoughts?
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Re: Speech Therapy

Brooke Leiman
I think your statement "I agree with the general method of Avoidance Reduction—so much so that I am not sure why speech pathology is needed for it" can be answered simply by "speech therapy might not be needed"  There are most definitely people who stutter who do not warrant speech therapy.  However, there are also people who stutter who may find having a speech therapist helpful in guiding them to identify unhelpful habits/thoughts and in facilitating challenges.

I agree with you that some speech pathologists may either intentionally or inadvertently communicate the message that it is the person who stutters that has sole responsibility for any activity limitations and restrictions they may experience.   I can only speak for my practice, but I try to take steps to prevent sending this message.  Even for my young clients, we discuss myths and misconceptions that people may have who are not familiar with stuttering.  I facilitate stuttering awareness activities so that my clients can help educate people either close to them or possibly addressing a larger audience.  I hope that I'm communicating that some experiences they have may be completely out of their control and are a result of some of the political and social issues you speak of while also empowering them to feel that if they want to (and I stress IF), there are certain things they can do that may help them navigate these issues.  Just as I don't want my clients feeling as though they are solely responsible for situations they experience, I also don't want them to feel like they have to throw up their hands and feel angry every time they come across a person or a situation that doesn't go well.  Whether its a political/social issue or not, they are the ones having to go through it and I'd hope they feel like they have the means to get through it.  

Again, I stress that there most definitely are people who stutter who do NOT need speech therapy but I do think that speech therapy can be very effective for people who do warrant it.  

I sincerely hope I was able to answer some of your questions.
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Re: Speech Therapy

Zach Richter
One major problem with the therapy model as the delivery system for "Avoidance Reduction" is that speech therapy as an end unto itself can be isolating from the disability community and often pairs dysfluent persons with people who do not share their experiences.

I would challenge the speech therapy community to pair its practice of "avoidance reduction" with a practice that encourages dysfluent people to get involved with the dysfluent and disabled community.

Part of the process of confidence building is finding people who one relates to. Knowing the history of disability rights as well as being acquainted with leaders in disability activism can help a person with low self esteem identify with others who are empowered enough to challenge the dominant ableist structure.

Additionally, speech pathologists should endeavor for their clients to challenge ableist attitudes not only in themselves but in their friends and family. If a person is surrounded by ableist voices, it will be hard for them to become empowered.

I also want to specify that this does not mean "self-help" because self-help often results in re-internalizing the compulsion toward fluency and smoothness. In referring to disability activists, I am implying people who oppose normalization.

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Re: Speech Therapy

Brooke Leiman
Zach- interesting points, but I actually think we are on the same page to an extent.  I am a huge advocate for building a support system and address this by providing group therapy, by including and educating families/friends of my clients and also by introducing them to the many support groups that are available such as FRIENDS and NSA.  I'm wondering what specific groups you are referring to?

I also think that there are many stuttering programs and speech therapists that are unfortunately giving the "therapy model", as you referred to it, a bad name.  However, I have to say, although I may not agree with the rationales and themes behind some of the programs I have heard of, I am slowly starting to realize that although I, myself, could not stand by and provide some of those programs, I also can't judge them or the people who believe in them. If people who stutter are coming out of these programs feeling more positive about themselves and themselves as communicators, then who am I to tell that person their feelings of progress or success aren't valid.  

I am concerned that when people denounce speech therapy, certain programs/methods or altogether, they are assuming that people who stutter are a homogenous group that all benefit from the same thing.  We know from research this is far from the truth.  People who stutter most likely have different factors that contribute to the onset and persistence.  People who stutter have different temperaments and personalities.  People who stutter have different environments and interaction experiences.  Therefore, we can't possibly assume that one method is helpful for all or none.  Avoidance reduction therapy is helpful for some.  Becoming involved in the disability community is helpful for some.  Even, fluency shaping approaches like Hollins is helpful for some (gosh I NEVER thought I'd say that and I'm still cringing a bit while saying it...I'll get there:)).  

Just my two cents.

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Re: Speech Therapy

joshualane
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This post was updated on .
Brooke,

I want to reiterate that I very much appreciate your dialogue on the forum. These are discussions that I hope will increase and I would love for stutterers who have been involved in various types of speech therapy to be involved as well.

I think there is a way in which we are speaking past each other, and it may be helpful to draw a couple analogies in order to articulate the type of different response I am talking about than support-groups. Analogies by definition don’t map exactly, so please bear with me. First, consider the Gay Rights movement (or, more radically, queer liberation movements). Before the DSM-III, homosexuals were understood as having a psychiatric disorder. Within such a medicalized context, support groups for “being” homosexual would involve coping with “symptoms” and gaining support from friends and family in dealing with something that is fundamentally a psychiatric condition (many Christian gay-therapy clinics still operate under a similar model). With the Stonewall riots and the ACT UP movement, gay identities were both de-medicalized and politically charged. Queer activism became an issue of justice, and “support structures” (or coalitions) focused both on interrogating the way in which the idea of “straight” and “queer” are social constructions and what the proper political response should be.

The disability rights movement follows a similar trajectory (although the disability rights movement, like the queer justice movement, is anything but homogeneous). Disability rights activists deny that disability is fundamentally about our bodies; we deny that it is a medical and individual thing. Rather, disability is first and foremost a social and political category produced in opposition to able-bodied privilege and the notion of “normalcy” that works to exclude only certain kinds of bodies. A radical example of this is the members of (capital D) Deaf culture, who don’t even consider themselves disabled, but rather as occupying a linguistic subculture. Their “disability” has nothing to do with being unable to hear and is only is produced by an “auralist” culture that assumes speaking by voice rather than sign is natural/more preferable/etc. To offer therapy based on the medicalization of Deafness is to completely miss their point and struggle—to reinscribe their oppression.

Stuttering has overwhelmingly been dominated by the scientific-medical-therapeutic model. The Did I Stutter Project is wanting to develop a radical disability consciousness. Thus, while there is a very prominent way (and I want to stress this) in which we don’t judge speech pathology insofar as it helps many people, and has helped myself when I was younger, I believe that at the same time we must critique the medicalization of stuttering as a whole. I understand stuttering first and foremost as a form of ableist discrimination against those who speak non-normatively. Stuttering is inherently a complex social, communicative event that is discriminated against. Since I do not see stuttering as a biological “thing” for an individual to cope with (physically or emotionally), but rather see it to be produced by a system of oppression, it is best understood and acted upon politically. From this perspective, the struggle for inspiration and "support" covers up the actual cause of stuttering. I strongly believe it is far more empowering to join a fight for wide-spread social inclusion on our own terms.

Personally, I am not convinced that any form of therapy that starts by addressing a stutterer to help them through their difficulties is going to lead to radical social change. Thinking in the big picture (recognizing that such a shift in understanding could take decades or longer), speech therapy, like gay or deaf therapy, could be understood not only as unnecessary, but counter-productive. I would like to hear from stutterers regarding this.  

Unlike many other forms of disability, stutterers are not politically organized in such a way to speak back against the institutions and forces that (complexly) create and discriminate against our voices. There are many stutterers who will not be interested in this movement. That is perfectly fine. However, we want to offer an alternative framework that they can understand themselves, their bodies, and their speech through if they want it. We totally respect what groups like the NSA and FRIENDS are doing. However, we are doing something different.    
Kaz
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Re: Speech Therapy

Kaz
In reply to this post by joshualane
joshualane wrote
Is it possible to have speech therapy that doesn't also teach there is something wrong with your voice that needs to be fixed? What has your experience with speech therapy been?
I am frankly dubious that it's possible. It certainly wasn't for me: the last speech therapy I did managed to give me various feelings of shame and self-blame around my stutter and avoidance behaviours that I'd happily dodged up until that point. I'm still pretty bitter about that.

I mean. The core aim of any speech therapy I've experienced is reducing stuttering. Moreover, any serious speech therapy entails a lot of effort in form of practice and applied techniques, and quite possibly unnatural-sounding speech depending on what type of therapy it is. And I'm sorry, there is a contradiction between "stuttering is fine and good and avoidance is bad!" and "but you should do these things that are difficult and take lots of effort and may end with your speech sounding strange in order to avoid stuttering." Maybe some people can manage to reconcile that, but I certainly can't.

Not only did my last speech therapy manage to give me avoidance behaviours, but they feel like a natural outgrowth of the therapy technique they taught me - that the goal was *avoid stuttering*, the means presented was *use technique* but alternate means such as different word choice were a very logical second choice and came quickly to hand. And any mention of "don't use avoidance techniques" by the therapist just came off as lip service because what exactly were they teaching me but another kind of avoidance technique, anyway?

Also... mm... has anyone else had problems with speech therapy permanently changing how they stutter, and not in a good way? This is probably really bad for me because not only did I do a fluency shaping course (the Kasseler Stottertherapie, it's pretty well-known in Germany) but I really sunk my all into it. It's a two-week residential course[1] and I spent ten days only speaking in the strongest technique they had and at least six months practicing regularly until I gave up. That was around five years ago and my speech has permanently changed in ways that make life quite a bit harder. In a weird way it's as though I've "forgotten" how to stutter certain sounds, so that now when I reach them I can't stutter them but I still can't say them so I'm just completely stuck and have to use substitution or some leapfrogging thing from a previous word. Also, my stutter has always been prone to absorbing speech therapy technique, so now aspects of fluency shaping have been incorporated into my stuttering symptoms such as very low volume on plosives... which makes me harder to understand but also messes up the whole pattern of the block and means I struggle to get past it. And I am now capable of stuttering in the middle of words, which is freaky. Ironically, I almost feel as if a speech therapist is called for, but I think the chances of me finding someone who wouldn't just stare at me blankly if I came in saying "hi, is there a way of removing this past speech therapy from my speech so I can just stutter normally again, thanks" is pretty small!

Really, I think that overall this is my main beef with speech therapy: that it's seen as *mandatory* and is so focused on reducing stuttering. I mean, there were people at that course who viewed it as life-changing (in a good way) so I'm always reluctant to say that speech therapy is a bad thing, period, because I feel like I'd be speaking over them. But the fact that it's basically seen as the most important thing for PWS, period... all that talk about early intervention being oh-so-necessary... hardly any talk about ableism and prejudice and responsibility on the side of the listener... hardly any talk about the potential for alternative methods of communication like sign language or text-to-voice for those who might desire it... hardly anything that's focused on making your stutter easy and comfortable for you and others instead of trying to get it to go away... it makes me seriously uncomfortable. Especially combined with stuff like the low long-term efficacy rates and amount of snake-oil "cures" out there, which just encourages PWS to wear themselves out with therapy after therapy while at each step blaming themselves for not being fluent, but even without that.

[1] on that note: a word of warning about residential speech therapies. Being surrounded with people who are absolutely focused on FLUENCY with barely any outside contact does bad things to your mindset and ability to think independently. I view the KST as a very ethical therapy in terms of the information they give out and the introductory sessions and so on, but all the same the first word that comes to mind when I think of that place is "cultlike" and I have had nightmares about ending up there again.
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Re: Speech Therapy

Jonathan Hsy
In reply to this post by Brooke Leiman
This is really, really interesting. Thanks for initiating this conversation. Still making my way through Brooke's  comments and the various responses. Glad that this discussion is taking place.
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Re: Speech Therapy

ElleEh
In reply to this post by Kaz
"Also... mm... has anyone else had problems with speech therapy permanently changing how they stutter, and not in a good way?"

Really great points, Kaz. My mother was raised in Europe and her family was not well off and they lived in a very rural community. She did not receive any speech therapy when she was a kid. She moved to Canada in her late twenties and began speech therapy when she was fluent in English (she probably would have been about 30).

One of the strategies her therapist shared with her was to speak in a sort of sing-song manner because, as we've all heard, singing is easier for people who stutter. I would say this strategy has negatively affected her. She really only uses this sing-song manner on people she doesn't know (so those she'd naturally be nervous speaking with) and I've noticed that some of them respond to her as if she were a little simple or unintelligent. So I definitely see this as a drawback. She'd probably be better off just speaking in her normal authoritative voice with the occasional (or more frequent) stutter.
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Re: Speech Therapy

Brooke Leiman
In reply to this post by Kaz
Kaz-

Your honest account of your speech therapy experience probably rings true for many many people who stutter out there.  I can't blame you for having a bad taste in your mouth about speech therapy.  There are plenty of speech programs and speech therapists out there that most definitely do push speech modification techniques.  I wish I could argue with you on behalf of my profession, but I can't because you're right!  All I can say is there are also plenty of speech pathologists that DO share your sentiments and measure progress not by how many fluent syllables that person has but rather by how often the client is saying exactly WHAT they want to say WHEN they want to say it, whether or not they stutter.  I assure you we are working to educate speech pathologists on the dangers of "chasing fluency" and the role we, as speech pathologists, may play in encouraging that chase (even if we don't mean to).  As I encounter speech therapists that are providing therapy that only works on speech fluency, I will be directing them to this forum (and forums like this), in hopes that hearing your first-hand experiences will open their eyes.  

If you're interested, I have included a link on the bottom of this post to an article that I have often share with parents/families of my clients and speech therapists on how to help develop healthy communication attitudes for their children. I'm wondering your thoughts on it and do you think it would have been helpful had you or your parents/family been educated on this line of thinking when you were young.  I hope that this article further demonstrates that although we may not share the exact same views on stuttering and stuttering therapy, I think you'll see there are many parallels.  

http://www.marshall.edu/cohp/assets/documents/HealthyAttitudes.pdf
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Re: Speech Therapy

Brooke Leiman
This post was updated on .
In reply to this post by joshualane
Joshua-

Your last post did help me better understand the movement you are aligning yourself with.  With that being said, I still feel as though there is power in numbers and by completing writing off all speech pathologists (I agree you have to write off some and I can probably give you some names :) ), you are alienating A LOT of people who might help your cause and care very much about "speaking back against the institutions and forces that (complexly) create and discriminate against our voices."  By working to educate and encourage speech pathologists to join your movement, not only might you have a stronger voice  (more people involved, not to mention people who might be helpful in gaining political attention), but you will also have more power in bringing much need education and awareness to speech professionals who might otherwise have seen stuttering differently (think Kaz's experience).  

On a side note: I understand that the very name of our profession, Speech Pathologists, carries a connotation that something is wrong.  Maybe there is something to be said about changing the name but I think we have bigger fish to fry :) I know I often tell my clients to think of me as a speech coach.  When you're out on the football field, the coach isn't there because you have a problem playing football (you've already made the team now), but rather they are there to give you support when challenges arise.  The challenge does NOT have to be stuttering and how fluent they are, rather the challenge for many of my clients is often "speaking back against the institutions..." or in other words, educating themselves and their peers, teachers and community on stuttering so that they can speak freely, reduce the negatives feelings they have about their speech/stuttering and reduce the impact of stuttering has on their lives.  
 





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Re: Speech Therapy

joshualane
Administrator
Brooke,

Yes, that is helpful. I want to note that we are not completely writing off all speech pathologists, as people, but rather critiquing the practise and discourse of speech pathology. I think this is an important difference. That is, there is a difference when a speech pathologist speaks to us as a person and when they speak to us as a speech pathologist with the "expert" authority of the discourse of speech pathology behind them. Or, in academic terms, with "discursive" authority. This fundamentally changes the relationship.   For example, I wrote a blog post on speech therapy a couple days ago and linked it to a Facebook stuttering group. Some of the responses were telling insofar as it was clear that the discourse of speech language pathology was being used in attempts to reassert authority over stuttering bodies. I agree this has something to do with the personalities and motivations of individual SLPs, but I think discursive authority cannot *not* be wielded by SLPs. This is true, I think, even if SLP is understood in terms of coaching rather than treating. 

This is all preamble to my main point. I am hypothetically okay with SPLs becoming part of this movement but I am also wary of this for two reasons. 

First, this needs to be a movement of stuttering voices. While there is strength in numbers, as you say, in a general sense, there is not strength in numbers if our voices end up being co-opted by speech language pathologists. It is very important that our voices drive this movement and that we are heard *on our own terms*.

Second, and related, I believe it is very easy--especially in the early stages of movements--for our goals to be watered down. That is, I can easily imagine people saying "so what you mean is that we just need to accept ourselves and get others to accept us too. Got it." rather than understanding that our aims are far more radical. (I.e., Dismantling the very logic of pathologization). Strength in numbers often comes at the cost of settling for a lowest common denominator. 

With this being said, I would be incredibly happy if SLPs joined what we are doing! I agree with you that in the long run, we will likely want access to political attention so that our movement can enact greater social change. So we are trying to walk many delicate lines here. We don't intend to categorically exclude all SLPs since we recognize them as potential allies. At the same time, it is incredibly important that we are heard on our own terms, and the discursive authority that comes with speech language pathology inherently produces obstacles to this goal which cannot simply be overcome with good will. These are surely not obstacles impossible to overcome, but this process will require much thought on both of our sides, as well as a relinquishing of (discursive) authority over stuttering bodies on the part of SLPs. In other words, we need to be the experts over our own bodies. 

Best,

Josh


On Mon, Aug 18, 2014 at 7:34 PM, Brooke Leiman [via Did I Stutter?] <[hidden email]> wrote:

Joshua-

Your last post did help me better understand the movement you are aligning yourself.  With that being said, I still feel as though there are power in numbers and by completing writing off all speech pathologists (I agree you have to write off some and I can probably give you some names :) ), you are alienating A LOT of people who might help your cause and care very much about "speaking back against the institutions and forces that (complexly) create and discriminate against our voices."  By working to educate and encourage speech pathologists to join your movement, not only might you have a stronger voice  (more people involved, not to mention people who might be helpful in gaining government/political attention), but you will also have more power in bringing much need education and awareness to speech professionals who might otherwise see stuttering differently.

On a side note: I understand that the very name of our profession, Speech Pathologists, carries a connotation that something is wrong.  Maybe there is something to be said about changing the name :) I know I often tell my clients to think of me as a speech coach.  When you're out on the football field, the coach isn't there because you have a problem playing football (you've already made the team now), but rather they are there to give you support when challenges arise.  The challenge does NOT have to be stuttering and how fluent they are, rather the challenge for many of my clients is often "speaking back against the institutions..." or in other words, educating themselves and their peers, teachers and community on stuttering so that they can speak freely, reduce the negatives feelings they have about their speech/stuttering and reduce the impact of stuttering has on their lives.  
 








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Re: Speech Therapy

Jack H.
This discussion has been fascinating and I'm just now coming upon it. I have many thoughts to many points made but I'll just go for now with what it on the op of my head.

First off, a bit of back story: I am both a Person Who Stutters and a Speech-Language Pathologist. I have stuttered all my life and had good and bad experiences in speech therapy (which has run the gamut from fluency focused to avoidance, attitudes, and beliefs focused). I work as a SLP in a public school system in a rural school district. During my undergraduate and graduate studies I worked in a lab that asked questions about the connection between developmental stuttering, language, and emotions.

There are many SLP's who are also people who stutter. Some are very important figures in the field of stuttering. Any movement that seeks to re-frame or radically change the nature of how we treat stutering should have these voices heavily involved.

To look back at the opening question: "Is it possible to have speech therapy that doesn't also teach there is something wrong with your voice that needs to be fixed?" My short answer is a categorical yes. I think one of the foundations that make this possible is shifting the focus of your practice from a "medical" to a "solution focused" one. The medical approach sees a problem and attempts to fix it using varied strategies and tactics. Even more "inclusive" approaches like stuttering modification could be viewed as ways to fix a problem. Approaching therapy not with a problem to fix, but a solution to reach changes, in my opinion, a whole lot. Talking with your client about what they want to get out of therapy, seeing what their fears and hopes are can inform how you set your goals. During this whole process you can be both receptive to what they say, and frame it in a way that does not pit "wrong" speech against "right" speech. I agree that avoidance reduction and acceptance therapy are powerful tools are should be at the forefront of a SLP's agenda. I would also love to argue that incorporating some aspects of fluency shaping into therapy does not necessarily mean that we are attempting to "fix" broken speech. Robert Dellinger, on a StutterTalk podcast framed fluency shaping activities as a way of exploration. We pair it with voluntary stuttering, and education about the speech anatomy and physiology as a way of exploring what all we do when we talk. We should never as he puts it, "Impose fluency" on anyone.

I agree 100% with Brooke that there are a depressingly large number of our colleagues who treat therapy with PWS as working towards fluency and nothing else. I get mad as hell about it but I'm also glad at those moments I'm in this field as well so that I can try to change how they think about stuttering and working with those who stutter.

I could go one for a long time but I want to hear what others think.
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Re: Speech Therapy

Frank Stechel
In reply to this post by Brooke Leiman
I'm a 63 yr. old PWS. I attended the Hollins program (fluency shaping) in the 1970's. Like many people I learned the skills to virtually eliminate my stuttering but couldn't transfer those to my everyday speaking environment, although I use some of the techniques (e.g., gentle onset, slower speech) when I focus on them. I'm frankly surprised that the stuttering community hasn't demanded from professionals more efficacious therapies with the research to back them up. I personally believe that the emphasis on the "acceptance" of stuttering - as important as that is given that there is no therapy that is effective in reducing disfluency in many of us -  takes the onus off of the professionals, be they speech pathologists or medical professionals - to improve the efficacy of existing therapies and finding new ones. How much money goes into research on stuttering therapy? How is this research coordinated? Can someone name a new or improved therapy directed to adults in the last 40 years? Certainly the speaking environment in which many of us live can and should be improved, especially in families, schools and perhaps the workplace, but I don't agree that the "stigma" of stuttering, and the personal costs resulting from it, can be ameliorated by trying to change society's view of disfluent speech. We need better, individually targeted and affordable therapy that affords stutterers the opportunity of optimal fluency.
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Re: Speech Therapy

joshualane
Administrator
Frank,

Thanks for stopping by! As you might guess from everything we write on this site, we respectfully disagree that "the 'stigma' of stuttering, and the personal costs resulting from it, can be ameliorated by trying to change society's view of disfluent speech." Will this social change happen tomorrow? No. Ten years? Maybe, if only in select pockets and to varying degrees. However, following in the disability rights movement we believe that widespread social change is both necessary and possible for liberation. Moreover, I can say that for myself, rejecting the medical model of my stuttering and engaging in resistance against the ableist structures and values that discriminate against our speech has been the most freeing and empowering process I can imagine. I am learning to speak on my own terms, not on the terms of normalcy.        
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Re: Speech Therapy

joshualane
Administrator
In reply to this post by Jack H.
Jack,

Hi! Thanks so much for your comment. I agree that this has been and continues to be a really fascinating discussion and is one that needs to continue. First off, I am curious why you say that any movement that "seeks to re-frame or radically change the nature of how we treat stuttering should have these voices heavily involved." Do you mean people who both stutter and are SLPs? This combination definitely offers an interesting perspective, but I'm wondering why you think SLP in particular should be given extra authoritative weight in this type of movement? (I apologize if I misunderstood you)

I'm also really interested in the difference you are drawing out between a "medical" and a "solution focused" model. Don't both, as you outline them, start with the assumption that stuttering is an individual and physiological condition? It seems that the focus is still on the client-therapist relationship and focuses on what the client should or can be doing. What would you think of a solution focused model where the person who stutters never goes to therapy and parents, friends, teachers, and coworkers rather take turns going to the SLP to learn how to adapt themselves to the speaking patterns of the person who stutters?  

Lastly, if we think about fluency shaping as an exploration of how we speak and ways of speaking, could we not imagine a person who doesn't stutter start meeting with a SLP because she wants to be taught how to stutter and to explore those ways of speaking and using her body? Perhaps because she wants to stutter? (would she quickly be referred to a psychologist?)

I realize these are seemingly absurd questions, but the absurdity of them is perhaps telling, no? I guess I am wondering how much we are still operating against a background assumption that being able-bodied is better than being disabled, and that stuttering is ultimately something that I do and that ultimately only I can deal with. I think both of these question are at stake when we ask if we can have speech therapy without understanding our voices as something to be fixed.    

 

Kaz
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Re: Speech Therapy

Kaz
In reply to this post by joshualane
You know...

A few weeks back I went to a talk about speech therapy by an SLP. And it started off surprisingly well - a lot of talk about how every stutterer is on their own journey, about the importance of trying to reduce avoidance and be comfortable with your stutter, and so on. She was talking a lot about working with the stutterer to find the result that's best for them and all that sort of thing that you people are associating with the "good" SLPs... I was almost relaxing.

And then, when she was talking about voluntary stuttering, things got weird. For one, I'd always assumed that voluntary stuttering was just that - stuttering on purpose when you weren't going to, for nice things like taking back control over your speech, intentionally disavowing fluency as a goal, becoming more comfortable with your stutter, etc. But here she was talking about how voluntary stuttering meant taking the tension out, how there was discussion among SLPs about whether you could/should voluntary stutter repetitions or only prolongations (uh, dude, my natural stutter is about 98% repetitions, what the hell are you saying only prolongations work as voluntary stutters-) and even a smiling remark about how in her experience, trying a voluntary stutter on prolongations often meant people stuttered less afterwards-

And while I was reeling from *that*, she said something like "see, the important thing is to pull away all the layers of anxiety and avoidance and fear so that we can dig down to the actual stutter and address *that*." That's not quite it, I don't remember what it was exactly, but it left me thinking:

Oh. Right. You're trying to make people fluent.

You're dressing it up in very nice language, you may not admit that's what you're after, you may not even really *realise* that's what you're after, but you've just said that the problem with avoidance and anxiety isn't that it makes people miserable but that it gets in the way of dealing with the actual stutter - that the point after you get rid of avoidance and anxiety isn't "okay, job done, happy stutterer!" but when you can really get to work and tackle the core symptoms.

Frankly, I'd rather talk to someone doing fluency shaping. At least they're honest about what they're doing.

Whiiiich is really my whole problem with what Brooke and Jack are talking about. With all due respect, the idea that SLPs should be teaching people to embrace their stutters comes off a bit like saying cosmetic surgeons are optimally situated to teach people body acceptance. They might talk a good game, they might even sincerely believe they're doing what they can and that what's on offer is simply a last resort, but do you *really* think it's an appropriate venue? That the brochures and before/after pictures of what they can do won't have an effect? That a little "and if you really can't come to terms with this, we happen to offer these surgical services..." might not slip in?

Fluency as superior, fluency as an end goal is SO deeply embedded in everyone's psyches, you are really *that confident* the idea won't affect what you're doing?

(And, of course, things fall apart entirely when we get to the idea of e.g. fatphobia as an institutional discrimination and discussing and resisting that - which is probably the metaphor's equivalent of stuttering as a disability and taking a disability rights approach that Josh and co are doing here.)

If I wanted professional help dealing with my feelings about my stutter, I'd go to a convential therapist - NOT an SLP. Because then I could be certain that they wouldn't slip in a little "oh how about you try this technique" and know they're far less likely to set themselves up as the expert on how I should best deal with my stutter. But honestly, I am doing absolutely fine with just me and my local stuttering community.

And none of this is addressing the whole part where speech therapy is mandatory for stuttering kids. I always find the talk about acceptance and being happy with your stutter as an end goal for speech therapy ironic, because that's actually how I *started out* - I was the most supremely self-confident stuttering kid you can imagine - but I certainly didn't get to opt out of speech therapy. And in fact, it was speech therapy that ruined those feelings for me.
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Re: Speech Therapy

sachin
In reply to this post by joshualane
Very very interesting discussion. As to my take on - "Is it possible to have speech therapy that doesn't also teach there is something wrong with your voice that needs to be fixed..?" I think at this point in time, it would be very very very difficult, if not plain impossible. But, pws are a diverse lot, caught at different life stages - and therefore they do take their chances. But, yes, in the long run, we must educate and change the society - beginning with ourselves. This, at times,  seems like the old debate between the social and the medical model of disability. SLPs are product of their times and culture, the dominant discourse of modern/ western medical science - The same way as we, the average pws, are the products of our times and upbringing. But considering the big changes all around us, it is time that we question these assumptions - who puts the label of "stuttering" to our speech? Why? Why and how are we nudged into buying it?
This movement MUST be owned and fueled by pws. PWS who happen to be SLP, I am afraid, would bring in "old consciousness" knowingly or unknowingly, and will end up diluting the focus. Can they unlearn speech pathology as it is conceived and taught today, learn afresh the social model of disability, look at the big picture, and the politics behind? And then contribute?
Thanks everyone for their thoughts, convictions and courage...
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