The immense challenge of being fluent outside of the therapy office:

The importance of using fluency strategies in functional communication situations cannot be stressed enough. Changing the way one speaks is a enormous challenge. Trying to decrease stuttering and be part of the "fluent" world is an added stress and often appears insurmountable to the person who stutters (PWS). This paper is going to describe a social interaction activity used for teens and adults who stutter to reinforce skills and one that I consider a necessity in my treatment. Teen and adult clients either come to my practice for intensive therapy or ongoing maintenance from a previous intensive therapy program. Many state that it is difficult to utilize fluency skills learned in the therapy room and transfer it to the outside world. They are afraid of sounding different and cannot seem to maintain any semblance of fluency under stress. Several people have stated they arenšt able to participate in spontaneous conversations and immediately experience breakdowns with their newly learned fluency strategies. This creates despair for the PWS and a huge dilemma for the treating speech therapist.

Social Interaction Activity:

The social interaction phase of therapy is introduced immediately. This serves many purposes. First, to connect the PWS with at least one other person who also stutters. Many have never met anyone else who stutters. If fear is expressed, I suggest calling me on the phone weekly to get used to phone work. This seems to be a fairly easy step since I am a PWS as well as a speech-language pathologist. The next step is to introduce simple advertising of their stuttering in a way they feel comfortable. Role playing starts in my office and then transfers to telephone calls. I videotape this phase and play it back to desensitize the client to his/her stuttering. I try and introduce voluntary stuttering at this point to elevate stuttering to its maximum intensity. Why? I would rather the severity increase in front of me so we can talk about the feelings that arise. Teens especially will say they feel embarrassed and humiliated seeing themselves stutter. Deep feelings of shame usually arise and they donšt want to be different from their peers in any way, let alone in how they sound. We immediately try and call another person who stutters to talk about these feelings. I maintain a list of clients who have given their written consent to be contacted. If it is a teen, I have both the patient and parents sign the consent. I find it helpful to have teens contact adults. This provides them with great inspiration and hope. If another teen is contacted, we try and set up other times for them to speak in private. Second, once the fluency shaping tools are established, the same scenario follows to practice fluency enhancing strategies. I have found that this is an important first step before attempting to use these tools in the outside world. It allows PWS to realize they are not alone. I caution them that talking is not solely about fluency, but about being able to communicate effectively. This is a vital fact that is often overlooked in stuttering treatment.

Persistence Pays Off:

I encourage exaggeration and what I call slightly "abnormal" sounding speech in the therapy room and with others who stutter. As I stated before, I am a PWS, thus I am able to provide a model of exaggerated speech transforming into "acceptable" sounding speech. The ability to be able to exaggerate is vital to maintaining fluency under stress. I emphasize the importance of acceptance and persistence. It pays off! Remember, as the adage goes, no pain, no gain!

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