How many times have you heard this from an adult or teen who stutters? How many times have you thought this as you work with an adult or teen who stutters ? This statement seems to come most often from stutterers who have had some or even a lot of speech therapy.

For the most part, their speech therapy has focused on fluency shaping and/or fluency modification. Their therapy has only focused on the mechanics of talking--or as they say, "The tip of the iceberg." Why? Because that kind of therapy is the easiest way to create fluency and results in less stutters. If less stutters are present, does that mean therapy has been successful ? The answer is NO-No- and No. What it means is that there is a lower percentage of stuttering when it is measured in a specific point in time. In this counting, there is no measure of what the stutterer feels--his fears and his avoidances and his resulting shame of stuttering. Until we as speech pathologists help the person who stutters reduce his fears, avoidances, and shame of stuttering, his lowered percentage of stuttering will mean nothing as a measure of success. Why?

When the stutterer leaves the therapy session where he has practiced fluency shaping and/or modification techniques and enters his everyday life--at home, at work or school, and in the community--the odds are very good that he will not hold his improved fluency levels. His fears and avoidances are too great and he will not be able to use his mechanical speech tools. The stutterer will revert back to his old pattern of stuttering because he has very strong learned habits. In the past, these secondary behaviors when they were new did help him cope with his stuttering. This reversion back will only increase his fears and avoidances and his shame of stuttering. Then the thought will persist: "If I practiced more, I would stutter less."

What does a person who stutters need to do to break this cycle of "practicing more equals stuttering less"? With our help as professionals, the stutterer needs to begin to feel responsible for his own behavior and needs to realize that change happens in small steps. He needs to begin to work on his fears and avoidances in a systematic way and try to reduce his "shame of stuttering". Basically, he needs to work on the part of the "iceberg that is under water".

• First, he needs to be told over and over "It's not your fault that you stutter. It just happens. It's nobody's fault. Please try to accept that stuttering is something that just happens. You don't have to like it but you need to accept it as an entity."
• Second, the stutterer needs to "advertise" that he stutters--tell everybody possible that you stutter and besides they know it anyways. Laugh at yourself. Put stuttering on your voice mail. Make a joke about your stuttering.
• Third, start eliminating the avoidance behaviors in a systematic way. Change happens in small steps so create some small step tasks. For example, make some phone calls, order what you want in a restaurant, try to stop switching words--basically let your stuttering hang out. Tell yourself "It's OK to stutter." "I won't die from stuttering."
• Fourth, work on eye contact with your listener and become a more effective communicator. Keep doing these kinds of things over and over and the small step tasks will get easier.
• Fifth, measure success by keeping track of small accomplishments and changes and give yourself a special reward when you have entered a difficult speaking situation, faced the fear, and did it anyways. Share your successes and failures with your speech pathologist. Then as a team use this reporting as a measure of change and success.

As a person who stutters begins to develop unemotional acceptance of his stuttering, begins to advertise that he stutters, begins to have less fears and avoidance behaviors, and improves his eye contact, something magical happens. His fluency improves, his secondary behaviors are greatly reduced, and he is a much better communicator. Yes, he still stutters but he is now willing to say "what he wants, when he wants, and where he wants" with some stuttering. It is here that fluency enhancement tools can by taught by a speech pathologist. These tools can include slowing rate of speech and use of prolongation (easy onsets), lights contacts, pull-outs, and cancellations. Most important, don't forget use of voluntary stuttering. It's always good to keep advertising stuttering and using voluntary stuttering even if the client doesn't need it. His speech tools will be ready when he wants to use them.

Because stuttering is a cyclical disorder and waxes and wanes, when it appears more prevalent, maybe the stutterer will no longer say, "If I practiced more, I would stutter less." Rather, he would take the time to examine what is happening in his life to increase his stuttering, plan what he can do to modify that, and make darn sure he is not slipping into the pattern of using avoidance behaviors to cope with his stuttering. At all costs, he needs to "avoid avoiding" and "feel the fear and do it anyway" in his everyday communication at home, at work or school and in his community. Eventually, his more fluent speech will return and his speech tools will work better. The cycle will repeat itself over and over but that is something that just happens.

Life is full of changes and challenges and stuttering occurs more and less as he goes through life. Learning to expect these cycles is most helpful and defensive for the person who stutters. Always remember AVOID AVOIDING is most important for the person who stutters and the speech pathologist working with him. It will allow him to move through cycles of stuttering more or less and his stuttering will not become an out of control monster which needs to be feared and avoided.

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