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From: Walt Manning
Date: 16 Oct 2009
Time: 22:46:36 -0500
Remote Name: 76.17.183.48
Bobby, you've already received some useful responses to your questions and I'll add just a few more comments. Other reasons why it's relatively easy to achieve fluency in the treatment setting is that the speaker adjust to the expected roles in that setting. The give and take of some treatment procedures quickly become predictable in what is typically a safe and accepting environment (as Ken St. Louis pointed out). I've often likened performance in the therapy setting to shooting baskets in your driveway or by yourself- its not difficult to have a high rate of success. Of course, what really counts is such performance under the distractions and time pressure of a real game when the price of failure can be high. As everyone has already pointed out, you have to practice the techniques under game conditions until the techniques become more than techniques - they become of who you are. You have to practice until you develop the confidence in your ability to respond successfully and eventually the ability to perform them automatically without even thinking about it. Your other question about the typical situation where the clinician is female and the speaker is male is something I've often thought of and an issue that probably should be investigated. I can see the situation where an adolescent male (or adult male for that matter) is unlikely to honestly discuss his anxieties and fears with a female (perhaps especially a young, attractive female). Clinicians should at least be aware of this possibility and devise a strategy or two to deal with this. Lastly, and related to the first question, the speaker is likely to produce fluency in the treatment session, especially if that is the primary thing or perhaps the only thing that is rewarded. Of course it is possible to avoid certain words and sounds and change or substitute words. I have no doubt that some clinicians unknowingly reward such avoidance if they are overly-focused on fluency as the only goal of therapy. Here is a quote from one of the people we included in a recent investigation that explains it nicely: When I was in therapy in junior high I would "substitute and I would not stutter and she [speech therapist] would think that I was making progress, but I was hiding it the whole time. I don’t know why I would hide it from the speech pathologist you know, but it was just that I was ashamed of it, so any chance I could dodge a block I took it. So she thought I was making so much progress." You asked great questions Bobby and they show a lot of insight about the therapeutic process.