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From: Ken Logan
Date: 19 Oct 2010
Time: 14:48:14 -0500
Remote Name: 128.227.135.16
Interesting observations. Many clinicians use an "integrated approach" wherein the so-called "fluency shaping" strategies (e.g., regulated articulation rate) are introduced (often first) to develop a person's capacity for smooth speech, and then supplemented with stuttering medication techniques to help the person deal with residual disfluency. Have been through fluency shaping therapy myself back in college and having introduced it to many other people since, I can say that it can be very useful in helping people to speak more smoothly, but as with most things in life, there is no free lunch! Even after extensive practice, it often still requires a fair amount of effort to employ (and may feel “funny” to use), and even then, a person may still find it difficult to speak smoothly in certain situations no matter how much effort (self-monitoring, self-regulation) they attempt. And, as you point out, there is a risk that a person can attain the capacity to speak fairly smoothly, but yet still feel very apprehensive about speaking...(the "what if it doesn't work and people hear me stutter" scenario). So, I have found that it is usually good to supplement fluency shaping strategies with stuttering modification (stutter easier) approaches so that a person has a "fall back strategy" in those times when, despite one's best efforts, they still stutter. In my experience, one of the bigger challenges associated with stuttering modification techniques is that the speaker may not be very keen on letting other people hear them stutter. In such cases, it helps to introduce activities that are designed to reduce the speaker’s sensitivity to stuttering. (My comments above suggest that the sequence is always “fluency shaping first, stuttering modification second”, but I have used the opposite order in a few cases where clients have balked at the fluency shaping techniques because they felt too unnatural to use.) And, of course, there are people who have found success using either of the two methods in isolation.