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From: Paul Goldstein
Date: 08 Oct 2011
Time: 23:02:09 -0500
Remote Name: 88.88.238.25
Hi, Irene. Let me tell you my thoughts on this matter. First of all, I think it's important for all of us to realize that we each are individuals when it comes to stuttering; that our speech and stuttering patterns are all unique; that our coping mechanisms and ingrained habits of dealing with our stuttering are all unique; the etiologies of people's stuttering disorders are different; the genetic factors are different for each individual; and of course severity varies immensely in frequency, intensity, and patterns of blocking. Of course, as an SLP you know all this. But given all these wide variations in parameters, it certainly makes sense that the optimal type or types of speech therapy for each of us would also be considerably different. Every type of stuttering therapy has its enthusiastic adherents who have derived great benefits from it; as well as those who have derived a small amount of long-term benefit; as well as those whom the therapy didn't help in any significant way, including those whose speech worsened (in either the short term or the long term) as a result of the experience. In other words, what helps one person who stutters may not help another at all. The factors that determine these differences in the efficacies of different treatment options for particular individuals are not fully understood. I myself have found fluency shaping very helpful. I attended the Hollins Institute in 1984, and worked with targets diligently in formal practicing, transferring, and monitoring for some 16 years. When I formally practiced for an hour a day, I would generally have excellent fluency for at least the remainder of that day, and often with accumulated daily practicing, I could extend my fluency for many days, weeks, or even months. But I could never maintain targets consistently over a protracted period of time without the drudgery of daily hour-long formal practice. And when my fluency targets collapsed (which they often did), it was devastating to my self-confidence, and on many occasions I couldn't again climb back into good target use without an expensive refresher. When I had these speech collapses, it was especially difficult with people who I had spoken very fluently with on prior occasions. My speech during these down periods was often worse than it had been prior to the most recent fluency surge. At times the person would be astonished that I would be having so much disfluency when I may have had perfect fluency with them on the last occasion. I eventually decided that the disadvantages to making an intensive effort to practice and monitor targets outweighed the advantages, particularly here in Norway where I have found an especially relaxed attitude towards differences and disorders. The wild swings of great fluency and severe disrfluency, combined with the intensity of monitoring, and the time commitment to practice just no longer seemed an effort to me worth justifying - having consistent fluency of speech no longer seemed to carry the substantial benefits in my life as it once did. That you and I have had very different experiences with the Hollins program is not surprising, because as individuals we all differ. I have personally known hundreds of people who stutter who have gone through Hollins or similar intensive fluency shaping therapies. I have met them through fluency shaping reunions and refreshers, national stuttering conventions, and online stuttering forums. While many of these have done quite well with Hollins or similar programs (including some who claim to be fluent or nearly fluent all the time), others have only found limited long-term benefit; and still others, like yourself, weren't helped at all, or developed worsened speech as a result. Certainly there is no such thing as "one size fits all" in stuttering therapy. There are two widely heard complaints from those who are less than satisfied with their Hollins experiences - the fact that therapy does not change at all in response to individual needs (the "one size fits all" philosophy), and that there is nothing offered other than strictly physical targets; that is, that Hollins does not work with the whole person, something which you have pointed out. With regard to the second complaint, there exist a number of clinics which do combine physical fluency shaping targets with an emotional/psychological approach, and advice for dealing with reviving targets and confidence after the inevitable relapses. I'm familiar with clinicians and clinics in New York and Boston which take such an approach. In a way these clinics combine the best of both worlds. There are also clinics around which offer fluency shaping therapy as one option among many, and administer differential diagnosis tests to determine beforehand which type of therapy would be most efficacious for particular individuals. Severity of stuttering does not seem to play much of a role in deternining the possibilities of success with Hollins. Many who are or have been very severe (including myself) have done quite well with Hollins, while many others with only very minor stuttering don't fare as well. I believe that if Hollins used a differential diagnosis strategy for potential clients, it may find ahead of time people who are not likely to benefit from the program. The overcompensation factor you mentioned could also be at play here, it seems to me. When we focus excessively on the vocal folds, gentle onsets, and breathing, this adds a major stress factor in what are ordinarily very natural actions for normally fluent people. Excellent targets could eliminate or override this stress - but if one's targets are not effective in this situation, the stress factors could easily make one's speech worse. Like you, I have also encountered programs that did nothing for me. When I was in high school and in college, I tried a weekly therapy at a state college clinic based on Joe Sheehan's approach. This simply made my stuttering worse. "Different strokes for different folks", as the old saying goes. Although I don't have dysphonia, I have - during some of my worst speech periods - blocked in such a way that I literally could not open my mouth, breathe in calmly, or move my articulators at all. This is a condition described in one of Van Riper's texts as "abulia". Practicing diaphragmatic breathing and gentle onsets helped overcome this. Under certain circumstances fluency shaping targets can overcome a dysphonic-type condition. But obviously, the Hollins program was not a good fit for you (in the same way that Sheehan-based therapy wasn't a good fit for me). It is only a shame that there wasn't a pre-therapy differential diagnosis test to discover that. I hope this has been helpful. Once again, good luck, Irene!