[ Contents ]
From: Bob Quesal
Date: 10/6/01
Time: 2:06:28 PM
Remote Name: 134.29.30.167
Great Question, Tom!
I'll try and answer point by point:
You asked: Specifically, is the decline in fluency primarily related to: 1) the nature of stuttering itself, I'd say it's more the nature of behavior itself. Most folks who have had therapy have been stuttering for some period of time. I think that it is very difficult to totally extinguish the "old" behavior - the one that was learned first - so it is likely to begin to re-emerge after the focus on new skills that takes place in therapy is no longer prominent.
2) the nature of the social environment (the importance attached to fluency in communication) In spite of therapy and no matter how good that therapy is, fluency is still going to vary. Often, social environment contributes to this variability. But difficulty speaking in situations in which one is trying to make a good impression doesn't differ all that much between people who stutter and those who don't.
3) the type of therapy I guess some therapies might be more prone to relapse than others, but it's usually the "match" between the treatment and the person receiving the treatment. If you do the right therapy for the client, I believe that relapse is less likely (although not totally out of the question). If there is a mismatch (trying to teach acceptance to someone who wants fluency and nothing else, for example) therapy is less likely to be successful (over both the short and long-term).
4) individual characteristics of people who stutter (age, etc.) This ties in with my answer above, to some extent. We know that early therapy generally has better success (less relapse) than therapy begun after a child has been stuttering for some time. However, regardless of age, the "mismatch" idea applies to therapies and people. One of the real challenges, in my opinion, is determining the "best" treatment for a particular client. I'll also point out, however, that sometimes the client doesn't realize the treatment that is best. I worked with a fellow who wasn't all that disfluent,but when I asked him to be more open about his stuttering ,he acted like I was crazy. After a few semesters of off-and-on therapy, he had an experience (taking a public speaking class) in which he finally realized that being open about his speech and stuttering was a good thing. He is now a school teacher.
5) other factors. There are always going to be "individual differences" that perhaps cannot be predicted. Sometimes we do our best therapy and there is still relapse. If we knew exactly why it occurred, we could bottle the recipe and become rich. ;-)>
Thanks for a great question. I feel good that I was finally able to beat Ken St. Louis to an answer! ;-)>
Bob Q.