|About the presenter: Peter Reitzes, MA, CCC-SLP is an ASHA certified, New York State licensed speech-language pathologist working in an elementary school and in private practice in Brooklyn, New York. Mr. Reitzes is co-host of the StutterTalk.com podcast and author of 50 Great Activities for Children Who Stutter: Lessons, Insights, and Ideas for Therapy Success (PRO-ED).|
People who stutter and speech-language pathologists often use the term fluency even though there is no accepted definition or description of what constitutes fluency (Plonsker & Osborne, 2007). As Osborne (2007) stated, "Our knowledge base regarding normal fluency is lacking depth and succinctness" (p. 3).
The term fluency is often used to mean the absence of noticeable stuttering (Reitzes, 2006a; Starkweather, 1984). Finn & Ingham (1989) noted, "Of the 93 studies that reported using a guideline for identifying fluency, 71 virtually defined fluency as the absence of stuttering or disfluency" (p. 405). Manning (2009) pointed out that "fluency" and "normal speech" are often viewed as "equivalent terms" (p. 48).
I have observed numerous people who stutter demonstrate or model what they call "fluency" or "fluent speech" after participating in fluency shaping based therapies. However, the type of fluency displayed may appear to some to be struggled, effortful, and labored. Similar observations led Starkweather (1998) to note that this type of struggled or disrupted fluency is not fluency at all, but is "stuttering in a new form" (par. 6).
It is commonly assumed that "fluency" should be the end result of treatment. Healey (2006) noted that "most clinicians simply focus on fluency or reducing stuttering as the main goal of therapy" (par. 2). One well known therapy program states that "93% of clients attain normal levels of speech fluency by the end of our 12-day program" (HCRI). However, it has also been noted that "Measuring the use or discontinuation of trained speech patterns requires that these trained speech patterns can be distinguished clearly from spontaneous fluent speech" (Alpermann, Huber, Natke & Willmes, in press). How can speech be both fluent and distinguishable from fluent speech? Such stark differences or disagreements reveal a field that is clearly confused about the meaning of fluency.
Fluency is also used as a euphemism for stuttering (Reitzes, 2006b). For example, some people who stutter may say "I have a fluency problem" when they really mean "I stutter." This may help explain why one speech-language pathologist, perhaps inadvertently, advertised specializing in "fluency reduction" (Weidig, 2010). After all, a speech-language pathologist who specializes in fluency reduction may be considered akin to a weight loss counselor who specializes in weight loss reduction.
As a person who stutters, as a speech-language pathologist and as a co-host of a podcast dedicated to stuttering issues, I am very concerned about the use and misuse of the term "fluency." Using specific, descriptive language instead of labels or vague terms such as fluency can be a productive way to help people who stutter explore their speech and explore the process of change (Johnson & Moeller, 1972; Quesal, 1997; Quesal & Yaruss, 2000; Reitzes, 2006b; 2006c; 2010; Williams, 1957; 2003).
In 1957 Dean Williams suggested that "It can be extremely clarifying to refrain from using the word 'stuttering' in the clinical situation. This is not just a verbal gymnastic. It is important because it forces the person to describe what he, himself, is doing that he is calling 'stuttering' (p. 393)." Similarly, it can be extremely clarifying to refrain from using the word fluency in the clinical situation.
The Fluency Challenge
Williams (1957) offered a Stuttering Challenge of sorts when he explained, "If one begins describing speaking behavior and omits the word 'stuttering,' it can be extremely sobering to re-evaluate what the subject is doing" (p. 393). Similarly, the Fluency Challenge asks people who stutter and professionals to consider replacing the word fluency and related terms such as fluent speech and spontaneous fluency with specific and descriptive language (Reitzes, 2010). When taking the Fluency Challenge it is suggested that people who stutter and professionals challenge themselves to think and talk about communication and speech without using the words fluency or fluent. If the word fluency is used in thought or conversation, one should challenge him/herself to replace it with more specific and descriptive language.
For example, a client taking the Fluency Challenge may say during therapy, "I am working on being fluent." When asked by the clinician to specifically describe what is meant regarding being fluent, the client may then explain, "I am working on not stuttering" or "I am working on speaking smoothly." In the latter example, the clinician asks, "What does speaking smoothly mean?" Such an exchange promotes the use of descriptive and specific language and serves to support the client in moving closer to the meaning of what he or she is thinking, seeking and doing. During one such exchange with a ten year old, she initially stated "I want to speak fluently." When challenged to replace the word fluently with other language, she said "I want to speak easily." The girl then changed easily to smoothly, softly, gently and without bumps until she finally said, "I want to speak without stuttering." This admission allowed us to explore not wanting to stutter.
During a session, a 20 year old client who had been through several fluency shaping therapies stated that his main goal of attending speech therapy was to speak fluently. He modeled what he called "fluency" several times during the session. However, his modeled "fluency" sounded rigid and struggled - sounds were prolonged and his speech contained tense blocks and tense prolongations. He seemed to be putting a lot of effort into talking. When I modeled back the client's example of fluency he was clearly confused and stated that perhaps his speech at the time was not really fluent. The client then explained that he had been speaking using fluency tools. We were then able to discuss the possibility that using or attempting to use fluency tools may not lead to the desired result.
Professionals such as speech-language pathologists should also consider taking the Fluency Challenge. It has been pointed out that clinicians should be willing to model any behaviors that clients are asked to use (Breitenfeldt & Lorenz, 2000; Ramig & Bennett, 1995; Reitzes, 2006c). During an evaluation or session a clinician may say to a client, "The goal of our work together is fluency." A clinician who speaks or thinks in such a manner should challenge him/herself to define what is meant by fluency. In this example, is it possible that the intended message is to suggest that "The goal of our work together is not stuttering?" If this is indeed the intended message, then why not just say so? Why work towards something vague called "fluency" if what the clinician really means to say is "We will be working on not stuttering"?
When a professor says to graduate students, "We are going to talk about fluency tools today" the professor should think about how students may be internalizing and interpreting this message. Are students thinking "We are going to learn about ways to help people who stutter communicate more effectively" or are students thinking "We are going to learn the secret to making people stop stuttering"? How students hear the word "fluency" and what it implies will impact how they view the disorder of stuttering and how they may ultimately treat and work with people who stutter.
Alpermann, A., et al. (in press). Measurement of trained speech patterns in stuttering: Interjudge and intrajudge agreement of experts by means of modified time-interval analysis. Journal of Fluency Disorders (2010),doi:10.1016/j.jfludis.2010.05.007
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