1/17/95
From: Dick Mallard
Dr. Schwartz, a colleague forwarded a copy of a brochure from the National Center for Stuttering to me. He had questions about some information contained in this brochure. Will you please clarify several points for me so I can respond to him accurately?
1. On the cover of the brochure, the following statement is made: "a success rate of 93.4% for its graduates." We were wondering how do you define a graduate? What must one of your clients do to "graduate?" What does the 93.4% mean?
2. I was curious about the following. On the back of your brochure, the following statement is made: "NCS treats more stutterers than any other program in the U.S." What data do you have concerning the number of stutterers our program (Southwest Texas State University) has treated? How many individuals have we treated? Where did you obtain this information about our program?
Thanks in advance for your response.
Dick Mallard, Director, Communication Disorders
Southwest Texas State University
1/18/95
From: Martin Schwartz
Dear Dr. Mallard:
Thank you for your questions. With respect to a definition of "graduates," allow me to quote from page 136 in my book, Stutter No More: "Each patient was treated using the methods described in this book. All received weekly individualized assignments and sent tape cassettes to their therapist at the Center on an average of at least once every ten days during the follow-up period (one year). All were required to attend local club meetings or to communicate regularly by telephone with fellow patients in their area. All attended at least two regularly scheduled refresher courses."
Of all patients seen, somewhat under 72% follow-through with the program and graduate. We view this as a reasonably good number and are continuously trying to raise it. The success rate of 93.4% applies to the graduates, just as the brochure indicates. Obviously, success rates for individuals who do not practice is no test of the efficacy of the program. That is an important but entirely different issue.
I have no data concerning the number of PWS that S.W. TX St. U. has treated but the Center conducts treatment workshops in New York City, Atlanta, Boston, Chicago, Dallas, Detroit, Houston, LA, Minneapolis, Philadelphia, Phoenix, San Francisco, Seattle, St. Louis, and Washington, DC. It truly is a National Center For Stuttering. If your university treats more individuals, I apologize.
MARTIN F. SCHWARTZ
1/20/95
From: Kevin Eldridge
Dr. Schwartz,
Your response to Dr. Mallard was discouraging to say the least. In a time when insurance companies and medical providers are more and more concerned with treatment efficacy, you stand behind a statement concerning treating more PWS than any other program with nothing more than listing the many cities in which you hold workshops and then stating that you apologize if you are wrong. Shouldn't you have checked the data? Realizing that you have not makes me question any other "fact" you purport, such as your percentage of "successful clients".
I posted this reply to the list, since as clinicians and researchers (or in my case researchers-to-be) we have a responsibility to PWS as well as the payers in the system (bottom line that's you and me) to report accurate information with data to back it up. Many people are trying to meet that challenge. When any "professional" doesn't stand up to these standards we are all hurt, especially the person who stutters. If you don't know how many people other programs have treated, you can't say you've treated the most. It's that simple.
Kevin Eldridge
University of Pittsburgh
Dept. of Communication Science and Disorders
1/19/95
From: David Bertollo
[Message directed to Dr. Schwartz]:
People usually drop out of medical treatment programs because the treatment is not working, or has unacceptable side effects. To be on the conservative side then, (assuming all drop outs are failures), your success rate at "graduation" is 67.2%, not 93.4%. But again, most medical studies, especially for conditions in which relapses are common (such as cancer, or psychiatric illness), use the five year success rate as their measure.
What's your long-term success rate?
David Bertollo
Statistical Sciences and Epidemiology Division
Nathan Kline Institute
New York State Office of Mental Health
Orangeburg, NY
1/19/95
From: Martin Schwartz
Mr. Bertollo:
Your assumptions regarding the group I selected to include are not correct. Rather than spend a great deal of time on this, I refer you to my book for a more detailed analysis. The answer to your question re long-term success rate can also be found in my book. If you do not have the book, please send your postal address and I will send one off to you straight away.
MARTIN F. SCHWARTZ
1/19/95
From: Howard Schwartz
Dr. [Martin] Schwartz: I'd like to pose this question. Why is it that you freely share your opinions regarding what you perceive to be the positive aspects of your model and treatment, and yet are reluctant to debate or refute a question that challenges some aspect of your treatment. You appear to slough off the response of Dr. Bertollo by suggesting that he read your book. Why not respond?
Howard D. Schwartz Ph.D.
Associate Professor
Northern Illinois University
Dept of Communicative Disorders
r10hds1@corn.cso.niu.edu
1/19/95
Mr. [Martin] Schwartz:
Bertollo's analysis seems straightforward. Please share with us all, via the'net, how his assumptions are incorrect.
Bruce Larkin larki001@mc.duke.edu
1/20/95
From: Martin Schwartz
Dear Dr. [Howard] Schwartz:
As I have indicated elsewhere, it is my intent in this context to present a model of stuttering which accounts for the behavior in an orderly fashion. It is NOT my intent to pursue issues of therapy at this time.
I have never presented the positive aspects of my treatment in this context.
I am not reluctant to debate a therapeutic-oriented question at some future time - but only when both parties share a common base of information. To do this properly I must first be given the opportunity to FULLY present my model because all of my thinking (including those relating to therapeutic issues) rests on this orientation.
I'm certain that when you were a student and asked your professor a question he/she might, in responding, have referred you to a source to read. Was he/she "sloughing"?
MARTIN F. SCHWARTZ
1/20/95
From: Martin Schwartz
Dear Mr. Larkin:
My intent, in communicating with this list, has been to present a model of stuttering which attempts to account for the behavior in a reasonable way. Discussions of commercial brochures and therapeutic results represent issues outside of the purview of my intent. And I do not intend to pursue them. However, I will answer your question in the following way:
One hundred men have a serious bacterial infection. All will die unless they take an antibiotic. If they take the antibiotic all will survive. Seventy take the antiobiotic; thirty are Christian Scientists and refuse. The seventy who take the antibiotic survive; the thirty who do not die. The question is, how successful is the antibiotic?
Like the antibiotic, the techniques I employ in my program work for virtually everyone. ..... But, then I suggest you read my book.
MARTIN F. SCHWARTZ
1/23/95
From: Bruce Larkin
Dear Mr. Schwartz:
Let's alter your parable slightly; make it an analogy that better fits your program:
One hundred men have a serious bacterial infection. All will die unless they take an antibiotic. All begin a course of treatment; for thirty men, the treatment is ineffective or produces unacceptable side effects. They die, or find another treatment, or whatever. The seventy who take the antibiotic survive, but it is not clear whether they are healthy or not, since they are not examined by medical personnel. They are known to be alive because they periodically send tapes to the doctor to confirm that they are still breathing. The question is, how successful is the antibiotic? How accurate are the measurements of survival rates? What is being measured, and at what interval(s) after treatment? The doctor claims a survival rate of 93.4%, others dispute that, and demonstrate different reasonable interpretations of the doctor's own data. The doctor refuses to answer questions concerning survival rate but continues to attract patients with his advertised claim of 93.4%. The question is, should we trust this guy?
Bruce Larkin
1/20/95
From: Dick Mallard
Dr. Schwartz, thanks for your prompt reply to my inquiry. When you revise your brochure you might want to indicate that your program treats more stutterers than any other program "to the best of my knowledge." You would not want the recipients of your brochure to think that you treat more stutterers in your program than any other program when in fact you may not.
I had a situation come up several years ago that relates to your success claim. An adult stutterer called for an appointment to see me. I had never met this person before. We talked for about 20 minutes. He was by any description an uncontrolled, severe stutterer. He had numerous secondary features and struggled considerably with speech. He then asked if he could make a recording in my presence. He proceeded to take out a recorder and go into his passive air flow technique he learned from you. He started the conversation something like this, "Hello Dr. Schwartz, this is ___ ___ and I am conducting a conversaton with Dr. Mallard in his office. I am using my airflow technique, etc." I immediately stopped him and told him he could not misrepresent himself to you in my office. The fact was he did not use his technique during the first of our conversation and did not give any impression that he was trying to, yet he was going to make it appear to you that he had been all along. This was clearly an attempt to complete an assignment and then report something quite different. I told him I would not be part of this situation. We talked further, he left, and I never saw him again.
Do you believe that the tapes you get back are representative of real speaking situations for your clients? Since your clients are followed through long distance (it appears), how do you judge the reality of what you are sent? How would this person fit into your 93% success rate? If you never saw him personally again but only heard tapes that were good examples of passive air flow, would he be considered a graduate?
Another point that I have always wanted to ask you deals with ethics. As members of ASHA, we are not to "... evaluate or treat speech, language, or hearing disorders solely by correspondence" (ASHA Code of Ethics, Principle IG). If I understand your procedure, you see individuals for a weekend and then they forward tapes to your staff (or you) periodically. The tape is evaluated and some type of correspondence about the tape takes place. If you conduct the workshop, let's say, then are you the only one who will follow up with the clients who attended that workshop? Or, can one of your staff members answer the phone, or evaluate a tape, and then give advice to a person that the staff member has never met?
Your program is well known and I frequently get calls about it. I do appreciate your helping me understand your procedures better. Thanks.
By the way, thanks for the book.
Dick Mallard, Director
Communication Disorders
Southwest Texas State University
1/23/95
Thank you for your suggestion.
MARTIN SCHWARTZ
1/22/95
From: Steve Hood
Dear Friends --
I have been following with keen interest the posts to the net concerning the Schwartz model and up until now have refrained from commenting. The recent comments made by Dr. Mallard are extremely well taken, and are the basis for what follows. Recently, Dr. Mallard reported on a person who, in his office, prepared to make an audio tape of his "recovery."
I had a similar experience. A man in his late 20's called and asked if he could meet with me "off the record" to discuss our therapy program. He did not want to schedule a complete evaluation until after discussing his situation and learning more about our program. I scheduled a time to talk with him on an informal, off the record basis.
During our conversation, several things became apparent: (1) as a youngster and teen-ager he had been stuttering quite severely, (2) his moments of stuttering were quite frequent (I gather 25% of words spoken), (3) his stuttering has highly overt with obvious secondary symptoms of tension and struggle, along with characteristics that were highly vocalized and audible: in other words, phonation was rately suspended, and "silent blockages/closures" were infrequent." (4) He had received air-flow therapy from Dr. Schwartz and had experienced significant short-term success. (5) His audiotapes were made under conditions that would allow him to appear fluent. (6) Since audio tapes do not show a visual component, the brief silent blocks he experienced were not detectable from the tape.
What also became obvious was that he had become remarkably "successful" in interiorizing his stuttering by successful avoidance. He was extremely selective in terms of the people he spoke with, the situations in which he spoke, the manner in which he spoke, and the topic about which he spoke. He "got by" with frequent word changes and paraphrases of what he wanted to say. He had even made an audio tape of various food orders he could place at the drive-thru windows of places like McDonalds and Wendy's -- hence, all he had to do was hit the "play button" of his cassette tape recorder and wait for the pre-recorded message to order his "quarter pounder with fries and a medium sized coke." One time, when the tape recorder jammed, he just said, "Never mind, I forgot my money" then proceeded through the line and left -- both hungry and empty handed.
When the end-product of any therapy is the interiorization of stuttering through tricks and crutches to avoid, then no matter what the "objective standard of measurement", the end result is far from a success.
The most successful outcomes I know of are people who can talk any time they want, to any person(s) they want, in any situation(s) they want, and who can communicate effectively, with a minimum of fluency disruption. Those disruptions that remain are of short duration, and not accompanied by physical tension and struggle. These people may have some disruptions in fluency, but these people are not bothered by them, nor are their listeners.
Fluency is more than the absence of stuttering. Frequency counts, such as attempts to reduce moments of overt stuttering down to a preconceived level (e.g., 0.2 stuttered words per minute) are misleading.
I seriously question the wisdom of "therapy follow-up" via correspondence course methodology and audio tapes.
Regards and best wishes,
Steve Hood
p.s. --
A college student with whom I once worked entered therapy as an extremely severe pws. A teen ager he, along with his mother and public school clinician, had traveled to New York to spend a day with Dr. Schwartz. I'm not sure if/how he would fit into the data because the experience was totally unproductive and there was no follow up.
p.p.s.
If the original book, **Stuttering Solved** held the key, then why the sequel of **Stutter No More**?
Maybe we all need to rethink the title of a book published many decades ago entitled, **The Riddle of Stuttering."
1/23/95
From: Silvano Colombano
The "bacterial infection cure" analogy is a perfect example of the kind of complete misunderstanding of the stuttering phenomenon that has plagued relationships between PWS and SLP. I am sorry for letting go of my customary scientific circumspection. This is a stutterer speaking now, and one who is very grateful for the kind of care and real understanding that is being dispalyed by most SLPs on this list.
You put me in a room, ask me to focus on fluency for a reasonable period of time and you won't be able to tell me apart from any other fluent speaker. I have learned to control my speech so that I don't stutter if I put my mind to it. Am I cured? Can I then set forth and "Stutter no more"? In analogy with the Cristian Scientist, am I making a CHOICE not to use the speech "tools" I acquired because I believe that God willed it that I be a stutterer? Do I have some perverse psychological reason for refusing to use the tools that would liberate my speech for good?
The answer is NO to all of the above. The simple fact is that the controls that enable me not to stutter require a constant mental effort that fluent speakers do not have to exert. The problem is not that I am unable to exert control or that I am unsuccessful at it, the problem is that I HAVE to. THAT is the problem. Therapy that focuses on providing these control techniques is certainly welcome for those who need it, and many do, in order to do the many things we have to do to survive, but please don't call it a cure! The problem is still there even if we can momentarily get around it.
People leave therapy programs because they either have difficulty accomplishing these speech "control" tasks, or because they realize this is not what they thought a "cure" would be. In some cases they even feel that exerting speech controls is far more cumbersome than stuttering.
This is the reality of the stuttering phenomenon, and this aspect needs to be accounted for by any "model" of stuttering just as much as all other obvious external manifestations.
It is also the case that speech controls can become less cumbersome and more "subconscious" with time (my experience). Perhaps new neural "remedial" pathways are formed, just like learning a new language. This "model" however does not account for "sudden cures". So, there are four possibilities: they are not really "sudden", they are not really "cures", the phenomenon was not really "stuttering" or the model is wrong.
Silvano Colombano
1/24/95
From: Martin Schwartz
Dear Dr. Colombano:
I take no exception with what you have said in your recent posting. I believe I can clarify my position. With respect to my analogy with the antibiotic, notice that I have not used the emotionally-charged word, "cure." I agree with those who say that there can not (at this time) exist a cure for stuttering. But as you will discover I will use my model to state precisely why this cannot be. I would therefore beg that you not make cure inferences from what I say. But allow me to just dwell here for one additonal moment. Notice that the seventy people who took the antibiotic are not truly cured. At some future date they can be re-exposed to the bacteria and develop the same infection. Their problem was not solved permanently. The only point I was trying to make was that if individuals do not avail themselves of a therapeutic regimen one can not be justified in suggesting that the regimen is not successful. If I hire the best piano teacher in the world, take lessions, but refuse to practice does that mean that the teacher and/or the teacher's techniques are unsuccessful? I think not.
But you may suggest, as has been suggested by others that the reason the individuals were not compliant was that the technique was not successful in producing fluency. As I will suggest, the techniques which I will eventually discuss produce immediate fluency for the vast majority of individuas who stutter. And you may respond that that is not remarkable since one can, for example produce immediate fluency by distorting speech by a number of means - such as having individuals sing, or speak very slowly, or change the pitch of their voice, or soften their voice or speak to the rhythm of a metronome. And I would respond that you are correct. It has never been a challenge to produce immediate fluency if you distort the speech enough. The key has been to produce immediate fluency and still sound like yourself. If you do not accomplish this there will be conscious and/or subconscious resistance to employing the technique. As I will show at some future time, their are several ways to produce an immediate fluency without appreciably changing the speech. These techniques are not complex and, since they tend not to be obtrusive, are far easier to habituate. These techniques alter the way an individual gets set to speak and largely totally ignore the speech and the stuttering (This is probably the most controversial point I've made to date). There are virtually no speech control tasks involved.
Dr. Colombano, the issues surrounding habituation are complex and truly fall outside the purview of this communication. I promise a full discussion at a later date. But suffice to say, my orientation to the problem is so vastly different from the conventional wisdom that I can understand the incredulity you so articulately express.
MARTIN F. SCHWARTZ
1/25/95
Dr. Schwartz,
You keep referring to your technique (the passive airflow technique) as something revolutionary and totally outside the traditional thinking of other clinicians and researchers. I would like to disagree with this statement. Anyone who ever cares to open a comprehensive textbook on stuttering will see quickly that your treatment technique is not all that revolutionary but, indeed, has a long history. Just to set the record straight.
Luc De Nil
1/25/95
Dear Dr. DeNil:
Just to set the record straight I use seven (7) techniques with each patient. My airflow technique, one of the seven, is different from all others described in the literature. The precise details of my airflow technique are not described in any of my books. Just an overview is given. If you take the time to observe exactly what I do, I am certain that you will discover the technique is revolutionary. It is based upon a conceptual framework which is revolutionary. I therefore extend an invitation to you to come to one of my workshops to see exactly what I do.
MARTIN F. SCHWARTZ
1/25/95
From: Peter Ramig
Luc,
Thank you for your comments regarding the implications that airflow is something new and revolutionary. You are absolutely correct, airflow strategies pertaining to stuttering have been around for a long time... probably for as long as stuttering has.
What is new and revolutionary, in my view, are some of the extraordinary claims of how successful it supposedly is. My contact with scores of former airflow patients I have worked with, as well as other participants of this program I have talked with, do not support the implied claims. There are aspects of this type of therapy that are important; however, more is needed to establish long term success for most of us who stutter.
Peter Ramig, Ph.D.
Department of Communication Disorders and Speech Science
University of Colorado
1/25/95
From: Woody Starkweather
Hello Everyone,
In response to Luc's call for more explicit standards, I should say that the Guidelines for the Treatment of Stuttering have been adopted as a policy statement of ASHA. These guidelines were originally proposed to do essentially what Luc called for. Originally they were even called "stan- dards." Although, shortly into the debate, it became clear that we do not at present have measurement techniques that are adequate to the task of determining in a truly objective fashion whhat treatments are effective. As a result, we stopped calling them standards, and decided to call them guidelines of treatment, since they were based on common accepted practice.
It should be noted too that since we have no truly objective means of deter- mining effectiveness, it is not really proper to report a percentage of suc- cess. It is a **subjective** report, by necessity, and consequently deceptive, since it sounds objective. I should note that Dr. Schwartz' treatment program is outside the guidelines in a number of ways, which have already been mentioned in the discussion -- treatment by correspondence and oversimplification specifically.
Woody
1/25/95
From: Woody Starkweather
Hello Everyone,
I should just respond to one statement that Dr. Schwartz made about the stuttering observed in users of sign language. There were of course not very many of these individuals since stuttering among the deaf is extremely rare, but the descriptions given in the article do show most of the phenomena that Dr. Schwartz said was absent. There was anticipation, substitution, word fears, etc. There was no evidence about signing in unison or alterations in feedback. The descriptions were convincing to most people reading them that this was indeed a real stuttering phenomenon. This is also true of the clinical accounts of stuttering in handwriting. I am sure that some of the people on the list who stutter can attest to this phenomenon. It DOES have the characteristics that stuttering has.
As for laryngectomees, I think I said in the first place that it does happen that stuttering disappears in many people who have had their larynges re- moved, but it is also a fact well documented that one can stutter without any vocal folds at all. And of course it is very well known that some people who stutter do so with parts of the vocal tract other than the vocal folds. Indeed, the vocal folds do not need to be involved at all during stuttering, although typically they are because of their pervasive involvement in any type of speech production.
Woody
1/25/95
Dr. Starkweather:
If applying a number to a subjective report is deceptive, as Dr. Starkweather states, than all of psychometrics would be deceptive. I would suggest that a moment's reflection would indicate the inappropriateness of this position.
MARTIN F. SCHWARTZ
1/26/95
From: Dick Mallard
Dr. Schwartz:
Material contained in information you send to prospective clients includes a letter from Lorraine Schneider, Administrative Director, The National Center for Stuttering. She indicates that your "...services are typically covered at 80% by major medical insurance." Ms. Schneider advises prospective clients "...to refrain from contacting your insurer until you have called the Center for the appropriate terminology."
I have worked with several of my clients concerning insurance coverage for the therapy. Some have been successful in obtaining coverage and some have not. Will you please share with us the terminology that you use? Increasing coverage for our services will help us as providers and our clients.
Thanks.
Dick Mallard
1/26/95
From: Lorraine Schneider
Dr. Mallard:
The wording we use when submitting insurance claims is specific to the treatment approach we employ and the model of stuttering upon which it is based.
Accordingly, it would be inappropriate for a therapist who does not subscribe to this same model and treatment to use such wording, just as it would be for the Center to suggest such use.
Lorraine Schneider
Administrative Director,
National Center For Stuttering
1/27/95
From: Jim McClure
Ira Zimmerman raised a valid issue that merits a better answer than he got from Martin Schwartz.
On the TV show, Dr. Schwartz made an unequivocal claim that his technique works for every person who stutters. Then he demonstrated his technique on a young woman and pronounced her "cured." Asking whether the promise was kept is a reasonable question and deserves a straight answer. Otherwise we have no recourse but to question Dr. Schwartz's claims in the absence of independent research.
The academic debate on this list has been interesting. I give Dr. Schwartz some credit for opening the subject and taking considerable heat. But wouldn't it be better if the self-help and academic communities teamed up on some large-scale research on the long-term success of various therapies?
-- Jim McClure
1/27/95
Hi Everyone,
Because I am geographically close to Dr. Schwartz' main center, I see a lot of people who have been through his program, and in those I have seen, he uses the code for laryngeal spasm, i.e., spastic dysphonia.
Woody
1/27/95
From: Woody Starkweather
Hi Everyone,
The comparison of a report like "85 per cent succuss" with a psychometric evaluation is indeed an instructive comparison. In psychometrics, the operations that are performed are very clearly specified, in terms that so explicit that everyone else can duplicate them. When this is done, then a psychometric conclusion, such as an IQ score, is an objective report of the result of the operations performed. If someone else performed the same operations they should expect to get the same result. It is in precisely this sense of replicability that the psychometric score is ob- jective. This is exactly what is missing from a report such as "85 per cent success." It doesn't say in any clear or operational way what the term "success" refers to. I expect, for example, that for stuttering, "success" means talking freely without any sense of having to think about what you are doing in order to talk. But I imagine that since Dr. Schwartz teaches his clients a special way of initiating phonation and perhaps other special ways of talking, he must define "success" in a different way. Since we don't know how he defines it, and we don't know what operations he performs in measuring it, we don't know what the term "85 per cent" means, yet it sounds quite authoritative and clear, hence it is, in my opinion deceptive in exactly the way that psychometric tests are not deceptive.
1/27/95
Dr. Starkweather:
You are incomplete and incorrect. The term spastic dysphonia, as everyone knows, is not stuttering and should not be used as the basis for an attempt at insurance compensation. The center's administrative director made our position clear.
MARTIN F. SCHWARTZ
1/27/95
From: Steve Hood
Loraine Schneider, apparently responding on behalf of Martin Schwartz, said that the wording of insurance claims depends upon the type of treatment offered.
WOW !! Things must be different in New York, or other Centers where Dr. Schwartz bills for services. It has always been my understanding that most SLP's/Clinics use the generic Health Care Finance Administration (HCFA) coding system that required an ICD-9 Diagnostic code (307.0) and the appropriate CPT (Common Procedural Terminology Code) when submitting insurance. This makes me wonder if possibly there is a different ICD-9 code used. for example, if the assessment or treatment involves the larynx, as would be the case with "air flow" then I wonder if Dr. Schwartz uses a code for something related: e.g., something that might pertain more to something like spasmodic dysphonia, or a laryngeal dysfunction with a known or suspected organic/neurological etiology.
I'm of the opinion that Dr. Schwartz response to the questions raised by Dr. Mallard and others only begs the question.
Sharing the ICD-9 and CPT options and choices would be helpful, and I think Dr. Schwartz should share these options. After all, if insurance does cover at least some treatments, based presumably on at least some diagnostic reason, then this information would be helpful both to the PWS as well as those who treat them.
I hope to hear more about this from Dr. Schwartz, or others who have insights.
Steve Hood
1/27/95
From: Martin Schwartz
Dr. Starkweather:
I would suggest that if you took the time to read my book you would discover that I define success on pp. 136-137. I would be happy to send you a copy free of charge. When you read it you will also discover that I do not teach patients a special way of initiating phonation or a special way of talking.
Only when a shared base of information forms the basis of discussion can meaningful conclusions be drawn; what seems to occur in the absence of such information are thinly veiled attempts at discreditation. Such activity has no place in a forum of this sort.
MARTIN F. SCHWARTZ
1/27/95
From: Dick Mallard
Dr. Schwartz, as I indicated to you earlier, I am asked frequently about your program. I want to be sure I understand your program as much as possible so I can refer, or at least have an intelligent discussion, with clients who ask.
You have referred individuals to your book when asked questions about therapy effectiveness, etc. I assume you are talking about the chapter that begins on page 135 in your 1991 edition of STUTTER NO MORE.
On January 23 of this year you indicated that the National Center for Stuttering treats about 417 individuals in a typical year. The first book of yours that I have is STUTTERING SOLVED which was published in 1976. Thus, it has been 14 years since STUTTERING SOLVED was published and the public was made aware of your program. That time frame suggests that you have treated 7,506 stutterers since 1976.
My question is this. Why are you reporting data on only 625 clients, which is 8.33% of the population you have apparently seen? Reading further, on page 137 you state that "...well over nine out of ten (adults) can expect to have a relatively permanent success with the techniques described-provided that they are religious in their adherence to all aspects of the program." Am I to tell stutterers that over a 14 year time span that only 8.33% of the clients you treated had "relatively permanent success" with your techniques? 8.33% is quite a bit different than 96% to 93% figures you report on page 136.
Six hundred twenty-five is an impressive number. So is 93% success. Unless I am told that my numbers are incorrect (perhaps based on insufficient information), I am afraid that what the public is seeing here is a small subset of data taken from a much larger population pool. To be included in that small subset, clients had to meet stringent criteria that only a few either could, or would, meet. Thus, from your information, it appears that 93% of 8.33% of 7,506 clients is getting fairly close to your "success" rate.
This is the information I shall share with future cleints who ask about your program so they can make a decision about whether or not to work with you. If I need additional information or if some of my assumptions are not correct, please let me know.
Thanks
Dick Mallard
1/27/95
From: Martin Schwartz
Dear Dr. Mallard:
Thank you for your question. Since 1976 I have treated over 6000 individuals who stutter. During that time my thinking and techniques underwent a number of changes. For example, in my first book, Stuttering Solved, I hypothesized the existence of an airway dilation reflex as a primary triggering agent for stuttering. This I subsequently found to be a completely untenable hypothesis. My discovery of target areas in the german exercise physiology literature provided me with a clue to the present hypothesis which suggests that individuals who stutter are born with a tendency to target stress-induced tension at the larynx. This, of course, is part of a larger hypothesis and, like all hypotheses is subject to change, modification, and even total rejection.
This same took place with my approaches to treatment. With such a large number of individuals to work with it became apparent that my original notion of a passive airflow beginning each breath group would work for some but not others and that later I discovered that a slowed first word was also required. Later still I discovered that no "co-articulation" could be allowed to occur between the flow and the first word. I called such "co-articulation" Preforming. Still later I discovered that it was imperative to determine the mental intent of the patient during the passive airflow and I developed special techniques to effectively insure that this was occuring in the manner I wished. Then later I discovered that simply a mechanical technique, while quite enough to stop stuttering in virtually all non multiply handicapped indivuals could not possibly insure compliance. So I developed a self-hypnosis technique taught to all individuals to bring the subconscious mind along as a willing ally in the process of change. I developed clubs of users of the techniques in most major cities, instituted day, night, and weekend hotline numbers to provide a knowledgable, sympathetic, supportive trained individual to help patients in moments of difficulty or to prepare them for upcoming difficult situations. Still that was not enought. So I, with the aid of nutritionist colleagues at NYU Medical Center started to test the effects of different vitamins and minerals to lower muscles tensions. I also learned about a self-administered test that individuals can employ to see if they are eating any provocative foods, food that are capable of increasing muscle tensions in the body, including tensions at the larynx.
My orientation and techniques underwent a continuous process of change over a number of years. Gradually, the level of change seemed to asymptote and I felt that I could begin to consider a relatively stable approach. The 625 patients reported constitute apporoximately 70% of a group of 900 consecutively treated individuals treated over a period of several years. My earlier reports, published in my earlier books, like the 89% reported by Azrin and Nunn for their regulated breathing method, was not examined over the long term.
Sorry to be so long-winded, but I felt your very reasonable question deserved a proper answer.
MARTIN F. SCHWARTZ
1/27/95
Dr. Schwartz...
You stated that the 625 clients were a subset of 900 clients served over a period of several years. What happened to the other 275 clients?
Kevin Eldridge
1/27/95
Mr. Eldridge:
Please read my book.
MARTIN F. SCHWARTZ
[Unfortunately the answer to Kevin's question can't be found in Schwartz' book. It only talks about the 625 clients who finished his program. There's no mention of the 275 who dropped out. -- J. Swaney]
1/30/95
From: Marshall Rice
Dr. Schwartz:
Will you put your money where your mouth is?
I have been reading with great interest the debate over your 90+ success rate. I would like to challenge you to put your money where your mouth is (so to speak).
Based on reading your book, I am interested in taking your course. However, the lengthy discussion on STUTT-L has made me skeptical about your methods and success rate.
My insurance company does not pay for speech therapy and I do not want to spend a lot of money on any therapy that does not provide long term benefit. However, I would be more than happy (in fact, ecstatic) to pay your fee if it does provide lasting benefit.
Therefore, are you willing to accept me into your program and dely my tuition payment for six months? A post-dated cheque will be provided. If at the end of that time, I have maintained any gains that I achieved in therapy, you are welcome to cash the cheque. If fluency gains have not been maintained, then I would expect my cheque to be returned. Of course, I would personally cover the costs of travelling to the United States, accomodation etc.
Given your claimed success rate, I view this as very low risk to you. I am extremely motivated and a hard worker on speech targets. A number of years ago I took the Precision Fluency Shaping Program and practiced diligently (often 2-4 hours a day) for many, many months following the program. However, even after very hard practice, my fluency declined and old stuttering patterns returned.
Given my high motivation and work ethic, I believe I must be in the group most likely to succeed with your program (which I understand takes consistent and dedicated practice). In addition, if I fail to follow through with even one post-therapy assignment/homework you can take that as evidence that I did not put absolute effort into your technique and you can cash my cheque. In addition, if you want, I will provide you with a detailed daily log of my practice and transfer activities as further evidence of my commitment to your methods.
If your success rate is indeed 90+, my request appears reasonable and you must be fully confident that you will receive your fee. I look forward to hearing from you about his matter.
Marshall Rice, Toronto, Canada
3/6/95
On March 3rd Martin Schwartz responded to comments I made in which I
claimed that, in my opinion, he was building his entire approach to
stuttering around a PARTIAL truth.
Dr. Schwartz responded thusly:
"John is simply incorrect. A substantial tensing of the vocal folds is
the triggering mechanism for stuttering in the vast majority of
individuals who stutter. The etiology is unidimensional; it is not a
partial truth - it is the complete truth."
I debated whether I'd just let this go by. I decided I wouldn't.
But first, some general observations. I was initially surprised to find
Dr. Schwartz on Stutt-L because he has been controversial in the past.
Therefore, I was pleased by his apparent willingness to explore his
knowledge and understanding of stuttering with other members of this
forum. Unfortunately, my enthusiasm was hastily conceived. In the several
months that Dr. Schwartz has been a member of Stutt-L, he has not been
forthcoming, although he has certainly made enough promises to share his
philosophy, ideas and findings. To date, we have all been left waiting.
I can live with that. But what I find difficult to accept is the rather
cavalier (in my opinion) way in which Schwartz relates to those who don't
agree with him. I previously addressed some concerns in an earlier e-mail
to Dr. Schwartz. I spent some time trying to word my comments as
explicitly as possibly. The issues I raised came from my 50 plus years
experience with stuttering. I feel I talk from some authority, not just
because I personally dealt with the problem for 25 plus years, but also
because I completely recovered from it. Also, as one of the earliest
members of the NSP, I've had a broad and intimate relationship with
members of the stuttering community. Hearing people's stories over 18
years...as well as facilitating hundreds of chapter meetings and
workshops...has given me some feeling for the issues involved. It has
also put me in a position to offer some interesting and perhaps unique
insights into the problem.
In Schwartz's first response to me, he dismissed my carefully composed
comments with what metaphorically felt like a sweep of his arm.
Specifically, he disposed of me in a one sentence response. So when he
indirectly sent me the above message, it caused me once again to sit back.
Was I being oversensitive? I had a spent half hour or so carefully
presenting my thoughts, and along he comes and says. "John is simply
incorrect...the etiology is unidimensional; it is not a partial truth, it
is the complete truth." Boom. End of discussion.
That struck me as reminiscent of what a parent might be likely to say to a
kid who doesn't want his authority challenged -- "Don't question me. Just
do it!" Quite frankly, that may have played okay when I was 10 years old,
but it doesn't speak well for his interest and respect for other people's
ideas and experience.
That said, I want to address what Schwartz has presented in his books.
I've read two of them. The first was "Stuttering Solved" which I perused
not long after it came out. Recently, Dr. Schwartz was kind enough to
send me a free copy of "Stutter No More" and it is to this book that I
want to address my comments and observations.
On page 17 of "Stutter No More" Schwartz says this --
"I now began to suspect that ALL (my emphasis) of the stuttering I
observed was a learned response to a common core problem, a spasm of the
vocal cords. Here at last, I felt, was the stutter reflex."
And again on page 22 --
"Some form of stress perceived by the stutterer triggers the locking of
the vocal cords; it is an inborn reflex. This in turn triggers
stuttering, a learned reflex. So there are two reflexes -- one inborn,
the other learned. Stutterers are born with the tendency to tense their
vocal cords when stressed, and it is the way they learn to handle this
tendency that dictates the kind of stuttering they will exhibit."
This appears to be the basis of Schwartz's proposition: that stress
creates a laryngospasm -- an inadvertent locking of the vocal cords.
I can understand how Schwartz, someone who is not a PWS, could have
arrived at this conclusion. However, he operates at something of a
disadvantage because he has not personally experienced the problem and
therefore has no real subjective way to validate the truth of what he
believes. (Not that it's necessary to have stuttered to successful treat
the problem. I've met a number of SLPs who I felt have had remarkable
insights into the experience of stuttering.)
Specifically, I take issue with the idea that stuttering is **caused** by
a laryngospasm. Schwartz rightly observes that the larynx will tighten
under stress, more so with some people than with others. But I know a
number of people whose tension is reflected in their voice. Their voices
are tight, constricted and sometimes high pitched. But they don't LOCK
their vocal cords.
My observation is that the locking up is not an inadvertent physiological
response but a LEARNED behavior. Sheehan came closest to this in his
description of approach-avoidance behavior. A person wants to let go, and
at the same time he doesn't. He pushes himself to speak, but because
there is a risk in doing so, he also reins himself back. When these
forces are of equal strength, the person becomes blocked -- unwilling to
go one direction or the other. One way -- but only one way -- to stop
oneself talking is to lock the vocal cords. When this act becomes so
habitual that it drifts out of conscious awareness, the block then appears to
happen by itself. This leads to a feeling of being helpless and out of
control, which leads to fear. The fear triggers more helplessness which
triggers more fear...and you end up with a closed loop. Fear of blocking
creates more fear which creates more blocking.
Most every PWS who talks about his or her fear of speaking ties this fear
to stuttering. In my opinion, this is one of the biggest mistakes that
people make, because it's much too limiting. I, too, as a kid thought
that if only I didn't block when I talked, speaking would be easy. Wrong.
When I brought the muscles I was tensing back under my conscious control
so that I could learn to relax them and not block, I discovered that I
still had a fear of talking. I was afraid, not of stuttering, but of the
feelings I had associated with stuttering. Feelings like fear,
embarrassment, helplessness, anger, etc. I did not want to experience any
of those emotions.
Now here's the key point -- THOSE FEELINGS ARE NOT ASSOCIATED ONLY
WITH STUTTERING.
I'm suggesting that the threat of having to reveal or experience unwanted
feelings themselves -- whatever they are -- can trigger the individual to
hold back (block).
If you get right down to it, without the feelings I would have had no
reason to block. What I learned over time was that it was the feelings,
not the stuttering per se, that triggered my impulse to hold back. Fear
of being too assertive, too forceful, too demanding, too emotional, too
original, too out of character, too different, too...whatever!...can all
trigger the person to block (hold back)...as much as can a fear of
stuttering.
Consider this scenario. You're in a no smoking section of a theater.
(Okay, I'm dating myself, but this happened to me.) The guy right in
front of you is smoking a cigarette, and even worse, the smoke is drifting
right in your eyes. There are no empty seats you can move to. You have
no choice (other than leaving) but to tap him on the shoulder and ask him
to put out the cigarette.
Here's what went on in my mind. Back then I had major self-assertion
problems. One aspect of being non-assertive is that it feels enormously
risky to speak out, because if you come on forcefully, it assumes the
other person will be thrust into a weak position. Win-lose; that was the
game. I wanted the guy to stop smoking, but I assumed that he wouldn't
want to stop, even though the smoke was bothering me. So his immediate
response would be to say "no"...and thrust me into a weak (lose) position.
Actually, in my mind he had already said "no". So I was already mad at
the guy and I hadn't even tapped him on the shoulder yet. Furthermore,
back in those days, being openly angry at someone was a no-no. I would
NEVER do that. Most of the time I wouldn't even allow myself to be aware
I was mad, though it would be apparent to the observer. Also, the anger
would be inappropriate.
I tapped him on the shoulder. He turned around, bothered at being
interrupted. I started to speak. I wanted to say, "Could you please put
out the cigarette. This is a no smoking section." At that moment I felt
like I was going to block. How did I know this? I felt fear. My vocal
cords were tight. My chest was tight. My throat was tight. Why?
Because I was holding myself back. I DIDN'T WANT TO SPEAK! But why?
Back in those days my self-awareness wasn't very high. All I was aware of
then was that I might block. I wasn't aware of these other issues that
were encouraging me to hold back. My attention focused totally on the
block, the one part of this process I was conscious of, the part of the
iceberg that broke the surface and could be seen. But was fear of
stuttering the real issue? It was certainly part of it. But it was
undoubtedly not the whole issue. Not by a long shot.
Now, let's say in this situation I would have tried to use air flow, or
fluency shaping, or something else that would allow me to speak. Keep in
mind that holding back (blocking) was really a protective measure to keep
something untoward from being expressed. If I didn't block, there may
have been all kinds of consequences. The guy may have gotten pissed and
punched me in the snoot (unlikely.) He may have told me to bugger off
(more likely), making me feel even smaller and madder. But whatever
happened, I would have been forced to feel things that I was not
comfortable with. Thus, the block became a strategy with a specific
purpose. By blocking, I kept my feelings hidden, kept myself from
suffering the consequences of being too forward, and kept my self-image
intact.
Hopefully, this example will help to demonstrate why some people are
simply unable to use fluency controlling techniques in particularly
stressful situations. The situation has become too threatening for them
to let go and speak. So they drive with one foot on the gas pedal and the
other on the brake.
All this might lead you to believe that I see stuttering as a
psychological problem. If that's so, it means that you're caught in the
common either-or paradigm. Of course, psychology plays a part of it. But
so do your emotions, beliefs, perceptions, physiological responses and the
incorrect behaviors you adopt when you go to speak. It's all of these
things WORKING TOGETHER AS A SYSTEM that creates the chronic blocking
behavior. More specifically, it's the WAY they interrelate that
creates the block. This is what I discovered as I successfully worked
through the problem. For those interested there's a paper on the gopher
site at Mankato State called "Introducing a New Paradigm for Stuttering" that
discusses this concept in more detail.
Back to Schwartz. I take issue with his suggestion that there's something
called a laryngospasm. My observation is that the locking of the larynx
(not the tightening but the locking) is done for a specific reason --
either to protect the individual from the experiences associated with
speaking (and the imagined consequences) or, as the NSP's Bill Parry has
pointed out in his book, it is a misapplication of the Valsalva maneuver.
Parry shows that when a person expects to have difficulty speaking, he can
mistakenly execute a Valsalva maneuver which involves a constellation of
specific muscular responses normally associated with efforting (as in
lifting a heavy valise, opening a stuck bottle, giving birth, etc.)
Blocking air flow builds internal air pressure to make the body rigid and
stronger. If you lock your hands together and try to pull them apart,
you'll see how you automatically do this, and how this locking in of air
resembles the blocks associated with chronic stuttering. If you want to
see the similarity even more clearly, do this while saying a word that
begins with a plosive. Parry proposes that a person will prepare
himself to execute a Valsalva Maneuver if he believes he will block on a
word and, therefore, will "tune" those muscles so they ready to react.
Consequently, when he goes to say the feared word, he quickly executes an
effort closure in the misguided belief that it will help him push through
the block...whereas, ironically, what's he's doing is actually
counterproductive to speech.
Either scenario -- fear of letting go or a misapplication of the Valsalva
maneuver -- can create a block. However, I simply can't buy into the idea
of a laryngospasm being the cause. It doesn't fit with my experience.
Nor, in my opinion, has Schwartz successfully made a case for it.
Tightening the vocal cords, yes. Locking them, no.
On page 63 of "Stutter No More" Schwartz says this --
"Patients are encouraged to imagine themselves as machines sitting in a
room generating one perfect sentence after another, taking time between
each sentence to set themselves up properly to produce the best possible
example of technique."
And again...
"If there is the slightest imperfection in technique, any stress will
exaggerate it, and can lead to stuttering."
Personally, I think that encouraging people to talk perfectly is the wrong
orientation. It certainly wouldn't have worked for me. My problem was
that I was already too caught up in talking perfectly. Most of us who
grew up with a stuttering problem have been overly perfectionistic and
self-conscious -- just the things I wanted to be able to give up.
I got through my problem...not by learning to place more controls on
myself...or by trying to speak perfect sentences...but by learning to let
go of the things that I was controlling and by substituting having FUN for
having to be perfect. I stopped seeing speech as a performance, and over
considerable time, my experience of speaking (and of myself) became
transformed. As a by-product, I became fluent as well. It was not a
simple process. It didn't happen overnight. But it did last. Now, I'll
grant Schwartz this. If a person discovers that there are things he can
do to avoid a block...that blocks are not something that "hit" him but
something that he has some say over...a great deal of the fear of the
unknown is removed. As such, any fluency enhancing technique, including
the Edinburgh Masker, can serve this purpose. But unless the person is
willing to make other associated changes in how he (or she) perceives,
believes, feels, reacts, etc., the system that supports the original
behavior will remain. This is because all living systems (of which
chronic stuttering is one) want to maintain themselves in a homeostatic
balance. Just changing one's speech and nothing else is like trying to
row upstream. You can make progress as long as you work real hard. But
the moment you stop for a breather, the flow of the water will pull you
downstream again. To beg the metaphor, if you want to go "upstream"
without so much work, it helps if you can change the direction in which
the stream flows.
The one thing I do notice in Schwartz's approach that differs from his
earlier book is the importance he places on support groups. He says...
"We have repeatedly discovered that monitors are crucial to the
establishment of success and that patients who try to go it alone court
disaster. Although it is possible for some individuals to succeed on
their own, their number is small. The general suggestion is: get a
monitor. And if you can find two, you are twice blessed."
"We have found these support systems absolutely critical in making success
stick. Without them, patients must fend for themselves and,
unfortunately, very few have enough personal resources to make such a
major permanent change."
Without question, in this area Schwartz is right on. Support from others
is vital.
On page 96 Schwartz says...
"Any program, if it is good, will produce an initial fluency quickly. If
the technique does not accomplish this, the program should be discontinued."
Whew! I'll bet that most of the SLPs on this forum will have something to
say about this. Instant fluency is not what it's about. It may be what
Schwartz's program is all about, but in my humble opinion, instant fluency
does not prove anything. Besides, most SLPs I've talked to say that
creating instant fluency is generally not that difficult.
On page 97 Schwartz says...
"In 1989 several investigators report discovering the area of the brain
responsible for the locking of the vocal cords in stutterers. This
finding means that researchers may now begin to attempt to develop
medications targeted to work in that area. It is conceivable that in the
future, stuttering might be treated by the simple expedient of taking a pill."
Oh yeah? That sure wouldn't have worked in my life. But this belief is
consistent with the idea that stuttering is a laryngospasm. Personally, I
think that Schwartz's statement puts out the wrong message...and false
hopes...to people in need. Also, has anybody out there ever heard of this
research?
On page 101 Schwartz has some interesting things to say about the
Edinburgh Masker, a device that buzzes in your ears through a headset
every time you talk, thereby making it impossible to hear your own voice.
Schwartz says...
"The reason it works, however, did not come to light until recently. The
hearing nerve, as it courses to the brain, attaches to the nerves coming
up from the vocal cords. There is a commingling of fibers and impulses.
When a loud noise is presented to the ears, a very strong signal comes up
the hearing nerve, and when this signal commingles with the vocal cords'
nerve signals, it alters them. This altered signal is no longer the
correct stimulus for triggering stuttering -- and no stuttering occurs."
Again, this may be consistent with Schwartz's belief that stuttering is a
laryngospasm. However, I have problems with his explanation. For one
thing, can anyone out there in the professional community substantiate
that research has proven this to be the reason? I'd be surprised if this
has been positively determined as Schwartz implies. But I'm always ready
to be surprised.
I can think of a better reason why the Masker works for many people. I
tried it back in the early 80s when someone brought it to a local NSP
chapter meeting. It was very weird, because when I spoke, I had the
sensation that I wasn't speaking. I was totally detached from my voice.
Now, if my feelings and my self image are tied up with hearing myself
speak, then being disassociated from my voice means that my voice is no
longer an extension of me, and thus, what comes out of my mouth can be
disassociated from my feelings, self image, etc. In other words, my voice
cannot be a threat if it's not "mine." Thus, there is no reason to hold
it back.
On page 102 Schwartz says...
"It is clear that what every stutterer in the world is looking for is an
expeditious cure -- a cure that requires no effort. The prospects for the
future are thus particularly appealing because they are passive. Apart
from presenting himself for treatment, the patient is not called upon to
participate in any way in his recovery. In addition, the treatment
usually requires a single intervention and the recovery period is short. It
is my believe that by the year 2000 some of these approaches will
begin to be manifest."
That left me so dumbfounded that I'm not going to even comment. Maybe
someone else would like to.
On page 125 Schwartz says...
"The treatment I have described may enable you to profit still further.
Your stress may be so low you may be able to treat yourself. But this
book is not intended as a self-help manual. Self-treatment is not advised."
So what was the purpose in writing the book? I cannot comment as to
Schwartz intentions but I will venture a personal impression. My feeling,
based on the style of the book and how issues are treated, is that the
book is one long infomercial for Schwartz's program. That's my impression
and nothing more.
As far as the effectiveness of Schwartz's program, I'm really not in a
position to comment, since I've never been through it. I've talked to
people who have, of course, but I'm reluctant to speak from their
experience. My guess is that the program is probably pretty good for some
and not as effective for others. I would think that it would be most
effective for the person who has his s**t together in life but is simply
practicing bad speech behaviors. Such a person would already have
developed a foundation to support a more fluent, self-expressive
lifestyle. On the other hand, a person who is holding back in many areas
of his life might be led to false expectations. Changing his speech might
be easy to accomplish at first, but over time, would be difficult if not
impossible to maintain since his life would be pulling him in an opposite
direction. This is the person for whom Schwartz's claim of a universal
answer would be a disservice, and telling him that he could become fluent,
or that by becoming fluent he could transform his (or her) life would be
imprudent and at the very least, a travesty of good sense. Such a person
would not be cut out for such a program, and encouraging him to take the
program (until he had made progress in other areas) would simply set him
up for failure and exacerbate his low sense of self worth. (My opinion,
again.)
I realize that much of what I've said here may be seen as pretty harsh
criticism of Schwartz's program and/or ideas. However, he was the one who
chose to participate in this forum. He's the one who offered to send free
copies of his book. And he's the one who has chosen to skirt every
invitation to present his research and ideas in detail. As always, I
would be more than delighted to have him respond to the issues I've
raised, and any others he may choose to address.
Schwartz may still wave away this lengthy critique with a sweep of his
arm. But at the very least, he can't deal with it by simply saying "Read
my book."
John Harrison (johnnyh@holonet.net)
3/7/95
John:
Thank you for your comments. Your discussion of the psychological
components of stuttering are very relevant to you. They undoubtedly
account for the success you have had. They also account for your
resistance to admit the possibility of a purely physical core of the
problem.
With respect to some of your comments. I do not teach individuals how to
speak perfectly - I teach them a new way to get set to speak.
Your negative comments about my suggesting that worthwhile techniques
producing fluency quickly are noted. My conclusion derives from my
observation that both precision fluency and my approaches produce initial
fluencies and that many of the conventional therapies that never succeed
do not.
My comments about an eventual cure derive from my belief that
pharmacology probably holds the answer to the problem; given your
orientation my statement would seem absurd.
Since I tend to be a pragmatist the one statement you make that
seems to make the most sense is "As far as the effectiveness of
Schwartz' program, I'm really not in a position to comment, since I've
never been through it."
MARTIN F. SCHWARTZ
3/7/95
Jim:
Thank you for your comments. I am in essential agreement with what you
say in your post. Allow me to make 2 points as clearly as I can. I have
a notion about stuttering. I have developed a multidemensional program
for treating the disorder which seems to follow logically from my notion.
The techniques tend to produce immediate fluency for virtually everyone.
But that does not in anyway suggest that the techniques are suited for
everyone. As I've indicated elsewhere, the number of variables which
determine whether or not an individual will follow through with a given
treatment regimen is large. Indeed, I frequently make use of other well
known treatment techniques when my work with a given individual indicates
that my standard approach will not be successful in the long term.
My first point is that there are two things at work here. First, does the
clinician have techniques that stop stuttering? I have some, others do too.
Second, does the clincian have techniques that can keep stuttering stopped?
I have some that work for a number of people; others also have ones that
are successful.
My second point is that my model has the power to explain why so many
apparently dissimiliar approaches can produce fluency and why so many
dissimiliar approaches can maintain fluency.
I hope, eventually, when the smoke and fire about what I have to say
settles a bit I will finish my model for this list and then demonstrate
its explanatory power. In that way, perhaps those who view this dialog
will understand that its presumed controversy is illusory.
3/7/95
John Harrison writes:
"'On page 96 Schwartz says...
'Any program, if it is good, will produce an initial fluency quickly.
If the technique does not accomplish this, the program should be
discontinued.'
Whew! I'll bet that most of the SLPs on this forum will have
something to say about this. Instant fluency is not what it's about.
It may be what Schwartz's program is all about, but in my humble
opinion, instant fluency does not prove anything. Besides, most SLPs
I've talked to say that creating instant fluency is generally not
that difficult."
Quite right. Most SLPs know that establishing fluency is relatively
easy compared to maintaining fluency. In fact many of us have, at one
time or another, used the techniques which Dr. Schwartz advocates.
Few of us, however, have found these techniques to be sufficient
treatment. I my experience they are most effective for PWSs toward
the end of therapy, not at the beginning.
Simple answers to complex questions are always attractive. In my
estimation, Dr. Schwartz's theory and the treatment derived from it
are incomplete and inadequate. The theory does not sufficiently
explain many observations about stuttering which have been noted over
the past several months (and recently) on this list. The treatment
does not meet the rigorous test of effectiveness over a suitable
period of time. As others have noted, the selectivity of the
treatment sample and the loss to follow-up distort the apparently
favorable outcome.
SLPs are bound by ethical principles which require that the patient's
welfare be considered foremost. We are therefore constrained from
rushing to embrace treatments which are not adequately documented and
supported by clinical research. So far, Dr. Schwartz is the sole
advocate of his approach. There needs to be independent evaluation
of his treatment approach. That is only possible with full
disclosure. To the extent that Dr. Schwartz has provided us with
information neede to evaluate his treatment, we should be grateful.
Certainly, his theory has contributed to much discussion and debate,
something which theories are supposed to do. Let us distinguish,
however, between theory, and established and accepted practice.
3/8/95
MARTIN F. SCHWARTZ said [in response to John Harrison's detailed,
well-thought out comments]:
"Since I tend to be a pragmatist the one statement you make that
seems to make the most sense is "As far as the effectiveness of
Schwartz' program, I'm really not in a position to comment, since I've
never been through it."
Then, to Jim McClure, he says:
"I hope, eventually, when the smoke and fire about what I have to say
settles a bit I will finish my model for this list and then demonstrate
its explanatory power. In that way, perhaps those who view this dialog
will understand that its presumed controversy is illusory."
Why, Dr. Schwartz, is it impossible for you to accept any type of criticism
without responding in a patronizing manner? Over the past few months,
there have been numerous posts regarding your theory, your therapy, some of
the claims you make, etc. In essentially all cases, you dismiss the
comments with "a sweep of the arm" as John H. so clearly put it. You've
done the exact same thing here.
I get the sense that you think you are better than others on this list.
That somehow your "science" is better than their science. That what you
see so clearly is not seen by others because they are fools. Meanwhile you
"dance around" any challenges put to you by others.
You say you "tend to be a pragmatist." I can think of a lot of words I
would use to describe you (based upon reading your books and reading your
posts on this list). "Pragmatist" would come pretty far down on my list.
"Egotist" comes pretty much near the top. "Supercilious" is probably the
most accurate. "Sanctimonious" comes to mind as well.
I hate to flame over the net like this, since I've gotten into some trouble
for doing so in the past. But I'm tired of sitting back and letting you
stroke your ego at others' expense. I agree that *some* posts that have
been directed to you have been unduly harsh (this one included, I guess).
Those, by far, have been the minority. Most, however, have simply been an
attempt to either challenge your positions, or to ASK YOU TO CLARIFY your
positions. And in essentially all those cases, what you do is exactly what
John said:
"But what I find difficult to accept is the rather cavalier (in my opinion)
way in which Schwartz relates to those who don't agree with him."
This is a well-established behavior pattern of yours. The discussion can
only center around what *you* want to talk about. Anything else is off
limits because you've decided that it's off limits.
Frankly, I'm sick of it. From now on, I'll just stop reading anything from
'schwrtz' because it's just more of the same old crap.
Since I also tend to be a pragmatist the one statement I would make that
seems to make the most sense is "As far as the multidimensionality of
stuttering is concerned, Martin Schwartz is really not in a position to
comment, since he's never been through it."
BTW, I fully expect a patronizing response to this post, as well.
I apologize to any list members I may have offended with this post.
Bob Q.
3/8/95
Bob Quesal,
AMEN! You've said to Dr Schwartz what many of us have wanted to say but
haven't had the courage to do so. THANK YOU FOR SPEAKING FOR ME AND
SEVERAL OTHERS!
Peter Ramig
3/8/95
Dear Martin,
I have received your personal message to me which was, I believe, in
response to my posting on Stut-l. My message there agreed with John
Harrison's statement that fluency is relatively easy to establish, but
difficult to maintain. I also suggested that your theory, while
interesting and useful, tends to simplify the problem of stuttering,
and that your follow-up data are incomplete. Your response to me
follows:
--------------------------------------------------------------------
The next time I am in California I would be happy to show you
precisely what I do so that you can determine, first hand, what I am
talking about.
The offer is free, the offer is genuine, the offer is serious.
MARTIN F. SCHWARTZ
I have just finished reading Bob Quesal's response to you. Although
I do not think I can rise to his level of disdain or stridency, I
very much understand the reason why he was motivated to write what he
did. The key is in the character of your response to me (and others).
There is nothing in your response to me which is substantive, or which
even acknowledges the several points I made in my posting. The
impression you leave behind is clearly condescending. It is
something akin to a parent patting a young child on the head and
telling him to run outside and play.
Well, I am not a child. Nor am I a bumbling or ineffective
therapist. As a matter of fact, I am 56 years old and I have been
doing stuttering therapy for over 30 years. I have had my share of
successes and failures. Alas, my success rate is not 89% or 90%.
But neither is yours. My background and training is not limited to
clinical speech-language pathology. My later graduate work included
a Ph. D., jointly in Speech and Hearing Science, and Psychology. For
many years I have been a member of the APA Division of Psychotherapy,
as well as a certified member of ASHA. I have trained as a
psychotherapist and for a dozen years pursued a private practice in
that area. I teach a course to graduate students in Counseling and
Psychotherapy. I also teach courses in Fluency Disorders, Speech
Science, and Research Methods. I supervise student clinicians, who
are treating stuttering, and I continue to do direct therapy myself.
I mention all this just to point out that my background is not
unidimensional and that I am active professionally. Consequently, I
believe I am able to read and evaluate clinical research and make
some sound judgements about what is well proven and what is not.
I do not wish to promote a verbal shoving match here over
qualifications or achievements. There are many subscribers to this
list whose background, experience and qualifications dwarf my own and
yours. I ask only that you yourself acknowledge the fact that many of
the criticisms and earnest questions about your theory and treatment
which have appeared on this list have come from thoughtful and
experienced researchers and clinicians. As a matter of fact, many
fine points have been made by individuals who are not SLPs, but are
nevertheless clear and precise thinkers, some with impressive science
and research backgrounds. In brief, you would do yourself and all of
us a tremendous service by treating us as responsible adults rather
than as truculent children. We are not going to go outside and play,
Martin. We are going to stay right here and insist that you play by
the rules.
Sincerely,
Bill
3/8/95
Yikes, Woody goes away for a week and there's an uprising of sorts. I've
never bothered to take the time to respond to the comments about Martin S's
comments, as condescending as they are to everyone, because, frankly, I feel
that I have so many other important things to do each day. But each time
someone is brave enough to say something eloquent and honest about their
reaction to Martin's comments, and especially the way he presents them, I
feel good. Hurray for all of you, John, William, Janet, and especially
Robert Quesal. There's room on this network for honest controversy although
it can be a little tricky.
I've read some of Martin's postings. For me, it's like watching the
extreme religious shows on television...once in a while I do it for sport.
But it gets old quickly. I've not read his newest "book" but I did read
"Stuttering Solved" and if his newest effort is anything like the first
one....well, I KNOW I have better things to do. My favorite "chapter" in
"Solved" was the one about Martin taking his dog to the top of the Empire
State Building to watch his nostrils (the dog's). I believe that "chapter"
ranks right up there with Bennie Bogue's chapter in his 1926 "book"
(Stammering, it's cause and cure- notice the similarity in the titles)
called "My Mother and the Institute". I have both "books" side by side on
the lower shelf in my office.
I have no doubt that Martin has helped some people who stutter, others
he has not helped much for I've had the opportunity to work with them after
their experience with air flow therapy. Nearly any treatment that helps the
speaker to monitor and modify his fluency in some reasonable manner can have
a positive effect so I'm sure that Martin has done some good. But, geeze,
give us a break. If you really have all the answers why are you so afraid of
the questions?
Dr. Schwartz:
Will you pay me the respect of a reply to my message.
More than an month ago I posted a message asking about taking your
therapy. I repeated my message several weeks ago. For some reason,
you have chosen not to reply to my concern and interest in taking
your therapy. I am at a loss to know why you refuse to answer my
question about taking your program. My question, as others have
commented on over the past weeks, is reasonable and deserves response.
Do others on the also find this inexplicable?
Frankly, I find it uncaring and unprofessional on your part not to respond
to a stutterer sincerely seeking help. Further, I must confess it makes
me more skeptical about your claims. In any event, however, my question
and offer still stands. I have included my original message
below. I eagerly await a reply to my message.
******************* ORIGINAL MESSAGE FOLLOWS *********************
Dr. Schwartz:
Will you put your money where your mouth is?
I have been reading with great interest the debate over your 90+
success rate. I would like to challenge you to put your money where
your mouth is (so to speak).
Based on reading your book, I am interested in taking your course.
However, the lengthy discussion on STUTT-L has made me skeptical
about your methods and success rate.
My insurance company does not pay for speech therapy and I do not want
to spend a lot of money on any therapy that does not provide long
term benefit. However, I would be more than happy (in fact, ecstatic)
to pay your fee if it does provide lasting benefit.
Therefore, are you willing to accept me into your program and dely my
tuition payment for six months? A post-dated cheque will be provided.
If at the end of that time, I have maintained any gains that I
achieved in therapy, you are welcome to cash the cheque. If fluency
gains have not been maintained, then I would expect my cheque to be
returned. Of course, I would personally cover the costs of travelling
to the United States, accomodation etc.
Given your claimed success rate, I view this as very low risk to you.
I am extremely motivated and a hard worker on speech targets. A
number of years ago I took the Precision Fluency Shaping Program and
practiced diligently (often 2-4 hours a day) for many, many months
following the program. However, even after very hard practice, my
fluency declined and old stuttering patterns returned.
Given my high motivation and work ethic, I believe I must be in the
group most likely to succeed with your program (which I understand
takes consistent and dedicated practice). In addition, if I fail to
follow through with even one post-therapy assignment/homework you can take
that as evidence that I did not put absolute effort into your
technique and you can cash my cheque. In addition, if you want, I will
provide you with a detailed daily log of my practice and transfer
activities as further evidence of my commitment to your methods.
If your success rate is indeed 90+, my request appears reasonable and
you must be fully confident that you will receive your fee. I look forward
to hearing from you about his matter.
Marshall Rice, Toronto, Canada
3/10/95
I would like to add my voice to the chorus of comment
regarding Bob Quesal's recent open letter to Martin
Schwartz. My opinion is that the letter was well-written,
well-deserved and long overdue.
To Dr. Schwartz I would say the following: Stubbornness has
no place in science. Those who disagree with us should be
treated as respected colleagues, PROVIDED THE DISAGREEMENT
IS EXPRESSED LOGICALLY, THOUGHTFULLY AND RESPECTFULLY. It
is only in this way that dialogue (not diatribe) among
scientists can take place, which is essential to scientific
progress.
John Nichols
3/11/95
As readers of the list now, I requested that Dr. Schwartz let me
take his therapy on the condition that I pay his fee if (after six months)
I have maintained any fluency gains from his course. This request
was flatly refused.
My objective in this request was simple and honest - the course is
expensive and I do not want to pay a lot of money for a therapy that
is not helpful in the long term.
As my earlier message stated, I am skeptical of the claimed 90+ success
rate claimed by Dr. Schwartz. Simply, I have not seen one bit of credible
evidence to support that claim (other than his book which was not reviewed
by any professional source).
Why has Dr. Schwartz not published his results in a referred journal like
"Journal of Fluency Disorders"? I would think that if his results are as
remarkable as they claim, that any credible journal would readily accept the
article and the "debate" about his methods would end.
Dr. Schwartz, I do not want to see you get a "bum" rap if your success
rate is as high as you state. However, you must provide the community
of stutterers and professionals with some type of scientific evidence
for your claims. An article in a quality journal would provide that.
Why don't you submit your results for professional review, rather
than keep on with your unsubstantiated claims? If a professional review
substantiates your results, I would then be ready to pay for your course as
the risk would be less.
Marshall Rice, York University
3/12/95
Hi Stutt-l'ers....
I'd like to publically join those who are commending Bob Quesal for
his recent comments directed to Martin Schwartz. BQ said things
that needed to be said. Like a great many people on this list, I
have become quite exasperated and disillusioned with Dr. Schwartz
for his refusal to respond forthrightly to reasonable and
thoughtful questions and criticisms.
Dr. Schwartz has said, in essence, that only those folks who have
read his book and observed one of his workshops are qualified to
comment on his approach. To his credit, he has made his book
available for free to list members, and has issued invitations to
several researchers to attend a workshop. (Of course, we would all
be more informed about his program if he would simply publish his
research findings in a respected journal. But Marshall Rice has
already made this point very well, and I'd just like to express my
wholehearted agreement with what he wrote.) In my case, tho,
there's no need for him to send me his book, or invite me to a
workshop. I've read all his books, and I attended a workshop (in
1984) & went thru the Schwartz program. So I've met the
prerequisites. I'd like to make some observations and pose some
questions, based upon my experiences. I very much hope Dr.
Schwartz will respond, but based on recent experience I'm not very
optimistic.
An issue was raised several weeks back regarding the efficacy and
propriety of treatment via audio tape correspondence. My
recollection is that Dick Mallard related an anecdote about a
young man who stuttered severely in conversation, but suddenly
became quite fluent when he turned on his tape recorder in an
attempt to fulfill an assignment from Dr. Schwartz.
I can honestly say I never did anything so flagrantly misleading
during the time I was sending tapes to Dr. Schwartz' staff. My
tapes were a pretty fair representation of my general use of the
airflow technqiue. But I wasn't above fudging a bit. There were
a few times I'd screw up a phone call pretty badly, and not wanting
my "monitor" (the staff member who reviewed my tapes) to perceive
me as one of the 6% failure group, I'd rewind the tape and make
another phone call. I didn't feel real terrific doing that, but
I'm only human, and there's no doubt in my mind that sort of thing
is pretty common amongst Schwartz' patients. It's too easy to
rewind the tape when you screw up. It's one of the inherent
shortcomings of conducting therapy by correspondence.
Let me relate something else that illustrates another shortcoming.
After being in the Schwartz' program for about a year, I had the
opportunity to take a brief trip to New York. (At the time I was
living in Portland, Oregon.) I told my monitor I'd be in town, and
we arranged to have lunch together. We had a pretty good rapport,
and I enjoyed having the chance to talk with her face-to-face.
She told me something I found very interesting, and a little
disconcerting.
She said she always looked forward to getting tapes from me,
because--in addition to sending the tape--I always tried to give
her a lot of written information as to how I was doing; that is,
my ups & downs, things that had gone well or not so well, my
anxieties about certain situations, etc. etc. (BTW we were
specifically instructed by Dr. Schwartz to provide such info only
on the written form, not on the tape; the tape was to be used only
for recording our speech assignments. I inferred from this that
the monitors didn't listen to the whole tape, just to selected
portions of it). She liked & needed that kind of feedback, and
lamented the fact that she didn't get it from the vast majority of
her patients. Most of them just sent in the tapes, and had little
or nothing to say about what was really going on for them.
I bring this up, not to flatter myself for being such an
incredibly conscientious guy... :-) ...but rather to point up what
I see as another inherent flaw in conducting therapy via
correspondence. The therapist (or monitor) is deprived of the
opportunity to view the patient face-to-face, for an extended
period of time, to observe secondary symptoms and the like, and to
discuss with the patient the normal ups & downs of therapy and to
get a feel for what's really going on in the patient's life. As a
PWS I think this is an essential part of the therapy process. In
the absence of it, what you have isn't what I'd call therapy.
It's my understanding that therapy (such as it is) via
correspondence is not sanctioned by the ASHA guidelines. IMHO,
based on my experience, this policy is exceedingly well-founded.
I see this post is already plenty long enough. I'll save the rest
of my comments for another day.
John Swaney
3/12/95
Hi John S. and others,
Is it just my imagination, or is the truth slowly beginning to come out?
Dave
From: John Harrison
From: Martin Schwartz
From: Martin Schwartz
From: William Rosenthal
From: Bob Quesal
From: Peter Ramig
University of Colorado
From: William Rosenthal
William:
----------------------------------------------------------------------
First of all, I thank you for the generous offer. Time permitting I
intend to accept. I am always eager to learn what other clinicians
are doing. I have often found such collaborations to be helpful in the
evolution and improvement of my treatment of stuttering. Also,
thank you for sending me a copy of your book. It is proving to be
interesting reading.
From: Walt Manning
From: John Nichols
research assistant
Wendell Johnson Speech and Hearing Center
University of Iowa
Iowa City, Iowa
From: Marshall Rice
From: John Swaney
From: David Forster
added March 18, 1997
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