1997 Stutt-L Archive of discussion between Martin Schwartz and others

John Swaney and Tony Troiano extracted the public files of discussion between Martin Schwartz and several others from the 3/12/97 - 4/9/97 archives of Stutt-L. They are printed below as submitted with the permission of the list owner, Woody Starkweather. You can search what various discussants contributed by using the "find" function on your browser and typing in the last name. The discussants included: Larry Burd, Lee Caggiano, Steve Caruso, Robin Changarathil, Adam Charney, Silvano Colombano, Kevin Eldridge, Frances Freeman, Alex Godden, Louise Heite, Marty Jezer, Marty Leisner, Richard Merson, Steve Morse, Bob Quesal, Peter Ramig, Cynthia Scace, Martin Schwartz, Woody Starkweather, John Swaney, Jean-Pierre Tibi, Tony Troiano, J. Scott Yaruss, and Ira Zimmerman

3/12/97
From: Steve Caruso

To All PWS
About a week ago while flipping through the channels on TV, I happened to catch a therapist named Martin Schwartz on MSNBC. I was amazed, Martin had a client on with him whose stuttering was cured. Martin stated that stuttering is easy to cure. Indeed the twenty-something client's fluency was excellent and claimed that it was Martin Schwartz's therapy that was responsible. Martin's therapy focuses on the patient's air flow, a strictly behavioral approach. There is no physiologic treatment of the stutterer's disfluency. Are there any PWS who are familiar with Martin Schwartz's therapy program that can fill me in as I am interested in any program that claims to cure stuttering.


3/13/97
From: Richard Merson

Steve:
Martin Schwartz has been around a loooooooong time....he'll be lurking on this very list....he is a speech pathologist....works out of New York.....markets his stuttering techniques throughout the world.....gets a lot of interesting press, primarily because of his skillful use of semantics.....he also gets good results in treating patients who stutter....he likes to talk a lot about that....

I'm also a speech pathologist.... and I've been around a loooooonng time...I work out of Michigan...I also try to market my stuttering services ...only in my local market....I also get some interesting press in my local market...I'm less skillful with semantics.....I also get good results with PWS.... I also fail with some ... and fall short with too many....

Dr.Schwartz ( Ph.D.in SLP) says stuttering is primarily an "airflow" problem...abnormal laryngeal reflex... or excess laryngeal tension......he's been saying that for some years now....

I ( Dr.Merson, Ph.D...SLP) tested this notion of laryngospasms several years ago....we paralyzed the vocal muscles of severe stutterers ( 6 male adults) double blind ( with and without toxin to paralyze the muscle).....results ... Vocal Paralysis or weakening the muscle did not clearly resolve the stuttering ... in fact placebo injections often reduced stuttering....

We have much more to learn about Stuttering, Treatment, and ways in which we should market our services to PWS......

Martin Schwartz's just introduced another one of his techniques to resolve stuttering.... a vibrator.... to remind PWS to use their controls. Its called the MotiVader.....cute huh.....I've been try to motivate my PWS patients for years.....to think all I needed was MotiVader.....you see its all in the semantics......

Semantics......."People in Quandries" ....that's me....( rest well Jack Johnson...I still use your ideas...)

Hi Marty.........I know your lurking.......God Bless.....

Rick Merson............Michigan


3/13/97
From: Woody Starkweather

Hi Everyone,

I thought it relevant to comment that Martin Schwartz' Ph.D. is not in Speech Pathology but in Speech Science, a related area. I don't believe his doctoral work had anything to do with the clinical treatment of stuttering. If this is not true, I am sure he will correct me.

He did get a Master's Degree, which would necessarily have involved some clinical work in all of the areas of speech pathology, but his formal training in stuttering therapy is no more than a master's level clinician. He is also, as we all know, not certified by the American Speech-Language- Hearing Association, and as a result of not being certified and not being a member of the national organization of speech pathologists and audiologists he is under no requirement to abide by the Code of Ethics of the Association.

He has, as far as I know, only one published article on stuttering, a theoretical piece published in the 70's. Several letters to the editor were published in response to this article, in which he set forth his theory of stuttering, which criticised the article on grounds of inaccuracy with regard to the physiological details that supported the theory. My recollection is that in response to these criticisms, Dr. Schwartz essentially agreed with them, although I do not believe he retracted his theory.

Woody Starkweather


3/13/97
From: Martin Schwartz

My masters degree in speech pathology was received from the University of Michigan in 1959. My Ph.D. in speech science was received from The Ohio State University in 1962.

While that might seem like a long time to some; its seems like only just yesterday to me.

There are some errors in Dr. Merson's observations. I do not say that stuttering is an airflow problem. I use an airflow technique as one of several to treat the problem. I do not say that stuttering is an abnormal laryngeal reflex. He is quite correct in pointing out that excess laryngeal tension is important. It is what I believe to be the core of the disorder. But the trigger for the stuttering is a characteristic afferent array that comes up both recurrent laryngeal nerves with the attainment of a critical threshold level of tension. So injecting the folds is not the best way to deal with the hypothesis. The only appropriate measure would be bilateral deafferentation of the recurrent laryngeal nerves. What this means is that the approach used was probably inappropriate. Its a difficult problem, I'll grant you, and Dr. Mereson is to be commended for making the attempt.

The MotivAider is not a technique for treating stuttering. It is a device that simply reminds individuals (privately) to use whatever fluency enhancing techniques theyve learned. It was invented by a clinical psychologist a number of years ago and I find it a useful adjunct to therapy. Most clinicians have also found it of value. A fuller description of it can be found on the National Center For Stuttering website. It has not been described as cute before, more often as useful.

With respect to Mr. Caruso's comments. I have gone back and looked as the MSNBC piece. He is incorrect about his observation. I did have a patient on who used to stutter. However, the word cure was never used.

I did indicate that it was fairly easy to produce fluency, but immediately followed it up with noting how hard the patient must work to establish a relatively permanent fluency. It was clear, in reviewing the tape, that the wishful thinking of all people who stutter for a cure had distorted his perception of what was said. This tape is available for those who wish confirmation.

I hope this clarifies some of the issues raised.

Sincerely,

Dr. Martin F. Schwartz


3/13/97
From: Martin Schwartz

I would inform everyone that virtually on a daily basis I am in contact with individuals who have been the recipients of unsuccessful and expensive therapies administered by individuals who hold the certificate of clinical competence from the American Speech Language and Hearing association. It is clear to me that certification is no degree of competence in the treatment of stuttering whatsoever.

Dr. Starkweather's observations regarding my eductional background are correct. His comments about the responses to my article are not. Also, had he read my past two books or looked at my website he would have seen that I recanted by earlier position regarding the airway dilation reflex. I would be happy to provide Dr. Starkweather with specific references and page numbers if he wishes.

Finally, I think it inappropriate that Dr. Starkweather obliquely implies because I am not a member of ASHA I violate their code of ethical behavior. To my knowledge I have not. To even suggest that I have, in the absence of specific evidence, clearly demeans him.

Sincerely,

Martin F. Schwartz


3/13/97
From: Marty Jezer

Martin Schwartz has been discussed many times on this list. You can check in the archives for many of the posts. I did his therapy many years ago. It didn't do much for me (except that I did learn much about my stuttering) but I know that it helped others. The problem many have with Schwartz is with his salesmanship, not with his therapy. If you're willing to work hard and practice for months, years, even many years, it might work. The same can be said about most other therapies. Most work for some people. But none of them work magically and there is no cure in the sense that you can expect to take a therapy course and suddenly stop stuttering.

One thing I liked about Schwartz's therapy is his maintenance self-help groups and tape pals. I think it is essential to be involved in some form of self-help during the therapy process. Either in a group strictly devoted to practicing a technique (the airflow with Schwartz) or better, groups like the NSP and Speak Easy (which evolved out of an airflow group) in which essential issues like attitude, self-esteem, how you feel about yourself and your stuttering, etc. are openly discussed.

As for his theory about laryngospasm, which I don't believe is uniquely his, there are studies that give it credence. Peter Ramig did a workshop at the NSP conference last year in Denver in which he showed a remarkable film taken from inside the larynx that showed the vocal folds tightening up during incidents of stuttering and vibrating naturally when the speak was fluent.

It may not represent THE CAUSE but it does seem to be a factor.

Cheers,
Marty J


3/13/97
From: Woody Starkweather

In reply to Marty Jezer's recent post,

Marty, no one denies that the vocal folds are involved in stuttering. They are so totally involved in any act of speech that it would be quite astonishing if they were not part of stuttering behavior also. Peter Ramig's and others' research have shown that this is, just as you say, the vocal folds tighten up, squeeze shut, tremor, etc., depending on the person. Gloria Borden did a study which showed that the vocal folds during stuttering are exquisitely well coordinated with the stuttering behavior. But all these studies show is that there is stuttering in the vocal folds for some clients just as there is stuttering in the lips or jaw for others. Where the excessive tension is located is quite individualized. Often, very often, there is excessive tension in the vocal folds, but that is easily explained by the fact that the vocal folds participate in just about every speech act.

What Schwartz' theory maintained is that in stutterers the reflexive action of the vocal folds that opens them wide when there is a need for air (the airway dilation reflex) is triggered at a lower threshold, indeed arising as a result of the air loss during speech. This of course doesn't square very well with the typical laryngeal behavior of stuttering, which is excessive closure instead of opening. But he responded that stutterers **react** to the tendency for the cords to open by closing them even more tightly than necessary as a kind of overcompensation. Needless to say, a theory that cannot be contradicted by contrary data leaves something to be desired. He may have formulated the theory yet again in his most recent "books" which I haven't read.

Woody


3/13/97
From: John Swaney

RE Dr. Schwartz' comment:

"Finally, I think it inappropriate that Dr. Starkweather obliquely implies because I am not a member of ASHA I violate their code of ethical behavior. To my knowledge I have not. To even suggest that I have, in the absence of specific evidence, clearly demeans him."

What about ASHA's prohibition on conducting therapy by correspondence (i.e., cassette tapes)? Is that an ethical standard, or a treatment standard, or is it something else? I'd appreciate some clarification from either Dr. Schwartz or someone else.

When the Schwartz program was debated at length here a couple years back, I posted a message -- with no response from Dr. Schwartz -- which touched on this specific issue. The essence of my post was that IMHO, based on some of my experiences in the Schwartz program, stuttering therapy conducted via correspondence has some inherent severe limitations, and that -- again IMHO -- ASHA's policy (whether one labels it an ethical standard, or something else) is the correct one.

One other thing -- RE the "Motivaider". Cute or not, it's been around for awhile now -- I bought one from Dr. Schwartz about 7 or 8 years ago. It wasn't helpful. After a few weeks my brain just tuned out the reminder that I was getting from the Motivaider.

John Swaney


3/14/97
From: Tony Troiano


Greetings,
Good points, but there are other issues as well. In the past I also have posted several questions regarding the Schwartz program, one of which, is how Schwartz defines "success". A running advertisement he places in New York Magazine boasts a 93.4% success rate. Although the word *cured* is never mentioned the reader could easily assume that success equals cure. Unfortunately, Martin Schwartz answered most of my questions with one word answers and suggested I purchase his books for more information. Also, as a former patient who received no benefit from his therapy after regularly attending the prescribed support groups for over a one year period, he chose to blame me for the failure.

--Tony Troiano--


3/14/97

Dr. Schwartz,

Some months ago you got my name and e-mail address of this list and asked me to visit your web site. I consider that solicitation. I'm not sure if that is technically unethical, but it sure feels like you are out there fishing.

Cynthia Scace


3/14/97

I am sorry if you were offended. I believed you might find it of interest. I do hope you took the opportunity to read it.

Martin Schwartz


3/14/97
From: Martin Schwartz

Dear Dr. Starkweather:

Thank you for your kind words.

I do not consider the Airway Dilation Reflex a useful concept in my current model of stuttering.

In the website (http://www.stuttering.com) I posit a model which reflects my current thinking. As one can conclude from a reading of it, the model looks at the degree of laryngeal tension PRIOR to the onset of speech as critical in the understanding of stuttering. Laryngeal behaviors during stuttering are considered misleading since they have superimposed upon them the struggle behaviors associated with stuttering.

Again, to repeat, the discussion of laryngeal behaviors DURING stuttering, which you refer to, is not the focus of my current model.

Finally, it is the afferent array from the larnynx associated with the attainment of a critical threshold level of tension (at the larynx) which is the stimulus that triggers the learned extrictory struggle behavior called stuttering.

Any therapy which sufficiently alters this afferent array will produce fluent speech.

Sincerely,

Martin F. Schwartz, Ph.D.


3/14/97
From: Woody Starkweather

You state this idea as if it were a fact. Do you have any published evidence for it? Or are you saying simply that when the person begins to stutter, or senses that they are about to stutter, they tense up in antici- pation and begin to struggle. That's pretty standard thinking.


3/14/97

Dr. Starkweather:

Forgive me for being unclear. The statements appeared in the context of a model of stuttering. A model is just what it purports to be.

Martin Schwartz


3/14/97
From: Martin Schwartz

Dear Mr. Swaney:

All initial treatment, the first 14 hours, are conducted face to face. The follow up phase is conducted by electronic means, i.e., cassette tapes, telephone calls, and email. I do not believe this violates the code of ethics of ASHA. Additionally, as the web proliferates, we will shortly be able to have live and audio and video two-way transmission capabilites. The implication of this for clinical treatment should be substantial. Again, though, I think this should be part of the follow-up, and not the initial treatment phase.

One important feature of the MotivAider is the avoidance of stimulus saturation. If one wears the device continuously, one tends to stop attending to it. That is why we suggest usingit no more than three hours a day, changing the inter-stimulus interval frequently, and varying its intensity. Had you manipulated these parameters, the result would have been better. By the way, there is a masters thesis done at U Kansas which demonstrated the value of the MotivAider is fluency therapy.

Sincerely,

Martin F. Schwartz


3/14/97
From: Woody Starkweather

What I said was that Dr. Schwartz is not obligated to follow the ASHA ethical code. I didn't say that he hadn't followed it. But the code of ethics is there for a reason -- to protect the public from charlatans. And when someone calls himself a speech pathologist but is not required to follow the code of ethics, then the public has no assurance about the practices of that person.

Providing therapy by correspondence is indeed a violation of the code of ethics. What Dr. Schwartz does is have clients who have been in therapy send in tapes of themselves. It has been my impression that the feedback the clients get in response to those tapes is preprinted boilerplate rather than actual reactions to the tapes. If they are actual reactions, then therapy is being done by correspondence, but if they are just preprinted materials sent back to motivate, then I wouldn't consider them therapy, and I wouldn't charge for them. I am sure Dr. Schwartz does not charge his clients for this material; that would clearly be a violation of the code of ethics. It might even be illegal, although I don't really know.

It does strike me as important that his doctorate was in speech science and had nothing to do with stuttering. It means that his formal education in stuttering was the equivalent of a person who has a master's degree, yet he is certainly thought of as a specialist in stuttering, even though he doesn't have the education of a specialist. Dr. Schwartz, even if he were a member of ASHA, would not qualify for the specialty recognition that we are developing because he lacks the education.

Woody


3/14/97
From: Martin Schwartz

Dr. Starkweather:

As a point of information. I was granted the Certificate of Clinical Competence from the American Speech and Hearing Association on January 1, 1969. This automatically was cancelled when I resigned from the association five years later. I must also point out that I hold current valid licenses as a speech pathologist in 8 states. Each of these states has their requiresments which essentially parallel ASHAs. In my letter to Dr. Merson, I indicated some of the luminaries in stuttering with whom I studied. In the early 1970s I was on the editorial staffs of both JSHD and JSHR.

You are misinformed regarding the nature of the responses. They are not boilerplate, but individual responses to specific exercise assignments. My response in a previous letter regarding the requirement of face to face initial treatment - followed up by electronic means seems in agreement with the guidelines. Also to be noted are face-to-face booster sessions, local support groups, day, night, weekend hotline numbers, and periodic banquets.

I believe the program I have developed far exceeds those currently offered by most programs.

If by education in stuttering, Dr. Starkweather means the conventional thinking on the subject, then I profess guilt. Not because I am unaware of this literature, but because, given my orientation, I perceive most of it to based on a set of premises which are incorrect.

Martin F. Schwartz


3/14/97

Mr. Troiano is incorrect. It is not in my nature to blame.

Success is defined in the NCS website and in my books. It is available for anyone to read.

Martin F. Schwartz


3/14/97
From: Larry Burd

Talking about code of ethics.

I remember this clear as day, just like yesterday. 20 years ago, I was not responding to Schwartz's group therapy. Schwartz said, "were going to send Larry into my office for the 20,000 volt shock treatment." I really thought he was serious. I was only 13 years old.

There was a girl in his office who tried to work with me privately, but needless to say, the therapy did not work for me.

Larry Burd


3/14/97

I am afraid that Mr. Burd's memory is at odds with mine. Such a phrase is not in my lexicon nor has it ever been.

MF Schwartz


3/14/97
From: Larry Burd

Schwartz, your an unforgettable guy. I remember the experience vividly. I remember people's names that were in the group. I remember it was a rainy day, everyone had there umbrellas. You went around the room, asking what kind a problem we each had. It was the first time I heard of a closet stutterer, I was totally amazed someone could hide there stutter. I could continue, but I see you built a reputation over the years; and it speaks for itself.

You should hear what my parents have to say about you. It's unprintable.

Larry Burd


3/20/97

Dear Mr. Burd:

I am truly sorry that you and your parents continue to harbor such intense feelings.

Dr. Martin F. Schwartz


3/15/97
From: Lee Caggiano

Cynthia,

I received the same invitation from Schwartz, immediately after posting a message about my son on Stutt-L. I WAS offended, and angered by his intrusion into my e-mail address.

After reading Larry Burd's post, and having heard many, many stories of disappointed folks who did not fit into Schwartz' 94% success rate, I wonder...are those people who aren't successful with Schwartz even included in his data? Or are they just dropped from the program?

Lee


3/20/97

Lee:

The answer to your question can be found on the NCS website. Under the research section.

Dr.. Martin F. Schwartz
Executive Director
The National Center For Stuttering
and, Research Associate Professor
New York University Medical School


3/15/97
From: Jean-Pierre Tibi

Cynthia,

I always read your posts with great interest, and apologize in advance for sounding suspicious in my questions about your last post.

Could you be more precise and tell us how Dr. Schwartz asked you to visit his Web site? Did you respond to him telling about your impression that it was solicitation? Did you tell other members on the list at that time?

I personally find your accusations weak and, consequently, not acceptable as they are.

A while ago, Dr. Schwartz suggested to me in a private e.mail to visit his Web site, as he was responding to one of my questions posted to the list. His Web site was presented as a continuation to his response, already long and detailed.

I must add that in general his private e.mails were rather short, pointing to a part of his Web site for an answer to one of my posts to the list. It's not more solicitation than when Judy Kuster tells the whole list about the new additions to the Stuttering Home Page.

Please give us a better description of the fisherman, if you wish your accusations to look 'ethical' to the list.

Jean-Pierre


3/16/97
From: Woody Starkweather

Regarding the statements of Martin Schwartz, I wondered if he had evidence for the statements he was making, and he replied that he was presenting a model. I must deduce from this that he believes that a model need not be related to documented data. That is not a use of the term model that I have heard in scientific circles. Usually, a model is a compendium of research results that are shown by the structure of the model to be in a certain relation to each other. It is very much like a theory, except that the theory can, and usually does, go slightly beyond the established research results to reach some explanatory statement about the phenomenon. What Dr. Schwartz seems to be presenting is a notion, unsubstantiated by any research. That is fine in a forum like this; we have seen many of them. Usually, however, they are introduced with terms that make it clear that they are simply ideas and opinions.

Woody


3/20/97
From: Cynthia Scace

Jean-Pierre,

I'm sorry if I was not clear. I try to keep my posts short, because I know for myself that when they are too long I don't read them.

When Schwartz asked me to visit his web site he was not responding to my post. He was not answering a question or furthering some point.

There are lots of SLPs on this list, many with their own treatment models and some with there own web pages. None have appoached me in this way before. When Judy K. points us to a new addition to the Home Page she provides us with general information and does not advertise any one point of view.

Cynthia


3/20/97

Cynthia:

If trying to make you aware of an alternative way of looking at stuttering is a solicitation, than I am guilty.

Dr. Martin F. Schwartz
Executive Director
The National Center For Stuttering
and, Research Associate Professor
New York University Medical School
http://www.stuttering.com


3/20/97

I am pleased that Dr. Starkweather has chosen to move from personalities to the arena of ideas. Now I invite him to choose some data or clinical observations and I shall then attempt to explain them within the context of the model I present in the NCS website.

Dr. Martin F. Schwartz
Executive Director
The National Center For Stuttering
and, Research Associate Professor
New York University Medical School
http://www.stuttering.com


3/20/97

I will repeat my former request to Dr. Schwartz for data in support of his model.

Woody


3/20/97

I guess I did not make myself clear. Take any data from any researcher that Dr. Starkweather respects and I will show how those findings are explained by and support my model. We are awash in a sea of data.

Dr. Martin F. Schwartz
Executive Director
The National Center For Stuttering
and, Research Associate Professor
New York University Medical School
http://www.stuttering.com


3/20/97
From: Martin Schwartz

My response to each of the individuals contacted by private email was to a comment made by them in a post. My mistake was in assuming that they would understand that.

It is quite clear to me that many of the the threads developed on the list may have light shed upon them by reference to some portion of the website I have been pleased to help develop. I tend not to do this and take the private route because it appears that certain individuals will tend to find fault with just about anything I say.

Dr. Martin F. Schwartz
Executive Director
The National Center For Stuttering
and, Research Associate Professor
New York University Medical School
http://www.stuttering.com


3/21/97
From: Louise Heite

[RE Dr. Schwartz comment:] "I guess I did not make myself clear. Take any data from any researcher that Dr. Starkweather respects and I will show how those findings are explained by and support my model. We are awash in a sea of data."

That's not the same thing. In all other scientifically structured endeavors I know of (including some pretty soft social sciences like cliometrics, semiotics, and anthropology) the person who formulates a model is expected to provide his/her own data structure. It can include data other people have collected, of course, if the researcher takes the trouble to refit the data, and check its validity. But the person promulgating a model had better be prepared to present a body of data to support it, and explain the reasoning processes that led to the conclusions represented by that model, or s/he gets dismissed right quickly as a daydreamer. The question here is the reasoning process, of which raw data is really only a part. For such a complex phenomenon as stuttering, that ought to be a pretty massive tome.

Regards,

L H


3/21/97

Dear L.H.

What you say is largely untrue. The history of science contravenes your statement. More important, it delays a consideration of substantive issues.

Dr. Martin F. Schwartz
Executive Director
The National Center For Stuttering
and, Research Associate Professor
New York University Medical School
http://www.stuttering.com


3/21/97
From: L.H.

The history of science is largely a catalog of errors, both substantive and procedural, from which we have, one hopes, learned. The history of science is also not the standard to which most scholars aspire. One hopes the golden age is in the future, not the past. Either substantiate your model or admit that it is merely a good idea, but nothing more.

Regards,

L H


3/21/97

Dear L. H.

The model of stuttering, developed on the NCS website, has the power to explain, in an efficient manner, both clinical observations and research findings. I shall, at the sufferance of the list manager, and at times appropriate, demonstrate this to those interested.

I shall not engage further in this discussion.

Dr. Martin F. Schwartz
Executive Director
The National Center For Stuttering
and, Research Associate Professor
New York University Medical School
http://www.stuttering.com


3/22/97
From: John Swaney

Lee Caggiano wrote:

"After reading Larry Burd's post, and having heard many, many stories of disappointed folks who did not fit into Schwartz' 94% success rate, I wonder...are those people who aren't successful with Schwartz even included in his data? Or are they just dropped from the program?"

Dr. Schwartz replied:

"The answer to your question can be found on the NCS website. Under the research section."

Well, not exactly. I took a look at the research section of the NCS web page. The text there is very similar to the text in the appendix of his 1991 book wherein Schwartz documents (if that's the correct word) his success rate. The only significant difference is the number of patients reported in the population size -- 625 in the book versus 221 on the web site.

What's interesting is that, in a discussion on this list a couple years back, Dr. Schwartz stated that the 625 patients were a sub-set of a larger population of 900 patients who enrolled in his program. I believe Dr. Schwartz stated that the other 275 people failed to follow through with the program. (If I mis-state what he said, I'm sure he'll correct me).

Some questions for Dr. Schwartz: How large is the actual population size from which the 221 patients are drawn? More importantly -- why aren't prospective patients told that a substantial percentage of patients drop out of the program within the first year? It is true that the book and the web site indicate that "religious adherence" to the program is required to attain permanent success. But no indication is given that a great many people opt not to religiously adhere to it -- this in spite of having paid a hefty sum up front to start the therapy. This IMHO is a very lamentable lack of full disclosure.

Of course there is a whole other issue involved -- the great many other people (in my observation) who *do* religiously adhere to the program, but who nevertheless fail to attain permanent success. But that's another post for another day.

John Swaney


3/22/97
From: Woody Starkweather

[RE Dr. Schwartz comment:] "I guess I did not make myself clear. Take any data from any researcher that Dr. Starkweather respects and I will show how those findings are explained by and support my model. We are awash in a sea of data."

I guess it is a case of "water, water everywhere nor any drop to drink"!

Your answer was very much as I expected. Please let us know when you actually are prepared to substantiate either your theoretical or your therapeutic claims with evidence. We all look forward to it.

Meanwhile, I will continue to be impressed with your marketing skills. Almost as much as I am unimpressed with your knowledge and understanding of stuttering and your lack of credentials as a self-proclaimed authority on the subject even though you lack the CCC and the formal training that would qualify you as a recognized specialist.

Woody


3/22/97
From: Martin Schwartz

Dear Dr. Starkweather:

Thank you for your reply. It does appear you have made these points before.

Allow me to introduce something different. In the NCS website I describe six conditions which affect the prespeech tensions on the vocal cords. These can be found in the section called The NCS Model Of Stuttering. I would welcome your reasoned consideration of these six conditions. I would also welcome comments from anyone else on the list. I continue to look for ways to improve my model.

Dr. Martin F. Schwartz
Executive Director
The National Center For Stuttering
and, Research Associate Professor
New York University Medical School
http://www.stuttering.com


3/25/97
[in response to a lengthy post from Alex Godden]

Dear Mr. Godden:

Dr. Starkweather serves a useful function in the area of stuttering: the articulate sceptic. He tends, I'll agree, to be sometimes over zealous; we must, however, be patient, and write it off to youthful exuberance.

Dr. Martin F. Schwartz
Executive Director
The National Center For Stuttering
and, Research Associate Professor
New York University Medical School
http://www.stuttering.com


3/25/97

Dr. Schwartz...

Your signature states "Research Associate Professor..."
What is your current research interests, and what do you teach at New
York University Medical School.

Kevin Eldridge


3/25/97
From: Martz Jezer

Martin Schwartz describes Woody as an "articulate sceptic." I obviously can't speak for Woody who, at any rate, is a speech pathologist and not, as I am, a PWS. But as a stutterer I would like to embrace Schwartz's term and state that from the point of view of a consumer of therapy, skepticism, articulate or not, is absolutely proper.

And the extended and often heated argument with Alex Godden exemplifies the reason why.

There are all kinds of people offering help to the PWS. "It's a jungle out there," as they saying goes, filled with experts, charlatans, people with good intentions and bad, people who know what they are talking about and some who don't. The stutterer looking for help has a difficult time deciding who to take seriously. What makes it most difficult is the lingering fear that the therapy we reject might be the one therapy that might work. But how are we to know?

Many therapists and therapy programs claim an impressive record of success. But there are no objective standards of success, no underwriters laboratory examining these claims with a single and objective standard. Those of us who have experience in the therapy scene and who, through self-help groups, know lots of stutterers and recovered stutterers as well, know first hand how phony these claims always are. This is too bad.

I know at least two well-known therapy programs that have helped a lot of people -- one of them is the therapy program run by Dr. Schwartz. (I've seen this with my own eyes and I've seen "success" last many years and in all kinds of speaking situations). However, these programs undermine themselves with claim rates of success that are meaningless by any objective standard and are obviously false given the number of people who have failed at them. Marketing strategy may dictate falsified claims, but the therapists who run these program would gain much more respect from consumers were they honest in their claims and say "my program works for a lot of people; I'll give you my best shot at it, if you give me yours." .....

Cheers,

Marty J.


3/25/97

Woody, you must be thrilled to be accused of being youthful...

John Swaney ;-|>


3/25/97
From: John Swaney

Hi Everybody,

I think I need to "close the loop" on something here. A few days back I posed some questions to Dr. Schwartz via the list regarding the population sizes reported in his 1991 book and on his web site. He did respond to me, but in a private message. I wrote back and encouraged him to post the message to the entire list, since I feel his comments might be of interest to many of the list members. Evidently he prefers not to, which is fine, I suppose. In the interests of netiquette, I won't forward his message to the list. I'm reluctant to even summarize his comments. It's a little awkward... But I will say this: he didn't give me any reason to think I unfairly characterized the manner in which he calculates and presents his success rates (and if he feels that way, he didn't say so directly). And he didn't dissuade me from feeling that he could be more forthcoming in providing information to potential patients. Based on what he wrote, I think most reasonable people would agree with me. And I would only point out that, if Dr. Schwartz truly believed otherwise, he would no doubt have sent his message to the entire list.

John Swaney


3/25/97

Am I included in those success rates? I followed through with 1 years worth of tapes. I never received a survey asking me if I "stutter no more".

Larry Burd


3/25/97
From: Tony Troiano

Dr. Schwartz,

How can Dr. Starkweather or any one else not reserve a fair amount of skepticism regarding your program? Why do you resist producing and relating to the list the information which justifies the basis of your program? It is unseemly to undertake the persona of one who is misunderstood when you do nothing to clear the supposed misunderstanding.

When directing questioners to visit your website or purchase your books for information you insulate yourself from follow-up questions. Why do you resist openly explaining and arguing your theories in this open forum in the same manner as other SLP's and interested parties? As a longtime subscriber to stutt-l you know discussions sometimes become heated. Why does the prospect of facing challenge on the list and justifying your professional ideas intimidate you to such a degree? I, as a lay person (and unsuccessful former NCS patient), have posed a number questions about your practice directly to you on this listserve only to have you accuse me of being on a "crusade" against you. Is this how you routinely deal with former patients who have the "audacity" to question your program?

I know I am wasting my time in this effort to draw substantive information from you. But know this -- you would do well to take a cue from Dr. Starkweather. He is a realist and upfront with people who suffer from a stuttering condition.

--Tony Troiano--


3/26/97

John:

You are free to post my response to you. The information for patients is all on the website and in my book Stutter No More. I define success precisely and specify the conditions that must be met to obtain the success rates I report.

Dr. Martin F. Schwartz
Executive Director
The National Center For Stuttering
and, Research Associate Professor
New York University Medical School
http://www.stuttering.com


3/26/97

Virtually everything Marty says is correct.

At our program for the past decade or so, all patients enter with the understanding that they may come for the first seven hours of therapy with the option of discontining after that at no charge. I would suggest that all therapists provide their patients with a similiar trial opportunity.

While not solving all of the issues, it would provide the consumer of therapies with some measure of protection.

Dr. Martin F. Schwartz
Executive Director
The National Center For Stuttering
and, Research Associate Professor
New York University Medical School
http://www.stuttering.com


3/26/97

Dear Mr. Troiano:

One of the reasons for creating the NCS website was precisely to answer the flood of questions posed earlier. If you will kindly restate your questions I would be delighted to point you to the section in the website where I have attempted an answer.

Dr. Martin F. Schwartz Executive
Director The National Center For Stuttering
and, Research Associate Professor
New York University Medical School
http://www.stuttering.com


3/26/97

Mr. Burd, Mr. Swaney, and Mr. Troiano were not successful in my program. For that I am sorry. I have refrained from asking the many people who have been successful from subscribing to this moderated list, because I feel that would not provide a useful function, but I am reconsidering that decision.

Dr. Martin F. Schwartz Executive Director
The National Center For Stuttering
and, Research Associate Professor
New York University Medical School
http://www.stuttering.com


3/26/97
From: Larry Burd

I asked Schwartz a question, "am I included in his success rates?." He did not answer directly, I guess it doesn't matter.

I will discuss his web site, and his web address. Schwartz does have a nice world wide web address. www.'anything'.com is a great address for any BUSINESS. These www addresses cost money to buy, and they cost money to keep the name. There is a monthly fee to keep a www address like that. And for any business, it is a worthwhile investment. I guess you see my point.

I also looked at his web site. It is an amazing piece of work. I would surely say it was done by a professional web site builder. The material within the web site is quite convicing too. It does seem to explain much about stuttering, and I couldn't argue with any of it.

But there is one problem.....the therapy does not work (at least not for me). Go figure?

Larry Burd


3/26/97
From: Woody Starkweather

Yes, John, I was reminded of when at the age of 35 I was carded in a bar. Schwartz' comment gave me the same feeling.

I have been musing over the exchanges with Schwartz and Godden and thinking that the real problem is that we don't have therapy for stuttering that is as good as it should be. I know we can help just about all stutterers somewhat and some stutterers a great deal, but that isn't the same as having a really clear technique that everyone knows does what it should. It is like a power vacuum in international politics. All kinds of evil and/or well-intentioned but misguided stuff falls into that vacuum. So, as far as I am concerned, the important thing is to keep trying to develop effective therapy techniques.

One of the big problems, as Marty Jezer mentioned, is for the PWS to know, given this inherent uncertainty, how to go about finding a clinician who can help. We have a little section on it in our book. I think one really has to spend some time to find someone who (a) knows what they are doing, and (b) feels right for you personally. The (b) part will always have to be done by shopping, but the (a) part can be helped by making sure the person has the appropriate credentials (a minimum), making sure they don't oversimplify the problem, and being skeptical of big claims of success. It also takes time to make progress in recovery from stuttering. Anyone who promises short-term therapy is to be suspected. There are potential exceptions to most of these ideas. It is conceivable that someone who lacks credentials could have wonderful insight and be very helpful, but I think it would almost always be another PWS who would be this exception. For a nonPWS to develop a useful understanding of the disorder takes a lot of reading first to get a general grip on the nature of the problem, and then it takes a lot of hands on experience with PWS -- experience in which the clinician does a lot of listening (just administering some canned program over and over wouldn't be very educational).

Someone said the other day that knowledge didn't have much to do with it, but I disagree with this. Knowledge of the fluency-enhancement literature is what makes me know not to suggest to stutterers that they should talk in a different voice. I know that it will make them fluent but only temporarily, not because I have tried it, but because the research has demonstrated it. One of the common mistakes of the neophyte clinician is to ask a stutterer to say a word they just stuttered on over again in order to "reinforce" the correct speech. But, if you know the literature you understand why this is not an effective technique and only increases frustration. I could give other examples. But that general knowledge is important, although perhaps not as important as the hands on experience.

This is why I object to Schwartz and Godden. Neither really knows that much about stuttering. Schwartz has an M.A. degree in Speech Pathology, which he received many years ago. In that course, I would guess he read Van Riper's general text on speech pathology. There wasn't much else around. A few year's ago, I saw an opinion that Schwartz wrote in a legal case (I was on the other side). His opinion showed woeful ignorance of the subject. He claimed that since all stutterers are fluent when they sing and talk under DAF that the man he examined (who was claiming psycho- genic stuttering) must have been malingering because he stuttered under these two conditions. In his opinion, he cited only works that were very general, and they were all over 15 years old. Anyone who knows the stut- tering area well, knows that psychogenic stutterers **typically** stutter under the conditions that make developmental stutterers fluent. I had no trouble winning the case for my client because of this error.

In a year or two, we will have an examination as part of the procedure byng which one becomes a recognized specialist in stuttering. I would like to ask Dr. Schwartz and Alex Godden to take that test. If they pass it, I will publically apologize. If they are really knowledgable about stuttering, they have nothing to fear. If they aren't, they should not act as if they were experts in this area.

Woody


3/26/97
From: John Swaney

Dr. Schwartz:

Thank you for allowing me to post your message sent to my private e-mail address a few days ago. I'll append it to the end of this post, and leave it to the list members to decide for themselves who's right and who's wrong about that specific issue.

Let me just interject here a comment regarding something you said in a separate message. I for one would welcome the participation of your successful patients on the list. I've known a few, and have talked with them about some of the issues that we've talked about here. Those conversations have almost always been amicable, undoubtedly because they've been face-to-face rather than via the Internet. I suppose that when those patients show up we'll have to work a little harder at being civil, lest the discussion turn into a slugfest, but one way or another I guess we'll manage...

John Swaney

P.S. As promised, here's the message I had previously received from Dr. Schwartz:

"The criteria for inclusion in the subset given in both examples is to be found in both citations. If the individuals do not meet those criteria, they are not included. If they do, the odds of success (and please see the definition for success - it's all there) are as given. At the present time, about 15% fail to make the cut.

"The success rates reported are not so remarkable, after all Azran and Nunn, using a similar method, in the 1970's, reported similar success rates."

Dr. Martin F. Schwartz


3/26/97
From: Marty Jezer

Marty Leisner wrote:
"It takes a lot of thought to just try breathing properly. It takes too much thought to concentrate on other things (IMHO)."

My fellow Marty makes a good point. One of the good parts of the Schwartz therapy is that there's only one "target" -- the airflow and the intent to use it before one speaks. I had trouble with Hollins because in addition to full breath, there was gentle onset, stretched syllables, and a couple of other targets that I now forget. I'd get one right and screw up on the others. Just thinking about all of those targets was mentally exhausting. And then you still have to think of something to say. (Yet, for the record, I know that many people have benefited greatly from the Hollins program).

Therapy ought to be simple (IMHO). One target or one technique at a time. That may be one of the positive aspects of the Muirden/Godden technique. That's not to say that stuttering is simple. Better motor control may work for some. But most of us (as John Harrison, Ed Feuer, Woody, and many, many others have said) need a multidisciplinary approach that addresses the problem from the psychological as well as the motor/coordination side.

Cheers,
Marty J.


3/27/97

Dear Mr. Burd:

Thank you for your kind words about the website. Again, I am sorry that the techniques did not work for you. So very much has changed since I worked with you that virtually nothing is the same.

Dr. Martin F. Schwartz
Executive Director
The National Center For Stuttering
and, Research Associate Professor
New York University Medical School
http://www.stuttering.com


3/27/97

Charles Starkweather, for some reason, engages is repetitive sophistry whenever my name appears.

Dr. Martin F. Schwartz
Executive Director
The National Center For Stuttering
and, Research Associate Professor
New York University Medical School
http://www.stuttering.com


3/27/97

Marty [Leisner]:

Unlike other airflow therapies, there is a very critical component involved. And that is, as the air is passively flowing out of your mouth, there must be no influence of the upcoming first sound on the flow. The articulators must be in a neutral position. If not, the articulators, as well as the vocal folds will start acquiring the tensions associated with that first sound. If I was speaking to a speech pathologist I would say there must be no coarticualtion between the air flow and the first sound.

Dr. Martin F. Schwartz
Executive Director The National Center For Stuttering
and, Research Associate Professor
New York University Medical School
http://www.stuttering.com


3/27/97
From: Silvano Colombano

Woody:

I mainly want to thank you for taking the time to address both Schwartz and Godden (and Muirden's book). Unfortunately you are right about the problem you stated. An additional problem is a lack of understanding of the scientific process. Skepticism is to KNOWLEDGE what fitness is to evolution.

Those who don't ackowledge, respect and accept the role of skepticism (even when - or especially when - directed at them!) in the advancement of knowledge, ipso facto lose my confidence.

Those who try to set up a "me" misunderstood genius vs a "them" establishment controversy immediately lose my confidence. This is usually a way (conscious or unconscious) to avoid debating substantive issues. To be sure there have been "misunderstood geniuses", but science HAS to be probability driven. Genius or not one must recognize this fact, accept it, and patiently try to get through to one's seemingly obtuse colleagues. In science we all play both roles at different times. Of course nobody can be compelled to play this "game", but those who don't, for whatever reason, ipso facto lose my confidence.

Science IS about earning the confidence of your colleagues. Just like you want to trust that your army buddy will cover your back, you want to trust that your science colleagues will not waste your time. This doesn't mean that you expect them to agree with you. It simply means that you expect what they tell you to be the the result of a lot of work and a lot of critical thinking, or, at least, of some very special vantage point they might have, which could add to your experience.

Every socio/human endevour sets up its own "confidence building rules". When you look for a car mechanic, you consult consumer guides, you ask friends, you look at how clean and well organized the shop is etc.. You do this because you don't want to risk your car and your money. Would you trust a mechanic who tells you he's the ONLY one who knows how to fix cars?

Sarcasm doesn't build confidence. A note starting with "Oh dear, oh dear.." catapults my finger to the delete button in a wink. As to the "see my web site for the answer", I'm sorry, but it doesn't cut it. You GIVE the answer and PROVIDE the data. You may also refer to the work of others and your previous work in support of your argument, but you do so after you have at least convinced the reader that there is enough "meat" in your argument to make it worth their time. I did have some useful and more substantive exchanges with Dr. Schwartz a couple of years ago (they have hopefully been archived) my conclusion was then and remains now that indeed he has been helpful to many stutterers (partly by adopting a more eclectic and open approach to therapy) but his etiology model showed a real lack of understanding of stuttering and his claims of success were not based on the same assumptions made by others SLPs, i.e., in the context of the profession they remain grossly misleading.

The irony of stuttering, of course, is that one can misunderstand the problem and STILL be helpful. This is particularly true short term. When Alex boasts of his "success" with people "declaiming", my reaction is "so? What else is new?". The fact that he would go on and build this into a "cure" idea simply shows a gross lack of understanding of the problem. Some time ago people undoubtedly showed "success" in cutting off the tip of a stutterer's tongue. Yes, stutterers CAN and DO speak fluently at least some of the time, and they can be induced to do so with a variety of situational devices. The problem, however, is NOT the fact that any such device (e.g. a "resonant" voice or what have you) is what was missing from the stutterer's repertoir, rather, the problem is PRECISELY the fact that a number of such devices will work - usually for a while - yet the stutterer will typically become tired and disenchanted with any particular device, or s/he will turn it into a deleterious mannerism.

In some cases, SOME devices are useful to have to get you out of a bind, so, therapy that can provide a stutterer with such "tools" is certainly useful and appreciated. A stutterer will be glad to know that a feared word can now be handled, but s/he won't feel or indeed BE "cured" by the adoption of (even) useful devices.

Anybody who provides the equation: STUTTERING + DEVICE = END OF STUTTERING simply does not understand stuttering. Unfortunately we PWS can, understandably, be so eager to hear a simple answer, that we will always (until we really figure it out) be vulnerable to the kind of well meaning but misguided individual who has stumbled onto yet one more such device.

Again, thank you, Woody, for patiently continuing to make this point. I thought it would be good if this came from a PWS as well.

- Silvano


3/28/97

Dr. Schwartz,

There seem to be a good many of us PWS on this list who went through your program and "failed". I did your workshop in NYC in the Fall of 1986 (I think). I was Cynthia Fiske at the time and lived in Brattleboro, VT. I don't know if any one else would want to go through your program again, but if so very much has changed would you be willing to let us do it again for free?

Cynthia Scace


4/2/97

From: J. Scott Yaruss

[RE This quote from Dr. Schwartz]: "Most of the sources of variability in frequency and severity of the disorder can be accounted for by sources III, IV, and V to be found in the NCS Model of Stuttering on the website given in the sig."

Dear Dr. Schwartz,

I fail to see how your response to my post does anything to advance our dialogue on this subject or to enhance our knowledge about this complex disorder. I know YOU think you understand this problem in its entirety, but the rest of us feel we have a lot to learn.

Thank you, however, for yet another (ANOTHER!) opportunity to read your blatant advertisements for your web page. Really, we all know it's there. Enough already!

Perhaps, in the future, I should simply preface my posts with the following statement: "To those of you who DON'T think you know everything about stuttering..."

Here we go again...
S

ps: WHERE ARE YOUR PEER-REVIEWED DATA ?!?


4/2/97

When you take the time to read what I have written and discuss it as it stands without reference to me you will have taken a significant step forward.

Dr. Martin F. Schwartz
Executive Director
The National Center For Stuttering
and, Research Associate Professor
New York University Medical School
http://www.stuttering.com


4/3/97
From: J. Scott Yaruss

I am quite happy to do this. Indeed, I have tried.

What I am not happy to do is discuss your "facts" in the absence of any objective data. Really, there's enough of that in the field and we don't need to make the situation worse, IMHO.

Show me the data, and I'll be happy to discuss the model.

Like I said, here we go again...

JSY


4/3/97

Make the same comment about the other models discussed on this list in the past 24 hours by others and I will say you are even handed; until then I am convinced otherwise.

Dr. Martin F. Schwartz
Executive Director
The National Center For Stuttering
and, Research Associate Professor
New York University Medical School
http://www.stuttering.com


4/3/97
From: Woody Starkweather

For Scott,

The issue with Schwartz is a little worse than the absence of peer-reviewed data. I personally don't believe he has any data at all. I don't think he has done any research on stuttering or on therapy for stuttering. If he had done any at all, surely he would be able to cite it, tell us where to look to find it. If he could in any way document his claims, surely he would want us to know how to find that documentation. He would want it to be public. He would put it on his web page!

Woody


4/3/97

Charles continues to obfiscate. He is determined to play the same note over and over. The model I propose in the website has the power to explain some of the data reported by others; it purports nothing else. When he takes the time to read it, we will rejoice in the reduction of his karmic debt.

Dr. Martin F. Schwartz
Executive Director
The National Center For Stuttering
and, Research Associate Professor
New York University Medical School
http://www.stuttering.com


4/3/97
From: Frances Freeman

Additional Information for those interested --

I was a little hesitant to add this information because it seems a little like "gossip." Perhaps those interested in Dr. Schwartz should simply ask Martin to provide the information of interest. However, given the mixture of information and misinformation offered thus far, I thought the following might clear up some issues:

Dr. Martin Schwartz was previously a certified member of the American Speech Language and Hearing Association. He is therefore fully trained as a SLP. In the late 1970's, he was asked to answer charges before the Ethical Practices Committee of that Association, and declined to do so. He was formerly a member of the faculty of Temple University, where he taught courses in communication sciences. His association with that institution ended shortly after he developed his approach to the treatment of stuttering.

Dr. Schwartz's work and publications in the area of speech science are highly respected. To my knowledge, no one questions his knowledge and competence as a scientist. It is my understanding that at NYUMC, Dr. Schwartz uses his expertise in the diagnosis and planning of remedial strategies and surgerical procedures for patients with cranial-facial anomolies, including velopharyngeal incompetence. This last information is second hand, and somewhat dated, so it may be inaccurate.

Liscensure in most states requires that professionals meet "Standards" set by the ASHA for a CCC. Most do not require that professionals hold the CCC in order to be liscensed. However, holding the ASHA CCC is the easiest way to prove that you meet their standards. I do not know in how many states Dr. Schwartz is liscensed to practice. However, this information can be obtained by anyone who wishes to contact the liscensure board in their state of residence. Some states have a "visiting" clause which allows a professional liscensed in another state to practice a given number of days in their state without having to obtain an in-state liscense.

F. J. Freeman


4/4/97
From: Bob Quesal
[Subject: "How to patronize"]

This may be one of those IAIA [I apologize in advance] posts, but I think I have this figured out:

1. Include lengthy quote of previous post(s) (must exceed one screen in length, and the more screens the better). Quote should include multiple questions, at least one cogent argument, and at least one reasonable request.

2. Respond with answer that all the information requested can be found on a certain web page, if one would simply take the time to read it. Be sure this is stated in a condescending, patronizing way that suggests that the person asking the questions is of substandard intelligence, at best (i.e., even if the person read the web page, they couldn't figure it out). Referring to one by a non-preferred name (e.g., "Charles" instead of "Woody") works pretty well to keep others in their place. Make tone of answer such that it is clear that even responding to such persons is a waste of your valuable time.

3. Make sure that your answer is significantly shorter than the post you are quoting.

4. Put in an occasional "big word" to send the fuzzy thinkers scrambling for their thesaurus.

5. Probably most important: Make sure the post is shorter than your .sig file.

6. Include web page address in all correspondence.

Have I left anything out?

;-)>>

BQ


4/4/97
From: Martz Jezer

As for the main point: As a PWS who has been publicly critical about aspects of Schwartz's program, I'm getting a little tired of the vendetta against him. There's a long history of enmity between Schwartz and other speech professionals, but as a PWS it doesn't help me when that enmity prevents helpful discussions.

Others on this list have suggested that people look at their websites; others have suggested reading books or articles; others have cited articles in professional journals. I know there is a difference: professional journals are peer reviewed (which doesn't necessarily make them credible -- but that's another thread), websites aren't. But a website is public, anyone on this list can access it, read it, and take issue with Schwartz about what's on it.

Though I wish that Schwartz would make his arguments on-line, he has at least stated his case in books and on his website. It's public, read it, and then argue with him.

The interesting thing is that Schwartz's theories are similar in many ways to other mainstream theories. (For example, at the Denver NSP Peter Ramig and others presented a video tape of the vocal cords that substantiated one of the key tenets of Schwartz's position). I have arguments with his salesmanship and his efficacy data. I think the titles of his books are terribly misleading and underline a not very constructive arrogance. Some might say this is sufficient to dismiss him. But life isn't that neat. Help comes in many disguises. General Patton was not a nice guy. But were I an American GI in World War II, I'd have liked to have served in his army.

As a PWS I'm gonna look for help wherever I can find it (and hope I can learn to distinguish between the real thing and charlatans). I took Schwartz's program. It didn't help me become more fluent (though it did teach me a lot about my speech), but I witnessed how it helped others. On issues of cause and "cure", what he has to say is, I believe, of interest to everyone who stutters.

Cheers,
Marty J.


4/4/97
From: J. Scott Yaruss

"Make the same comment about the other models discussed on this list in the past 24 hours by others and I will say you are even handed; until then I am convinced otherwise."

In fact, the reason I crawled out of my lurking hole is to do just that. I saw some comments being made in the absense of objective data (they weren't made by you, but by others on the list), and felt compelled to talk about it. Hell, I can criticize anybody :-)

I didn't focus on your comments at all until you decided that it was appropriate to interject your web address into what I thought was a fruitful exchange between WOODY and me. (Sure wish I knew YOUR middle name...). Anyway, I reacted specifically to your suggestion that you already understood all there was to understand about variability with another advertisement for your model and web page (and again, in the absense of any objective data). I found that annoying, since it didn't add to our discussion, and I responded as I felt appropriate.

I believe that I am trying to suggest that we ALL need data -- not just you. However, let you think I am not being even-handed, let me say at the outset that there are simply some posts to this list that I don't feel it is even worthwhile to try to respond to. I tend to read many of your posts as condescending and patronizing (and apparently I am not alone in this), but I'm afraid that you don't win the prize for that on this list. So, there are some threads I don't see any point in entering. It's not that I want to single anybody out for special attention. It's just that I find that there are certain posts that are best sent to the trash without response. It's a judgment call -- we each do it in our own way.

So, to clear up any miscommunication. I firmly believe that ANY proposed model or claim of treatment success should be backed up by data. I don't think I've been selective here. I think we all need to do that. I'm trying to do it with my treatment program here at Northwestern University; I've encouraged Woody and others to do it with theirs, and I encourage you to do it with yours. Perhaps my "encouragements" to you come out a little stronger because your claims of success are more vociferous than most.

In truth, I'm less likely to be offended by claims of success by somebody who says "I believe that my approach works and I've collected this set of data to demonstrate this and here's how I collected them and HERE ARE THE DATA and here are some concerns I see with the data and I'd welcome any input about how to better demonstrate the efficacy of my program--let's have a dialogue" than somebody who says "Of course my approach works...read my web page." (Indeed, I am having some wonderful off-list communications with people who have taken the former approach -- there is a lot we can learn from one another if we are willing to accept that we don't already know everything.)

Hope this clears anything up. I truly believe that people will be more willing to consider what you say if you consider packaging it in a more palatable way. Really, you shouldn't be surprised that people have difficulty separating the message from the messenger -- you, too, bear responsibility for how a message is received.

S

BTW, even though I've taken the time to respond to your post, it really DOESN'T work to deflect valid criticisms by saying that others are bad, too. Each of us is responsible for our own data. I am STILL waiting for empirical demonstration that your approach is effective and that your model is viable -- this little interlude hasn't deflected my interest.


(entry removed at request of author)


4/6/97

There is an assumption underlying the request for peer reviewed data: that I am interested in persuading others of the value of my approach through scientific means. Let me state categorically: I am not.

I am only interested in explaining clearly what I do so that others, if interested, may see for themselves. It is through practical experiences that the clinician and/or patient become persuaded. Data do nothing in that regard and never will.

Dr. Martin F. Schwartz
Executive Director
The National Center For Stuttering
and, Research Associate Professor
New York University Medical School
http://www.stuttering.com


4/7/97

What can be learned about long term effectivity of your treatment by attending a two day workshop of yours? Maybe it's the kind of stutterers I meet through NSP but I keep on meeting failures of your program.

Ira Zimmerman


(entry removed at request of author)


4/6/97
From: Tony Troiano

Marty Jezer wrote:

"As for the main point: As a PWS who has been publicly critical about aspects of Schwartz's program, I'm getting a little tired of the vendetta against him. There's a long history of enmity between Schwartz and other speech professionals, but as a PWS it doesn't help me when that enmity prevents helpful discussions."

Hi Marty,

I respect your opinion on this subject but cannot understand it.

First off, I do not agree there exists a vendetta against Martin Schwartz. The posts regarding Schwartz focus on his program and practices and are appropriate topics for this list. I do not see anyone attacking him personally. Threads tend to run in circles when his name is in the subject line because of the condescending, evasive, stonewalling replies given by Schwartz himself. In reality, the majority of SLP's who subscribe to this list rarely ever inject their two cents worth concerning Martin Schwartz's program, data, practices and success claims. The few who have, most recently and notably Woody Starkweather, have posed valid, appropriate questions to Schwartz. Mr. Schwartz's reaction to Woody's queries is to refer to him, twice, as a 1950's serial killer. Who shall we say is taking the low road?

"Others on this list have suggested that people look at their websites; others have suggested reading books or articles; others have cited articles in professional journals. I know there is a difference: professional journals are peer reviewed (which doesn't necessarily make them credible -- but that's another thread), websites aren't. But a website is public, anyone on this list can access it, read it, and take issue with Schwartz about what's on it. Though I wish that Schwartz would make his arguments on-line, he has at least stated his case in books and on his website. It's public, read it, and then argue with him."

Others have discussed their theories, debated others, and generally made their case on this list initially and may have directed readers to visit a website for further information. I cannot remember a single instance when Martin Schwartz divulged information about his NCS program openly on this list. His replies consist of 95% quotes and 5% split equally toward a reply which does little to answer the original post and advertisement for his website and books. Speaking of the NCS website, when Dr. Starkweather asked Schwartz to submit data to support his (Schwartz's) theories, Martin Schwartz replied (quote): "I invite him [Starkweather] to choose some data or clinical observations and I shall then attempt to explain them within the context of the model I present in the NCS website". Are we to conclude from this statement that Dr. Schwartz's program is based on data collected by others and can be explained by anyones data? Are his theories based on the works of others, and if so, who? Has he formulated data of his own? What is one to conclude from Martin Schwartz's non-commital, one sentence replies? Semantics and fifty dollar words will take one only so far.

"The interesting thing is that Schwartz's theories are similar in many ways to other mainstream theories."

At one time, yes. During the 1970's many aspects of Schwartz's therapy program was considered mainstream and appropriate to what was known about stuttering at the time. His setting up post-therapy support groups to reinforce usage of the programs techniques was and probably still is considered good practice. His follow-up maintenance program of weekly reviewed tape recordings of patients by staff clinicians may have been considered good practice at the time although these days most SLP's agree that therapy via correspondence is not a reliably effective method in the treatment of stuttering. I suppose at one time or another every treatment put forth to "cure" stuttering had its day in the mainstream sun. In the mid 1800's J.F. Dieffenbach was part of the mainstream belief that stuttering could be effectively treated by surgically cutting out a portion of the patients tongue. This practice was embraced by other surgeons of the day and the procedure became widespread. Benson Bobrick states in his book Knotted Tongues, "There had been little peer review, and almost no attempt to verify the surgeons claims". Subsequently, many needless mutilations were performed and several lives were claimed as a result of this radical surgery. Thereafter Dieffenbach's name was irreverently lent to that of the common houseplant dieffenbachia, colloquially known as dumbcane.

"As a PWS I'm gonna look for help wherever I can find it (and hope I can learn to distinguish between the real thing and charlatans). I took Schwartz's program. It didn't help me become more fluent (though it did teach me a lot about my speech), but I witnessed how it helped others. On issues of cause and "cure", what he has to say is, I believe, of interest to everyone who stutters."

Marty, I would like to share with you, and the list, my experience and perception of Dr. Schwartz's program. Although both of us received no benefit from the program whatsoever in the fluency department obviously our perceptions about the program differ substantially.

When I entered Martin Schwartz's NCS program I believed the message put forth by Dr. Schwartz that if his learned airflow technique was practiced religiously in combination with relaxation excercises and prescribed vitamins eventually fluency would become second nature and the stuttering would become a thing of the past. To those who are unfamiliar with the program, when the patient attempts to employ "technique" it involves intense concentration by the speaker to breathe in the manner Schwartz prescribes and to begin speaking at the "appropriate" time. This concentration requires a great deal of effort and in the process the speaker articulates in a robotic cadence or may even forget the content of what he/she was trying to express. Schwartz again explained that with conscientious practice these undesirable patterns would eventually disappear.

My desire to succeed in this program was such that I attended two different support groups regularly for approximately fourteen to eighteen months. I moderated many of the sessions and found ways to create situations in that clinical setting in which all who attended would all have opportunity to put the learned "technique" to use. I should add that the premise of NCS support groups is that all participants may only speak when employing "technique" properly. During my involvement with these sessions I witnessed many PWS experiencing difficulty maintaining consistent "proper technique". When a participant strayed (even fluently) from the prescribed method of speaking it became the duty of the group to stop the speaker and instruct him/her to start again using "proper technique". To those who were unable to attain this standard the interruptions were so frequent that sometimes hardly any dialog were permitted to pass their lips. The recited mantra was practice, practice, practice. A fair number of "NCS Alumni" gradually stopped attending the support group never to return. I reckon many of these individuals, frustrated by failure during the controlled setting of a support group, were not able to maintain fluent speech in their everyday lives. The few whom I developed a friendship with continue to stutter to this day.

One day, when I was still actively involved with the program, I phoned the NCS hotline number. This toll free number is set up by the clinic to supposedly deal with patients experiencing a fluency crisis. We had been told we could reach a therapist at the clinic through this number who would guide us through rough patches during our efforts in maintaining "proper technique". My attempts at achieving and maintaining a real and lasting fluency had been crumbling terribly. I called the clinic in a demoralized state, reached Dr. Schwartz's secretary Lorraine Schneider, and asked to speak with a therapist. She informed me no therapist was available and then proceeded to tell me "what I was doing wrong when applying technique". I've often wondered how often Schwartz's secretary doubles as a therapist and what type of degree she holds in the speech/language pathology field. I never received a callback from Schwartz or any therapist from his office.

Getting back to the issue of support groups, the word *support* (as does the word *success*) takes on an unclear meaning in the NCS glossary. Some individuals assume a leadership role within the group and take a hard line with those who do not adhere to Schwartz's prescribed "technique" totally and consistently. The overt message is: practice and use technique while you are here, or we would rather you not attend at all. Any dialog that contradicts the NCS way of thinking or questions the program in any manner is quickly condemned. The support groups exist solely to promote Schwartz's therapy program and does not offer support to PWS as the label suggests. I have noted and find it interesting that some PWS who adopt this total commital to the program and display little patience for others who do not achieve the expected level of success with the program, in fact continue to stutter themselves. I have seen it. Although Schwartz has recently stated that it is not in his nature to blame PWS who fail in achieving fluency through his program the implication surely exists in the NCS support network.

These are some experiences which shaped the way I view this brand of therapy. Perhaps others can share their own. I welcome those who have experienced a positive reaction resulting from Schwartz's program. Hopefully, such posts will be heavy on informational content, light on preachiness, and contain no websites, phone numbers and other forms of advertisement.

In closing, Marty, you recounted a story recently about a form of therapy you received as a child from a Dr. Kerr (sp) from Britain. You explained that your father was so moved when he thought the therapy was successful he excused himself, went into another room, and cried. I imagine your dad may now view Dr. Kerr's practices in much the same way Larry Burds parents view the methods practiced by Dr. Schwartz. The issue runs that deep for me.

I my opinion, there exists no vendetta against Martin Schwartz. The word maligned does not come to mind when I think of him. In fact, if he were more forthright to the list this discussion might have already ended.

Be seeing you,

Tony Troiano


4/7/97

From: Marty Jezer

Thanks, Tony, for challenging my remarks about the Martin Schwartz controversy. I appreciate the spirit of your criticisms, especially since you think my opinion on this issue is off the wall.

Right off, I'm going to violate one of your strictures, as you want follow-up posts "to be free of websites...and other forms of advertisements."

My book "Stuttering: A Life Bound Up in Words," to be published by Basic Books on June 4th, has an extended discussion on Hollins, Schwartz, and other therapies that include my critique of their use of data. Much of what I wrote for the book I posted as early drafts on this listserv. I think what I say in the book is fair, but I expect I'm gonna catch hell.

I don't have the desire to defend Schwartz, who is pretty good at defending himself. My experience with him in some ways is not unlike yours. Schwartz told me at the start that in 6 months to a year I'd be speaking fluently. I put in two plus years with a similar intensity attending all the self-help groups, doing the phone calls, reciting the mantra in the hot bath, sending cassettes to tape pals, and practicing constantly, but in the end I couldn't transfer any of it to the real world.

But what if at our initial interview he told me that he couldn't help me at all. How would he know at the start? And wouldn't I hsve gone away feeling worse? I probably fit within Gene Cooper's Chronic Preseveritive (spelling?) Syndrome (chronic adult stutterers who probably will never be fluent). Look at the criticism Dr. Cooper got for saying some PWS can't be cured. There is a mushy middle ground in there between certaintude and surrender, but where it is, I don't know

I too spoke with Lorraine on the hot line number. I felt she knew what she was talking about and was satisfied. Often when you call into a doctor's office, the secretary -- if she's experienced -- gives you advice. I remember when my child was sick I used to call the pediatrician (which was not something I did easily). The secretary gave me advice and knew what she was talking about. This happens all the time.

I think in monetary terms I got my money's worth. Schwartz never asked me for an additional fee after the first year passed. In terms of the time my therapist in his office spent with me it was a good deal. I think therapy by tape is problematic. But I was living in Vermont and couldn't see a therapist weekly. (Barry Guitar at U. of Vermont is 150 miles away -- I attended a few of his self-help sessions, but that's a five drive for each one).

You and I, Tony, are on the severe side of the stuttering curb. I'm critical of Schwartz for making a promise but I don't blame him or myself for my "failure" in the program.

I continue to think his therapy program "in the ballpark." He introduced me to the idea of self-help, for which I'm grateful. To be sure, his self-help is really a maintenance program, and, as you say, strictly tied to his program. Still it's valuable. My group in Boston was much more supportive than yours seemed to be. Like you, I had a hard time with the airflow. But I got support and help from everyone, not grief. As we've seen on this list, even NSP chapters have leaders who are not fit to lead.

The comparison with Dr. Dieffenback who cut stutterers' tongues with a knife is a bit absurd. But I will take it with the same sense of humor by which I take Schwartz's calling Woody "Charles," a cheap shot maybe, but a far cry from implying that Woody is the mass murderer, Charlie Starkweather. Come on, Tony, do lighten up.

There are two real issues here: One, does the program work. Not as well as Schwartz asserts. Like you, I witnessed the fact that most people drop out because it's not helping them. They are not part of the data base. On the other hand, some people are helped. In writing my book I phoned I guy I knew from the group who I hadn't seen in fifteen years. He was very good in the group and I wondered (resentfully) if he was one of the people who hardly stuttered and so are relatively easy to "cure." Then one day I ran into him in a restaurant just prior to the group meeting. He wasn't prepared for me, didn't use his technique, and really stuttered bad. Fifteen years later, he works on the phone, is very fluent, but says he still has to practice, and that every day he gets out of bed and makes a decision: Am I going to use the technique or not. And if he does, he's fluent. My friend has the same criticisms of Schwartz about his data and his personality that you and I and many make. But he also credit's him with giving him the technique that turned his life around. He also reported that others who were in the program when I was in it have held their progress. The program works for a some adult stutterers, and, IMHO, it's not just luck that it works for some.

I wish, as I've said, Schwartz would make his case on the list. For what it's worth I find Schwartz irascible and abrasive, at least in his professional dealings. With a more cooperative attitude towards the profession he could get their respect. But maybe I'm naive. The profession seems to be as hostile to him as he is to it, and in this case it's not important who cast the first stone.

I don't like his salesmanship, but what he promises is no worse than what a lot therapy programs promise; and as Jim McClure points out, he is a good salesman. Many people who are good at what they do are not nice people (at least in the pursuit of their profession). As a New Yorker, you remember Leo Duroucher's "nice guys finish last." I don't believe that, but sometimes not nice guys finish first.

The second issue is that of qualifications. There is no simple answer. I understand why a therapist ought be certified and have to undergo specific training and follow certain rules. Schwartz is not certified and this, to my mind, is a big strike against him. On the other hand there have always been iconoclasts who refuse to work inside the system, catch hell from the establishment, and are sometimes right. I talked about Paul Goodman, in this regard, in an earlier post. Goodman wrote the book on gestalt therapy but was not a trained psychologist so was barred from doing therapy. Citizens are always told by experts to shut up and listen to expert advice when often, it turns out, the citizens are right and the experts wrong (Vietnam, e.g.). I do not know where to place Schwartz in the spectrum outsider/insider and recognize that there is a legitimacy in professionals asking everyone to play by the rules. But the fact that someone doesn't play by the rules, to my mind, doesn't automatically condemn them. It just makes like messy. 99.9% of the outsiders may be quacks. From my experience with him, I don't think Schwartz fits into that category.

Certainly, I'm as wary as you are of his claims. And he does bring a certain amount of disorder to the speech profession, but I view the world as full of mayhem anyway and my experience is that troublemakers sometimes have something of value to say.

Cheers,
Marty J.


4/7/97
From: Steve Morse

I HAVE A GOOD IDEA WHY DON'T WE CHANGE THE NAME OF THIS LIST TO WITCHHUNT-L? I FOR ONE AM SIGNING OFF. HAPPY HUNTING FOLKS.


4/7/97

Stutt-lers

I wish to clarify what may be some misperceptions regardings my (and Dr. Marshall Smith) research videos on the vocal cords and stuttering. Specifically, this relates to the NSP presentation in Denver delivered by Dr. Trish Zebrowski and me............

The videos clearly show vocal cord struggle during stuttering; however, I did not and have not ever stated that our videos support Martin Schwartz's contentions. As stated on this network previously, I do not accept the notion of "airway dilation relfex" that has been coined by Dr. Schwartz relative to stuttering since it is not data based.

Peter Ramig

4/8/97
From: Tony Troiano

"The comparison with Dr. Dieffenback who cut stutterers' tongues with a knife is a bit absurd. But I will take it with the same sense of humor by which I take Schwartz's calling Woody "Charles," a cheap shot maybe, but a far cry from implying that Woody is the mass murderer, Charlie Starkweather. Come on, Tony, do lighten up."

Marty, perhaps you are being too literal here or maybe I was not very clear. I was not comparing Schwartz's practice directly with Dieffenbach's but merely drawing the parallel that exists between the two situations regarding peer reviewed data and mainsteam therapeutical practices of any given time period. After all, it was you who stated that "Schwartz's theories are similar in many ways to other mainstream theories". To a limited extent I agreed with you on some points. I think we can both agree that Schwartz does not perform or advocate this type of surgery on the tongue.

Likewise, I realize Schwartz did not call Woody a mass murderer in the literal sense. Obviously you missed the point of my comment. By making this unprofessional reference to Woody, Schwartz succeeded in deflecting the heart of the matter to such an extent that, here we are, still giving the comment undeserved bandwidth. Perhaps if someone exhumes Charles Starkweather's body there may be some supportive data buried along with it. Please note happy face>> 8-)

Have to leave for work...hope to see you in Buffalo.

All the best,

Tony T.


4/8/97
From: Woody Starkweather

There is SOME peer reviewed data with regard to treatment but not much. The issue is not really that. The issue with Schwartz is that he makes claims that most of us suspect are false. So we ask him to prove that they are not false, and he doesn't. The issue is the claims he makes.

I have no data in support of the approach I am using now. Someday, I might have that, but at the moment I am still developing the method. But, being in that state of development, I make no claims about its successfulness.

An accurate statement about stuttering therapy's successfulness would have to be qualified. This would be true of any therapy. The various techniques that are in use today by well trained specialists can be very helpful to people who stutter. Most people who stutter can learn how to reduce both the behavioral and the emotional aspects of stuttering to the point where it is no big deal. That's not a cure, but it sure is a great help. In ad- dition, there are some clients who seem not to respond well to almost any treatment. Maybe they aren't "ready," or maybe it is some other factor. We don't know.

The trouble with Schwartz' claims are that we all know they are grossly exaggerated. So why would he do that? What is his motive in overstating his success. And why does he avoid so carefully any real discussion on the issues? Why won't he actually discuss what he thinks stuttering is? I don't know the answer to these questions, but they make me very suspicious of everything he says.

The credentialing issue is also serious, in my view, for what it tells us about his character and about his knowledge. He has a masters degree in speech pathology, taken many years ago. I don't see any evidence that he has read anything or done any research or published anything since that time to make him current. And a great deal has happened in the field. I don't even know whether he had a clinical training as part of his masters degree. He may never have been trained in clinical work, for all I know. We WOULD know the answers to these questions if he were certified by ASHA. It is worth noting that virtually 100 per cent of all legitimate speech pathologists are certified. He is the only practicing clinician I have ever heard of who is not certified. I know he resigned his membership in ASHA just at the time when he decided to begin clinical work, but that is quite backwards. That is the time when he should have gotten certified. So, it is confusing at the least.

Woody


4/8/97
From: Adam Charney

It seems to me that buried in the recent discussions of Dr. Schwartz, Muirden and other miscellany are two distinct threads, representing the different needs and interests of list subscribers. I think that some of the ire that has surfaced here is a result of confusion of these needs and perspectives.

First, from the standpoint of a PWS - I am less concerned with scientific bases for cures or relief from symptoms if there is in fact, from a certain control technique, a reduction in symptom. Analogously, my wife is not terribly interested in the data relating certain calcium supplements to relief of PMS symptoms, so long as there is a discernable reduction in those symptoms. Possibly the reduction in symptoms is a result of a suggestive effect, however, such a psychosomatic effect in reducing symptoms even in the absence of a chemical alteration of physical reality is equally desirable from the patient's standpoint. Therefore, a non-clinician's assessment of a program needn't be based on a review of techincal articles and reviewed data.

From the clinician's standpoint, and in light of Woody's remarks about the availability of data, it seems to me that the primary problem is that SLP's have not (a) defined a set of objective goals and (b) attempted to establish guidelines for testing achievement of those goals. Although one might take issue with whatever sets of standards are established for measuring success rates, nontheless, the complete absence of those tools means that there are simply no standards, established by anyone, to determine what is an acceptable method of determining efficacy rates and what is not. Whether Dr. Schwartz is successful or not is entirely a matter of definitions of subject populations. Until the SLP community establishes reasonable standards for measuring success, it is entirely inappropriate to lambast someone for not adhering to them (tough to do, since they don't exist). Anticipating an objection to this, I contend that given the subjective nature of any evaluation of rates of improvement of speech, I suggest that the normal scientific measures of cure normally used in medical studies are inapplicable here.

To conclude, it is meaningless in any context for a patient to demand peer reviwed blah blah, the mesure for the patient is subjective. It is further inappropriate for the clinical community to take issue with someone's measures of success when they have not defined the ground rules for doing so. Woody and other clinicians here need to define goals and objectives and bases for measuring acheivement of those goals and objectives. When they do, they will in a position to make reasoned arguments about cure efficacy.

Regards.

Adam M. Charney


4/8/97
From: J. Scott Yaruss

Hi Adam

Thanks for your input. I think I understand your argument, but I have to say that I don't really agree with what you've written. I think there's some miscommunication going on in terms of important and quite fundamental issues associated with these threads. I'll try to clarify my position since I've been writing some of this stuff. Of course, I won't try to talk for others, so I hope they'll clarify any miscommunications they see.

You wrote...

"First, from the standpoint of a PWS - I am less concerned with scientific bases for cures or relief from symptoms if there is in fact, from a certain control technique, a reduction in symptom."

I agree -- I don't think I've been asking for the "scientific basis for the relief from symptoms," but rather a simple demonstration that there is a "reduction in symptom." To discuss the etiology of stuttering to too great an extent will simply be conjecture and hypothesis (and really, there's enough of that already).

All I'm saying is that when we're talking about treatment, and making what appear to be extravagant claims about the success of treatment, we need to see some proof that those claims can be substantiated. That's it.

"Therefore, a non-clinician's assessment of a program needn't be based on a review of techincal articles and reviewed data."

Technical articles? NO. (I think I said in a previous post, efficacy studies may be difficult to do, but they should not be difficult to interpret.)

Reviewed? most definitely YES. There's just too much opportunity for bias when a person who has something to prove tries to prove it. I think we've all seen on this list how basic facts (e.g., laryngeal involvement) can be interpreted in several different ways by various proponents of different hypotheses (valsalva, larygospasm, whatever...). So, objective, independent review is a crucial aspect of demonstrating that an approach works.

For the next part of your post, I don't want to excerpt too huge a section (I'm already pushing the bounds of netiquette, here), so I'll try to do this within reason.

"From the clinician's standpoint, and in light of Woody's remarks about the availability of data, it seems to me that the primary problem is that SLP's have not (a) defined a set of objective goals and (b) attempted to establish guidelines for testing achievement of those goals."

True, but many are working on it. The nature of outcome measures is the topic of the ASHA SID Leadership conference in Tucson at the beginning of next month. Also, I just returned a couple of weeks ago from a conference on treatment efficacy at the University of Georgia. Plus, there are published proceedings from two previous efficacy conferences in stuttering (one published by ASHA, 1990 and the other in JFD, 1993). I may be missing others...but this makes the point. The field is working on this, but of course, there are differences of opinion.

"Although one might take issue with whatever sets of standards are established for measuring success rates, nontheless, the complete absence of those tools means that there are simply no standards, established by anyone, to determine what is an acceptable method of determining efficacy rates and what is not. Whether Dr. Schwartz is successful or not is entirely a matter of definitions of subject populations. Until the SLP community establishes reasonable standards for measuring success, it is entirely inappropriate to lambast someone for not adhering to them (tough to do, since they don't exist)."

Here's where I disagree fundamentally. As I have tried to say in previous posts, it is up to the individual clinician to thoroughly state what their goals are for treatment, in terms of behavioral, cognitive, affective, whatever, types of changes they expect to see as a result of treatment. Then, it is their responsibility to demonstrate that their treatment actually achieves those goals.

Will they achieve them for everybody? NO WAY. In stuttering, as in any human condition, no treatment will be 100% effective -- or even close to it. There's too much individual variation between people who stutter, and indeed, within people who stutter over time and situation, to say that any type of treatment can work all the time. That's why the documentation of the efficacy that actually IS achieved (and ideally the client population with whom the treatment was most effective) is so crucial.

And no, I do not expect that our field will ever have ONE set of defined criteria for success in stuttering treatment. In fact, I'm not certain that there should be. There are simply too many opinions about the nature of the problem and the responsibility of the clinician in treating the problem.

Also, each person who stutters is an individual -- I truly believe that there is no single treatment program that will work for all people who stutter, so we NEED different options. They should just be options that have been shown to work, at least with some people.

So, whether Schwartz (or anybody) is successful or not is not a matter of subject population, but a matter of clearly stating the treatment goals and demonstrating that those goals are met. This is what he is being lambasted for (although I don't see as much lambastation, if that's word, as I see frustration that he is able to get away with making such extravagant claims without being willing to back them up. As clinicians, we've all seen the clients who feel like failures because they were one of the "5%" or whatever for whom the approach didn't work -- or weren't included in the success calculation at all.)

Again, what I am criticizing Schwartz for is specifically his unwillingness to simply provide documentation that his program works.

"To conclude, it is meaningless in any context for a patient to demand peer reviwed blah blah, the mesure for the patient is subjective."

I just don't get it. I had a bad case of shingles a couple of weeks ago, so I went to the doctor. I think it is entirely appropriate for me to expect and indeed demand that the treatment he prescribed for me has been shown to be effective. Yes, the extent to which I received relief is subjective (they still hurt like hell), but I know that there is data that the particular medication I'm taking reduces the effects of the zoster virus. To seek out treatment without some knowledge that it achieves the goals that are set for it is in my mind ludicrous.

"It is further inappropriate for the clinical community to take issue with someone's measures of success when they have not defined the ground rules for doing so."

In my opinion, it is not the clinical community's job to define somebody else's success. It is each clinician's job to define the success they are looking for and demonstrate that it works. Then, the client can be informed about the nature of the treatments they wish to seek (everybody will have their own goals) to find a match between the client's needs and the treatment approach that an individual clinician provides.

"Woody and other clinicians here need to define goals and objectives and bases for measuring acheivement of those goals and objectives. When they do, they will in a position to make reasoned arguments about cure efficacy."

Yes, but again, it is not MY job to say what Schwartz's (or anybody else's) program should do -- it is THEIR job. I do believe that there should be certain commonalities in the goals that many people strive for.

And, really, do you think Schwartz (or anybody) would be willing to accept my (or anybody's) proclamation of what successful treatment SHOULD be? No, of course not. I cannot dictate what somebody else should do in a therapy session.

I believe that many in the field WILL arrive at some consensus about what components of a treatment program are important, but there will always be different approaches. Again, this is good -- different approaches work with different people. The problem is, when we don't have any data to say that a given approach actually does work (however "work" may be defined for a given approach), then we need to really question that program and demand that documentation.

That's all I'm trying to say...

S


4/9/97
From: Adam Charney

I am pleased to learn from Woody and from Scott that the issue of standards is being addressed. I suspect that the codification and publication of those standards will assist both the clinician and patient communities in assessing treatment efficacy.

Ira's continuing haranguing is troublesome from several perspectives - first, it would appear to me that in this group, with respect to Dr. Schwartz, Ira is preaching to the converted. Confrontation of Dr. Schwartz in this group does nothing to educate the consuming public about his therapy, his claims and the options available. Second, the general tenor of Ira's posts is one of hostility towards treatments plans that claim success and towards individuals who assert they have had symptoms relieved. I suggest, then, that Ira's hostility towards these individuals is a result of the failure of a number of control methods for his specific condition. Now that in and of itself is not a value judgement - certain patients respond to certain treatments and certain don't. What is objectionable, though, is the implicit denial of the possibility that someone else might have relief from symptoms. Therefore, I suggest that Mr. Zimmerman is far from being an objective arbiter on behalf of the consumer.

Third, implicit in the assertion that therapies are fundamentally ineffective is a rejection of SLP's in toto. I would suggest, then, that participation in a list entitled "Research and Clinical Practice" is inappropriate unless one wishes to function as a spoiler.

Consumers are less stupid than most consumer activists would have us believe. Scott's analogy of speech therapy to shingles is, I think, inapt - more appropriate is an analogy to taking vitamin C as a rhinovirus preventive or as a natural antihistimine. Does it work? Not according to many clinical studies. Do people believe it works? You betcha - and that means that it works.

Adam M. Charney


4/9/97
From: J. Scott Yaruss

Hi again Adam... A quick response...

"Confrontation of Dr. Schwartz in this group does nothing to educate the consuming public about his therapy, his claims and the options available."

Well, actually, it WOULD if he were willing to participate in the discussion with something other than patronizing condescension and skillful redirection. For my part, I am hoping to LEARN about the approach, and about stuttering in general through the list. But, it takes two to have a meaningful exchange of ideas and information...

"Third, implicit in the assertion that therapies are fundamentally ineffective is a rejection of SLP's in toto. I would suggest, then, that participation in a list entitled "Research and CLinical Practice" is inappropriate unless one wishes to function as a spoiler."

I guess I haven't seen any assertion that "therapies are fundamentally ineffective." I believe that MANY (but not all) are, but that we need to see some verification of this.

"Scott's analogy of speech therapy to shingles is, I think, inapt - ...."

Actually, I think the analogy is EXACTLY what we're talking about (at least, what I'VE been talking about...). All I've been pushing for in my too-numerous posts to the list is that we need to have documentation and demonstration that treatment approaches can be successful, and that it's appropriate for consumers to demand this information.

I have not been talking about whether or not a consumer "believes" an approach to be effective. It's a worthwhile thing to consider, but it was not the topic of the previous threads...Since you brought it up, though...

"....more appropriate is an analogy to taking vitamin C as a rhinovirus preventive or as a natural antihistimine. Does it work? Not according to many clinical studies. Do people believe it works? You betcha - and that means that it works."

If only it were that simple in speech therapy. But really, it's not. If it were, then hypnotism would have shown greater promise. Are you suggesting that if we can only convince the client that what we're doing is effective to the point where the person really believes that they're better, then the treatment is effective? That may work in the psychosomatic response to unproven homeopathics, but I would submit that it is NOT enough when treating stuttering. If so, then we've moved out of the realm of speech therapy and into the realm of evangelism.

If I am going to claim that my clients "get better" in speech therapy, then (a) I'd better have a good definition of what "better" means in terms of my treatment program, and (b) "better" had better mean some type of tangible change in speech output, willingness or ability to enter speaking situations, feelings and attitudes about spech, cognitive reactions to speech disfluencies, or whatever it is that my treatment program is all about (ideally, in my mind, a combination of these and other goals). I really think we'd be pushing the ethical bounds if I were just to say, "the person is going to feel better about their speech" without there being any actual change in the speech or the client's reactions to it (and this second part is really important).

As I see it, another major problem with the "believe it" approach is the issue of RELAPSE. This has come up from time to time on the list, and it's one of the most important topics in the field, IMHO. If we convince a client that he's doing better, so he really believes he's better, then it's likely (at least possible) that at some point this belief will waver. The result of this wavering belief is likely to be an increase in the occurrence of speech disfluencies, and a return to the previous complex of feelings, emotions, and behaviors that accompanied the person's stuttering disorder before the "conversion" to believing that he was better. This in itself would not be so bad if it weren't for the inevitable guilt that accompanies this fall from grace..."What did I do wrong? How did I fail? The SLP told me that if I only did this, then I'd be better! I used to be better, what's wrong with me? 95% of the SLP's clients do it, why can't I? I felt better when I was with the speech therapist...maybe I'd better re-enroll -- I can't do it without him/her!" The cycle is vicious and difficult to interrupt.

Now, this is not to say that this doesn't ALSO happen with traditional speech therapy. Certainly, it does. First, though, if all there really was was a change in belief, without a change in behavior, then I believe this type of relapse would be more likely. After all, the stuttering behaviors would still be there. Second, and more importantly, I believe that the type of treatment that Woody and others have described on this list -- the type that addresses the whole disorder, not the just the observable characteristics of stuttering -- can help with this and give the client the tools and attitudes he needs to be able to redirect this type of guilt-producing thought.

So, in sum, I really don't think the field should base its recommendations for treatment on "if the client thinks it works, then it does." This is pretty much akin to Ed F's complaints (no adjective this time, Ed :-) about SLPs who get people fluent in the treatment room then send them out into the real world. The change is hollow, incomplete, and less likely to be lasting. IMHO. Finally, I don't think we could consider ourselves a field based on science if the notions underlying our practice were based only on the client's beliefs that he got better, rather than some type of documentation that he actually did get better.

We do need to allow scientific practice and methodology to inform our clinical practice. Without it, then we'll have earned the dubious reputation that goes along with taking vitamin C to ward off a cold (no, I don't really want to start a thread on this...just trying to make a point).

Just my thoughts...said it would be brief. Guess I was wrong. Thanks again for the dialogue.

Scott


5/26/97
From: Robin Changarathil

I'm very familiar with Dr. Martin Schwartz's therapy as I took this therapy myself. Unfortunately, I can't say many positive things about how well the therapy was for me.

Before I write anything else, I want to make it clear that it is not my intention to hurt the reputation or feelings of any well meaning speech therapist. I believe Dr. Schwartz is a hard working therapist who truly wants to help stutterers. When I was at his 2 day workshop, he worked very hard at helping all of us.

Also please note that since this was a few years ago, everything I say about my therapy may not be 100% accurate.

I must point out that I'm an internalized stutterer in that I hide my feared words. My avoidance behaviors are extreme. Almost everyone thinks I'm a normal speaker.

I tried his therapy about 4 years ago. His program is a two day workshop (conducted by Dr. Schwartz himself) where you learn his techniques. The rest of his therapy you do on your own at home. There are lessons you have to complete. You record some of your home practice and mail it to his center. One of his speech therapists evaluates and gives you feedback. You continue mailing these lessons throughout the course. This is a very basic description of his course. I should say that since this was a few years ago, his program may have changed a lot since then.

I worked extremely hard at his course for about 1 and a half years. Although he recommended about 45 minutes of practice per day, I often practiced over 5 hours per day. I tried very hard to do whatever his therapists advised me to do on the tapes.

His program is largely based on his 'airflow' technique. The details of his technique are on the WEB, and many speech pathologists can give you a better description of it than me. I'll just say that the hardest part of his technique (for me) was trying not to think of the word that you were about to say (and focus on resting). In his book, he says that you must try to fool your brain into thinking that you are not going to say anything, or you are just going to take another breath. If you do this, your vocal folds will not lock because your brain does not think you wlll speak.

Everything I practiced at home did not work in the outside world. I even tried the gradual systematic desensitizaton, and all his other extra techniques.

At the workshop, people were basically speaking fluently. I should say that this was in a controlled setting. I did try one of my greatest feared words with his technique. It took about three tries until it worked. That was in the clinic. It never worked again after that.

You mentioned the person on television who was 'cured'. I also have a tape with all the newsbroadcasts of his patients speaking fluently.

You said that you were amazed that his client spoke fluently. I sincerely hope that Schwartz's therapy works for that client, but I should emphasize that it was in a controlled setting. Perhaps some speech pathologists can confirm this, but I think that most certified speech therapists can make any stutterer fluent in a controlled setting.

I have to mention that I totally disagree with the title of the book he wrote about 5 years ago which was called 'STUTTER NO MORE' (if I recall correctly, I don't think this book had any references either). He also wrote an earlier book called 'STUTTERING SOLVED'. I think Dr. Schwartz made these titles to give stutterers a positive attitude. I think he meant well. Perhaps he was trying to promote the attitude, 'Expect the best and get it'.

However, these are completely false statements. Many stutterers who dream of speaking fluently may be overjoyed when they see these titles. It is very dangerous to raise the hopes of people in this way.

In his books, there are people who describe how they have used his techniques to help them. It's great that he has helped some people. My problem is that he makes it sound like he has cured stuttering. I hope he does. Again, perhaps he is trying to give the stutterer a positive attitude (i.e. that stuttering can be eliminated with the right attitude.)

You said that in the newscast you saw, he said that stuttering is easy to cure. Are you sure he made that exact statement? Unless he is using a totally different therapy than what I took 4 years ago, I can't imagine that he would say that.

As for myself, I was fortunate enough to find another speech therapy program. This was at the late Dr. Einer Boberg's Institute for Stuttering Treatment and Research (ISTAR) in Edmonton, Canada. Since it's not the purpose of this message I won't say much about it. I'll just say that it is an outstanding program that has done wonders for me (it hasn't cured my stuttering, but I'm getting there).

There is a lot of information you can find about stuttering on the WEB. I like to use the Stuttering Homepage which lists many speech therapy programs, including Dr. Schwartz's. Please note that Dr. Schwartz's program is listed only at the end of the therapy programs section where it lists speech therapy programs which are not currently certified by the American Speech-Language-Hearing Association for 'various reasons'.

All I can honestly tell you Steve is that his program did not work for ME. I did my very best to follow through with his program. If he has helped other stutterers though, I can not discourage you from his program. I would advise you to keep reading this newsgroup for others who have tried his therapy. Perhaps some of his successful clients will recommend it. I would also advise you to privately contact other Speech Pathologists for an opinion.

I think Dr. Schwartz has a lo