Before Christmas I attended a talk by Professor Scott Yaruss at London’s City Lit, titled ‘How speech therapy can change your life for the better’. Having heard good things about Scott, I was looking forward to it. Here’s a summary of what he said.
Firstly, a little background: Professor J. Scott Yaruss is an internationally renowned speech and language therapist and researcher based at Michigan State University. Having had a grandfather who stammered, Scott has a special interest in stammering and its impact on quality of life and has published around 85 peer-reviewed papers and over 100 other articles on the subject.
In a nutshell, Scott said, in his highly entertaining two-hour talk (which flew by), that to date many therapists have unsuccessfully focused on the mechanical aspects of stammering, but are starting to rediscover the need to look at the entire person. Read on for more.
He began by saying that stammering therapy once focused on a person's experience of living with a stammer; on the importance of being able to communicate what you want to say even if you stammered. Then, in the 1960s and 70s, it kind of lost its way when there was a greatly increased focus specifically on fluency. Of course, increased fluency has always been one goal of therapy, but it became the most important goal for some therapists.
One consequence of this is that therapists tended to overlook the consequences of trying too hard to be fluent, which can result in teaching 'tricks' to achieve it, Scott said. He gave the amusing example of a teenage boy wanting help to ask out a girl he liked. The boy’s therapist told him to try tapping out a rhythm with his fingers on his leg whilst speaking to the girl. This seemed to work in the therapy room but when the boy complained that it would look very odd, the therapist said, ‘why don’t you try putting your hand in your pocket whilst tapping?’. Now, just imagine how that might have looked...
Scott labelled this an example of ‘bad’ therapy and listed others, such as being told to sing what you want to say or speaking along to music. Okay, they kind of work, but the trouble is they aren’t practical in every situation and when you don’t use them, you're likely to go back to your old stammering ways.
People who stammer aren't to blame for their stammer coming back.
He said that therapists back then thought that stammering could be treated with classical conditioning - i.e., that it’s possible to condition stammering out of someone in the same way you might stop a dog barking by punishing it when it does bark.
Inevitably, stammering always seemed to come back. People relapsed because, hey, it can be hard to keep so much focus on something when we lead busy lives. No-one knew why stammering returned, so the blame was put on the patient: ‘If only you’d tried hard enough with the technique it would still work’, was a common response.
Differences in brain activity
In the 1990s however, therapists started to learn more about neurology, Scott said. They discovered differences in the brains of people who stammer.
A study of cerebral blood flows showed that people who stammer have different blood activation in the brain. The left hemisphere of the brain controls the planning of our speech. But with MRI scans, they could see more activation in the right-hand side than would normally be expected.
The point of all this, Scott argued, is that when techniques fail, it’s not because the person has failed, it’s because their brains act differently.
He went on to say that the biggest mystery facing researchers is variability – why speech can be more fluent one day but less fluent the next. Stammering is one of only a few conditions that has such a big degree of variability, he commented.
A new focus
Recently, different goals, other than fluency, have resurfaced, goals that deal more with the emotional side of stammering.
Scott argued that when a difference is stigmatised and is visible, as stammering is, it’s harder to deal with; harder to face and accept. It’s therefore not a lack of fluency that’s holding people who stammer back, it’s the feelings that hold us back.
He said that’s where speech and language therapy can make a difference: therapists need to help people come to realise that they're okay, and that it’s okay to stammer.
In a mercifully non-pressured bit of audience participation (I hate audience participation), Scott asked us what one single thing helped us the most on our stammering journeys. The most popular answer was meeting others who stammer and realising that we’re not alone. He asserted that it’s about breaking that isolation caused by the stigma. Self-help groups can also help do that, being places where you can talk and learn more about stammering with others.
Voluntary stammering helps people learn along the way that it's okay to stammer.
Desensitisation can play a very important part too, he said. Voluntary stammering, for example, and working on a speech hierarchy (starting with someone you feel most comfortable with, then working your way up to the least comfortable) to see that reactions aren’t as bad as we think and to help us reduce our own negative reactions. Yes, there’s always going to be a jerk who says something negative, but the vast majority of people will be fine and reassuring about your stammer. He said voluntary stammering helps people learn along the way that it's okay to stammer.
In conclusion, Scott said that the new therapy goal shouldn’t be just fluency; it should be getting to the stage where a person says, ‘I don’t mind that I stammer and I can say anything I want to say’. That greater sense of acceptance and comfort is the pinnacle - when you achieve that, what people think doesn’t matter to you; the negative impact of stammering will be reduced and you can start saying what you want to say without being held back.
If you'd like to read more from Professor Scott Yaruss, take a look at this article we published in 2006 featuring a debate between him and Professor Mark Onslow about how stammering can be treated effectively in children if the causes are not yet known: https://stammering.org/speaking-out/articles/theory-treatment-early-stut...