STUTTER TREATMENT

Del7

In Sweden, it is mainly speech therapists at the phonological departments who are engaged in stutter treatment. Usually it is the most significant hospitals in the region we talk about as the Karolinska Hospital, The Hospital of Sabbatsberg and the Hospital of Sahlgrenska. Here we find the speech therapists and psychologists who are specially trained in stutter. In Gothenburg they are responsible for the national Intensive Stutter Therapy, which is taken place in boarding schools.                     
Privatized speech therapists are also available. Some speech therapists specializing in stutter show up at regular intervals. In addition to this there exist therapy and training courses which can be useful for stuttering people to participate in. Sometimes a stutterer returns from the U.S and brings with him a certain type of therapy.         

In the 80s when I was chairman of the Stockholm stutter club we had at most three events each week. The fact that we had much activity made it possible for us to practice the therapy we found useful as e.g. systematic non-sensitivity, Stromsta therapy (2 years) and Creating Drama. There are other clubs which practice stutter self-therapy. A successful club is the Linköping Club, Academy of Speech under the leadership of Åke Byström.                  
Stutter Treatment is difficult for those who perform it. The patient often speaks about finding the "last straw.”                   

Early treatment   
Lidcombe for stemming preschool           
Stammering children are treated early today. The Lidcombe program is a relatively new method which is tested increasingly in Sweden.        

The origin is from Australia. The method is aimed at allowing children to achieve fluent speech. The program is based on a behavioural approach where the child's natural fluent speech is encouraged and the stuttering is corrected.         
 
It is the parents who carry out the treatment and   parents in the supervision of speech in how to treat the children. The treatment is done daily and parents can also estimate their children's production rate on a scale of 1-10 every day. The program is divided into two stages. In step 1, the goal is to achieve fluent speech. In step 2, the goal is to keep your fluent speech. Contact with the speech therapist occurs once a week in step 1 and more sparsely in step 2.

Evaluations in Australia and England have shown very good results. An evaluation of the Lidcombe program in Sweden have been started by the speech therapists Lovisa Femrell, Danderyd Hospital, and Marita Åvall, Alingås  Hospital. The Lidcombe program is available at most Speech-receptions in the country.                      

Criteria for searching speech therapist    
"1.If the child is embarrassed. 2. If your child shows signs of avoiding words or is struggling with the speech. 3. If the parents are worried.” Only one of these criteria is enough to seek help, says Lovisa Femrell. (DN Lofors.)                     

Criteria to search for another treatment  
If the child has one parent who shouts at it. That is to say that the child is used by the parents for outbursts of aggressions. Everything comes from   insider source.                      

Children or parents?          
P Strang: "From a psychoanalytic point of view it is important to begin as early as possible with treatment. The question is whether you should treat the child or the parents. In the case of adult populations, treatment must be tailored to the patient's grade of motivation, an understanding of the possible causes of the stuttering and the degree of open and hidden stuttering.”  

Sheehan´s vision of the stuttering of children

 First, he prefers to work with parents, and secondly, directly with the child. Parents must first of all  fill in an observation schedule for the child. If this proves to have large demands on the child attempts are made to reduce these.               

Target therapy and development    
The traditional therapy has the objective to talk more with less stutter. How much and for how long you train to get away the stuttering there is always a risk that it shows up again. If you have pretended to be a normal speaking person, it can create anxiety and fear at the thought of that you, at any time can be unmasked as a stutterer. The biggest obstacle is to get the speech to work in real life.

                     
The problem with therapy is that what we learned in the treatment room and what we were so good at does not work outside treatment room.                    

The Accept ideas were implanted in Sweden by Viktor Bloch. The Clinic Chief Ernest Douglas operating in Canada was the one that inspired him. They realized that an important part of the stuttering was the fear and anxiety to reveal your stutter. Instead of that at all costs try to get rid of our stutter, we would accept it. The idea was that the stutterers would repeat stutter voluntarily resolved easily. In fact, the technology was an integral core production-moment which was to dare to show that you are a stuttering person.        

Saying that the treatment would be "far more than the cause of the disease.” In Europe you meant that the stuttering was a symptom of a neurotic condition that was necessary to treat "far more than the symptom.” Viktor Block believes that whether it is a symptom or not the stuttering itself keeps itself alive by the well-known circulate cycle "stutter - anxiety - more stutter - more anxiety, and so on.” Although the underlying causes would be cured the stuttering can continue.                     

My experience is that stutter can vanish if the underlying causes are minimized. It takes at least six months, a minimum of time in the most favourable of circumstances.                    

The attitude of the stutter club was that information would be disseminated to selected groups in support of the stutterer. As the information emanated from the stutter clubs was one of the target group speech therapists, but also the school teachers. Through newspaper articles and other media, we wanted to teach people to take account of our disability. They would be aligned as far as possible to us.

Stig in speech practice in the Academy Bookshop in Stockholm.

I myself have been a great supporter of the Accept ideology and tried and received both positive and negative experiences of the technology. The positive considered. When I was in a Nordic seminar for stutterers the primary impact showed up. It  showed that there were 50 % of the participants who had embraced the technology. The question was whether it led to improved speech?       

What scared me were all those persons who misunderstood or abused the technology - all those who continued to stutter on with their old habitual stutter.

Intensive Stutter Therapy  
In Intensive Stutter Therapy some participants are assigned a "toolbox" to assist them in the event speech. When the stuttering occurred the first step was to stop, copy the stuttering speech precisely and thereafter was the next step to say it correctly. The copying of the stuttering speech I understood as a form of voluntary stutter. When maturity was reached you were allowed to remove the copying phase. It appeared that as soon as I worked with the speech in this manner I was rewarded in form of fluent speech because it was a slowed down  normal speech. This therapy is a holistic therapy which means that it is based on the individual. Is it the case that individuals do not want, or for any other reason, can not work with the technology, it is OK.           

Depending on what kind of person you are and what kind of problem you have, you need a therapy that suits you. If you have a hidden stutter, you may need to work to become more open, daring to stammer and daring to talk about stuttering management. It   may be a way to play down your stutter. Do you have a severe stutter, but with dimensions of psychological problems, you may instead need to do the opposite.  

A developed Accept technology like this, and conducted in the manner it does, I regard as a sterling stutter therapy.

Stutter Free Speech            
A technique like Stutter Free Speech has managed to unite the opposites that exist between classical therapy and accepted therapy. The reason may be that it is not prohibited to stammer, which diminishes the drama of it all. Moreover, they have succeeded to develop the classical technique to work outside the treatment room. The ground stones to develop fluency in speech are tempo control, co articulation and tempo shift. Åke Byström believes that the better you talk the less you stutter. Moreover, you must control the tempo to get floating in the speech.       

Once the speech has improved the stutterer discovers sometimes that there are other problems that stand in the foreground and call for a solution.       

Fluency with fluency technology              
Stutter Free Speech has taken on the recommendations of coordination by Cortney Stromstad which is certainly to their advantage. The McGuire method is about to make contact with a large number of people on the street. This is reportedly both an active and fluency building therapy with fluency speech as their ultimate goal.                     

NLP – Neuro linguistique pro-programming                     
Therapist Lars Gimstedt from Psychosynthesis Forum in Linköping has worked with panic disorder, phobias, jealousy and since four years back trained in short-term therapy in stutter. He argues that a speech blocking is a disturbance of the speech which can be removed. The approach is that whatever we do, it is automated behaviour. He calls it a "trigger" that is an inevitable reflex. Even   behaviours that are not good are unfortunately also automated.               

NLP may be many things and for Lars Gimstedt the meaning in the stutter context is as follows:          
Visualization in deep relaxation – the subconscious mind is reprogrammed. The patient population has typically been stuttering consistently for maximum 5-6 years. Lars Gimstedt means that older stutterers have improved by working with self-images. He argues that what we are fighting against grows, the best is to let go. Go on stuttering, after that step into another state. Examine what happens when you speak fluently. It is much about the internal state - that is not enough to work with only the behaviour. A multiple diagnosis complicates everything. If I am depressed by the fact that I stutter, the depression must be dealt with first.                                   
The treatment includes:     
Basic elocution and breathing technique. Analysis of internal states for floating speech. Analysis of triggers and avoidance behaviour. Stress management, control of less resistance. Perception positions. Work with self-image - self-confidence versus self-esteem. Work with internalized trauma. Visualization exercises. Develop and produce new permanent reaction patterns. Everything is according to Lars Gimstedt.                    

He carries out visualization of deep relaxation for subconscious reprogramming. The goal is "Position 1" in which you are present, can act directly  be authentically visible with both the environment   and yourself in your feelings.           

Therapy ten times. Check-up after six months.                                                             
You can read my assessment on page 220.

Unfortunately, no representative response exists from this therapy. The time of treatment is remarkably short.                    

This therapy is new. New therapy that may give new possibilities. A new therapist also means another chance. The question is if you become permanently stutter free.                     

Classical therapy versus acceptance to float technology         

The stutterers´ manifesto in China          
"For too long we have tried to hide our stuttering, while we participated in the usual mis-conception that stutter is a defect, a disability, a disease. Too long have we lived in sorrow and fear, and we did not want others to know that we could not speak fluently. Our attempts to improve have sometimes meant that we have lost our supply opportunities and our jobs when we have submitted to the idea that "stutter can be cured and must be cured!" But despite of all the world's therapeutic professionals, trainers and researchers, serious and honest attempts no completely successful "remedy" has not yet been found. On the contrary it is the stutterer´s self-esteem which has prevented his course of treatment, his aversion to his own speech, his non-acceptance of his own ego. And too often it has happened to ordinary stutterers that they have moved away and fled from an active and responsibly filled life, and put all their hopes on the date of the magic remedy will, but not all! Many ordinary stutterers live active, positive, successful and happy lives regardless of their stuttering. For ten years, the Stutterers´ Association for mutual help and friendship (the Stutterers' Mutual Aid and Friendship Society) have devoted themselves to encourage stutterers to live joyful and positive lives. We invite all our fellow stutterers across the country to: Stop looking down on yourself because of your non-fluent speech! Devote your energy to live constructively in society rather than to daydream about a life without stuttering! Break yourself out of the mind that is bordering your inherent ability! The first step is to meet and openly admit our situation as stutterers and when we have done it to continue to establish a way of life that accepts this situation. Who knows better than us how bitter it is to be put aside by others because of a minor or less perceived inability! By taking advantage of our own experiences we will strive towards a society where people are equally worthy and allowed to fully exploit their personalities and opportunities. We must do this manifesto as stutterers and when we have done it, we will put it aside so that we can live vigorously, creatively and constructively with all other members of society. This is our manifesto, we who are stutterers.” Zenkoku Gen'yukai Ren-rakukyogikai (Confirmed at the ten-year-jubilee meeting in our association, the l May 1976).”             

When I read this in the Plus Magazine, I was greatly astonished. For sure it has affected me too. What I did not understand then was that it was about ordinary classical therapy. Now when the American therapies are established in China, the results will also improve. This shows how it is in China, and also how important it is for them to have stutter organisations.   

Stammer voluntarily          
With the American therapies the view came that it is better to anticipate no stuttering by stuttering voluntarily, an approach which I very successfully used when I stuttered the worst. The effects of this are many. What I know of is that no one has mentioned them. It can even happen that just the idea of stutter voluntarily make the stuttering disappear. The weakness of this is that when you are not able to prepare yourself then you speak normally. It also appears that the technology is "abused.” It is not only to release the stuttering uncontrolled and claiming to work with your stutter. In all situations they shall be resolved easily. The advantages are especially good for the stutterers that have total ban. The goal is to achieve stuttering with fluency, a fluency that actually everyone can accept. Moreover there are no based adverse reactions.                  

Advanced voluntary stutter
Body of the stutter is voluntary Slowed down Normal Speech. Those who can do this properly and who have acquired a new pattern of speech are likely to have a good speech.

Can we as stutterers move forward?       
The chastened stutterers who have been members of stuttering associations or participating in different therapies may have had a desire "to move forward." The question arises: "where to?" Stutter Free Speech could be the answer. Some stutterers begin with the therapy directly. The advantages of Normally Slowed down Speech and Stutter Free Speech is that in the end it is not perceived as stutter. This makes it easier to absorb. The latter I consider the most user-friendly.                      

The Super technology - can it be created? Read more on page 205.     

Will it work outside the treatment room?
One of the main criteria for a good treatment is that it will operate outside the treatment room.