In the Winter 2004 edition of Speaking Out, Jan Logan described the introduction of a new intensive course which combines a 'speak more fluently' approach with a 'stammer more fluently' approach. Below, clients and London's City Lit team talk about the results so far.

Fluency plus

For the first time in the UK, City Lit is offering a 3-week intensive course which combines several approaches. The block modification and desensitisation work (where the focus is on becoming more open about stammering and better able to manage moments of stammering) is taught alongside an effective fluency shaping technique - vocal fold management. In addition, cognitive therapy helps people to challenge some of the unhelpful thoughts they may have about their communication skills. This integrated approach gives adults who stammer a range of tools from which to choose, depending on the situation.

What is vocal fold management?

Many people who stammer report that they experience most tension around their voice box. This is not surprising when you consider how many muscles in that area are involved in producing speech. Moreover, the voice box seems to be involved in most moments of stammering even if there is also tension in the mouth. Vocal fold management (vfm) helps to reduce that tension by first of all focusing on smooth, deep breathing, followed by combining relaxed breathing with gentle voicing of single vowel sounds. Once the person who stammers is confident at this stage, they move on to co-ordinating breathing with voicing and articulation by saying single words on one breath, gradually building up to 3 syllables per breath, then 5 to 6 syllables per breath before moving to sounding normal. By co-ordinating breathing, voicing and articulation smoothly in this way, the person who stammers achieves greater fluency.

Success so far

We have run five courses so far and we and our clients have been very encouraged with the results. We analysed the results of one group in detail by asking them to complete assessments before the course, directly after the course and six months later. We also asked them to complete a questionnaire six months after the course. Many of them talked about feeling more confident and being more open about stammering. 60 percent said the fluency technique was one of the key aspects of the course for them, in addition to other elements such as desensitisation, cognitive therapy and modification techniques.

How to get the best out of the course

The course covers many different areas and requires you to work hard and consistently, both during the three weeks and afterwards. As with learning any new skill, you need time, commitment, patience and perseverance to learn the fluency technique. You'll also need the support of those around you.

To find out more
Please contact us at City Lit:
www.citylit.ac.uk/stammeringtherapy
tel: 020 7492 2578
email: speechtherapy@citylit.ac.uk
Before you join one of our courses, we like to meet you for an advisory session. If you decide to go ahead we can give you advice on how to find somewhere to stay during the course.

Case study 1: Stephen

I felt I needed the course at this moment in my life for my career and with my children starting school. I expected it to help me identify why I stammer and to be more relaxed in hard situations such as presentations or talking in groups. I hoped that I would learn different techniques to give me a more controlled and fluent speech.

Of the techniques, the breathing, slowing down and relaxing has almost made my blocking non-existent. The course spent quite a while on vocal fold management and it was useful to find out how my vocal folds 'freeze' when blocking. I grasped the technique, but it takes a lot of practice after the course and I still find it very hard to use at a normal rate of speaking.

I never talked about my stammer outside of my family, so desensitisation was challenging and very useful, especially using voluntary stammering and telling people that I stammer.

The course is quite heavy in that you learn a lot of different techniques so you can find the ones that work for you. As well as the work during the day I had to practice in the evenings. After the course I still have to practice and revise the techniques, which can be demanding on my time, but if I want fluent speech then I have to put the time in - hopefully this will reduce as I mature in my new speech.

Case study 2: Steve

I attended the City Lit integrated course in May 2005. I was a very severe stammerer; avoidance was really my only coping strategy. For example, two years ago if I got to my local train station and the ticket machine was out-of-order and I didn't have a pen and paper to write down what I wanted, I would walk two miles to the next station; all to avoid one moment of stammering. By way of contrast, this year I presented an hour-long workshop at the BSA conference.

The two main things that stand out for me about this course are, firstly the integrated approach, and secondly, doing stammering therapy as an 'active student', with motivation, determination, and an open, enquiring mind.

The integrated approach is working for me because speaking more fluently (and stammering more fluently) have become part of my life story now - part of who I am and how I communicate. This is very different from concentrating on all the problems and avoidance of stammering. The fluency technique of vocal fold management has been very useful in replacing stammered speech with fluent speech, although it does require a commitment to do the twenty minutes daily practice. However, the fluency technique alone is not enough: I need the desensitisation to stammering, the avoidance reduction, and the block modification.

I realise it is up to me to put in the hard work, but I'm also learning that working on your speech can be fun!

From the Winter 2006 edition of Speaking Out, pages 8-9

See also:
How I escaped the comforts of stammering - by a participant in the integrated therapy course.
Our City Lit page
Catherine Montgomery, integrated therapy - summary of conference call in May 2005.