This page provides information about the range of different stammering therapy options provided for adults, by therapists with qualifications recognised by the Royal College of Speech and Language Therapists. Within the UK, a number of non speech and language trained therapists also provide therapy for people who stammer. This page covers only those therapies offered by fully trained speech and language therapists and counsellors. On request, we can provide information about therapy options not included in this page.

Note: 'stammering' and stuttering' mean the same thing.

Speech and language therapy for adults who stammer is available throughout the UK on the NHS. You can ask your GP to refer you to your local NHS speech and language therapy department or (in most areas) you can refer yourself. We will let you know if there is a NHS specialist therapist in your area who works with people who stammer. We also have information on courses available at specialist centres throughout the UK. Alternatively you can contact The Association of Speech and Language Therapists in Independent Practice (ASLTIP) who will provide the name of a private therapist in your area.

Therapy for stammering is usually offered on an individual or group basis for a predefined period of time. You will be offered an initial appointment with a speech and language therapist who will discuss your individual needs with you. A recent survey of speech and language therapists throughout the UK, carried out by the Bristol Stammering Research Project, revealed that the following approaches are most commonly offered:

Therapy for stammering can be structured in a number of ways. The length, number and timing of sessions offered will largely depend upon the particular needs of the client and the therapy approach being undertaken. Non-intensive therapy may consist of weekly, one-hour; individual and/or group sessions, and it can be of short term or long term duration. Intensive therapy courses may consist of six hours of daily individual and group therapy, for anything between one and four weeks.


Stammer More Fluently (Stammering-modification approaches)

Block Modification
This approach was developed by Charles Van Riper, an American speech and language therapist who stammered. The aim is not for total fluency but to help the client stammer more easily. Van Riper held the view that people's feelings and the way they see things can contribute to the maintenance of stammering. Block Modification therefore involves work on attitude change as well as communication behaviour. There are five stages to the approach:

1. Identification: of what you do when you stammer and when you avoid stammering. Also identification of your feelings and attitudes to stammering.
2. Desensitisation: reducing fear and sensitivity about stammering.
3. Variation: experimenting with change and different ways of tackling a problem.
4. Modification: aiming to help you stammer more fluently.
5. Stabilisation: maintaining the changes you have made.

The stages of the approach will not necessarily he taught one after the other. Your speech and language therapist will engage you in those parts of Block Modification best suited to your needs

Avoidance Reduction Therapy consists of steps to help the person accept their problem and to acknowledge this acceptance to others. The person who stammers is taught to approach speaking situations instead of avoiding them. This takes courage and can be more easily achieved with group support. The overall aim of Avoidance Reduction Therapy is to reduce the fear of stammering. Since Sheehan's approach addresses some of the psychological aspects of stammering, Avoidance Reduction Therapy could also be considered to be a psychological approach.

Speak More Fluently (Fluency-modification techniques e.g. Slowed Speech/ Prolonged Speech)

A number of different Speak More Fluently (fluency-modification) techniques have been devised to help people who stammer.

All incorporate the following features to some degree:
- slowing rate by prolonging syllables
- pausing in a relaxed manner
- flowing words together
- articulating sounds using less pressure than is used in stammering
- paying attention to breathing patterns

The aim of these approaches is to replace stammered speech with fluent speech in the clinic setting. The client is encouraged to manipulate and modify their speech pattern in order to develop fluent speech. Once fluent speech has been attained, the client is helped to carry over the fluency techniques into outside situations. It is now widely accepted that it is necessary to combine fluency modification approaches with work on the client's fear about stammering or their avoidance of speaking situations.

Research has shown that fluency techniques can be relatively easily taught and easily learnt. That said, however, not all people are happy with how their speech sounds or the continued effort involved in speaking in a new way all the time. It can be difficult to change a behaviour such as speaking and maintain a fluency technique without continued support and regular practice.

Evesham and Fransella found that, when Speak More Fluently techniques were used in combination with Personal Construct Therapy, clients were less likely to relapse.

Psychological Approaches

Personal Construct Therapy (PCT)
Personal Construct Therapy was first used with people who stammer by Fransella in the late 60s and early 70s. This theory became popular with speech and language therapists because if offers a framework for understanding why changing behaviour can be difficult, even when the person is highly motivated to make the change. Personal Construct Therapy helps the client and therapist understand the psychological effects that stammering has upon the client's life. Through careful self-exploration and experimentation, the client works to increase fluency and develop a more positive attitude towards any stammering that remains.

Personal Construct Therapy has been found helpful in combination with other stammering therapy approaches, and for those who are very distressed by relatively mild stammering. This approach is used widely by speech and language therapists throughout the UK.

Counselling
Counselling may be part of a comprehensive treatment approach. This form of talking therapy can be helpful for people who stammer who feel they might benefit from talking about negative feelings, unhappy experiences and the effects of their stammer upon their lives. Counselling can be particularly helpful in providing support for those struggling to make changes in the face of intense feelings.

There are different theories and approaches to counselling. The two most commonly used approaches are person-centred counselling and psychodynamic counselling. Whilst both types of counselling can be of benefit to people who stammer, person-centred counselling is most likely to suit the stammering person's needs. In person-centred counselling clients identify issues and difficulties they feel they would benefit from looking at and maybe working through. With the support of the counsellor, clients are then encouraged to help themselves work towards feeling happier about themselves and their lives.

Depending upon training, some speech and language therapists offer counselling for people who stammer. Alternatively, you can find a reputable counsellor by contacting your GP or the British Association for Counselling.

Cognitive Therapy
Cognitive Therapy is based on the principle that our thoughts are important not only in determining how we feel but also how we act. Clients learn first of all to identify thoughts which trigger feelings such as self-consciousness, embarrassment or anxiety. They then learn to challenge or question these rather than accept them as fact. Cognitive Therapy is not about "positive thinking" but rather about learning to stand back mentally in order to consider the alternatives. Cognitive Therapy is typically short term, between 12 to 16 sessions, and aims to help clients develop a "toolkit" of strategies for dealing with difficulties independently. Any therapy process which encourages people to "look at things differently" or to "think about things from another point of view" has a cognitive basis.

Cognitive Therapy for people who stammer is currently only available in a limited number of speech and language therapy departments. We will aim to provide details of therapists and centres offering this approach.

Relaxation techniques
Often included as part of a comprehensive treatment approach, relaxation techniques aim to help the client develop healthy ways of responding to stressful situations. Different speech and language therapists use different relaxation techniques. Some people find learning skills to relax very beneficial for their overall wellbeing. It takes practice to use relaxation skills in stressful situations but there can be benefits in being able to relax after a stressful event.

Other approaches that may be offered by speech and language therapists
Anxiety control management.
Assertiveness training.
Brief therapy (solution focused therapy).
Hypnosis.
Social skills training.

Speech and language therapists will tailor the therapy they offer to suit your individual needs and may combine elements from a number of different approaches. Depending upon your needs, your speech and language therapist may feel that following one approach is the best course of action. As in most therapies, stammering therapy is a partnership between the therapist and the client. The therapist needs your feedback and involvement in order for therapy to develop appropriately for you.

Self-help
For some people who stammer taking part in self-help activities, instead of, alongside or after therapy, can be very beneficial. We can provide information about self-help groups, pen-pal schemes and Open Day activities available throughout the UK.

Useful addresses:

The Royal College of Speech and Language Therapists
2 White Hart Yard,
London SE1 1NX
Tel (020) 7378 1200
Website: www.rcslt.org

Association of Speech and Language Therapists in Independent Practice
Coleheath Bottom, Speen,
Princes Risborough, Bucks, HP27 0SZ
Tel: 01494 488306
Website: www.helpwithtalking.com

British Association for Counselling (BAC)
1 Regent Place
Rugby, Warwickshire CV21 2PJ
tel: (01788) 550 899
Website: www.counselling.co.uk

The City Lit - Speech Therapy Department
The City Lit,
Stukeley Street (off Drury Lane),
London WC2B 5LJ
Telephone: (020) 7242 0224
Website: www.citylit.ac.uk

The City Lit is an adult education centre that offers a range of reasonably priced specialist intensive and non-intensive courses for people who stammer. You do not need a referral to attend City Lit courses, clients are welcome to refer themselves. (Click here for details of City Lit courses - Webmaster)

Acknowledgements: this leaflet has been produced with the financial support of the Underwood Trust. The text was written by Anne-Marie Cray MRCSLT, of the Bristol Stammering Research Project, with the assistance of the British Stammering Association's speech and language therapy advisory panel.

See also: Adult Therapy and Courses.