I think most of us tend to approach stuttering therapy as we do any physical problem. That is, we follow the medical model. If you have a headache, you take an aspirin and the headache "goes away". You may realise that the headache could be a symptom of some underlying cause, but probably you hope that the underlying cause can itself be eliminated by some kind of medication. Our belief in medicine starts early in life. We want something to happen to us, with no effort on our part. Medicine does this. The aspirin takes care of the problem, with no responsibility laid on us. It's a drag to have to do something to change yourself. I once heard a four-year-old stutterer tell her mother, "Mommy, give me some medicine so I can talk." It tore at my heart.

This is not to say that various drugs don't have direct or indirect effects on speech (including fluency), but these effects are always temporary, and frequently are accompanied by irrelevant and unwanted side effects. To date, there is no generally effective medical treatment for stuttering, and no such treatment appears to be in sight.

So we are left with stuttering therapy consisting of a variety of techniques designed to produce changes in speaking behaviour and attitude. It has been said that we don't cure behaviour, we change. This process of change can take a very long time before it becomes stabilised, with many ups and downs along the way. The curve of learning is always bumpy.

We still have a tendency to view a program of speech therapy as we do a dose of medicine. We take a three-week, or three-month, "dose" of therapy and hope that it will have permanent effects. This is especially true of programs based on "behaviour modification" (response shaping) or "behaviour therapy" procedures, in which cognitive and emotional change is minimised or ignored. Indeed, these programs may be marketed in such a way as to engender the belief that attitude and feelings are not important in therapy.

We blithely overlook the fact that the "dose" of therapy is usually bucking many years of habit and attitude formation and reinforcement, many years of particular self-perceptions and life experiences. To expect the "dose" to permanently reduce or remove stuttering behaviour (and all that goes with it) is like expecting to stop a charging bull elephant with a popgun. It may take a great many doses. Real, solid, long-term voluntary behaviour and attitude change is slow, hard work - far harder than many people are willing to do. You don't always get a pat on the head for doing the right thing, and it isn't always fun.

All of this is not to denigrate stuttering therapy of any type. As long as we don't know for sure just what stuttering is, or what the causes are, we can't always worry too much about the degree or "respectability" of the method, how well it has been accepted by the professional community. Stutterers have reported improvement, temporary or seemingly permanent, stemming from all sorts of events and procedures. Sometimes these events and procedures have nothing to do with planned treatment; a therapist was never involved. The stutterer himself may not have been aware that anything was going on that directly affected his stuttering, until after some period of time he did begin to notice that he was stuttering less, or that what stuttering he did continue to do bothered him much less than it used to.

Bloodstein gives examples of some of these unplanned events that apparently eliminated stuttering:

"For example, one stutterer, according to a reliable report, recovered from stuttering after surviving an airplane crash. In a similar case ... a young man got over his stuttering when his hand was battered in a machine-shop accident that almost cost him his life. The incident was said to have made his old problems and anxieties seem like trifles.
... recovery from stuttering may come from vicissitudes which recreate the stutterer's system of personal values so radically that fears or pressures involving speech no longer have a high priority.

Certainly the whole problem of stuttering, along with a great many other problems, would be vastly simplified if we had some kind of "stuttering aspirin" that would instantly and totally be effective with anyone of either sex, any age, any degree of stuttering, any personality, any background of life experience. Lacking any such medication, what can we say about the therapies that are available to us?

For stutterers, I think it is safe to say that no therapy will help everyone but that almost any therapy will help someone. In some cases recovery takes place with no therapy. The same therapy may help someone at some time in his life but not at other times. Therapy may have no immediate effect, but may have a delayed effect when the stutterer finally begins (months or years later) to act on what he learned during the active therapy period. Effects of therapy are frequently unstable; the problem of relapse remains a crucial issue in dealing with stuttering. As any number of therapists have noted, it's no big deal to get a stutterer fluent - the problem is to keep him that way.

One thing is apparent. Any decrease in stuttering means that something has happened. If a number of different therapies all produce a decrease in stuttering, it would seem that there is a common factor among these therapies, a common denominator, operating to reduce stuttering. The alternative assumption would be that there is co common denominator, that the different therapies produce different effects all of which educed stuttering. This possibility seems less likely: it is certainly less parsimonious. So, assuming there is some common denominator, just what is it? That is an intriguing question. If we knew the answer, we would probably have the answer to the entire riddle of stuttering.

All things considered, I believe we are left with the inescapable realisation that success in stuttering therapy results from an incredibly complex interaction among a great many variables, some known, many unknown. Some of these are client variables: the stutterer's neuro-physiological condition, his motivations, aspirations, emotional stability, insight, personality, life history, and God knows what else. Some are therapist variables: clinical experience and skill, knowledge of stuttering, personality, ability to motivate and empathise with client, flexibility and so on. Some are methodological variables: type of therapy employed, therapy schedule, clinical environment, and whatever.

Obviously no therapist can control and manipulate all of these variables, since we don't even know what all of them are. Quite probably only certain ones are significant in the therapy process. Would that we knew which are necessary and sufficient! I have always had a sneaking suspicion that success in stuttering therapy may be due in part to clinical skill and in part to sheer luck ... the therapist just happened to punch the right buttons, and the stutterer just happened to have the right buttons to punch.

In 1981, Bloodstein analysed 116 published reports of stuttering therapy. These studies used a wide variety of therapy methods, and they varied in methodology. Taking into account various ambiguities in comparing one study with another, Bloodstein inferred that substantial improvement as defined in these studies typically occurs as a result of almost any kind of therapy in about 60%-80% of cases. He concluded: "It would seem that therapy itself, apart from what is done in therapy, has considerable capacity for effecting change."

While the permanent elimination of stuttering in adults with or without therapy happens too seldom, it does happen often enough to raise tantalising questions. Why does it happen at all? Most of our thinking has always been directed towards the question of why people stutter. Of equal importance is the question: Why do people stop stuttering? There has been speculation about this, with no definitive answers.

So we come to the inevitable question: what seems to be the best course of action for stutterers? Is all this buzzing confusion cause for dismay, frustration, pessimism, throwing in the towel, throwing up our hands, throwing up? I don't think so. If you wait until you have all the answers to your questions about yourself and your stuttering, you're going to wait until hell freezes over. The main point is: do something. Don't be frozen into impotent inactivity. A feeling of total helplessness in the face of any kind of threat, of not knowing anything to do, builds up tremendous fear and insecurity. Taking action of any kind tends to reduce anxiety and bring about change. Almost anything you do will help in some way and to some degree.

If you are involved in any kind of specific, planned, systematic therapy program, give it your best shot. Go at it whole-heartedly and optimistically, make a commitment to it, and stick with it long enough to get a real feeling about its usefulness to you. If you are working with a therapist, learn everything you can from him or her. Do what the therapist says and see what happens. Evaluate everything that goes on, and be aware of your own feelings. Don't hesitate to ask questions, to get opinions or information. Try to be totally honest with yourself as well as with the therapist. To make any therapy effective you've got to (1) know what to do, (2) understand and accept the reasons for doing these things, (3) be willing and able to do what you should, and (4) keep doing them until there is a real chance in your feelings and behaviour.

If you are not currently active in specific therapy, what can you do? You can simply do your best as you go along, handling each situation as it occurs. Try to stutter as easily and "gracefully" as you can, and do your best to resist time pressure (the feeling that you must say something immediately and fluently). As you speak, don't try to talk abnormally slowly, but do try to stutter slowly, delaying and slowing down all your stuttering feelings and behaviours. This tends to counteract the panic and tension that are the essence of stuttering.

When you have a bad time of it, try to let that moment go and to hell with it; it's history. Don't belittle yourself because you stutter. Enjoy life as much as you can; try to keep a sense of humour, of proportion, and balance. I think the main thing is to learn not to be afraid of people, to realise that everyone has worries, fears, insecurities about all sorts of things, real or imagined. You are much more like other people than you are different from them, stuttering or no stuttering. We're all in the same boat.

At best, stuttering is a nuisance, at worst it can be a nightmarish, ego-shattering experience. It's never fun. And it's right there where everyone can see and hear it. You've spent tremendous amounts of time and energy trying to avoid and conceal it, and of course you really can't. Your efforts to do so have succeeded just enough (always temporarily) to keep you trying, though, and that's what causes the constant frustration. So it helps a great deal if you can stop fighting your stutter so desperately and fruitlessly. Instead, try to go along with it just a little more, ride it out. Be happy when you handle your blocks well or reasonably well, but don't feel guilty when you think you have screwed up. Be tolerant, be patient with your self, try to like yourself.

Your stuttering is an important and unwanted part of your life. It has caused you pain. But think very carefully about this: Of all the pain coming from your stuttering, how much has been caused directly by other people - by their actual reactions to you - and how much has been caused by yourself, by the way you feel about yourself in relation to others? It took me many years to realise that I was the source of nearly all my pain. As Pogo said:

From the Summer 1997 edition of Speaking Out