Finding Solutions to Managing Stuttering

About the presenter: Bryan Melvin is 51-years-old and stuttered most of his life. Only at the age of 50 did he finally get serious about therapy. Since enrolling in therapy, he has employed a variety of techniques to help him speak more fluently and found that with practice and persistence one can find success. He has benefited from being an active participant in therapy and consistently applies techniques into his daily speech. Bryan enjoys physical fitness, family, and travel.

About the presenter: Charlie Healey is a professor of speech-language pathology at the University of Nebraska for the past 34 years. During his career, he has received a University Distinguished Teaching Award, the honors of the Nebraska Speech-Language-Hearing Association, and last year was inducted into the University of Kentucky Alumni Hall of Fame. He also is an ASHA Fellow and a Board Recognized Specialist in Fluency Disorders. Charlie has published many journal articles and book chapters concerning adults and children with fluency disorders. He also has presented numerous workshops and seminars on the diagnosis and treatment of stuttering in school-age children who stutter.

Finding Solutions to Managing Stuttering

by Bryan Melvin and Charlie Healey
from Nebraska, USA

This article showcases Bryan Melvin, a 51 year-old individual who has stuttered since early childhood. What is particularly remarkable about this case is the phenomenal amount of improvement Bryan made in his speech and speech related attitudes after just 22 hours of treatment. Bryan attended therapy for his stuttering at the University of Nebraska-Lincoln (UNL) Speech and Hearing Clinic from February, 2010 through April, 2011. He received treatment that focused on improving his thoughts, attitudes, and feelings as well as his use of both fluency shaping and stuttering modification techniques. Approximately one-half of the treatment sessions were devoted to cognitive restructuring activities.

Bryan did not have any therapy for his stuttering except for a couple of years in elementary school. When he reached his late 40's, he said he was tired of being self-conscious about his stuttering and it was time to "man up" [sic] and do something about it. In 2010, he decided to enter treatment at the speech and hearing clinic at UNL after hearing about its stuttering therapy program.

Prior to treatment, Bryan completed the Erickson S-24 scale (attitudes toward communication), the Willoughby Social-Emotional Sensitivity scale, the Perceptions of Stuttering Inventory (PSI), the Overall Assessment of the Speaker's Experience of Stuttering (OASES). His stuttering frequency was measured in reading and conversation. The results showed that Bryan had highly negative attitudes about his communication abilities (Erickson S-24 = 24 out of 24) and moderate social sensitivity & anxiety as evidenced by his Willoughby scale score of 65. His PSI score was 36 out of 60 and he had a moderate-to-severe rating on the OASES. His frequency of stuttering was 3% in both oral reading and conversation.

On April 29, 2011, Bryan completed the same scales and measures obtained during the pretreatment assessment. The results showed significant improvements in all components addressed in treatment. Comparing his post-treatment and pretreatment scores, the data show that his attitudes toward communication were typical of a person who doesn't stutter (an Erickson score of 8 vs. 24) and his social sensitivity changed from a high moderate to a low moderate social sensitivity (a Willoughby score of 42 vs. 65). His PSI score was 10 compared to 36 before treatment and his OASES score changed from moderate-to-severe to mild-to-moderate. In 2010, Bryan produced approximately 3% stuttering in both reading and conversation. Reading and speech samples taken in April, 2011 showed that Bryan's stuttering frequency was 1% or less.

Given the substantial progress Bryan made on his own and through therapy in a relatively short period of treatment, we thought it would be helpful to others who stutter to have Bryan discuss what he found to be the keys to his success in managing his stuttering. Most clients don't improve their speech, thoughts, and feelings quickly, but Bryan is a unique individual who has profound self-discipline and motivation for change. Much of Bryan's self-discipline results from being a professional boxer and knowing what it takes to train on a regular basis. Bryan and I recognize that what worked for him might not work for others who stutter but many of his insights, successes, and failures might help others who are starting therapy, in the middle of therapy but not making progress, or who are discouraged about previous stuttering therapy. Here is what Bryan has to say.

Improving My Thinking

I have found it helpful to never lose sight of the fact that it is important to keep a realistic perspective about my stuttering. When I stuttered, I used to think I was a failure. Through therapy, I learned it's not the end of the world and it shouldn't define who I am. I try to think positively and use what I have learned in therapy. However, I wasn't able to change until I reached a point where I was fed up with my stuttering and I "hit rock bottom." At that point, I was emotionally ready for change. But, to keep moving forward, I had to remember not to resort to methods that have failed in the past. I needed to keep looking at my speech in new ways. If something seemed to work, I'd try it again. If not, I'd see if there is another way I could approach it.

When thinking about the approach I used to change how I viewed my stuttering, I think it's like learning to ride a bike. When a young child learns to ride a bike, the first thing the child thinks about is not falling off the bike and getting hurt. Focusing on the falling or all the negative outcomes takes away from the real focus of riding the bike, which is maintaining balance. With the help of training wheels and someone holding you up, your brain eventually teaches your body to maintain your balance. You gradually get better and your views about bike riding begin to change. The more you ride, the better you get until it becomes second nature. You are also able to make adjustments as you face various obstacles while riding (swerving to miss something, riding on a bumpy street or road, etc.)

This analogy is essentially the thought process I went through early in therapy. I focused so much on trying to be fluent so I didn't stutter, that is, not falling off the bike. I quickly learned there were other things I needed to change before I could speak more fluently. I had to change my perspective about my stuttering, become a more positive thinker, focus on not giving up, and committing to change. So, if a person who stutters says, "My stuttering is never going to get better", then that negative thinking will destroy the positive changes that could take place over time. That's where a speech therapist knowledgeable about stuttering can help.

I also thought early in my treatment that people I talked to were hanging on every word I said. Through time and therapy, I came to realize that I was being too self-conscious about my stuttering. Therapy really helped me get over being so critical of how I sounded and paying too much attention to how much I stuttered. There was one other important part of my improvement and that came from a spiritual connection I had with God. I never lost sight of how important having faith in God and myself was at the core of making changes in my stuttering.

Improving My Speech -- My Number One Priority

As I said above, I had to reach a point where I was fed up with my stuttering to be motivated to work on it. I finally got to the point where it was important for me to do what I had to do to make a change. But I also knew it would take a lot of hard work to improve my speech. That meant I needed to be actively involved in treatment that could guide my thinking, feeling, and behaviors. I also entered treatment with the understanding that I would probably have small set backs and failures. Sometimes what I tried to do to improve my speech didn't work. But, I couldn't give up because I knew I had to fail before I had success. I wanted my speech to improve quickly, but realistically, I knew that was not going to happen. I had to modify my expectations of what I could accomplish in the short-term and the long-term. It's an instant gratification world we live in but I didn't look for the "quick fix." I was prepared that it might take months or even years to improve my speech but it was so important to me to try everything that was suggested to me. I was committed to working hard to keep the small successes going. I made working on my speech a daily priority.

Improving My Speech Mechanics

In my stuttering therapy, I was taught a number of techniques to help me talk more fluently. The techniques were helpful but as I said above, my success was more than just learning how to control my stuttering or using techniques. I wondered what other people who stuttered did to improve their speech. I asked Charlie about this and he gave me the book called, "Advice For Those Who Stutter" (Stuttering Foundation Publication #9) and it's about people who have successfully managed their stuttering. The stories I read from most of the 28 contributors were helpful and inspiring. A common theme that ran through each person's story was that in some way, all of them learned to use techniques to make talking easier. Because there are several techniques clinicians teach people who stutter, I needed to find the ones that would work best for me.

First, I needed to learn all the things I could do to become more fluent or decrease the severity of the stutters I had during a conversation. Charlie and his graduate students taught me how to produce easy onsets of phonation, use a more continuous phonation pattern while talking, make less forceful contact as I said certain sounds (light articulatory contacts). I also learned how to pullout or cancel a stuttering moment. I practiced all of these techniques as much as I could. After therapy, I would dedicate myself to practicing my fluency enhancing strategies each day while reading the newspaper aloud. I practiced for about 10-15 minutes in the morning and again in the evening.

I think the practice everyday was a key to my success in improving my speech. Being a former professional boxer, I understood what it took to train on a regular basis and learn the proper methods of boxing. Training to be a boxer is very similar to the dedicated hard work needed to be a more fluent speaker. I often recall a phrase used by Larry Merchant, an HBO boxing commentator, who said, "Good things happen when you don't give up." I never wanted to give up on the techniques that might help me gain more control over my stuttering.

Over the course of time, I found that I was able to use some of the techniques more effectively than others. So, I focused on those that helped the most and let go of the ones that I didn't use very often. The techniques I stuck with didn't help me all the time, but if they helped me get out of or stop one stuttering moment, it was worth it. Without a doubt, I found that I just had to "toughen up" when the techniques wouldn't work as well as I thought or hoped they would. But, I never let myself get discouraged.

I also discovered that I needed to keep everything simple. The more I over planned on how to do something or thought too much about the strategies while talking in conversation, the less the techniques worked. This was frustrating so I just let go of trying to produce speech that was perfect. I also tried to challenge myself to find speaking situations or people outside of therapy that tested my ability to use a particular strategy like I had practiced it. I also used the positive self talk phrase of "I can do this, I can do this." Charlie and his graduate student clinicians motivated me to do my best but I also had a strong desire to get better without their help. I found that when I was having success, I was developing more confidence in my abilities to speak to anyone in any situation.

Finding My Solution

What worked for me might not work for others who are trying to work on their stuttering but if what I have learned about myself through therapy will help someone else who stutters, that would make me feel terrific. I never got discouraged or gave up on myself. I stayed the course and was not overly discouraged when I failed or made mistakes. It has been a long, tough process but I have improved the way I think and feel about myself and my stuttering as well as how I manage my speech in a number of speaking situations. Before I entered therapy, I used to dread the phone or making phones calls. Now, I look forward to talking on the phone and making phone calls! So, I face every speaking situation as a challenge rather than with fear, apprehension, or feeling like I will lose control over my stuttering.

I will continue to work on all aspects of my speech for a long time because I don't feel that I am "cured." There are times that I still stutter but I will never let my guard down. I will continue in therapy as long as I need to as a way to maintain my improvements but I also realize it's up to me to be my own speech therapist.