Articles

Let's mention the F word by Rachel Everard, The City Lit London. Signal Issue 22 , Winter 2004
Change is afoot at the City Lit. Not only are we shortly moving to a brand new building in the heart of London, we are also introducing a new intensive course in January ­ 'Stammering therapy: an integrated approach'.

As many of you will be aware, our therapy approach has been based for some time on Block Modification (Van Riper, 1973) and Avoidance Reduction Therapy (Sheehan, 1975) both of which sit firmly within the 'stammer more fluently' approach to stammering therapy. Over the years we have made developments to our Block Modification Therapy programme. Underlying these changes has been our strong belief in the power of desensitisation and avoidance reduction work to help our clients to make significant changes, both psychologically and behaviourally. We have also been influenced by the social model of disability and how this can be applied to stammering; as a result of this we developed a ground-breaking course 'Self-advocacy for people who stammer'.

Up to this point we have always been wary of focusing too much on fluency as we believe that to maintain long-term changes acceptance of stammering is essential. This new course represents a radical departure for us in that for the first time since the early 1980s we will be teaching a fluency technique, in addition to existing aspects of our programme. So, why the change?

We have been aware that, for some people who stammer, Block Modification Therapy has not given them everything they need. This is particularly true for people who experience severe or frequent stammering and who find it difficult to modify moments of stammering. We believe that this new course will offer people who stammer a greater range of tools from which to choose.

In addition, we have been particularly impressed with the work of Catherine Montgomery (the Director of the American Institute for Stuttering in New York). Her programme is based on an integrated model of stammering therapy and incorporates a 'spectrum of approaches'. She draws on both 'stutter more fluently' and 'speak more fluently' approaches, combining desensitisation with stammering management and fluency-shaping techniques. Whilst in the past these two approaches have seemed mutually exclusive, Catherine is successfully combining them with positive results.

We heard Catherine present her way of working at the American Speech and Hearing Association conference in 2001 and at the Oxford Dysfluency Conference in 2002. To learn more about this approach two members of our team visited the USA in 2003 to observe her working. We were inspired by this experience and returned feeling optimistic about bringing together what we had previously felt to be distinct and opposing approaches.

The decision to make this change has not been easy and much talking, thinking, reading and reflecting on our beliefs about stammering and our experience as therapists has taken place. Rachel and Carolyn have shared personal experiences of stammering and therapy which has been invaluable. We remain committed to the ideas of Van Riper and Sheehan. However we are introducing this new course as it offers an additional tool (vocal fold management) which can sit alongside other ways of handling moments of stammering (such as Block Modification). Our hope is that using vocal fold management (combined with other strategies) will enable people to have a greater level of fluency than might be possible with a straightforward Block Modification approach. Not forgetting the central importance of offering people an opportunity to explore their feelings and beliefs about stammering, the course will continue to address the psychological aspects of stammering with greater emphasis on cognitive therapy.

We are running this intensive course twice next year and believe that intensive therapy is essential to this type of approach.

We will keep readers informed about the outcome of this approach and are currently considering different ways in which we can evaluate the course. We are particularly interested in hearing Œthe client¹s perspective¹ on therapy and are hopeful that people attending the course will contribute to the evaluation by sharing their experiences with us.

If you have a client whom you think would benefit from such an integrated approach, please contact us.

Once we have experience of running this type of course, we plan to share our knowledge with others through short training courses.

For more information contact: speechtherapy@citylit.ac.uk
Tel: 0207 242 0224
See also: www.citylit/speechtherapy

References: Sheehan, J., (1975) Conflict theory and avoidance-reduction therapy. In J. Eisenson (Ed.), Stuttering, a second symposium. New York: Harper & Rowe.

Van Riper, C., (1973) The treatment of stuttering (2nd ed.). Englewood Cliffs, NJ: Prentice-Hall.

Logan, J., (2002) An integrated treatment model for effective stuttering management. Speaking Out, Vol. 23 No 1.