Most significant breakthrough

Hi friends,

I have a question that I thought might bring up some interesting very short-answer responses. For anyone who cares to respond, “What do you regard as the most significant breakthrough in the nature or treatment of stuttering since people have been trying to make sense of stuttering or to help those affected?

Ken St. Louis

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Comments

Most significant breakthrough — 13 Comments

  1. What a great question, I get asked something similar at workshops and conferences on occasion. While there are several great ones to choose from, if I had to pick one, I would say the findings (which are on-going) on neuroimaging studies (e.g., MRI, fMRI, PET scan, SPECT, etc.). For decades, as you know, the prevailing paradigm regarding the etiology of stuttering (or, at least, one of them) was that the parents caused it by misdiagnosing normal disfluencies as stuttering. Or, the PWS were just overly anxious or had some sort of psychological disorder.

    At this time, though we still can’t say what causes stuttering definitely, results from imagining studies have shown that there are both structural and functional differences in the brains of PWS. These findings have the potential to help us make great strides in etiology, nature, early detection, and possibly even treatment of stuttering. I’d say the same for all the recent research we’ve seen on the genetics of stuttering as well. I think such research findings are vital for us to able to understand the complete nature of stuttering and those who stutter.

  2. Hi, Ken,

    Great question. Since Paul already stated the first breakthrough that came to my mind, I’ll add another, the positive influence of the counseling professions on our field which has led to a number of what I believe are very important breakthroughs in treatment. While addressing the emotions and attitudes related to stuttering are not new ideas, several more recent benefits include, first, the notion that the client owns the problems associated with their stuttering. Working from a perspective of collaborating with the client and addressing the issues that they see as important leads to stronger and more durable treatment outcomes. Secondly, the availability of training in cognitive behavioral therapies for speech-language therapists has led to SLPs becoming more effective in working with their clients. I am pleased that more university programs are including counseling courses in their curricula, and that there is more cross-training avaiable, as well, for the professional clinicians.

    Regards,

    Lynne Shields

  3. Hi Ken-
    What an interesting and thought-provoking question! I would have to agree with Lynne and say that the increased role of incorporating counseling into the field of speech-language pathology has been extremely positive. Since Lynne mentioned CBT approaches, I’ll focus more on mindfulness specifically. I’ve been incorporating mindfulness into my therapy sessions with clients who stutter (and those with other communication disorders) for several years. As well as practicing mindfulness myself. I’ve found that mindfulness can help my clients to tune into their thoughts, emotions, and the physical sensations they feel in their bodies. Many of my clients have made observations about their breathing patterns and locations of tension during an actual stuttering moments. While others have learned to notice their thoughts (perhaps about a speaking situation or listener reaction) and instead of fusing to those thoughts and giving them power, they let them go. The really exciting piece is that the field of neuroscience is showing that mindfulness practices are physically changing the brain with as little as 5-10 minutes of mindfulness activities per day! I hope that our field continues to learn from and incorporate the work of other disciplines as we continue to learn and grow as a profession and guide our clients and their families in the best way we can!
    Best,
    ~Jaime Michise

  4. Hi Ken,
    This is a great question – thank you for it. I couldn’t agree more with the answers given by the colleagues who responded earlier – I absolutely agree with their ideas. I would add from my Polish perspective one more aspect which I believe is a kind of a significant breakthrough – the quality of relationship between the client and the SLP. Treating the client as an expert in his/her stuttering is essential. When the client and the therapist have similarly important positions in this relationship and when the client’s opinions, values and goals are crucial factors in the decision-making process, it is easier to tailor the therapy process to the client’s individual needs. This is in my opinion a real foundation for meaningful and successful therapy.
    Kind regards,
    Katarzyna Węsierska

  5. Hi Ken,
    Many thanks for initiating this interesting and thoroughly enjoyable thread! Adding to the list of influential findings, I would like to mention the work of Boyle and others exploring the links between support groups for people who stutter and lower levels of internalized stigma, etc. These findings highlight the value of support groups and networks within therapy.

    • I absolutely agree with you Kirsten. I cannot imagine my stammering journey without the support of fellow PWS from TISA (The Indian Stammering Association). Support groups are a pillar on which a PWS develops. Thanks for putting this out.

  6. Hi Ken,
    I love this discussion. So much of what others have mentioned is spot on. It is interesting to see the trends or “zeitgeist” of the area of fluency disorders, all helping to push our knowledge forward. Certainly, as Paul mentioned, one of the biggest breakthroughs to me has been the advancement of our understanding of the genetics and stuttering…more specifically, the role genetics may play in persistence and recovery. In addition to that, the recent neuroimaging work by Chang et al investigating the grey matter and white matter tracts in children who stutter. Lastly, I very much appreciate the current trends in the counseling aspect of CWS, whether it be growth mindset or resiliency. As always, this is such an exciting time to be working in this area.
    Best,
    Brent Gregg

  7. Hi Ken,
    I love this discussion. So much of what others have mentioned is spot on. It is interesting to see the trends or “zeitgeist” of the area of fluency disorders, all helping to push our knowledge forward. Certainly, as Paul mentioned, one of the biggest breakthroughs to me has been the advancement of our understanding of the genetics and stuttering…more specifically, the role genetics may play in persistence and recovery. In addition to that, the recent work by Chang et al investigating the grey matter and white matter tracts in children who stutter contributed new information to the growing body of literature in neuro and stuttering. Lastly, I very much appreciate the current trends in the counseling aspect of CWS, whether it be growth mindset or resiliency. As always, this is such an exciting time to be working in this area.
    Best,
    Brent Gregg

  8. An excellent question Ken! I agree with all the previous responses. Since neuroimaging studies, it has been a breath of fresh air to be able to definitively tell parents that stuttering is not their fault. For me as a clinician, learning of the Common Factors Model (CFM) and how it relates to changes seen because of therapy has had a significant impact. It has helped me realize it is more important to focus on the individual, to tailor management to his or her specific needs, and to not align myself with one specific therapy approach.
    Another encouraging development has been the stronger emphasis being placed on the speaker’s experience of stuttering, instead of measuring success based on listeners’ perceptions. When one reads the numerous papers in this conference, it is clear there are commonalities with experiencing stuttering, but each person’s story is unique. Likewise, therapeutic success is unique to the person who stutters and can vary widely from one person to the next. To me, our role as clinicians is to help guide the person to discover his/her meaningful success on the road to becoming a more effective communicator.
    Wampold, B. and Imel, Z. (2015). The great psychotherapy debate: the evidence for what makes psychotherapy work (2nd ed.). New York: Routledge. ISBN 9780805857092. OCLC 227918397.

  9. Hi Ken,

    What an interesting question. I’d never thought about that before. Funny, the first three things that popped to mind were the neuroimaging studies mentioned by Paul, the influence of counseling on stuttering therapy as mentioned by Lynne, and the application of mindfulness to stuttering therapy as mentioned by Jamie. Although I am late to this party, I will add that mindfulness practices appear to me to hold exceptional promise in the overall treatment of stuttering. For me personally, the insights gained from meditation and other mindfulness practices are a game changer. I cannot overstate the value of learning to recognize that thoughts, feelings, and even the physical sensations of stuttering do not represent a stable, unchanging “reality,” but are simply appearances in consciousness that continually come and go. I am always looking for ways to scale mindfulness experiences down to school-age levels for my students. Best,

    Rob Dellinger

  10. Hi, Ken. Thank-you for the question. Similar to what others have mentioned, I believe the most significant breakthrough relative to the nature of stuttering is the evidence for a biological explanation of stuttering (e.g., identification of gene mutations & structural brain differences in children)rather than a psychological explanation. Relative to the treatment of stuttering, I believe the most significant breakthrough is the establishment of community for people who stutter – the various ways people who stutter can connect with one another (e.g. in-person, on-line, conventions, podcasts, etc).

  11. Hi Ken,
    Short and Sweet: 1) Joseph Sheehan’s observation “Stuttering is what we do to avoid stuttering”; 2) Wendell Johnson’s observation that our existential selves are consist of hundreds of characteristics an actions and to define ourselves by stuttering is silly; 3) Albert Ellis observation of how to change beliefs and attitudes in order to manage emotions and learn to talk without forcing or struggling, and 4) learning from the American Nazi Henry Ford “I have met people those who say they can and those who say they can’t. They are both right.” As applied to stuttering, if you can envision it, learn to believe it, you can achieve it. You can learn to talk with easy Iowa bounce, stop thinking 24/7 about stuttering, and really live a full life.

  12. Thank you so much for your wonderful question, Ken!

    Regarding the nature of Stuttering, I agree With my colleagues above. In addition, I do hope that we will be able to find treatment approaches which more accurately can support people who stutter. I do think that we should be even more creative in our search for finding and combining treatment elements and to document the treatment more properly.

    One important professional breakthrough for me was when I realized that I had to search outside the ‘traditional treatment box’ for finding even more effective and valuable treatment for people who stutter and who were seeking support.

    Another personal breakthrough was when I discovered that the working alliance in larger degree (than I earlier thought) influenced the treatment outcome. I then realized that this working alliance was worth to evaluate regularly -especially from the perspective of the PWS. I also realized that meaningful tasks and mutual goals or changes expressed in therapy are very important parts of this working alliance, and not only the quality of the bond between two persons.

    Well, this was a short reflection from me. One day I would love to share and discuss more with you, Ken! 🙂

    All the best wishes from
    Hilda