Curing Stuttering – Michael Susca

Michael SuscaAbout the Author:

Michael Susca, Ph.D., C.C.C.-SLP, BCS-F, is an associate professor at the University of the Pacific.  Dr. Susca is an ASHA Board Certified Specialist in Fluency, a member of the Special Interest Group Four—Fluency and Fluency Disorders, and has over 40 years experience in treating people who stutter.  Dr. Susca has published in national and international journals, presented at state, national, and international conventions, and is a former person who stutters himself.  He also continues a small private practice primarily for people who stutter. 

Which word caught your eye: “curing” or “stuttering”…..or both?   My bet is that you had a stronger response to the first word than the second word.  Ask yourself what motivated your response.

In the stuttering community, “cure” is a loaded word.  Sometimes it is used as a noun, other times as a verb (and sometimes as a pejorative.)   If you look up its definition in a dictionary you will find multiple definitions.    One’s perspectives, experiences, knowledge, and contextual use of the word will also influence its meaning to an individual.  As an academic, researcher, SLP private practitioner, BCS-F, person who stuttered, and an old man nearing 70, I wish to share some thoughts about this word that sometimes needlessly divides the stuttering community.   I hope to broaden our conception of functional communication for PWS and decrease myopic, singularly narrow definitions, approaches, and solutions to the clinical experiences of stuttering and its intervention.   I’m sure to incense some readers, but that is not my intention.   I simply hope to expand our understanding of communication with or without stuttering.

Is stuttering curable?   Yes.    Is there A cure for stuttering?  No.    Is the goal of stuttering therapy to eliminate stuttering?   I don’t know, ask the client.  Must stuttering be managed or can it come and go unexpectedly?  In some cases yes and in other cases no, to both questions.    Substitute the word “cancer” for “stuttering” in these questions and I’d come up with the same answers.  Parallel to cancer, to understand stuttering as a finite, unidimensional, simple event is to miss what stuttering is.  

Most of us recognized the multifactorial, complex, and dynamic characteristics of stuttering.  Because of that, it is silly to think of stuttering as a singular, concrete (i.e. observable characteristics), and static “thing” to address, which the term seems to imply for many.   For some, that later viewpoint may apply if the PWS is seen at a good point for personal change and is able to eliminate stuttering to a point where it is no longer an issue in communication.   That might be the “cure” many mistakenly apply to the results of therapy to some stuttering.  For others, a reduction in the periodicity, duration, severity, reactions, struggle, agency, and/or difficulty with social communicative functioning may be sufficient.    Let me use myself as an example.

I started stuttering at age 4.  It was the beginning of a life process of change: my path.   In retrospect (and after lots of education and counseling) I have identified multiple factors that I believe contributed to my stuttering.  It is important to note there may be a whole set of different factors contributing to someone else’s stuttering…..but back to me.   My parents set me up with one SLP and I went from “bad” to “worst” in that I often ended up writhing on the floor trying to get a sound or sequence of sounds out through my bodily contortions when responding to comments or volitionally making my own.   Of course, being quiet and not speaking at all was a more comfortable response (for me and my listener.)   My parents eventually set me up with a new SLP who guided me to greater fluency (but not elimination of stuttering).   I got to a point where I was comfortable and accepting of myself as a mild to moderate PWS….at least I could remain standing while I stuttered my utterances.  In contrast to the severity I formerly experienced, I could remain at this level of disrupted spoken communication and be happy for the rest of my life.  The relative level of distress and discomfort speaking was much reduced.  But like so many PWS, I regressed (or relapsed), started returning to my physical secondaries (and withdrawing in school participation on many fronts) and returned to my second SLP.   After a few more years of speech therapy, and encouragement from my SLP, I entered the field of Speech and Hearing Sciences, with a special interest in treating people who stuttered.  I have worked with many people who stuttered throughout my life, each of whom had different outcome(s) specific to him or her.    Although all had the problem of stuttering, no two followed the same path (even siblings.)   Many had changing paths during the duration I knew them.  Many (including me) underwent a protean process of change.  Today, I no longer stutter.    Some would call that “cured”.   But during my period of mild or moderate stuttering, I felt “cured” because I was a functional communicator who happened to also stutter.  I was an impaired communicator when I relapsed and spent a lot of time managing my observable speech, exploring my thoughts about myself as a communicator, and my dealing with feelings that varied with various situations one finds oneself communicating with a stutter.   I was naturally fluent after my Master’s degree and upon entering my first year as an SLP.   It was not for another 25 years that I could comfortably refer to myself as a “former PWS” or “cured” (in the sense of no longer having an observable stutter and all the “below the surface” components that accompany it.)

Note that my path, and the path of many people I have treated, is along a path focused on being a functional communicator, NOT experiencing communication as a PWS or not.   When we focus on stuttering vs. not stuttering or cured vs. not cured, we are missing the point of a PERSON and being a person with functional communication.  Functional communication implies degrees of self-expression with perhaps different levels or forms of stuttering or fluency.  The “cure” of stuttering may be the idea of communicating a thought, feeling, experience, or desire from one individual to another, as efficiently and effectively as possible, however that is defined for that individual.   For some, curing stuttering may be entering uncomfortable situations and verbally expressing oneself regardless of the level of stuttering or fluency.  For others, it may be having the confidence to express an idea to influence decision making in a group.  Maybe it is making a joke or quip in a social context.   Consistently saying what one intends to say, speaking with less struggle (not necessarily the absence of struggle), and/or have a sense of full being, intactness, and total communicative self-reliance are all markers of “curing stuttering.”  Thus, curing stuttering becomes an individualized definition and process. 

Back to the cancer metaphor.    There is no one type of cancer, as there is no one type of stuttering.   Cancer comes in many forms, as does stuttering.   Cancer comes in many degrees, as does stuttering.   There are many forms of treatment for cancer as there are different kinds of treatment for stuttering.  There are different choices of treatment for cancer patients to choose from, as there are different choices of treatment for stuttering—in each case a choice of the patient to the options presented by a professional.   Is cancer curable? Yes.  Is there A cure for cancer? No.  Some people can be “cured” of their cancer, but not all cancer is curable.  The same is true with stuttering (in terms of absence or experience of the problem.)  Some people learn to live with their cancer, so it is with stuttering.   Sometimes there are multiple approaches to manage cancer, so it is with stuttering.   As there are different cancer support groups, there are different stuttering support groups.  In all cases (of cancer and stuttering) the challenge is to find the best solution or combination of solutions to allow the individual with the problem to live out his or her life to the fullest.  There is no one solution to whatever problem(s) with which one is living. 

So let’s stop focusing on singularly curing stuttering, modifying stuttering, enhancing fluency, developing positive attitudes of self and/or stuttering, using cognitive behavioral therapy, counseling, developing mindfulness in stuttering therapy, or engaging in A tool in the treatment of stuttering.  Let’s focus on enhancing the person’s effective and efficient communicative functioning, however defined, as individually determined.  Let the client’s changing needs guide us to draw from multiple strategies so they may live their functional communicative life to its fullest.   

 

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Comments

Curing Stuttering – Michael Susca — 27 Comments

  1. Well said Mike! Being a functional communicator (and comfortable with who you are as a communicator)is what it is all about. To me, as a clinician, that is what makes working with people who stutter so fulfilling. What an honor it is to be able to join with another person to help him or her determine the path they want to choose. Thanks for clarifying the word “cure.”
    Charlie

  2. Michael,
    Your writing took me through a journey. I have to admit I was a bit taken back by the title. In fact, I reacted strongly to the word “curing” rather than “stuttering”. As an undergrad, this is very much a hot topic and your take on it is quite interesting. I also agree that treatments should depend entirely on what the speakers wants, rather on what the clinician or society thinks is correct. I am glad you have found peace in your journey. Thank you for sharing.

  3. Michael,

    This article you wrote really stands out as you center your writing around the idea of the word “cure”. As clinicians, we are all focused on our patient’s goals and can often have the mentality of “fixing” instead of letting the patient/client determine their own definition of their cure. I found the imagery between cancer and stuttering to be quite interesting in how two vastly different things can have so much in common. Lastly, I admired your willingness to talk about your own story and what being “cured” meant to you. You specifically stated, “But during my period of mild or moderate stuttering, I felt “cured” because I was a functional communicator who happened to also stutter”. This really blew me away as I felt like I truly understood the variability and individuality that comes with the idea of “curing stuttering”.

    Thank you for sharing.

  4. Michael,

    This article you wrote really stands out as you center your writing around the idea of the word “cure”. As clinicians, we are all focused on our patient’s goals and can often have the mentality of “fixing” instead of letting the patient/client determine their own definition of their cure. I found the imagery between cancer and stuttering to be quite interesting in how two vastly different things can have so much in common. Lastly, I admired your willingness to talk about your own story and what being “cured” meant to you. You specifically stated, “But during my period of mild or moderate stuttering, I felt “cured” because I was a functional communicator who happened to also stutter”. This really blew me away as I felt like I truly understood the variability and individuality that comes with the idea of “curing stuttering”.

  5. Michael,

    What were some of the goals/strategies that the first SLP you saw made you go from “bad” to “worst” that you can recall? For future SLP’s, how do we make sure we are more like the second SLP versus the first SLP you saw to help PWS become functional communicators?

  6. Hello Michael,
    this was greatly put into perspective and I like how you used cancer as an analogy because cancer is not a one cure fits all. I am currently in my undergrad into becoming an SLP and I think this will be very useful into allowing patients to know that there is a way to uniquely help the person but there is no cure and working towards what is comfortable for them and what best fits their needs.

  7. Nice question, myoung. There’s actually a lot I remember (and have learned from.) The bottom line is this: DON’T hold only one perspective, approach, or theory of stuttering for everyone but DO learn as many different perspectives, approaches, and/or theories of stuttering as you can. My experience is that there are MANY variables that could (and could not) be driving the stuttering in any one person at anytime in their lifespan. Do as deep a differential diagnosis as you can to 1)see what the individual (and/or environment (like family or significant others)) needs right now, 2) explore what is and is not possible for that individual as you work with him/her/they and 3) stay flexible and adaptable to the changing needs of your client. If you come across something for which you are unprepared, LEARN, LEARN, LEARN what you need to know to address that “something.” Don’t stay stuck in what you know, stay flexible, adaptable, and a bit humble to address the individual as an effective and efficient communicator instead of only as a PWS. Later in my professional life I realized the second SLP (my mentor) was constantly learning and trying out different things with me as a client. The first SLP was stuck in only what he knew.

    With hopes of not opening pandora’s box, good luck. Thanks for the question.

  8. Hi Michael! Thank you for sharing your thoughts! I enjoyed hearing your story and your take on stuttering and the term “cure.” I think it is very important that we focus on enhancing someone’s productive communicative function as defined by whatever they choose! I very much agree with your article and learned so much from reading it! Thanks! – Madison Ingrassia

  9. Hello! Thank you for sharing! First, I want to just say thank you for how well you explained functional communication and the ‘cure’ to stuttering. I found myself really wanting to take some quotes from this to share with some clients I have in my clinical placement. I thought the brief reflection you shared on your own life with stuttering was really valuable and hopeful as well. I feel sometimes it is easy to feel hopeless about a stutter and one’s communication, and your perspective showed that while its not a linear straight up path, achieving ones goals (both in life and communication) is possible. Thank you again for sharing.

    • You’re welcome and thank you for your kind comments. Feel free to share my comments or quotes with your clients as you wish.
      Warm wishes to you and for a career of helpfulness.

  10. Hi Michael – thank you for amplifying the complexities and dimensions of the stuttering experience. In the case of a young child, the real client is the parent. How do you recommend working with the parent who just wants their child to be fluent and not have to go through life with this struggle?

    • If the real client is the parent, as you say, then you’ll need to counsel and educate the parent. Some people will always stutter with little change in the observable characteristics, some people may mitigate their observable stuttering to some extent, some some will become fluent (with or without therapy). I’d help contrast and help the parent to understand the difference between a functional communicator and a person who stutters, and the two may not be in conflict. Explore with the parent if “she just want their child to be fluent” and what that means. Same with “not have to go through life with this struggle”. I would steer away from “absolutes” in making suggestions, especially on a bipolar or two-choice level, and see how to manage the parental apprehensions and anxieties with the child’s ability to communicate needs, feelings, wants, thoughts, etc. in a real and meaningful way. I would also suggest dealing with issues in the present and leave the future for the future.

      There is no simple answer to your question, but it is a real issue that presents itself often. Seek some solutions in your client’s family dynamics. Sorry I can’t be more helpful in this respect.

      good luck and thanks for your comments.

      Mike

  11. As a PWS who’s also “old” (i.e. 70), and after a lifetime of stuttering, I found the article something of a tease. Yes, I did read the article because the first word of the title is “curing”. And yes I appreciate the fact that there is not one definition of cure or a singular technique for curing/helping everyone with their goals. But you say that after much therapy and effort on your part you now regard yourself as a “former PWS”. Yet you don’t elaborate on how you went from a severe to a mild to moderate stutterer to a former PWS. How many adults who stutter become a “former PWS? (I’m not an SLP but I imagine very few). Obviously there is a process that you underwent where you no longer anticipate stuttering and/or react to that anticipation. I can understand where, perhaps, the consistent application of fluency shaping techniques could lead to the elimination of stuttering. Could you elaborate on what primarily helped you become a “former PWS”. Thanks for your article.

    • Hi Frank. My response to your question is too long for this environment. But I can help you get some insight to your primary questions regarding my history. If you got to the Stuttering Homepage you will find a section on personal stories of PWS. Mine is there as “My Story” ….which was originally for a research project Walter Manning was doing but which Judy saw and asked me if she could post it on the Homepage. So, check it out and if you want to discuss it more, I am happy to in email or however.
      One other thing: there is no one thing that “primarily helped” me. It was a continuous rollercoaster process. The “former PWS” label I accepted for myself didn’t occur until I had lived more than half my life without the stutter….it was a threshold of a psychological change of self-perception of living without the stutter that, for me, allowed me to refer to myself in that way.

      I hope that helps. Thanks for your questions.

      Mike

  12. Micheal, I enjoyed reading your thoughts about stuttering and the term “cure.” I liked how you incorporated your own experiences of stuttering into this as it was very helpful. I am currently an undergrad planning to major in speech pathology and am in a stuttering course. Before beginning this course I did not know much about stuttering so over this semester I have really enjoyed earning and becoming more familiarized with it. I really liked how you incorporated the cancer metaphor into this reading as it gave me better understanding with stuttering and the term “cure.” Thank you again for sharing!

  13. Hi Michael,
    I enjoyed your perspective on different ways one could consider oneself “cured” from stuttering. I certainly did click on this article because of the word “curing,” as I’ve been taught that treatment should often focus more on self-compassion, acceptance, and successful, functional communication as defined by the client rather than “curing” or eliminating a stutter because that may not be possible. I think that it’s important to work toward achieving the client’s goals while also being realistic in potential outcomes. I love how you really illustrated how each individual’s journey, outlook, and goals will be unique. There is no one, “right” way to treat people who stutter.
    I find it fascinating that it took you 25 years to identify as a former PWS. Were there still covert symptoms present for part of that 25 years, were you not yet ready to accept that you no longer stuttered, or was it something else that influenced that? Thanks for sharing with us about your experiences!

    • Hi Hmiller,
      No, I didn’t have covert symptoms during my enhanced fluency period, but you did hit on something: acceptance that I no longer stuttered. In the second 25 years of my life it was almost like looking backwards over my shoulder for the stutter to come back, especially since my workload was so much with PWS who had relapsed and I had severely relapsed in my own history. As a clinician, for those who achieve effortless and natural fluency, many are uncomfortable and “unaccepting” of their newfound fluency (all else being equal). Think about it: if you’ve only known yourself as a person who struggles to speak, speaking without the struggle is going to feel “weird” (with or without strategies.) [This may be a poor metaphor: imagine living your first 10 years hobbling around with a smooth stone in your shoe and then walking without the stone in your shoe: it would not be what you had know up to that point in your life and would take some adjustment(s) to walk around (not hobbling) without the stone in your shoe.] My point is, sometimes it takes many forms of adjustment (physical, mental, emotional, social, etc.) to make a change in your self-perception or sense of self. It is usually not a unidimensional change. I would guess what is changed and how integral to who you are also plays a role in the change process (a stone is nowhere near a stutter.) What influences/ed that “new identity”?—I don’t know. I just know it was a process of change and for people who stutter and make changes with their speech or their relation with their speech, allow time to process and adjust to the change, whether it be acceptance, management of the stutter, fluency, or anything else. It’s a process, not an on/off light switch.

      Thanks for your question. I hope that helps.

      Michael

  14. Hi Michael,
    You’re perspective on the idea of “curing” stuttering is poignant. Despite how daunting the comparison of stuttering to cancer can be at first glance, you make some convincing arguments for people to adjust their perspective on the idea of “curing” stuttering.

    As a student at CSUF studying Communication Disorders and Science, I’ve learned that some PWS are able to have spontaneous recovery either through therapy sessions with an SLP or for adults through self-management. My question for you is, how would you make the distinction between cure of your own stuttering and self-managed (spontaneous) recovery?
    I look forward to reading your response. Thank you so much for sharing your perspective and story!

    ~Elilta Zellalem.

    • Hi EltltaZ,
      Mine was NOT spontaneous recovery. I don’t know how I’d make the distinction you’re asking about. All I can say is, different people move themselves in different ways to different levels of functioning.
      Sorry I can’t be more clear. I imagine that answer is different for each individual who goes through changes with respect to their stuttering.

      Maybe I’m not understanding the question. Wish I could be more helpful.

      With respect,

      Mike

  15. Hi Michael,
    I want to thank you for sharing your perspective and ideas about stuttering. The idea of substituting Stuttering to Cancer was brilliant and cleared that pathway to really understand what stuttering really is. Stuttering is very complicated and just like cancer there is no cure like mentioned I really enjoyed the part I which you stated, “we need to stop focusing on a single cure and instead start believing and advocating that the challenge people who stutter have to face is finding the best solution or combination of solutions to allow the individual with the problem to live out his or her life to the fullest”(Susa, 2021).

  16. Hi Michael,
    First of all, I want to thank you for sharing your knowledge, thoughts, and experiences as being a (cured) PWS and as an SLP. Secondly, as a current SLP graduate I am so happy you focused so much on how PWS do not have the same paths and journeys while in speech. It is so important to individualize sessions and goals based on the client’s personal and emotional goals. In addition, the metaphor about cancer is so relevant. I chose to read this article because the word “cured” caught my attention (as you knew it would), but now it makes complete sense when referring to the metaphor.
    Thanks again,
    Lauren

  17. Hi Dr. Susca,

    I’ll admit that what caught my eye was “curing” because I realized that I didn’t know what that meant in terms of stuttering. You answered this quickly by stating, “ask the client”. I am taking a course of fluency disorders and have been reading a few posts from ISAD and am learning how important a holistic therapy approach is. Stuttering is different for each individual and likewise, their goals may also be.

    Best,
    Amanda

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