There’s no cure for adult stuttering yet. So what’s the point of speech therapy?
Even just five years ago, I would have said that the answer is obvious: to reduce stuttering severity by using evidence-based speech restructuring techniques like the Camperdown Program.
But I’ve since learned – from clients and from other people who stutter, from the thought-provoking work of researchers like Assistant Professor Christopher Constantino and colleagues, and from stuttering rights advocates – that people seek out stuttering therapy for lots of reasons. Not everyone who stutters is looking to reduce or mask their stuttering.
To support people who stutter, it helps to understand that stuttering is a physical problem – too often mocked, stereotyped, and stigmatised and discriminated against by others – that can affect quality of life:
1. Stuttering can be physically exhausting, frustrating, and embarrassing
Stuttering is a physical problem. It’s surprisingly common, affecting up to 1% of the population at any time. It’s got a lot to do with genes. But it has nothing to do with character or moral fibre. It is not caused by anxiety or stress – but anxiety and stress often follow stuttering, and can make the symptoms worse.
Stuttering physically interrupts speech. It can be unpredictable or situation-specific. It can happen at the least convenient times, like at networking events or dates, at work, when speaking on the phone, when giving a formal presentation to a group, or even just ordering food. Stuttering severity can fluctuate, at times because of things like fatigue or anxiety, but sometimes for no obvious reason at all.
2. Society assumes that speech should be fluent and effortless
Constantino and colleagues ask us to think about work as an example. Many employers, in Australia and elsewhere, demand “excellent communication skills” and “fluent spoken English” for all sorts of jobs. Almost every job requires a personal interview, either face-to-face or by video call, like on Zoom. Some jobs require applicants to submit live ‘video introductions’ so HR can screen out obviously ‘unsuitable’ applicants before interviews.
The hidden – unquestioned – assumption behind many of these workplace practices and routines is that rapid, fluent speech is a sign of competence and intelligence. But, as Constantino and colleagues make clear, that’s far from the truth.
How many job tasks actually require rapid, fluent speech these days? Even in “speaking professions” many of us communicate with each other asynchronously and in a variety of ways, e.g. by email, Slack, texting, group text chats, and pre-recorded presentations. But many people interview like we are still in the early 1900s and make judgments about others’ competence, likability, and talents based on how they speak in person in a single high stakes interaction.
3. People who stutter are often bullied and discriminated against
Adults who stutter have several legal rights, including:
- the right not be discriminated against at work because of stuttering; and
- the right to be safe at work.
These rights are not always respected in practice. Workplace bullying happens. Even in day-to-day interactions, people who stutter often encounter more subtle forms of negative feedback on their speech (e.g. having people finish their sentences or talk over them, cutting conversations short, or breaking eye contact). Adults who stutter are sometimes mocked openly for their speech, e.g. during interpersonal conflicts at work.
4. Lazy stereotypes: fictional characters who stutter are too often depicted negatively in films, books, music and other media
Constantino and colleagues agree there are exceptions like “The King’s Speech”. But think about how stuttering is usually shown in movies and books, or lampooned in songs. How many times have writers used stuttering as a shorthand way of demonstrating that a character is weak, scared, nervous, mentally ill, a bumbling fool, or even evil? Think about how these stereotypical depictions affect people who stutter.
5. Stuttering can affect mental health, social and work participation, and quality of life
The research is clear. Stuttering increases the risks of social rejection in childhood, and social anxiety as an adult. It can limit job opportunities and outcomes. It can affect intimate relationships. Many people who stutter report that they have been hung up on when making phone calls. Some people who stutter have been denied service in bars. People have been overlooked for promotions and been fired for stuttering. People who stutter have even been detained at airports and accused of making up their stuttering!
6. The uses and limits of stuttering therapy models
The traditional medical model of stuttering focuses on “impairment”, and “treatment” by an “expert” speech pathologist. The social model views stuttering as a “disability” experienced when “social barriers” prevent a person who stutters from participating fully in society because of a mismatch between their body and their environment.
To do our jobs well, speech pathologists need to be aware of these mental models. But as we’ve argued in other contexts, all models are wrong; and the map is not the territory. Framing stuttering therapy as a black and white choice between the medical or social models can lead to extreme positions and “all or nothing” decisions that reduce client choices. In practice, elements of both models may appeal to different people who stutter, at different times, in different situations.
Constantino and colleagues point to the fact that other models and possibilities exist too, including the stuttering pride and neurodiversity movements. Some people who stutter do not see stuttering as an impairment, disorder or disability; or as a social problem requiring external barriers to be dismantled. Some people opt not to change their speech patterns, but instead to be proud of how they speak as part of who they are; and to find meaning in their identity as people who stutter.
7. Speech pathologists need to listen more and not make assumptions
Different people who stutter contact speech pathologists with different goals and priorities. The most important thing speech pathologists can do is to listen to our clients before jumping into therapy:
- Some clients want direct speech therapy, like the Camperdown Program, to reduce the severity of stuttering, either generally or in particular circumstances like public speaking or job interviews.
- For other clients, mental health support might be their immediate priority. For example, Professor Ross Menzies and his colleagues at the Australian Stuttering Research Centre have developed a free evidence-based social anxiety treatment for adults who stutter called iGlebe.
- Some clients may want support to advocate for their legal rights, e.g. in the workplace.
- Some clients may want help to advocate for specific changes and adjustments in specific situations, e.g. for a job interview or speech.
- Speech pathologists should partner with people who stutter to educate people who don’t stutter to dismantle stereotypes and myths about stuttering.
- Speech pathologists can help connect people who stutter with self-help groups. For example, some of my clients have had great joy from participating in self-help groups, like meetings of the Australian Speak Easy Association.
- Everyone can play a role to dismantle social barriers for people who stutter. Examples of such initiatives, led by people who stutter, include the following organisations and projects: 50 Million Voices, British Stammering Association, Action for Stammering Children, National Stuttering Association, and WeStutter @ Work – National Stuttering Association.
Constantino and colleagues make it clear that stuttering is both a biological reality and a social challenge for many people who stutter. For some people who stutter, it can be a frustrating, embarrassing and even painful physical problem. These negative effects can be exacerbated by:
- the way society is set up, including the often hidden assumptions that people “should” be able to speak fluently, e.g. at work, and that fluent speech signals competence and intelligence; and
- prejudice, media stereotypes, and social stigma associated with stuttering, often based on ignorance about what stuttering is (and isn’t).
Different people who stutter want different things from their speech pathologists. We have ethical obligations to listen to what our clients want, to help clients sort evidence-based information from misleading and deceptive information, to explain the risks and benefits associated with different options and approaches, and to help clients to make informed choices about how they want to pursue their goals.
Key source: Constantino, C., Campbell, P., Simpson, S. (2022). Stuttering and the social model. Journal of Communication Disorders, 96, 106200.
- The Camperdown Program
- Adult stuttering: 19 things to know + new resources
- Stuttering: what do we mean by ‘recovery’?
Hi there, I’m David Kinnane.
Principal Speech Pathologist, Banter Speech & Language
Our talented team of certified practising speech pathologists provide unhurried, personalised and evidence-based speech pathology care to children and adults in the Inner West of Sydney and beyond, both in our clinic and via telehealth.