Speech Therapy: What, Why and How ?

Speech Therapy is the therapy that an individual undergoes to deal with various disorders of speech, voice and language. It has been particularly successful in dealing with stuttering and many people have gained tremendously through the process.

A speech therapist is a specialist with training in the diagnosis and treatment of a variety of speech, voice, and language disorders who works with people, unable to make speech sounds or cannot make them clearly.

In terms of our context, they work with people who stutter, have fluency and rhythm problems, inappropriate pitch, or harsh voice and speech quality problems. The most widespread and obvious speech disorder is stuttering, often caused by anxiety. The speech therapist sets up a program of speech exercises to reduce the disability, and if necessary, enlists the aid of a psychologist or psychiatrist. Speech therapists keep careful records on the evaluation and progress of patients, often developing and implementing individualized treatment programs based on the input of physicians, psychiatric social workers, and psychologists. In fact, because speech disorders are usually related to neurological, psychological, and physical conditions, speech therapists must be able to work as a member of a team which may include other health care specialists such as a neurologist and psychiatrist.

An important part of a speech therapist’s work is the counseling and support of individuals and families on speech disorders and on how to cope with the stress associated with these problems. Therapists also work with families on treatment techniques to use at home and on how to modify behavior that impedes communication. Although a speech therapist’s job is not physically demanding, it does require patience and compassion, as progress may be slow and halting. Speech therapy is a painstaking process, but it can be as rewarding as it is frustrating. Tremendous attention to detail and sharp focus are necessary in the evaluation of the patient’s progress. Overall, speech therapists must be able to understand and empathize with the emotional strains and stresses that such problems bring, both from the patient’s and family member’s point of view. Speech therapists, like other health care professionals, must carefully diagnose problems and if necessary call upon the advice of other health specialists. The ability to distinguish the need for the professional input of specialists is critical to the therapist’s success.

Therapists must also monitor the progress of patients, eliminate certain programs, and introduce others that are more effective. The ability to make informed decisions that may define the success and failure of any individual program is a skill that can only come with years of experience. Many teens and adults who stutter have been to speech therapy for their stuttering at least once in their lives.

It is important for you to have a clear idea about your motivation for going to therapy because your reasons for seeking treatment will help you decide:

1. The ‘right’ speech-language pathologist;

2. The amount, length, and cost of treatment;

3. Possible goals for speech therapy; and,

4. The amount of success to be expected.

How is stuttering/stammering treated?

The therapist will first assess the problem. Fluency is measured by counting repetitions, prolongations, blocks, interjections, revisions – during reading, monologues, recitations and conversation.

Aspects of home background, early history, educational performance and medical history are explored. The therapist also assesses the pressures and current problems of the child or adult patient at home, in school or at work.
Any worthwhile treatment works at two levels, both of which mean hard work and are used in conjunction:
1.    Methods aimed directly at eliminating the stutter.
2.    Therapy to build the person’s self-esteem and to create acceptance of the elimination.

• The most common method currently in use to build normal fluency is slowing down the speed of speech. A stutterer can speak fluently if he allows himself enough time to control his speech, to speak  “syllable-by-syllable” as it were. Various techniques / devices can be used to help the stutterer slow down his speed of speech. One, for example, is a machine which clicks in rhythm to a slow beat. The patient speaks in timing with the clicks. This is especially effective for a small child, who learns to speak single words first, progressing to two, three and so on to continuous speech. As his speech control improves under the guidance of a speech therapist, the stutterer speeds up his speech in stages until he has control at normal times. The goal is to carry over the practice such measured speech into everyday conversation so that the stutterer gains confidence in real-life situations.

• Other techniques, such as appropriate pauses, help to de-tense the muscles involved in speaking.

• To tackle delay in auditory feedback (the stutterer waiting to hear the words he has spoken), a few speech therapists (though not commonly in India) use a machine called a “masker” that emits a humming noise into the child’s ears while he speaks or reads, which prevents him from hearing his own voice and teaches him to learn to speak without waiting to hear the sounds he is producing. The speech is taped and played back to him, and eventually he learns to speak fluently unassisted.

• Reading exercises, recitation, singing and spontaneously conversation may also be used in therapy.

• The therapist tries to remove or modify environmental factors – such as physical abuse of the child, or over-ambitious parents – that contribute to the stuttering. The family is encouraged to help.

• Most professional therapists do not use the pebbles-in-the mouth remedy originally devised by Demosthenes. The method is based on the premise that when a person speaks normally, his tongue touches certain areas in the mouth; a stutterer’s tongue however touches other areas. Putting pebbles or marbles in the mouth supposedly achieves two things: the tongue is prevent from touching the familiar (wrong) spots, and, two, the obstructions in the mouth cause the person to elongate his words and speak slowly for fear of swallowing the marbles (thus transferring the anxiety of speech to attention to the marbles.) However, this method is not too efficient because, without the marbles, the anxiety level drops and the stutterer reverts; it is also risky because of the danger of swallowing the marbles.

• The second approach in therapy is based on the fact that the patient ostracizes himself due to feelings of stress, inadequacy or peer inequality. The therapist therefore aims to restore self-esteem by getting the person to accept himself as someone who stutterers but can be helped. Ironically, a stutterer finds it difficult to change his image of himself as a stutterer. It is akin to a fluent speaker being told that all the world stutters and he must do so, too. The second step therefore focuses on achieving speech fluency in stressful situations in which the individual previously stuttered. A hierarchy of anxieties is first determined: Say, if the person fears his principal, his teacher, his father and the opposite sex, in that order, the goal is to help the stutterer overcome the least stressful situation with ease. Such systematic “de-sensitization” helps to break the vicious circle of fear-stuttering-fear.

• Social skills training is also included so that the stutterer finds it easier to approach people and talk to them.

Choosing the ‘right’ Speech-Language Pathologist (Courtesy : The Stuttering Foundation, USA)

The key to success with any kind of treatment is finding someone who is knowledgeable about that particular treatment. This is especially true of stuttering.

How do you find a speech pathologist who is right for you? First, begin thinking about the goals that are important to you. You may even want to read more about stuttering therapy. Good sources of information can be found in the Stuttering Foundation books: Stuttering, An Integration of Contemporary Therapies (=0016), Advice to Those who Stutter (=0009) or Self-Therapy for the Stutterer (=0012).

Then, use a referral source. The Stuttering Foundation’s referral list has names of people who specialize in treating stuttering. If none is located near you, contact a local university, hospital, or speech and hearing clinic. Universities that have training programs in speech pathology often have a speech that will provide therapy for stuttering.

Once you’ve contacted a speech pathologist, interview them. There are many important questions you will want to ask, but a few in particular are very important.

How do you find a speech pathologist who is right for you?

• How comfortable are you with treating stuttering? This is important because some speech pathologists are not comfortable working with stuttering.

• How many teens and adults who stutter have you worked with? This will help you determine whether the speech pathologist has the kind of experience you need.

• What do you think the primary goals of stuttering therapy should be for a teen/adult? This will help you decide whether the speech pathologist’s ideas about goals match your own.

• What approaches do you use in speech therapy? How often is therapy scheduled?

Therapy Amount, Length, and Cost

This is completely dependent on the person and can be evaluated by a stuttering evaluation. Our own analysis has shown that a thorough evaluation usually ranges from two to four hours and may cost between $300 and $500 for the US, depending on your location and the speech therapist’s charges. These charges can vary greatly, so please understand these upfront. It might be possible that some health insurance might cover this cost / cost of therapy as well.

Before you start, please be sure that you understand and can commit to the length of time, frequency, type of therapy, goals and the cost of the same. This will set expectations and reduce any frustrations that you may feel later. Standard times usually range from 1 –hr a day for 4 weeks, followed by personal exercise time. This may take longer if the negative feelings about stuttering are higher. Hourly therapy charges can range from eighty to two hundred dollars – depending on location and speech therapist charges.

Expectations for Success

Many people are doubtful that stuttering therapy. They may believe this because they had limited success or a bad experience in therapy years ago, or because their stuttering is worse than it’s ever been. Even if you have stuttered all your life, it is quite likely that you will gain fluency. A speech pathologist who is knowledgeable about stuttering can almost always help adults and teens who stutter make positive changes in their communication skills. As you work with your speech pathologist to set your goals, you will also set your criteria for success. Becoming an effective communicator and living successfully with stuttering should be among the most important of these criteria.

Goals for Therapy Stuttering therapy for teens and adults usually means changing long-standing speech behaviors, emotions, and attitudes about talking and communication in general. As a result, length and type of therapy can vary greatly depending on your goals.

A list of sample therapy goals for teens and adults includes:

– Reducing the frequency of stuttering;
– Decreasing the tension and struggle of stuttering moments;
– Working to decrease word or situation avoidances; — Using effective communication skills such as eye contact or phrasing; and,
– Determining whether goals relate to long-term change or to meet a specific short-term need, such as a job interview.
– Working together with a speech pathologist who is knowledgeable about stuttering will help you identify your personal goals.