Knowing that differences exist, we need to specifically identify what our clients are doing differently from fluent speakers. Then we need to help our clients to function in the same way as people who speak fluently. You may ask if this is possible. My answer is absolutely yes. Up to date, through what research has told us and from my own clinical experience, I can now identify many of the specific functions that need to be changed. I am certain that these findings will become even more refined as research continues and as more people join me in looking at stuttering from the internal system perspective. Knowing what to change makes it possible to change. If it were not possible, and if I had not witnessed it myself, I would not be here today talking to you about this subject. I would be agreeing with those colleagues who believe that nothing can be done to help people who stutter speak fluently
This brings us to the subject of goals. What are the goals that will lead to our clients’ ability to speak fluently in their daily life? Before I tell you about the goals that I have found allow this to happen, I want to emphasize that there are some goals that can result in less stuttered therapy-room speech, but that make transfer outside next to impossible. These goals include any techniques that do not lead to speaking naturally and automatically. When clients are asked to do things that are not related to normal speech production, they will, of course, still have difficulty speaking. The speech won’t sound natural, and the whole activity will be mentally and physically taxing. Making the situation even worse, if the clinician tells clients to practice these artificial techniques for hours a day, the client will reinforce unnatural processes that still make it hard or harder for them to talk.
Sometimes clinicians ask clients to use a special abnormal way of speaking, such as speaking slowly, taking a deep breath, etc., during therapy and advise that once they get used to using the technique they will automatically speak in a more or less normal way in life. This makes no sense to me. If they practice and reinforce big breaths, that ‘s what the clients will do, or, alternatively, the clients will drop the big breaths outside the therapy and go back to their old way of talking. In this case clients justifiably are not motivated to transfer what they have done in therapy to the outside world.
If the goal of therapy is to learn a way of speaking that sounds unnatural such as slow, monotone, or rhythmic speech, the client will also be unwilling to speak this way in their daily life. In this case there is, of course, no carryover into everyday life. Unfortunately, the blame is sometimes placed on the client for not working hard enough.