Can therapists promote stammering acceptance while also providing therapy?

17th November 2021

Stephanie Burgess defends the role of the speech & language therapist, which has in recent years come under fire.

As therapists, can we promote acceptance of stammering while also providing therapy for stammering? During my training courses, this is probably the question which comes up most often. As speech and language therapists (SLTs), how do we manage that apparent contradiction of encouraging people to accept stammering while at the same time providing therapy for the stammering? 

It seems a conundrum, and it's one which a lot of us have wrestled with as the profession has shifted from a medical model to a social model approach over the last couple of decades, but I believe it is entirely possible and indeed desirable to do both. (Editor's note: The 'medical model of disability' says that a disability is the result of a physical condition; the 'social model' is the view that people are disabled not by their physical conditions, but by a society that excludes and discriminates against them. Read more). Before I explain why, we need to understand what stammering is and how it typically develops.

I believe it is entirely possible and indeed desirable to do both.

The problem with stammering is that it is in fact two things: a life-long neurological condition, whereby the subtly different structure and wiring of the brain affects the production of speech, and a transitory phase many children go through as they try to master the complex sequence of movements needed to be able to speak in sentences. 

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So although stammering is part of the neurodiverse group of conditions, it differs from other conditions such as autism and dyslexia, since nobody goes through a phase of being autistic or dyslexic. The difficulty we have as SLTs is that we have no way of knowing which category a child falls into. And actually, it's not as clear cut as being in one category or another, because there are many complicating factors which affect the onset and persistence of stammering. 

STRIPPING BACK THE LAYERS

For some children, as they start to be aware their sounds aren't quite coming out as they'd like them to, they may start to use extra pressure to force the sounds out — blocking may be a sign that this process has started. Over time, this extra pressure and tension can become part of their pattern of stammering and can cause the outward flow of air needed for speech to be blocked, hence the feeling of being stuck. This can cause negative thoughts and feelings towards stammering to creep in, and other peoples' negative responses to the stammering and environmental pressures also contribute to that process.  

It's not the stammer we're trying to fix or get rid of; it's the struggle, tension and negative baggage which can accompany it. 

These negative feelings can then lead to avoidance of talking. Word-switching might also start to be apparent; the child avoids a word they think they'll stammer on and substitute a different one. Over time, the extra tension, the negative thoughts and feelings, the word-switching and avoidances are layered over the stammer and become part of it, potentially turning it into something extremely problematic. However, with the right support in early childhood, it's not inevitable that these layers build up, even if stammering persists.

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And here we come back to the original question. Yes, we can absolutely promote acceptance of stammering at the same time as providing therapy, i.e. strategies, information and advice to stop those unhelpful layers from building up. In older children, teenagers and adults who stammer, therapy is often about trying to strip away the layers. So it's not the stammer we're trying to fix or get rid of; it's the struggle, tension and negative baggage which can accompany it. 

Essentially, therapy is about preventing or stopping stammering from being a problem, and acceptance of stammering (by the person who stammers, people around them and society generally) is a big part of this process, meaning therapy and acceptance are entirely compatible.

Do you agree? We'd love to know what you think. If you'd like to write an article giving your view, email editor@stamma.org and we'll send you our writers' guide.

Stephanie Burgess is a Specialist Speech & Language Therapist at Airedale NHS. This is an abridged version of Stephanie's blog post. You can read the full version at Airedale Stammering Centre's Blog. Read one of her other articles 'Medical vs social model of disability: It shouldn't be 'either-or''.