Speech Therapy Techniques for Stuttering

As a speech-language pathologist, you hold a wide range of tools at your fingertips to address stuttering. Speech therapy techniques can help clients speak with greater ease and manage stuttering more effectively.

Does speech therapy help with stuttering? Absolutely. That said, speech therapy techniques for stuttering can require a multi-pronged approach. It’s all about knowing what path best matches your clients’ goals for therapy. 

From tackling the underlying emotional components to developing speech modification strategies, speech language pathologists (SLPs) can mix-and-match treatments to suit individual clients’ needs. 

Still, it can be daunting to sort through the research to understand how to best support clients with fluency disorders.

Establishing a strong rapport and understanding the individual’s unique relationship (and history) with stuttering is the first step. 

This is especially true when working with speech therapy for stuttering adults, since they may carry years of emotional baggage about communication. 

Striking a balance between counseling and concrete, evidence-based speech therapy techniques for stuttering is key. 

Stuttering Goals in Speech Therapy

It’s imperative for SLPs to identify clear, measurable goals for therapy when working with people who stutter. 

Goal-setting is a collaborative process in which the client plays a central role. 

Remember: Your client is the expert on their own experience with stuttering. No one understands that experience the way they do. 

Validating their individual perspective and priorities for therapy is essential. 

People seek out speech therapy for stuttering for a variety of reasons. Some may be interested in reducing disfluencies. Others may be focused on boosting confidence in speaking situations and embracing stuttering as verbal diversity. 

Often, clients are unaware of the wide variety of speech therapy techniques for stuttering that exist. And, thus, they are unclear about the level of change that may be possible. 

Sharing a menu of stuttering speech therapy options can be useful in identifying objectives that resonate.

Some goal areas for people who stutter in speech therapy may include:

• Improving the efficiency and effectiveness of communication
• Reducing the negative impact of stuttering on quality of life
• Increasing acceptance of stuttering and reducing avoidance
• Boosting self-confidence and self-advocacy skills
• Minimizing concomitant behaviors

Discussing goal themes with clients on a broad scale before developing specific, measurable objectives allows people who stutter to be at the center of their own therapy experience. 

Stuttering speech therapy techniques are not one-size-fits-all. 

It’s important for SLPs to communicate this philosophy early-on with clients while actively listening to understand clients’ individual values, preferences, and stuttering goals. Speech therapy can then be tailored to address these specific client needs and preferences. 

Looking for a starting point as you begin developing goals? 

The American Speech-Language-Hearing Association (ASHA) offers a breakdown of stuttering goals for speech therapy through the lens of the World Health Organization’s ICF framework. 

Goals may relate to impairment in body function, activity limitation and participation restrictions, or personal and environmental context. 

Viewed through the holistic WHO ICF framework, stuttering exists within the context of an individual’s life. It’s not just about the surface-level behavior—but, rather, what’s beneath the iceberg. Thoughts, emotions, and experiences are inextricably connected to disfluencies. 

Keeping the whole picture in mind leads to more effective therapy and progress. 

Speech Therapy for Adults Who Stutter 

When working with adult clients, you can offer the best speech therapy help with stuttering by drawing from a range of strategies that prioritize quality of life and ease of communication. 

As an SLP, you have access to a deep body of research on stuttering speech therapy techniques. 

The most powerful treatment approaches usually involve a mix of strategies that address impairment in body function, cognitive restructuring, and desensitization.

Let’s examine some of the most effective, evidence-based practices. 

Stuttering and Speech Modification Strategies

When adults seek support for stuttering, their most immediate concern may be reducing the frequency of disfluencies. 

One way to support clients in achieving this goal is through reducing impairment in body function. This means offering speech therapy techniques for stuttering that lessen physical tension and increase the probability of fluent speech. 

Speech therapists can offer both speech modification and stuttering modification strategies in tandem. 

While both approaches are focused on body function, they address it from different angles. 

Stuttering modification strategies date back to the 1970s, when Charles Van Riper presented his three famous stuttering speech therapy techniques: pull-outs, cancellations, and preparatory sets. 

• Pull-outs refer to adjusting airflow, voicing, and the vocal tract itself to make a smooth transition out of a stuttered word, rather than getting “stuck.”
• Cancellations involve an adjustment of airflow, voicing, and the vocal tract after stuttering has occurred, reshaping the previously stuttered word so that it can be spoken again clearly.
• Preparatory sets are centered on the moment before stuttering, implementing light articulatory contact and prolongation of sounds to put the speaker in the driver’s seat and reduce the struggle and tension of speaking. 

The intent of this approach is to educate adults about the speech mechanism and empower them with strategies that alter or reverse stuttering in the moment.

Sharing these tools with clients and practicing them during therapy sessions can lead to a reduction in disfluencies and greater ease of communication.

Keep in mind that stuttering modification techniques may not feel natural at first, and while they might be a fit for some clients, they won’t be a match for everyone. 

Speech modification strategies are another valuable tool at your disposal. 

With speech modification, all speaking is adjusted with the aim of shaping more fluent speech as a whole. 

Clients learn to play with variables that reduce stuttering frequency. 

These variables include:

• Timing
• Tension
• Voicing 

Therapy involves training in techniques like prolongation of syllables, light articulatory contact, easy onset, and continuous phonation. Rate control is also emphasized. 

Your job as an SLP is to introduce and practice these techniques in the safe context of therapy. 

It’s important to emphasize to clients that progress takes time–and success doesn’t mean erasing stuttering. Success is defined as minimizing the negative impact of stuttering, so that clients can participate in life more fully. 

 

Avoidance Reduction and Cognitive Restructuring

Some of the most effective speech therapy techniques for stuttering examine thinking and behavior patterns to reconstruct the client’s relationship with stuttering itself. 

Speech-language pathologists serve as guides on the journey, gently challenging client assumptions and encouraging them to break away from old habits. 

What does this look like in practice?

Say you have an adult client who selectively avoids words and scenarios where he fears stuttering may occur (e.g. giving a presentation at work). Your treatment approach for this client involves desensitization to minimize anxiety about stuttering. 

Rather than attempting to eradicate stuttering altogether, you target the tension and struggle that come from anticipating disfluencies and avoiding the situations that might trigger them. 

Vivian Sisskin’s Avoidance Reduction Therapy for Stuttering is a prime example of a treatment method that incorporates this philosophy. 

To support your client in confronting his or her fears, you may build a hierarchy of speaking situations together. Then you ask your client to rank the scenarios from least-feared to most-feared. With your support, your client will gradually desensitize himself or herself to each scenario. 

This might look like pseudostuttering (voluntary stuttering) while ordering at a restaurant or self-disclosing stuttering before speaking at their next Zoom video meeting. 

Speech therapists can also integrate elements of Cognitive Behavioral Therapy (CBT) and mindfulness into treatment. 

The latest research in speech-language pathology supports combining these approaches to yield the best results. 

To begin, you may support clients in identifying cognitive distortions–thinking patterns that hold them back. Some examples include “all or nothing thinking,” labeling, and catastrophizing. 

You can help adults who stutter to pinpoint these negative thoughts and patterns, challenge them, and replace them with more productive thought patterns. 

Adding mindfulness meditation exercises into your therapy routine can also reduce the anxiety that surrounds stuttering.  

Speech therapy for stuttering adults doesn’t come with a formula. That’s what makes it one of the most dynamic and fascinating areas in our field. 

There’s plenty of room for creativity, and the most effective therapy draws from multiple approaches to craft a treatment plan that’s as unique as each client.

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