Go With The Flow: Current Approaches in Stuttering Therapy

Zoë Fabian
5 hours ago
8 min read

In this blog, we’re taking a look at current approaches in stuttering therapy and how they differ from traditional treatment. If you need a reminder about the basics of stuttering itself - or how to distinguish between ‘typical’ disfluencies vs. when to seek support - you can check out our previous blog here. We’ve also written about a lesser known fluency disorder known as cluttering - you can check out that blog here.

Okay, let’s get started with a quote that gets us into the right mindset:

“Stuttering is verbal diversity” (Reeves, 2020)

For us as SLPs, this means we assess and support stuttering as a communication difference not as a communication problem. The nuance is important here. Stuttering is often lifelong, so the goal of therapy is not to eliminate it. This is why there has been a paradigm shift in recent approaches to stuttering: away from fluency-enhancing techniques and towards supporting strong, confident communication, regardless of the amount of stuttering. As SLPs, our aim is that a person’s quality of life is not correlated with how much - or how little - they stutter. Instead, we can provide people who stutter with knowledge, strategies, and support to ensure that their quality of life is not reliant on their speaking fluency.

Putting too much focus on reducing stuttering (or speaking fluently) can result in pressure to ‘mask’ disfluent speech or to use avoidance behaviors, which is likely to increase negative thoughts and feelings around stuttering.

Let’s give an example of what avoidance behavior can look like.

Johnny is an eight-year-old who stutters. He is at a café with his parents, and while he’s ordering, he begins to stutter.

Johnny notices the waiter turn away from him and begin to ask his parents what he’s trying to say. He knows the waiter is trying to be kind, but Johnny feels embarrassed.

To escape his moment of stuttering, Johnny avoids the word that’s hard to say by ordering something different from the menu.

After this, Johnny feels mad at himself and frustrated that he didn’t get to eat his favorite treat from the café. Johnny avoided further stuttering, but he didn’t get to eat what he wanted, and he had lots of negative feelings around the interaction. We’ll come back to Johnny later when we talk about the kind of support that therapy provides.

We cannot tell children that it’s okay to stutter AND tell them to speak more fluently. Imagine how confusing that would be!

While a stutter itself isn’t problematic, its impact can be. Children (and adults) who stutter can feel restricted by factors including physical tension, emotional reactions, and societal expectations. If people who stutter feel as though they are being held back from communicating confidently, that’s when support from an SLP is helpful.

So what does good, evidence-based stuttering therapy look like?

Stuttering therapy: What does it look like?

Before we dig in, it’s important to remember as always that no two treatment sessions look the same, because no two people are the same. Hooray for individualized, holistic therapy plans! That said, there are some philosophies and strategies that provide a strong, evidence-based foundation for therapy.

The following outline is based on the Blank Center CARE™ Model of Treatment (Byrd, 2024):

C = Communication
A = Advocacy
R = Resilience
E = Education

Many components of the CARE™ model fit into more than one of the categories outlined above. That’s because our goal is ALWAYS to support comfortable, confident communication. As we talk about the ways we can support this, we’re going to go back to eight-year-old Johnny to see how therapy might look for a child who stutters.

Communication

Therapy can teach communication strategies to help people who stutter engage their listeners and strengthen the content of their message.

A note of caution before we take a look at some examples of communication strategies we might work on in therapy…

Strategies should be taught through the lens of giving a person who stutters helpful techniques to use if and when they want to reduce tension and decrease struggle. Saying it louder for those in the back: Strategies are NOT taught with the goal of reducing or eliminating stuttering.

Okay, so what kind of communication skills might an SLP work on?

Nonverbal communication. Communication isn’t just about words. In therapy, Johnny learns about other factors in communication. His SLP helps his practice relaxed, open body posture and using natural eye contact during moments of stuttering.

Self disclosure. Telling your listener about your stutter generally leads to more patient, empathetic communication. It also takes away any pressure to hide (or mask) moments of stuttering. Johnny’s SLP helps him write and practice different ways of telling people about his stutter, and they roleplay different scenarios where disclosing could feel helpful.

Stuttering openly. Whether people who stutter choose to disclose or not, therapy is a safe, supportive environment to practice stuttering openly without fear, anxiety, or pressure. Therapists sometimes will even encourage pseudostuttering (also known as voluntary stuttering, where a person stutters deliberately) as a desensitization* activity. We’ll talk about this more later.

*Densensitization is a process of increasing exposure to positive or neutral experiences with stuttering in different environments (generally starting with a safe and supportive therapy or home environment) to help decrease a person’s strong physical or emotional reactions to stuttering.

Advocacy

The ultimate goal: an individual embracing their own unique way of communication and supporting self-advocacy. Advocacy is closely linked to communication (above) and education (which we’ll talk more about below).

There are different levels of advocacy:

Self-advocacy. This often starts with self-disclosure (as discussed above) as well as practicing asking for any specific needs. SLPs can help people who stutter write disclosure script or practice different ways to ask their listener to be patient while they finish their message.

Community advocacy. This is about raising awareness and reducing stigma amongst a person who stutters’ wider community. With his SLP, Johnny makes a presentation to give to his classmates at school to help them understand more about his stutter.

Legal advocacy. At a higher level, SLPs advocate for more inclusive policies to support people who stutter. This includes advocating for better insurance policies (to cover therapy for people who stutter), better school or workplace accommodations, and promoting inclusion.

Why does advocacy matter? Because advocacy is empowering! If our goal is to support comfortable, confident communication, that’s easier when people who stutter feel empowered to advocate for themselves. And equally important, feeling empowered can boost self-esteem by helping people who stutter to embrace their communication differences.

Resilience

It’s sad but true that kids who stutter tend to have a tougher time socially at school and amongst peers, so providing social-emotional support is especially important in stuttering therapy.

Some techniques that an SLP might teach people who stutter include:

Cognitive restructuring. This is reframing negative feelings around stuttering. For example, in Johnny’s speech therapy sessions, he has written personalized positive affirmations, like “People care about what I have to say.” He uses these to talk kindly to himself before, during, and after moments of stuttering.

Desensitization. As discussed earlier in this blog, this is a process of exposure to help decrease a person’s strong physical or emotional reactions to stuttering. Pseudostuttering is a common technique used in the desensitization process. Generally starting in the safe, supportive environment of the therapy room, people who stutter are encouraged to do so on purpose. While encouraging someone to stutter more might seem counterintuitive, evidence shows this can significantly help a person reduce their feelings of fear, avoidance, and tension associated with their stutter. Caregivers and SLPs sometimes pseudostutter as part of the therapy process too.

Mindfulness techniques can help people who stutter regulate emotionally and physically. For example, in his therapy sessions, Johnny has learned about body scans, to help him identify and release any areas of tension in his body. This helps him feel grounded and relaxed.

Education

Education is about increasing knowledge both for the person who stutters and their community at large. This is a foundation for advocacy, because knowledge helps people who stutter advocate for themselves in an intentional, meaningful way.

In the early stages of providing support, education can help people recognize and normalize different ways people communicate, as well as the different ways that communication can break down.

Let’s take a look at some examples:

Building awareness of how speech feels in different environments or at different speeds. When Johnny started therapy, he started a stuttering journal. He noticed that he tends to stutter more while doing group work at school, and less during soccer practice.

Myth-busting some common misconceptions. Once, Johnny overheard someone tell his mom that Johnny probably stutters “because he’s shy.” This was confusing for Johnny, because he doesn’t feel shy! In therapy, he learns that stuttering isn’t linked to any personality traits, and he practices things to say if people ask him questions about his stutter.

Teaching friends or teachers about stuttering. This ties into the concept of community advocacy that we discussed earlier: Johnny’s presentation about stuttering helped his teachers and classmates understand more about his stutter, helping them become more empathetic listeners and increasing their knowledge of stuttering too.

Learning about famous people who stutter. One of our goals as SLPs is making sure that people who stutter know their voice, opinion, or chances of success aren’t lesser because they communicate differently. Teaching about inspirational figures who stutter can promote self-confidence and reduce stigma around stuttering.

My kid stutters. How can I support them at home?

It can feel emotional and overwhelming trying to do the best for your kid. Here, we’ll try and keep it simple with five SLP-approved tips on how to support your kids who stutter at home.

Be open about stuttering. Talking about stuttering as if it’s something to hide can build feelings of anxiety and shame. Instead, use direct language to talk about stuttering and avoid any language that suggests it needs to be managed or ‘fixed.’ This helps build a foundation of acceptance and emotional resilience.

Let them finish. You know this already, but what your kid has to say isn’t less important because they’re getting a little stuck saying it. You can show them that by letting them take their time to finish their thought without interruption.

Validate their message. When they’ve finished, emphasize that you’ve understood what they’re telling you.

Model, model, model. Kids learn by example. Model calm, unhurried conversation. An SLP might also teach you how to model easy pseudostuttering, which is when caregivers stutter on purpose in safe, tension-free environments.

Stay in the moment. Maintain typical eye contact (we’re not in a staring competition here) and keep your body oriented towards them. This shows your child that you’re listening and they have your full attention.

The bottom line:

Stuttering therapy isn’t just about stuttering itself, it’s about the whole person. One more time: our goal is to support confident, comfortable communication.

If you’d like to schedule a consultation, evaluation, or therapy with Talk Time Boston, we’re happy to help. Click here to connect with us.