1. Indicators of Successful Change
CHAPTER 12
Indicators of Successful Change
Following Treatment 1
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2. Recovery or successful management?
Recovery for children
Successful management adults
Continued vigilance and practice
High levels of success
Appreciation of earned fluency
Lessons learned from coping
Self-directed therapy
Changing core constructs
Forgetting to be a PWS !
Cognitive change catching up 2
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3. Problems with transfer and maintenance
“The essence of effective therapy is transfer”
(Gregory, 1995, p.199)
Speaker understanding the change process
Begin at the outset (monitor/modify beyond tx)
Bring in others, objects to tx
Huinck et al. (2006) and importance of change in cognitive & emotional features 3
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4. The possibility of relapse
Relapse the rule rather than the exception
Relapse rates as high as 70–90% (but often temporary)
Part of the human condition
Similar for many problems/conditions
(Van Riper, 1973)
(Craig & Hancock, 1995)
(Sheehan, 1970; Perkins, 1979; Manning, 2001) 4
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5. Signs of relapse Frequency a poor (& not the first) indicator
More than 2–4% SS?
Fear and avoidance
A lapse or a relapse
Temporary & shallow or more serious?
Not acceptable for a week? 5
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6. Possible causes of relapse
Entropy (Egan, 2007)
Speaker leaves treatment early
Techniques are unnatural
Speaking in nonhabitual manner
Loss of spontaneity, detract from communication
May prefer old stuttering to the new fluency
Requirement of continued vigilance & effort
Neurophysiological loading (genetics) for some speakers 6
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7. Possible causes of relapse (continued)
Instability of the new (fragile) fluency
Failure to practice to level of expertise
“The old patterns are always the strongest”
Overemphasis on fluency (Yaruss, et al., 2002)
Adjusting to the role of a fluent speaker
Feeling uneasy
Deceiving self & others
Not being honest with others
Listener adjustments to the new speaker 7
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8. Predicting success Less severe at outset (Hunick, et al., 2006)
Andrews & Cutler, 1974:
Good attitudes about communicating (S-24 Scale)
Internality on the LCB (inconsistent findings)
(Langevin, et al., 2007): Maintainers had:
Higher scores on S-24
Higher scores on SESAS-Approach
Less struggle, avoidance, and expectancy 8
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9. Responses to relapse Speaker: self-diagnose & prescribe
The value of support groups
Attendance by SLPs
Increase in the 1980s (consumerism)
Support for each other (& parents too)
Decrease in isolation
Advocacy 9
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10. Only 6.1% of the participants indicated no effect.
Yaruss, J. S., Quesal, R. W., Reeves, L, Molt, L., F., Kluetz, B., Caruso, A. J., McClure, J. A., & Lewis, F. (2002). Speech treatment and support group experiences of people who participate in the National Stuttering Association. Journal of Fluency Disorders, 27,
NSA attendees indicated that participation had “very positively” affected their self-image and acceptance of themselves.
Only 6.1% of the participants indicated no effect.
No respondent indicated a negative impact. 10
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11. Guidelines for successful management by adults who stutter (Spontaneous fluency is a realistic goal for many)
no longer chasing the fluency god
obtaining treatment as necessary
living without constant fear of uncontrolled stuttering,
using the telephone without fear
speaking without scanning for feared words and situations
initiating conversations rather than choosing to be silent
speaking for herself rather than relying on others
choosing to speak even if she believes she may stutter
selecting leisure and career options that require talking without worrying about the possibility of stuttering
stuttering gently without avoidance or shame 11
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