A young pws has asked me a blunt question; he has also asked me “not to side-step the issue”!
So, with all the honesty and sincerity at my command, I will try and answer the question: how useful is speech therapy for stammering?
Speech therapy is quite useful for conditions like Mis-articulation, Nasal voice, Paralytic aphasia etc. When it comes to stammering, speech therapy (as it is practiced in India) is of little use. Yes, I am comparing the usefulness of stammering therapy with therapy for other conditions (like Mis-articulation, Bronchitis, Tuberculosis etc.) and – find it NOT useful. Why?
- No therapy offers cure, since no Therapist really understands the cause of stammering at present. Very few therapists are really specialised in Fluency disorders.
- Many therapists sincerely believe that stammering is a faulty learned behaviour; that it can be totally unlearned by constant practice and by EXACTLY following the techniques ALL the time. Modern evidence questions these assumptions. Stuttering genes have been identified. This also puts tremendous pressure on a PWS, not to stammer. If he does stammer, he feels guilty and defeated. His entire life revolves around- did I stammer? All other pursuits, considerations, interests, goals, opportunities are ignored. THIS obsession causes more harm in the long run than stammering. Few therapies care to highlight this.
- In India, it COSTS quite a lot – and no insurance or health scheme will reimburse the cost; In India, you could be paying anything between INR 12000 to 40,000 – for a 2-3 week course. A young pws told me that a Psychologist in Chandigarh offered to CURE him completely for Rs 80,000.This is one reason why TISA officially recommends ONLY those Therapists who are working in a government hospitals. How effective are these costly courses in the long run – the less said, the better.
- If it does not cure, surely it must be offering some benefit, some improvement? you will think. The benefits are largely emotional and motivational. Someone has listened to us patiently and seriously, asked questions, encouraged us to talk – all this makes us feel really good. BUT this could have been done even by an understanding teacher, sympathetic friend or sibling or parent or a self help group – with SAME benefits and for FREE. In any case the emotional benefits of paid therapy may not last beyond a few months. What does last beyond a few months is often your own self-effort and explorations beyond the original therapy. It is well known that more than 90% of pws in India, never get to see a therapist and work on their own, using their own resources and coping mechanisms. And there is NOTHING wrong with that.
- In some cases therapy generates a dependence on a particular therapist. You keep going back again and again for more of it. A young pws mentioned that his father (a pws in fifties) continues to go back to Jaipur, every 1-2 months, otherwise he (father) thinks that his speech will disintegrate totally.. In other words, speech therapy, instead of EMPOWERING you, dis-empowers you.
- A big psychological problem faced by a young pws is: “I could do this or that ONLY when I am cured of my disfluency”- The pws is often unaware of such deep seated beliefs or assumptions, governing his thoughts, decisions and life. This is a well-known phenomena and has been called “Giant in Chain” syndrome. We, the pws think we are Giants who have been chained by our stammering. Once we are out of chains we will conquer the world! Therapy often reinforces these addictive ideas – instead of challenging them.
- A better approach will be, to convince us: You can conquer the world without waiting for a CURE, by necessary and relevant hard work on communication, social skills, preparing for interviews, gaining more vocational qualifications etc etc. But many therapists further deepen this belief: how can you do this or that, without fixing your speech?. As a result, pws starts ignoring other needs and opportunities of life and focuses on FLUENCY alone. This is like treating a “liver” or “heart” and ignoring the whole human being and his circumstances, his needs.
- Some therapists will claim a cure in the case of X,Y,Z. Such a claim will be true only if it could be proved that only therapy has contributed to the cure. This could be done only through a proper controlled trial to rule out cases of Spontaneous recovery and role of other factors (placebo effect, other simultaneous psycho-social changes in the individual’s life etc.). Here is an example: Let us Take 300 pws of comparable age and stammering difficulties etc. Divide them in three groups and put them through three kind of interventions for one month:
Group A- Speech therapy;
Group B- No Therapy at all (as is the case with many of us)
Group C- Self help approaches.
Now, if we compare the outcome after 30 days and again after 6 months, what do you think will be the outcome? Will it favor speech therapy (group A) clearly? After six months? I doubt it.Such studies have not been done in India. Instead, there are only bland claims like “I have cured 10,000 stammerers” . Very few therapists are doing LONG term follow up of their clients and COMPARING it with “NO therapy” group. If therapy has “cured” an occasional pws, there are four times more such cases where a pws made a complete recovery on his/her own. Correlation does not equal to Causation.
My experience in TISA is- many pws receive no therapy but learn to manage their speech on their own OR by receiving a little emotional support from a family member, teacher, friend or colleague OR by a change in life (new job; new city, marriage, theater, martial arts, language classes, Toastmaster, Brahmvidya etc.). I have also known cases of spontaneous recovery in adult life- something which happens more often in childhood.
Lastly, I don’t blame therapists for this state of affairs. It takes 2-3 decades (even longer in India) for new knowledge to soak down into the medical education system and to get translated into clinical practice. Till then, you are responsible for your own well being and your own budget!
Finally, let me say- Speech therapists are doing wonderful job in other areas, which I appreciate and acknowledge and YOU are welcome to approach them for anything you consider fit. But TISA is not a referral center! We are just a self-help association, where we listen to each other with respect, share (not force) whatever we know, with realization that what worked for me, may not work for you; have genuine friendships and above all- have FUN! Lots of fun…
We are a bunch of Happy losers!! We have lost shame, fear, guilt – and the endless search for “cure”.
You are welcome to join our exclusive club!
Happy Dusshera and Navratra!