Friday, July 08, 2005

Fluency shaping vs van Ripper

In a previous post, I have said that there are really two types of therapies out there that seems to be effective to some degree, at the very least on a short-term basis. Yesterday I was meeting up with Einar, who is from Island but was born in Luxembourg. He did a lot of therapy a la van Ripper. And we were discussing the pro and cons of therapies. He is rather more in favour of van Riper type therapies.

Let me just briefly summarise the two types of therapies. Pls correct me if I get it wrong. I first tried to use Wikipedia to cut and paste a definition, but its definition is so bad. It does not even mention fluency shaping, but only onetherapy del Ferro. This is mainly a breathing technique therapy based in Amsterdam. I wouldnt be surprised if someone close to them has modified the Wikipedia content to their advantage.

Fluency shaping is about working directly and mainly on your speech. The aim is to practise ways of speaking that enhance your fluency like gentle onset, slow speech, or connecting sillables. Van Riper-like therapies, also post-block modification therapies, (I hope I dont mix up things here) foccus on reducing the (overt and covert) symptoms of stuttered speech, but also reducing or easing stuttered speech. The aim is cognitive control over your (symptom) behaviour to change it, mostly post-stuttering event like avoiding eye contact, reducing fear of speaking, voluntary stuttering, stuttering easier. There are many variants of these two types and some even combine elements of both.

What is my view point? In a sense, they are concentrating on different aspects of PDS, and have "different philosphies". I guess, a van Ripperist would say: Avoiding eye contact has nothing to do with stuttering at all. It is a secondary symptom. So why dont you just keep on stuttering, but train yourself to normalise your natural eye contact. Fear and Tension is not directly related to stuttering. Why not stuttering without fear and shame rather than stuttering with fear and shame? So all these secondary symptoms are unnecessary and you really can unlearn them. And then I guess you could argue the same with stuttered speech. Why stutter hard with tension? Just try it without tension and easier. The result really is that ultimately many become very fluent as well. I guess as the secondary symptoms are considerably enhancing disfluencies, and most likely implicitly they might gain more control over their speech production processes. Fluency shaping really starts the other way round. It says, the problem is disfluent speech, which leads to all the secondary symptoms like eye avoidance, fear, shame, tension, etc. So by making people (more) fluent, you automatically eliminate all the secondary symptoms. It acts directly on speech production, the primary symptoms.

What is my experience? I personally did not benefit from van Ripper therapies much at least from a fluency point of view, but I do think that all the sessions did help me meeting other people and understanding that having PDS is just one part of your existence. Fluency shaping therapies had a much more dramatic effect on my fluency. But I know that other people experienced the opposite. There are no right or wrong in a person's experience.

I find it very difficult to change my behaviour when I am talking, i.e. take cognitive control. I remember that I did several months of post-block modification therapy (individual and group) at Indiana University (US). I even had problems identifying when I was stuttering! Then they gave me some fluency shaping therapy exercises, and within 1-2 weeks I was much more fluent. It didnt last very long. I remember being shocked at how fluent I was. It was May, and the end of my exchange year in the US, I had 5 months until the start of term in the UK. They even offered me to stay the five months and give me a job at the departement. But I declined, and went cruising through California with a friend of mine for 2-3 weeks and then back to Luxembourg. That was the most stupid decision I ever took in my life. I should have gone back after California to work on my speech. And they should have told me how stupid my decision was and done more lobbying! But they didnt. Too polite, too female. Actually, I probably would have changed my mind with more pressure. I guess the experience of being fluent and potentially more fluent was strange, uncomfortable and a bit scary tilted the balance in my decision making. I also did a fluency shaping therapy in Kassel, which produce more much long lasting effects.

To summarise, fluency shaping therapies make me much more fluent, van Ripper therapies were helpful on a psychological/social level but I could have gotten the same from well-informed self-help groups. What's funny, is that when I meet a fluency shaping person they say I think fluency shaping would help you, if I meet a van Ripper person they say I think van Ripper would help you. I think they are both right!! ;-) not being sarcastic here.

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