Thursday, February 15, 2007

Has therapy changed? (Part II)

c) Setting up meeting is so much easier.

We find each other who live in the same area much easier to form self-help groups or just go for a drink.

d) Making a more informed decision is much easier.

The Internet lets us compare different therapies, and understand the advantages and potential pitfalls.


All this changed but that does not mean that therapies are much more effective. But I would argue that now as compared to 20 years many many more people who stutter at the very least have gone from a state of ignorance to a state of understanding much better than stuttering is about.

8 comments:

adrian said...

I agree many things have changed for the better. The research is getting closer to showing us exactly what stuttering is. The internet has allowed us to connect with other stutterers and to research therapies to learn which are bogus and which are legitimate. There are many excellent self-help groups throughout the world thanks in part to the internet.

However, with all these advances, I don't believe the therapy itself has changed for the better. It seems the more we learn about stuttering, the more clear it becomes that stuttering should not treated by speech therapists, the problem is more of a medical issue and should be treated as such. It is also interesting that the best therapies today (SSMP, the Sheehan clinic, McGuire, etc.) are at least partially based on decades old work by Van Riper, Sheehan, and others. It seems stuttering therapy is not changing for the better, we only seem to recycle old ideas.

I am sure I will offend any SLPs here, but my vision for the future of stuttering therapy does not include SLPs. I see stuttering treatment in the hands of medical doctors and/or self help therapies and support groups.

Einar said...

Yes, in the distant future, maybe... Ok, the origin is medical. But to know this doesn´t help much for the moment, as the medical advances needed are in genetics or neurology are not there yet... We simply don´t understand enough yet about how the brain works, in order to specifically influence the activities in the brain areas where stuttering originates from... So, our only option so far is speech therapy . Maybe in 10 or 20 years things may have changed... Maybe, maybe not, speech production is a highly complex area afterall, with a almost endless number of factors to be taken into account...

Ora said...

Adrian said "It seems the more we learn about stuttering, the more clear it becomes that stuttering should not treated by speech therapists, the problem is more of a medical issue and should be treated as such."

Well, sure. But where are these medical treatments? I go to a medical doctor and he can do nothing for me. I go to a speech therapist and he can offer me treatment and the reality of improvement in many cases.

We're all hoping for that "magic pill" (or some other medical treatment). But until that day - if it every comes - speech therapy is the best we have. And there's plenty of evidence that it works. (For example, look at the article that Tom referred to on the blog a couple of days ago.)

adrian said...

Ora, studies have been done showing speech therapy works, but I am still not convinced this is true. There simply is no effective way to measure treatment success. Taking speech samples in controlled environments is meaningless, as is asking clients to rate thier own success (as they may have other motives for answering positively). Besides we all have differing opinions of what success is. SLPs are now calling for "evidenced based practice" which is a joke IMHO. There is no practical way to find real evidence that stuttering therapy works.

I am not stating PWS cannot be helped by SLPs, some certainly are, but the vast majority of PWS I know have failed miserbly with therapy. The state of stuttering therapy today is apalling.

Ora said...

Adrian, I can certainly agree that the "evidence based" research has methodological problems, and there are certainly good grounds to be skeptical and to apply strict standards in evaluating it. But to say that the results of these studies are "meaningless" goes too far IMHO.

You're clearly right that people might have ulterior motives to mis-reporting their success. (As an obvious example, after spending thousands of dollars in speech therapy, someone might have an incentive to report success to the researcher.) But there are ways of controlling for this bias at least in part, and I don't think that it's justified to dismiss this all as voodoo science because of certain methodological deficiencies.

There are hundreds of "soft" studies claiming success for stuttering therapy. But there are also recently review articles (such as the
Bothe article) and meta-analyses (such as the Herder article) mentioned in Tom Weidig's Feb 8 post and my comment. These studies attempt to weed out the many hundreds of "soft" studies with untestable claims, and to select the very small number (dozens or less) which are methodologically sound (double-blind techniques, etc.). Though far from perfect, these studies are also far from valueless.

Do you have the same opinion about claims of effectiveness for psychotropic drugs, such as antidepressants? Depression is fundamentally a mental state, and mental states and moods can't (yet) be observed directly. So necessarily the effectiveness of an antidepressant drug is based on self-reporting, and (as you suggest for studies of stuttering treatment) "[it's meaningless to] ask[] clients to rate thier own success (as they may have other motives for answering positively)."

It seems to me that your rationale for questioning the validity of speech therapy applies just as well to antidepressant (or anti-anxiety) drugs. Do you really believe that therefore the evidence for the effectiveness of antidepressants is "meaningless"?

adrian said...

Ora, I don't know enough about the effectiveness studies of antidepressants to comment on them. But I do personally know people who have overcome depression and/or anxiety using these medications. I have been involved in the NSA for several years and met hundreds of stutterers, but I don't know a single one who has overcome stuttering through traditional speech therapy (I have heard stories on the internet though). I am not suggesting subjective observation is a substitute for “hard” studies, but, sometimes, the studies do not jive with an obvious reality. I also realize a therapy “success” may end his involvement in the NSA, but the numbers still don’t add up.

The nature of the problem of stuttering makes it impossible to accurately gauge success. I have done many therapies and if you look at my before and after videos, they look like I was an obvious success. I have filled out perceptions of stuttering inventories and they always have been positive following therapy. But in the long term (or even short term) they were most often meaningless, but yet I was included in the success rates.

Interestingly, the best stuttering therapists don’t think in terms of a success or failure rate. It only seems to be the charlatans who rely on so called “success rate” studies.

BTW, I was not able to read the whole Bothe article, I was only allowed access to the abstract. I am not familiar with the Herder article, where can I read that?

Thanks for the debate.

Ora said...

Adrian,

Here's a link to the summary of Carl Herder's article: http://www.asha.org/NSSLHA/publications/csp06.htm

If you send me an email I can discuss how you can a copy of both articles. I'd prefer not to be more explicit on a public discussion board. (Maybe I'm being over-cautious - who knows?)

Anyway: My email address is omccreary (at) nyc.rr.com

adrian said...

Ora, thanks for the link. I will send you a private email.