“Clinic fluency”

 

You may have heard the term “clinic fluency.” This term is used to indicate the improved fluency many participants achieve in the clinic setting at some time during the course of therapy.

Participants who achieve it have a tendency to become ecstatic. This “high” feeling can come tumbling down quickly, however, because of the temporary nature of this type of fluency.

The clinicians have seen it time after time, and they’re the first to caution you about its temporary nature. Once you’ve finished the course and gone home, they say, you must continue to faithfully monitor “targets” (correct speech muscle movement patterns) to avoid backsliding.

Actually, failure to continue monitoring targets may not be what makes the newly found fluency temporary. The more likely reason is that the fluency-shaping programs have a built-in flaw: By focusing on the external speech muscles, they neglect the brain, where the root cause of stuttering lies.

On a related topic: The “counting” of dysfluencies by a researcher or therapist to determine the efficacy (“success rate”) of drug treatment or fluency therapy for stutterers is a well-intentioned attempt to provide an objective measure. But this method is inherently flawed. One reason is the natural “biorhythmic-like” waxing and waning of stuttering severity from day to day. Another reason is the wild card of “clinic fluency.” The controlled environment of the clinic setting tends to diminish excitation feedback (see The two components of stuttering), which tends to increase fluency. For these reasons, any references to “success rate” seem to me to be suspect and misleading. To get a truly objective measure, you’d have to somehow “secretly” monitor the PWS to count dysfluencies in everyday speaking situations over a reasonable period of time before and after therapy. Aside from that very difficult task, I don’t know that there can be a truly objective measure.

Probably the best “doable” and realistic way to determine treatment efficacy is to rely on the subjective account of the PWS himself/herself with a caveat to be as candid as possible. Each PWS is the world’s leading expert on his/her own individual stuttering condition. Only the PWS truly knows whether improved fluency has occurred over a given period of time. If significant improvement has occurred, he/she knows it. And if not, he/she knows that, too. And the PWS is the only person who can know it.

No nonstutterer can fully understand the stuttering condition or experience what it’s like to stutter. That’s why you hear simplistic “advice” like: just spit it out; slow down–your thoughts are getting ahead of your speech; relax, etc. This is a key reason why stuttering is so damned frustrating for PWS.