This may be as much a question as a postulation. I'm not an expert on mirror neurons; you'll see that I'm struggling to understand.

Mirror neurons have been suggested in reference to the successful use of the SpeechEasy device. It is my understanding that mirror neurons are used as the young child is imitating sounds and words or phrases, but their use is discontinued when the child has intuited the rules of language to create (not imitate) generally correct (syntax, semantics, etc.) sentences, which is around age three.

As a result of this transition to a new/parallel neuron pathway, the mirror neurons have no memory of stuttering. The concept seems reasonable and extremely exciting if, indeed, we know how to access the mirror neurons.

The SpeechEasy device is said to be passive inhibition of stuttering by accessing/using mirror neurons. However, the device imitates (via echo) the individual's speech. If the stutterer continues to stutter (albeit less) or begins to regress, are the mirror neurons being taught about stuttering, or taught TO stutter?

I dare not discount the number of stutterers who find absolutely energizing results during the initial evaluation (for SpeechEasy device candidacy) of two- to four hours. Indeed, it can be and often is a joyful, tearful, family-hug time (SLP included). In fact, in my experience these patients seem to have the fewest setbacks, if any.

My question, then, is about those who find a very acceptable increase in ease of speaking and a very acceptable degree of decrease in stuttering. Without considerable emphasis on and comprehension of first seeking ease of speaking (giving up the struggle) and allowing easy ("natural") stuttering, wouldn't the stutterer reflexively rely on the amygdala (fight or flight center) to be the first responder?

Is it possible to take any age stutterer back to early imitation and on to spontaneity and in this way access and use the mirror neurons that do not know stuttering? Or can we do the same by a paradigm shift of stuttering without struggle or struggling naturally (i.e., not fearing stuttering) using the presently used neural pathway?

In my own clinical experience I have attempted the latter with very rapid success with college-age students and even some early elementary school-aged children who are able to "allow" themselves to think very differently (paradigm shift). Can we identify this personality type?

These, to me, are important questions (or possibly I am totally missing the mark here)!

While the majority may say that Johnny just won't listen, or he has exceptional difficulty learning multiplication, or he can't navigate the computer, or he won't update his leadership skills ("Johnny" can be any age), seldom does it even occur to us that Johnny does not or cannot yet ALLOW particular changes.

When we ALLOW, we open our minds to accepting change via new information processed and stored by the brain. Allowing is also a belief that a positive outcome will occur. Fear of change, or having been told or overhearing that an approach won't work or change anything often denies our minds permission – permission to allow. Even a positive statement followed by a "but" can inhibit.

Years ago, John Harrison used the Stuttering Hexagon to depict what can occur when our beliefs conflict with our intentions, as he related it to stuttering. The hexagon can be used (and has been historically) as a means to understand the dimensions of desired yet seemingly unachievable change. Now there are two pretty popular new books out there called "The Secret" and "The Law of Attraction." There is also a CD entitled "The Art of Allowing." Harvard now has a program called Mind, Brain, Behavior. Until some of my linear-thinking professional friends find out that, by golly, even Harvard includes "mind" in the title of a program, they tend to call what I've been trying to say "psychobabble." Sometimes they need other terms to be used (that don't seem so frightening, or so outside their comfort zones) in order to allow themselves to consider the potential of thinking differently about their clients, patients, spouses, or themselves!

A good example of our ability to NOT 'allow' is hypnosis. If someone absolutely refuses to be hypnotized (like to quack like a duck or otherwise act out of character as part of an act on stage or TV – or to stop smoking, for that matter) he will NOT be hypnotized. He will not allow himself to be in that receptive state, feeling it is a loss of control.

A very real possibility is that our clients/patients are not progressing because, as John Harrison might say, the intention (positive or negative) and the belief do not support each other, so change cannot occur.

The balance of power within our minds and between people was well described by SLP Dr. Goldberg. Even though we may desire change and realize it is possible, that change is either not permitted, or it becomes altered. Some who are close to the one attempting change may find "the rug being pulled out from under" them in trying to maintain the balance of power. "Yes, I want my child or spouse to improve in (fill in the blank) – however, this has been a large part of our relationship. What will happen if I continue to support the change?" is what these loved ones may be thinking.

As guides/therapists, it is my opinion that we must get a handle on the true attitudes of clients/patients and their significant others. It is our role to clarify for each client the impact of allowing and, when needed, to guide that process.

The dynamics between the challenge of learning something new or changing a behavior and the challenge of allowing the learning/changing are far greater and deeper than this blog has space for. Yet it appears to me to be vital to the professional's learning! Have you attempted the maze of terms and their relationships to understand the role of the mind's decision or indecision to allow?

I challenge you to think of one of your own plans for change that just isn't happening, or a client who is of particular difficulty (even though you see potential), in order to use the terms, and perhaps discover allowing to be the fundamental issue.

I think it was four years ago when I was given a very brief time to present on therapy techniques. In my intro, I mentioned the mind-brain-body connection. I never got there in content because my A/V equipment failed me – and now I think it was also because in the synchronicity of my learnings I wasn't really ready to discuss it. Afterward, someone said she really wanted to hear about the mind; it had captured her interest. This past weekend she presented and without so bluntly saying mind/brain/body connection I could tell by her content that she'd been on a similar path, reading the same books since four years ago and maybe having personal experiences she was trying to better understand. In a few words exchanged afterward, I sensed this is likely true to whatever extent.

To use stuttering treatment as an example of utilizing parts of what is a pathway to learning of oneself and one's own powers, I agree stuttering therapy is a course on life. As with many pervasive disorders, stuttering begins to impact self image, limiting what is possible to achieve now and in the future and facing all the myths believed by supposedly smart people. So many pervasive disorders are a lesson in life even before appropriate therapy. However, too often the pain, shame and guilt are too great to handle alone or with those who don't "get it."

It's time we go beyond what is (or was, for some) considered the foundations and traditional and measured treatment. About six years ago a parent told me that another SLP advised her not to see me because I was "unconventional." Six years ago I was defensive; now I embrace that description.

If people want some book titles, I have so many. Ask about them and please tell me where you are in integrative therapy and what you have read about the power of the mind or books that might relate to Harrison's stuttering Hexagon, as an example within the field.

"The Secret," "The Passion Test," and the Stuttering Hexagon: The first was seen on TV by everyone (it seems) except me. The second is a short, business-like (in my opinion)motivational book. The last is prominent in John Harrison's book for stutterers and public speakers. I have not yet seen "The Secret" DVD but I have read the book (which, between the lines, echoes "The Passion Test"). I've struggled with the Stuttering Hexagon with many a client and now am trying to incorporate appropriate parts of the two new books. They are all about paradigm shift; I'll be one of those to say "paradigm shift" is getting overused. I'd love to create a synonym and write several books with it being a new concept!

My experience has been that once a child or adult "gets it" (in their own way), real change CAN begin. The dilemma or barrier is getting someone to begin to allow themselves to think differently about what they want and what they can have, or do, as opposed to what they do not want. This includes parents of children with disorders like stuttering. The parent/child/adult is locked in to stopping behaviors (negative thinking)rather than believing they ARE capable of conceptualizing it completely differently, and then doing so consistently. It's the paradigm shift. It is neither side of the coin; the new perspective is WITHIN the coin. Is it easy for me or for most I've spoken with? No. To stay within a different mind-set is through determination, let alone focusing on actively receiving what we want. We challenge what we've incorporated over the years or through our parents, friends, teachers, etc. Yet, some IS what our grandparents said and we recall: "Mind over matter," for example.

Someone asked me if we are predestined or if we can determine our destiny. I've read that we choose lessons to learn in a lifetime, which seems counterintuitive to being able to do a paradigm shift. If I am in the core of the coin I can encompass both, I believe. What do you think?

J. Harrison wrote an article for ISAD 2006 called "You can sink your own ship." The final story in the article is one that enables me to think that my aforementioned readings can hold water simultaneously. Once one breaks through this hurtle, or mind barrier, it is clear, but still not easy.

If someone knows an "easy" way for children to understand, I'd love to hear it. I'd like to know if anyone has used the paradigm shift in treatment, and if so, how!

I've had clients who arrive having read much more than I about the version of paradigm shift in these books and articles. However, they "talk the talk" but can't put it into action. This is a challenge for me and for them. I must discover WHERE to start for each in terms of "doing" assignments, and they must focus, for they tell me it's too easy to jump ahead since they believe they can predict what is ahead.

I've not promoted a product or device in this blog. Generally, I speak of what I know academically, and I have demonstrated techniques, etc.

But, last week I received an email from the mother of a 7th grade client whom I saw at age 9 initially. Her mother reported that "Jane's" response to the SpeechEasy device was excellent. Yet, I could not predict for her mother how this would play out.

Well, "Jane" emailed me herself to say that she never wears her SpeechEasy device anymore. She even asked whether she could sell it. I emailed her back asking if she was kidding around. No. She said seriously that she needed the device no longer.

I cannot/would not say that this is a common outcome I experience. I can say I've witnessed remarkable changes with a variety of people, from children to adults. Just why these remarkable changes occurred with some, I do not know.

I saw a middle-aged man for an evaluation for the SpeechEasy device, and he returned about four weeks later to pick up his device. After chatting for a bit, he asked me if I'd noticed anything. Yes. He had not stuttered once, but I had not commented. He has other health issues that have returned and his doctors are puzzled as to what, after about three hours of programming the device with him and having him speak in a few different situations, could cause a seemingly permanent state of fluency. I do not know.

No, I'm NOT talking medical miracles! I'm sharing two instances when I was honestly amazed. Yes, I can speak of more; I offer these two because of the individuals' dissimilarities.

I was one who denied myself and my clients the opportunity to see if this device made a significant positive change. However, I grew personally to realize that since every stutterer is unique, who was I to deny any chance available to me to challenge "stuttering." If someone made significant improvement by standing on his head for five minutes a day, I'd say "Do it!"

So -- I learned about this device and other electronic devices, and I can say that my ability to be open to what many poo-pooed has allowed several the freedom to speak without fear.

If you'd like to know more, please ask.

Prior to the holidays, right through them and into 2007, I was ill. Ill enough that driving seemed beyond imagination, and dangerous. A fever scattered my reasoning. I could not work (and in good conscience could not expose my clients to whatever I had).

Perhaps it was a blessing that it was the holiday season; however, adult clients (and parents of young clients) wanted to be seen before the holidays 'really' began, some in between and some randomly. A few colleagues suggested I contract with an SLP to see these clients. I learned that when you establish a precedent of developing a consistent relationship as the sole therapist, clients tend to reject this option.

Many clients reported feeling they had two options: find another SLP and hope for the best, or hope they/their children could sustain their progress and that I would return soon. Some who had attended centers or university clinics had experienced transitioning therapists due to a center's staffing (loss, policy, moves, etc.) or student therapists changing clients with semesters and classes. Young adults did not seem to mind this as much as teens' parents or those over 25. I do not know if in fact the children were as concerned as their parents, and wonder if there is any research on this.

I've only been back for less than two weeks, and not full-time. Thus far I'm finding approximately 80% are indicating a return, or have returned already, though I won't know the actual percentage for a while. It seems that some return as I catch up with reports and phone contacts. I did not send out a "mass mailing" about either my absence or return to work, and I wonder if this would be easier if I could have. But, this quirky illness was a guessing game for me, so I found I could not predict the length of my absence. Now that I've returned, my choice has been to make individual contacts by email, snail mail, or phone. Why? Because my client treatment approach has been a very personal one and this seems to support the validity of that.

This is a major issue in a sole-proprietorship and could be even more so if an illness or injury causes a longer absence. Anyone considering this should investigate the value of disability insurance.

Less significant than the above, but sequelae that bring stress, guilt, and more time demands (perhaps risking relapse), are the multitude of those other commitments to the profession, community, family and friends. I have professional obligations from prior to the illness left undone. You know how it is when you are late in doing something and the later you get the less you want to make contact and seemingly have a "new excuse." Such guilt! There's family you promised to see after the holidays/illness but now you must postpone all that to build your practice up again. How patient can they be? The time crunch is on. In the back of your mind you know that you can end up sick again or worse, but how many of us listen to our bodies and our common sense under the professional (and personal) pressures that never seem to let up?

Over the years I've investigated taking my skills to a different venue because of the above and other factors, too. But I always find that what I have done and can possibly do in private practice still suits my personality best. Yet I write about this so that those who consider a private practice become more aware and ask the right questions of themselves and others before making a change.

Stuttering is involuntary by nature; a person who has this disorder cannot “make” himself stutter or not stutter. It is this component of stuttering that confounds professionals and becomes the potential basis for psych-emotional pain that a stutterer experiences, no matter their age.

We as SLPs should/must learn from the writings of stutterers, the research on stuttering, and from our own clients in order to first try to understand it. Then we should do our darnedest to aid or guide the stutterer in understanding the disorder, as well as living with and growing from nit.

We cannot/must not believe we deal with this component by even beginning to think that modifying or shaping how one stutters is the first step (or, likely any of the steps) toward positive psycho-emotional change. Ask someone who stutters about the validity of this statement.

In my opinion, dealing with this topic is individual for the stutterer and the clinician. Also, age and the impact of the stuttering must be factored in. My goal is to give just a few examples (or sites) that can be referred to that can do a better job than I can in my limited space here. Listen, read, know your options, and understand your client and you’ve done more than most already. Two warnings, however: Do not buy into any single approach for treatment (including this aspect), and acknowledge when you lack the skills, etc. for a particular person.

Please read the three items linked here to learn of a few approaches. It will make the rest of this “short” blog easier to understand, and will equip you with questions that should be asked. The links are as follows: 1. John Harrison’s ISAD 9 article 2. SpeechPathologyOnline’s interview with MC 3. Marjorie Foer’s ISAD 5 article

At this point, you (hopefully) have read the article by Marjorie Foer, CCC-SLP, Board Recognized Fluency Specialist, of Rhode Island. Years after she wrote this article, I asked her to give me just one example of how she would use her philosophy with a client. Below is her reply: “Talked with Bob again tonight. He reminds me of a race horse. Built for the race, strong, has the drive, energy and ability to endure the entire race, and determination to finish...still working on the belief that he can win. He perceives himself as less capable, he feels less confident than he "should" be, and knows that that thought trips him up.

Bob told me he ‘cares too much about blocking and stuttering’...we talked about how ‘what you focus on grows’ so, focus on what you want, not on what you don't want. I taught him how to create his first Garden, using his imagination to create a world where there are no limits. He began learning how to re-program his subconscious mind where his ‘blocking and stuttering programs are housed,’

He enjoyed discovering this place and tapping into his subconscious mind to learn more about his beliefs. He's learning to listen to himself in a new way, to trust himself and believe in himself. He already knows that when feels confident and comfortable that he doesn't stutter. This inner work is increasing his confidence and comfort when speaking in any situation, he reports a definite decrease in his self-consciousness, an increase in his comfort when speaking one to one and small groups, even a large group!

He also reports an increase of "being in the zone of speaking using his natural fluency". In those moments, he's winning the race, everything is in synch, what a gift to watch him discover his innate ability to speak fluently and be in his own personal stride. We talked about praising himself, celebrating like he would with a little kid, every time he is in synch with his stride. This is a reinforcer for the subconscious mind, letting it know that this is the direction he wants it to go in. He understands the importance of focusing on what he wants.”

You read the interview of MC. Today he facilitates a support group, speaks about stuttering to groups and individuals, and has even created his own approach. I think in doing this, he doesn’t just deal with his fluency but also with continuing to work on psycho-emotional pain (past and present). Much of his present pain deals with the ripple effect of past behaviors related to acting out his anger and pain. His guides now are numerous, yet special, and the approaches he has chosen reflect what he can accept and/or work through.

A nine year-old boy found progress in therapy only after finding trust in the therapy room. He spoke of hating himself and not being able to say more than half the alphabet (meaning the words that began with certain letters). Two sessions of tears and acknowledging the ripple effect and the bottom of his iceberg growing was a great beginning. He began to see what he could control (such as playing baseball and being very good at it), but it became evident that he would not address a major issue: his parents. His father was stern and overly controlling, but his mother compensated for this by indulging him, and by asking his teachers not to require him to give oral reports, as an example. In this case, until I was able to get the parents to “see” and to “feel” in a new way, progress became difficult. When I began to approach the father (who brought him to therapy each time), I received the nod of “yes, but later.” This is one time when a referral was in order, or I didn’t look at enough approaches. He is one of those we all have at some point that we will always wonder about. Parents are so important, and we should start with them simultaneously with the child.

“Rich” is a great example of the need to involve parents immediately. I had begun to give parents a manageable quantity of quality materal to read about stuttering and its many facets. Meanwhile, I had already learned that I had to make parents responsible for doing the reading! Nonetheless, I began to note that if “Rich” had a couple of difficult days, or his stuttering was too public for their personal comfort, he received a gift or gifts of significant monetary value. This case took time because the parents could not meet with me at the same time and because they really felt that these gifts were a gesture of love. Yes, they loved him. They fairly quickly (given the initial reading material) figured out that they were not reinforcing love, but that the child was learning that stuttering could reap rewards.

Yes, you could challenge me there, but only if you generalized “Rich” to stuttering and to reinforcement. That is where knowing the child and parent and their dynamics is critical to appropriate intervention.

I hope we have given you much to consider and a reason to learn more about this aspect of therapy.

Support Groups

There are “too many to count” types of support groups. Within the area of stuttering they come in many different flavors. For example, some actually do therapy-type exercises, while others see it as a time to feel comfortable about being personal about their stuttering, and some have a variety of activities such as guest speakers and informational topics, etc.

Therefore, anyone forming a group must think about who should be part of the group. It seems the most common group form is that of adults (with age defined by group leaders); however, parents feel a need to get together as well as for their children who stutter, to have somewhat structured time together.

Some groups request a fee or donation, while others are free. Which of these motivates consistency in attendance? This is a valid question.

Many individuals feel they need not respond to individualized (electronic) announcements, but rather prefer to attend as they can. Well, I have a problem with no RSVP, but do feel there should be freedom to attend at will or according to need. Your thoughts?

It is known, however, that at least for local stuttering support groups their longevity is short, relatively speaking (I believe the average is 2½ years). When numbers dwindle but the leaders are faithfully there with plans (and space, and their time), I think everyone becomes frustrated. Many people have shared with me their experiences of finally giving up the group’s existence, but that seems unfair to those who continue to need them.

Perhaps you can respond as to what you have done or experienced. The group that I and another person facilitate (for adults) has been in existence for five years. We’re searching for fresh ideas and I’m sure other group leaders/facilitators are as well, so we can all benefit by sharing.

Some times I am still so surprised at the very interesting or special people we have the opportunity to meet and our possible impact on them.

To stay within HIPPA reg's, I must refrain from some particulars, but the general information is the heart of my blog, anyway.

I recently saw someone who was offering me vague answers or no information to many questions I ask on first seeing someone. Finally, I put pen and paper down and explained more thoroughly why I was asking questions he may not have expected (like genetic history). After some silence ( a lesson I learned has been to 'allow' silence to have its due time!), he slowly began to tell me his history. Then he began to softly weep. He had been put on a boat by his parents (alone) to be taken to a safer place than where they lived in Vietnam. From there and knowing no English, he was flown to his aunt's house in the USA. He had no contact with his parents for many, many years and spoke of years of nightmares. His memory of his boat trip were vivid and frightening to him. There was silence again.

He said he'd never opened up to anyone like that before. It was the beginning for us to be able to offer him the help he needs. I must add that he is very successful in terms of being an entrpeneur. I hope to learn more because I am fascinated by his life; maybe that will happen or perhaps not. But, I know again, that in our field, we do meet such people and can make the big difference!

Often it takes reading out of field to dig deep and find the words needed to express our own feelings or feelings we perceive. And, I think, often it takes some significant personal experience(s) to begin to understand how we can , without intending, place or add to the guilt and shame of parents, children and adult clients, due to perceived or spoken of inadequacies. There are many definitions of terms, so I've chosen some I've read or I've put together that seem to fit best here. Guilt has been defined as a set of thoughts, feelings and a belief. It is noted to be a primal reaction to believing , or being told, a "should(not), ought (not), can (not), must (not). Next enters the inner voice: " I am bad". ' Shame has been described as a painful emotion caused by a strong sense of guilt, embarassment, unworthiness or disgrace. 'Normal' shane does not seriously impair our overall self-esteem or relationships or cuase too many of the symptoms of guilt that goes beyond the norm. This is confusing and I still weed through it when I see my clients. But, as I try and perhaps you will, it may forever alter how you speack withe those you see and SEE those with whom you speak. I've heard that after guilt and shame comes hiding. Our cients hide their problems. That takes an incredible amount of energy and toll. The futility of it is likely known. Can you describe to a child what 'emotions' are or how to use them to actually increase their satisfaction with life? I hope you give that thought, too, and respond to all of us if you have your own way that you think does truly help! There is a high suicide rate amoung some of the disorders we see and, not surprisingly, there is also a high burn out rate amoung the SLP's who choose to treat those with the disorders. I hope you read this slowly and want to delve deeper so you are a better clinician.