Fluency Shaping Stuttering Therapy:

Techniques and Theory

Thomas David Kehoe

Owner, Casa Futura Technologies
Member, American Speech-Language Hearing Association

This free e-book is downloadable from

http://casafuturatech.com/medications-for-stuttering/

© 2013 Thomas David Kehoe

Last update: 2013 July 6
 Table of Contents
Fluency  Shaping  Theory  ...........................................................  1  
Motor  Learning  and  Control  ...............................................................  2  
Closed-­‐Loop  Motor  Control  .......................................................................  2  
Open-­‐Loop  Motor  Control  ..........................................................................  4  
Learning  New  Motor  Skills  .........................................................................  6  
Speech  Motor  Control  ............................................................................  7  
Prosody,  Parameterization  Schemata,  Response  Selection  .........  8  
Snake  Oil  and  Charlatans  .........................................................................  11  
Slow  Speech  Is  Not  the  Goal  of  Stuttering  Therapy  ......................  12  
Analogy  to  Touchtyping  ...........................................................................  14  
Using  DAF  to  Slow  Speaking  Rate  ........................................................  15  
Three  Stages  of  Motor  Learning  .....................................................  16  

Fluency-­‐Shaping  Techniques  ...............................................  20  

Choosing  a  Speech-­‐Language  Pathologist  ........................................  20  
Is  Self-­‐Therapy  an  Option?  ......................................................................  21  
Slow  Speech  with  Stretched  Vowels  ............................................  21  
Relaxed  Breathing  ................................................................................  23  
Phonation  .................................................................................................  26  
Gentle  Onsets  with  Vowels  ......................................................................  27  
Gentle  Onsets  with  Words  .......................................................................  29  
Voice  and  Voiceless  Consonants  ...........................................................  30  
Continuous  Phonation  ...............................................................................  32  
Gentle  Onsets  with  Multisyllabic  Words  ...........................................  33  
Articulation  .............................................................................................  34  
Biofeedback  ............................................................................................  36  
Which  Fluency  Skills  Need  Feedback?  ...............................................  36  
Van  Riper’s  Prediction  ..............................................................................  37  
 Biofeedback  Devices  ..................................................................................  39  
Efficacy  Studies  of  Fluency  Shaping  Programs  ........................  40  
Consumer  Reviews  of  Fluency  Shaping  Programs  ................  41  
Hollins Communications Research Institute (HCRI)  .........................  42  
Ross Barrett’s Precision Fluency Shaping Program (PFSP)  .........  50  

Beyond  Fluency  Shaping  .......................................................  52  

Improving  Cognitive  Stage  Speech  Motor  Learning  ..............  52  
Improving  Associative  Stage  Speech  Motor  Learning  ..........  53  
Lower  Vocal  Pitch  .......................................................................................  53  
Automatic,  Effortless  Fluency  .........................................................  55  
Where  Stuttering  Therapy  Fails  ............................................................  56  
Increasing  Force  and  Speed  ....................................................................  57  
Increasing  Force  ..........................................................................................  58  
Increasing  Speed  .........................................................................................  59  
Where  to  Practice  Force  and  Speed  ....................................................  59  
Reinforcing  On-­‐Target  Speech  ........................................................  60  
Swimming  Analogy  .....................................................................................  60  
Speech  Buddies  ............................................................................................  61  
My  Romantic  Disaster  of  1996  ..............................................................  62  
Start  a  Virtuous  Cycle  ................................................................................  63  
Practicing  Under  Stress  ............................................................................  64  
Practice  Scheduling  ....................................................................................  65  
Extinguishing  Old  Skills  ............................................................................  65  
Intensive  Residential  Speech  Therapy  Programs  .........................  67  
Your  Ideal  Practice  Schedule  ..................................................................  67  
How  Long  Does  Autonomous  Learning  Take?  ................................  68  
Zen  in  the  Art  of  Stuttering  ..............................................................  70  

REFERENCES  ..............................................................................  79  

 Thomas David Kehoe

Fluency Shaping Theory

Watch a stutterer struggle to talk. You see that stuttering is
primarily overtense, overstimulated respiration, vocal folds, and
articulation (lips, jaw, and tongue) muscles. Brain scans of adult
stutterers have found overactivity in the left caudate nucleus
speech motor (muscle) control area, during stuttering. This
suggests there’s a neurological basis for these overactive speech-
production muscles.
Fluency shaping therapy treats this problem. It trains stutter-
ers to speak with relaxed respiration, relaxed vocal folds, and
relaxed articulation muscles.
This chapter is longer than any other chapter. Fluency shap-
ing therapy is where you learn to talk fluently. If you don’t
master these skills, none of the other treatments—medications,
anti-stuttering devices, handling stress better, and psychological
interventions—will be fully effective.
Conversely, you may have tried fluency shaping therapy and it
didn’t work for you. What I call “fluency shaping therapy” is
different from the fluency shaping therapy practiced at most
speech clinics. I’ve added a theoretical basis for why fluency
shaping works (motor learning and control); new therapy skills
(e.g., lower vocal pitch); and a chapter about making fluent
speech automatic and effortless (“

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Fluency Shaping Techniques and Theory

Beyond Fluency Shaping,” page 52).

Motor Learning and Control

Motor learning and control is the study of how brains execute
complex muscle movements. Physical therapy and occupational
therapy students study motor learning and control. Speech
pathology students don’t (at least not for treating stuttering).
Sports coaches also study motor learning and control. The
principles of motor learning and control are usually illustrated
with examples from gymnastics, tennis, golf, or other sports.

Closed-Loop Motor Control

A muscle movement takes about 200 milliseconds (one-fifth of a
second) to execute:

1. Sensation, or neural transmission from sensory recep-

tors in your eyes, ears, etc., to your brain, takes about 15
milliseconds.
2. Perception, which retrieves long-term memories to or-
ganize, classify, and interpret your sensations, takes
about 45 milliseconds. Perception changes sensation da-
ta into perceived information or meaning.
3. Response selection takes about 75 milliseconds. You use
current perception and past experiences to formulate a
course or action. For example, in baseball, a batter

2
 Thomas David Kehoe

watches the pitcher and decides whether to swing at a

pitch, hit or bunt, hit to left field or right, etc. Psycholo-
gists differentiate conscious decisions from unconscious
translations, or relating a particular stimulus to a par-
ticular response.
4. Response execution of an action plan—a step-by-step
sequence of events that make up the planned move-
ment—takes about 15 milliseconds. In these events,
motor neurons carry signals from the brain or spinal
cord to muscles.

Under closed-loop motor control you use perception to con-

sciously, continuously adjust muscle movements. For example,
threading a needle. You look at the needle. You look at the
thread. You move the thread towards the needle. You look at the
needle again. You look at the thread again. You correct your
movement. You do this many times until the thread is through
the needle.
Each stimulus-response adjustment takes at least 200 milli-
seconds (one-fifth of a second). If you make ten adjustments, the
task takes at least two seconds.
Closed-loop motor control has two advantages. It enables
precise control, and it enables execution of novel movements

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Fluency Shaping Techniques and Theory

(activities you’ve never done before). For example, threading a

needle on the deck of a rolling ship.
Closed-loop motor control has two disadvantages. It’s slow,
and it requires your full attention.
Closed-loop motor control is good for learning new skills, or
for executing skills you rarely need. But you don’t want to use
closed-loop motor control for fast-paced, frequently used skills.

Open-Loop Motor Control

200 milliseconds—a split second—may seem fast, but it’s too
slow for many motor tasks. For example, a gymnast’s double-
back somersault requires muscle movements lasting only tens of
milliseconds.
How is it possible to execute a muscle movement in tens of
milliseconds, when the sensation to execution cycle requires
about 200 milliseconds? Simple—don’t do the sensation, percep-
tion, and response selection stages. Just do the response
execution. This final stage of muscle movements can be per-
formed in as little as 15 milliseconds. This is called open-loop
motor control. Open-loop motor control is the execution of
preprogrammed movements, called a motor program, without
perceptual feedback.
The colloquial term for this is “muscle memory.” For exam-
ple, gymnasts practice hours each day for years, until their

4
 Thomas David Kehoe

muscles seem to know what to do without the mind getting

involved.
After winning the gold medal in gymnastics at the 1984
Olympics, Mary Lou Retton said that coach

Bela [Karolyi] can really teach, I’ve learned so much

from him. Many long hours were spent in the gymna-
sium …repetition, feedback, repetition, and
experimentation. Somehow, after a lot of bumps and
bruises, it got easier, as if I could float.

Karolyi added,

Someone should be able to sneak up and drag you out

at midnight and push you out on some strange floor,
and you should be able to do your entire routine
sound asleep in your pajamas. Without a mistake.
That’s the secret. It’s got to be a natural reaction.

Open-loop motor control has two advantages:

1. It’s fast. You can execute muscle movements with split-

second timing.
2. It requires no attention. Movements under open-loop
control are automatic and mentally effortless.

Open-loop motor control has three disadvantages:

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Fluency Shaping Techniques and Theory

1. If your motor program contains errors, you’ll execute

the errors. You can’t stop and adjust a mistake. You
may not even be aware that you made a mistake.
2. Developing open-loop control of a motor skill requires
long practice—especially for adults. Children learn
some motor skills easily, that adults struggle for years to
master.
3. Novel or new situations can’t be handled. For example,
in the 2000 Olympics, officials set the gymnastic vault
two inches too low. The officials didn’t correct the
height until 18 of the 36 women had performed. These
18 athletes performed poorly, eliminating their hopes of
winning medals. The American hopeful, Elise Ray, suf-
fered a “devastating fall.”1

Learning New Motor Skills

Use closed-loop motor control for learning a new motor skill.
Then gradually increase your speed until you can perform the
motor skill using open-loop motor control.
For example, a tennis or golf coach will have you start with
swinging the club or racquet slowly, while she adjusts your
knees, elbows, etc. When you’ve perfected your form, your coach
will have you gradually increase the speed and force, while
maintaining form. After extensive practice you’ll be executing
perfect open-loop motor programs. You’ll smash the ball hard
6
 Thomas David Kehoe

and fast and accurately without paying attention to your elbows

or knees or anything other than the ball.

Speech Motor Control

Normal speech uses open-loop motor control:

1. Speech is fast. Phonemes (speech sounds) are typically

20 to 40 milliseconds.
2. Speech is complex, requiring coordination of hundreds
of muscles to produce sounds.
3. Speech is automatic and effortless. Speakers think about
what they’re saying, not about the muscles they’re mov-
ing.

Fluency shaping stuttering therapy uses closed-loop speech

motor control. You consciously relax your breathing. Then, as
you exhale, you slowly increase your vocal fold tension, until
your vocal folds hum. Then you slowly move your lips, jaw, and
tongue to form the sounds of each word. Stuttering is impossible
when using closed-loop speech motor control. Stuttering
disfluencies are open-loop speech motor programs.
Making stuttering impossible might sound appealing, but

1. Closed-loop speech motor control is slow. Closed-loop

motor control takes about 200 milliseconds per muscle
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Fluency Shaping Techniques and Theory

movement. Open-loop speech sounds are typically in

the 20-40 millisecond range. Closed-loop speech motor
control slows speech five to ten times, or one or two se-
conds per syllable.
2. Closed-loop speech motor control demands your full
attention. You must pay attention to your breathing, vo-
cal folds, and lips, jaw, and tongue. This isn’t a problem
when reading a list of words, but is difficult to use in
conversations.
3. Your speech loses prosody (emotional intonation). You
sound like a robot with dying batteries.

A fourth possible problem may be that stutterers learn

speech motor skills slower and retain them less than non-
stutterers.2

Prosody, Parameterization Schemata, Response Selection

Why closed-loop speech motor control loses prosody is an
interesting question.
A study of television talk show guests found that 94% of what
viewers remembered was prosody, or what actors call emoting, or
what lawyers call affect.3 Much—or almost all—meaning is
communicated by prosody. Schemata theory suggests that you
learn certain invariable characteristics of a motor skill, and you
learn certain execution rules or parameterization schemata. You
8
 Thomas David Kehoe

then combine the invariable elements with the rules to produce a

motor plan.
For example, in a public speaking class I read algebra prob-
lems in an angry voice, in a sad voice, and then with the rhythm
and emotional intonation of a stand-up comedian. The algebra
problems were invariable—I read the same algebra problems
each time. I changed the parameterization schemata to com-
municate different emotional states. Amazingly, the audience
laughed at the “punchlines” when I did the stand-up comedy
delivery. Even though the “punchlines” were just numbers, I
made the audience think that a punchline was coming, and they
laughed at the right times. 94% of the joke was the delivery.
Accents are another parameterization schema that conveys
meaning. For example, a waitress from Oklahoma asked me if I
wanted ah-iss. When I figured out that she was asking about ice,
I affirmatively answered yay-iss. I knew the invariable character-
istics of “yes,” and when I’d learned the rules of an Oklahoma
accent—e.g., break monosyllabic words into two syllables—I was
able to say a word I’d never heard.
In normal speech, we produce prosody through unconscious
response selection of parameterization schemata. Different
environmental cues cause us to select different responses. For
example, you walk into a church and immediately lower your
vocal volume. But if no one else is in the church, you could yell

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Fluency Shaping Techniques and Theory

“I hate to wear pants!” while turning somersaults down the aisle.

OK, that’s one of my eccentric hobbies, but most people
wouldn’t do that.
Another example is a person who grew up spending sum-
mers in Vermont and winters in Georgia. When she’s in New
England she speaks in a Yankee accent. When she’s in the South
she switches to a southern accent. Different environmental cues
cause her to unconsciously select different parameterization
schema to produce each accent.
Like prosody and accents, stuttering is a parameterization
schema. A stutterer responds to environmental cues to uncon-
sciously select fluent speech parameters or stuttering speech
parameters, which are then combined with invariable character-
istics of words to produce fluent or stuttered speech. Thus you
can treat stuttering by training stutterers to respond differently
to environmental cues (“Error! Reference source not found.,”
page Error! Bookmark not defined.), or by training stutterers to
use fluent speech parameterization schema (this chapter).
Training a stutterer to not feel fear or anxiety when answer-
ing the telephone is changing the response selection to an
environmental cue (a ringing telephone). In contrast, training a
stutterer to speak with relaxed vocal folds changes a speech
parameter.

10
 Thomas David Kehoe

Snake Oil and Charlatans

Closed-loop speech motor control is the “wizard behind the
curtain” of many stuttering therapy programs. Switch any
stutterer to closed-loop speech motor control and he or she will
be completely fluent.
You can switch to closed-loop speech motor control by mak-
ing any speech process conscious instead of unconscious. For
example, focusing on relaxed, slow breathing will switch you into
closed-loop speech motor control, with your vocal folds and
articulators (lips, jaw, and tongue) following right along. Or you
can focus on producing “gentle onsets” with your vocal folds.
This will switch your breathing and articulators to closed-loop
speech motor control. Or you can focus on “reduced articulatory
pressure” and your breathing and vocal folds will follow.
Always these “wizards” claim that their therapies are 100%
effective if the stutterer “really tries,” that is, if he devotes his full
attention to closed-loop speech motor control. If he instead pays
attention to a conversation, switches into open-loop speech
motor control, and then stutters, then he wasn’t “really trying.”
And the closed-loop speech motor control effect has caused
speech-language pathologists to hypothesize that stutterers have
something wrong with their breathing, or with their vocal folds,
or with their articulators, or even that stutterers’ brains are slow
in some way. That latter theory is like saying that student drivers

11
Fluency Shaping Techniques and Theory

have slower brains than Indy 500 race car drivers because
student drivers are safe at 20 mph but crash when driving at 200
mph. Everyone performs slowly when attentively learning a new
motor skill, then their speed improves with practice. For stutter-
ers in speech therapy, the new motor skill is fluent speech.
Some speech clinics tell stutterers that they’ll always have to
speak slowly. That’s like training a student driver to drive 20
mph, then telling him never to go faster.

Slow Speech Is Not the Goal of Stuttering Therapy

If you learn tennis or golf, you’ll use closed-loop motor control
when you’re learning to swing the club or racquet. As you
practice, increasing your speed and force, you’ll gradually
reinforce open-loop motor programs.
Similarly, you’ll use closed-loop speech motor control when
working with your speech-language pathologist. She’ll train you
to move your respiration muscles, vocal folds, and articulators
correctly to produce fluent speech. When you’ve mastered this at
a very slow speaking rate, she’ll help you to gradually increase
your speaking rate, while staying fluent. The goal is fluent,
automatic, effortless, normal-sounding and normal-rate speech.
Slow speech is not the goal of stuttering therapy.
Severe stutterers usually don’t mind learning closed-loop
speech motor control. If your stuttered speech is ten to twenty
times slower than normal speech, then closed-loop speech motor
12
 Thomas David Kehoe

control, which is typically five to ten times slower than normal

speech, will double your speaking rate. Some severe stutterers are
even willing to use closed-loop speech motor control outside of
the speech clinic. Record conversations with and without using
closed-loop speech motor control. Count your syllables per
second. You may find that closed-loop speech motor control
feels slower but is actually faster than your stuttered speech.
But mild stutterers don’t like closed-loop speech motor con-
trol. They can hide their stuttering by avoidance and substitution
(of certain sounds, words, or speaking situations). They can
sound fluent at a normal speaking rate. Closed-loop speech
motor control would “advertise to the world” that they have a
speech disorder. If they’re embarrassed to admit that they stutter,
they won’t want to use closed-loop speech motor control.
Mild stutterers should consider that closed-loop speech mo-
tor control enables them to say anything they want. For example,
a mild stutterer wants to buy a chess set. He’s afraid of s words,
so he calls a toy store and asks if they have “one of those games
with kings and knights and castles.”
The puzzled clerk responds that the store has many games
with kings and castles and knights. After five minutes of conver-
sation, the clerk asks, “Do you mean chess sets?” The stutterer
says yes. The clerk never knows that the caller is a stutterer, but
she thinks that the caller is an idiot. The stutterer wasted five

13
Fluency Shaping Techniques and Theory

minutes because he wasn’t willing to use ten seconds of slow

speech.
Or the stutterer drives to the store and looks for a chess set,
without calling first. If the store doesn’t have chess sets he wastes
an hour, to save ten seconds. Saying what you want slowly is
faster than saying something else, or not speaking at all.
Americans speak around 165 words per minute. Fast talkers
who speak more than 190 words per minute get complaints from
listeners unable to understand them. In contrast, Walter
Cronkite trained himself to speak 124 words per minute in his
newscasts. “Uncle Walter” may have earned his title as “the most
trusted man in America” in part because he spoke clearly.

Analogy to Touchtyping
I’ve never taken a typing class. I type with two fingers, about 45
words per minute. (I’m probably the world’s fastest two-fingered
typist!)
I tried to learn touchtyping. My speed dropped to less than
ten words per minute. Touchtyping not only slowed me down, it
required my full concentration. I couldn’t think about what I was
writing, only about moving my fingers.
I gave up touchtyping within a week. If I’d kept at it, my
speed would have increased and eventually surpassed my two-
fingered typing speed. I might have been typing 80 words per

14
 Thomas David Kehoe

minute now. The mental effort would have diminished, until

touchtyping was automatic and effortless.
Coaches say they’d rather work with a novice who’s never
played their sport, rather than with an experienced player who
uses incorrect techniques. It’s easier to learn a new motor skill
correctly than it is to correct an incorrect, deeply ingrained
motor skill.
Stuttering is difficult to overcome because we learned to talk
incorrectly. We have to learn new, fluent speech motor skills,
and we have to not use our old, disfluent speech motor skills. We
learned these disfluent speech motor skills in childhood, when
our brains were growing. Now the disfluent speech motor skills
are hardwired into our brains. Making fluent speech automatic
and effortless, for a stutterer, demands more time and effort than
learning a new sport or vocational skill.

Using DAF to Slow Speaking Rate

Many speech clinics use delayed auditory feedback (DAF, see
page Error! Bookmark not defined.) devices to establish fluency
using closed-loop speech motor control. With only a little
training a DAF device can help a stutterer maintain perfectly
paced, steady, mentally effortless, slow closed-loop speech motor
control.
The user’s speaking rate can adjusted by turning a knob. A
typical protocol is to train a stutterer to use closed-loop speech
15
Fluency Shaping Techniques and Theory

motor control with a 200-millisecond delay and one to two

seconds per syllable. The stutterer practices this until he’s 100%
fluent. That usually takes only one or two therapy sessions. (A
study found that without training a 195-millisecond delay
reduced stuttering only 85%.4)
When the stutterer can speak 100% fluently, the speech-
language pathologist then has the stutterer use one- or two-
second stretched syllables without the DAF device; in increasing-
ly stressful situations (e.g., calling the speech-language
pathologist’s answering machine); and then with the DAF device
adjusted for faster speaking rates. The stutterer must stay on-
target with 100% fluency, or go back to using the DAF device at
200 milliseconds and a one- to two-second speaking rate.
Typically, a 100-millisecond DAF delay is used with half-
second per syllable stretched speech, a 75-millisecond delay is
used with quarter-second per syllable “slow normal” speech, and
a 50-millisecond delay is used with a normal speaking rate.

Three Stages of Motor Learning

We learn new muscle movements, or motor skills, in three stages:
1. In the cognitive stage, an instructor demonstrates the mo-
tor skill to you.
2. In the associative stage, you learn to perform and refine
the motor skill. You perform the movements under
closed-loop control.
16
 Thomas David Kehoe

3. In the autonomous stage, the motor skill becomes auto-

matic. You perform the muscle movements without
mental effort, under open-loop control.
For example, imagine yourself learning golf or tennis. You
watch the coach hit a few practice balls. Then the coach hands
you the club or racket. The coach guides you through a swing,
telling you to drop this shoulder or extend that forearm. Soon
you can execute the swing perfectly, if you fully concentrate on
each movement. You then practice the swing, and your game
improves.
A few years later a novice admires your excellent swing and
asks you to explain how you do it. “I don’t know,” you say, “I just
do it without thinking about it.”
For another example, last summer I tried mountain bike rac-
ing. In four races I crashed four times. I then hired a coach. In
twelve hours over three weeks, he taught me how to ride down
hills, make tight turns, jump my bike over logs, climb hills, plus a
few tricks such as picking up a water bottle off the ground.
Then I quit mountain bike racing. I’d completed the associa-
tive stage and learned how to do each skill. Now I would have to
practice these skills hours a day, several times a week for years to
make the skills automatic in the fast, high-stress environment of
racing. In other words, I could do any of the skills if I thought
about it, but my body didn’t automatically execute the moves

17
Fluency Shaping Techniques and Theory

without conscious mental effort. I decided that mountain bike

racing isn’t important enough to me to spend thousands of
hours practicing skills.
Stuttering therapy follows a similar course. A speech-
language pathologist can show you the fluency skills—relaxed,
diaphragmatic breathing; vocal fold relaxation (gentle onsets);
and relaxed articulation muscles (lips, jaw, and tongue)—in ten
minutes. Teaching you to execute these skills takes a few hours.
You can then speak fluently in the speech clinic, when you
mentally concentrate on each skill. Almost everyone successfully
completes these cognitive and associative stages.
You then have to practice these skills thousands of hours to
make them automatic and effortless, in high-stress situations.
Many stutterers fail at this stage. But no one intentionally fails
for the reasons I quit mountain bike racing. No one rationally
weighs the alternatives and says, “Talking isn’t important to me.
I’ll learn sign language instead, or write notes.”
Instead, stutterers fail at the autonomous stage because
speech clinics don’t train this well. Speech clinics call this trans-
fer. Perhaps your speech-language pathologist takes you to a
shopping mall for a few hours. But the autonomous stage re-
quires thousands of hours of conversations, including high-stress
conversations. Stutterers habitually avoid such conversations.
You may find that the skills you learned in the low-stress speech

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 Thomas David Kehoe

clinic fail in high-stress conversations. Your therapy progress

begins to fail. You revert to old habits and avoidances. Your
stuttering returns.
The next chapter will detail the autonomous stage. The rest
of this chapter is about the cognitive and associative stages.

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Fluency Shaping Techniques and Theory

Fluency-Shaping Techniques
Fluency shaping therapy programs typically begin with slow
speech with stretched vowels, then work on relaxed, diaphrag-
matic breathing, then work on vocal fold awareness and control,
and finally work on relaxed articulation (lips, jaw, and tongue).
These techniques are all abnormal. They all produce “weird”-
sounding speech. The idea is to go to extremes when practicing
(in the speech clinic or at home), and then in “real world”
conversations you reduce the techniques so that you sound
normal, and speak fluently.

Choosing a Speech-Language Pathologist

Find a speech-language pathologist who specializes in stuttering.
About 100,000 speech-language pathologists are licensed by the
American Speech-Language Hearing Association (ASHA). Of
these, fewer than 400 are board-certified Fluency Specialists.
These specialists are listed on the website

http://www.stutteringspecialists.org/
The Stuttering Foundation of America also lists speech-
language pathologists. This webpage is

http://www.stuttersfa.org/referral.htm
You could also go to a National Stuttering Association local
support group and ask for recommendations. Their website is

http://www.nsastutter.org/
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 Thomas David Kehoe

Is Self-Therapy an Option?
You can’t learn motor skills out of a book. You can learn the
cognitive stage from a book or video. Analogously, many vide-
otapes offer to teach golfers how to improve their swing.
But the associative stage requires feedback. A trained individ-
ual must observe you and tell you when your performance is
correct, when your performance is incorrect, and what to change
to correct your performance.
You can watch my videos demonstrating slow speech with
stretched vowels, and lower vocal pitch with relaxed breathing
and relaxed vocal folds, at
http://www.youtube.com/CasaFuturaTech. If it helps you, great.
If not, make an appointment at a speech clinic.

Slow Speech with Stretched Vowels

Let’s start with how not to do slow speech with stretched vowels:

“I” < pause> “am” < pause> “an” < pause> “American.”

Saying “I am an American” normally takes about 1.5 seconds

(seven syllables at about five syllables per second). By silently
pausing two seconds between words, and saying each word
normally, the phrase would take about eight seconds. That
wouldn’t improve your fluency.

21
Fluency Shaping Techniques and Theory

Instead, stretch each vowel for a second or two. Also stretch

voiced consonants (e.g., /m/, /n/, /r/) a little longer then normal,
but not as long as vowels. Articulate voiceless consonants (e.g.,
/k/) lightly and quickly, just touching your lips or tongue and
then moving to the next voiced sound.
Join the syllables together, with no breaks or pauses between
words. The result should sound like:

“IIIIIIIIaaaaammaaaaannAAAAAmmeeeeerriiiiiiiikaaaaann”

Be sure that each syllable is held equally. In other words,

“American” should take four times longer to say than “I.” Don’t
make “American” the same length as “I.”
Should you hold each syllable for one second or for two se-
conds? Some speech clinics start with one-second stretched
syllables, when other speech clinics start with two seconds per
syllable. No research has investigated which is more effective. If
you’re 100% fluent at one second per syllable, that should be
slow enough. But if you’re not 100% fluent at one second per
syllable, use two seconds per syllable. According to motor
learning theory, you need to execute slow enough that your form
is perfect, but there’s no reason to execute slower. Use a stop-
watch to check that each syllable is the same length. If you have a
DAF device, set the delay to 200 milliseconds. Then hold each

22
 Thomas David Kehoe

syllable until you hear yourself in the headphones. Check your

stopwatch and you should see that each syllable is between one
and two seconds.

Relaxed Breathing
Place one hand on your stomach. Breathe so that your hand
moves out when you inhale, and in when you exhale.
Notice that you’re taking many small breaths. Your inhale
and exhale times are equal.
This is relaxed or diaphragmatic breathing. This is the way
people normally breathe.

SPEECH BREATHING
Large breath

Long exhale
Fast inhale

Small breaths

RELAXED BREATHING Equal inhale and exhale time

Figure 7: Thoracic vs. Diaphragmatic Breathing

Now switch to upper-chest breathing or thoracic breathing.

Take a big breath, using your upper chest muscles to expand
your lungs. Release the air slowly, while maintaining this upper
23
Fluency Shaping Techniques and Theory

chest muscle tension to hold air in your lungs as long as possible.

When you’ve released the air, quickly take another breath, filling
your lungs as rapidly as possible. Practice switching between
thoracic and diaphragmatic breathing.
Thoracic breathing increases our lung capacity. It enables us
to maximize our physical exertion. Our “fight or flight” instinct
switches us to thoracic breathing. We’re then better able to run
or fight.
Some individuals hyperventilate or switch to thoracic breath-
ing when experiencing non-physical stress. Stress reduction
classes teach students to relax by switching to diaphragmatic
breathing.
We also use thoracic breathing when talking. A large breath
with a long, slow exhale enable us to speak many words before
pausing for another breath.
Well-meaning people who know nothing about stuttering
may tell you to “take a deep breath” before talking. But the
opposite is better advice. Diaphragmatic breathing is the founda-
tion of many stuttering therapy programs. Taking smaller
breaths with your diaphragm can help you relax and talk
fluently.
Try it. Your relaxed breathing will relax your entire body.
Most importantly, it will relax your vocal folds, and then your

24
 Thomas David Kehoe

lips, jaw, and tongue. Your voice will deepen and sound
confident and even “sexy.” You’ll feel relaxed and confident.
Practice a word list (page Error! Bookmark not defined.)
using diaphragmatic breathing. Read a magazine page aloud
using diaphragmatic breathing.
You’ll soon discover a few problems trying to speak with di-
aphragmatic breathing. Each breath is small, so you’re able to say
only a few words on each breath. Inhale time and exhale time are
equal, so you have long pauses between short phrases. You’re
unable to speak loudly.
Like other fluent speech motor skills, speaking with dia-
phragmatic breathing is abnormal but useful. Include speaking
with diaphragmatic breathing in your stuttering therapy practice
exercises. Mastering this skill will enable you to speak short
phrases fluently in stressful situations. For example, a police
officer pulls you over for speeding. You don’t need to say much
besides, “Yes, officer,” and “No, officer.”
And as you master speaking with diaphragmatic breathing,
you’ll develop something in-between thoracic and diaphragmatic
breathing. This “in-between” breathing will be more relaxed
than thoracic breathing, yet your phrase length and vocal volume
will be within the normal range.

25
Fluency Shaping Techniques and Theory

Phonation
Your vocal folds are flaps of muscle in your throat. Making your
vocal folds vibrate produces sound. This sound then becomes
your voice. Vocal fold vibration is called phonation.
Two conditions produce phonation. First, you release air
from your lungs. Next, you tension or tighten your vocal folds.
Place your fingers on your throat. Exhale and hum. Your
fingers should feel a vibration. This is your vocal folds vibrating.
Stop humming, and feel the vibration stop. Practice switch-
ing your phonation on and off.
Now vary your phonation in two ways. Change your volume
(hum louder, then quieter). Change your pitch. Hum up and
down a musical scale.
How did you do that? You varied your volume of exhalation,
i.e., you increased or decreased the air releasing from your lungs
by tensing or relaxing your thoracic (upper chest) muscles. More
exhalation enabled you to produce more volume.
You also varied your vocal fold tension. Tense vocal folds
produce a higher-pitched voice. Relaxed vocal folds produce a
deeper or lower-pitched voice.
Tense your vocal folds as hard as you can. You’ll block your
throat, not allowing any air to escape. If you take a deep breath
and then block your throat, your increased lung pressure makes
your chest stronger. Like inflating a tire to carry a heavier load,

26
 Thomas David Kehoe

this is effective for lifting a heavy weight. But it’s not a good way
to talk!
Practice one more aspect of phonation. Take a breath and
hold it, tense your vocal folds, then release air. Switch to the
other way: take a breath, release a little air, then tense your vocal
folds. Note that the former produced a croak. The latter pro-
duced a nice hum. This shows that phonation requires timing
two muscle movements: exhaling a little air, and then starting to
tense your vocal folds.
You now see that three things can go wrong with phonation:
1. Releasing too much or too little air (inadequate breath
support).
2. Overtensing your vocal folds. Under stress, you may try
too hard to talk, tense your vocal folds too much, and
block off air flow. This results in a silent block.
3. Mistiming exhalation and vocal fold tension. A goal of
stuttering therapy is train the stutterer to consciously
breathe, release a little air, gently tense his vocal folds, and
then begin to talk. This exercise is called gentle onset or
easy onset.

Gentle Onsets with Vowels

To hit a baseball home run, you use all of your arm muscle
strength. In contrast, to putt a golf ball a few feet, your arm

27
Fluency Shaping Techniques and Theory

muscles are more relaxed than tense. Phonation is like putting a

golf ball, not hitting a home run.
To use gentle onsets (also called easy onsets), take a relaxed
breath with your diaphragm. Release a little air. Say ah as you
gradually increase vocal fold tension. Feel your vocal folds begin
to vibrate. Increase your vocal fold tension, until you reach
normal speaking volume. Gradually reduce vocal fold tension,
until you’re silent. Time this to take about two seconds. You
should be able to do this on one breath, without reaching residu-
al air.
You can buy computer applications that graph your phona-
tion contour. Applications include Dr. Fluency, Speak:Gentle,
and the Computer-Aided Fluency Establishment and Trainer
(CAFET). Or you can use a sound-recording and -editing
application (many such applications are available free). On a
computer monitor, your vocal volume should look like this:

Figure 8: Gentle Onset Voice Contour

28
 Thomas David Kehoe

Practice fifteen gentle onsets with the fifteen vowel sounds

(say the vowel, not the word):

Front Vowels: long e, as in beet

short i, as in bit
long a, as in bait
short e, as in bet
short a, as in at

Back Vowels: long u, as in boot

short o, as in book
long o, as in boat
aw, as in cause
ah, as in cot

Central Vowels: ow, as in about

short u, as in but

Dipthongs: long i, as in bite

oy, as in boy
au, as in bough

Gentle Onsets with Words

Now say “dog,” stretched over two seconds, with gentle onset.
Begin with a quiet, gentle /d/ sound. Switch to the /aw/ vowel
29
Fluency Shaping Techniques and Theory

sound and gradually increase vocal volume. After one second,

gradually reduce vocal volume. Switch to the /g/ sound, and stop
vocal fold vibration.

Figure 9: Gentle Onset with Words

Voice and Voiceless Consonants

All vowels use phonation. Some consonants use phonation, i.e.,
are voiced. Other consonants are produced without phonation,
i.e., are voiceless. You can whisper these consonants.
Place your fingers on your throat. Say ah to feel your vocal
folds vibrating. Say the following words and decide whether the
initial consonant is voice or voiceless:

/h/ hail /w/ whale

/f/ famous /v/ vacant
30
 Thomas David Kehoe

/s/ saber /z/ zany

/sh/ chenille /zh/ jeté (a ballet move)
/ch/ chive /j/ jive
/thr/ throw /th/ those
/p/ pipeline /b/ bison
/t/ tie-dye /d/ diner
/k/ kindness /g/ guide

The first column was voiceless. The second column was

voiced.
Did you notice that these sounds were pairs? /h/ and /w/
have your lips, jaw, and tongue in the same positions. The
difference is that your vocal folds vibrate to produce /w/, but
don’t vibrate to produce /h/.
To say a word with a voiceless consonant, take a breath, let
out a little air, shape the consonant with your lips, jaw, and
tongue, then switch to the vowel and gently start your vocal fold
vibration.
Practice a word list (page Error! Bookmark not defined.).
Keep your fingers on your throat to feel your vocal folds switch-
ing on and off as you go from voiced to voiceless sounds. Stretch
each word to two seconds.
Because most words contain both voiced and voiceless
sounds, we switch our vocal folds on and off many times each

31
Fluency Shaping Techniques and Theory

second while talking. A core behavior of stuttering is an inability

to switch phonation on at the right moments. The timing can be
as precise as one one-hundredth (1/100) of a second.
Normal speech is about five syllables per second, or 0.2 se-
conds per syllable. For this practice you’re using two seconds per
syllable stretched speech, or ten times slower than a normal
speaking rate. Slowing down your speech helps you develop
awareness and control of speech elements that are otherwise too
fast to notice or control. If you play a sport, such as tennis or
golf, your coach might videotape your swing and then replay it
back in slow motion. This improves your awareness and control
of the motor skill.

Continuous Phonation
Stuttering therapy sometimes teaches techniques that produce
fluency, but sound abnormal. For example, speech with dia-
phragmatic breathing produces fluency, but shortens phrase
length and makes you pause between phrases. The immediate
goal is to use these techniques to produce fluent speech, and over
time reduce the degree of exaggeration, until your speech sounds
normal. Another goal is have a “trick” to use in stressful situa-
tions, such as speaking to a police officer.
Continuous phonation is such a technique or trick. Recall
that consonants come in voiced/voiceless pairs. Simple substitute

32
 Thomas David Kehoe

a voiced consonant whenever you need to say a voiceless conso-

nant.
For example, “Patty” becomes “Baddy.” Say each word slow-
ly, with your fingers on your throat to feel your phonation.
You’ll feel your vocal folds switch on and off for “Patty,” but stay
on for “Baddy.”
If you shorten the consonants and stretch your vowels (pro-
ducing a slower speaking rate), listeners won’t hear the
difference between “Patty” and “Baddy.”

Gentle Onsets with Multisyllabic Words

Practice using a gentle onset on each syllable. Go loud on each
vowel. On the consonants, relax, go quiet, and lightly and
quickly articulate the sounds.
For example, on “American,” you start with a gentle onset on
the initial /uh/. Open your mouth wide at the loudest point in
the phonation contour.
Take the /uh/ sound down in volume, while at the same time
closing your mouth to articulate the voiced /m/. Bring the /eh/
sound up in volume. Again, open your mouth wide at the
loudest point in the phonation contour.
Take the /eh/ sound down in volume, while at the same time
reduce your jaw opening (but don’t close your lips) to articulate
the voiced /r/.

33
Fluency Shaping Techniques and Theory

Open your mouth wide again for the /ih/ vowel on the third
syllable.
Now you get to the only voiceless sound in “American.” Be-
fore the /k/ sound, take the down the volume of the /ih/ vowel.
Whisper the /k/. If you block, you dropped the /ih/ volume too
fast. Try again with a long, slow decline in volume on the /ih/.
Articulate the /k/ lightly, for just a moment.
If you still block on the /k/, change it to a voiced /g/. In other
words, say “Amerigan.”
Use another gentle onset on the final /eh/ vowel. Reduce
your volume on the final voiced /n/ consonant.
The result is an abnormal-sounding “sing-song” speech pat-
tern. Your jaw opens and closes noticeably on each syllable.
While you won’t want to talk like this for the rest of your life, for
practice or in stressful situations this technique helps you use
gentle onsets, continuous phonation, and a slower speaking rate.

Articulation
The third set of speech muscles (after respiration and phonation)
are your articulators: lips, jaw, and tongue. These muscles form
your vocal fold humming into sounds and words. If you phonate
without moving your lips, jaw, and tongue, all that comes out of
your mouth is humming. The goal of this last target is to relax
these muscles.
Reduced articulatory pressure is also called “soft targets.”
34
 Thomas David Kehoe

Lightly touch your tongue for the /t/. Lightly close your lips
for the /b/. Keep your speech production muscles relaxed for all
sounds.
The wrong way is to tense your lips and tongue and jaw too
much, and hold this tension too long.
You’ve learned to stretch and emphasize vowels. Now work
on de-emphasizing consonants. If you stretch and emphasize
vowels, and de-emphasize consonants, you should be able to
speak fluently.
Read another word list (page Error! Bookmark not de-
fined.) aloud. Feel how your lips, jaw, and tongue move to
change sounds. Say each word with normal articulation tension.
Then say the word again with tense articulation. Then say the
word again with relaxed articulation.
Some stuttering therapy programs at this point devote many
hours to teaching the stutterer the correct lips, jaw, and tongue
position for each of the 40+ sounds of English. This is unneces-
sary, in my opinion. Stuttering is not an articulation disorder.
Stutterers don’t, in general, misarticulate sounds (e.g., saying /w/
instead of /v/). Stutterers instead need to learn to relax their lips,
jaws, and tongues.
There are exceptions. If your speech-language pathologist
diagnoses that you have articulation problems, or if you speak

35
Fluency Shaping Techniques and Theory

with a foreign accent, do articulation therapy to train you to

place your lips, jaw, and tongue in the correct positions.

Biofeedback
The associative stage of motor learning requires feedback. In
sports this is called knowledge of results. For example, in golf or
tennis you see where the ball goes after you hit it. Playing golf or
tennis on a dark, foggy night would be difficult.
Feedback quality is affected by speed. If you hit ten golf balls
on a dark, foggy night, then the next day find one of the balls 150
yards away, you’ll have no memory of what you did right to hit it
so far.
Feedback quality is also affected by accuracy. If you and your
buddy each hit a golf ball, and one ball goes 150 yards but you
don’t know whose ball it was, you have inaccurate feedback.
Or the observer gets bored. If you hit golf balls for hours, and
have a person telling you how far the balls go, sooner or later the
person will stop paying attention.

Which Fluency Skills Need Feedback?

When you’re learning fluent speech motor skills, you need
knowledge of results. Some skills are easy to observe. For exam-
ple, resting your hand on your stomach tells you whether you’re
using diaphragmatic (relaxed) breathing or thoracic (speech)
breathing.

36
 Thomas David Kehoe

Your articulators (lips, jaw, and tongue) are a little harder to

be aware of, as you can’t see them. But you have good proprio-
ceptive awareness of these muscles, so developing awareness and
control isn’t hard.
Your vocal folds are another story. These muscles are deep in
your throat. You can’t touch them or see them. Most people
don’t even know they have vocal folds.
The most difficult feedback is with the timing of all this. For
example, your speech-language pathologist tells you to exhale a
little air and then increase your vocal fold tension. You do this
slowly and correctly. Then she tells you to increase the speed.
You must execute these movements within hundredths of a
second. You can’t tell whether you’re doing it right, and most
speech-language pathologists can’t either. A fluency specialist
who’s helped hundreds of stutterers has better-trained ear and
visual skills and gives better quality of feedback than a speech-
language pathologist who’s never treated a stutterer.

Van Riper’s Prediction

In 1974, Charles Van Riper (a stutterer and a “founding father of
the field of speech-language pathology”) predicted what a future
historian would say about the next hundred years of stuttering
treatments:

37
Fluency Shaping Techniques and Theory

Our scrutiny of two old books on the nature and treat-

ment of stuttering* that were published in the early
1970s reveals a vast collection of misinformation, igno-
rance, and benightedness. Preventative and remedial
practices were characterized by a primitiveness and
crudity that now seem appalling. The lot of the stutter-
er at that time must have been a very sad one.
Nevertheless, in the last two decades of the twentieth
century, we do find some progress in solving the
problems of this ancient affliction.5

Van Riper then predicted the organization of stuttering self-

help groups, a scientific journal devoted to research about
stuttering, and the certification of speech-language pathologists
specializing in stuttering. All of these have happened. He then
predicted that a stutterer would invent

a biofeedback computer system that provided a

backflow of error information from sensors that moni-
tored [breathing, speech motor tension, and
articulation errors and then] stimulated the pain cen-
ters when error signals appeared or alternatively
stimulated the pleasure centers when the stutterer did
not make these errors but instead spoke fluently.
[The biofeedback computer system] was able to
make…adult stutterers completely fluent after just a
few hours [in the speech clinic, and use of a portable
device produced carryover fluency and the subjects
were able to stop using the device] after only a month
of intensive therapy. Despite his success, we note [that
the inventor] found it very difficult to convince the stut-

*
Van Riper’s two books were The Nature of Stuttering (1971) and The
Treatment of Stuttering (1973).

38
 Thomas David Kehoe

tering specialists of his time that his invention was tru-

ly effective.6

Biofeedback Devices
Biofeedback is the measurement and display (to the user) of a
physiological activity, to enable the user to improve awareness
and control of the activity. Biofeedback machines:
• Provide faster, more precise, and more reliable feedback
than a human observer.
• Provide real-time feedback, beeping the instant you make
a mistake.
• Provide accuracy measuring things humans can’t see or
hear.
• Never get bored, even after hours of practice.
• Free the speech-language pathologist to spend more time
on psychological aspects of stuttering.
• Are effective for persons who learn visually rather than
aurally.
• Are designed for home practice use as well as clinical use.
But you still need a speech-language pathologist to train you
to do the target motor skills (cognitive stage). The machines can
only help you to refine your skills (associative stage).
Read more about biofeedback devices on page Error!
Bookmark not defined..

39
Fluency Shaping Techniques and Theory

Efficacy Studies of Fluency Shaping Programs

A rigorous study followed 42 stutterers through the three-week
program at the Institute for Stuttering Therapy and Treatment
(ISTAR) in Edmonton, Alberta, Canada.7 The fluency shaping
program was based on slow, prolonged speech, starting with 1.5-
seconds-per-syllable stretch, and ending with slow-normal
speech. The program also works on reducing fears and avoid-
ances, discussing stuttering openly, and changing social habits to
increase speaking. The program includes a maintenance pro-
gram for practicing at home. The program reduced stuttering
from about 15-20% stuttered syllables to 1-2% stuttered syllables.
Twelve to 24 months after therapy, about 70% of the stutterers
had satisfactory fluency. About 5% were marginally successful.
About 25% had unsatisfactory fluency.
A more recent study of the ISTAR program found that im-
proved results, with 71-86% of graduates retaining fluency two
years post-treatment.8
A study of Precision Fluency Shaping found that a three-
week intensive program followed by one year of follow-ups
reduced stuttering from 7.1% to 1.6%. A year later the average
stuttering was 3.6% (a 50% reduction in stuttering).9
After completion of another “smooth speech” fluency shap-
ing stuttering therapy program, about 95% of subjects were “very

40
 Thomas David Kehoe

satisfied” or “satisfied” with their speech at the end of the treat-

ment. A year later, their satisfaction dropped to 43%.10
Another study reported that 100% of subjects who completed
a year-long “prolonged speech” fluency shaping stuttering
therapy program were able to speak nearly fluently. But two-
thirds of the stutterers who started the program didn’t complete
it.11

Consumer Reviews of Fluency Shaping Programs

To read more reviews of stuttering treatments, written by
consumers, or to write a review of a therapy program you’ve
done, see my website:

http://casafuturatech.com/stuttering-therapy-reviews/

41
Fluency Shaping Techniques and Theory

Hollins Communications Research Institute (HCRI)

About: The Hollins Fluency Program is a prolonged speech
(fluency shaping) stuttering therapy program. It is a 12-day
residential therapy program in Roanoke, Virginia.
Evidence: No clinical trials have been published about the
Hollins Fluency Program. Their website claims that “Ninety-
three percent of HCRI program participants achieve fluency by
the end of our 12-day stuttering treatment program.”

From StutteringTherapyReviews.com:

One Size Fits All

Feb 15, 2008
Reviewer: Guillermo from New York, NY
For 11 days you work very hard, by yourself, in a little cubical.
Then, on day 12, you are told to make phone calls using the
robot-like speech you have learned (for mild stutterers, like me,
this can be very hard to do). That same day they take you to a
mall, and they instruct you to go around the stores asking
questions using what you’ve learned. Some people could do it,
they could behave like retards in the eyes of the people at the
mall (i.e. “Caaaaaaaaaaaaaan yyyyyyyyyyyou teeeeeeeeeeeeeell
mmmmmmmmmmmmme thhhhhhhhe tiiiiiiiime?). But others, like

42
 Thomas David Kehoe

me, could not. I simply could not make myself do it. That’s where
Hollins fails miserably, or at least where it failed for me: they
treat everybody in the same way, ignoring the psychological
aspects of stuttering, the years of accumulated fears, of
avoidance, that each of us, some more, some less, have dealt
with. Finally, their success stats are a sham. I’m sure they
counted me as a success. But I was not.

From StutteringTherapyReviews.com:

Hollins Communications Research Institute (HCRI)

Feb 01, 2008
Reviewer: Len from New Jersey
I took the HCRI program in the 80’s and even though it may
be based upon sound speech principles and provide speech
targets that can work when used, they however mostly fail and
cannot be recreated successfully in many important social
situations. The inventor of this program is Dr. Webster is a
behaviorist, that is, he believes strictly in behavior modification
as the only cure to solving stuttering. And even though stutter-
ing is very amenable to his speech targets, and even though he
has come up with a very important tool, he has done only half his
job. I say this because, not only do the majority of people who
take his program continue to have problems in using his speech

43
Fluency Shaping Techniques and Theory

targets which work ONLY in relaxed situations, Dr. Webster,

when questioned about this, simply blames the stutterer for
not follwing his speech target rules. Yes, Dr. Webster has come
up with something very important, but his behaviorist approach
as the only answer falls very short of being truly successful.

From StutteringTherapyReviews.com:

A program that was beneficial for many years

Jan 18, 2008
Reviewer: Paul from Norway
Of the many programs I’ve tried for relief of very severe stut-
tering, this one was among the best. I worked hard at the
targets and practiced diligently, often daily, for 16 years. I
loved the experiences of fluent speaking, and enjoyed many
periods of sustained total fluency, sometimes lasting for
months. But I also endured major relapses when I slacked off in
practicing, and these were very frustrating. Eventually I came to
the realization that I could just peacefully accept my stuttering
- and that putting the time and effort into practicing and
monitoring targets was no longer worth the associated pres-
sures and relapse frustrations. I began to realize that working
for consistent fluency was not essential for my current life
happiness. Today I’m no longer fluent, but my average disfluency
44
 Thomas David Kehoe

is less than it was before I entered Hollins. Though the program

has flaws (no work on psychological issues), I still do recommend
it for those willing to work hard to improve their fluency.

From StutteringTherapyReviews.com:

Doesn’t live up to the [claimed] success rates

Apr 07, 2007
Reviewer: Adrian from Glenmoore, PA
I did the original three-week program in 1997 followed by
weeklong refreshers the following two years. The physical
techniques made me basically fluent inside the clinic, but were
basically useless outside the clinic. As a previous reviewer
mentioned “leaving a calm relaxed non-judgemental environment
without any means for carryover is a set up for failure.” Hollins
claims in their Internet advertisements that “93% gain fluency.”
My understanding is these numbers are taken from exit inter-
views inside the clinic. This number is meaningless because it is
not representative of the client’s speech in the real world. The
Hollins marketing is not ethical in my opinion. Hollins does a good
job of teaching a good technique. But with no work on desensiti-
zation, emotional baggage, and no meaningful follow up support, I
would not recommend the program.

45
Fluency Shaping Techniques and Theory

From StutteringTherapyReviews.com

Feb 08, 2007

Reviewer: Ed Sandri from Gaylord, Michigan
Hollins provides speaking skills they call targets to improve
the speach of the stuttering. For 12 days you practice by
yourself on a computer and with other stutters. Hollins has
been around for some 30+ years and there targets are based on
their research on stutterers. You learn to be your own speach
therapist. After you “graduate” you have access to their
newsletters, refresher courses, summer alumni gathering, and
online computer practicing. Yes, you have to practice when
finished and the practice is tedious, but I don’t know of any
better method of improving and eliminating stuttering. I met
some great people there. I do recommend Hollins.

From StutteringTherapyReviews.com

Why intensive fluency programs fail adults who stut-

ter
Jul 14, 2006

46
 Thomas David Kehoe

Reviewer: Anonymous from New York, USA

I took the original Hollins Course in Virginia for 3 weeks and
then a refresher at Hollins in 1990. I found the course helpful,
but not maintenance offered. I also don’t understand why PFSP
does not offer training for SLPs. Would I recommend this
course. Yes, if and only if you first find a practice group in your
area with other PWS and a SLP who can provide maintenance.
Otherwise leaving a calm relaxed non-judgmental environment
without any means for carryover is a set up for failure.

47
Fluency Shaping Techniques and Theory

Institute for Stuttering Treatment and Research (ISTAR)

About: ISTAR is a prolonged speech (fluency shaping) stut-
tering therapy program. It is a residential therapy program in
Edmonton, Canada.
Evidence: About ten clinical trials have been published
about the ISTAR program. Two studies found that the program
was effective for 70% of adults and teenagers, marginally
effective for an additional 5%, and ineffective for 25% of stut-
terers.

From StutteringTherapyReviews.com

The Stars at ISTAR

August 04, 2007
Reviewer: Fluencymom from Algonquin, IL
I traveled from Chicago to Edmonton, AB with my 15 yr old
son to the ISTAR 3 week clinic. He stuttered as a preschooler,
got tx & was fluent but became a severe stutter again. ISTAR is
a godsend!!! The slp called us and was so warm and positive we
all felt very hopeful. She really CARED about helping us. The clinic
staff gave my son skills to help him increase fluency & stop a
stutter and smoothly recover. The way they addressed the

48
 Thomas David Kehoe

emotional side was also phenomenal. His slp was a former client
of ISTAR. The fun part was learning how to help him & seeing him
successfully practice talking on the phone, in a job interview, and
give a speech in a big lecture hall. SO MANY folks ask us where he
got tx to become so smooth in just 3 weeks and maintain it even
in stressful situations. If you want to change your life go to
ISTAR!! I’ve told all my fellow physicians about it. People travel
from all over the world to go to ISTAR.

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Fluency Shaping Techniques and Theory

Ross Barrett’s Precision Fluency Shaping Program (PFSP)

About: The Ross Barrett’s PFSP is a prolonged speech
(fluency shaping) stuttering therapy program in Norfolk, Virgin-
ia.
Evidence: No clinical trials have been published about the
program and the website makes no claims about effectiveness.

From StutteringTherapyReviews.com

An outstanding Precision Fluency clinic

January 19, 2008
Reviewer: Paul from Norway
This is a review of the Precision Fluency Shaping clinic run by
Ross Barrett at the Eastern Virginia Medical Center in Norfolk: I
attended Ross’s weeklong refresher programs 4 or 5 times
during the period 1988-1992, after earlier completing the full
3-week program at Hollins. Ross is a person who stutters, a
speech pathologist, and a master at use of Precision Fluency
targets. He is knowledgeable and personally experienced in
practical aspects of fluency shaping, and able to give additional
insights into target use that Hollins, with its more rigid struc-
ture and all-fluent clinicians, cannot. In addition, I found Ross to

50
 Thomas David Kehoe

be a sensitive, friendly and caring therapist. Unlike Hollins, he

understands that relapses should not be blamed on the client,
and that targets cannot be maintained 100% of the time. For
my assessment of Precision Fluency Shaping in general, see my
review of Hollins. For any who wish to learn those fluency shaping
targets with a master, I recommend this clinic.

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Fluency Shaping Techniques and Theory

Beyond Fluency Shaping

Advances in the field of motor learning and control could make
fluency shaping therapy more effective.

Improving Cognitive Stage Speech Motor Learning

In the first or cognitive stage of motor learning, you observe an
instructor performing a motor skill that’s new to you. But
speech-language pathologists may be the wrong people to model
fluent speech motor skills. When learning a new motor skill,
novices learn best by observing another novice making mistakes,
then getting it right.
In contrast, observing a skilled person perform the task
flawlessly doesn’t do you much good. For example, millions of
people watch Michael Jordan play basketball. Few of those
people could go out on a basketball court and repeat his moves.
The exceptions are people who are already skilled and want to
get better, e.g., college basketball players can improve their game
by watching the pros.
A stutterer watching a speech-language pathologist model
gentle onsets or pull-outs is like Joe Sixpack watching Michael
Jordan. The stutterer might learn more if the speech-language
pathologist modeled the mistakes her other clients have made,
and then showed how to correct those mistakes. Or the speech-
language pathologist could prepare a video of her previous

52
 Thomas David Kehoe

clients making mistakes, and then learning to correct their

mistakes.

Improving Associative Stage Speech Motor Learning

In the second or associative stage of motor learning, you learn to
perform and refine a new motor skill. But are there better fluent
speech motor skills than the skills taught in fluency shaping
stuttering therapy programs?

Lower Vocal Pitch

Speaking at a lower vocal pitch requires relaxing one’s vocal
folds, and reduces stuttering.12 Unlike other fluency-enhancing
techniques such as a slow speaking rate or gentle onsets, listeners
like the sound of a lower vocal pitch. A lower vocal pitch com-
municates confidence and relaxed authority. Some listeners even
say that a lower vocal pitch sounds “sexy.” Speaking with a lower
vocal pitch makes one feel relaxed and confident. Yet this
technique is not a target behavior in fluency shaping stuttering
therapy programs.
According to multichannel processing theory, performing
two tasks is easier if you integrate the tasks. For example, danc-
ing while playing the saxophone is easier than playing tennis
while playing the sax. Using fluency shaping motor skills while
paying attention to a conversation should be easier if the motor
skills relate to the conversation. If you’re trying to communicate

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Fluency Shaping Techniques and Theory

that you’re relaxed and confident, then using a “slow normal”

speaking rate with a lower vocal pitch should be easier than
using gentle onsets.
This technique can be trained by using relaxed, diaphragmat-
ic breathing while feeling (with your fingers or your throat)
and/or listening to your vocal fold vibrations. Begin by hum-
ming or saying “ahhhh.” Bring the pitch up, then down, then up
again, then down further. Repeat until your feel and hear your-
self humming at a very low pitch. Now speak slowly, stretching
vowels, while keeping your vocal pitch low.
Notice that your vocal volume drops as you lower your vocal
pitch. Don’t try to speak loudly with a low vocal pitch, you may
damage your vocal folds. A lower vocal volume is usually ac-
ceptable unless you’re speaking in a noisy environment or to a
person with hearing loss.
Frequency-shifted auditory feedback (FAF) induces a lower
vocal pitch in non-stutterers.13 One study tested whether a half-
octave FAF downshift changes stutterers’ vocal pitch. The results
were negative,14 but I believe that a greater frequency shift,
combined with the headphones we use today, would have
positive results. In other words, if you have an FAF device, set it
for one-half or one octave down, and use the best-quality head-
phones you have. Then say “ahhhh” or speak slowly with

54
 Thomas David Kehoe

stretched vowels, trying to slow your vocal fold vibrations to

match the frequency you hear in the headphones.
Lower vocal pitch may be difficult for women speech-
language pathologists to model, or for children or women
stutterers to use (Lauren Bacall might contradict that state-
ment!). Adult men are more capable of lowering their vocal
pitch. Listen to an audio book read by a male actor and then
listen to another audio book read by a female actor: you’ll likely
hear that the male actor can perform a wider variety and range of
character voices.

Automatic, Effortless Fluency

The third or autonomous stage of motor learning moves you
from closed-loop motor control to open-loop motor control. In
stuttering therapy, the autonomous stage makes fluent speech
automatic and effortless.
Autonomous stage motor learning results from:

1. Practicing target muscle movements faster and harder,

2. While making no errors,
3. In stressful situations,
4. With an ideal practice schedule,
5. For about three million repetitions.

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Fluency Shaping Techniques and Theory

For example, you take tennis lessons. Your coach shows you
how to grip the racket properly, and swing at the ball. At first
you execute this movement slowly, with little force. As your skill
improves, you swing faster, and hit the ball harder. Whenever
you make a mistake, your coach stops you and makes you begin
again, slowly. At first your coach hits you easy balls. Then he hits
harder balls to you, making the game stressful. Then you play
tennis regularly. Over several years your game improves.

Where Stuttering Therapy Fails

Most stuttering therapy programs do little to train autonomous
motor learning:

1. Your speech-language pathologist tells you to make a

conscious effort to speak fluently. You’re told that if
your fluency fails, it’s your fault for not concentrating
on your speech.
2. All practice is done with relaxed speech-production
muscles. You never increase muscle tension.
3. All practice is done at slow speaking rates.
4. All practice is done in the speech clinic, or at home
alone. You don’t do practice in high-stress situations.

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 Thomas David Kehoe

Increasing Force and Speed

Stuttering therapy programs fail to train the autonomous stage
of speech motor learning because of a counterintuitive aspect of
stuttering. Stuttering is characterized by excessive speech-
production muscle activity. The obvious but wrong treatment for
stuttering is to reduce speech-production muscle activity, i.e., to
speak with relaxed breathing, vocal folds, and articulation
muscles.
As noted earlier (page 16), speech-language pathologists see
that slowing down and using closed-loop speech motor control
eliminates stuttering. They reach the obvious but wrong conclu-
sion that stuttering therapy should be done at slow speaking
rates.
Fluency shaping therapy begins by training slow, relaxed,
fluent speech motor skills. Similarly, golf and tennis instruction
begins with slow, relaxed, correct movements. Golf and tennis
instructors then have you increase your force and speed. In
contrast, speech-language pathologists tell you not to increase
your force and speed. It may seem counterintuitive, but after you
master slow, relaxed fluent speech, you must increase both the
speed and force of your speech, without making errors, to train
automatic, effortless fluency.

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Fluency Shaping Techniques and Theory

Increasing Force
The force of your speech is measured by volume. Work on
getting loud. But don’t shout or yell. Instead, project your voice.
Vocal volume is a factor of both exhalation volume and vocal
fold tension. Increase your exhalation volume while keeping
your vocal folds relatively relaxed. This result is high volume
with the intonations of normal conversational speech. Stage
actors do this.
Increase your onset speed while maintaining long syllable
duration. Pretend that your forearm is a sports car’s accelerator.
When your fist is up, your vocal volume is quiet. As you push
your fist down, your volume increases. When your fist is all the
way down, you’re at maximum volume. Listeners one hundred
feet away should hear you.
Slowly lower your fist to produce a gentle onset. Then slam
your fist down fast to go from silence to maximum volume.
Then hold that volume while stretching the vowel. Pull your fist
up fast to end the word with speed. This is slow speech with
maximum effort.
Be careful not to damage your vocal folds. Stop if you feel
hoarse or start to lose your voice.

58
 Thomas David Kehoe

Increasing Speed
Shorten syllable duration from two seconds, to one second, to
one-half second, to one-quarter second. Practice this both with
relaxed, quiet speech, and with loud, forceful speech.
Using the practice word lists (page Error! Bookmark not
defined.) say each word four times:

1. Slow and relaxed (quietly).

2. Slow and projecting your voice (loudly).
3. Relaxed (quietly) with a quick onset.
4. Loudly projecting the word with a hard onset.

Where to Practice Force and Speed

It’s hard to practice loud speech in a small room. The ideal place
to practice is an empty auditorium. Have your speech-language
pathologist sit in the back row. Stand on stage and project your
voice to her. She yells, “Can’t hear you!” until you reach ideal
volume.
Another place to practice is near a building that produces an
echo. A third place to practice is on a freeway overpass. Demos-
thenes, the stutterer who became the greatest orator of ancient
Greece, projected his voice over breaking waves at the seashore.
Work on projecting your voice over the waves of traffic.

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Reinforcing On-Target Speech

Increasing speed and force myelinates or reinforces neural
pathways in your brain. A mistake reinforces the wrong neural
pathways.
Learning to talk fluently requires talking fluently 100% of the
time. That sounds like circular advice, and it is. Reinforcing
motor skills is a “virtuous cycle.” Using target skills reinforces
the skills, making the skills easier to use.
Conversely, stuttering reinforces undesirable speech motor
skills (core behaviors, page Error! Bookmark not defined.) and
bad communication habits (secondary behaviors, page Error!
Bookmark not defined.). Stuttering sets up a “vicious cycle”
instead of a “virtuous cycle.”

Swimming Analogy
I wanted to improve my swimming. At first I could swim only
one length of the pool, and then I had to rest. But I got in the
pool three times a week. I found that a small flotation device
helped me swim five or ten laps. After two months something
“clicked” in my brain and I swam half a mile. It was easy, almost
effortless. I didn’t need the flotation device any more.
Then I moved to a building without a swimming pool,
stopped swimming, and now I swim as poorly as I did before
that summer.

60
 Thomas David Kehoe

Similarly, stutterers go to speech therapy three times a week

for months. Then suddenly one day they find themselves talking
fluently, without effort. If they discontinue speech therapy, this
“lucky” fluency disappears and they go back to stuttering.
Stutterers’ brains have two sets of speech motor programs
(see the chapter “Error! Reference source not found.,” page
Error! Bookmark not defined.). Sometimes our brains pick the
fluent speech motor programs. At other times our brains pick
the stuttering speech motor programs. Speech therapy reinforces
the fluent speech motor programs. Eventually this fluent speech
becomes habitual. But during “lucky” fluency this habit is
precariously balanced. One stressful day, in which you allow
yourself to stutter, can reinforce the stuttering motor programs,
and your “lucky” fluency is gone.

Speech Buddies
Children learn grammar by listening to other people talking,
then speaking, then having their parents correct their grammar.
You may not remember this, but after a vacation to the seashore
you said, “We went nearly to the beach every day,” and your
mother corrected you, “No, dear, we went to the beach nearly
every day.”
Your mom was your speech buddy. You need another speech
buddy now, to help you correct your speech when you’re
disfluent.
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Fluency Shaping Techniques and Theory

Ask your speech-language pathologist to let you organize a

practice group with her other clients. Meet once a week to
practice fluent speech. Exchange telephone numbers and arrange
to call a speech buddy every day.
Here’s an idea that’ll get you talking fluently. If you have a
spare bedroom in your house, call your local university and offer
to let a speech-language pathology student live rent-free, in
return for reminding you to use fluency shaping skills. If you
don’t live near a university, call your school district and see if
they have a speech-language pathologist who’d go for free rent.
Train your spouse, housemates, and the people you work
with to remind you to use fluency skills. If you’re a parent with a
child in speech therapy, ask your child’s speech-language
pathologist to train you to correct your child at home (see
“Error! Reference source not found.,” (page Error! Bookmark
not defined.).
Bring your spouse or housemates to speech therapy. Ask
them to give you a warning sign when you don’t use your fluency
targets, and offer to pay them $1 whenever you stutter.

My Romantic Disaster of 1996

In eighth grade I had a teacher with a forceful personality. He
decided to cure my stuttering. Whenever I stuttered he stopped
me, then told me to say it without stuttering. I hadn’t had speech
therapy and had no idea what to do. His method was as effective
62
 Thomas David Kehoe

as teaching me Chinese by stopping me from speaking English

and telling me to speak in Chinese.
Twenty years later I’d completed several speech therapy pro-
grams. I’d used electronic anti-stuttering devices for several
years. I dated a woman who disliked my stuttering. Whenever I
started to block, she’d give me a certain look. I’d stop, relax my
breathing and vocal folds, and speak fluently.
After a few days with her I was talking fluently all the time.
The relationship crashed and burned shortly after that.
For an individual who hasn’t completed a speech therapy
program, a person pointing out his stuttering is the worst thing.
Such an individual doesn’t have any control over his speech.
Telling him to talk fluently increases his stress and his stuttering.
But for an individual who has mastered fluent speech skills,
pointing out his disfluencies and reminding him to use fluent
speech skills will help him. When you’re at that stage, find
someone to do this for you. (See the section “Error! Reference
source not found.,” page Error! Bookmark not defined..)

Start a Virtuous Cycle

Do whatever you need to get into the virtuous cycle. You may
have to do things that are difficult or embarrassing—e.g., telling
your co-workers that you stutter (hint: they’ve probably already
figured that out!).

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Fluency Shaping Techniques and Theory

Once you’re in a virtuous cycle, fluent speech will become

easier and easier with less and less effort. The difficult things will
become easier, and the embarrassing things won’t be embarrass-
ing (or necessary). If you’ve done it right, you’ll only have to do
these things for a few days or weeks.
Getting into a virtuous cycle may require:

1. Using closed-loop speech motor control (slow speech).

2. Using an electronic anti-stuttering device.
3. Taking a dopamine-antagonist medication.
4. Talking in uncomfortable situations, e.g., to strangers or
to telemarketers.

Practicing Under Stress

Autonomous motor learning requires practicing a new motor
skill in stressful situations.
Design a hierarchy of stressful situations. The first might be
leaving a message on your speech-language pathologist’s answer-
ing machine. When you can do that comfortably and fluently,
you might talk to telemarketers using closed-loop speech motor
control (slow, fluent speech). Then you could join Toastmasters
and make a series of speeches to your club. More about this in
the chapter “Error! Reference source not found.“ (page Error!
Bookmark not defined.).
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 Thomas David Kehoe

Practice Scheduling
The United States Postal Service studied workers learning to
operate mail-sorting machines (similar to typewriters). All
subjects received 60 hours of training. The scheduling varied
among four groups.
One group had two two-hour sessions per day, for 15 days. A
second group had one two-hour session per day, for 30 days. A
third group had two one-hour sessions per day, for 30 days. The
fourth group had one one-hour session per day, for 60 days.
The first group (two two-hour sessions per day) learned fast-
est, but in the long run had the worst performance. The fourth
group (one one-hour session per day) took the longest to get “up
to speed,” but eventually had the best performance.
Surprisingly, the postal workers preferred the two-hour/two-
session schedule, even though they had the worst performance.
People are impatient. They don’t want to spend 60 days learning
something, if they think there’s a 15-day shortcut.

Extinguishing Old Skills

We could simplistically conclude that you should practice
stuttering therapy no more than one hour per day. But there’s an
essential difference between speech therapy and mail sorting.
The postal workers were learning a new motor skill. Stutterers
have to learn a new motor skill and extinguish an old motor skill.
As noted earlier, coaches often prefer to work with individuals
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Fluency Shaping Techniques and Theory

who have never played a sport and haven’t learned bad habits,
rather than work with experienced athletes and have to break
their bad habits.
To extinguish an old motor skill you must stop doing it. Per-
haps the ideal stuttering therapy is done one hour per day, and
then you take a vow of silence the rest of the day. But that’s
unrealistic. To burn new fluent neural pathways, and extinguish
old stuttering neural pathways, you must use fluent speech every
time you talk. You must never stutter. Each disfluency weakens
your new fluent neural pathways and strengthens your old
stuttering neural pathways.
Extinguishing a maladaptive motor skill isn’t the same as
“breaking” a bad habit. Maladaptive motor skills enable you to
perform a desirable behavior, but not as a well as a better motor
skill. For example, touchtyping is better than two-fingered
typing, but two-fingered typing also gets the job done. In con-
trast, picking my nose is an undesirable behavior. I wish that a
teacher had taught me to touchtype when I was a child. I don’t
wish that a teacher had taught me a better way to pick my nose.
Because maladaptive motor skills enable you to perform a
desirable behavior, it’s hard to unlearn them and replace them
with optimal motor skills. Stuttering isn’t like picking your nose.
Your mother could slap your hand and stop you whenever you

66
 Thomas David Kehoe

pick your nose. If she stopped you every time you stuttered, you
wouldn’t be able to talk.
Extinguishing a maladaptive motor skill may involve “one
step forward, one step back” temporarily. To speak fluently, you
may have to speak much slower, or not respond immediately
while you focus on your speech motor skills.

Intensive Residential Speech Therapy Programs

Some stutterers go to intensive residential speech therapy
programs. These programs typically last three weeks. You’re
surrounded by speech-language pathologists and other stutter-
ers, and isolated from the real world. For the first two weeks, you
use two-second stretch all the time. In the third week, you move
to one-second stretch, then half-second, and finally quarter-
second slow normal.
Intensive residential speech therapy programs are like the
postal workers who did the “short cut” training. In three weeks
of intensive therapy you learn to talk fluently. But many stutter-
ers find that long-term results are disappointing.

Your Ideal Practice Schedule

Work with your speech-language pathologist to develop a
practice schedule. A severe stutterer may have to spend many
hours a day doing “homework.”

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Fluency Shaping Techniques and Theory

Don’t practice sitting alone in a room reading endless word

lists. This isn’t going to produce carryover fluency to stressful
situations.
A one-hour daily practice could have the following elements:

• After breakfast, twenty minutes of high intensity practice

(projection and hard onsets), with practice word lists
(page Error! Bookmark not defined.).
• During the day, a stressful twenty-minute session while
using a biofeedback device to keep your vocal folds re-
laxed. This could be calling strangers for your job.
• After supper, twenty minutes of very slow closed-loop
speech motor control conversation. Call another stutterer
in your support group. Or call infomercial toll-free num-
bers.

How Long Does Autonomous Learning Take?

Gymnasts practice daily for about eight years to become
proficient.
Motor learning researchers studied the manual (hand) skills
of cigar-makers.15 Beginner cigar-makers worked three times
slower than experienced cigar-makers. Becoming fully skilled
required making three million cigars.
Three million repetitions were also needed for Japanese pearl
handlers to become proficient. The Suzuki method of teaching
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 Thomas David Kehoe

violin to children requires the production of about 2.5 million

notes. Basketball, football, and baseball throws require about a
million practice throws.
This suggests that making fluent speech automatic and ef-
fortless requires saying about three million syllables. At five
syllables per second, talking four hours a day (just your time
talking, not combined talking and listening), you could produce
three million syllables in six weeks.
If you got a job answering telephone calls, and you did your
stuttering therapy skills on every call, and you connected a
biofeedback device into your telephone to alert you when you
missed a therapy target, and you spent your free time at Toast-
masters clubs making speeches or volunteering at a hospital’s
information desk, fluent speech might become automatic for you
in six weeks.
But most stutterers practice between ten minutes and one
hour per day. If they were silent the rest of the day, they’d say
three million syllables somewhere between six months and three
years.
No one has studied whether using undesirable motor skills
cancels out on-target practice. In other words, does a half-hour
of on-target practice get cancelled out by not using fluency skills
the rest of the day? Such a practice schedule might take years to
produce automatic fluent speech—or might never work.

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Fluency Shaping Techniques and Theory

Zen in the Art of Stuttering

Zen is the “everyday mind,” as was proclaimed by Ba-

so (died 788); this “everyday mind” is no more than
“sleeping when tired, eating when hungry.” As soon
as we reflect, deliberate, and conceptualize, the origi-
nal unconsciousness is lost and a thought interferes.
We no longer eat while eating, we no longer sleep
while sleeping. The arrow is off the string but does not
fly straight to the target…Calculation which is miscal-
culation sets in…The archer’s confused mind betrays
itself in every direction and every field of activity.
— Daisetz T. Suzuki, intro to Zen in the Art of Archery

Stuttering is what you do trying not to stutter again.

— Wendell Johnson

The goal of stuttering therapy is spontaneous fluent speech.

The goal of Zen is to do life activities without self-conscious
calculating and thinking.
Non-stutterers usually talk without self-conscious calculating
and thinking. But sometimes they are self-conscious about their
speech. Fear of public speaking is common. And non-stutterers
are self-conscious about asking the boss for a raise, or asking
someone out on a date, or when discussing an embarrassing
subject. Speech-language pathologists call this pragmatics—the
mental effort of calculating the listener’s reaction to your speech.
In the Zen framework, pragmatics is the calculation that is
miscalculation.

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 Thomas David Kehoe

A goal of stuttering therapy could be to become a “Zen mas-

ter of speech,” just as other Zen masters are archers or
swordsmen or calligraphers. To make an analogy to Baso, you
sleep when tired, eat when hungry, and talk when you need to
communicate. You don’t worry about the listener‘s reaction. You
don’t fear embarrassment. If the listener doesn’t do what you
want or expect, you don’t get upset.
You also talk fluently—but let’s define fluency as if we’re
learning a foreign language. You need vocabulary to express
your thoughts, grammar so your meaning isn’t misconstrued,
and accent and articulation to be understood. Mild stuttering
may be OK, if your listener understands you, and you don’t fear
or avoid speaking. Van Riper called this “fluent stuttering,” and a
Zen master might call it “fluency which is not fluency.”

Eugen Herrigel and Awa Kenzo

Eugen Herrigel (1884–1955) was a German professor of philoso-
phy, with a special interest in mysticism. From 1924 to 1929 he
taught philosophy in Japan, and studied archery with an eccen-
tric archery instructor named Awa Kenzo. Awa taught archery as
a mystical religion, called Daishadokyo. Daishadokyo had
nothing to do with Zen Buddhism or the traditional Japanese art
of archery (kyudo or kyujutsu).16 In 1936, Herrigel wrote a 20-
page essay about his experiences, and then in 1948 expanded the
essay into a short book entitled Zen in the Art of Archery. Re-
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Fluency Shaping Techniques and Theory

gardless of whether it accurately portrays Zen Buddhism or

traditional Japanese archery, the book has many accurate in-
sights into motor learning and control. For example, a central
theme of the book is that a complex and difficult motor skill
becomes seemingly mentally and physically effortless after years
of practice, and that the motor skill is best performed when your
body seems to execute the motor skill without your mind’s
conscious control. The book is wonderfully written and has been
a bestseller for more than fifty years, in many languages.
Master Awa’s first lesson was drawing the bow, letting “only
your two hands do the work, while your arm and shoulder
muscles remain relaxed, as though they looked on impassively.”
This step is like stuttering therapy, with the goal of speaking
while keeping your speech-production muscles relaxed.
Herrigel couldn’t do this first step. He wrote that he’d “start
trembling after a few moments, and my breathing became more
and more labored.” Sounds like stuttering!
He was trying to draw a six-foot bow held above his head,
which requires great strength. But somehow the Master did this
effortlessly.

…he called out to me to “Relax! Relax!”…the day

came when…I lost patience and brought myself to
admit that I absolutely could not draw the bow in the
manner prescribed.
“You cannot do it,” explained the Master, “because
you do not breathe right.”
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 Thomas David Kehoe

Sounds like stuttering therapy! The Master continued,

“Press your breath down gently after breathing in, so

that the abdominal wall is tightly stretched, and hold it
there for a while. Then breathe out as slowly and even-
ly as possible, and after a short pause, draw a quick
breath of air again—out and in continually, in a
rhythm, that will gradually settle itself. If it is done
properly, you will feel the shooting becoming easier
every day. For through this breathing you will not only
discover the source of all spiritual strength but will al-
so cause this source to flow more abundantly, and to
pour more easily through your limbs the more relaxed
you are.”
And as if to prove it, he drew his strong bow and
invited me to step behind him and feel his arm mus-
cles. They were indeed quite relaxed, as though they
were doing no work at all.
The new way of breathing was practiced, without
bow and arrow at first, until it came naturally. The
slight feeling of discomfort noticeable in the begin-
ning was quickly overcome. The Master attached so
much importance to breathing out as slowly and stead-
ily as possible to the very end, that, for better practice
and control, he made us combine it with a humming
note.

First relaxed breathing, and now vocal fold vibration!

I cannot think back to those days without recalling,

over and over again, how difficult I found it, in the be-
ginning, to get my breathing to work out right…
When, to excuse myself, I once remarked that I was
conscientiously making an effort to keep relaxed, he
replied: “That’s just the trouble, you make an effort to

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Fluency Shaping Techniques and Theory

think about it. Concentrate entirely on your breathing,

as if you had nothing else to do!”

I’ve heard speech-language pathologists say the same thing…

It took me considerable time before I succeeded in

doing what the Master wanted. But—I succeeded. I
learned to lose myself so effortlessly in the breathing
that I sometimes had the feeling that I myself was not
breathing but—strange as this may sound—being
breathed. And even when, in hours of thoughtful
reflection, I struggled against this bold idea, I could no
longer doubt that the breathing held out all that the
Master had promised.

Learning to draw the bow took a year. Perhaps stuttering

therapies are unsuccessful because we expect results too quickly.
Imagine stuttering therapy starting with a year of breathing
exercises!
Then Herrigel learned to loose the arrow. This was even
more difficult than drawing the bow. Herrigel kept jerking his
hand at the moment of release, which resulted in “visible shaking
of my whole body and affected the bow and arrow as well.” This
caused the arrow to “wobble.”
The Master told Herrigel, “Don’t think of what you have to
do, don’t consider how to carry it out! You mustn’t open the
right hand on purpose.”

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 Thomas David Kehoe

Herrigel told the Master that after drawing the bow, “unless
the shot comes at once I shan’t be able to endure the tension…I
can’t wait any longer.”
The Master replied that Herrigel‘s inability to wait was be-
cause, “You do not wait for fulfillment, but brace yourself for
failure.”
Herrigel spent three years learning to release the arrow. The
Master said to release the arrow without tension, like a bamboo
leaf holding snow, bending lower and lower until the snow slips
off. The bamboo leaf waits without effort until the snow falls off.
In stuttering therapy, the first word of a phrase should be
without effort, rolling off your vocal folds like the snow sliding
off the bamboo leaf. You shouldn’t intend to say the first word,
as the archer doesn’t open his hand on purpose. The word
should say itself, without your planning or calculating or trying.
Herrigel‘s three years practice releasing the arrow suggests
that learning to release the first word of a phrase may also take
three years, and be the hardest part of stuttering therapy.
Herrigel was dedicated to his practice, but he couldn’t release
the arrow smoothly. The Master kept telling Herrigel to become
“truly egoless.” Herrigel became dejected, and planned to discon-
tinue the archery lessons, concluding that, “all my efforts of the
last few years had become meaningless.”

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Fluency Shaping Techniques and Theory

Then, one day, after a shot, the Master made a deep

bow and broke off the lesson. “Just then ‘It’ shot!” he
cried.

“It” meant that Herrigel had loosed a shot without loosing

the shot. “It” had loosed the shot, not Herrigel. The Master could
not say anymore what “It” was, just that “It” can only be known
through experience.

Only after considerable time did more right shots oc-

casionally come off, which the Master signalized by a
deep bow. How it happened that they loosed them-
selves without my doing anything, how it came about
that my tightly closed right hand suddenly flew back
wide open, I could not explain then and I cannot ex-
plain today…I got to the point of being able to
distinguish, on my own, the right shots from the fail-
ures. The qualitative difference is so great that it
cannot be overlooked once it has been experienced.

In stuttering therapy, the difference between your relaxed,

fluent voice and your tense, stuttering voice is as obvious as
night and day—after you learn relaxed, fluent speech. Until then
it seems impossible.
The Master then began training Herrigel to shoot at a target,
adding, “He who has a hundred miles to walk should reckon
ninety as half the journey.”
The Master refused to teach Herrigel to aim, insisting that
the target was not the goal, and the goal cannot be aimed at, and

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 Thomas David Kehoe

that the goal doesn’t have a name, except maybe “enlighten-

ment.”
But even though the Master did not aim, all of his shots
lodged in the black center of the target, from sixty feet away.
At first Herrigel tried to shoot without caring if the arrows
hit the target. But he couldn’t do this, and “I confessed to him
that I was at the end of my tether.”
The Master replied:

You worry yourself unnecessarily. Put the thought of

hitting right out of your mind! You can be a Master
even if every shot does not hit.

Remember that you can be a Zen master of speech even if

you still stutter.
When the Master said he sees “the goal as though I don’t see
it,” Herrigel replied that the Master should then be able to shoot
blindfolded. The Master then had Herrigel set up the target in
darkness, except for one candle. Herrigel could not see the target
at all, but the Master shot two arrows. When Herrigel turned on
the lights, he saw that not only had both arrows hit the bulls-eye,
but the second arrow had hit the first and splintered it!
Herrigel describes the following months as the hardest yet, of
trying to hit the target yet not trying to hit the target. He gradu-
ally came to see the value of this training:

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Fluency Shaping Techniques and Theory

It destroyed the last traces of any preoccupation with

myself and the fluctuations of my mood.

Finally, the Master had Herrigel shoot in front of spectators,

and awarded him a diploma, “inscribed with the degree of
mastery.” Before Herrigel returned to Europe, the Master added,

I must only warn you of one thing. You have become a

different person in the course of these years. For this is
what the art of archery means: a profound and far-
reaching contest of the archer with himself. Perhaps
you have hardly noticed it yet, but you will feel it very
strongly when you meet your friends and acquain-
tances again…You will see with other eyes and meas-
ure with other measures.

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 Thomas David Kehoe

REFERENCES

1
America Wins Olympics, October 2, 2000,
http://truthnews.net/culture/2000_10_olympic.html
2
Namasivayama, A.K., van Lieshout, P. “Investigating speech
motor practice and learning in people who stutter,” Journal of
Fluency Disorders, Volume 33, Issue 1, March 2008, Pages 32-51.

3
Arielle Ford’s Complete Book Publicity Workshop.
4
Stager, S., Denman, D., Ludlow, C. “Modifications in Aerody-
namic Variables by Persons Who Stutter Under Fluency-
Evoking Conditions.” Journal of Speech, Language, and Hearing
Research, Volume 40, 832-847, August 1997.
5
Van Riper, C. “Stuttering: Where and Whither?” Asha, vol. 16,
no. 9, September 1974, page 486.
6
Van Riper, C. “Stuttering: Where and Whither?” Asha, vol. 16,
no. 9, September 1974, page 487.
7
Boberg, E., & Kully, D. (1994). “Long-term results of an intensive
treatment program for adults and adolescents who stutter.”
Journal of Speech and Hearing Research, 37, 1050-1059.
8
Langevin, M., Huinck, W.J., Kully, D., Peters, H.F.M., Lomheim,
H., and Tellers, M. “A cross-cultural, long-term outcome evalu-
ation of the ISTAR Comprehensive Stuttering Program across
Dutch and Canadian adults who stutter,” Journal of Fluency
Disorders, Volume 31, Issue 4, 2006, Pages 229-256.
9
Bloodstein, O., & Bernstein Ratner, N. (2007). A Handbook on
Stuttering, Sixth Edition. Clifton Park, NY: Thomson. ISBN 978-
1-4180-4203-5, page 398.
10
Craig, A., Calver, P. “Following Up on Treated Stutterers:
Studies of Perceptions of Fluency and Job Status.” Journal of
Speech and Hearing Research, 34, 279-284, April 1991.
11
Onslow, M., et al., “Speech Outcomes of a Prolonged-Speech
Treatment for Stuttering,” Journal of Speech and Hearing Re-
search, 39, 734-749, 1996.
12
Ramig, P., Adams, M. Vocal I have in stutterers and nonstutter-
ers during high- and low-pitched speech, Journal of Fluency
Disorders, Volume 6, Issue 1, March 1981, Pages 15-33

79
Fluency Shaping Techniques and Theory

13
Elman, J. (1981). “Effects of frequency-shifted feedback on the
pitch of vocal productions,” Journal of the Acoustical Society of
America, 70 (1). Burnett, T.A., Senner, J.E., and Larson, C.R.
(1997). “Voice F0 responses to pitch-shifted auditory feedback:
A preliminary study,” J. Voice, 11, 202-211. Burnett, T.A.,
Freedland, M.B., Larson, C.R., Hain, T.C. (1998). “Voice F0
responses to manipulations in pitch feedback,” Journal of the
Acoustical Society of America, 103 (6) June 1998.
14
Natke, U., & Kalveram, K.Th. (2001) Fundamental frequency
and vowel duration under frequency shifted auditory feedback
in stuttering and nonstuttering adults. In H.-G. Bosshardt, J. S.
Yaruss & H. F. M. Peters (Eds.), Fluency Disorders: Theory,
Research, Treatment and Self-help. Proceedings of the Third
World Congress of Fluency Disorders in Nyborg, Denmark.
Nijmegen: Nijmegen University Press, 66-71. Natke, U., Gross-
er, J., & Kalveram, K.Th. (2001) Fluency, fundamental
frequency, and speech rate under frequency shifted auditory
feedback in stuttering and nonstuttering persons. Journal of
Fluency Disorders, 26, 227-241.
15
Kottke, F.J., Halpern, D., Easton, J.K.M., Ozel, A.T., Burrill, C.A.
“The Training of Coordination.” Archives of Physical Medicine
and Rehabilitation, Vol 59, December 1978, 567-572.
16
Yamada Shoji. “The Myth of Zen in the Art of Archery,” Japa-
nese Journal of Religious Studies, 2001, 28/1-2;
http://www.nanzan-u.ac.jp/SHUBUNKEN/ publica-
tions/jjrs/pdf/586.pdf

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