Fresh eyes on a well worn path…

Re-visiting stammering therapy from the perspective of the social model and stammering pride.

Stammering therapists have looked on in awe at the emergence of the social model and stammering pride, largely supportive of the positive new narratives emerging in the stammering community. And yet, despite vocal support, the development of this powerful and revolutionary movement in the stammering community has not led to much meaningful change in clinical practice. This blog series is going to try to address this. It will explore how the social model of disability and stammering pride may challenge current clinical practice and begin to look into what new and empowering forms of therapy may emerge as a result.

The social model of disability had by and large passed by stammering until this decade (1). Over the past few years, however, we have seen a burgeoning, progressive and diverse set of individuals eager to make up for lost time. Their methodologies and perspectives on stammering have all been subtly different, but their attempts to create a society that enables rather than disables people who stammer unites them. We have seen the emergence of: social model conferences (2), that bring together a mix of people to speak on the attributes of stammering; networks of people who stammer at work (3), which aim to change how stammering is thought about and understood in the workplace; online spaces and blogs (4), which rethink speech dysfluencies in empowering ways; art (5), that vividly show the benefits of stammered speech; and soon a book (6), that chronicles these new narratives.

The term ‘stammering pride’ has begun to filter into the common consciousness. The exact definition remains abstract; to us, it is a variable mish-mash of ideologies, drawing from the social model, political model, neurodiversity movement and, more generally, a socially progressive cultural backdrop. Essentially, stammering pride sees stammering as a natural human difference of positive value. This difference merits respect and validity, rather than being ‘cured’ or ‘managed’. Instead of simply saying, ‘it is okay to stammer’, stammering pride positions stammering as a legitimate and valuable way of speaking in its own right.

Despite the widespread praise for the social model and stammering pride by therapists, if you look at any academic journal related to stammering today the social model and stammering pride is rarely to be seen. The premier stammering conference (the Oxford Dysfluency Conference) appears to have little room for anything other than medical model papers. This powerful movement for people who stammer exists almost solely in the ‘grey’ literature – only to be found by those therapists purposefully seeking it out. It has so far been given relatively limited academic space and thought by those who are researching ways to improve the lives of people who stammer.

This is understandable. The integration of new ideas and concepts into clinical practice is never easy, especially those that challenge some of the ideological foundations of the current practice. Added to this, people who stammer who approach their speech in a social model way are sometimes not keen (or even ideologically opposed) to collaborate with speech and language therapists and researchers. Moreover, the large differences in vocabulary used in medicine, the humanities and disabilities studies can make collaboration across these disciplines difficult to near impossible. It is said it takes around 17 years for research to change clinical practice (7). We need, as a community, to make sure it does not take as long for social progress to change clinical practice in stammering.

At the moment, the social model exists on the edges of therapy. Current ‘state of the art’ therapy is an integrated approach that uses both ‘cognitive restructuring’ and ‘fluency restructuring’ to meet the clients perceived needs (8) – also, known broadly as ‘stammer-more-fluently’ and ‘speak-more-fluently’ approaches. The social model is perhaps presented as suggested reading for clients after therapy and a thoughtful comment or two during a therapy session – for a select few clinicians it might a have deeper role in their therapeutic process. The heartland of stammering therapy, however, remains grounded in a medical model approach. The psychological depth of therapy advocated by Van Riper and Sheehan, as well as the encouragement of acceptance and openness under a stammer-more-fluently approach, can appear in-line with social model thinking, but the overriding aims of these approaches seek to effect change at the level of the individual and not society.

We do value the diversity of current stammering therapy approaches and appreciate that not all of these are rooted in the medical model. We do not wish to demean the hard, innovative and committed work clinicians put into stammering therapy nor the benefits it can bring to people who stammer. We also appreciate that an evidence base exists for current therapy (6). To move away from this to an unevidenced and untried way of working entirely under the social model would raise questioning eyebrows in the profession – and arguably be seen as clinically negligent. However, we firmly believe the social model opens up possibilities for powerful new ways of working that demand exploration.

Most writing so far on the social model and stammering pride has spoken to the person who stammers, not the speech and language therapist. We want to try to change this so that stammering therapists can find ways to meaningfully integrate the social model in their practice.

So, we are putting together a series of blog posts that look directly at stammering therapy informed by the social model and stammering pride. We want to start this here, in the grey literature. This allows for a different kind of conversation. The kind of conversation you have after a glass or two of red wine at a conference. Your grasp of references may be slipping; you are amalgamating sources, disciplines and lived experience; what you say may not stand up to the sobering light of peer review, but you nonetheless feel what you have to say is true and vital.

A taste of some of the blogs to come:

  • To what extent do stammering therapists gain appropriate informed consent from people who stammer before trying to change the very nature of how they communicate?
  • To what extent should stammering therapists input into changing society – for example, in advising business on appropriate employment and interview practices for people who stammer – and position this aspect of their role on an equal footing with their clinical work for individual people who stammer?
  • How can identification, desensitisation, and stammering modification be understood within a social model of disability framework?

We hope you will join us in this exciting conversation. We are keen to represent diverse voices and perspectives, so do get in touch if you would like to write a blog on the subject. Similarly, please email ideas and responses or even better comment and share on social media.

Patrick and Sam