The treatment process, regardless of age of the client should follow a logical sequence in helping them understand and effectively cope with a system sensitive to intermittent disruption. Underlying the treatment process is DEMYSTIFICATION of the stuttering problem through education. The client learns about the nature of speech communication and how his/her system responds to disruption in continuous speech. This includes not only disruption in speech movement but also the emotional, thought, and behavioral reactions of the system to disruptions. It is from this understanding that the clinician guides the client in self-identification of what s/he is doing, thinking, and feeling that interferes with natural communication. The "demystification" process helps the client understand the seemingly uncontrollable, and in some cases frightening, response pattern of stuttering. It is from understanding that the client learns what s/he can do to speak as naturally as possible given the limitations of their communication system and the speaking situation at hand. The client learns not to fear, but to understand and proactively solve the problems they are experiencing at the moment.

What does this mean in terms of behavioral speech goals? First, this program does not seek stutter-free speech as a definition of success nor is it a singular goal in treatment. This goal might not be attainable for some individuals, given their potential sensitivity to speech disruption. If stutter-free speech was attained it could be at the expense of more natural sounding speech or the feeling of "freedom" associated with non-inhibited communication. For some individuals, expectations for stutter-free speech, as criteria for success, could reinforce negative anticipatory behaviors and feelings of failure. This is particularly important for the young child experiencing disfluency. Sporadic episodes of speech disruption could be interpreted as failure.

Likewise, the systems program does not adhere solely to attempts to produce easy or fluent stuttering. It is important to reduce the perception that stuttering occurs on isolated language units. This promotes an erroneous belief that the stuttering problem lays with particular sounds, words, or phrases, and reinforces the drive to "get the word out" or "get out of the stutter." Despite the honest descriptions of stuttering children and adults alike, it is impossible for a word or sound to "get stuck in the throat" like a chicken bone.

The systems approach to therapy guides the client in learning to speak in the most natural manner possible given inherent limitations of their system and the environmental conditions at hand. Included is proactively using easy, natural speech movements combined with effective recovery from stuttering episodes. According to our concept of systems and behavior the principles of stuttering therapy could be applied to any type of movement training. Are the problems behind initiating the first speech movement in front of a classroom for a stuttering child fundamentally different from a new golfer initiating his golf swing in front of twenty expectant and often critical golfers? Apart from the obvious differences between the two activities, the "systems" model predicts no! Similar cognitive, emotional, and motor interactions would occur. The process of helping the disfluent speaker communicate effectively would be similar in concept to helping the golfer learn to focus on the easy swing movements in the presence of distracting thoughts and emotions. Focus of attention, confidence, and experience becomes central issues in both cases. In addition, the inherent ability or skill level at a particular point in time would determine realistic goals and definition of success. The difference is that the psychological, emotional, and social consequences of stuttering are more frequent, devastating, and long lasting than any other form of behavior.

Prevention and/or remediation of the stuttering response strives to help the individual accomplish several psychological and behavioral objectives. During the course of therapy, the client learns to:

1. Identify and understand talking and how thoughts, emotions, memories, language, movement, and experiences all contribute to how we learn to talk. Analogies between talking and other movement related behaviors are encouraged.
2. Understand the nature and development of the stuttering response as it relates to what we know about how our system functions. This includes factors that influence development and breakdown of the timing, coordination, and sequence of speech movements. Emphasis is placed on how our thoughts and emotional responses to the feeling of being out of control contribute to the fear, avoidance, and struggle behavior associated with the stuttering response.
3. Identify factors within the client’s own system and experiences that contribute to breakdown in speech and the development/maintenance of the inappropriate response patterns. Emphasis is placed on sensitivity to disruptive speech behavior, problems with effective recovery, and the thoughts and emotions the client experiences. Particular attention is given to identifying and understanding the "coping" or "adjustment" strategies the client uses to help themselves and whether such strategies increase or decrease the stuttering problem in the long run.
4. Learn how to proactively attend to and produce speech movements that facilitate natural sequencing and fluidity of speech. This goal should always be presented within the expected limit of the client’s talking ability, including the occurrence of intermittent speech disruptions. "Fluency" (i.e. the absence of disfluency) is not the focus of therapy. Developing confidence in shaping speech to more fluid patterns is what the client is striving for.
5. Learn to effectively recover from disruptions in speech. Emphasis is drawn away from the client’s natural inclination to avoid, or rapidly escape from moments of stuttering. Instead, the client is motivated to take a more natural approach oriented position to talking. The client learns to make effective adjustments in speech behaviors during stuttering episodes that help move toward more fluid, forward movement patterns experienced in the previous step. In this manner, the client is motivated to move toward more effective behavior, rather than away from ineffective and feared behavior.
6. Develop more natural cognitive, linguistic, pragmatic, and arousal response patterns associated with talking and prevent new disruptive response patterns from developing. This includes developing positive oriented self-talk, self-reinforcement skills, and positive perceptions about the nature of their communication problem and their ability to live normal lives.

In order to operate the speech process effectively the client must first understand what talking is and what might happen to disrupt talking. The client learns how we produce speech, the difference between language units and speech movements, and how certain behaviors can facilitate or hinder smooth, coordinated movement. The relationship between what we think and feel and the effect on speech is addressed. This foundation is then used to explore the nature of the stuttering response. The educational process allows the client to view his/her stuttering problem within a context that they can understand relative to natural behavior.

In this phase of therapy, the client identifies h/her specific thoughts, emotions, and speech/non-speech behaviors that interfere with the natural speech process. The client explores the difference between effective and ineffective ways s/he copes with speech disruptions and the fear of stuttering. During this phase the client begins to describe their problem in terms of "What am I doing?" instead of "What is happening to me?"

Here, the client learns to take a proactive instead of a reactive role in talking. The client learns to attend to and produce speech behaviors that facilitate natural, forward patterns. Forward speech patterns are not equivalent to "fluent" speech patterns. Forward Baseline speech includes easy disruptions as a natural part of the movement sequence. The client learns to produce Baseline speech in a hierarchy of cognitive, emotional, and social distractions. Through experience, the client develops a "feeling of being in charge" of speech movements in conditions of stress. In addition, the clinician guides the client in developing more positive and natural thoughts and attitudes about communication.

Once the client can proactively produce baseline speech movements s/he enters the recovery phase of treatment. The client learns specific steps that facilitate effective recovery from disrupted movement. Emphasis is placed on (1) reducing the drive to "escape" the stuttering moment quickly, (2) gaining control of disrupted speech movement, and (3) reinitiating gentle, Baseline movements under voluntary control. As with the BASELINE phase, the client learns to recover effectively from stuttering in a hierarchy of cognitive, emotional, and social distractions.

During the stabilization phase the client integrates the proactive and recovery methods into their daily communication. Emphasis is placed on increasing the feeling of confidence and control of speech and on integrating realistic and positive attitudes about his/herself. Positive imaging and self-talk are important attributes of the recovering, more successful client.

The successful client is one who freely approaches speaking situations, can voluntarily attend to and produce more natural continuous speech movements and, when necessary, effectively vary disrupted speech movements back to more forward, controlled speech. In addition, and just as importantly, the successful client thinks and feels more like a natural speaker who experiences intermittent disruption in talking. The effective interaction of each component of the system: cognition, sensation, language, motor control, and arousal, is critical to the long-term success of the client.

The Systems Approach to treatment is directly applicable to children, adolescents, and adults at all stages of stuttering development. The clinician uses the same concepts of behavior and adapts the goals to meet the individual needs of the client. The program is also designed to be flexible. The clinician follows a natural learning sequence while emphasizing areas pertinent to the client's needs. Regardless of the specific emphasis at various phases of therapy, the desired outcome is always the same: natural communication.

Each chapter presents a different phase of therapy. The clinician should be aware that the differentiation among treatment phases is narrow. Each serves as a building block for the one to follow. The clinician will often overlap the goals and procedures from different phases. The clinician should modify the therapy plan to meet the needs of the client at a particular point in the process.

Materials in understanding, describing, and quantifying various characteristics of the stuttering problem are included in the Appendix. Rating forms for both the segmental and movement characteristics of speech and stuttering are provided.