A Study of the Long-Term Effects of a
The purpose of this study is to present data relevant to the long-term
effects of the multidimensional treatment program described in this book.
The results are based upon a population of 625 patients who participated
in the NCS program.
Multi-Dimensional Treatment Program
Subjects. The experimental population was composed of 492 males (mean
age, 31 .6 years) and 133 females (mean age, 27.4). Almost all had had
speech therapy or psychotherapy at some point in their lives prior to enrolling
in the NCS program. For 538 patients, their overt struggle symptoms ranged
from mild to severe; for 87 patients, there were no overt struggle behaviors,
but rather a well-developed word-substitution capability. This group, labeled
"closet stutterers," was comprised of 62 females and 25 males.
Method. Each patient was treated using the methods described in this
book. All received weekly individualized assignments and sent tape cassettes
to their therapist at the center on an average of at least once each ten
days during the follow up period. All were required to attend local club
meetings or to communicate regularly by telephone with fellow patients
in their area. All attended at least two regularly-scheduled refresher
Prior to and at the end of the year period the patients were called
upon to complete a detailed questionnaire. The questionnaire was a self-assessment
of relative percent speaking success in each of twelve representative speaking
situations. The test was also readministered after twenty-four and thirty-six
months to determine the effects of post-treatment years upon the groups'
judgments of their performance.
Results. At the end of the initial twelve-month period, 96 percent of
the patients reported that the program had been successful. One year after
termination of therapy, at twenty-four months, the success rate had dropped
to 93 percent.
Discussion. The definition of success used in this study was "to be
essentially symptom-free in all daily routine speaking situations." There
was no attempt to define success as total elimination of undesirable habits,
but rather to define it in a functional sense - that is, to function routinely
without stuttering, word or sound substituting, or avoiding speaking situations.
Might the patients slip once in a while and stutter? The answer is yes.
But they could recover immediately and, most importantly, reported that
they were not psychologically devastated by the block. They knew it was
caused by a failure to employ technique and further knew they could take
immediate action to prevent further blocks from occurring.
Thus the results of this study indicate that for adults, well over nine
out of every ten can expect to have a relatively permanent success with
the techniques described-provided that they are religious in their adherence
to all aspects of the program.
But what of the "failures"? Some, interestingly, may not be. For example,
one of the patients, a stockbroker, entered the program, performed well
during the initial phase, followed that by entering a telephone hierarchy,
spent an unusually long time going through the hierarchy (four months),
practiced several other hierarchies to success and, at nine months, quit.
When tested, both at twelve and twenty-four months, the patient was still
stuttering in some situations but reported overall that he personally considered
the program a success. He revealed that his major, if not sole, purpose
in entering the program had been to become fluent on the telephone since,
if fluent, he could call new customers and be expected to increase his
income substantially. The excessive amount of time spent on the telephone
hierarchy was, therefore, a reflection of his personal emphasis. His business
had increased significantly and, although he was stuttering in a number
of situations, he had achieved his major goal. The program had performed
its function for him. It was a success.
Many patients, after improving substantially in a number of speaking
situations, are quite content with their accomplishment and simply stop
practicing. There may be several situations in which they have consistent
difficulty, but these occur for them so infrequently or are so relatively
unimportant that the motivation for continued practice is nonexistent.
These individuals are pleased with their result but from our research point
of view are considered part of the "non-success" group.
The slippage of three percentage points between the twelve and twenty-four-month
assessment represented approximately twenty individuals who reported the
reoccurrence of difficulty in some speaking situations. All 625 patients
had been without formal therapy for a year, and it was surprising to find
such a small number reporting difficulty. It was possible to reinitiate
treatment for eleven of the patients and, after a month, all had recovered
to their twelve-month levels. These results suggest that some form of periodic
refresher course may be required for a small group of patients for a period
beyond the formal year of practice.
One important additional result emerged from the study. The likelihood
of relapse appears to be great in the first five months of treatment. The
patients are fragile. A high-stress episode can provoke an onset of stuttering
that, if left unchecked, can result in a disastrous downward spiral in
performance. We have discovered that the support groups, hotlines, weekly
monitorings, and refresher courses have saved dozens of patients from relapse.
We are left with the inescapable conclusion that all treatment programs
must provide these services if patients are to achieve comparable levels
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