APPENDIX

A Study of the Long-Term Effects of a
Multi-Dimensional Treatment Program for Stutterers

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.

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 courses.

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 of success.


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