Stutterers rarely, if ever, stutter when they talk to themselves out loud alone. Any attempt, therefore, to make a permanent change in stutterers must consider the "outside world" - that is, the world of speaking individuals. It is terribly difficult for a stutterer, after stuttering for his whole life, to suddenly communicate fluently with others, and sometimes the strain is so great that the patient suffers a relapse and begins stuttering all over again. Knowledgeable friends and family members can offer reassurance and reinforcement, but we have discovered that a more systematic program is what is most effective. Indeed, to assure permanent fluency in any and all situations, any treatment should continue to offer a follow-up program long after the stutterer has demonstrated fluency in the classroom and at home or work - and this may take some time.

There are a lot of resources available, among them the system of reinforcements that The National Center for Stuttering has developed over the past twenty-nine years to assist the stutterer in his transition and help him maintain fluency. There are several components to this system, enabling patients living anywhere in the United States to refresh their technique and get moral support from professionals and other stutterers. Patients have found this support network extremely helpful, and it has become an integral part of the NCS program.

Therapists. The ongoing support of a therapists can be invaluable. Our patients participate in an active exchange process with a trained therapist for 9 to 12 months after basic training is over. The therapist monitors the patient's performance weekly via a cassette tape, and guides him through difficult speaking situations.

While one can learn to completely stop stuttering in a few short months, it can take much longer to overcome anticipatory stress - the habit of scanning ahead for feared sounds, words, or speaking situations. The patient's "scanner" must be put to sleep, and since it is deeply imbedded in his subconscious, this can be a complex psychological process. The stutterer must be patient. In the course of working with thousands of stutterers, I have learned that if a patient stops practicing the Air Flow Technique when he no longer stutters, but still scans, his risk of having a relapse is great. Having the ongoing support of a therapist gives many the extra incentive they need to stick with the program.

Refresher Courses. Many stutterers have found refresher courses invaluable as a way of brushing up on technique and renewing motivation to practice. These refresher courses are conducted periodically throughout the United States, giving patients fact-to-face contact with a therapist. The refresher courses also allow time for dealing in depth with particular questions raised by the patients, and provide an opportunity for discussing highly refined strategies for handling unusual and high-stress speaking situations.

For example, one patient worked in a nuclear electric generating plant. He was an evening supervisor and virtually ran the plant. His stuttering was controlled, but his greatest fear was that in the event of a crisis, when called upon to give a long and complex series of commands rapidly, he would find himself unable to do so. He lived in fear that if a crisis did occur, it would prove devastating not only to him but to those who relied on him. This knowledge weighed heavily upon him, and he thought a great deal about changing jobs.

He came to a refresher course and I suggested that he stage simulated emergencies or full-blown dress rehearsals on a regular basis. Emergency drills were, of course, routine procedure at the nuclear installation, but by increasing their frequency and making them as vivid as possible, he would be able to practice speaking under pressure, and learn to control the emotional responses that might occur in such a situation.

Six months later I received a letter from him informing me that there had been a true emergency at the plant, and that he had handled it flawlessly. Not only had he achieved a personal victory, but he had also been promoted to a new position, one that did not require him to speak under stress. His practice had moved him into a low-stress speaking situation.

The National Stutterer's Hotline: 1-800-221-2483. One component of our support network that has helped countless stutterers with their problems is the special hotline number established for patients of the Air Flow Technique. This toll-free number is manned by trained professionals, and is available to anyone who stutters, or his family or friends. It is extremely comforting to know that a knowledgeable therapist is available to provide support and advice. If you stutter or know someone who does, you are encouraged to call the hotline for information concerning the availability of treatment programs in your area.

In the past, stutterers have called about particular assignments, or if they are having a bad day, or if they are worried about an upcoming speaking situations and want a strategy for maximizing their success, or if they are in an emergency situation and need help - quick! For example, several years ago I treated a patient who worked for the State Department. He had performed reasonably well in his career because he was a closet stutterer. But he was hampered by his inability to learn a second language - which is a requirement for advancement in the State Department. The difficulty was that in the second language he did not have the facility to word-substitute. He would have to say all of the feared sounds, and his anxiety over this prospect had grown to gargantuan proportions; the mere thought of having to study a foreign language was terrifying.

He wanted to learn French, but all attempts in the past had failed miserably. He had been practicing the air-flow technique for six months and felt he was ready. In the State Department courses are provided in which one can study a foreign language intensively - six hours a day for a number of weeks - until mastery of the basic elements of conversation is achieved.

The first day of training began. The session went well for the first half-hour, and then he hit his first serious block on a "t" sound. His base-level stress shot up and he found himself suddenly unable to continue. All of his old fears about learning a second language returned with full ferocity. He asked to be excused, went to the nearest pay phone, and dialed the toll-free Patients' hotline number. A therapist responded and counseled him about both technique and strategy. She reviewed the basic features of the technique and, in addition, suggested he continue, but speak softly and slowly the remainder of the day. She also suggested that he inform his instructor that he would speak speaking in this manner. He was told to call back as often as necessary. On the first day he called a number of times. On the second, twice. He successfully completed the course.

While professional support of the type provided by our therapists, refresher courses, and the national stutterer's hotline has proven extremely effective in helping former stutterers remain fluent through attention to technique, we've found that it is the successes of other stutterers that provides the real psychological edge, the greatest hope and motivation to stutterers still working to overcome their affliction. Let's consider some of the other support programs that have proven effective.

Clubs. Sharing a problem with others who are working through a similar situation can be invaluable. Clubs for Air Flow users have been established in most major cities in the United States. These generally meet twice a month in local hospitals, churches, or libraries and serve as power support groups. A rotating leadership system prevails, allowing each member to lead a meeting, and members perform various exercises to refresh their technique. Most importantly, though they are able to share their stories of victory and defeat with who really understand - and the support members provided for each other provides maximum motivation to continue practicing Air Flow technique on a daily basis. While some people may be nervous at first, they soon feel at ease in the club meeting situation.

Advanced members often function as a sort of miniature lecture bureau. They arrange to give group lectures on stuttering to various local organizations such as a speech-therapy class at a local college, or a women's group. Their goal is not only to educate a public that needs such knowledge, but, in the process, to use the support of the club as a tool to broaden their public-speaking experience and gain self-confidence. Newer members in the club aspire to join these mini-lecture bureaus and, once they have become sufficiently expert in the use of the technique, are welcomed into the bureau.

Many club members have also given interviews to local newspapers and have spoken on radio and television. To go from being a person who stutters to one who receives applause for a public lecture represents the most dramatic change in self-concept possible. The individual who accomplishes this goal has gone so far psychologically that the possibility of relapse is extremely remote.

Many of the participants in these club meetings go on to join a national public-speaking organization called Toastmasters. There they have an opportunity to give a speech before an audience every week. A number of Air Flowers have become presidents of their local Toastmasters chapters, and others have won regional public-speaking competitions.

The Monitor System. Another helpful technique draws on the age old concept of the buddy system. We call it the Monitor System - a monitor being a person (spouse, parent, or friend) who has a vital interest in the stutterer.

A monitor totally understands the stutterer's treatment program. He may practice the Air Flow Technique with the patient or encourage him to confront speaking fears. He is almost like a surrogate parent, a mother or father who is intimately involved with the child's homework. We have discovered that patients make much greater progress if there is someone at home and/or at work or school who is intimately involved with the rehabilitation program. People have a lot more power to change when they are with another person rather than alone.

From time to time a stutterer reports that he lives alone, that he knows virtually no one, that his work is done in isolation, and that he cannot think of who might be a suitable monitor. I suggest that he go out and hire one, that he pay a high-school student a few dollars an hour to function as a monitor. At all costs, he must not try to go it alone. He is to think of the stutterer inside himself as a sort of child - a child that needs parenting.

We have repeatedly discovered that monitors are crucial to the establishment of success and that patients who attempt to succeed alone court disaster. Although it is possible for some individuals to succeed by themselves, their number is small. The general suggestion is: get a monitor. And if you can find two, you are twice blessed.

Banquets. One of the most satisfying occasions for any former stutterer who has triumphed over his affliction is the opportunity to share his achievement with others. Each year, throughout the United States, banquets are held in a number of cities. They celebrate the achievements of Air Flow students. After dinner, thirty individuals present short speeches on a topic related to the theme "How My Life Has Changed." Their speeches are testimony to how far these individuals have come in changing their lives. You'll read some of these wonderful first-person success stories in Part III of this book.

A call for speakers for an upcoming banquet is usually announced a month in advance; the first thirty to respond are chosen. In recent years, far more have responded than time allotted. Those who are "shut out" are given top priority for the following year's presentation. I recall one patient who felt so disappointed at not being able to speak at a Washington, D.C., banquet that he submitted his name for one in New York, was accepted, and flew up for the dinner.

Individuals who have shown an interest in learning Air Flow but who have not yet done so are invited to attend a banquet and listen to the speakers after the dinner. Many of these stutterers are skeptical about being able to recover. They have had many therapies in the past, none of which have ever worked for any considerable amount of time. As these individuals hear one success after another, a glimmer of hope begins to develop.

We have found these support systems absolutely critical in helping establish a permanent result. Without them, the patients are left to fend for themselves and, unfortunately, very few have enough power on their own to voluntarily make the major changes required. 

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