It’s hard to get 20 stuttering experts from around the country to take time out of their busy schedules and congregate in one place for a weekend, but that’s exactly what happened on October 18-20th at the Language Science Center at the University of Maryland. HESP Clinical Professor Vivian Sisskin and her associates at the Sisskin Stuttering Center hosted 22 stuttering specialists for a 3-day workshop about the nuts and bolts of Avoidance Reduction Therapy for Stuttering (ARTS®).

The workshop began with lecture and discussion about the theory of ARTS®, much of which is underpinned by conflict theory and role theory.[1][2] Workshop participants engaged in passionate discussion about various theories of stuttering treatment, what aspects they viewed as essential to a successful treatment approach, and the components of ARTS® they resonated with most strongly. The group of 22 clinicians spanned across the country and even the globe, coming from as far away as California, Alaska, and even France! “It was humbling to be in a room with so many experienced and talented therapists,” said Ryan Malliger, Speech-Language Pathologist at the Stuttering Association for the Young (SAY) in New York City. “As a relatively young clinician, it was inspiring to see clinicians with decades of experience challenging themselves and questioning their practice.”

The catalyst for self-exploration and reflection was the presentation of the fundamentals, theory, and treatment approach of ARTS®. ARTS® is a stuttering therapy approach based on the principle that what fuels the problem of stuttering is not the overt disfluencies themselves but instead the fear of stuttering. In response to this fear, many people who stutter learn avoidance behaviors, such as losing eye contact during disfluency, substituting words, saying “uh” or “um” before a feared word, not answering the phone, not introducing oneself at a party or work meeting…the list goes on and on.

These avoidance behaviors maintain the fear of stuttering, which leads to what ARTS® therapists call “struggle”: learned physical reactivity to stuttering, such as vocal cord tension or feeling stuck on a sound.

This struggle causes many people who stutter to have feelings of shame or embarrassment about their speech, and negative thoughts related to listener reaction. ARTS® operates on the principle that if one can remove the “fuel” of stuttering — fear and avoidance — one can reduce the physical, cognitive, and emotional struggle; leading to a more comfortable, forward-moving speech pattern and increased spontaneity and joy in communication.[3]

These ideas were laid out to workshop participants on Day 1, but it wasn’t until the second day when the stuttering specialists were taught the systematic approach and stages of change of ARTS®. The therapy was broken down into four motor stages: becoming an expert on one’s stuttering pattern, reducing escape behaviors, achieving an “open stuttering” pattern, and exercising choice in the way one stutters. The goals and concepts of each stage were presented with rationales, treatment activities, and client questions and problems that frequently arise in therapy.

The day was highlighted by a panel of people who stutter involved in ARTS®  groups who shared their stories of acceptance, courage, and change as they progressed through the therapy. Workshop participants saw a variety of clients at various stages of therapy. The values of group therapy — support, motivation, change, and connection — emerged as a theme from the day’s panel members. “I really liked hearing the stories of real clients,” said Jessica Hudson, Speech-Language Pathologist and Founder of Stuttering and Speech Therapy of Arizona. “I have thought group therapy was a great idea for a while now but it really sunk in listening to others.” Ms. Hudson reported that she will begin group therapy this Winter for her clients in Mesa, Arizona.

The third and final day of the workshop focused on the cognitive and affective changes that take place during the therapy process. Workshop members were familiar with how to encourage cognitive and affective change in their clients, but the connection to the motor aspects of therapy were less well known.

The afternoon featured a panel of people who stutter covertly (PWSC) who had been or were currently in ARTS®. PWSC are those who have the ability to pass as fluent speakers, but are working on revealing, enacting, and accepting their identity as people who stutter. One might think that if a PWS can pass as a fluent speaker, then there’s no problem.

However, the mental work and increased fear and anxiety that goes into successfully avoiding stuttering each day can be physically and emotionally exhausting.

There were few dry eyes in the room as panel members shared their stories of fear-facing, shame-seeking, acceptance and growth. Many of the stuttering specialists saw their own clients in the stories of the panel members. It was an emotional and inspiring afternoon that made an impression on each person in attendance.

ARTS Participants in front of MLK Memorial at night
The three-day conference left attendees (and presenters) on an emotional high — inspired by stories of courage and change, eager to implement new frameworks of stuttering treatment with their clients, and grateful to connect with other specialists who share a passion for helping those who stutter.

[1] Sheehan J.G. (1953). Theory and treatment of stuttering as an approach-avoidance conflict. Journal of Psych, 36, 27-49.

[2] Sheehan, J.G. (1968). Stuttering as a self-role conflict. In H.H. Gregory (Ed.) Learning theory and stuttering therapy. Evanston, IL: Northwestern University Press.

[3] Sisskin, V. (2018). Avoidance reduction therapy for stuttering (ARTS®). In Amster, B.J. & Klein, E.R., (Eds.) More than fluency: The social, emotional and cognitive dimensions of stuttering. San Diego, CA: Plural.

Ben Goldstein Headshot

Ben Goldstein (M.A., 2016) is a graduate of the master’s program in speech-language pathology at the University of Maryland. He is a person who stutters and is an active member of the National Stuttering Association (NSA). Ben is the former co-chapter leader of the Rockville NSA Chapter and has presented on Avoidance Reduction Therapy at several national conferences. He enjoys playing guitar, traveling, and watching his favorite football team — the Baltimore Ravens.