Stuttering treatment is a mystery. Traditional interventions that prioritize fluency drills and speech strategies often fail to generalize. We are left wondering, why isn’t the client making progress?

Maybe we're looking in all the wrong places.

What actually accounts for change

We know from psychological research¹ that the specific techniques used is not the only variable contributing to success in therapy.  Extratherapeutic factors (qualities of the client or environment), common factors (clinician/client relationship), and expectancy (client’s belief that the therapy will work) are other factors that contribute to treatment success. Lambert¹ reported that extratherapeutic factors have the greatest influence followed by the therapeutic relationship. He breaks it down as follows:

Thinking beyond techniques

Sonsterud and colleagues² recently researched the clinician-client relationship in stuttering treatment. They evaluated whether the working alliance (the healthy, trusting aspect of the client-clinician relationship), is associated with client motivation and treatment outcome. Eighteen adults who stutter participated in this treatment study and were given standardized tests to measure working alliance, motivation, and stuttering severity.

Rapport matters

The researchers confirmed that the working alliance between a speech-language pathologist and a person who stutters is important. A positive working alliance was associated with positive outcomes 6 months post-therapy. 

Within working alliance, the authors found that mutual agreement on therapy tasks and goals is the most significant factor for determining success in stuttering therapy with reductions in anxiety, stuttering severity, and avoidance behavior. 

In addition, self-reported client motivation (the ability for a client to dedicate time and energy to speech therapy) was associated with both working alliance and a positive outcome in therapy. 

Implications for clinicians

• Invest time in developing a strong clinician-client relationship early on in therapy
• Focus on client-led therapy, keeping the client engaged and motivated along the way
• Establish meaningful treatment goals together with your client and check in regularly
• Become knowledgable on different kinds of stuttering therapy. Be flexible and willing to throw your therapy plan out the window.
• Brush up on your counseling skills!

1. Lambert, M. J. (2013). Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change. Hoboken: Wiley.

2. Sonsterud, H., Kirmess, M., Howells, K., Ward, D., Billaud Feragen, K., & Seeger Halvorsen, M. (2019). The working alliance in stuttering treatment: a neglected variable? International Journal of Language & Communication Disorders, 00(0), 1-14.