Discussion among clinicians: Fluency vs. Acceptance (2025)

Discussion among clinicians: Fluency vs. Acceptance (2025) **Charles Van Riper**: Decreasing sensitivity to stuttering is one side of the coin, and letting go of the struggle to avoid stuttering is the other side. Researcher: This focus on fluency is not helpful. One has to address the root cause of the suffering, which stigma (rather than stuttering). Building fluency is not a goal. Avoiding stuttering and avoiding living are goals. The way our brains work is not right or wrong. It simply Is. The word Cure should not be used. This seems to be a term from a medical model of disability (difference). The result of letting go is not controlled fluency, but rather stuttering without struggle. I am actually relieved and pleased when I stutter openly, even with excellent blocks lasting a number of seconds. That is who I am. I lecture, I conduct business, and I stutter. Identify and let go of that struggle. I try to avoid judging any aspect of my speech and my stuttering, and try to make my content of value. SLP: I think it's wrong to assume fluency is the desired or correct state, and that stuttering represents a disruption to be fixed. From a stuttering-affirming standpoint, that is exactly the problem. When fluency remains the ultimate goal, we reinforce the same fluency dogma under new terminology. Administrator: What does “fluent” really mean? The word fluent comes from the Latin fluere; meaning to flow. That’s it. Flow. Movement. Continuity. Somewhere along the way, though, people redefined “fluent” as perfect speech without a single stumble. That’s not what the word means, and it’s not how it’s used anywhere else in life. Think about it: You can be fluent in French without being flawless. You make mistakes, you learn, and you keep going. So why, when it comes to speech, do people suddenly think fluency means “perfection”? Historically, fluency referred to the natural flow and rhythm of language -- not the absence of stuttering. When people who stutter (and their families) understand that, it takes pressure off the idea that only stutter-free speech counts as success. By reclaiming the word, we can move toward a healthier perspective: fluency as communication that carries meaning, not perfection. Make all approaches available: acceptance, openness, modification, desensitization, and fluency-shaping techniques among them. Each has value when pursued voluntarily and with understanding. As long as they are grounded in clinical science and lived experience, not rhetorical tradition. The word fluency has evolved in modern communication sciences to encompass the natural flow of speech -- not the unattainable ideal of perfection. SLP: You set up a comparison with language acquisition, music and sport, calling the whole act fluent, then mark some of the performance as: mistakes you have to learn to do less of (language); slipping off notes (music); not flawlessly (sport). The basic narrative is always to do better, to better the Fluency. You are not redefining or taking "Fluency" back to include stuttering. You are setting up the same narrative as stuttering being the mistake, the slips, the flaws. SLP: Studies in communication shows that PWNS favor stuttering speech over speech with modifications. There is nothing wrong with Fluency, I just disagree with the rational and attempt to change the meaning. Fluency has been the ideal, putting stuttering into Fluency wont change it. SLP: Many researchers and therapists still insist on measuring stuttered syllables, and even telling clients "it's ok to stutter, but try say that again without stuttering". To me, this approach is absurd and harmful. We are certainly not going from judging stuttering in a negative way to judging struggle in a negative way. SLP: If building fluency isn't a goal for people who stutter, then why are people with dyslexia taught to build reading fluency, and nobody sees that as a problem? SLP: Stuttering techniques is a life long thing, practice, relapse, practice, relapse. All because we don,t accept the loss of control. Administrator: Just as people with dyslexia work to build reading fluency . . . not because they’re ashamed of how they read, but because it helps them participate more fully and comfortably . . . people who stutter may also choose to build speech fluency for the same reason: to make communication easier and more effective in their own lives. Working toward fluency doesn’t mean rejecting who you are. It simply means strengthening a skill, gaining confidence, and finding more ease in moments that matter. The goal isn’t “perfect speech” any more than reading fluency means “perfect reading.” It’s about access, empowerment, and choice (core values). SLP: The purpose of desensitization is to strengthen your resiliency and not allow "stigma" to take over your world. Researcher: we should just allow ourselves to stutter. SLP: you are reinforcing neural pathways when you do that. Take a hard look at successful therapy for aphasia. SLP: We, as therapists have tried this for a long time. The notion of using desensitization to increase fluency etc etc is a psychological paradox. With all respect to Dr.Hugo Gregory and Van Riper that is really becoming very visible these days), the field have developed over the years, and their understanding of stuttering was a crucial foundation. But let us keep developing and not be stuck in the past. SLP: Pioneers like Dr. Hugo Gregory and Charles Van Riper remains relevant, not as an endpoint, but as part of a continuum of knowledge and practice. We don’t view these contributions as being “stuck in the past,” but rather as a base upon which today’s research and clinical practices continue to build. Our aim is not to argue, but to make room for multiple perspectives -- historic and current -- so people who stutter and professionals alike can choose from the full spectrum of ideas available. SLP: I absolutly agree on the perspective that the work of Dr.Gregory, Van Riper and many more have been leading us in the right direction. And I deeply admire Charles Van Riper and his ideas. But now it seems like quotes from the 1970\`s are being used to legitimate the same practice as we have always had. That is my main concern. That is not something I say to decrease their relevance, but putting them into perspective. We have to be mindfull and maybe more important: honest, about of what we communicating. SLP: If an adult PWS wants to work toward increased fluency, then a stuttering-affirming approach may just not cut it. At least, offered from the perspective of a lifelong PWS who got real fed up with accepting long blocks, which fed into more more secondaries and social isolation. A Van Riper approach was quite helpful in the mid 70’s, and led to a “more fluent” life, a degree of stuttering that became acceptable to me and ultimately less life controlling. Administrator: Fluency goals should belong to the person who stutters, not to ideology. What you described is exactly what Van Riper meant by “stuttering easier.” Acceptance and growth can absolutely coexist. Acceptance first. Options always. Respect for every voice. Researcher & SLP: we are seeing a considerable number teens in our practice who went through acceptance only therapy and report feelings of trauma over it. They never wanted to go to therapy solely for acceptance and wanted to find ways to speak more easily. We need to go back to client centered therapy and honor the goals of the client, whatever they be. We asked how many people, in the 35 years had been in practice came in looking ONLY to feel better about their stuttering and not looking for any changes in speech. Zero, absolutely no one. I use this in teaching my grad students all the time. Very powerful testament to the shame that this movement can create for those who stutter who want more than acceptance. SLP: In my case, blocks were several minutes in duration, which precipitated some bizarre secondaries. I was ready to dig in to a methodology that at least allowed me to more easily blend into a new career, perfect speech was not the goal, but an easier way of speaking in which blocks b came shorter and much less a hindrance to interactions. I don’t deny it took work, it required an acceptance that achieved “fluency” was far from perfect (especially in feared situations), but it also lowered the threshold on “helplessness”. Would I have achieved this with. Stuttering-acceptance approach? I believe - for me - the answer would have been more snake oil for my tool box. SLP: it is not up to me to question what works for you. SLP: I worry that this focus on acceptance and stutter-affirming therapy (which in and of itself not a bad thing) can cause unnecessary shame for those who would like to change their stuttering. SLP: I’ve come far with my stuttering and acceptance and am all for that part of therapy but I absolutely wouldn’t be where I am today if I didn’t learn and work on managing my stuttering. I feel like those skills and techniques definitely have a place in stuttering therapy SLP: It’s also important to remember that life experience with stuttering can vary greatly. For some, stuttering may feel like an occasional inconvenience. For others--those with a heavier or more persistent stutter--it can feel like an ongoing barrier that affects everything from daily communication to career choices and relationships. SLP: Personally decreasing sensitivity did not improve my fluency. I needed that to improve on but my vocal folds locked so I needed intensive approaches. SLP: What may feel like a nuisance for one individual can be a real barrier to education, employment, or social opportunities for another. For those individuals, having strategies to change the way they stutter can make a meaningful difference in quality of life. SLP: You also can’t claim to support acceptance while promoting the idea that we should reduce or change how we speak. Saying “it’s not about perfect speech” doesn’t change the fact that the focus is still on altering it. You don’t get to say stuttering is okay and then encourage people to do it less. That’s contradictory and reinforces the belief that fluency is the standard. People who stutter don’t wake up one day believing their speech is wrong. They’re taught that from childhood. Parents, teachers, SLPs, peers—everyone around them sends the same message: fix it, hide it, smooth it out. They aren't choosing fluency work in a vacuum; they’re operating under lifelong conditioning that says stuttering is unacceptable. It’s a conditioned response to ableism, not self-directed freedom. When organizations with power and reach reinforce that idea, even subtly, it doesn’t offer “options.” It cements the belief that conformity is necessary for belonging. What you’re calling “comfort and confidence” often turns into dependence, avoidance, and constant self-monitoring. Fluency strategies teach people to think about how they sound instead of what they’re saying. That pulls them out of the moment, limits expression, and makes speaking a performance instead of a connection. That isn’t empowerment, it’s containment. Adults who have spent years trying to manage or reduce stuttering often end up tying their worth and success to how fluent they are on a given day. When fluency becomes the measure of progress, relapse feels like failure. That is incredibly harmful. I’m someone who stutters at a high frequency and I communicate well without hiding it. The idea that fluency is required for opportunity is exactly the mindset that needs to be challenged. SLP: Only when I completely embraced IDGAS in relation to my stuttering and fluency was I able to release the vast amounts of Natural Speech I always possessed. The real “f” word - to me - is fluency…. The words “stuttering” and “fluency” are heavily weighted in semantics, especially to those of us who stutter.