I've worked with speech coaches (and some professional therapists), and based on what I learned, I've also coached few friends/acquaintances. From my experience, the difference between people that see success vs. failure boils down to following: Mindset of experimentation: People that are willing to try new things, and chalk up ANY new experience as a net positive, are the ones that succeed. For example, any new experience, positive or negative, can benefit you, IF you have the right mindset. For example, lets say I stuttered when ordering coffee today. My younger self would've gotten extremely embarrassed and would've slinked back, and I'd never order coffee again if I see the same barista. But my speech coach challenged me to double down by stuttering voluntarily during those situations, maintaining full control of my breathing, maintaining steady eye contact. The coach basically had me do 20 such interactions every week for 6 months. AND guess what, after doing this \~500 times, I realized that when people react negatively to our stutter, they're actually reacting to the shame/embarrassment that we unconsciously project. However, I realize that if I maintain smile, be confident and show composed demeanor while stuttering, other people did't seem to be bothered by my stuttering AT ALL. I'd NEVER have realized this if I hadn't opened myself up for new experience. So therapy is simply a GUIDE. Depending on the therapist, it might just be a 1-1 conversation, never going out of the office. OR it could be the speech course like I was part of where we had to start engaging with strangers from day1. There were other PWS in my group that refused to do those exercises, or gave up after doing couple. And as expected, they didn't see the benefits.