Speech therapists are a mixed bag. There's helpful ones and unhelpful ones. I've been to three different ones, and the one I'm seeing right now is the only one whose actually helped me and taught (and still is teaching) me strategies and things to do the others have not. The others taught me the basic breathing, pause and plan, and linking, and had me speak incredibly slowly and monotone. Something I definitely don't want to do in real life. If one doesn't work for you, try another. You're saying it's been on-and-off for 6 years. That's a really long time, and if it's on-and-off, you're probably not keeping up with your strategies as well as you would if it was a regular thing. Is there a way you can get in-person help? Can your doctor refer you to a speech therapist? Could you cancel things with her and talk to a different one on Skype? Do you practice by yourself? Take 10 minutes and practice diaphragmatic breathing. Read aloud from a book or internet. Watch a scene on TV and repeat the lines a character says, inflection and all. Talk to yourself about your plans for today and tomorrow. I know it's really hard to implement strategies into real-life scenarios. Could you try with a family member or friend? Do people in your life know you're trying speech therapy? Tell them you're going to practice strategies with them for a few minutes. Call them on the phone and tell them the same thing. Practice with friends and family, with their knowledge. Move on to just doing it without telling them. Move on to strangers. You can just ask strangers what time it is; if you're heading to a certain building or store, ask someone for directions there, even though you know where you're going. Positive thinking definitely does help. In comments you're saying things like "I can't do it, it's too hard". Instead of being negative, try to be positive about it. Don't say "this is going to be hard. I can't do this", say "I'm going to use my strategies so I can speak as smoothly as I can". By telling yourself you're going to fail, you're building anxiety and preventing your confidence from building. The best thing to do is telling yourself to use your strategies and say you'll do the best you can. Even if you do have a bad block, don't beat yourself up. It happens. Reflect on what you had a problem with, and what strategies you could have used to help it. Did you reply too early and have to back up and start again or say something different? Then you should work on pause and plan and slowing down. Did you have a hard block on a consonant sound? Then you should practice light touches. Obviously, the only way to get better at this stuff is to practice it. If you only practice it on Skype, but don't carve some time out every day to work on it, of course it isn't going to help. Practice by your self first, tell family and friends and practice with them, move on to not telling them, move on to talking to strangers. As a reminder, the lock screen on my phone is a screenshot from my notes app that says "Relax, breathing, pause and plan, light touches, linking, slow down, cancellation". You could do something similar and remind yourself throughout the day to use your strategies.