Stuttering Modification (Van Riper) Therapy
About: In the 1930s, 1940s, and 1950s stuttering therapies were based on the then-correct assumption that there was no effective treatment for stuttering. Instead, the aim was “a reduction of fear and avoidance of stuttering” via self-acceptance of one’s disability, open disclosure to others that one is a person who stutters, and intentionally stuttering (“voluntary stuttering”).
Watch a person who stutters struggle to talk. You see overtense, overstimulated respiration, vocal folds, and articulation (lips, jaw, and tongue) muscles. Brain scans of adults who stutter have found overactivity in the left caudate nucleus speech motor (muscle) control area, during stuttering.
Evidence: Only one study of stuttering modification therapy met the 2006 AJSLP trial quality standards.(1) A 2005 study investigated 19 adult persons who stutter in the 3.5-week Successful Stuttering Management Program (SSMP) in Spokane, Washington.(2) Immediately post-treatment the subjects’ speech improved on average 10%. Six months later this modest gain had all but disappeared. Several measures of anxiety found a 10-15% psychological improvement. The researchers cautioned that this small psychological gain might not last, given the absence of improved speech. The researchers concluded, “…the SSMP appears to be ineffective in producing durable improvements in stuttering behaviors.”
A 2007 literature review observed that these older therapies(3)
…tended to make relatively heavy demands on the time, skill, patience, and insight of both the stutterer and the clinician. In the hands of poorly trained therapist, it could degenerate into little more than an attempt to teach people who stutter to live with their speech difficulty. At best, it almost never resulted in normal fluency.
(1) Anne K. Bothe, Jason H. Davidow, Robin E. Bramlett and Roger J. Ingham. Stuttering Treatment Research 1970–2005: I. Systematic Review Incorporating Trial Quality Assessment of Behavioral, Cognitive, and Related Approaches. American Journal of Speech-Language Pathology, Nov 2006, https://doi.org/10.1044/1058-0360(2006/031)
(2) Michael Blomgren, Nelson Roy, Thomas Callister and Ray M. Merrill. Intensive Stuttering Modification Therapy: A Multidimensional Assessment of Treatment Outcomes. Journal of Speech, Language, and Hearing Research, Jun 2005, https://doi.org/10.1044/1092-4388(2005/035)
(3) Bloodstein, O. & Bernstein Ratner, N. 2007. A Handbook on Stuttering: Sixth Edition, pages 386-387.
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I had Van Riper therapy in 1972. I later became an SLP and still use many elements of this program with my clients. I think of it as "old gold"… while its hard to directly confront your own stuttering, I see that as the best part… looking your "enemy" directly in the eyes. Its a struggle to get past everything that stuttering has come to mean to you at any stage in life. But dealing with it directly, as this program does, can be the most meaningful way of abandoning the "ghosts" that stuttering can create. It is very difficult work and takes time to "sink in"… but I can still remember the feeling of success and empowerment in becoming able to control my disfluencies. Today, YEARS later, and hundreds of thousands of speaking opportunities later, my fluency is very, very good and I have a lot of confidence in my speaking abilities. Some limited stuttering still remains, but it rarely, rarely, has but the slightest impact upon me and does not limit my life in any way.
