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Our approach

Most speech therapy in the UK takes place within the National Health Service. We believe there are advantages to providing speech therapy within an educational environment. Stammering is not an illness and we do not see people who stammer as 'patients' in need of 'treatment'. Our clients enrol as students who engage in a process of learning. We believe that this encourages an active approach to change which is essential to successful stammering therapy. Also, working in education means that we are able to offer group work, and for most people who stammer we see this as a positive choice.

Our beliefs about stammering and therapy
'Stammering is what you do when you try not to stammer'
 Wendell Johnson

The causes of stammering are complex and individual and there are often a number of different factors involved attitudes, thoughts and feelings play a big part in stammering avoidance (trying to conceal the stammering) is a driving force in maintaining stammering avoidance maintains the fear of stammering - the more you avoid stammering the more you fear it stuttering behaviours may develop and change over time in an attempt to gain control. Many of these are unhelpful and lead to an increase in tension and struggle.

It is important in therapy to address the emotional, attitudinal and avoidance aspects of stuttering as well as the speech itself people who stammer do have a choice about the way they stammer change is a process and takes time therapy is a partnership but ultimately only the person who stammers can make the changes they want to people only change by doing something different, not just by thinking or reading about it group therapy is often particularly beneficial.


Our philosophy
The therapy offered at City Lit is nationally and internationally recognised for its excellence as well as the comprehensive nature of the therapy courses on offer. We are one of a very few specialist centres for adult stammering therapy in the UK. At City Lit we seek to empower clients and we have found the adult education environment lends itself to this approach. We approach therapy as a partnership and encourage people who stammer/stutter to take responsibility for their own learning. We see the client as being the 'expert' on their stammer, and work with 'people who stammer' rather than 'stammerers' - a label that may deny individuality and promote stereotyping. Unlike some othe stuttering therapy programmes our therapy is not a 'quick fix'. Whilst it is possible to gain fluency relatively quickly, it is usually hard to maintain unless work is done on the whole of the stammering iceberg. 

Stuttering is a complex multidimensional disorder that requires a whole person approach. Our approach to therapy is holistic and is designed to address all aspects of stammering - the feelings and attitudes as well as the speech - leading to more lasting change. We would endorse the famous American stammering expert, Wendell Johnson, who stated; 'stammering is what you do when you try not to stammer'. We believe that trying to 'fight' your stammering is unhelpful and can be damaging in the long run. Fundamental to our philosophy is our belief that paradoxically working on acceptance and openness leads to greater fluency.

One of the key issues in stammering therapy is what happens when a course ends and how each individual maintains the changes they have made. We believe it is important that each client becomes their own therapist so that by the end of a course they can choose from a range of familiar tools and ideas. We seek to involve clients at all levels of our service and with this in mind are setting up a user group to advise on the structure and content of our programme. We also have strong links with the British Stammering Association and self help groups.

Our therapy programmes We believe each person who stammers is an individual and so our therapy offer is not a 'one size fits all' approach. We offer different programmes to suit the various needs of people who stammer. stammer more fluently and speak more fluently approaches There are two schools of thought about the treatment of adult stammering: stammer more fluently and speak more fluently. Stammer more fluently methods are largely based on the work of Charles Van Riper and Joseph Sheehan who both were speech and language therapists who stammered themselves.

The main aims of this approach are for the person who stammers to:

• Take charge of their speech
• Learn new ways of coping with the physical aspects of stammering
• Reduce tension and modify or manage moments of stammering leading to easier speech
• Reduce the amount of avoidance strategies
• Reduce any negative feelings about speaking/stuttering

Speak more fluently methods are often called 'fluency shaping' and deal with the physical side of speaking. The person who stutters is taught a more fluent way of speaking. The main aim is to increase an individual's level of fluency by retraining the speech and vocal muscles to move more smoothly and easily. There are a range of speak more fluently methods and all require rigorous daily practice for a considerable period of time.Block modification therapy: this is an example of the speak more fluently approach. This programme combines Charles Van Riper's block modification therapy with Joseph Sheehan's avoidance reduction therapy. We believe it is important for individuals to have an opportunity to address the emotional aspects of stammering as well as to work on the speech itself.

To this end, this course has two main aims:

• to reduce the negative feelings people may be experiencing as a result of stammering
• for individuals to learn some stammering management techniques which contribute to greater ease of speech.

By the end of the course our aims are for participants to:

• have a clear understanding of stammering and its causes
• have identified their own particular pattern of stammering
• have identified and worked on reducing unhelpful thoughts, feelings and avoidance strategies
• say what they want to without changing words
• speak up in situations they may previously have avoided
• use stammering strategies to manage moments of stuttering effectively so that it does not get in the way of their communication
• feel more comfortable in themselves and their speech
• be a more confident and assertive communicator
• reduce the tension that accompanies stuttering

Integrated approach to stammering therapy:
as the name suggests the integrated course combines elements of both stammer more fluently and speak more fluently methods as well as elements of cognitive therapy. This is an exciting and recent development to our programme. It was developed from Catherine Montgomerey's stuttering therapy programme at the American Institute for Stuttering in New York. The therapy addresses the many different aspects of stammering integrating desensitisation, block modification and cognitive therapy to address the mental and attitudinal aspects of stammering. However, the key difference is that it also includes a fluency technique, vocal fold management.

By the end of the course our aims are for participants to:

• Manage stammering more effectively
• Reduce the use of avoidance strategies
• Have reduced the fear that often accompanies stuttering
• Experienced increased confidence in themselves and their communication
• Be able to co-ordinate their breathing and speaking for easier speech
• Have retrained their speech and vocal muscles in order to speak more fluently

This course offers a comprehensive range of tools to assist the person who stammers to manage their speech more effectively. At the end of a course each individual can choose the combination of therapy tools that suits them best.

Interiorised stammering therapy
 We offer particular courses that we feel are more suitable for people with interiorised or covert stammering. This course is offered as part of our weekly evening class programme. As the term suggests interiorised or covert stammering is hidden inside the speaker and is often unknown to the listener. Numerous and often ingenious avoidance strategies are used to conceal the stammer. There are often strong negative feelings about stammering.

We believe that therapy for people with more covert stammering is most effective when:

• the therapy approach is block modification (stammer more fluently)
• the therapy is offered in a group
• the group consists of people with interiorised stammering
• the therapy is weekly rather than intensive

These courses address in particular the more emotional and psychological aspects of stammering. They aim to help people to reduce negative feelings, learn strategies to modify or manage their stammer and increase confidence in themselves and their communication. We offer both intensive courses as well as evening courses.Intensive courses We have found that working intensively can be a most effective way for people who stammer to achieve change, and we view therapy as a journey with people making changes along the way. These types of changes are likely to be longer lasting. Whilst people make many significant changes on an intensive course it is not a 'quick fix', and we believe follow-up therapy and support over time is essential in order to help maintain and develop the changes each individual has made. We offer a variety of follow-up courses to accommodate the different needs of our clients and we refer people who live outside of the London area for follow-up therapy close to where they live.

Evening classes
The evening class programme consists of weekly two hour classes of up to twenty five weeks. Shorter follow-up classes run for ten weeks. 


Group therapy
We believe that, for most people, group therapy is the most effective way to work on stammering because: it provides a realistic setting to work on interpersonal communication 

• it offers valuable support from other people who stammer
• it leads to feedback and help from a range of people - not just the therapist
• in a group there is a greater range of skills and ideas to draw on
• it provides positive role models
• people grow in confidence through experiencing some challenge in a supportive situation
• it is possible to develop greater confidence in talking to groups through participating in group therapy
• it provides exciting opportunities for real talking situations

Our groups vary in size from six to ten and participants are from a wide range of backgrounds. There is pair- and small-group work as well as whole-group discussion. Each individual sets their own personal aims at the start of a course and personal goals are revisited at all stages of the course. Most courses also include some individual time with the therapist to discuss any individual issues. Whilst many people initially express some concern about being in a group, often at the end of a course our clients tell us that the group experience has been one of the most positive and valuable aspects of their therapy.

'Stuttering is one thing that gets a lot easier if you don't try to hide it'
Barry Guitar