Facilitating transfer and maintenance of fluency in stuttering therapy

The present state of stuttering therapy programs enables the clinician to render many stuttering virtually stutter-free in the clinic. A major clinical problem, however, is the transfer of fluency to nonclinical situations and its maintenance over time. Concepts and techniques extrapolated from the literature on behavior change are applied to assessment, treatment objectives, treatment techniques, and to a number of procedures designed to facilitate transfer and maintenance during therapy. When fluency has been established, self-control techniques based on speech practice, self-monitoring, and the deliberate use of self-administered and social contingencies are stressed. Guidelines for termination of therapy and follow-up are given. For many of these techniques, specific examples are offered from clinical work with stutterers. Other techniques are presented because of their potential relevance and their demonstrated effectiveness with a variety of clinical problems.