“Experiences cause structural changes in the brain, sculpting synapses in profound ways. This ‘plasticity’ of the brain has been demonstrated by neuroscientists over the past decades.” (p. 189-190). This statement, which I have taken from the book The Anatomy of Hope,* is a crucial concept in speech therapy. It justifies the therapeutic process. There are times when the small step-by-step process of speech change seems to take so very long. But we persist because we expect to alter speech production pathways in the brain.

Let’s imagine, for the sake of simplicity, that neurons in the brain are organized like a road map. This is an analogy that children may understand. Some children spend a lot of time traveling short distances to sports and school events or long distances to vacation spots. Parents teach map skills by highlighting routes and talking about roadways, exit numbers, and geography. Stuttered speech is like driving on a bumpy road in rush-hour traffic! It can be uncomfortable, stressful, stop-and-go, include wrong turns, and involve some unpleasant interactions with others.

Speech therapy is road construction. The child, parent, SLP and other helpers, team up to build new roads along which a child’s ideas can travel through his brain to his mouth more easily. The new roads, the new neural pathways, take time to build and are constructed with care. During this construction phase, it is the expectation of a better road, the hope of an easier route, that helps us to be patient with the process.

In The Anatomy of Hope, the author seems to say that hope is essential to change. “Hope can arrive only when you recognize that there are real options and that you have genuine choices. Hope can flourish only when you believe that what you do can make a difference, that your actions can bring a future different from the present. To have hope, then, is to acquire a belief in your ability to have some control over your circumstances. You are no longer entirely at the mercy of forces outside yourself.” (p. 26)

Stuttering involves loss of control. Stuttered sounds seem to occur at random and then much later appear to be predictable on letters such as /b/, /s/, or /g/. This loss of control leads to struggle, anticipation anxiety, and avoidances. Listeners don’t understand what’s going on or know what to do and soon the person who stutters finds entire conversations out of his control. Some outside force, unknown even to the experts, wreaks havoc with speech and communication.

SLPs have no cure. Yet, they do offer hope in the form of speech therapy that encourages self-acceptance, behavioral changes, and ways to educate listeners. SLPs must convey the multiple messages: we can’t “fix” you (you are not broken) but we can give you reasons to hope for improvement. We cannot minimize the effort that will be required. We prepare for a speech therapy process that involves education, experimentation, trial and error, team work, persistence, and hope.

In The Anatomy of Hope, there is one cancer patient in particular who is also a cancer doctor. He selects an extremely intensive series of treatments that no doctor would ever recommend because of the debilitating side effects and uncertain results. This patient/doctor explains, “’I knew all the arguments made in cases like mine…I find these arguments patronizing…Most patients don’t really understand what’s happening to them… because they’re not clearly told the odds by their doctors…I, of course, had a crystal-clear understanding of my chances. And it was my right to choose what I did.” (p. 75)

This doctor was cured and later “he visited cancer patients in the hospital who were losing hope. He was an inspiration. His survival showed them that there is inherent uncertainty in the behavior of even the worst diseases…He sought to assist people in making choices that addressed their own particular needs, desires, and beliefs.” (p. 78)…To hope under the most extreme circumstances is an act of defiance that…permits a person to live his life on his own terms. It is part of the human spirit to endure and give a miracle a chance to happen.” (p. 81)

After much research into the concept of hope, Dr. Groopman suggests that realism plus positive physiological change is necessary to achieve positive emotional change. Therefore, he recommends that early treatment be designed to give patients some kind of immediate physiological improvement. With this in mind, I am spending more time encouraging my students to complete very simple, very successful speaking tasks at the beginning and at the end of every session whenever possible. I am relaxing my own, egocentric, need to see “progress” along any hierarchy, so that the student can experience speech success at whatever level that might be.

“Kindling and sustaining hope depend not only on images that may be conjured in the mind but also on how those images are brought into focus or blurred by the ongoing input of nerves from organs and tissues to the brain.” (p. 181) Students must experience success and understand how they were responsible for it. If SLPs push too hard, our students may experience more failure than success. Given the messages in The Anatomy of Hope, perhaps whatever cognitive therapy approaches we favor might be most effective when accompanied by carefully planned behavioral training that ensures speech change, even if that means slower “progress” along a hierarchy. Let’s remember that speech therapy is for the student’s benefit, not the SLP’s need to document professional competence.

*Jerome Groopman, M.D. (2005) The Anatomy of Hope: How People Prevail in the Face of Illness, NY, NY: Randomhouse, Inc.

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.