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First, Do No Harm: Navigating Our Responsibility to People Who Stutter

Updated: Nov 22, 2023

SLPs should ask themselves: “Why am I teaching this person to change their speech patterns? Why are they learning this particular skill?” Perhaps even more importantly, stutterers need the opportunity to explore those questions for themselves. – Dr. Ryan Pollard
Dr. Ryan Pollard, PhD, CCC-SLP, BCS-F

On the evening of Saturday, June 3, 2023, I had the opportunity to attend a live taping of the Mile High Stash podcast at Roots Music Project in Boulder, Colorado. Another friend and colleague was also there that night of the taping: Dr. Ryan Pollard. Pollard is a fellow Speech-Language Pathologist (SLP), a board-certified stuttering specialist (BCS-F), an assistant professor at the University of Colorado-Boulder (CU), a person who stutters (PWS), and also a gifted fiction writer.

I first met Pollard as a graduate student in the fall of 2005. We were both studying at CU—I as a Master's candidate, and he as a PhD candidate. In the years that followed, I have been fortunate to cross paths with him periodically and share in enthusiastic conversation about all things life, and of course, stuttering. I always walk away from our conversations more knowledgeable than before. I’ve approached him at least a few times to ask if I could feature his story on the Cadence Speech Blog.

The evening of the podcast taping was no different. Pollard and I were seated at a high-top table waiting for the show to begin and I found myself pitching story ideas with the hope it would lead to a shared blog post. As mentioned, he is a talented writer and would ideally coauthor any piece appearing on the site. After a few duds, I said, “How about an article about the potential harm that can be caused by stuttering therapy?” His eyes immediately lit up and he replied, “I’ve actually had the same idea! I wanted to write a piece called ‘First, Do No Harm,’ based on the old Hippocratic medical principle.”

Six weeks later we found ourselves at dinner with a mutual friend and the idea came up again. When I hear stories about PWS who report harm in stuttering therapy, it hits close to home. There is a dark complexity in this truth—that it’s possible to want to be helpful but carry out actions that are ultimately hurtful. In addition to finding this to be a compelling and potentially divisive topic, Pollard has a unique backstory. It felt important to also share more about his journey with stuttering if we moved forward with this post.

In considering what causes harm to PWS, it occurred to me that it is not which approach we utilize in therapy (e.g., fluency-focused or acceptance-based), but rather the need to adhere to any definitive approach at all. The most effective SLPs are adept at listening, empathizing, sharing, supporting, and giving individuals the power to choose what helps them the most.

The “best” solutions in stuttering therapy will be revealed when PWS are skillfully guided through a process of learning and self-discovery. Our onus as SLPs, then, is to embody that knowing guide. Or to send PWS to those we can trust to carry out that role. Dr. Ryan Pollard is certainly a knowing guide and is also among those I inherently trust.

My deepest thanks to you, Ryan, for taking the time to share your story, your wisdom, and your beautiful writing. May we all have the good fortune to have such friends and colleagues in this life! Take it away. —Allegra Ludwig


Wow, what an introduction. I feel like there should be a microphone here. Allegra is right that this topic is something that deeply stirs me, as I’ve grappled with it professionally for many years. Beyond that, though, the more I’ve thought about it and discussed it with colleagues like Allegra, the more I’ve realized that unintentional harm has been part of my stuttering journey since the beginning. I had two kind and knowledgeable school SLPs growing up, and I trust they did all they could to try to help me. But even still, I wanted nothing to do with it. I wangled my way out of speech therapy in eighth grade and didn’t return to a clinic room until I was nearly twenty. It would take another few years before I finally found that confluence of personal readiness and knowing guide that set me on the path to lasting change. Even all these years later, I’m still surprised to find stray remnants of those dark years popping up at odd times. I suppose hating how I talked for so long and how I assumed the world saw me because of it did some lasting damage. Perhaps I’ll never fully be able to root out all the shame and self-stigma from those formative years.

I realize that’s a bit of a dismal way to start things, but I want to impress upon the reader just how insidious and far-reaching the harm from what most would call competent stuttering therapy can be. I’ve met many adult clients through the years who’ve shared similar stories with me. I’ve also seen it at various stages in any number of children and teens. What nearly all of us have in common is the belief—sometimes the conviction—that it’s not okay to stutter. Or, more to the point, that I’M NOT OKAY because I stutter.

How did we all come to that conclusion?

Certainly, society plays a role. It’s no secret that stutterers are subject to the same mistreatment and negative reactions that our lovely ableist world bestows on all manner of disabilities and differences. The well-intentioned but misplaced value that parents and loved ones often place on fluency can also take a toll. But, unfortunately, sometimes that terrible notion and all the havoc it can wreak comes straight from the speech therapist. It can be something as seemingly innocuous as praising a child when they’re having a particularly fluent day or using a management skill that makes their speech more fluent. It can be the subtle judgment implied when words like “great,” “good,” and “easy” are linked to fluency, while words like “bad” and “hard” are reserved for stuttering. John Hendrickson’s new memoir Life On Delay has a trenchant line about the harm clinicians can do: “When a person of authority tells a young stutterer to ‘use techniques,’ they are confirming the stutterer’s worst fear: no one is listening to what you say, only how you say it.”

I believe when unintentional harm occurs in stuttering therapy, it usually stems from that message, however it’s delivered. The child learns, and the adult they eventually become believes, that they will only be heard—meaning: respected, taken seriously, accepted by others, even loved—if they talk like everyone else. The problem, of course, is that often they simply can’t. After the window of recovery in the earliest years closes, most stuttering kids are faced with a chronic condition, a permanent way of being that may fluctuate day to day and situation to situation, but is always there, looming.

So where does that leave the sincere and kind-hearted SLPs who want to help their clients? Should they forgo all methods of stuttering management, regardless of what approach they come from? I’d argue no. Just as I’d argue (because I’ve met them) that there are some autistic people who’ve found value in learning ways to alter how they behave and navigate the largely neurotypical world, I’d say that those who stutter (myself included) can benefit from changing how we talk. To my mind, it seems to come down to Allegra’s call for giving people the power to choose. That kind of empowerment only exists, though, if both sides fully understand what’s at stake. SLPs should ask themselves: “Why am I teaching this person to change their speech patterns? Why are they learning this particular skill?” Perhaps even more importantly, stutterers need the opportunity to explore those questions for themselves. Only with eyes wide open can we truly have a choice that’s worth the name.

Chris Constantino writes eloquently about the reasons a person might want to speak more fluently, with less struggle, effort, and disruptions: normalization and subjective well-being. Normalization means that we strive to sound like everyone else so we aren’t singled out as different. It’s easy to see the appeal, especially for younger folks desperately wanting to fit in. Well-being suggests feeling good about ourselves and enjoying communicating. If using management skills to be more fluent produces a client bent on normalization, or even vaguely grasping toward it because that’s the message they received, odds are that’s going to be a losing game. But if a stutterer is seeking well-being and that happens to include physically struggling less when they talk, then techniques, and the teaching of them, need not cause the harm I’ve been speaking of. They can integrate easily into a holistic framework alongside acceptance, self-advocacy, desensitization, disclosure, and the rest.

This brings us back to Allegra’s wonderful advice about skillfully guiding clients through a process of learning and self-discovery. That’s what was missing from my early therapy. I didn’t have the power to choose what would be most helpful to me because I didn’t understand what was underlying all the passage reading and word lists and praise I received when I didn’t stutter. I sure felt it, though—viscerally, you might say—and I’ve since learned I’m far from the only one. But I remain hopeful. My continuing journey and the hundreds of stutterers I’ve met, befriended, and served over the years have convinced me that unintended harm can be avoided. The SLP merely needs to help allay their client’s worst fear, rather than confirm it. —Dr. Ryan Pollard

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