Carolyn Specialist Adviser – Lead clinical specialist for stammering "In a week I spend some time managing a team of speech and language therapists and some time working with children and adults who stammer to improve their communication skills. I believe that stammering should not get in the way of anyone achieving their aspirations that fall within their potential."

Carolyn certainly believes that people should work towards aspirations. Carolyn was born with short arms (her arms are about 6 or 7 inches long) and with little use of fingers. She manages a team of about 15 speech specialists and 3 bilingual co-workers. This takes about 2 days each week. For the rest of the time she works directly with people who stammer.

Stammering's when people can't say certain letters, isn't it?

Not really, no. When we speak we all hesitate, it's natural. There's a sort of line between no hesitation and so much hesitation it gets in the way of communication. It's hard to say exactly where stammering 'starts'. Stammering is a repeated pattern of hesitation.

Sometimes people have a difficulty with a consonant, like g-g-g-g-green. Sometimes it's an elongated vowel sound, like m-u-u-u-u-u-mmy. Other people block altogether, like “My name is [silence] John.” People then may develop physical habits to fill in the 'gap', like shaking their head, blinking, or smacking their leg.

How do you work with people?

If they're very young children, say 2 – 4, stammering can be particularly upsetting for parents; but this may be developmental – the children may grow out of it. So the first thing I would do is assess the level of 'risk' of the stammer being a developmental difficulty or whether it has the potential to be a chronic dysfluency.

Dysfluency?

It's the word we use when people's speaking doesn't flow naturally.

I see teenagers in small groups, usually in the early evening so they don't have to miss school or their paper rounds; adults one-to-one and in groups. I also work with parents, sometimes parents with children and sometimes with whole family groups so I can see how they interact.

Can you cure stammering?

I don't really believe there is a cure for stammering especially in adulthood, at least not one that's appropriate for everyone. There are two broad approaches that can be used. I prefer to work with patients so that they 'stammer more fluently', in other words we work with them as they are, we work towards increasing communication skills. The other method is to teach techniques for enabling people to speak more fluently, but this isn't the method I use.

Why not?

People sometimes feel this isn't 'them', an unnatural way of speaking and they don't like to use it. It also encourages the person to think they have to be fluent – if they find it difficult, and cannot keep control, this may lead to negative feelings such as inadequacy and guilt.

Here's how I work. Stammering (dysfluency) has a lot of possible side effects. People can lose confidence, they avoid certain stressful situations, they may have poor eye contact, or be too shy to take part in conversations or discussions. So we start from where patients are and encourage them to be aware of what they are doing that's good and what they're doing that is a 'coping' strategy.

Then we work towards overcoming these strategies. I once had an adult client who was going for an important interview. So I suggested that, once she'd done her presentation, she should say to the interview panel: “I need a ten minute break.” A person has a right to ask for reasonable adjustments to be made within the Disability Discrimination Act. The break gave her time to relax and be more fluent in the interview. She got the job.

You'd be surprised the people I've worked with... actors, lecturers, potential MPs. All sorts.

What about the management side?

I line manage the staff; this includes responsibility for regular appraisals and staff development. I work mainly in a city and am actively involved in seven Sure Start programmes. I'm involved in recruiting and regularly work on developing speech and language strategies for the Primary Care Trust we come under.

Any bits you don't like doing?

Sometimes being a manager can be hard. It's hard implementing new policies, too, when there never seems enough time and people want it done yesterday.

And good bits?

The clinical side is very rewarding. From the manager's side – I like supporting staff in developing their skills and confidence in being a clinician.

Is it a good career?

Yes – I've been in it for 21 years! I could have moved into research but chose not to; I find it more rewarding looking at stammering in more depth. I enjoy the challenge of saying to myself “What I do isn't good enough” and then finding new and better ways of doing things, of making the therapy better.