This is important because many clutterers find it difficult or uncomfortable to review their own speech. People with cluttering frequently need to practice controlling their speech. It helps to analyze conversations that have been recorded on video or audio. Clinicians can discuss the clients’ worst, average and most clear speech samples.
Then it comes down to encouraging them to listen to recordings on a daily basis. There is a “but”, though: for some clutterers listening to recordings of their speech could be a traumatic experience. It then may be best to build rapport with the client over several sessions and really work on that trust, before playing recordings for them.
Slowing down speech rate
Slowing down is very effective in cluttering. Clients can get rid of a broad set of symptoms of cluttering. This isn’t easy for them, though. Bear in mind that a clutterer has a considerably harder time achieving and maintaining a lower tempo of speech than a typical speaker. Telling a client to “slow down” is not helpful and might even be harmful.
Talking at a lower pace requires the client to use the skills learned to achieve heightened monitoring. But this all depends on the specific situation that clients are in: when they aroused or in an emotional state of mind, clutterers find it even harder than normal to control their speech rate.
Phonetics and naturalness of speech
It speaks for itself that clinicians should give feedback to their clients in order for them to sound more natural. For example by focussing on the stressing of syllables, intonation, pitch and volume. The way the message comes across phonetically is an important aspect of speech.
Working on the client’s articulation
A positive side effect of slowing down is that if often leads to a more articulated and clear speech. If not, the client needs additional treatment. There are several techniques that can be used to target often seen, systematic patterns in speech that result in misarticulations.
Speech-language therapists could also work on the content and form of a client’s story. The problem in some clutterers’ speech is not their intelligibility per se but their fluency. Some clutterers need to practice a lot to be able to tell a story in a logical way, using the right sequence, and so on.
Too many disfluencies
If clients still show cluttering disfluencies after targeting rate, monitoring, articulation, and language, fluency shaping techniques can be used to lower the frequency of disfluencies to a manageable level.
An often neglected part of cluttering speech therapy is the interaction with listeners. The result of cluttering are communication breakdowns, so it is important to keep the listeners reactions in mind when treating cluttering speakers. The goal is to recognize cues offered by listeners, like frowning, and start practicing with turn-taking; giving each other enough time to express one’s thoughts.