In this series, we unravel common misconceptions about Stuttering Affirming Therapy (SAT): what it is, and what it isn’t. SAT (sometimes referred to as neurodiversity affirming therapy) builds on established approaches to stuttering therapy while simultaneously revisiting their underlying assumptions. The therapy is highly person-centred and explicitly considers context alongside the emotional, cognitive, and social impact of stuttering. The goal is to increase communication freedom, autonomy, and participation for people who stutter.
But… doesn’t that sound like how our more traditional stuttering therapy has been heading anyway? Yes and no; what really sets SAT apart is that it starts from a fundamentally different conceptual framework. Over the past 10–15 years, a clear paradigm shift has been taking place within our field, shaped by insights from stigma and identity research and -crucially- voices from the community of people who stutter. Stuttering is no longer framed as a “disorder,” but as a natural variation in speech, a difference in communication, and an expression of neurodiversity. That may seem like a small nuance, but it has a fundamentally different effect on our therapeutic practice.
Using ten common misconceptions as our guide, we invite you to explore what this shift could mean for your day-to-day work with people who stutter.
Misconception 1) “With SAT, therapy has to change completely”
Misconception: SAT means throwing away your entire therapeutic toolbox.
Reality check: A lot stays the same; the lens changes.
What we actually do: Structure, therapy progression, desensitisation, generalisation, parent/school support, and many exercises remain. The difference is the underlying framework: What is therapy for? What message does it send? How do we define success? Not “as fluent as possible” or “learning to make the stutter itself as easy as possible,” but “communicating as spontaneously as possible.”
For many clients, “as freely as possible” means working on struggle or avoidance behaviours: everything someone does to stutter less or keep the stutter shorter. As those behaviours soften or drop away, clients often experience more and more stutter-philic (Constantino, 2023) sensations, and a lot of freedom and ease emerges.
That is fundamentally different from what is often meant by “easier stuttering,” namely modifying the stutter through techniques such as an “easy onset” (which are in essence stutter-phobic and rarely easy to do in real life 😉 ). The same applies to desensitisation: aiming for the client to (only) withstand or bear stuttering moments is different from being able to talk the way you talk and truly engage the environment. That difference matters.
Misconception 2) One size fits all
Misconception: SAT is one fixed package.
Reality check: SAT is individualised.
What we actually do: We tailor goals and interventions to a person’s life, values, age, context, and support needs, everything in relation to the environment they enact in. One person may focus mainly on participation, confidence, and speaking enjoyment; another on strengthening communication skills; and someone else on reducing avoidance and struggle behaviours within the stuttering moment (when that fits; often in ways that differ from traditional approaches).
Misconception 3) “You stutter – Like it or not, you must accept it asap”
Misconception: SAT is acceptance and nothing else.
Reality check: SAT is action towards gradual acceptance.
What we actually do: We practise hard situations, build exposure in a safe and paced way, make space for emotions and day-to-day experiences, work to change environments, build coping and communication skills, explore identity, evaluate (self-)stigma, strengthen resilience, reduce what people do around and within a stutter, help people find community, and more.
Like in the Relational Model, it is the relation between the person who stutters and the environment. It’s an illusion to think a radical change of society will solve all problems. On the other hand, it is not entirely (or for the biggest part) up to the person who stutters to change. It is working on both, and most of all the relation between the two.
Misconception 4) “Stuttering is never a problem! NEVER!”
Misconception: In SAT, you are not allowed to find stuttering difficult.
Reality check: SAT explicitly acknowledges impact and distress.
What we actually do: We take shame, fear, frustration, and avoidance seriously, and the lived experience that speaking while stuttering can feel deeply unpleasant or exhausting. We acknowledge the impact stuttering can have, and we understand the causes of that impact as much broader than the internal stuttering experience alone.
Growing up and participating in environments where your way of speaking is in the minority means many children encounter misunderstandings, stereotypes, bullying, and stigma. That’s why we also look closely at (often subtle) responses from other people. We explore the interaction between the client and how the world responds, and we think alongside them about how to prepare for misunderstanding and how to respond in ways that protect agency and dignity – and with that, change the environment.
When someone views their talking as a difference in talking, they respond fundamentally different than someone who thinks they have a fluency disorder. The latter can still stand up for themselves and ask the environment not to be mean (see inclusive belonging, by St Pierre, 2024); the former will advocate and show the beauty in verbal diversity (transformative belonging). We know which of the two will get further in life.
Misconception 5) “Everyone has to be proud of stuttering”
Misconception: SAT pushes pride as a required end goal.
Reality check: Pride(-like) feelings are not mandatory or “right or wrong.”
What we actually do: We make room for the full range: anger, sadness, neutrality, mixed feelings, as well as feelings like appreciation, uniqueness, or even pride. Positive feelings in a disorder is difficult; in a difference is a whole different kind of cookie. The focus is autonomy: you decide what stuttering means for you, now and over time. Many clients may feel neutral or gently positive about stuttering when finalising therapy. For a fairly large group, it becomes part of identity. And sometimes someone becomes genuinely proud of stuttering. We support that too.
Misconception 6) “There’s no place for technique(s)”
Misconception: SAT is anti-technique.
Reality check: Techniques aren’t banned; they may differ from what speech therapists have traditionally used, and they sit in a different place in therapy.
What we actually do: We treat techniques as tools, not as the measure of success. Together we choose what fits a person’s goals. Many people have built a whole “museum” (after Sisskin) of strategies meant to stutter less. Practising fluency-shaping and/or stuttering-modification techniques often adds even more to that museum, and multiple studies suggest this is not durably effective for most people.
SAT is not centred on techniques aimed at stuttering less or making the stutter smaller. If you think: “My therapy is mostly desensitisation, so I’m already there,” please look closer: in a traditional MIDVAS approach desensitisation is necessary to work with modification, so stutter-phobic (Constantino, 2023) responses can stay in place (even if smaller). If you think: “I stop when my client doesn’t want modification anymore,” please look closer: what was your message during the desensitisation-phase? Is stuttering with you truly a natural way of speaking, in any form it occurs?
Within SAT we look -step by step- for ways to fully approach the stuttering moment and replace stutter-phobic responses with more stutter-philic ones (Constantino, 2023). When someone can truly do that, struggle and avoidance behaviours drop away. Only then the overall stuttering moment often becomes smaller and easier. So the “museum” isn’t expanded; it is gradually emptied.
Misconception 7) “SAT means the therapist have to watch their words/language all the time”
Misconception: SAT is a linguistic minefield: everything must be said perfectly.
Reality check: Language awareness helps; perfection isn’t required. If it feels like “you can’t say anything anymore,” you’re missing the point.
What we actually do: We explore which words create pressure, shame, or a “fix-it mode,” and we look for language that supports safety, agency, and participation. It’s a learning process, nuanced, with humour, and with room to stumble.
It has to be tested: with colleagues, with clients, and out in the world. You can think theoretically about what to say, but only when you try it in real life, with real people who stutter and their parents. Only then you develop a felt sense of what language does. There isn’t a list of right and wrong words. At the same time: words do make a difference.
Misconception 8) “As a therapist you can conceptualise SAT without practising it”
Misconception: “I’ve read about it and heard talks at conferences: so now I know what it is and what it does.”
Reality check: SAT is something you need to embody in the therapy room. You need to communicate it sincerely and consistently, using congruent language, before you can truly understand its impact.
What we actually do: We learn about SAT through conferences, articles, webinars, and conversations; and we also live it: testing it out, noticing what it evokes, listening back to clients’ experiences, reflecting on our own reflexes (fixing, suggesting therapy is done, pushing fluency, pushing pride, discomfort with stuttering, “isn’t not stuttering nicer?”), and adjusting. SAT asks for lived experience, responses from the other side of the table, reflection, and supervision—not only knowledge and theory.
When we truly practised SAT, starting just a few years ago, we experienced a different mindset with clients. The most grateful are not the parents of young children who stopped stuttering, but the ones who see their child stutter with confidence. We notice that, although many people initially come in seeking help to reduce stuttering, this question already shifts after the first contact toward a more realistic expectation and, more importantly, toward what truly matters in order to express oneself well, with enjoyment and freedom. Letting go of their first expectation gives them freedom and our attitude towards stuttering as a difference, not a disorder, helps them with that.
Misconception 9) “New therapists don’t understand the different messages in different approaches”
Misconception: The field has to communicate only one approach because early-career clinicians get confused and don’t understand different therapy approaches.
Reality check: They often understand the implicit messages of different approaches very well. Many younger clinicians have grown up with much more diverse frameworks, almost “in the DNA.” In our Stuttering Affirming Therapy (SAT) courses, what we often see is not confusion, but that they don’t understand why stuttering is framed as a disorder.
What we actually do: We recognise that newer clinicians are often perceptive and responsive to inclusion and neurodiversity. The tension is often not a “lack of understanding,” but a values mismatch with older frameworks (taught during their education) that feel less intuitive. In our SAT courses, early-career clinicians often feel liberated. Good mentoring helps people hold frameworks side by side and make intentional, informed choices, not top-down, figured out for them, but their choices.
Misconception 10) “SAT is not for young children”
Misconception: Stutter-affirming therapy (SAT) is something for older children or teens. With young children, you have to intervene early to reduce stuttering, otherwise you miss the window of opportunity.
Reality check: SAT isn’t about not helping. It’s about what kind of help we offer and what message that help communicates. For young children, the most meaningful goals are often safety, connection, participation, communication joy, and an environment that doesn’t treat stuttering as a problem to fix. Early support can absolutely be valuable within a stutter-affirming approach; it just doesn’t define success as “as fluent as possible, as fast as possible.” Success can also look like a child who speaks freely, doesn’t shrink back, and caregivers who know how to support without pressure, monitoring, or constant “checking” of speech.
What we actually do:
- We work developmentally: play-based interaction, turn-taking, and communication in real-life moments.
- We coach parents (and sometimes daycare/school) on creating space: letting the child finish, fewer rapid-fire questions, more following and affirming.
- We normalize stuttering in an age-appropriate way, without making the child responsible (“you can stutter; you don’t have to hide it”). Listening to the content is important here.
- We look broadly at load and vulnerability: temperament, sensitivity, stress, expectations, and the overall communication climate.
- If structure or strategies are helpful, we use them, but always in service of autonomy, safety, and communication freedom.
- We don’t talk about ‘intervene’ or ‘window of opportunity’. Stuttering is absolutely fine, so let’s stop treating it as a disorder to get rid of. In daily life there is enough that will make them grow an iceberg, let’s not help making it grow in therapy.
- We don’t know whether a specific child will outgrow stuttering. So let’s treat every child if it would keep on stuttering, to give them the best possible start in life regarding communication.
In other words: SAT is for young children. It often starts by building the foundation early: “You are okay as you are, and your communication matters, including stuttering.”
We invite you to read more about our view on early stuttering therapy in our paper Strong from the Start for ISAD 2025: https://isad.live/isad-2025/papers-presented-by-2025/research-therapy-and-support-2025/strong-from-the-start-a-new-focus-in-early-stuttering-therapy-joeri-van-ormondt-femke-de-smit-tjitske-hofstee-bootsma/
Concluding thoughts about polarisation and SAT
There are polarising voices in our field and the community. We see it on both sides of the spectrum, hence the name ‘polarising’. We think we have to be careful with that term. We read too often that people find the field too polarised. When you read further we get the opinion that people mean that there are different opinions than theirs. We understand why SAT can feel polarising to some people; it can be uncomfortable when established beliefs or habits are questioned. Sometimes to get a field moving new opinions have to be strong. In principle, they are with less, so they have to be louder.
Throughout history you have seen it everywhere in society. If it weren’t for strong voices homosexuality for example would still be considered a disorder. The field of stuttering is certainly not an early adopter for neurodiversity, opinions however are changing. Change is coming from people who stutter. There probably are a million or more stories worldwide from people who stutter not being happy (or stronger feelings) about the therapy they received from trained SLT’s. What some people are saying does not always feel fair. We do think we have to look beyond the used language. Therapy has to do better, and listen more. We see too many top-down mindsets, of telling clients and therapists how therapy should be. We see it both with traditional therapy and with (unhappy) people who stutter. We suggest for the traditional side to follow a clinical course, then try it out and see why your colleagues truly see a paradigm shift in therapy and will dispute that it is old wine in new bags. Mostly educated by traditionalists there is a heartfelt reason why those new therapists ‘will not swing back’ (see Blank Center). Second, we suggest the strong community voices start talking (again) to therapists who see at this moment clients on a day to day basis. And find out how many allies there are. And see that every therapist wants to do good for people who stutter. Although some therapies might turn out not so helpful, we truly believe that there is a good intention behind each and every one. That sometimes seems to get forgotten.
It is easy for both ends of the continuum to stay in their inner circle and shout more and more. Accusing the other side of polarising. It’s the middle that is left behind and has a tough time.
We think that SAT in itself is not polarising. It is to build on what works and let go of what doesn’t or what turns out to be counterproductive. It’s an evolution toward more effective and more inclusive stuttering therapy.
There is the middle of the continuum. With this series we tried to support the middle by unbunking misconceptions of both sides.