Patients are encouraged to imagine themselves as machines sitting in a room generating one perfect sentence after another, taking time between each sentence to set themselves up properly to produce the best possible example of technique. The axiom of quality rather than quantity is reinforced.

Foundation Exercises. The first four weeks of Basic Training are devoted to Foundation Exercises. In these, the patient must demonstrate an absolutely consistent use of Flutter and slowed first words on short, simple sentences and short speeches composed of simple sentences. This phase is critical because it constitutes the basis for subsequent progress. If there is the slightest imperfection in technique, any stress will exaggerate it, and can lead to stuttering. In order to build a permanent edifice of totally fluent speech, the patient must have a completely sound foundation.

Bridging Exercises. The next four or five weeks are devoted to using the technique in structured, real-life situations. These are called Bridging Exercises. The goal here is to bridge the basic practice exercises into the real world. These exercises are performed with a friend, family member or co-worker.

At this stage of the program the patient is introduced to the Motiv-Aider, an electronic timer device that looks like a personal pager and can be attached to a belt or slipped into a pocket. The Motiv-Aider can be programmed to go off at any interval from once a minute or once a day and, when activated, produces a half-second-long vibration, reminding the patient to attend to technique.

The Motiv-Aider was invented by Dr. Steve Levinson, a clinical psychologist in Minnesota to remind patients to perform a task at selected intervals. In an early study, he selected a group of depressed patients who were constantly thinking depressing thoughts. He selected a positive statement and required his patients to repeat it aloud fifty times each day for several days. After that they were given the Motiv-Aider. Each time the Motiv-Aider went off, they were to repeat the positive statement to themselves as a thought. The chain of continuous negative thinking was thus broken at regular intervals and the depression lifted for a certain number of patients.

In our program, the Motiv-Aider is set to go off once every three minutes and is used for three hours a day for three weeks. Each time it goes off the patient is trained to think, "The next sentence is with perfect technique." After the three-week period of use the patient goes on vacation for a week and then resumes use. It has been found that several three-week cycles of Motiv-Aider use are all that are required to make a permanent habit of the Air Flow Technique.

During Motiv-Aider use we introduce the concept of Nickel and Dime Practice. The term, Nickel and Dime refers to the fact that during the course of the day one can always find a spare five or ten minutes to practice. For example, many people commute to work by car. A typical trip may last twenty to forty minutes each way. During this time one is captive. What a perfect place to practice!

In the car the patient is required to generate strings of unrelated sentences. It has been estimated that if a patient drives an average of an hour a day, he can produce approximately five thousand practice sentences a week - in that one location alone!

One patient generated sentences while watching television commercials. Another practiced each time he went to the toilet. And a youngster reported Nickel and Diming during chores.

There are three types of Nickel and Dime Practice. The first is "Out Loud." In this, the patient uses perfect technique (a Passive Air Flow followed by a slowed first word) to generate a series of sentences out loud.

The second type is called "Silent," and in it the patient practices silently. The Air Flow still emerges passively, the first word is still spoken slowly, but the articulations are unaccompanied by vocal cord vibration. Silent Nickel and Dime practice is used in public situations where the audible production of unrelated sentences would be inappropriate or distracting to others.

The third form of Nickel and Dime practice is called "Silent and Covered." In it, the patient repeats Silent Nickel and Dime Practice but, in addition, covers his mouth with his hand, looks up at the ceiling, and appears to be thinking. Since it can be used anywhere, it can immediately be put to use in virtually every situation. Of course, since the speech is silent and no one knows, there is no stuttering. But it doesn't matter, the patient is actually starting to get better in that situation. He is taking practice swings on his turf. And if someone comes up to him and asks him a question, it's more of the same, but out loud.

In this "bridging" phase of Basic Training the patient begins to show signs of automatic use of the technique. He reports speaking for an hour and discovering that he has been using technique without actually being conscious of precisely when he began to use it. He experiences a greater frequency of real-world successes. He begins to see that the technique really has the power to stop his stuttering, that it is not merely something that works in carefully structured situations, but has definite, practical applications. As all this becomes manifest, his motivation starts to soar as he begins to see the light at the end of the tunnel.

Real World Exercises. The third, and final, stage of Basic Training has been developed to confirm the stutterer's technique in any and all situations. It's called Real World Exercises. All of the prior weeks' practice can now be seen to have been a preparation. Here is the stepping off point for the future.

We introduce the patient to a series of exercises which are graded along a hierarchy of distractibility, that is, in terms of their ability to distract the patient's attention away from use of the technique. For example, we'll assign a simple conversation exercise that requires the patient to discuss some neutral, or uninteresting topic with a friend. When the patient exhibits consistently perfect technique at this level, he progresses to conversations that are somewhat more distracting. For example, if the patient was interested in baseball, a discussion on that subject would be initiated. Again, the requirement for consistency in technique is strongly reinforced.

At this point we introduce the telling jokes exercise. Stutterers report telling jokes to be difficult - particularly when it comes to the punchline. The punchline carries the information of the joke. It is usually a high-stress utterance, one associated with more tension on the vocal cords. In addition, amateur joke tellers tend to deliver punchlines quickly - and this raises vocal cord tension as well.

Patients are assigned the task of telling jokes to a variety of people. Samples are recorded and sent to the Center for evaluation. Occasionally one hears a burst of laughter coming from a therapy room where a therapist is monitoring tape cassettes sent by patients to the Center. One can be fairly certain she is listening to jokes.

Following jokes, we enter into a group of exercises known as debates. In these, the patient is required to take a position on a subject of great personal interest and to debate his position with an opponent. Often debates are held under contract. If a patient becomes distracted and forgets to use technique, he must pay for this oversight. Debates are the most powerful of the class of distraction exercises and successful mastery of them signals the completion of the last phase of Basic Training.

The patient now has an automatic and powerful habit. The next step is to eliminate the habit of scanning - the process of looking ahead for feared sounds, words, or speaking situations. I have found that if a patient stops practicing when he no longer stutterers but still looks ahead, he runs a substantial risk of having a relapse. All vestiges of anticipatory stress must be eliminated to insure a permanent result.