I agree with everything you've mentioned. You described the experience of losing fluency as soul-crushing.. from my personal perspective, effective therapy should include a solid relapse prevention program in case stuttering re-emerges.. so that the soul-crushing experience (that you pointed out) can be addressed. Such a program should also address cognitive distortions.. also, research shows that people who stutter often struggle with intolerance to the sensation of losing control and the fear that stuttering is always looming around the corner, even during periods of noticeable fluent speech. Anticipation of stuttering and related anxieties can be significant challenges. So, that is the reason I'd say that a relapse program should address: Acceptance, spotlight effect, dunning-kruger effect, social comparison, fear of failure, imposter syndrome and locus of control. There are various approaches to acceptance. I mean, think of ACT, mindfulness, and CBT. Yet, these therapies and modalities differ from the acceptance that is learned in traditional speech therapy. In fact, it's the opposite. If we start believing that stuttering will persist no matter what, we risk reinforcing future-telling - yes indeed, a cognitive distortion. Individuals with OCD, adhd, etc in therapy focus on addressing such cognitive distortions. I find that stuttering (the underlying mechanism) and OCD have a lot in common. I've read quite a lot of books about OCD. The point I'm trying to make is, I think that we should adopt a similar approach to acceptance, that is provided in ACT, mindfulness, OCD/ERP therapies - that focus on preventing cognitive distortions. Of course, this goes without saying that we should distinguish between genetic stuttering (difficulty speech planning type stuttering) and execution type stuttering (triggered by a too high execution threshold mechanism). We cannot remove genetics, but we can unlearn executing type stuttering (and unlearning conditioning, 'the poorly fine-tuning of the release threshold'), in my opinion