Speech-language pathologists make clinical decisions informed by evidence-based theory and “beliefs, values and emotional experiences” (Hinckley, 2005, p. 265). These subjective processes, while not extensively studied, underlie the workings of the therapeutic relationship and contribute to treatment outcomes. While speech-language pathologists do not routinely pay attention to subjective experiences of the therapeutic encounter, social workers do. Thus, the field of social work makes an invaluable contribution to the knowledge and skills of speech-language pathologists.

Purpose

This clinical focus article focuses on the clinician's contribution to the therapeutic relationship by surfacing elements of the underlying subjective processes.

Method

Vignettes were gathered from clinicians in two community aphasia programs informed by the principles of the Life Participation Approach to Aphasia.

Results and Discussion

By reflecting on and sharing aspects of clinical encounters, clinicians reveal subjective processing occurring beneath the surface. The vignettes shed light on the following clinical behaviors: listening to the client's “whole self,” having considerations around self-disclosure, dealing with biases, recognizing and surfacing clients' identities, and fostering hope. Speech-language pathologists are given little instruction on the importance of the therapeutic relationship, how to conceptualize this relationship, and how to balance this relationship with professionalism. Interprofessional collaboration with social workers provides a rich opportunity to learn ways to form and utilize the benefits of a strong therapeutic relationship while maintaining high standards of ethical behavior.

Conclusion

This clinical focus article provides speech-language pathologists with the “nuts and bolts” for considering elements of the therapeutic relationship. This is an area that is gaining traction in the field of speech-language pathology and warrants further investigation.

References

Austin, W., Bergum, V., Nuttgens, S., & Peternelj-Taylor, C. (2006). A re-visioning of boundaries in professional helping relationships: Exploring other metaphors.Ethics & Behavior, 16(2), 77–94. https://doi.org/10.1207/s15327019eb1602_1
Crossref Google Scholar
Beach, M. C., & Inui, T. (2006). Relationship-centered care: A constructive reframing.Journal of General Internal Medicine, 21(S1), 3–8. https://doi.org/10.1111/j.1525-1497.2006.00302.x
Crossref Google Scholar
Bright, F. A. S., Kayes, N. M., Cummins, C., Worrall, L. M., & McPherson, K. M. (2017). Co-constructing engagement in stroke rehabilitation: A qualitative study exploring how practitioner engagement can influence patient engagement.Clinical Rehabilitation, 31(10), 1396–1405. https://doi.org/10.1177/0269215517694678
Crossref Google Scholar
Bright, F. A. S., Kayes, N. M., Worrall, L., & McPherson, K. M. (2015). A conceptual review of engagement in healthcare and rehabilitation.Disability and Rehabilitation, 37(8), 643–654. https://doi.org/10.3109/09638288.2014.933899
Crossref Google Scholar
Chapey, R., Duchan, J. F., Elman, R. J., Garcia, L. J., Kagan, A., Lyon, J. G., & Simmons-Mackie, N. (2000). Life participation approach to aphasia: A statement of values for the future.The ASHA Leader, 5(3), 4–6. https://doi.org/10.1044/leader.FTR.05032000.4
ASHAWire Google Scholar
Charon, R. (2001). Narrative medicine: A model for empathy, reflection, profession, and trust.JAMA, 286(15), 1897–1902. https://doi.org/10.1001/jama.286.15.1897
Crossref Medline Google Scholar
Clandinin, D. J. (1985). Personal practical knowledge: A study of teachers' classroom images.Curriculum Inquiry, 15(4), 361–385. https://doi.org/10.2307/1179683
Crossref Google Scholar
Connelly, F. M., & Clandinin, D. J. (1999). Knowledge, context and identity.In F. M. Connelly & D. J. Clandinin (Eds.), Shaping a professional identity: Stories of educational practice (pp. 1–5). Teachers College Press.
Google Scholar
Cruice, M., & Ten Kate, O. (2019). Clinicians' views and practices in quality of life in aphasia rehabilitation: A preliminary study.Aphasiology, 33(11), 1293–1318. https://doi.org/10.1080/02687038.2019.1632787
Crossref Google Scholar
Dewane, C. J. (2006). Use of self: A primer revisited.Clinical Social Work Journal, 34(4), 543–558. https://doi.org/10.1007/s10615-005-0021-5
Crossref Google Scholar
Duchan, J. F., & Byng, S. (2004). Challenging aphasia therapies.In J. F. Duchan & S. Byng (Eds.), Challenging aphasia therapies: Broadening the discourse and extending the boundaries (pp. 8–18). Psychology Press.
Crossref Google Scholar
Gibson, B. E., Terry, G., Setchell, J., Bright, F. A. S., Cummins, C., & Kayes, N. M. (2019). The micro-politics of caring: Tinkering with person-centered rehabilitation.Disability and Rehabilitation, 1–10. https://doi.org/10.1080/09638288.2019.1587793
Crossref Google Scholar
Hilari, K., Northcott, S., Roy, P., Marshall, J., Wiggins, R. D., Chataway, J., & Ames, D. (2010). Psychological distress after stroke and aphasia: The first six months.Clinical Rehabilitation, 24(2), 181–190. https://doi.org/10.1177/0269215509346090
Crossref Google Scholar
Hinckley, J. J. (2005). The piano lesson: An autoethnography about changing clinical paradigms in aphasia practice.Aphasiology, 19(8), 765–779. https://doi.org/10.1080/02687030544000092
Crossref Google Scholar
Hinckley, J. J. (2008). Narrative-based practice in speech-language pathology: Stories of a clinical life. Plural.
Google Scholar
Kagan, A., & Simmons-Mackie, N. (2007). Beginning with the end: Outcome-driven assessment and intervention with life participation in mind.Topics in Language Disorders, 27(4), 309–317. https://doi.org/10.1097/01.TLD.0000299885.39488.bf.
Crossref Google Scholar
Kagan, A., & Simmons-Mackie, N. (2013). From my perspective: Changing the aphasia narrative: Laying down the gauntlet: Our modest proposal for an elevator pitch describing the aphasia services SLPs deliver—and why SLPs are the ones to provide them.The ASHA Leader, 18(11), 6–8.
Google Scholar
Kagan, A., Simmons-Mackie, N., Rowland, A., Huijbregts, M., Shumway, E., McEwen, S., Threats, T., & Sharp, S. (2008). Counting what counts: A framework for capturing real-life outcomes of aphasia intervention.Aphasiology, 22(3), 258–280. https://doi.org/10.1080/02687030701282595
Crossref Google Scholar
Kayes, N. M., Mudge, S., Bright, F. A. S., & McPherson, K. (2015). Whose behavior matters? Rethinking practitioner behavior and its influence on rehabilitation outcomes.In K. McPherson, B. E. Gibson, & A. Leplege (Eds.), Rethinking rehabilitation theory and practice (pp. 249–271). CRC Press.
Crossref Google Scholar
Lawton, M., Haddock, G., Conroy, P., & Sage, K. (2016). Therapeutic alliances in stroke rehabilitation: A meta-ethnography.Archives of Physical Medicine and Rehabilitation, 97(11), 1979–1993. https://doi.org/10.1016/j.apmr.2016.03.031
Crossref Google Scholar
Lawton, M., Sage, K., Haddock, G., Conroy, P., & Serrant, L. (2018). Speech and language therapists' perspectives of therapeutic alliance construction and maintenance in aphasia rehabilitation post-stroke.International Journal of Language & Communication Disorders, 53(3), 550–563. https://doi.org/10.1111/1460-6984.12368
Crossref Medline Google Scholar
Mumby, K., & Whitworth, A. (2013). Adjustment processes in chronic aphasia after stroke: Exploring multiple perspectives in the context of a community-based intervention.Aphasiology, 27(4), 462–489. https://doi.org/10.1080/02687038.2013.772559
Crossref Google Scholar
Northcott, S., Simpson, A., Moss, B., Ahmed, N., & Hilari, K. (2017). How do speech-and-language therapists address the psychosocial well-being of people with aphasia? Results of a UK online survey.International Journal of Language & Communication Disorders, 52(3), 356–373. https://doi.org/10.1111/1460-6984.12278
Crossref Google Scholar
Sekhon, J. K., Douglas, J., & Rose, M. L. (2015). Current Australian speech-language pathology practice in addressing psychological well-being in people with aphasia after stroke.International Journal of Speech-Language Pathology, 17(3), 252–262. https://doi.org/10.3109/17549507.2015.1024170
Crossref Google Scholar
Shadden, B. B. (2005). Aphasia as identity theft: Theory and practice.Aphasiology, 19(3–5), 211–223. https://doi.org/10.1080/02687930444000697
Crossref Google Scholar
Sherratt, S., & Hersh, D. (2010). “You feel like family…” Professional boundaries and social model aphasia groups.International Journal of Speech-Language Pathology, 12(2), 152–161. https://doi.org/10.3109/17549500903521806
Crossref Google Scholar
Soklaridis, S., Ravitz, P., Adler Nevo, G., & Lieff, S. (2016). Relationship-centered care in health: A 20-year scoping review.Patient Experience Journal, 3(1), 130–145. https://doi.org/10.35680/2372-0247.1111
Crossref Google Scholar
Spiegel, M., & Spencer, D. (2017). This is what we do, and these things happen: Literature, experience, emotion, and relationality in the classroom.In R. Charon, S. DasGupta, N. Hermann, C. Irvine, E. Marcus, E. R. Colón, D. Spencer, & M. Spiegel (Eds.), The principles and practice of narrative medicine (pp. 37–62). Oxford University Press.
Google Scholar
Sudbery, J. (2010). Key features of therapeutic social work: The use of relationship.Journal of Social Work Practice, 16(2), 149–162. https://doi.org/10.1080/0265053022000033711
Crossref Google Scholar
Walters, H. B. (2008, Fall). An introduction to the use of self in field placement.In The New Social Worker: The Social Work Careers Magazine. https://www.socialworker.com/feature-articles/field-placement/An_Introduction_to_Use_of_Self_in_Field_Placement/
Google Scholar
Worrall, L. (2019). The seven habits of highly effective aphasia therapists: The perspective of people living with aphasia.International Journal of Speech-Language Pathology, 21(5), 438–447. https://doi.org/10.1080/17549507.2019.1660804
Crossref Medline Google Scholar
Worrall, L., Davidson, B., Hersh, D., Ferguson, A., Howe, T., & Sherratt, S. (2010). The evidence for relationship-centred practice in aphasia rehabilitation.Journal of Interactional Research in Communication Disorders, 1(2), 277–300.
Google Scholar