In this article, we seek to re-examine traditional treatment outcomes related to communicative success after total laryngectomy. Specifically, the three most common alaryngeal speech methods are presented in relation to typical speech intelligibility outcomes. Factors that interact with intelligibility highlight how formal measures of intelligibility are necessary, but insufficient, for determining communicative success. A multidimensional context in which the communicative dyad is presented as an additional factor must be considered. In this paper, we outline several clinical examples that highlight the importance of this factor and its implications for rehabilitation.