People with aphasia’s perspectives of the therapeutic alliance during speech-language intervention: A Q methodological approach

Abstract

Background: The therapeutic alliance has been found to be a critical component of treatment delivery in mental health interventions. This construct may have the potential to inform both treatment efficacy and adherence in aphasia rehabilitation. However, little is known about how people with aphasia perceive therapeutic alliance construction in the context of aphasia rehabilitation. Aims: This study aimed to investigate people with aphasias' subjective experiences and reflections of constructing and maintaining therapeutic alliances in aphasia rehabilitation. Methods & procedures: In-depth interviews were conducted with eighteen people with aphasia who had received aphasia rehabilitation following a stroke. Interviews were subject to thematic analysis. Outcomes & results: Data analysis revealed five core themes: 1) readiness to contribute to the alliance; 2) proximity with the therapist; 3) perceived attunement with the therapist; 4) receiving information; and, 5) collaborative engagement. The therapist's perceived ability to read and respond effectively to individuals' relational and situational needs contributed to the success of the alliance. Conclusions: These findings offer novel insights into current practice, highlighting considerable variation in alliance formation across the profession, with ineffectual alliances Alliances in aphasia rehabilitation 2 obstructing engagement and eroding hope and effective alliances promoting adherence and instilling hope. Further research is recommended to understand which aspects of the therapeutic alliance are essential for optimising therapeutic efficacy.

Creating therapeutic relationships through communication: a qualitative metasynthesis from the perspectives of people with communication impairment after stroke

“…Our consultation with experienced researchers took place in March 2018. References were updated prior to submission for publication; accordingly two papers [18,33] which were published online during or before April 2019 have been updated after being assigned to a specific volume/issue of the journal.…”

“…Depression was not uncommon [22,33]. The presence of a strong relationship, one in which the person felt understood and supported, and where they felt they could trust the clinician [12,18], could provide safety and security that could alleviate this emotional distress: "When a patient realises that the carer really wants to know and understand, he/she finds it easier for feel safe" [21,p.2508]. The relationships could also support life reconstruction [33], foster hope and positivity for the future [35], help people persist in the face of fear and uncertainty [11], and influence satisfaction with services [36].…”

“…Relationships helped create an environment which helped people "make sense" of their situation after a stroke [12]. The presence and strength of the therapeutic relationship could be critical in people having and developing their hope for the future [5,18] and helped people persist in the face of adversity [22,37]. When struggling with rehabilitation, one participant described how the relationship was important when struggling: "I hate what I have to do … but if it had to be with Setting refers to the profession or service that is the focus of inquiry, if specified.…”

Therapeutic relationships in aphasia rehabilitation: Using sociological theories to promote critical reflexivity

“…People with aphasia describe the importance of therapeutic relationships in rehabilitation, and there is growing evidence that these relationships influence patient experience, engagement and outcomes in aphasia rehabilitation (Bright et al 2017, Lawton et al 2018a, 2020. There is some suggestion these relationships may be particularly important for those with more severe aphasia and/or those with greater rehabilitation needs (Lawton et al 2019). Therapeutic relationships are valued and deeply embedded within the professional identity of speech-language therapists (SLTs) and within the discourses and sociocultural practices of the speech-language therapy community (Byng et al 2002, Hersh 2010.…”

“…There is some suggestion these relationships may be particularly important for those with more severe aphasia and/or those with greater rehabilitation needs (Lawton et al . 2019). Therapeutic relationships are valued and deeply embedded within the professional identity of speech–language therapists (SLTs) and within the discourses and socio‐cultural practices of the speech–language therapy community (Byng et al .…”