Aphasia often leads to severe restrictions in communicative behaviour and social participation. Therapeutic strategies aiming at improving communicative competence usually have to be carried out over a long period and may be very costly. If prescribed, such therapies will be financed by the health insurance systems. Prescriptions, however, must respect the individual needs of a patient as well as certain restrictions outlined in insurance guidelines. This can lead to problems if the patient's or relatives' wish for therapy is completely or partially ignored. Here we discuss the rational for prescribing therapy for aphasia patients based on current guidelines and discuss how the patients and relatives can be best advised.