Therapeutic connection in neurorehabilitation: theory, evidence and practice

Kayes, Nicola; McPherson, Kathryn; Kersten, Paula

doi:10.1002/9781119067344.ch29

Cited by 9 publications

(14 citation statements)

References 63 publications

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“…The notion that the alliance may in fact be a variable component of treatment outcome has only recently begun to gain recognition in the arenas of healthcare and rehabilitation (Hall et al 2010, Lawton et al 2016, Morrison and Smith 2013. Preliminary findings suggest that the development of a positive alliance may affect treatment adherence, depressive symptoms, satisfaction, engagement and treatment efficacy (Hall et al 2010, Bright 2015, Kayes et al 2015.…”

Section: Introductionmentioning

confidence: 99%

Speech and language therapists’ perspectives of therapeutic alliance construction and maintenance in aphasia rehabilitation post‐stroke

Lawton

Sage

Haddock

et al. 2018

Intl J Lang & Comm Disor

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BackgroundTherapeutic alliance refers to the interactional and relational processes operating during therapeutic interventions. It has been shown to be a strong determinant of treatment efficacy in psychotherapy, and evidence is emerging from a range of healthcare and medical disciplines to suggest that the construct of therapeutic alliance may in fact be a variable component of treatment outcome, engagement and satisfaction. Although this construct appears to be highly relevant to aphasia rehabilitation, no research to date has attempted to explore this phenomenon and thus consider its potential utility as a mechanism for change.AimsTo explore speech and language therapists’ perceptions and experiences of developing and maintaining therapeutic alliances in aphasia rehabilitation post‐stroke.Methods & ProceduresTwenty‐two, in‐depth, semi‐structured interviews were conducted with speech and language therapists working with people with aphasia post‐stroke. Qualitative data were analysed using inductive thematic analysis.Outcomes & ResultsAnalysis resulted in the emergence of three overarching themes: laying the groundwork; augmenting cohesion; and contextual shapers. Recognizing personhood, developing shared expectations of therapy and establishing therapeutic ownership were central to laying the groundwork for therapeutic delivery. Augmenting cohesion was perceived to be dependent on the therapists’ responsiveness and ability to resolve both conflict and resistance, as part of an ongoing active process. These processes were further moulded by contextual shapers such as the patient's family, relational continuity and organizational drivers.Conclusions & ImplicationsThe findings suggest that therapists used multiple, complex, relational strategies to establish and manage alliances with people with aphasia, which were reliant on a fluid interplay of verbal and non‐verbal skills. The data highlight the need for further training to support therapists to forge purposive alliances. Training should develop: therapeutic reflexivity; inclusivity in goal setting, relational strategies; and motivational enhancement techniques. The conceptualization of therapeutic alliance, however, is only provisional. Further research is essential to elucidate the experiences and perceptions of alliance development for people with aphasia undergoing rehabilitation.

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Section: Introductionmentioning

confidence: 99%

Speech and language therapists’ perspectives of therapeutic alliance construction and maintenance in aphasia rehabilitation post‐stroke

Lawton

Sage

Haddock

et al. 2018

Intl J Lang & Comm Disor

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“…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. Kayes et al (2014) argue that in rehabilitation, a therapeutic relationship involves activating the patient's own resources, moving the relationship from being an interpersonal connection to one that has a therapeutic effect. Therapeutic relationships do not happen by chance but require intentional action from the practitioner (Kayes et al 2014, Bright et al 2018a, Lawton et al 2018b.…”

Section: Introductionmentioning

confidence: 99%

“…Kayes et al (2014) argue that in rehabilitation, a therapeutic relationship involves activating the patient's own resources, moving the relationship from being an interpersonal connection to one that has a therapeutic effect. Therapeutic relationships do not happen by chance but require intentional action from the practitioner (Kayes et al 2014, Bright et al 2018a, Lawton et al 2018b. In aphasia rehabilitation, strong therapeutic relationships require a holistic authentic relationship that recognizes and responds to the personhood of the client with aphasia (Bright et al 2018a, Worrall et al 2010, Lawton et al 2018b, 2020.…”

Section: Introductionmentioning

confidence: 99%

“…Therapeutic relationships are critical for patient outcomes and satisfaction in rehabilitation (Terry and Kayes 2019, Kayes et al . 2014). 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 .…”

Section: Introductionmentioning

confidence: 99%

“…Kayes et al . (2014) argue that in rehabilitation, a therapeutic relationship involves activating the patient's own resources, moving the relationship from being an interpersonal connection to one that has a therapeutic effect. Therapeutic relationships do not happen by chance but require intentional action from the practitioner (Kayes et al .…”

Section: Introductionmentioning

confidence: 99%

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

Bright

Attrill

Hersh

2020

Intl J Lang & Comm Disor

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Background: Therapeutic relationships are fundamental in aphasia rehabilitation, influencing patient experience and outcomes. While we have good understandings of the components of therapeutic relationships, there has been little exploration of how and why therapists construct and enact relationships as they do. Sociological theories may help develop nuanced understanding of the values, assumptions and structures that influence practice, and may facilitate critical reflexivity on practice. Aims: To explore the potential for theoretical approaches from outside speech-language therapy to enable a deeper understanding of the nature and enactment of therapeutic relationships in aphasia rehabilitation. Methods & Procedures: An explanatory single case study of one speech-language therapist-patient dyad in an inpatient stroke rehabilitation setting. Data included observations of five interactions, two interviews with the client and three interviews with the speech-language therapist. Analysis was guided by analytical pluralism that applied aspects of three sociological theories to guide data analysis and make visible the contextual factors that surround, shape and permeate the enactment of therapeutic relationships. Outcomes & Results: The analysis of this dyad made visible individual, interactional and broader structural features that illustrate the dynamic processes that practitioners and patients undertake to enact therapeutic relationships. Clinical practice could be viewed as a performance with each person continually negotiating how they convey different impressions to others, which shapes what work is valued and foregrounded. The patient and therapist took up or were placed in different positions within the interactions, each with associated expectations and rights, which influenced what types of relationships could, or were likely to, develop. Organizational, rehabilitation and individual practitioner structures assigned rules and boundaries that shaped how the therapist developed and enacted the therapeutic relationship. Whilst the therapist had some agency in her work and could resist the different influencing factors, such resistance was constrained because these structures had become highly internalized and routinized and was not always visible to the therapist. Conclusions & Implications: While therapists commonly value therapeutic relationships, social and structural factors consciously and unconsciously influence their ability to prioritize relational work. Sociological theories can provide new lenses on our practice that can assist therapists to be critically reflexive about practice, and to enact changes to how they work to enhance therapeutic relationships with clients.

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It takes two to tango: The therapeutic alliance in community brain injury rehabilitation

Williams

Douglas

2021

Brain Impairment

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Objective: A positive therapeutic (or working) alliance has been associated with better outcomes for clients in the psychotherapeutic and traumatic brain injury (TBI) rehabilitation literature. The aim of this pilot study was to gain an understanding of the therapeutic alliance in community rehabilitation from the perspectives of adults with TBI and their close others who have completed a community rehabilitation programme. Method: This study used a constructivist, qualitative methodology which applied grounded theory analysis techniques. Using purposeful sampling, three pairs of participants (adults with TBI and close others) who had finished a community rehabilitation programme completed separate in-depth interviews which were transcribed verbatim and progressively analysed using a process of constant comparison. Results: A preliminary framework illustrating participants’ experience of a therapeutic alliance was generated, comprising three interconnected themes: being recognised as an individual, working together and feeling personally connected. All participants viewed being able to work together as important in their experience of community rehabilitation and described features that helped and hindered the alliance. Conclusion: These pilot study results demonstrate the importance of the therapeutic alliance to the rehabilitation experience of individuals with TBI and those close to them.

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Therapeutic connection in neurorehabilitation: theory, evidence and practice

Cited by 9 publications

References 63 publications

Speech and language therapists’ perspectives of therapeutic alliance construction and maintenance in aphasia rehabilitation post‐stroke

Speech and language therapists’ perspectives of therapeutic alliance construction and maintenance in aphasia rehabilitation post‐stroke

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

It takes two to tango: The therapeutic alliance in community brain injury rehabilitation

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