Speech and language therapists' perspectives of therapeutic alliance construction and maintenance in aphasia rehabilitation post-stroke.
Michelle Lawton, Karen Sage, Gillian Haddock and 2 others
PMID 29349881WHAT IT FOUND
Therapists described building a working relationship by getting to know the person, setting shared expectations, fostering goal ownership, and responding flexibly.
Time, setting, family, and therapist biases shaped how these relationships developed.
Key findings
01Therapists described laying the groundwork through recognizing personhood, sharing expectations, and activating ownership.
02Therapists described augmenting cohesion through being responsive and resolving conflict to sustain engagement.
03Therapists described setting, organizational drivers, relational continuity, and family as contextual shapers of alliance development.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study reports therapists' perspectives only, so it does not capture what patients or family members experienced. It did not measure treatment outcomes, so it cannot show that these alliance strategies improve aphasia rehabilitation. Participants were purposively recruited from UK NHS services, and private-sector therapists were excluded, so the findings may not apply to all settings or countries. The first author was a speech and language therapist with stroke rehabilitation experience, and no member checking was used, so interpretation may reflect the research team's perspectives. The sample was small and qualitative, so it is useful for exploring experiences but not for estimating how common these experiences are.
The easy way to misread this
Do not conclude that these alliance strategies improve aphasia therapy outcomes. The study explored therapists' experiences and did not measure patient progress.