Qualitative study of the therapeutic relationship in speech and language therapy: perspectives of adults with acquired communication and swallowing disorders

Abstract

Considerations of the negotiated therapeutic relationship in speech and language therapy are somewhat scarce, with specific therapeutic factors generally framed from psycholinguistic, behavioural, or neurological perspectives. To explore the therapeutic relationship in speech and language therapy, focusing on the personal meanings and experiences of adult clients with acquired communication and swallowing disorders. The study was qualitative, using methods from Grounded theory to analyse eleven interviews with adults who had acquired disorders of communication or swallowing, as they described their perceptions of speech and language therapy and therapists. Five males and six females with a mean age of 62 years, ranging from 25 to 87 years, with varied communication disorders, were interviewed. A preliminary theoretical framework explains how speech and language therapists supported alienated, demoralized or confused clients with therapeutic qualities, such as Being Understanding, Being Gracious, Being Erudite and Being Inspiring; and with therapeutic actions, such as Being Confident, Being Soothing, Being Practical and Being Empowering. These categories provided a basis for the researcher to construct a substantive theory of restorative poise which characterized the attitudinal and behavioural characteristics of an ideal speech and language therapist from the perspective of the client. Participants were aware of the components of a therapeutic relationship and valued these as essential to their own personal understanding of positive outcomes in speech and language therapy. Therefore, specific types of attitudes and actions that constitute the speech and language therapist's contributions to the therapeutic relationship seemed to provide catalytic conditions for successful working together in therapy; and consequently, may have a bearing on effective practice and treatment efficacy.