Relationships in aphasia therapy: Why do we work as we do?

Background and Objectives: Relationships are central to speech pathology practice, influencing rehabilitation processes and clients’ experiences and outcomes. However, there has been limited exploration how and why therapists construct and enact relationships as they do. The objective of this research was to use sociological theories to examine client-practitioner relationships and, in particular, what influenced how relationships were enacted.

Method: A case study of one speech pathologist-client dyad. Data included observations of six interactions between them, two interviews with the client, and four interviews with the speech pathologist. Three sociological theories (critical theory, Social Interaction and Structuration Theory) informed data analysis.

Results: The therapeutic relationship occurred in a complex context. While it was considered important, relational work did not hold the same legitimacy as other aspects of practice. Multiple forms of power relations were evident, expressed subtly in interaction through word choices, proxemics, touch, use of time and space. While the therapist exerted power with the client, she herself was influenced by, multiple power relationships with other practitioners. This was evident in her seemingly subconscious desire to present herself in different ways to different stakeholders. Structural influences included the dominance of the medical model, and conceptualisations of legitimate practices. While at face value, the therapist had agency in her actions, analysis demonstrated this was constrained by internal and external structures.

Conclusion: Sociological theory can help reveal implicit assumptions about relationships and relational practices, and can open up different ways of critically reflecting on speech pathology practice.