Therapeutic relationships in aphasia therapy: Why do we work as we do?

Background: Our effectiveness as clinicians is as much about who we are and how we relate to our clients as about what we actually do. With relationships being central to aphasia therapy, we need to understand how they develop, and how they are influenced and potentially constrained by the contexts and structures surrounding practice.
Aims: To examine the social and structural influences on how therapeutic relationships are enacted in aphasia therapy.
Method: An explanatory single case study of one speech pathologist-patient dyad in an in-patient setting. Data included observations of six interactions, two interviews with the client, and four interviews with the speech pathologist. Three sociological theories (Critical Theory, Impression Management and Structuration Theory) informed data analysis.
Results: The therapeutic relationship occurred in a complex context where relational work did not hold the same legitimacy as other aspects of practice. The medical model shaped what work was considered important and constituted professional competence. While the therapist tried to work ‘relationally’ with her client, she herself was influenced by multiple power relationships with other clinicians and by service structures. She was not consistently conscious of how these influenced her ability to develop the therapeutic relationship with her client.
Conclusion: While clinicians commonly value therapeutic relationships, social and structural factors limit their ability to prioritise relational work. This presentation will demonstrate that sociological theory can provide new lenses on our practice that can assist us to reflect about and enact changes to how we work to achieve optimal outcomes for clients.