Therapeutic Relationships in Aphasia Rehabilitation: Using Sociological Theories to Promote Critical Reflexivity

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aut.relation.journalInternational Journal of Language and Communication Disordersen_NZ
aut.researcherBright, Felicity
dc.contributor.authorBright, FASen_NZ
dc.contributor.authorHersh, Den_NZ
dc.contributor.authorAttrill, Sen_NZ
dc.date.accessioned2021-01-15T01:49:11Z
dc.date.available2021-01-15T01:49:11Z
dc.date.copyright2020-12-14en_NZ
dc.date.issued2020-12-14en_NZ
dc.description.abstractBackground 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 in‐patient 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.
dc.identifier.citationInternational Journal of Language and Communication Disorders, doi: 10.1111/1460-6984.12590
dc.identifier.doi10.1111/1460-6984.12590en_NZ
dc.identifier.issn1368-2822en_NZ
dc.identifier.urihttps://hdl.handle.net/10292/13921
dc.publisherWileyen_NZ
dc.relation.urihttps://onlinelibrary.wiley.com/doi/10.1111/1460-6984.12590
dc.rights© 2020 The Authors. International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
dc.rights.accessrightsOpenAccessen_NZ
dc.subjectTherapeutic relationships; Aphasia; Rehabilitation; Sociology; Theory; Critical reflexivity
dc.titleTherapeutic Relationships in Aphasia Rehabilitation: Using Sociological Theories to Promote Critical Reflexivityen_NZ
dc.typeJournal Article
pubs.elements-id395799
pubs.organisational-data/AUT
pubs.organisational-data/AUT/Health & Environmental Science
pubs.organisational-data/AUT/Health & Environmental Science/Clinical Sciences
pubs.organisational-data/AUT/PBRF
pubs.organisational-data/AUT/PBRF/PBRF Health and Environmental Sciences
pubs.organisational-data/AUT/PBRF/PBRF Health and Environmental Sciences/HH Clinical Sciences 2018 PBRF
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