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People with aphasia’s perspectives of the therapeutic alliance during speech-language intervention: A Q methodological approach

Lawton, M and Haddock, G and Conroy, P and Serrant, L and Sage, K (2019) People with aphasia’s perspectives of the therapeutic alliance during speech-language intervention: A Q methodological approach. International Journal of Speech-Language Pathology. ISSN 1754-9507

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Abstract

© 2019, © 2019 The Speech Pathology Association of Australia Limited Published by Taylor & Francis. Purpose: To identify which elements of the therapeutic alliance are important to people with aphasia (PWA) attending speech-language pathology post-stroke. Method: A Q methodology design was adopted to explore which elements of the therapeutic alliance were valued by PWA. Statements (n = 453) relevant to the research question were extrapolated from the literature and qualitative interviews. A representative sample of statements (n = 38) was identified from the expansive data set. PWA (n = 23) sorted statements hierarchically according to whether they thought the statement was important or unimportant. Completed Q sorts were analysed using a by-person factor analysis. Result: Analysis yielded a five-factor solution, representing five distinct viewpoints: (1) acknowledge me, help me to understand; (2) respect me, listen to me; (3) challenge me, direct me; (4) understand me, laugh with me; and (5) hear me, encourage me. Conclusion: The findings highlight the need for clinicians to adopt a flexible and idiosyncratic approach to therapeutic alliance construction in order to meet the relational needs of a heterogeneous population. This is the first study to use Q methodology with PWA, demonstrating that Q methodology is an effective and viable method for investigating subjectivity in this population.

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