It is time to talk about our relationships: Exploring the role of therapeutic alliance in speech and language therapy, with stuttering intervention as an exemplar

Abstract

The value of the therapeutic alliance as an essential component of psychotherapy has been recognised for several decades. For example, research has shown that the therapeutic alliance contributes positively to treatment outcomes and client satisfaction. In contrast, knowledge about the role of therapeutic alliance in speech and language therapy (SLT) remains at an emerging level, due in part to the discipline’s primary focus on the development, use and scientific validation of specific intervention methods and techniques. This paper aims to increase speech and language therapists’ (SLTs) understanding and implementation of constructive therapeutic alliances in their work with individuals with communication needs. In particular, we focus on adults who stutter, to convey the importance of fostering these alliances in clinical practice. We begin with an exploration of the meaning of the therapeutic alliance and the range of person-related and contextual variables that influence its establishment and maintenance. We continue with a discussion on what SLTs can learn from the psychotherapeutic literature on therapeutic alliance. In addition, the gaps in our knowledge that remain in terms of the need for an SLT-specific and stakeholder-informed conceptualisation of the therapeutic alliance are discussed. Finally, we provide key recommendations for fostering a therapeutic alliance with adults who stutter in order to enhance the relational competence of SLTs working in clinical practice. It is imperative and timely that the discipline of SLT redirects its attention to the role of variables beyond specific treatment techniques that influence treatment outcomes. This will ensure the design and delivery of effective stuttering interventions, and enhance treatment outcomes for those who stutter.