Identifying perspectives of adults who stutter on therapeutic alliance in stuttering intervention

BACKGROUND: Despite acknowledgement by various stakeholders that therapeutic alliance (TA) is an essential component of stuttering intervention, a comprehensive understanding of this concept is lacking in the field of speech and language therapy. There continues to be a significant gap in our knowledge regarding what adults who stutter (AWS) perceive to be the qualities and activities required by both themselves and the speech and language therapist (SLT) to facilitate an effective TA. Collection of such knowledge will support the establishment and maintenance of positive TA in clinical contexts and enhance treatment outcomes for those who stutter. OBJECTIVE: To explore the perspectives of AWS on the meaning of TA and the variables that influence its establishment and maintenance. METHODS: Semi-structured interviews were completed with eight AWS. The interview questions centred on three key topics: the conceptualisation of TA through the perspective of AWS; the activities and personal qualities of the SLT that influence TA; and the activities and personal qualities of the AWS that influence TA. RESULTS: Reflexive thematic analysis identified two overarching themes: ‘Recognising stuttering in a biopsychosocial context in order to enhance therapeutic alliance’ and ‘Person-related variables influencing therapeutic alliance’. In addition, five subthemes were identified which further illuminated each overarching theme. CONCLUSIONS: Findings of this study highlight the benefit of collecting patient-based evidence to support our understanding of TA. Results demonstrate the complexity of TA in stuttering intervention, and the impact that person-related variables have on its quality.