Student clinicians’ and clients’ perceptions of the therapeutic alliance and outcomes in stuttering treatment

Croft, Robyn; Watson, J. P.

doi:10.1016/j.jfludis.2019.105709

Cited by 13 publications

(9 citation statements)

References 43 publications

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“…The current review reported similar outcome associations with client and therapist TA ratings, in line with existing research showing that the significant impact of alliance on outcome from psychotherapy is independent of whose perspective is captured (Horvath et al, 2011). However, given that some studies suggest subtle differences between client and therapist evaluations of the alliance in other presentations (e.g., Croft & Watson, 2019), further research on psychological interventions for psychosis should explore the impact of any such discrepancies, as well as the potential for distinct perceptions regarding the role of the TA in therapy.…”

Section: Discussionmentioning

confidence: 99%

Systematic review and meta‐analysis of therapeutic alliance, engagement, and outcome in psychological therapies for psychosis

2021

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AimThe moderate association between therapeutic alliance (TA) and psychological therapy outcome is well established. Historically, the field has not focused on people with a severe mental illness. This is the first review to conduct a meta‐analysis of associations between TA and therapeutic engagement as well as outcome in psychological therapy for psychosis.Eligibility criteriaEligible studies conducted a quantitative investigation of the relationship between TA during a psychological therapy and outcome at a subsequent time‐point.MethodA systematic review examined the relationship between TA and engagement as well as outcome measures within psychological therapy for psychosis. Correlational meta‐analyses using an aggregate random effects model were conducted.ResultsTwenty‐four studies were eligible for inclusion (n = 1,656) of which 13 were included in the meta‐analyses. Client‐ and therapist‐rated TA were associated with engagement in therapy (rclient (c) = 0.36, p = .003; rtherapist (t) = 0.40, p = .0053). TA was also associated with reduction in global (rc = 0.29, p = .0005; rt = 0.24, p = .0015) and psychotic symptoms (rc = 0.17, p = .0115; rt = 0.30, p = .0003). The systematic review identified no evidence or limited evidence for a relationship between TA during therapy and depression, substance use, physical health behaviours, global as well as social functioning, overall mental health recovery, and self‐esteem at follow‐up. Although number of studies was small, TA was related to a reduced risk of subsequent hospitalization in 40% of analyses (across two studies) and improved cognitive outcome in 50% of analyses (across three studies).ConclusionsThe observed TA‐therapy engagement and TA‐outcome associations were broadly consistent with those identified across non‐psychotic diagnostic groups. Well‐powered studies are needed to investigate the relationship between TA and process as well as outcome in psychological therapy for psychosis specifically.Practitioner points This is the first review to conduct a meta‐analytic synthesis of the association between therapeutic alliance (TA) and both engagement and change in outcome in psychological therapies for psychosis. TA (as rated by therapist and client) was associated with the extent of therapeutic engagement as well as reduction in global mental health symptoms and psychotic symptoms. The significant associations between TA and engagement as well as change in outcome identified in the current review are broadly consistent with those observed across non‐psychotic diagnostic groups. We consider factors that could impact upon the dynamic and potentially interdependent relationships between TA and therapeutic techniques, including attachment security and severity of paranoid ideation.

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Section: Discussionmentioning

confidence: 99%

Systematic review and meta‐analysis of therapeutic alliance, engagement, and outcome in psychological therapies for psychosis

2021

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“…Given the dynamic and reciprocal process of relational and transactional interactions, to truly understand the role of sociolinguistic adaptation in therapeutic practice, insight into clients’ competency evaluations of SLTs’ styles is needed to complement the SLT perspective. In earlier studies, the role of the SLT's standard/colloquial language did not explicitly come forward in client interviews (Bishop et al., 2021; Croft & Watson, 2019; Fourie, 2009; Fourie et al., 2011), and the present SLTs made inferences about the impact of their style on their clients’ perceptions. By conducting interviews with clients and combining this with matched guise testing, we may gain insight into how clients evaluate the style used by the SLT in specific contexts.…”

Section: Discussionmentioning

confidence: 65%

“…Therapeutic alliance entails that the therapist and client build a relationship of equal social status through shareddecision making and collaboration (Bishop et al, 2021;Croft & Watson, 2019;Fourie et al, 2011;Lawton et al, 2018), which requires the therapist to be authentic and empathic (Bishop et al, 2021;Plexico et al, 2010). Empathy and solidarity attributes that patients greatly value in an SLT because they make patients feel heard (Fourie, 2009;Lawton et al, 2018Lawton et al, , 2020, are also associated explicitly with CBD (Impe & Speelman, 2007).…”

Section: Language Adaptation In Therapymentioning

confidence: 99%

‘Talking Very Properly Creates Such a Distance’: Exploring Style‐Shifting in Speech‐Language Therapists

Rombouts

Fieremans

Zenner

2023

Intl J Lang & Comm Disor

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BackgroundIn the governmental delineation of the speech‐language therapist (SLT) profession and in preservice SLT education, Flemish SLTs are considered as gatekeepers of the standard language in Flanders. Yet, most Flemish clients typically use a colloquial language style. Following earlier research on how teachers' language style affects teacher–student interactions, an SLT's strict adherence to standard Dutch may potentially evoke perceptions of inequality in their clients. As a result, Flemish SLTs may find themselves torn between on the one hand adhering to the standard language and on the other hand adapting to the sociolinguistic style of their client and establishing trust. In the present study, we explored SLTs’ views on using standard/colloquial language varieties in their practice.Methods & ProceduresIndividual semistructured interviews were conducted with 13 Flemish SLTs who worked with children, adolescents and adults in special schools, private practices and hospitals. Interview transcripts were analysed with reflexive thematic analysis.Outcomes & ResultsAnalyses yielded three themes. Switching between styles was (1) triggered by client characteristics (age, style, therapeutic needs), and it was shaped by (2) the need for establishing trust and (3) a balance between the SLT's professional and personal identity. Notably, most SLTs described partially converging with their clients’ colloquial style, effectively reconciling their professional identity as expert speakers with their personal identity as a colloquial language user.Conclusions & ImplicationsDespite consensus on the role of the SLT as gatekeeper of standard language, many SLTs felt that colloquial language also plays an important role as it bolsters therapeutic alliance and rehabilitation of functional communication. By implementing reflective mixed methods and integrating the client perspective, future studies should further examine how authentic style‐switching occurs and how various styles used by the SLT are evaluated by clients in different contexts. These findings may guide the development of style‐switching as a communicative strategy that can be addressed in preservice education.What this paper addsWhat is already known on the subjectIn Flanders, the existence of various (non‐)standard varieties of Dutch may evoke some tension regarding the preferred variety in a given context. Flemish teachers switch between standard language and colloquial language (style‐shifting), depending on the foregrounding of the transactional or relational nature of the context. Moving towards students’ colloquial speech builds trust and perceptions of equality. Despite the importance of alliance in speech‐language therapy, little is known about how speech‐language therapists (SLTs) feel about using colloquial speech given that they are considered expert speakers.What this paper adds to existing knowledgeWhile ‘talking properly’ is part of the SLT's professional identity, many Flemish SLTs felt that strict adherence to the standard language variety hinders therapeutic alliance. While standard language was strongly associated with professionalism, strict adherence to standard language was used only when SLTs felt they had to prove their clinical competency or when language scaffolding was in the foreground. Partially converging with the clients’ language use allowed SLTs to reconcile their professional identity as expert speaker with personal identity and authenticity.What are the potential or actual clinical implications of this work?Both colloquial speech and standard speech serve a function in SLT practice. Therefore, switching between standard and colloquial speech needs further consideration as a communicative strategy rather than instilling in therapists an ideological, normative stance towards language.

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“…Ocorrem rupturas involuntárias do fluxo da fala, evidenciadas por bloqueios de posições pré-articulatórias ou articulatórias fixas, repetições de sons e de sílabas, prolongamentos de sons, pausas extensas e intrusões nas palavras de sons ou segmentos fonológicos não pertinentes e uma diminuição da velocidade de fala (Celeste & Reis, 2013;Andrade et al, 2014). São interrompidos ritmo, a continuidade, a suavidade e a produção de fala (Croft, 2019;Andrade et al, 2017;Silva et al, 2016). Em crianças, as dificuldades iniciais para falar podem resultar em constrangimento, medo ou frustração, levando ao desenvolvimento de comportamentos de evitação de palavras e de situações de comunicação (Richels & Conture, 2007).…”

Section: Introductionunclassified

“…Essas pessoas são vulneráveis ao surgimento de dificuldades psicossociais e ansiedade social, bem como a desafios (negativos) acadêmicos/vocacionais (Blumgart et al, 2014;Croft, 2019). Já na infância os sinais de gagueira podem levar a timidez e medo relacionado à fala (Silva, 2016).…”

Section: Introductionunclassified

Construção e validação de conteúdo de material educativo sobre gagueira

Kira

Alpes

Mandrá

2023

RSD

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O objetivo foi construir e validar o conteúdo de material ilustrativo para aconselhar familiares e educadores de crianças com gagueira. Estudo com abordagem metodológica, seguindo as etapas preconizadas em literatura para a validação de material educativo. Foram selecionados três grupos de juízes: oito fonoaudiólogos, 10 educadores de educação infantil e 10 familiares de crianças e adolescentes gagos. Os juízes responderam um questionário autoaplicável para julgar o conteúdo, a linguagem, as ilustrações, o layout e a motivação dos materiais. E, após a leitura do folder deveriam assinalar um dos níveis de concordância (escala Likert): (1) discordo totalmente, (2) discordo, (3) não discordo nem concordo, (4) concordo, (5) concordo totalmente, e depois três questões dicotômicas (sim/não) associadas a um espaço para comentário/sugestões. Após a organização e categorização dos dados, o Índice de Validade de Conteúdo (IVC) foi aplicado para medir o grau de concordância entre os juízes com o ponto de corte de >0,78. Foram necessários ajustes nas categorias ilustração e layout (<0,78). Foram consideradas sugestões e comentários individuais dos juízes envolvendo conteúdo e linguagem. A versão final em folha A4, modo paisagem e com três abas, disposto da seguinte forma: capa, contracapa com a incidência e tipos (desenvolvimental, neurogênica e psicogênica), diagnóstico e tratamento, atitudes favoráveis e um lembrete sobre o bullying na gagueira, além da definição e principais manifestações da gagueira. O material foi construído e seu conteúdo validado, apresentando alto índice de aceitação e concordância entre os juízes, sendo um suporte para os profissionais da área de saúde e da educação e aos pais acerca da temática da gagueira. A próxima etapa do estudo contempla a determinação das propriedades psicométricas do material, a fim de validar os itens e torná-la completamente validada.

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Student clinicians’ and clients’ perceptions of the therapeutic alliance and outcomes in stuttering treatment

Cited by 13 publications

References 43 publications

Systematic review and meta‐analysis of therapeutic alliance, engagement, and outcome in psychological therapies for psychosis

Systematic review and meta‐analysis of therapeutic alliance, engagement, and outcome in psychological therapies for psychosis

‘Talking Very Properly Creates Such a Distance’: Exploring Style‐Shifting in Speech‐Language Therapists

Construção e validação de conteúdo de material educativo sobre gagueira

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