The working alliance in stuttering treatment: a neglected variable?

Sønsterud, Hilda; Kirmess, Melanie; Howells, Kirsten; Ward, David; Feragen, Kristin Billaud; Halvorsen, Margrethe Seeger

doi:10.1111/1460-6984.12465

Cited by 34 publications

(35 citation statements)

References 50 publications

(145 reference statements)

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“…2009) and motivation (Sønsterud et al . 2019). Despite this, SLT educational programmes highlight efficacy evidence and most studies investigating stuttering treatment efficacy fail to acknowledge the role of such extra‐therapeutic factors in therapy outcomes, instead contributing most if not all of the therapeutic success to the specific intervention under examination.…”

Section: Discussionmentioning

confidence: 99%

“…2018), and the benefits of its use for evaluating relationships in stuttering intervention have been recently highlighted (Sønsterud et al . 2019). It is equally important that clinicians also reflect on the quality of the therapeutic alliance with their clients to increase their awareness of their personal qualities and the impact these may be having on the development of a favourable alliance for both parties.…”

Section: Discussionmentioning

confidence: 99%

“…The client-rated Working Alliance Inventory-Short Version-Revised (WAI-SR) (Hatcher and Gillaspy 2006), for example, is a useful assessment tool to measure the strength and quality of the relationship. This measure is commonly used in psychotherapy research (Flückiger et al 2018), and the benefits of its use for evaluating relationships in stuttering intervention have been recently highlighted (Sønsterud et al 2019). It is equally important that clinicians also reflect on the quality of the therapeutic alliance with their clients to increase their awareness of their personal qualities and the impact these may be having on the development of a favourable alliance for both parties.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to being highly individualized in our approach to intervention, it further incorporates factors related to per-sonal characteristics, specifically client and clinicianrelated qualities, and the therapeutic alliance. A range of client-related factors that influence intervention outcomes have been previously discussed in the stuttering literature, including client readiness for change (Floyd et al 2007, Manning 2010, Turnbull 2000, coping style (Plexico et al 2009) and motivation (Sønsterud et al 2019). Despite this, SLT educational programmes highlight efficacy evidence and most studies investigating stuttering treatment efficacy fail to acknowledge the role of such extra-therapeutic factors in therapy outcomes, instead contributing most if not all of the therapeutic success to the specific intervention under examination.…”

Section: Discussionmentioning

confidence: 99%

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International expert perspectives on the principles and components of effective intervention for adults who stutter

Connery

Galvin

McCurtin

2020

Intl J Lang & Comm Disor

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Background: While evidence-based practice is widely endorsed by researchers, clinicians and professional bodies as a guiding framework for the provision of quality care to clients, the reliance on efficacy evidence may overshadow the benefits of other knowledge forms in supporting intervention design and evaluation. Due consideration needs to be given to varied forms of evidence, including practice and patient evidence. Stuttering intervention for adults is one area in which there is a significant shortage of practice-based research literature. Aims: This study aimed to add to practice evidence by exploring the perspectives of international researchers and clinical experts on the components of effective stuttering intervention. This practice-based evidence will be used to inform the multi-stakeholder co-design of an evidence-based stuttering intervention for adults. Methods & Procedures: Criteria defining expertise were developed based on a review of the literature. Experts were recruited using purposive sampling and snowballing. Seventeen international experts were approached, of which 10 completed semi-structured interviews. Interview questions were developed and centred on five topics: the nature of stuttering; efficacy evidence base; intervention techniques, principles of effective intervention; and outcome measurement. Outcomes & Results: Inductive thematic analysis identified three overarching themes: 'One size doesn't fit all', 'A really collaborative relationship where we are both bringing our sense of expertise to this' and 'Some of the most frustrating things'. Conclusions & Implications: These findings emphasize the complexity of stuttering intervention, the need for individually tailored treatments and the role of multiple factors, beyond therapeutic technique, that influence treatment outcomes. Findings also demonstrate the benefit of collecting practice-based evidence to support clinical decision-making and intervention evaluation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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International expert perspectives on the principles and components of effective intervention for adults who stutter

Connery

Galvin

McCurtin

2020

Intl J Lang & Comm Disor

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“…There is a need to explore the concept of the working alliance and its role within cluttering therapy. Based on the studies of Sønsterud et al (2019aSønsterud et al ( , 2019b, it may be particularly important to focus on the agreement of therapy goals and related tasks, as well as aspects related to the bond between the client and the clinician. However, in addition to the challenges of recruiting participants for a study of cluttering, how and to what extent are the collaborative process and the working alliance affected when part of the clinician's role is to draw the client's attention to their challenges and goals?…”

Section: Issues Related To Development and Measurement Of The Workingmentioning

confidence: 99%

The Importance of the Working Alliance in the Treatment of Cluttering

Sønsterud

2019

Perspect ASHA SIGs

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It is expected that the quality of the working alliance between speech-language pathologists (SLPs) and persons who clutter matters. The term working alliance is an important concept in cluttering and stuttering treatment and can be described as the degree to which the therapy dyad is engaged in collaborative, purposive work. The concept includes, among other factors, a shared understanding of therapy goals and the relevance of the therapy approach to achieving those goals. There has been an increasing interest regarding research that supports the therapeutic relationship as an evidence-based component of interventions in speech-language pathology, and recent research ( Sønsterud et al., 2019 ) supports that a critical element for successful stuttering therapy lies, among other factors, in the concept of the working alliance. Purpose Although there is consensus that SLPs should openly and honestly discuss the individual's goals and expectations for therapy, personal motivation and the impact of the working alliance for people who clutter have not been investigated. This clinical focus article highlights the importance of open and honest discussion around not only the individual's goals for treatment but also the tasks or activities to be incorporated in that treatment. Relevant and specific quantitative and qualitative assessments for measuring the working alliance are required to investigate the concept of the working alliance in more detail. The Working Alliance Inventory–Short Revised version is regarded to be one useful tool to evaluate this client–clinician relationship. The Working Alliance Inventory–Short Revised version is quick and easy to use and explores the working alliance across the 3 processes of bond, goal, and task. Conclusion This clinical focus article contains no research results. Anyhow, some considerations on this concept, both from a person who clutters and SLP perspectives, are included in this clinical focus article. Research is required to investigate whether shared understanding of treatment goals, agreement on tasks, and a respectful and trustful bond may become important predictors for successful therapy outcome also for people who clutter.

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