Counseling and Aphasia Treatment Missed Opportunities

During clinical interactions between speech-language pathologists and adults with aphasia, a variety of emotional issues arise. The literature suggests that while counseling is within the scope of practice, SLPs tend to avoid emotional issues in therapy (A. Holland, 2007a). The precise mechanisms employed for circumventing emotional issues in speech-language treatment sessions and the source of such behaviors have not been explored. An ethnographic microanalysis of 4 individual aphasia treatment sessions was undertaken to identify and describe discourse strategies associated with "missed"counseling opportunities. Several strategies for avoiding counseling were identified including focusing on "facts," engaging in superficial "staged" conversation, deflecting emotion with humor, and shifting to "objective" therapy tasks. Interpretation of these data suggest several possible reasons for these clinical behaviors including avoidance of awkward social situations and intimacy, narrow views of the job, and learned professional values.