Lawton, Michelle, Gillian Haddock, Paul Conroy, Laura Serrant, & Karen Sage (2020). People with aphasia’s perspectives of the therapeutic alliance during speech-language intervention: A Q methodological approach. International Journal of Speech-Language Pathology, 22(1), 59-69. (doi: 10.1080/17549507.2019.1585949) (Link:

Abstract: Purpose: To identify which elements of the therapeutic alliance are important to people with aphasia (PWA) attending speech-language pathology post-stroke. Method: A Q methodology design was adopted to explore which elements of the therapeutic alliance were valued by PWA. Statements (n = 453) relevant to the research question were extrapolated from the literature and qualitative interviews. A representative sample of statements (n = 38) was identified from the expansive data set. PWA (n = 23) sorted statements hierarchically according to whether they thought the statement was important or unimportant. Completed Q sorts were analysed using a by-person factor analysis. Result: Analysis yielded a five-factor solution, representing five distinct viewpoints: (1) acknowledge me, help me to understand; (2) respect me, listen to me; (3) challenge me, direct me; (4) understand me, laugh with me; and (5) hear me, encourage me. Conclusion: The findings highlight the need for clinicians to adopt a flexible and idiosyncratic approach to therapeutic alliance construction in order to meet the relational needs of a heterogeneous population. This is the first study to use Q methodology with PWA, demonstrating that Q methodology is an effective and viable method for investigating subjectivity in this population.

Michelle Lawton <> is in the School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.

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