A social approach: solution focused aphasia therapy

Document Type


Conference Title/Conference Publication

10th International Aphasia Rehabilitation Conference


Brisbane, Australia

Conference Dates

July 24-26, 2002

Date of Presentation



In previous work (Boles & Lewis, 2000), a method of counselling couples with aphasia was presented. The current study used principles of solution-focused therapy during communication therapy for an individual with aphasia, while incorporating his wife in the conversation-based approach. Exceptions to problem behaviours were emphasised, with success based on client-generated goals. While the couple in this study conversed, the clinician encouraged certain communicative acts while discouraging others. SFAT had a “counselling” orientation, although communication improvement was the underlying goal. For example, “Louise” complained they seldom talked about “deeper issues” compared to pre-stroke conversations. In focusing on exceptions, the clinician might have asked, “when was the last time you did talk about one of these issues?” The therapy task soon became focused on how they could recreate that calmness that was revealed in Louise’s response to the question. SFAT used scaled questions as the benchmark for improvement. For example, when Louise said that “Mark” rarely asked her any questions, the clinician asked Mark how difficult (1–10) it was to ask her questions. The final component of therapy was 10 minute daily conversations, during which distractions were minimised. No topics were imposed. This homework provided a safe environment in which to practice their improving skills in talking to one another. The authors of this paper challenge the following assumptions of traditional aphasia therapy:

  • Once the patient has been cued, and produces the desired (by the expert) response, and that has been reinforced, that response is more likely to recur.
  • The cueing used by the aphasiologist is likely to occur outside the therapy room.
  • The “expert/patient” format of traditional aphasia therapy, wherein the aphasiologist elicits responses and the patient responds, is likely to generalise to the communicative situations practiced outside the therapy room.

The following principles (Simmons-Mackie, 1998) were applied to the SFAT approach:

  • Conversation is the focus, rather than discrete linguistic units.
  • Social interaction and information exchange are both worthy goals for therapy.
  • Address communication within authentic, relevant, natural contexts.
  • View communication as a dynamic, flexible, multidimensional activity.
  • The collaborative nature of communication is the focal point, rather than on the individual with aphasia.
  • Focus on the social and personal consequences of aphasia.
  • Focus on adaptations to impairment.

Mark and Louise made measurable gains in their communication with one another. The measures of that success included an increase in their self-rat ings of communication, increased facilitative gestures by Louise, and an increase in communication independence by Mark.

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