Monday, 15 April 2013


In the 23 years of my clinical practise I have never ceased to be amazed by the progress our clients can make despite their initial prognosis and I have become increasingly convinced that the therapeutic relationship is critical to this.

It is my ambition to develop a greater understanding of this and in turn to put the therapeutic relationship back on the map, as a professional necessity not nicety.

In a recently published book by Robert Fourie Therapeutic Processes for Communication Disorders 2011 he and his co authors, compel us to renew our understanding of the importance of the therapeutic relationship, as integral to our work.

The idea of recognising the necessity to nurture the therapeutic relationship is nothing new though. In the days of my training and early practise it was regarded as critical to the furtherance of our work.

Shula Chiat in 1997 stated

  The emphasis… is on interactions: between intact and impaired levels of processing; between observations emerging from assessments and those emerging from therapy; between the patient and therapist. Therapy so conceived is dynamic, moving from initial hypotheses about the sort of intervention that will facilitates the patient’s processing, according to the patients response to that intervention”

However such determined advancement of the therapeutic relationship as a vital part of our work, is in stark contrast to the current practise of many SLT’s, particularly those of us who work within the NHS, many of whom rarely see their clients.

This is, in my opinion, the negative heritage of the sole use of the scientific model as a methodology to provide us with professional credibility.

In the early 90s the scientific model took a foothold as the main and only means of legitimately researching our work. Unfortunately in attempt to become methodologically clean, the relationship has been airbrushed out.

It seems to me that the subsequent devaluing of the relationship with our clients in albeit in a legitimate attempt to tighten up our act, has however, left us professionally vulnerable and far less certain about our work.

The human face of our work has virtually disappeared and therein we have lost sight of the real power house of change.

Rupert Sheldrake in his inspiring book The Science Delusion published 2012 discusses the immense power of the placebo effect on healing

“Placebo responses show that health and sickness are not just a matter of physics and chemistry. They also depend on hopes meanings and beliefs. Placebo responses are an integral part of healing” Sheldrake 2012.

The placebo we bring to our clients is the knowledge and experience we have accumulated over the years, which reassures and brings hope and the sense that they, the client, are in our good hands.

The therapeutic relationship is though more than a cradle of human comfort. It is through this crucible of human connection that we deepen our understanding of our client’s needs and advance our therapeutic efficacy. Those of us who work closely with our clients know very well that the relationship is the birthplace of our intervention. The intimacy of our interaction with our clients enables us to accumulate more and more information, from which a picture emerges and it is upon this we develop our insights and our therapeutic intervention.

However those of us who work closely with our clients, also recognise that the insights that ignite life into our work, are arrived at not just through the outcomes of the manual labour of our tests and assessments, but also through the volume of information we ‘pick up’ unconsciously as we work alongside our clients.  It is this emergent intuitive aspect of the relationship that is recognised as the real source of change and insight.

The power of this innate human ability for what is now regarded as ‘unconscious rapid cognition’ or ‘thin slicing’ is beautifully described by Malcolm Gladwell in his book Blink 2006.

“The notion of an ‘adaptive subconscious’, is thought of as a giant computer that quickly and quietly processes a lot of data we need in order to function as human beings” Gladwell 2006

The resultant ‘gut feeling experience’ he argues can be, contrary to conventional thinking, more reliable than information we consciously filter and it is this skill that enables us to get nearer to that, which remains unknown to us.

It seems to me that being able to utilise these subconscious levels of understanding doesn’t just provide another way of exploring the clients internal processing, but facilitates an  opening up between therapist and client through which we experience intuitive leaps.

Intuitive leaps are without question the recognised touchstone of human creativity and discovery. It is through these leaps of intuition that we advance a deeper understanding of our work and as a result more meaningfully develop our therapeutic interventions.

Astonishingly though, the notion of intuition remains, within our profession at least, either ignored or perceived to be of interest only to the vague and woolly minded.  The unbelievable foolishness of hanging on to such ideological position can more be properly appreciated when you cast a look around at the great thinkers of our time, many of whom understood only too well, the immense value of our ability as humans to access our intuitive mind.

“The intuitive mind is a sacred gift and the rational mind is a faithful servant. We have created a society that honours the servant and has forgotten the gift”. Albert Einstein

In view of this I believe it is critical we recognise the gift and the power of the therapeutic relationship as the touchstone of our work.

And more to the point I believe if we continue to ignore its importance, we do so at our professional peril.

S.Chiat, J Law, & J Marshall (1997) Language Disorders in Children  and Adults. Whurr Publishers

The Consultative Model: Advancing the Stereotype and Undermining Our Therapeutic Skills  GeraldineWotton 2003

 The Science Delusion Rupert Sheldrake 2012
 Blink Malcom Gladwell 2006

 Presentation made at Association for SLT in Independent Practitioners Conference March 2013
Author Geraldine Wotton- People are free to use this material from this article as long as you credit the author

1 comment:

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