Disclaimer: this resource is intended for speech and language therapists and students of this profession. If you require therapy for aphasia please contact a speech and language therapist. 

Conversational Coaching / Conversation Therapies

Summary: Developed by Audrey Holland (see Holland, 1991), Conversational Coaching is an approach in which the therapist supports a client with aphasia and their conversation partner to identify and implement useful verbal and nonverbal strategies to facilitate communication. Therapy is collaborative and involves the use of these communication strategies in semi-controlled tasks intended to promote their use outside of therapy sessions. Interactions between the client with aphasia and their conversation partner are analysed in order to increase their awareness of the communication strategies that are most effective for them. 
Example​:
Initial session outline
  • The client is shown a short video (e.g. a short segment from a TV show). The conversation partner is not present at this stage.
  • The conversation partner is brought into the room and a video recording made of the client attempting to relate the content of the short video to their conversation partner. At this stage no strategies have been taught to either the client of their conversation partner and the therapist does not intervene.
  • The therapist, client and communication partner then watch the video recording of the interaction. While doing so the therapist highlights any supportive strategies that are likely to have made communication in this interaction more effective (see examples of communication strategies, below) as well as noting any strategies observed that appeared to hinder communication.
  • Following discussion of these and other strategies, the client and their communication partner agree on their preferred strategies. Key words reminding the client and their communication partner of these strategies are printed on paper and used as a reminder during future interactions in therapy sessions. 

Treatment session outline
  • The client with aphasia is again shown a short video, unseen by their communication partner. 
  • The client again attempts to relate communicate the content of the short video to their conversation partner. Both parties are reminded to use their preferred strategies during this task. It may be useful to again make a video recording of this stage for later viewing with the client and their communication partner.
  • If a miscommunication or communication breakdown occurs, the therapist steps in to offer support (after having given the client and their communication partner 2 chances to independently repair the interaction), e.g. prompting the communication partner to ask the client with aphasia to try a different strategy or suggesting new strategies that might suit the situation.
  • The therapist, client and communication partner then reflect on the interaction (viewing the video recording of the interaction if this has been made). The effectiveness of the strategies used by both parties in the video are discussed and, where necessary, changes made to their list of preferred strategies. 
  • This process is repeated with the client and their communication partner swapping roles (i.e. the communication partner watches the short video and attempts to relate its content to the client with aphasia).  

Examples of communication strategies for client with aphasia:
  • Focusing on the key concept first
  • Drawing
  • Gesturing
  • Gesturing and drawing
  • Writing
  • Use of circumlocution
  • Correcting partner when misunderstood
  • Telling partner when they are close

Examples of communication strategies for communication partner:
  • Prompting partner to focus on the key concept first
  • Prompting partner to use a different strategy
  • Repeating back what they have understood regularly and at the end
  • Drawing/writing key points to check they have understood 
  • Not guessing partner’s meaning until more information has been gathered
  • Asking specific questions
  • Writing out questions
  • Confirming yes/no using writing
  • Gesturing to aid partner’s comprehension

Adapted from Hopper et al. (2002) & Hinckley (2008 & 2009). 
Evidence Base​: ​Hopper et al. (2002) provided Conversational Coaching therapy to two participants with severe Broca’s aphasia and their partners over 10 sessions. Both participants were able to communicate significantly more concepts to their conversation partners following treatment and one participant was noted to improve significantly on the Communication Activities of Daily Living. Additionally, observers viewing the couples’ interactions understood more of the content post-treatment. 
References
Hinckley, J.J., 2008. Intervention for anomic aphasia from a functional perspective. In: Martin, N., Thompson, C.K., & Worrall, L. eds. Aphasia rehabilitation: The impairment and its consequences. Oxford: Plural Publishing, 181-198

Hinckley, J.J., 2009. Conversational Treatments: Aphasia. Treatments that work for both dementia and aphasia. Seminar presented at the 2009 ASHA Convention (New Orleans, LA). [online] Available at: http://www.asha.org/Events/convention/handouts/2009/1206_Hinkley_Jacqueline [Accessed 26/02/2016]

Hopper, T., Holland, A., & Rewega, M., 2002. Conversational coaching: Treatment outcomes and future directions. Aphasiology, 16(7), 745-761

Holland, A., 1991. Pragmatic aspects of intervention in aphasia. Journal of Neurolinguistics, 6(2), 197-211
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