Consensus on the Components of Therapeutic Alliance in Stuttering Intervention: An e-Delphi study with Speech and Language Therapists

Abstract

BACKGROUND: Therapeutic alliance is the term used to describe the interactional and relational processes that occur during therapy. The strength of a therapeutic alliance is associated with treatment adherence, treatment outcomes and clients’ satisfaction with treatment. Therapeutic alliance has been identified by key stakeholders as an essential component of stuttering intervention, however, this construct and its components remain relatively underexplored in the literature. OBJECTIVE: This study aims to build consensus amongst speech and language therapists working with adults who stutter on the core components of therapeutic alliance, and the factors that influence its development. It also aims to develop a guiding framework for the establishment and maintenance of therapeutic alliance with this client group. METHODS: Speech and language therapists participated in a three-rounded e-Delphi survey focused on: (1) identifying the core components of the therapeutic alliance; and (2) gaining group consensus on the core components of therapeutic alliance. Statements representing the core components that obtained consensus were categorised using a framework of therapeutic alliance. RESULTS: A total of 24 speech and language therapists agreed to participate. 24/24 (100%) completed Round 1, 24/24 (100%) completed Round 2, and 23/24 (95.83%) participated in Round 3. Following inductive content analysis of Round 1, 62 statements were generated, and consensus was achieved on 60 statements which were agreed by participants to represent the core components of therapeutic alliance. These statements were then categorised, resulting in a guiding framework of therapeutic alliance to support speech and language therapists working with clients who stutter. CONCLUSIONS: Consensus on the core components of the therapeutic alliance for stuttering intervention was reached through engagement with speech and language therapists. The framework presented demonstrates the vital role speech and language therapists play in the formation and maintenance of therapeutic alliance during the delivery of stuttering interventions with adults.