Building Therapeutic Alliances in Aphasia Rehabilitation: Developing Relational Competencies Through Narrative Practice

Abstract This study explored how graduate clinicians developed relational competencies while facilitating the My Story Project, an evidence-based narrative intervention in which clinicians support people with aphasia to co-construct personal life stories. Using reflexive thematic analysis, focus group data from 11 graduate students in speech-language pathology who served as story coaches were analyzed. Each coach facilitated weekly virtual story co-construction sessions with one person with aphasia during a clinical practicum. Coaches received training in the relationship between narrative and identity, and person-centered principles, including the PULSE framework. Focus groups explored their experiences. Four interconnected themes characterized coaches' development: Opening Space for Stories (embracing uncertainty, creating safe environments), Discovering Their Story (seeing beyond diagnosis, recognizing the whole person), Holding Space for Emotion (remaining present during emotional vulnerability), and Building Story Partnerships (co-constructing authentic relationships). Themes captured both the relational competencies coaches developed and how they emerged through authentic relationships with people with aphasia. Relational competencies essential for person-centered aphasia rehabilitation—including building therapeutic alliances, addressing psychosocial needs, and supporting identity work—develop through experiential learning within therapeutic relationships rather than through didactic instruction alone. Clinical training programs should prioritize direct practice opportunities through authentic relationships with people with aphasia.