The therapeutic use of email in adult stammering therapy

Introduction: Therapist-client interaction in Speech and Language Therapy (SLT) traditionally occurs on a face-to-face (FtF) basis but use of mainstream online communication in a therapeutic setting is now emerging in clinical practice, prompting the recent development of new UK professional guidelines. Within counselling and psychotherapy services there is recognition that online communication can provide increased choice as to how clients present themselves to therapists, may be less threatening than attending a clinic in person, and can allow clients to view their difficulties from an external perspective. Remotely provided care may also increase access to healthcare services, particularly where travel to appointments is inconvenient or difficult. Such benefits also have relevance for adult stammering therapy in which an approach-avoidance conflict may hinder clients from easily confronting their stammering or the severity of stammering prevents a full account of the speaker’s experiences being shared within the necessarily limited time of a clinic appointment.

This researcher exchanged emails with clients, first as a convenient way of arranging appointments, and later as a means of clients sharing reflections on their communication experiences between FtF sessions. To contribute to the developing evidence base for the use of online communication in a therapeutic setting, this study had the following research questions:

1) How do AWS experience blended face-to-face and email contact in speech and language therapy?
2) How can such a blended approach to adult stammering be maximally operationalised?

Methods: Semi-structured interviews were used to explore the experience of using email as part of adult stammering therapy with six adults who formerly received SLT input from the researcher. Phenomenological principles guided the data collection, interpretation and presentation, and researcher attitude during the study.

Results: Individual participant stories derived from interview data highlight the unique nature of email use for each participant and enhance the group analysis. Cross-group thematic analysis revealed five key themes: Easier Communication; Integration of FtF Therapy and Remote SLT contact; Sharing Information; Altered Communication Style; and Engaging with Therapy. Participant experiences within these themes and related sub-themes were both shared and divergent.

Discussion: Incorporating email exchanges with FtF contact can offer therapeutic benefits for adults who stammer, but the unique nature of email use for each of the participants emphasises that such communication exchange needs to be considered on a case-by-case basis and requires negotiation with individual clients to ensure therapy remains client-centred. Participants unanimously agreed that email communication can offer a wider choice in how some aspects of therapy are delivered but cannot be a complete substitute for FtF support. Using email more regularly in therapy requires attention to email management from both client and therapist and consideration as to how verbal therapeutic exchanges can be translated to written communication.