Mapping the Role of Therapeutic Alliance in Speech and Language Therapy to the Rehabilitation Treatment Specification System

Purpose: The purpose of this clinical focus article is to highlight the significance of the therapeutic alliance (TA) and how it relates to speech and language therapy practice. We define the components of the TA through the Rehabilitation Treatment Specification System (RTSS) framework in an effort to increase clinician understanding and implementation of the components of TA. Method: With the introduction of the RTSS, there have been ongoing efforts to increase specificity in describing and outlining rehabilitation treatments to better understand, research, and translate knowledge across the field. However, the inclusion of representations and volitional ingredients is often missing from current literature or limited to certain patient populations. We map the ingredients of the TA as intentional clinician actions to provide increased specification of volition components, with the goal of shaping and enhancing the patients' mental representations and offer insights for direct application in clinical practice. Conclusions: Ongoing efforts to educate and train speech-language pathologists on the invaluable contribution of mental representations and TA are imperative. Embedding this education within the RTSS framework may serve to underscore its equal contribution to the patient experience and associated outcomes. Ongoing research and efforts to further delineate volitional ingredients into therapeutic practice is essential to maximize patient engagement and outcomes.