Access Type

Open Access Dissertation

Date of Award

January 2019

Degree Type


Degree Name



Communication Sciences and Disorders

First Advisor

Margaret L. Greenwald


The goal of this study was to investigate the relationship between self-awareness and therapeutic alliance in dyads of speech-language pathologists (SLPs) and their clients with traumatic brain injury (TBI). Although both topics have been independently associated with treatment outcomes in individuals with TBI, there is little research that investigates how these elements interact as they relate to client and SLP behavior. A mixed-methods approach was used to examine the interaction between these elements. Research questions targeted the communicative-behavioral manifestations of SLP self-awareness and the ratings of client self-awareness related to the client’s perception of therapeutic alliance. Additionally, the findings were discussed with respect to clinical implications for the field. Nineteen dyads of SLP and TBI clients participated in this study. Procedure included a three-part process: (1) baseline assessments of self-awareness and therapeutic alliance, (2) participation in a video-taped therapy task, and (3) completion of a follow-up assessment by the SLP during a post-task video review. Results indicated that therapeutic alliance is correlated to specific intentions that drive SLP behavior; these intents were to convey receptiveness and to explain, judge, or label the other’s experiences or behavior. Therapeutic alliance was not correlated to the frequencies of SLP verbal or nonverbal behaviors, but was negatively correlated to longer periods of time post-injury, time from DOI to rehabilitation admission, length of rehabilitation, and the number of speech treatment sessions. Client self-awareness was not associated with ratings of therapeutic alliance. Impairments in client self-awareness were associated with a greater number of speech treatment sessions, and the frequency of SLP verbal behaviors correlated to the clients’ motor/sensory self-awareness. The key clinical and theoretical implications of these findings are that self-awareness can be qualitatively measured by both internal intentions and external behaviors, in addition to being objectively measured by performance-based or self-other rating scales. Additional research is needed to (a) clearly identify which clinical behaviors and intents have efficacious results on client self-awareness and therapeutic alliance, and (b) further examine the relationship between self-awareness and therapeutic alliance. Finally, based on the results of this study, SLPs should use a collaborative, open, and receptive approach to their clients when providing cognitive-communicative rehabilitation in preference over the more traditional, verbally-didactic teacher/student approach.

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Communication Commons