Breaking the connection: Why is it so difficult to talk about discharge with our clients with aphasia?

This paper, drawn from a study into experiences of treatment termination in chronic aphasia, discusses why communication, between speech-language pathologists and clients with aphasia, breaks down so frequently during discharge negotiations. Considering our role as communication experts and our awareness of the barriers faced by people with aphasia in sharing decisions about their care, this is a concern. Eight general reasons for communication breakdown are discussed: the presence of aphasia; inadequate explanations or shared understandings of therapy in general; discharge reflecting other aspects of professional-client communication; discharge as "bad news"; discharge and the limits to negotiation; discharge as an unclear phenomenon; discharge documentation; and discharge evaluation. These reasons are illustrated by several real stories gathered from in-depth interviews with 30 speech-language pathologists, 21 people with aphasia and 16 family members. This paper aims to help speech-language pathologists reflect on how they break the connection, so important in therapy, between themselves and their clients with aphasia at discharge and how this is communicated. This issue is important, not only because of the centrality of communication to our work, but also because it has implications for the overall success of therapy and for our clients' wellbeing.