Learning‐in‐interaction: Resourceful work by people with aphasia and therapists in the course of language impairment therapy

The author would like to acknowledge the contributions of all participants—people with aphasia and therapists alike—who generously permitted collection and analysis of their therapy data. Great thanks are due to three reviewers of very early versions of this paper, and to two further reviewers of a more recent version for their very helpful comments. Many thanks to Paul Conroy for illuminating conversations about errorless learning.

Abstract

Background: “Learning” in aphasia language therapy has been studied in various ways. Empirical approaches to learning potential have been proposed, and attempts have been made to apply a range of concepts from learning theory. “Error” has been an important consideration and has received much recent attention through the application of “errorless learning” approaches. Errorless learning has been conceptualised in terms of error‐elimination and error‐reduction methods, with and without feedback. Authors have addressed questions of how “easy” and “difficult” may be embodied within the learning context. Key principles from adult learning models have also been espoused as relevant to aphasia language t`herapy. Therapist–client interactions in aphasia language therapy embody a range of features that are implicated in the learning process.

The author would like to acknowledge the contributions of all participants—people with aphasia and therapists alike—who generously permitted collection and analysis of their therapy data. Great thanks are due to three reviewers of very early versions of this paper, and to two further reviewers of a more recent version for their very helpful comments. Many thanks to Paul Conroy for illuminating conversations about errorless learning.

Aims: This study seeks to explore how detailed examination of situated and contextualised interactions can further our understanding of learning. It addresses three main themes—“error and effort”, “feedback”, and “mutuality and partnership”—entailed in the learning process.

Methods & Procedures: A qualitative study of therapy in day‐to‐day practice was carried out, applying Horton's (2006) therapy process framework to audio/video data, focusing specifically on “doing therapy tasks”. Extracts from 15 sessions involving 10 therapist–client dyads were purposively selected. Analysis examines interactional aspects of “Task Introductions”, “Summary”, and “Task/response management” as relevant to the three learning themes.

Outcomes & Results: Key features of learning‐in‐interaction as a socially situated phenomenon emerge: “effort and error” is realised in therapist explanations, contingent enactment of accuracy/acceptability of responses, and mediated through the relative complexity of stimulus items; “feedback” functions flexibly, is calibrated responsively, and interfaces with and contributes to the ways in which “effort” is constructed in interaction; “mutuality and partnership” operates at levels that may be (quasi)conscious—through therapist/client control, or collaborative decision making for example—or unconscious, through clients asserting their processing needs or displaying their own standards.

Conclusions: Concepts associated with “learning” have been explored in interaction. Close scrutiny of therapy process has revealed subtle but powerful resources brought to bear by people with aphasia. Acknowledging these contributions and incorporating them into language therapy will help to develop a more comprehensive epistemology of therapy, and ensure that people with aphasia are active participants. Future research into error elimination/reduction approaches may benefit from these findings. Translational research may benefit from the insights of this study, enabling clinicians to apply novel therapies in day‐to‐day practice.

Keywords:

• Learning
• Aphasia language therapy
• Therapy process
• Patient–therapist interaction

Notes

The author would like to acknowledge the contributions of all participants—people with aphasia and therapists alike—who generously permitted collection and analysis of their therapy data. Great thanks are due to three reviewers of very early versions of this paper, and to two further reviewers of a more recent version for their very helpful comments. Many thanks to Paul Conroy for illuminating conversations about errorless learning.

1. Funded by the Stroke Association, England (Grant No: 18/98) as an award to Professor Sally Byng. Multi‐Centre Research Ethics Committee ref: MREC/99/2/18.