Challenges in providing psychotherapy to adults with neurogenic communication disorders

Background: Cerebrovascular conditions (e.g. stroke) are increasing in most developed countries. Over 15 million people in the US have adult-onset brain diagnoses. The prevalence of neurogenic communication disorders is unknown. The loss of vocal language has been identified as a key predictor of post-stroke depression.

Aim: To examine the current scope of the literature and the evidence of effectiveness with regard to psychotherapy for people with neurogenic communication disorders

Methods: Structured literature review of Medline, PsycINFO, Embase, Social Work Abstracts, British Nursing Index (1990-2010) limited to English language.

Results: After removal of duplicates 41 publications were identified. Few intervention studies were identified that specifically address psychological concerns of non-vocal adults. Most communication disorder studies so far have focused clients with autistic spectrum disorder. Moreover, psychotherapy has been explored with Deaf individuals. The scientific literature is limited to case and exploratory studies. Interventions are primarily offered by speech language pathologists but not clinical psychologists or trained mental health counselors. No discussion of needed adaptation of diagnostic instruments has been found. Dysarthric or anarthric individuals may not be able to verbalize their emotional state but could be effectively assisted by technology. Tele-psychiatry and –psychotherapy have been identified as holding substantial potential.

Discussion: The potential of technology-supported psychotherapy interventions for non-vocal adults is considerable. There is scope in developing and validating alternative formats of existing diagnostic tests. Mental health professionals need to be trained in embracing assisted and augmentative technologies.

Providing access to psychotherapy for non-vocal clients is a matter of social equality.