Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park.
Am J Speech Lang Pathol. 2022 Sep 7;31(5):2268-2282. doi: 10.1044/2022_AJSLP-22-00089. Epub 2022 Aug 16.
The purpose of this review article is to examine interacting factors that affect the psychotherapeutic process for patients who use augmentative and alternative communication (AAC). This is examined from two perspectives: (a) how the skills and needs brought by the individual with communication disabilities influence the process of therapy and (b) how the individual's ecological systems may affect an individual's mental health and their access to mental health supports. Understanding these factors will guide future efforts aimed at ensuring that individuals with communication disorders have adequate access to services and supports for mental health.
A narrative synthesis approach was used to explore the interaction of psychotherapy and the use of AAC. Existing research in the fields of psychotherapy and speech-language pathology was examined for its relevance to issues of communication using AAC. Specifically, information was synthesized concerning mental health, prevalence rates of mental health diagnoses, the provision of traditional psychotherapy, and communicating via AAC in order to describe the intersection of psychotherapy and AAC. This narrative synthesis approach sought to initiate discussion of relevant factors that may affect the psychotherapeutic process for patients who use AAC.
A variety of factors may affect the psychotherapeutic process for patients who use AAC. Bronfenbrenner's (1977) Ecological Systems Theory was used to explore access to mental health services for individuals who use AAC at the levels of microsystem, mesosystem, exosystem, and macrosystem. Such factors include alterations to communication between patient and psychotherapist, skills brought by the patient, involvement of a communication assistant and/or speech-language pathologist, education and skill level of the psychotherapist, appropriateness of billing codes, and system and policy factors that may affect the provision of mental health services to patients who use AAC.
It is necessary to explore the factors that affect the provision of psychotherapy for patients who use AAC in order to more fully address the mental health needs of individuals with communication disorders. Further research is needed to determine the impacts of these factors and ways to address those impacts.
本文旨在探讨影响使用辅助沟通（AAC）的患者接受心理治疗过程的交互因素。从两个方面进行了考察：（a）具有沟通障碍的个体所具备的技能和需求如何影响治疗过程；（b）个体的生态系统如何影响其心理健康以及他们获得心理健康支持的机会。了解这些因素将有助于指导未来的工作，确保有沟通障碍的个体能够充分获得心理健康服务和支持。
采用叙述性综合方法来探讨心理治疗和 AAC 使用的相互作用。考察了心理治疗和言语病理学领域的现有研究，以了解其与使用 AAC 进行沟通的问题相关的信息。具体来说，综合了有关心理健康、精神健康诊断的流行率、传统心理治疗的提供以及通过 AAC 进行沟通的信息，以描述心理治疗和 AAC 的交叉点。这种叙述性综合方法旨在启动对可能影响使用 AAC 的患者心理治疗过程的相关因素的讨论。
多种因素可能会影响使用 AAC 的患者的心理治疗过程。布伦芬布伦纳（Bronfenbrenner）的生态系统理论（1977）用于探讨使用 AAC 的个体在微观系统、中观系统、外部系统和宏观系统层面获得心理健康服务的机会。这些因素包括患者与心理治疗师之间沟通的改变、患者带来的技能、沟通助理和/或言语语言病理学家的参与、心理治疗师的教育和技能水平、计费代码的适当性以及可能影响向使用 AAC 的患者提供心理健康服务的系统和政策因素。
有必要探讨影响为使用 AAC 的患者提供心理治疗的因素，以便更充分地满足有沟通障碍的个体的心理健康需求。需要进一步研究以确定这些因素的影响以及解决这些影响的方法。
