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A traditional interaction between a speech-language pathologist and a client is most frequently characterized by a request for some sort of speech and language performance, followed by the client’s response, and evaluated—usually for accuracy relative to some objective—by the clinician. This interactional sequence is so pervasive that it is usually described as a request-response-evaluation exchange. It been described and observed in all different types of speech-language therapy sessions, across diagnoses and treatments. When clinicians’ responses to their clients’ communicative acts are primarily on the accuracy of the production, rather than the content, the clinician is communicating, possibly unintentionally, that the form of the production is more important than the content. Although in some cases, it may be advantageous for clients to practice drills that are separated from meaning making, communication in real contexts is always focused on communicating meaning, whether or not the production itself was completely accurate. A primary focus on evaluating the accuracy of the form of the production creates at least an implied separation between the person who is the client, the production, and the person who is the therapist. It is as though the production, which is the target of the clinician’s attention, is separable form the client. It is a thing that can be placed on the table, examined, poked, dissected, sewn together, repaired, and—perhaps—replaced. But the words that flow out of any of our mouths are intimately integrated with our image of ourselves and our beings. Another consequence of the separation that comes from traditional therapeutic interactions is that the therapist is separated from who he or she is as a person. Clinicians spend relatively little time interacting with their clients in a truly human interaction; most often, this is limited to the first and last few minutes of any therapeutic session. During the ‘‘work’’ portion of a typical therapy session, the clinician may stop paying attention to interactive meaning making. Doing so, the clinician may unwittingly take away the client’s selfhood and his or her autonomy of communication. ‘‘If I say to you, speaking of the wedding I attended last week, ‘And then there was the most amazing coincidence!’ I expect you to reply ‘Really? What happened?’ I will be surprised and not especially pleased if instead you say, ‘Isn’t it interesting how you make ordinary events so dramatic?’ To pay attention to speakers’ rhetoric seems to rob them of authority. It suggests that narrators do not know what they mean to say or cannot find the way to say it and that someone else—the interpreter—can do a better job.’’ Why would a clinician ‘‘rob’’ their client of ‘‘authority’’ over their own message? Most likely, clinicians believe that they are conducting exercises that are in the best interest of their client, or they would not choose to do such a thing. But are these traditional therapeutic interactions in the best interest of our clients? Does focusing on production for the majority of any therapeutic session produce the ultimate outcomes that we desire for our clients? A focus on production and content, with a deemphasis on affective/emotional communication, has thus far been shown to be much less

The Tools of Our Trade: Ethics, Outcomes, and Effects of Therapeutic Discourse