The facilitator’s role in addressing personal troubles in online aphasia group therapy

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Background Group therapies for people with aphasia (PWA) offer more than language rehabilitation. They create social connectedness, support identity work and enable emotional exchange. Although online aphasia groups are increasingly used, little is known about how conversations about personal trouble develop there. Conversation analysis (CA) has examined Troubles Talk (TT) conversations in non-aphasic speakers describing it as a flexible, non-linear process involving the phases Approach, Announcement, Delivery, Work-Up, Closing Implicature, and Exit.Aims This study investigates how TT occurs in online, biographically oriented group therapies with PWA, focusing on the role of the facilitators, who guide and support the group sessions.Methods Video recordings from the TELE-narraktiv project, in which the biographic-narrative intervention narraktiv was delivered via videoconferencing to PWA, were analyzed. The fourth of seven sessions from three groups (4 participants per group, n = 12; two facilitators in total), was selected for its focus on “health, illness, and age”, containing particularly rich TT instances, totaling 257 minutes. All TT sequences were transcribed following CA conventions and analyzed for TT phases and interactional function.Results Twenty-one TT sequences were identified, reflecting all TT phases. In 16 cases, they were initiated by facilitators. When trouble was introduced by participants, affiliative reactions were crucial for the continuation of the narrative. The facilitators influenced whether TT was picked up or redirected. Despite word-finding difficulties, PWA successfully engaged in TT using gestures, chat, or by showing objects, while facilitators and peers acted as co-narrators through supportive feedback. In 11 cases, participants collaboratively reflected on problems and shared similar experiences. In the closing sequences, facilitators picked up on positive statements, emphasized commonalities and thus strengthened the group cohesion.Conclusions & Implications The results underline the importance of online group therapy for PWA as a space for emotional support. Participants are able to address personal troubles and work through them together in a supportive environment. The study provides detailed insights into how the therapy concept narraktiv enables narrative identity work and social connectedness. While TT in these groups followed patterns known from non-aphasic interactions, facilitators played a pivotal role in initiating, sustaining, and closing TT sequences, bearing primary responsibility for securing and maintaining emotional narrative spaces.

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