How to Handle Conflict in Speech Therapy

February 11th, 2015 by

Therapist and Patient When you work with people, conflict is bound to happen.  The dictionary defines conflict as, “A serious disagreement or argument, typically a protracted one” or “To be incompatible or at variance; clash.”

Having worked in the field of speech therapy for some time, I am providing a few tips on how to handle conflicts that may arise from time to time.

Team Members/Conflict Partners

We can have disagreements with patients and their families, other service providers (doctors, other therapists, nurses, insurance) and our bosses.  The roles of our team can and do collide.

Let’s look briefly at the roles of the team to identify possible conflict areas:

 Patients and Family Members

Most patients and family members want to get better and improve their situation.  Adult patients may be recovering from stroke, head injury, etc.  Children want to talk and play.  Many family members want to help but don’t know how.

The patient and family may be under a lot of pressure due to illness, new diagnosis, finances, and their work schedules.  Patients may not see the need for speech services.

Other Service Providers

Except in the school setting, speech therapists can’t see patients without a doctor’s referral. Doctors have many patients to see and very little time.  Just contacting them can cause conflict.

Nurses in the SNF (Skilled Nursing Facility) and hospitals have similar issues. Before speech therapy can make a difference, patients need to be medically stable.

Other therapists (OT, PT, Respiratory) all have important jobs.  We often get into conflicts for the patient’s time to schedule and conduct therapy with any and all of these providers. It is important to recognize that every service provider has an important role to play and must be respectful of each other’s scheduling needs.

Insurance Companies

Basically, insurance companies are business entities with the primary goal of making money.  In marketing the companies all claim to have the patient’s best interest in mind; however, it is often a challenging process to get funding for services which causes conflict for providers, the patients and their families. Being persistent is the best way to deal with the insurance companies and always be an advocate for the patients.


It is important to remember that managers and supervisors have the bottom line to think about and the running of a department or an agency, as well as having other employees to manage.  Treatment issues may not seem as important to them as it does to the therapists.

Conflict Resolution Tips

Keep in mind the role of the people you work with, especially patients and family members.  If you can state your case with their perspective in mind, a lot more productive therapy can be done in less time.  I often ask family, “Is there a particular goal you want me to work on?”

I will ask nurses, doctors and other treating therapists for their perspective on the patients’ communication, what they are doing.  I try to incorporate their perspectives into my therapy, (positioning, sequencing transfer strategies).

Listen to the perspective of all the team members.  They all have something to teach us.  During meetings, try to think collaboratively.

Know your limits.  Sometimes patients can’t work with you.  They don’t see or understand the need.  I have some patients who can’t keep appointments.  We have to discharge them. Try to educate the patient and family and then let it go.

If you are working with a difficult team member, try to get cooperation from a different team member.  Ask a different therapist for help.  You can ask another therapist or your supervisor to hear both points of view as a third party to help resolve conflict.

Be flexible.  Your way is not the only way.  Be willing to change time of day for treatment, treatment methodologies, goal order, treatment location (a different room).  When other team members see you being flexible, that can help them to be more flexible as well.

I hope these tips help you get through the day and meet the common goal of helping our clients be the best they can be with their communication.




About the Author:

Sandra Alexander has over 20 years of experience in the speech therapy field. In 1994, she received her Master’s Degree in Communicative Disorders from San Diego State University and in 1985 she received a B.A. in Communicative Disorders from the University of Redlands. She is also a returned Peace Corps Volunteer who taught speech therapy in Ecuador from 1987-1989.

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