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Silent Room Interview with Dr Sophie MacKenzie
Spirituality and Expressive Aphasia

Dr Sophie MacKenzie is the programme director for the PGDip Speech and
Language Therapy programme, run jointly by Canterbury Christ Church
University and the University of Greenwich. She has worked with adults with
acquired neurological conditions, particularly stroke and traumatic brain injury.

Publications and research outputs

MacKenzie, S. (2017) PhD research: ‘Mosaics, Ambiguity and Quest:
Constructing Stories of Spirituality with People With Expressive Aphasia’.
MacKenzie, S. (2016) Sacred work?: exploring spirituality with therapists
working with stroke patients with aphasia. Journal for the Study of Spirituality
MacKenzie, S. (2015). Spirituality and Speech and Language Therapy. In: J,
Stokes, and M. McCormick, eds.,Speech and Language Therapy and
Professional Identity: Challenging received wisdom.
MacKenzie, S., Gale, E. and Munday, R. (2006). The Putney Auditory Single
Word Yes/No Assessment (PASWORD). Development of a reliable test of
yes/no at a single word level in patients who are unable to participate in
existing assessments which require a specific motor response: an exploratory
study.International Journal of Language and Communication Disorders, Mar-
Apr, 41(2), pp. 225-34.

Millwood, J., MacKenzie, S., Munday, R., Pierce, E. and Fiske, J. (2005). A
report from an investigation of abnormal oral reflexes, lip trauma and
awareness levels in patients with profound brain damage.Journal of Disability
and Oral Health,October, 6(2), pp. 72-78.

Why did you decide to focus your PhD research on the role of
spirituality with clients who have expressive aphasia?

Aphasia was an interest of mine. I had worked a lot clinically with clients who
had expressive aphasia when I was a speech and language therapist for a
number of years. My last job was in an acute hospital [ward] so the focus was
allowing the patient to express their basic needs. We would make sure that
someone with significant expressive difficulties would have, for example, a
picture chart, whether they were thirsty or in pain that they would be able to
express their basic needs which is really important.

I came to recognize that people who had been through a huge life-
changing event like a stroke probably had other things that they wanted to
communicate as well - not just their basic needs. All this other stuff such as
‘why has this happened to me?’ All those existential questions which anyone
of us would ask after having gone through a life changing experience. Is there
a role for us as speech and language therapists in listening to those questions
or facilitating those expressions of spirituality?

Initially speech and language therapy training focused on the medical
model of disability. Is this practice still medically orientated?

When I was training [in speech therapy] it was more medically orientated but
as I progressed through my career, I became much more involved in
working with the social model of disability [rather than the medical model] and
that's the model that we now promote on the speech and language therapy
programme [at Canterbury Christ Church University and the University of
Greenwich]. It is now the social model of disability rather than the medical
model. I think most speech and language therapists and certainly the
graduates from our university programme work with the social model of
disability. It is the client who is the expert in their condition; it's not us as
healthcare professionals. We're in the business of facilitating people and
maximizing their language and communication skills. We talk about setting
collaborative goals and work jointly with our clients so I would definitely say
that we fit in with the social model of disability.

At your recent lecture at Aphasia Re-Connect, you said: “If we think
about mind, body and spirit, speech and language therapy rarely takes
into consideration the spiritual side with clients.” What is your definition

of spirituality when one considers expressive aphasia and if you had a
definition of spirituality before you started your research has that
viewpoint since changed?

Defining spirituality is a very difficult thing and spirituality means something
different to everybody – I think that’s the answer. When I started my PhD
research about what is spirituality, I wanted a definition for spirituality as there
were lots of definitions. Some people conflate spirituality with religion, others
separate spirituality from religion. Authors talk about spirituality as being
related to the meaning of life and purpose and love. I have my own sense of
what my spirituality is. Mine is related to a religious faith but I recognise that
this is not the case for everyone. I think for my research because I was using
a hermeneutic phenomenological approach, I had to acknowledge what my
spirituality was - it was important for the reader. My definition of spirituality has
since shifted a little as spirituality is a fluid concept - it changes throughout our



How important is the concept of spirituality with patients who have
engaged with speech and language therapy for the first time and for
those who have had aphasia for a longer time?

I had a small number of participants [for my research]. I interviewed three
participants soon after their strokes or in the first couple of weeks following
their strokes. The other five [participants] had been living longer with their
strokes from nine months to many years but I did notice a difference. The
difference was that people who had just had a stroke were much less likely to
engage with any kind of discussions about spirituality. They were very
focused on the here and now - their physical needs - so participants would
often talk about being hungry or thirsty during the session or their bodily
needs. They were less likely to talk about things of a spiritual nature. It felt a
bit anachronistic talking about the meaning of life and spirituality to one
patient when he was in pain and coughing a lot with a gastric tube in situ. He
had to focus on just being physically well and there wasn’t the time or space
to think about anything else. While participants who had been living with a
stroke condition for a far longer period seemed more ready to engage with
those discussions.



One client for your case study was a poet. In your research, did you find
a connection between spirituality and creativity?

There seemed to be a link between spirituality and having a creative way of
expressing it. One participant was exploring sculpture and another one was a
poet. Someone talked about opera as being a “meaning maker” in her life.
Another participant recognised the creativity of gardening and being in nature
as giving his life meaning; interestingly, his speech became more fluent when
he discussed his garden, compared to when he told me about the day he had
his stroke.

Regarding the research about spirituality and expressive aphasia, how
would you like to see the concept of spirituality implemented in the
practice of speech and language therapy, particularly among the new
generation of speech and language therapists who are undergoing

I like the idea of thinking about the client’s spiritual needs as well as the
physical needs which I would like to be part of the speech and language
therapy pre-registration programme and curriculum. We are hoping to
integrate that element into pre-registration so that the new generation of
speech and language therapists think about the client’s spiritual as well as
physical needs. I hope that they think about engaging with their clients with an
attitude of openness.

Further reading about Dr Sophie Mackenzie’s research:

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