Complaint, demand and wish in speech-language pathology clinical practice: a case study

摘要

The complaint is the first contact between pacient and therapist and will provide information about the symptoms and their features. It will also provide data about related subjective issues: demand and wish. The purpose of this paper is to identify, through a case study, how the acknowledgment of wish and demand underlying the subject's explicit complaint can determine the course of the speech-language-therapy process since the first interview. The method was a follow-up study of an 11-year-old boy attending speech-language therapy from September 2003 to December 2004. The father's explicit complaint was "T doesn't talk he only communicates through signals". The interpretation of the clinical data was supported by the theoretical speech-and-language-pathology and psychoanalytical frameworks. This study followed ethical procedures determined for research with human beings. Results point out that the patient's demand was related to his need of being heard by his family. On the other hand, his wishes were directed towards the maintenance of the symptoms as a way of securing the continuity of the family's attention. Such information provided the background to the therapeutic intervention that resulted in an improvement of the child's oral utterances and communicative exchange alternatives, reshaping the family's complaints. The interviews should precede and support the speech-language therapy processes and the complaints should be considered beyond its literal meaning. The unspoken wish may interdict planned therapeutic processes because psychic contents related to the symptoms cannot be controlled by pre-programmed activities.