Summary statement

Difficult conversations are often an integral part of speech and language therapy. Having the confidence, knowledge, and skills to facilitate those conversations enables service-users and employees to share their concerns, understand their needs and ultimately make choices, decisions and plans.


These pages will sign post you to relevant resources and give you the opportunity to think through difficult conversations in practice-based scenarios.

Difficult conversations in speech and language therapy may include:

  • Giving diagnosis
  • Feeding-back assessment results
  • Discussing management plans and treatment options
  • Preparing for discharge
  • Interactions with families/relatives/friends/other professionals
  • Managing and supervising staff

These are all essential conversations, difficulties usually arise when there is a mismatch between understanding and expectations.

Please contact us with any feedback on these pages.

Related Pages


Visit professional accountability and autonomy for guidance to support you in adhering to the standards of the regulator, the Health Care Professions Council (HCPC). Key sections include:

  • Promote and protect the interests of service-users and carers
  • Communicate appropriately and effectively
  • Work within the limits of your knowledge and skills
  • Delegate appropriately
  • Respect confidentiality
  • Manage risk
  • Report concerns about safety
  • Be open when things go wrong
  • Be honest and trustworthy
  • Keep records of your work

The Health and Social Care Act (2008) Regulation 20: Duty of Candour states that every healthcare professional must be open and honest with patients when something that goes wrong with their treatment or care, causes, or has the potential to cause, harm or distress.

Being prepared

Anticipating that a conversation may be difficult enables you to be prepared and achieve the best possible outcomes for the conversation.

You should consider:

  • Where the conversation will take place, in terms of comfort and privacy
  • Your body language, facial expression, positioning
  • Your knowledge of, and relationship with, the service-user/employee
  • Timing of the discussion
  • Time for questions
  • Support from others/family members/advocates/key workers
  • Having associated written information ready
  • How you will document the conversation

Ask what the service-users/employees understanding is and what is important to them. Don’t make assumptions. Listen to them. Know the legal processes behind consent, confidentiality, capacity and documentation.

Building skills

Peer, clinical and managerial supervision is an excellent way to reflect on difficult conversations.

Some Trusts/organisations offer training in managing conflict/difficult conversations.

See Practice-Based Scenarios


ACAS Challenging conversations and how to manage them – support/advice for line managers

Clinical Excellence Networks / RCSLT Groups – seek advice/support from your peers/reflect on actions.

University College London: Better Conversations with Aphasia – a free online course aimed at SLT’s, other health professionals, carers and people with aphasia

ACAS Having difficult conversations – watch this video to reflect on how difficult conversations with staff can go wrong

General Medical Council and the National Council for Palliative Care : Talking about end-of-life care: communication – aimed at medics, this educational film contains insights from service-users about what constitutes good communication

Rosemarie Mason, Jennie Vitkovitch, Jill Jepson, Rod Lambert (2012) Professionalism: having the conversation. Bulletin, Pg 18-19.

RCSLT Practice-based Scenarios


Kathryn Cann

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