I can't - The Importance of the Aphasia Mental Game

“I can’t say it”

This is one of the most common things we hear from our clients with aphasia. I may even be shortened to “I can’t” or just a head shake. You may be surprised by this, but a lot of aphasia recovery is a mental game. Just like in other aspects of life, if you focus on the negative, you lose hope. More importantly, clients don’t acknowledge the progress that they’ve made.

Some of the “I can’t” stems from not seeing progress in their therapy. When you’re loved one is told  that they havehit a plateau and there’s nothing else to be done, it can have a huge impact on their motivation. One of the best parts of meeting each new client is showing them that their doctor/therapist was wrong and that they just need a different approach.

Aphasia therapy can become discouraging if they don’t feel that they’re getting anywhere. Occasionally clients make huge communication leaps within the first two weeks of intensive treatment, but most people make steady gains over the hours. We often discuss the importance of thoughts and words–saying “I can’t…..” isn’t allowed at my center. They can say “I can’t do this right now, but it will get better”—I will even help them say it and write it. This little change in how they approach a difficult process can make a huge difference in their mental game.

I often draw out steps or a mountain for my clients. At the top is a stick figure–them before the stroke or brain injury. If they look at themselves now compared to then, then they’re a lot farther down the side. But, if they compare now to day One after the stroke (at the bottom of the mountain), they will see that they have actually made massive progress. They’re much closer to the top than before, and they will keep moving towards your goals, step-by-step.

We talk to our clients about reaching goals or expectations, and that when you are at the top of one level, you’re feeling very good about yourself. Then the work becomes harder because you can do more, and suddenly you find yourself at the bottom of the next level. Many people with aphasia become discouraged and focus on how poorly they’re doing at the next level. Many clients weren’t aware of their specific deficits in communication, so the awareness that comes with intensive aphasia treatment can be shocking at first. But awareness is key to progress, so it’s a necessary part of recovery.


  • Focus on “I can”
  • Count the positives in life every day
  • Compared to before aphasia, it can be a very slow uphill war to “be who you used to be”
  • Time and the right therapy are the two most important ingredients

Most families with aphasia don’t realize that intensive aphasia therapy is a whole different approach and process. A consultation is a great place to start to learn about how to get more out of your therapy time, even if you don’t do intensive therapy with us. Many families are doing activities that are more ‘busy work’ than actually contributing to speech and language recovery.

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About Dr. Bartels

Dr. Bartels is the owner of The Aphasia Center Intensive Aphasia Programs. She helps families with aphasia through communication training, personalized treatment plans and customized home programs.