Humanising Communication Care

I put the Humanising Care booklet together a couple of years ago. In publishing a link to the booklet here, I wanted to take the opportunity to reflect on my ongoing learning, both as a professional and personally, with a particular focus on communication and listening.

 

Listening as care

As a Speech and Language Therapist, listening is an important part of my job. I listen to those seeking my input to understand how I can best offer support. Listening is also part of communication, and as a professional supporting communication, it may be an area where I am asked for specific advice. In humanistic, relationally focussed care listening plays a further crucial role, beyond taking a case history or assessing abilities against checklists and norms. Listening weaves through the relationship that is co-created between therapist and the person being supported and as such is integral to the care that is offered (Shannon, 2020).

 

Making time to listen

Listening relationally involves making time to listen (Shannon, 2022; Hackett et al., 2025) with curiosity and an open mind (McGreevy, 2024). The time needed should be led by the person we are working with, not by systems, nor confined to predefined packages and blocks of therapeutic input. 

SMART (Specific, Measurable, Achievable, Relevant and Timebound) measures are further redundant, as therapy moves away from neat, regimented and replicable boxes. The focus moves away too from the 'business management' ethic of the original acronym, that sits within the productivity mantras of much of what the Global North holds to be wellness. "Not everything that can be counted counts, not everything that counts can be counted" (Shannon, 2022). Therapeutic success is felt instead in the strength of relationship and the power of connection.  

 

Ensuring caring spaces for listening

The nature of the space a person inhabits at any moment is a further important consideration for listening and supporting different voices to be heard (Hackett et al., 2025). Ensuring spaces respect a person's individual listening needs means making person-centred adaptions and accommodations, including those to the sensory environment (Doherty et al., 2023; McGoldrick et al., 2025). When we tune into what helps others feel more comfortable, and offer universal design as a matter of routine, we are already showing that we are listening and that we value what everyone brings to the interaction (Vozes da Inclusão, 2025).

Embracing all ways of listening

Humanistic communication care involves acceptance and advocacy for the many different ways humans listen, understand and communicate. We must learn to listen beyond words hear what is unpredictable and possible, and not just focus on communication as a transaction of what is fixed and certain (Badwan et al. 2025). There is no singular best way to use language (Robinson & Henner, 2023), 

and no best way to listen. We communicate with the entirety of our body (Bottema-Beutel et al., 2025; Hackett et al., 2025) and the nuance of our spirit and soul. Whilst society expects listening to look a certain way, and a quick search on the internet gives plenty of rules for 'good listening', the way each of us listens is personal and unique. 

The default understanding is that listening happens best in quiet spaces. Whilst this is indeed my preference, I have learnt to value how listening is individual to the person and to the environment a person is in. I covet deep quiet and stillness to process. The background noise present in an open-plan office or packed business meeting means that I find it much harder to listen and expend greater amounts of energy to focus on what is being said. Listening can equally happen with movement; auditory, visual and physical. My autistic teen loves to fidget in a variety of ways and will happily and successfully process information whilst listening to music, gaming or playing his guitar. In fact, these are also inputs that can give him energy to focus more deeply (Chapman, 2025a). Listening can furthermore occur without looking directly at the person who is talking (Munday, 2022; Hackett et al., 2025). The 'rule book' on how 'best to listen' quickly falls apart when we start to hear and value difference, and this opens space to query where the rules came from in the first place. 

Not one human being is identical to any other. Expecting a one-sized-fits-all way of being and experiencing the world results from aligning with socio-cultural preferences, rather than respecting natural diversity (Walker, 2021). Meanwhile, in indigenous worldviews balance between all entities in a person's relational world, including environmental elements, is a key element of wellbeing. Agency and autonomy are further recognised within all entities, human and non-human (McMahon, n.d). 

No matter how 'neuro-affirming' the blurb, underlying tones of 'expectation' and 'aspiration', and their mirror images of 'deficit' and 'disorder', are in reality ableism, hierarchy and control hiding in plain sight. We must instead recognise a person's epistemic authority and their 'rights as talkers' (Hackett et al, 2025). Restoring linguistic justice is respecting the person's ability to be best placed to know what ways to listen work for them, and to then have control over how they choose to listen and communicate, without fear of reprisal or repercussion (Roche, 2026). 

 Co-creating therapeutic listening spaces

Listening, as an intrinsic part of communication, is also a shared venture.  When communication breaks down, this is not because any individual person is 'lacking in ability' in some way. Instead, breakdowns in communication occur within the co-created space between one person and another. This is particularly the case where there is a mismatch of experiences between those involved in an interaction, which in turn leads to greater gaps in empathy in the shared relational space. There is in effect a Double Empathy Problem or gap (Milton, 2012; Milton, 2018) and a greater potential for messages to be misunderstood.

Being sensitive to the experiences of others, helps us to listen and communicate better, as we aim to come 'alongside' the person we are with, instead of staying in hierarchical positions of epistemic power. 

Eight dimensions of experience sensitive care 

McGreevy et al. (2024) describe eight dimensions within an experience sensitive approach to care:

 

 

 

      

A change in shape of the interactional space

Experience sensitive approaches to care bring a different shape to the interaction (Chapman, 2025d), a move from hierarchy where those in power know and enforce what is 'best', to a mutual relationship where knowing and learning can go both ways.

This in turn opens more expansive and relational possibilities for listening and communication care (Chapman, 2025c)

Listening to communities

When we think about communication relationally, the importance of 'community' across all our practice becomes clear. A focus on community involvement is integral to the social justice ethic of the neurodiversity movement (Walker, 2021); to be neurodiversity-affirming in our practice inherently means valuing collaboration and equity, with the therapist cultivating epistemic humility in all therapeutic partnerships (Chapman & Botha, 2023).

The importance of valuing community input is mirrored in the principles of inclusive research practice, where the involvement of people whose lives are being researched is crucial to the design, implementation and dissemination of the research (Fletcher-Watson et al., 2025). The authors emphasise the importance of collaborating to identify what is a priority, taking into consideration past and current needs, and the presence and influence of multiple identities. All these elements support better provision for comfort and wellbeing regardless of the setting for the relationship. 

Crucially, an investment in relational working is necessarily reflective, continuous and expansive. Where considerations feel like a tick-box exercise, and are sequential or linear, there is a risk that practice remains tied to productivity and hierarchy. Communication is living, moving, flowing, not static (Badwan et al., 2025); our commitment to listening must be equally dynamic.

How losing a focus on labels creates a clearer path to balanced care

In shifting our paradigm from transaction to relation, the metrics of deficits and disorders further lose much of their currency. The balance shifts from assessing what is wrong 'within a person', to considering what is working well or less well in the spaces between and around people. We can then move the focus of input from treating a person to looking at what we can change in their environment that may be a burden upon them (Lukito et al., 2025).  Unique and authentic ways of communicating are meanwhile recognised, valued and celebrated. The therapist works as collaborator and companion, instead of director or expert, offering new viewpoints and different places to journey to, rather than selling mass-produced, best-value and 'gold-standard' therapeutic 'itineraries'.  Listening to the biographical and relational elements of care, means that as therapists we bring greater balance into our practice, opening space to plant and tend to ‘roses’, alongside acknowledging the 'sustenance' of ‘bread’ (Heath & Montori, 2023).

Through the vehicles of 'care, kindness and love', an experience sensitive approach to communication care leads to genuinely affirming new experiences. Rich, organic and rhizomic communication (Chapman, 2025a) and language 'flourishing' (Farah & Nair, 2025) can be the destination, as opposed to linear achievement within the fiction that is standardised language competence (Nair et al., 2023).

 

 Communication flourishing as a destination

"Closing the Double Empathy Gap one rose at a time!"

Furthermore, as confidence in what it means 'to be' grows and communication expands (McGreevy, 2025), there is potential go beyond communication in terms of what it 'means' (Farah et al., 2025), and break free from the language of 'concern', used where meaning is not understood of judged to be faulty in some way. Instead, we can broaden our horizons to think about what language 'does' (Farah et al., 2025) and reclaim all forms of conversation (Lea, 2025) and modes of communication as expressions of identity (Harrison & Mears, in press). This is significant, as positive identity has been associated with improved mental health and wellbeing (Davies et al., 2024), regardless of any diagnosis (Kroll et al., 2024). The joint cultivation of self-discovery can furthermore have positive, 'joyful', implications for the wellbeing of all involved (Wilson et al., 2026). Such mutually created and equitable spaces are where communication can flourish as a medium for being well and where language is indeed 'worldmaking' (Hackett et al., 2025).

Personal notes

Learning about human communication has always been a passion. I am not at all ashamed to say that I explore extensively around this topic outside of my work hours and never think of these musings as work per se. In my professional life I have learnt to step back from rushing in, and instead take the time that is needed for the person I am working with to lead me. It is humbling, nerve-wracking at times, but ultimately so much more human. Together, we come to places I may never have planned for, and each new destination feels so much more whole, than any plan I'd ever written, formed around 'gold standards' and the evidence that comes from doing to others. 

I have grown so much from walking alongside, stepping off the pedestal of expert and being the human who can offer ideas, instead of teaching from a place of 'best'. Once so reliant on the narrow, limiting and ableist assessments from my training (Nair et al., 2023), I now value deeply all narratives, all ways of knowing and telling, and the many different arcs of time and space in which experience can be shared. 

I appreciate too the consequences of offering safe passage to those who are travelling, so that people may go to places that are authentically meaningful, and not just popular 'getaways' and 'takeaways', the headlines so often dictated by the system I work within. This is about leaning into more than just spoken language and recognising the embodied nature of human communication. In reclaiming listening that is respectful of environments in the broadest sense, including both external and internal spaces, experience sensitive listening harmonises rather than forges a one-size-fits-all path, and offers a deeply human intervention for wellbeing. Experience feels like the very essence of communication, and in being sensitive to it, that feels like the very best work that I can do as a Speech and Language Therapist. 

Communication is necessarily both fluid and fragile. It is in the moment but also contains echoes and threads from someone's past, as well as insights and hopes for the future. I often see how destinations depend on paths already travelled, as well as viewpoints in the present and those that someone is perhaps hoping to move towards or discover. Communication is always open to interpretation, and its shape will naturally reflect a person's personal journeys in the world (McGreevy et al., 2024). In this respect, holding the space to allow exploration of something new, to move and disrupt boundaries, to create and defend a new worldview, is where most energy is expended.

Stepping out in a different direction can be fraught with tension and uncertainty, compounded by the perceived loss of substance from stepping on less familiar ground. Safety therefore becomes a further relational consideration alongside communication; the safety that I try to bring to others as they begin to explore different directions in their journey, sits alongside the safety I need, without fear of condemnation, to offer alternative perspectives so others may have new experiences. In these moments it can feel like being a very small drop of water in a very big ocean, especially in spaces where what has gone before feels deeply embedded and entrenched. I hold on to the idea that even small drops can make ripples and change itself takes time. Yet sometimes the energy required to bring worlds together and to build affirmation of the sovereignty of self (McGreevy et al., 2024), is beyond what is mutually available. These are times when listening may lead to me stepping back or stepping away. 

Listening to others is then also about learning to listen to ourselves. We are all many things to many people, the same person, yet with different roles. We often perform multiple roles simultaneously; the professional who is also thinking about their friends and family, whilst sitting in a meeting or the person running through and preparing for the upcoming day at work, whilst reflecting on what may have been a more difficult morning at home. Most of the time our roles feel relatively distinct, and when they do cross over, it may be only briefly, often with little to no consequences: the discussions of school routines with a colleague at lunch or talking about what we have done during our working day over the evening meal to a partner. Nevertheless, our lives are in constant motion, and it can be easy to forget how we are more than just the role we are inhabiting at any given moment or the energy it takes to honour these multiple truths in and across different spaces. All of these experiences further build together and feed into each moment. Taking time to take stock, to hear our own stories, to revisit and stay a while with ourselves as a fellow traveling ‘companion’, is about building compassion for the unique humans we all are. This is important time to make and to defend. 

Communication care is something that is important to everyone. We all have a right to be heard, and the safety in which we can express ourselves in ways that are authentic, and which honour and respect each moment. We also need time to listen to the rhythms, tides and seasons of our past as well as those for our future. In humanising communication care, we can move towards greater compassion for what it is to be human and counter the powerful undercurrents of dehumanisation that are increasingly present in so many areas in the world around us. Disrupting the notions and actions of communication and linguistic power is both resistance against what has gone before, whilst offering the chance to 'make a different world' (Hackett et al., 2025), one where strength doesn't come from being the best, but from being together in valuing each person for who they already are.

References

Badwan, K., Dower, R. C., & Hackett, A. (2025). Language beyond meaning. In: Badwan, K., Dower, R. C., Farah, W., Flewitt, R., Hackett, A., Holmes, R., Macrae, C., Nair, V. K. K, and Shannon, D. B. (Eds.) Language, Place, and the Body in Childhood Literacies. Routledge 
https://shura.shu.ac.uk/36567/ 

Bottema-Beutel, K., Zisk, A. H., Zimmerman, J., & Yu, B. (2025). Conceptualizing and describing autistic language: Moving on from ‘verbal’, ‘minimally verbal’ and ‘nonverbal’. Autism, 29(6), 1367-1373. https://doi.org/10.1177/13623613251332573 

Chapman, L. (2025a, March 8th). My Fuel Bubble. https://a-labour-of-moles.blogspot.com/2025/03/my-fuel-bubble.html 

Chapman, L. (2025b, May 12th). The Rhizomic Heritage of Language and Communication. https://a-labour-of-moles.blogspot.com/2025/05/the-rhizomic-heritage-of-languaging-and.html 

Chapman, L. (2025c, November 6th). The Shape of an Interaction. https://a-labour-of-moles.blogspot.com/2025/11/the-shape-of-interaction.html

Chapman, L. (2025d, December 11th). Experience Sensitive AAC is for Everyone. https://a-labour-of-moles.blogspot.com/2025/12/experience-sensitive-aac-is-for-everyone.html

Chapman, R., & Botha, M. (2023). Neurodivergence-informed therapy. Developmental medicine and child neurology, 65(3), 310–317. https://doi.org/10.1111/dmcn.15384

Davies, J., Cooper, K., Killick, E., Sam, E., Healy, M., Thompson, G., Mandy, W., Redmayne, B., & Crane, L. (2024). Autistic identity: A systematic review of quantitative research. Autism Research.  May;17(5):874-897. 

https://doi.org/10.1002/aur.3105

Doherty, M., McCowan, S., & Shaw, S. (2023). Autistic SPACE: a novel framework for meeting the needs of autistic people in healthcare settings. British Journal of Hospital Medicine, 84:4, 1-9 

https://www.magonlinelibrary.com/doi/full/10.12968/hmed.2023.0006

Farah, W., & Nair, V. K. K. (2025). Spaces of reprieve. In: Badwan, K., Dower, R. C., Farah, W., 
Flewitt, R., Hackett, A., Holmes, R., Macrae, C., Nair, V. K. K, and Shannon, D. B. (Eds.), Language, place, and the body in childhood literacies: Theory, practice, and social justice. Routledge.

Farah, W., Hackett, A., Holcomb, L., Nair, V. K. K & Shannon, D. B. (2025). Coming together: Roundtable discussion on place and language. In: Badwan, K., Dower, R. C., Farah, W., 

Flewitt, R., Hackett, A., Holmes, R., Macrae, C., Nair, V. K. K, and Shannon, D. B. (Eds.) Language, Place, and the Body in Childhood Literacies. Routledge.
https://shura.shu.ac.uk/36569/

Fletcher-Watson, S., Joseph, H., Crane, L., Pavlopoulou, G., Lukito, S., Funnell, E., Alcorn, A. M., & Crompton, C. J. (2025). Applied Principles for Inclusive Practice in Neurodevelopmental Research: A Selection and Report of Illustrative Case Studies. Current Developmental Disorders Reports. 12, 7 

https://doi.org/10.1007/s40474-025-00318-1

Hackett, A., Badwan, K., Dower, R.C, Ehiyazaryan-White, E., Farah, W., Flewitt, R., Karen, G., Holmes, R., Macrae, C., Nair, V. K. K., and Shannon, D. B (2025). The Rights of the Talker. In: Badwan, K., Dower, R. C., Farah, W., Flewitt, R., Hackett, A., Holmes, R., Macrae, C., Nair, V. K. K, and Shannon, D. B. (Eds.) Language, Place, and the Body in Childhood Literacies. Routledge. https://shura.shu.ac.uk/36431/ 

Harrison & Mears (in press). Exploring Semi-Speaking as a Communication Identity

A Reflective Practice Guide. Routledge.

Heath, I. & Montori, V. M. (2023). Responding to the crisis of care. The British Medical Journal; 380. https://doi.org/10.1136/bmj.p464 

Henner, J., & Robinson, O. (2023). Unsettling Languages, Unruly Bodyminds: A Crip Linguistics Manifesto. Journal of Critical Study of Communication and Disability, 1(1), 7–37. https://doi.org/10.48516/jcscd_2023vol1iss1.4

Kroll, E., Lederman, M., Kohlmeier, J., Kumar, K., Ballard, J., Zant, I. & Fenkel, C. (2024). The positive impact of identity-affirming mental health treatment for neurodivergent individuals. Frontiers in Psychology, 15:1403129.

https://doi.org/10.3389/fpsyg.2024.1403129

Lea, A. (2025). Who chooses my words? In: Badwan, K., Dower, R. C., Farah, W., Flewitt, R., Hackett, A., Holmes, R., Macrae, C., Nair, V. K. K, and Shannon, D. B. (Eds.) Language, Place, and the Body in Childhood Literacies. Routledge.

Lukito, S., Chandler, S., Kakoulidou, M., Griffiths, K., Wyatt, A., Funnell, E., Pavlopoulou, G., Baker, S., Stahl, D., Sonuga-Barke, E. and the RE-STAR team. (2025). Emotional burden in school as a source of mental health problems associated with ADHD and/or autism: Development and validation of a new co-produced self-report measure. Journal of Child Psychology and Psychiatry, 66: 1577-1592. https://doi.org/10.1111/jcpp.70003 

McGoldrick, E., Munroe, A., Ferguson, R., Byrne, C., & Doherty, M. (2025). Autistic SPACE for Inclusive Education. Neurodiversity, 3.
https://doi.org/10.1177/27546330251370655 

McGreevy, E., Quinn, A., Law, R., Botha, M., Evans, M., Rose, K., Moyse, R., Boyens, T., Matejko, M., & Pavlopoulou, G. (2024). An Experience Sensitive Approach to Care With and for Autistic Children and Young People in Clinical Services. Journal of Humanistic Psychology, 66(1), 107-133. https://doi.org/10.1177/00221678241232442 

McMahon, M. (n.d.). Aboriginal and Torres Strait Islander childhood: Our kids growing up strong, happy and healthy. https://stormchild.org/flip-books 

Milton, D. E. M. (2012). On the ontological status of autism: The “double empathy problem”. Disability & Society, 27(6), 883-887. 

https://doi.org/10.1080/09687599.2012.710008

Milton, D. E. M. (March, 18, 2018). The Double Empathy Problem. The National Autistic Society. 

https://www.autism.org.uk/advice-and-guidance/professional-practice/double-empathy#Theory%20of%20Double%20Empathy

Munday, K. (2022, May 13th). Autistic listening: no eye contact please! https://autisticltd.co.uk/2022/05/13/autistic-listening-no-eye-contact-please/#:~:text=So%20when%20an%20Autistic%20person,to%20listen%20to%20the%20radio!

Nair, V. K., Farah, W., & Cushing, I. (2023). A Critical Analysis of Standardized Testing in Speech and Language Therapy. Language, Speech, and Hearing Services in Schools, 54(3), 781-793. https://doi.org/10.1044/2023_lshss-22-00141

Roche G. (2026). Five Key Concepts for Autistic Linguistic Justice: Securitization, Revitalization, Rights, Planning, and Ethics. Autism in Adulthood. 0(0). https://journals.sagepub.com/doi/10.1177/25739581251408623

Shannon, B. (2020, May 31). Rewriting social care. Words that make me go ‘hmmmm’:  Care. https://rewritingsocialcare.blog/2020/05/31/care/ 

Shannon, B. (2022, Aug. 27). Rewriting social care. Words that make me go ‘hmmmm’: Kairos Time. https://rewritingsocialcare.blog/2022/08/27/kairos/

Vozes da Inclusão [@theadnetwork]. (2025, September 17). The campaign “The world is harder when it wasn’t designed for you” was created by the Vozes da Inclusão Institute [Video]. Instagram. 

https://www.instagram.com/p/DOsiiHCDwue/ 

Walker, N. (2021). Neuroqueer Heresies : Notes on the neurodiversity paradigm, autistic empowerment, and postnormal possibilities. 1st ed., Fort Worth, TX: Autonomous Press

Wilson, J., Heinsch, M., & Canty, J. (2026). “Trans joy is contagious… it’s fucking beautiful”: Mental health practitioners’ perspectives on the joys of supporting transgender youth. International Journal of Transgender Health, 1–14. https://doi.org/10.1080/26895269.2025.2607586