These are real barriers that need to be taken seriously if clinicians are to change the way they engage clients in the therapeutic process. By the end of this chapter, my goal is to have provided at least tentative ways to address each of these four barriers, with the hope that clinicians might use this as a starting point for reconstructing their clinical practices. Let’s start out with a bold statement: The role of professionals who work with individuals with communication disorders, that is, speech-language pathologists and audiologists, is not simply to remediate disorder. Yes, individuals who come to us for treatment for a communication disorder do so with the hope of improving or remediating the disorder, and, on the surface, this would appear to be a relatively simple “transaction.” In this simpliﬁed view, the individual comes to therapy and the therapist uses his or her expertise to facilitate changes in the person’s communicative behaviors. In reality, however, such therapeutic interaction is far from simple. The purpose of speech and language is communication; and communication is inextricably woven into the very fabric of human existence, becoming bonded to the individual’s understanding of self, the world, and the role that the self plays in the world. When faced with signiﬁcant change to communicative ability (i.e. remediating an old problem or dealing with a new one), individuals must “reconstruct” their understanding of self and their role in the world by meaningfully integrating new behaviors into their established self and world image.