In this chapter, the authors talk about the significance and potential pitfalls of first encounters with the PWA in the SLT clinical setting. Many areas in the UK offer six weeks of Early Supported Discharge from hospital, where a rehabilitation assistant visits the patient at home to carry out SLT or physio or TO exercises which have been directed by a qualified therapist. The case history at the end of the chapter illustrates the need for caution when reading a referral letter about a PWA. Language assessment carried out on the background described in the chapter will be far more meaningful for client and therapist, and far more likely to foster engagement, as a sound therapeutic relationship and trust can begin to form.