Although researchers are developing a useful understanding of aphasia as a neurocognitive condition, the world we experience is a social and interactive one. The social aspects of life contribute to quality of life, although quality of life has been difficult to characterize scientifically and in ways that have clinical utility (Hilari et al., in press).

Psychosocial refers to the social context of emotional experience. Most emotions are closely associated with social interactions. Aphasia has implications for the individual's whole social network, especially the immediate family. The value dimensions in our lives, such as health, sexuality, career, creativity, marriage, intelligence, money, and family relations, contribute to quality of life and are markedly affected for the aphasic person (Hinckley, 1998) and that person's relatives. All may expect considerable disruption of professional, social, and family life, reduced social contact, depression, loneliness, frustration, and aggression (Herrmann and Wallesch, 1989).

Recovery and response to rehabilitation in aphasia are also significantly influenced by emotional and psychosocial factors. The aphasic person's family and other caregivers need to be involved as much as possible in intervention, and this involvement extends beyond discharge. The experienced disability rather than the impairment itself is the focus of rehabilitation. Rehabilitation increasingly includes community-based work and support from not-for-profit organizations and self-help groups.

Whereas intervention during the acute stages of aphasia is largely based on the medical model, adjustment to aphasia is set more broadly within a social approach. Several broad psychosocial and quality-of-life areas have been incorporated into rehabilitation: dealing with depression and other emotions, social reintegration, and the development of autonomy and self-worth. Autonomy involves cooperating with others to achieve ends, whereas independence implies acting alone and may not be an achievable goal. These areas provide a basis for developing broad-ranging programs.