A patient with expressive aphasia expressing herself by crying and cursing

I am currently on a neurology placement and one of my patients suffered a (L) stroke 4 weeks ago which left her with right hemiplegia. She has good static and dynamic sitting balance and reasonable static standing balance with 2 x moderate assistance. Her right upper and lower limb are both gowland stage 3 of recovery. She also has expressive aphasia which she finds very distressing. As she was still a two person transfer to plinth (and it was only our first week of the placement) I saw her with another student. Her previous physio informed us that she had been working on sit to stand for about a week so we could continue to improve her perfomance of this task and progress her work in standing.

The first session did not get off to a good start. Even before the first transfer to the plinth the patient's breathing became shallow and she appeared very anxious. After some work in sitting working on internal displacement we decided to try a sit to stand. She managed it well and only required moderate assistance of 2. However, once she was standing her breathing once more became quicker and shallower and she begged us to let her sit down. I checked her pulse while she was standing and although it had slightly increased, it was still strong and WNL. Also, her standing position had not changed and she was not utilising us for support any more than she was previously. I tried to engage her in conversation, asking her about the visitors I had seen in her room in order to distract her. Unfortunately, she wasn't able to communicate this as a result of her aphasia and began to swear and cry. We asked her to stand for 10 more seconds which she consented to and then allowed her to sit down. Once sitting her crying increased as she swore and apologised alternately between sobs.

I asked her what it was that was causing her to be upset, suggesting a few causes I thought most likely in order to make the communication easier. I soon found out that she felt as though she 'couldn't do it' and 'wasn't good enough' to be standing. She was very unconfident about her abilities despite being much better than some of my other patients who were also standing. I explained this to her, and tried to convey how well she was doing, with little success. After a rest, we were able to convince her to stand once more, which culminated in a similar teary conclusion.

I talked to her when she was back in her room and it was obvious to me that she genuinely wanted to do well and was extremely frustrated at her inability to comply with our instructions. I wasn't sure what else to do but provide encouragement and assurance that she was improving and that standing would get easier with each session.

Several things I learned from this encounter: sometimes you can do more harm than good when your patient has expressive aphasia and you ask them questions (particularly if they are easily discouraged and you are doing an exercise), even when patients are being particularly trying they often still have good intentions, and just because a patient is crying doesn't necessarily signal the end of the session. If anyone has any strategies on communicating with patients with expressive aphasia please share them.