BACKGROUND: There are two distinct theoretical positions underlying approaches to aphasia therapy. The first addresses the language impairment directly through tasks designed to improve performance in that language function. This form of therapy was employed in a related study involving the participants reported here (Hickin et al., 2002a). The second seeks to bypass the language impairment by, for example promoting alternative forms of communication, and stressing the importance of successful rather than normal communication. There are few studies that combine the structured principled methods of the first with the ecologically valid basis of the second approach. AIMS: Our aim was to investigate the effectiveness of combining a lexical therapy, targeting a discrete set of items and using cues to prompt name retrieval, with communicative use of those items, in tasks ranging from naming to definition through to structured conversation. We investigated the effects of the therapy in terms of gains in picture naming, and performance in a task simulating communication situations (production of nouns in everyday communication). METHODS AND PROCEDURES: The study is a case series design involving six people with aphasia. All were adult English speakers aged 39 and upwards who were aphasic following a single left hemisphere stroke. Picture naming and production of nouns in everyday communication was assessed prior to and after therapy. OUTCOMES AND RESULTS: The combined therapy described here was effective for five of the six participants in terms of gains in picture naming, and an increase in communicatively effective responses in the noun production task. One person, for whom the lexical therapy described in Hickin et al. (2002a) was not effective, did however respond to the therapy reported here. For one of the six participants, the therapy was not effective. CONCLUSIONS: Therapy that targets a specific set of words, and encourages their use in tasks approaching everyday communication, can be effective in improving word finding in picture naming and in a functional speech task. As therapy effects are restricted to items undergoing therapy on the whole it is essential that words are selected for therapy on the basis of their functional use to the participant. This therapy was effective for most of the six participants and we are unable at this stage to identify exclusion criteria for undergoing this therapy.