Is It Me? Tips for Clinical Problem Solving

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One of the main questions parents send me at is…

I am not seeing progress in my child’s therapy. What should I do?


One of the main questions therapists send me is…

I am not seeing progress in a client’s sessions. What should I do?


These are different perspectives of course, but it’s the same question!


Today I want to share the first things I analyze when I need to make changes in a child’s treatment plan. I’ve shared previously about the value of “backing up” or selecting an easier goal to target since the one you’re working on is obviously too difficult or you would be seeing some gains.


But sometimes, changing other factors first can make a big difference.


Here’s the first thing I I think about in addition to “backing up” when a child isn’t making progress as quickly as we’d like…


Is it me?


What can I change about myself that will make it easier for this child to learn?


Before we can change a child, we often must change ourselves first!


This means that we need to adjust the things we do, as the adult, before we can expect any improvements in the child we’re working with. We’ll keep the same goal and strategies, we just change our own personal approach.


For example, things I try myself and then recommend to parents are…

  • Be more fun and animated! Any time we work with toddlers, playfulness should be our cornerstone approach. Late talkers who are innately quiet and sensitive could sense that you are too mission-oriented and are focused on “making them talk,” which is very difficult. This kind of attitude often causes very young children to shut down completely. The antidote is… loosen up and play! Lots of times this simple shift can turn things around. If you’re looking for ONE change to make, this is the one to try before you change anything else.


  • Slow down. Another simple fix is slowing down your pace. In our quest to be more playful and fun, we may amp it up so much that we end up feeling like a runaway mountain train during a session! Instead of barreling ahead, pull back the reigns and think about how purposeful you’re being in implementing your strategy. Are you rushing ahead at all costs, regardless of a child’s responses? If you describe yourself as “Type A” or a “control freak” this is probably a change you already know you should make! For example, when a child isn’t responding, instead of becoming frustrated or even panicky, try a more relaxed pace. Breathe. Give the child and yourself a chance to regroup.


  • Simplify your plan. For me this usually means parring back my treatment plan. In our desire to design comprehensive plans that address the whole child, we may come up with 10 diffrent goals! That can be overwhelming, for all of us… a child, a parent, and a therapist. Instead of working on 3 or 4 different goals in a session, try just 1 or 2. Rather than giving parents 8 different strategies to implement this week, provide only a couple, maybe just 1. If those don’t work for a child or family, you can always revisit and try something new. Earlier in my career I piled it on… not just for parents, but for me! Implementing more than a few goals increases the likelihood that nothing will get better or it will take too long to see results because we’re not as focused as we should be.


  • Adjust your expectations. Rather than pursuing immediate change, we may need to enjoy meeting a child where he or she is. One big mistake all of us make, both parents and therapists, is starting our work with a child at the “long-term” goal or end result. For example, with a nonverbal child, an SLP might begin her first few therapy sessions by trying to elicit words, even though the child ignores her, shows little sustained cooperation with her during play, and doesn’t complete any of her requests. At first glance, you may think, well of course she’s trying to get him to talk—that’s why he’s in speech therapy! However, when we take a step back and ask ourselves if talking is a realistic short-term outcome for a child like this, we begin to see the problem making this our initial focus for therapy. Just as you’d never expect a baby who can’t sit up on his own to suddenly jump up and run across the room, we can’t expect a child to consistently communicate by saying “real words” until he’s met other prerequisite skills for talking.


  • Focus on building a relationship with a child, not just building skills. All of us enjoy being with other people who “get us,” who like us, who want to be with us just because we’re who we are. Kids are like that too. They innately sense when you are somehow unhappy with them and how things are going. When this is the case, focus on being together first before you move on to working on a “goal.”







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