By Nicole Kolenda, M.S., CCC-SLP, P.C.
As a supervisor in a graduate clinic for Speech Pathology students, the first goal we instruct our students to write is to “establish rapport”. We encourage our students to cite research to “back-up” this goal—and there is a plethora available. I always tell these budding clinicians, “How can you expect the client to work for you—and in many cases on challenging treatment goals—if they do not feel comfortable with you?” In the pediatric world, we also must contend with separation anxiety, where the physical act of separating from the parent/caregiver to go into the therapy room, is extremely difficult and often, debilitating. Therefore, if we, as treating therapists, do not take the concept of establishing rapport seriously, there will be ramifications and a ton of time lost.
Similarly, if you are going to therapy or counseling for yourself—you would make sure that relationship between you and your therapist felt good. How many of us have stopped going to a therapist because something inherent in the rapport made us uncomfortable or caused us to feel bad? Or, we just didn’t feel like the doctor or counselor was a good fit? Or, after some time, we didn’t feel we were making progress?
In the world of pediatric therapies, many parents rely on word-of-mouth referrals. And, sometimes, these parents wait for months until a spot becomes available in the therapist’s schedule. So, in this instance, when the parent starts to get the initial feelings that maybe the therapist is not a good fit, it becomes difficult to actively engage in this idea because so many other parents spoke so highly of this therapist—or you don’t want to feel like you waited months to get into the schedule to only be disappointed. These feelings tend to blur the lens and are often the reason as to why some parents wait so long to switch therapists.
There are a few other reasons for hesitating to get a new therapist:
- The therapy schedule that you spent weeks revising and perfecting will get ruined (maybe that is a dramatic statement, but it will be a pain to re-do it).
- You do not want to offend the therapist.
- You do not want to offend the referral source of the therapist.
- Your current therapeutic team appears to work well with the therapist.
- Your child appears to be improving.
I am writing this post to encourage you to take a good look at the current situation and ask yourself the following questions:
- Does your child appear happy before and after therapy? Sometimes transitions are difficult for children—which makes starting or stopping anything hard—you will know when your child is having a challenge with a transition or just doesn’t like spending time with the therapist.
- Are you seeing tangible, measurable progress in your child? Remember, many times progress can be slow—but the reason your child is attending therapy is to progress.
- Do you feel comfortable expressing your feelings and concerns about your child to your current therapist? If you do not, this is a red flag.
- Does your therapist adhere to professional standards? Your therapist is expected to:
- Be on-time for all scheduled therapies. Obviously, there are exceptions to this rule—but if punctuality is an issue—precious time is being taken away from your child and there is no excuse for that.
- Communicate with the other therapists. This will ensure consistency and foster progress.
- Complete all documentation—including progress notes and quarterly reports.
- Respect your other therapists, as well as your family and your personal space (if therapy is happening in your home).
When a parent begins to express concern—I always encourage them to do the following:
- Set up a time to observe your child in session with the therapist. If you find your child is too distracted with you in the room, ask a trusted source to do it for you—or request to video the session.
- Set up a time to discuss your concerns with the therapist and gauge their reaction. There have been a few occasions where I have seen the therapist is relieved and steps off the case because they were aware they weren’t a good fit.
- If speaking to the therapist feels uncomfortable (and it may) consult with your team leader or the agency lead and tell them your concerns, if possible.
- If you have a large Early Intervention team, share your feelings with the therapist you trust the most and get their input. Often therapists know each other from other cases and you must be cognizant of how you approach this so as not to offend anyone. The information gleaned in this encounter may be very helpful.
What I have frequently found is that a parent’s gut instinct is typically correct and when we take a look at the above points and really begin to tease out what is really a concern—I typically encourage the parent to find another therapist and absolve them of any guilt they may feel. In some instances, the therapist has been working with the child for a while and there is a real relationship there—so this “break-up” can be difficult. But, remember, at the end of the day, what matters most is your child’s success and sometimes getting a new set of eyes on your child by a different therapist can be a game changer.
Nicole Kolenda, M.S., CCC-SLP, P.C., is a NYS licensed/ASHA certified Speech and Language Pathologist with twenty years’ experience working with children and young adults diagnosed with Developmental Differences. Nicole ran a thriving practice on Manhattan’s Upper East Side for 15 years and has taught and supervised throughout New York City’s elite graduate programs, including Teacher’s College and New York University. Nicole has also collaborated with Manhattan’s top rated developmental pediatricians and has contributed to research in the area of speech development. Nicole continues to adjunct at NYU and Hofstra and is a supervisor/externship coordinator at the Hunter College Center for Communication Disorders. Nicole is also the clinical coordinator for the Atlas Foundation for Autism and frequently writes for parenting magazine and blogs. Most recently, Nicole has joined the team of Write Brain Books as a special needs products and program consultant. Her unique combination of training (including a health and wellness coaching certification from the Institute of Integrative Nutrition) and experience has also allowed her to seamlessly support the special needs community as a Special Needs Mom Coach. You can learn more about her at www.nicolekolenda.com. Facebook: https://www.facebook.com/NicoleKolendaSLP/ Twitter: https://twitter.com/NKolendaSLP