Being the SLP Families Will Trust (Part 1)

By Toby Stephan,
Hanen Instructor and US Representative

If your experience is like mine and like those of many recent SLP graduates I’ve met over the years, we are very client focused. We want to do what’s best for the client. We want to be the one who helps the client make progress and move in the direction they need to move to get better.

These are not bad wants; however, problems can arise if our definition of the client is limited. In my early years, I can recall feeling a bit of excitement when I got my first referral for a child with Down Syndrome or Autism, or any other diagnosis. I saw each referral as an opportunity to expand my skills as the helping professional I wanted to become. My first thoughts didn’t adequately consider what it might mean to the parent who has a child with Down Syndrome, Autism, or any other diagnosis. What I didn’t realize is that, in early intervention, the client is not just the child; rather, it’s the family.

 

As an early interventionist, here is our reality. The child isn’t concerned that he or she has some sort of diagnosis. The child is living life large, in the only way he or she knows how. The parents, though, are consumed with their child’s difficulties. When a child has been diagnosed with a delay, the question that comes to the parent’s mind is, “Now what?” The parent will want to know what steps to take. The parent will want to move in a direction that will help their child learn to communicate more effectively and they will want to move in this direction with confidence. Choosing the right therapist is one of the first steps the parent takes when answering the “Now what?” question in a way that makes the most sense for their family. So, how can we be the therapist that the family will trust?

The Two-fold Process of Early Intervention

Dathan Rush and M’Lisa Sheldon have published a book entitled The Early Childhood Coaching Handbook, a recommended read for any professional entering the field of early intervention (Rush & Sheldon, 2011). They also published an earlier book with Barbara Hanft (Hanft, Rush, and Sheldon, 2004). In both these books, the authors describe the work we do with families as a twofold process: relationship-based and performance-based.

First, let’s talk about the relationship-based part of the process. As interventionists, we have to start by building a partnership so that the interventionist AND the parent can both bring their knowledge and skills to the relationship. So, it’s two way learning: “Mom, you know your child and your family best and I know about language development and how to foster it. Let’s keep sharing our ideas so that together we can figure out how to move forward”.

Moving forward calls for action, which gets us to the performance-based part of the process. If we have a relationship, performance comes more easily. Together, the parent and the interventionist can be goal-oriented and action-based. “Mom, it seems we agree that this (goal stated specifically) is what we want to see (child’s name) learn and this (actions stated specifically) is what we plan to do to help accomplish the goal.

I’ll add one final idea to conceptualize Rush & Sheldon’s process: being reflective. The best work happens when the parents and the coach are reflecting together on the most basic questions:

• What actions are working already?
• What should we be doing differently, if anything?
• What actions might fit with what’s already working that would help accomplish the goal even better?

Reflection is what binds the performance-based and relationship-based components of our work.

Clinician to Clinician

In this section, I want to discuss a classic mistake, present one concrete idea that I’ve come to believe will help offset the classic mistake, and list some additional reflective questions that I hope will prove helpful.

First, the classic mistake: I did this in my early years. I’ve seen countless other interventionists do the very same thing. In fact, I’d say this mistake was a constant in just about every new interventionist or graduate student I’ve ever been charged with mentoring. We jump right into the action without first developing a relationship. My theory is that we tend to assume that if we recommend it, the parent will do it. After all, we’re the experts! We learn quickly that this doesn’t work . The best-case scenario is what I call the “nodder” parent. They’ll nod their head “yes” and nod their head “yes” when I’m there with them in session, but when I come back next session, it’s clear they haven’t done anything about it in between sessions. The worst case scenario is we’ll lose the parent. They may go to another therapist or they may elect not to pursue intervention at all. My knee jerk reaction in both the best and worst case scenarios is to blame the parent, but in reality, it’s on me. I didn’t do enough to develop the relationship before jumping into action.

Next, one concrete idea to offset the classic mistake: When I was in graduate school, I once had to write on an essay question on whether thought organizes language or language organizes thought. My response at the time was “... of course thought organizes language otherwise how would we ever come up with language in the first place.” Now, I lean more the other way and believe that language organizes thought. What we call it is what it becomes. The pronouns we use communicate volumes. If we say “I”, “me”, or “you”, then we separate ourselves from the family and it becomes action-based therapy without enough consideration for the relationship. If we say “we”, the actions taken evolve more out of the relationship. I’m always amazed at the impact the simplest ideas can have. I had to force myself to say “we”. At first, I had to keep repeating to myself the “say we” mantra. Over time, I didn’t have to say “we” anymore because I was thinking “we.” Language organizes thought.

Finally, some additional reflective questions: The list below includes just a few of my favorites. If interested, the reference list gives resources that can help provide an extensive list. After reading the list, please don’t walk away thinking we can’t add our comments, thoughts, suggestions, opinions. We certainly can or it wouldn’t be a relationship-based two way learning process. It becomes a balance.

Reflective questions to use with parents

The Hanen Centre is a Canadian not-for-profit charitable organization with a global reach. Its mission is to provide parents, caregivers, early childhood educators and speech-language pathologists with the knowledge and training they need to help young children develop the best possible language, social and literacy skills. This includes children who have or are at risk for language delays, those with developmental challenges such as autism, and those who are developing typically.

Stay tuned for Part 2 of “Being the SLP Families Will Trust” as we share what Hanen Certified SLPs say are the three biggest things parents should look for when choosing an SLP.