Therapy Gone Wrong for a "Type A" SLP

Every Speech-Language Pathologist dreams of the day when they will have back-to-back perfect treatment sessions. Imagine finding that perfect game, having all three of your patient’s brothers and sisters sitting quietly off to the side as you and your patient work without interruption; or imagine zero behavioral outbursts, despite challenging your patient with more difficult tasks.

More often than not, this “perfect” treatment session is not what my treatment session looks like! 

During a treatment session or an assessment my telephone will ring or a colleague will knock on the door.  Shoes and socks are not just slipped off, but are thrown into the air for an unknown reason. The special reinforcement snack (that I bought especially for my patient) is now considered “yucky” and inevitably the bubbles, which are my back up for when all goes wrong, are spilled everywhere. The toy or game that I imagined the patient requesting, describing, or problem solving with, just goes awry!

As a Speech-Language Pathologist who admittedly has a Type A personality, these scenarios left me frustrated, overwhelmed and exhausted. Frustrated, because I couldn’t get this treatment right.  Overwhelmed, because I personally felt embarrassed that my therapy plan was not playing out the way I wanted in front my of patient’s parents. Exhausted, because I spent countless hours revisiting the treatment session in my mind, trying to pin point the moment where I lost control of the appointment, thinking of reasons why the toy wasn’t the right fit, and contemplating the possibility of having the wrong room. In reality the problem wasn’t any of that. It was myself, and dare I say it was my very own Type A personality traits, getting in the way!

When I took a step back, and pushed my Type A personality traits aside, I realized all of the amazing therapy opportunities that I was letting just slip through my fingers! The telephone ringing, people knocking on my door, toys breaking, shoes flying, yucky snacks… yes all of it could be used in treatment with benefit! I started to ask myself questions such as: “Did my patient attend to the telephone ringing? Could they localize the sound? Did they label the telephone or imitate the sound? Did they ask a “wh” question? Did they relate a personal experience regarding the phone? For my older patients, were they able to return to task? Was the ringing a distraction? Could my patient continue to attend to their first given task despite the background noise?” I found that a plethora of analysis and treatment options just opened up all in a natural opportunity!

You may be thinking, alright the telephone rang, I can overcome that, what about a toy breaking, shoes flying, a yucky snack, or bubbles dumped over my head? All of these seemingly problematic scenarios present with equal and unique opportunities for treatment. Broken toy or a toy with missing pieces? Go on a scavenger hunt! Model asking to fix the toy, “mommy fix please?” Talk about the disaster, “Oh no, toy broken!” Take the opportunity to teach how to trade it in for a new toy! Yucky snack? One-by-one throw pieces of it away telling each piece goodbye or emphasize the appropriate pragmatics of “no thank you!” Bubbles spilled everywhere? Let’s practice learning how to take turns, practice saying “sorry,” model cleaning up with the clean up song, or teach new vocabulary such as, “oh no!” “gross!” or “sticky bubbles!”

Learning to let go of “the plan” can sometimes be the most beneficial and fun part of your treatment or assessment. So push those Type A tendencies aside and let the creative juices flow. Look for the hidden speech and language treasures that can come out of a “therapy gone wrong” session!