Throw away your first/then boards. Seriously. Throw them out—shocking advice from a pediatric SLP. Let me explain why.
Over the years, I have taken courses and delved deeper into learning about child-led therapy and the importance of having a strong rapport with each client and family. Early in my career, I was taught to have a lesson plan/printed worksheets, follow strict language programs that provide little flexibility, and that the best therapy sessions are done when the client is seated at a table and following the adult-directed schedule. I also learned how to describe my client’s behavior based on their response to my choice of activity-This may ring a bell for any parent with a child described as non-compliant.
As a result of adopting a child-led therapy approach, I find and focus on each child’s strengths and join them in their interests. My first goal is to demonstrate shared enjoyment in child-led activities. Why? Because it builds trust in me as their therapist and teaches them their interests/the way they play are valid
Here is a brief list of things you will never hear me say during therapy sessions: “Johnny did okay today but had difficulty focusing on our book when asked to sit at the table.”
“Johnny displays many non-compliant behaviors that hinder our ability to target goals.”
“Sarah needed several verbal reminders and redirection to attend to the worksheets.”
“Sarah often scripts lines from a favorite show and isn’t paying attention to my questions.”
The day that I say any of these statements is the day I close my practice and choose a new career because, as an SLP, I have failed to see the strength in each of my clients in these examples.
Let’s discuss my controversial opening statement and why specific visuals are not used during my child-led sessions. During child-led therapy sessions, I usually don’t say “no” unless something is a safety risk. Nor do I give options on what a client “can” do.
If a client wants to jump into a ball pit repeatedly, let’s jump into a ball pit. You don’t need to formulate a 3-4 word utterance requesting the ball pit each time you want to jump. We can practice generating utterances while playing in the ball pit instead.
If a client wants to ditch the farm animals in favor of turning the barn upside down to look at the bottom, cool; let’s look under the barn together. You don’t need to play with my farm animals first. We can work on joint attention and social skills playing your way.
If a client wants to wrap themselves up in my sensory tunnel and inspect the wheels of a firetruck, awesome, I love the creativity; let’s make it a game. We can work on answering questions and other language skills using the tunnel and firetruck.
I won’t use a first/then board to say, “first answer questions, then get the sensory tunnel.” That isn’t child-led therapy. My clients don’t need to earn toys.
When I started letting go of “control” during my sessions, bringing in sensory supports, and allowing my clients to be active and move around, I realized I was building trust and rapport with my clients. Once you have trust, good connection, and strategies to support sensory needs, you can start targeting areas of weakness and teaching communication skills.
Sensory input can often be seen as a "break" from doing the "real work" in therapy. I invite you to view sensory activities as a necessary part of treatment sessions because it allows each client to regulate to get to a place where they can learn.
Our next post will discuss all the visuals I love to use during my child-led therapy sessions and how I incorporate sensory strategies into my sessions.
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