Let's Philosophize
How to Choose Your Speech Language Pathologist (SLP): Philosophy
Part 3 in our ongoing series How to Choose Your SLP.
You've learned about Setting and Location, two of our six key factors for choosing an SLP who will be the best fit for your child. If you haven't read those yet, check out the links above to see our related posts!
Now, we will delve into our third factor: PHILOSOPHY
Philosophy
No, we aren't talking about Plato or Descartes or Nietzsche. We know nothing about whether God is dead. And sure, 'I think, therefore I am' sounds cool on a T-shirt. But we aren't experts in philosophy tracts.
We are experts in communication, and that includes the philosophy we take when approaching our client's needs.
If you are a parent looking for an SLP, here are the five major philosophies that we suggest parents look for in a potential therapist:
Strengths-Based
Speech therapists work with kids who have delays and disorders. But when we look at what a child can't do, we can miss so much of what a child is already doing well.
A deficits-based approach is one that focuses on what is disordered or missing. Therapists who use this approach often mean well, trying to fill-in the gaps that they see in expected skills. But this can often cause children to lose confidence, become frustrated, and even withdraw.
In the worst case scenario, therapy is ineffective because the focus is on skills a child 'should' have rather than skills that the child is ready for or interested in.
A strength-based approach, on the other hand, acknowledges what your child is already doing well, integrating those skills into the treatment plan, and building off those skills so your child can access new or more challenging skills.
This type of approach supports your child where they are at and recognizes that treatment should not focus on achieving a predetermined set of skills. Rather, it focuses on what your child needs!
NOTE: Strength-based approaches do not only apply to communication skills. It is also an approach that can be applied to your child's behavior and socio-emotional skills. A child's brain is still developing; they may have tantrums or meltdowns, struggle with attention or impulsivity, and may have avoidant behaviors when things become too difficult. It is essential that we, as therapists, provide supports for the child based on their needs rather than seeing these behaviors as deficits.
When selecting a therapist, parents should ask the clinician about their treatment approach and evaluate whether they focus on your child's deficits or if they notice all of the things your child can do.
Individualized
Therapy should be individualized. Always. Objectives selected for each period of treatment should reflect upon three main questions:
Is this child ready to learn this skill? Do they have the necessary prerequisite skills? What level of support to they need for success?
Is this skill meaningful to the child? Does the child want to communicate about this? Are we framing this skill within an activity the child enjoys?
Is this skill functional in the child's daily life? Is this something that will help them communicate their wants/need? Is this a skill that the child will use often in their routines? Will this reduce frustration for the child?
When choosing a therapist, parents should ask the clinician how they choose their treatment objectives and how they are adjusted over time. When presented with your child's objectives, think about whether these are skills that are meaningful to your child and functional for them.
Neurodiversity-Affirming
The neurodiversity movement has been gaining more and more traction over the past few years thanks to neurodivergent voices who have been self-advocating for themselves and others.
Neurodiversity is the idea that individuals have natural differences in the way that they learn and think, interact with others, and process information. This includes individuals who have diagnoses of Autism and ADHD or those who stutter.
Neurodiversity-affirming care values acceptance and inclusion for neurodivergent individuals. It also values self-advocacy skills and authenticity over conforming to make others more comfortable.
IMPORTANT: This does not mean that neurodivergent people won't benefit from services and therapy!
This movement is a direct challenge to what many people call the medical model of care, where differences are often portrayed as part of a disorder or a deficit to be fixed. This model often centers around forcing neurodivergent people to act more like neurotypical people, forcing them to change rather than encouraging acceptance of their differences. This is called masking.
And, as more research is coming to light (especially for the Autistic community), it is becoming clear that the medical model of care leads to poor mental health outcomes and prevents these individuals from connecting in their authentic way.
A neurodiversity affirming therapist will:
Focus on strengths-based language in their assessment of your child's profile. They will not rely solely on standardized testing for evaluation as these tests are not designed for neurodivergent children.
Create goals for your child that supports their communication and fosters their authenticity. They do not choose goals based on what a neurotypical child their age "should" be doing.
Avoid any goals that simply seek to mask autistic traits (e.g., forcing eye gaze, eliminating stimming behaviors, eliminating echolalia).
Understand neurodivergent communication styles and ways that neurodivergent individuals prefer to show interest, engage in joint attention, and communicate with others.
Provide multimodal support and be aware of sensory needs to make sure that your child is at their best when learning.
Respect your child's bodily autonomy and any limits or boundaries they set. They care for the emotional well-being of your child.
Encourage self-advocacy skills and work with the child and their family to determine what supports the child needs to navigate interactions with others.
When selecting a therapist, parents should ask the clinician about their experience with neurodivergent clients. Notice in their response whether they seem to be aligned with a neurodiversity-affirming approach or if they tend towards a medical model.
If you want to read more about Neurodiversity, check out these resources:
Child-Led
When working with children, there are three main ways to approach therapy: child-led, adult-led, or a hybrid approach.
A child-led approach sounds, at first, like complete chaos. Children get to lead the therapy session? Well, of course they are just going to want to play the entire time. That can't be right...can it?
But what if we told you that it could work? Child-led therapy values connection over compliance. This means that, first and foremost, we are fostering a relationship with the child. This is crucial for progress because, honestly, we all learn better from someone we trust and like.
So, rather than forcing the child to do what the clinician wants to do, we allow the child to have some choice over their therapy. In play, we join in on the child's ideas and build language tasks into their interests.
Yes, we still set limits and hold boundaries when needed. But by using the child's interests and meeting the child where they are at, we can build on their strengths and use our connection with the child to encourage faster, more meaningful progress.
An adult-led approach is exactly what it sounds like. The clinician chooses set activities and the child is asked to comply with them. This can work for older children who require less support and are self-motivated, but it is generally our recommendation to use a hybrid approach if some structured tasks are needed.
A hybrid approach is, as you may expect, a blend of these two. This is because sometimes the language tasks or speech tasks require some structure beyond just free play. Perhaps the clinician chooses the activities for the speech plan, but the child has a choice in the matter (e.g., choosing one of two games). Or perhaps the clinician uses the child's interests to build an activity around. For children working on speech sounds, the clinician might use a list of words from their favorite movie or video game.
When selecting a therapist, parents should ask the clinician about their therapy style. Consider whether your child would benefit from a play-based child-led style (usually best for any child under 5) or whether a hybrid approach would work. Adult-led approaches are limited in their effectiveness, even for older children.
Family-Centered
You learned a lot about setting in our first blog post. For some settings, interactions with your therapist are easier than others. However, no matter what setting you are at, it is essential that your therapist include you in their plan of care.
Family-centered will mean something different depending on the age of your child.
For young children in early intervention or private practice settings, family-centered care includes educating families about language development and communication strategies. It means empowering families to feel confident in supporting their child at home.
For older children in public school or private practice settings, family-centered care includes educating families (and the child!) about their goals in speech and offering updates on their child's progress (after each session or during specific times during the year). It also includes offering home-carryover activities for practice when appropriate.
For children of all ages in all settings, family-centered care also includes acknowledging that being a parent is often challenging and chaotic. Therapists should consider the realities of the family's situation when considering therapy frequency, therapy setting, and providing home carryover.
When choosing a therapist, parents should ask the clinician how they include the family in their treatment. It is important to consider the setting, age, and profile of your child, but, no matter what, you as parents should be given some level of involvement.
Scenarios
These are all fictional scenarios to help you in your decision to understand what philosophy might be best for your child.
Shiva
Shiva is a non-speaking 3 year old. Her parents brought her for an evaluation with a speech pathologist at a diagnostic center associated with a large hospital. After waiting weeks, the report came back. Shiva was "significantly below average" in all of her testing, and the report seemed to only talk about all of the things Shiva couldn't do. Her parents were in tears reading the report feeling like the therapist didn't truly see their daughter and all the things that she can do.
Shiva's parents are not alone. This happens frequently with large centers who use templated reports that list the results of standardized tests. When Shiva's parents look for a therapist, they should look for a therapist who is neurodiversity-affirming and provides a strengths-based approach who can provide qualitative assessment during therapy, looking beyond standardized test measures to understand Shiva's true abilities and build new skills from there. And someone who is neurodiversity-affirming will understand how to support Shiva and her family with acceptance and connection.
Emry
Emry is a 7 year old who has been in speech therapy for years. He is still working on his /l/ and /r/ sounds with his therapist, but he hates therapy. He is tired of doing flashcards with his speech therapist, and he refuses to do any home practice with his parents.
Emry is not responding well to an adult-led approach and would benefit from a hybrid or even a child-led approach to help him feel part of his therapy. Using flashcards for articulation drill isn't working well for Emry. Instead, his therapist should try building words into games that he likes or having him choose his own target words. Once Emry is given some choice in his treatment, he will likely feel more motivated to work on his sounds.
Hugo
Hugo is an 18 month old boy who is receiving Early Intervention services. The therapist comes each week to their home, and his mother watches the session. After several months now, Hugo's mother still feels like she hasn't learned anything, and there hasn't been a lot of progress.
Hugo's mother is looking for a more family-centered approach. She would benefit from more explicit parent coaching so that she can use strategies during the week when Hugo is not actively in session. Hugo's mother seeks out a private therapist who has more flexibility in their service delivery. The new therapist offers her one virtual 30 minute parent coaching session to learn hands-on strategies to use with Hugo during his in-home session. She also sends videos from home to her therapist to discuss at their virtual sessions.
Ready, Set, Talk Time
So let's see how Time Boston fits into the Philosophy category.
Where does Talk Time Boston fall?
Strengths-Based: Talk Time highly values a strength-based approach. We create treatment objectives by building off your child's strengths. We also know that neurodivergent individuals will learn differently and focusing on deficits means we miss what your child can do.
Individualized: Talk Time individualizes each and every one of our treatment plans. We work closely with your child and your family to see what is functional, meaningful, and feasible for your child. And we provide progress notes approximately every three months so we can adjust the plan as needed!
Neurodiversity-Affirming: Talk Time is committed to neurodiversity-affirming practice. We accept neurodivergent individuals as they are, and we respect that their differences are not deficits. We believe in supporting these individuals using unrestricted access to multimodal communication and sensory supports, and we teach self-advocacy skills to empower these individuals as they navigate interactions in their life.
Child-Led: Talk Time generally provides a child-led approach. We believe in building strong relationships with our client based on trust and acceptance. And yes, we will be doing therapy even while we are playing with your child! We do use hybrid approaches when structured activities are necessary, but we always work with your child to make sure they feel heard and motivated to work on their goals.
Family-Centered: Talk Time values family-centered care. That's why we include families in every step of our process -- from goal creation to progress updates to therapy sessions to home carryover. We are in constant communication with families, and we are always open for questions and concerns!
WANT TO LEARN MORE?
Check out our services and our intake process on our website here.
And, if private practice is the right fit for your family, please reach out to us:
Email us directly at info@talktimeboston.com
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