One of the most common complaints I hear from therapists is, I don’t feel like we’re getting anywhere in therapy. It’s so frustrating!
We pour our hearts and souls into these kids, and sometimes it can feel personal when they’re not making progress. What am I doing wrong? What am I missing? These are questions we constantly ask ourselves when our kids are plateauing.
So what should you do when you feel like you’re seeing a child in therapy who isn’t progressing?
Take a step back. Often times we are so in it that we have trouble thinking from a different point of view. So step out of your role as therapist for a few minutes, and start to think objectively. And take your emotions out of it. Because it can be upsetting to us when a child isn’t making progress. Maybe we blame ourselves. Maybe we blame parents for lack of carryover. But are we just projecting? If a parent isn’t working on our goals at home, is there something more we can do? Did we give them the strategies and tools they need? Did we give them the confidence they need? Did we model the strategies well enough? Do they need some sort of system for accountability? Do they see the value?
Re-evaluate. Now take some time to really think about the child outside of your therapy sessions. If you take videos in sessions, this would be a great time to review them. Where was the child when he started? Where is he now? What’s working? What’s not working? Are your goals appropriate? Where is the missing link? Often times, there is something we’re missing - we just need to figure out what that is. What I see most often, is that we’re not working on the right things. Your job is to figure out what the right things are.
When I met two year old Frankie, he was nonverbal. He was also dysregulated, not engaged, and didn't seem motivated to communicate. He would come into my room, find something that could roll (balls, eggs, Lysol wipes container, you name it), and he would lay on the floor and roll it back and forth. Often times we see a child like this, and we think, this child needs to talk. I’m going to work on language. But that wasn’t the right thing for Frankie. Frankie had such great deficits in foundational skills for language development. If I had met Frankie and immediately started working on language, I would probably be able to teach him some functional vocabulary in a few months. Within 6-12 months I could probably have him saying “I want juice” and “I want ball.” But after that point, he would likely plateau. Why? Because he would have ended up in Rote Language Land. He would have learned rote phrases, but would struggle significantly with developing novel, spontaneous language. So upon meeting Frankie, I knew that working on language was not the right thing. Working on his regulation, engagement, and motivation was the right thing.
Change it up. It’s ok to go in a completely different direction in your therapy. If you’re used to having the child come into sessions and sit at a table the whole time for structured language games, but you decide the child needs to work on regulation and engagement, it’s ok to take your therapy sessions in a completely different direction - because you’re not going to be able to work on regulation and engagement during structured table games. You need to get the child up and moving! You need to start working on the child’s connection with you, not the child’s ability to sit at a table and answer WH-questions. So if you feel like you need to do a U-turn in your therapy, I give you permission to do that. Remember, it’s all about finding the right thing.
Jessie Ginsburg, M.S., CCC-SLP is a speech-language pathologist, creator of ASD from the Inside Out, and owner of Pediatric Therapy Playhouse, a multidisciplinary clinic in Los Angeles.