You've prepped for your speech therapy session with a student. You've picked out your therapy materials, have your goals for the session mapped out, and are excited to see your student engage with all the fun activities you've chosen for them that day. The student comes in, and not one minute after you introduce the first activity the session already feels like it's gone off the rails.
Sound familiar? This was a common experience I had when working with students in graduate school and during my clinical fellowship (CF). At the start of my CF, sessions going sideways felt like a nearly daily obstacle for me. Eventually, though, the sessions that didn't go as planned taught me lessons that encouraged me to grow as a clinician. They still happen regularly now that I've worked as an SLP for several years, and I've learned a few things about how to move forward even when the unexpected happens. Here are some takeaways I've learned as an SLP from sessions that didn't go as planned.
What's your approach to session prep as a clinician?
When I was in graduate school, I spent lots of time trying to prep for my sessions. I'd be in the therapy materials room at the clinic, looking for activities or books to pick out for sessions later in the day. I remember running through a bunch of different questions in my head while doing this:
- How many materials do I need to pick out?
- How am I going to use these during the session?
- How will these materials keep someone engaged for an hour? 30 minutes? 20 minutes?
- How do I know that this is going to go over well with the person I'm seeing?
These questions would often leave me with a sense of dread, anxiety, sometimes even panic leading up to sessions. And then inevitably, the session plan would go sideways anyway.
One thing I learned during my CF and my first few years after getting my CCC is that this style of preparing for therapy sessions, picking out all the materials and planning out activities ahead of time, was not working for me as a clinician. Don't get me wrong, for some clinicians this approach is very helpful. And if this works for you, keep at it! For me though, I spent so much time trying to come up with a plan for all my sessions, that I wouldn't know what to do when the materials or activities weren't engaging the student I was working with. I learned that I was much more comfortable with improvising as a therapist with a few core materials I had picked out, tailoring the goals for the client, and adapting the activity as needed depending on if it was engaging the client or not.
Learning what prep style fits best for you as a clinician can help you pivot in the middle of a session. Are you someone who likes having a plan and backup ideas if things go unexpectedly? Are you someone who likes using the same materials and adapting the therapy activity to work on different goals? Are you someone who likes to improvise in the moment? Find an approach that works best for you and is comfortable to use.
How are things with the person sitting in front of you?
When you've developed relationships with the people you work with, you often learn what they're usually like when they come to a session. Are they usually cheerful? Quiet? Are they bouncing off the walls with energy? When you get a sense of how the people you work with usually are in sessions, you may start to notice when they come in and something has changed. Sometimes asking them if something's going on can explain why a session is going sideways. Maybe they didn't get enough sleep the night before, they missed breakfast, or something stressful is going on at home, work, or school. Maybe they're taking in sensory information from the environment that's bothering them. Maybe they're missing their favorite school activity or a special event to come see you that day.
So what could help in those situations? It could be switching to a game just for the session to work on goals, or a fun activity they prefer instead of what you had originally planned. You may choose to give a few short breaks to reset and self-regulate during the session. If all else fails, you could try again at a different time during the day or week. You may not get as much done as you'd originally thought because of the changes you're making. But if these changes can increase participation in a session, they may be worth considering. Asking questions to figure out what's contributing to things going sideways can help you understand what changes are needed in the session.
What's being brought in today that you can work with?
Let's say nothing you brought with you to a session today is engaging the client. What now? In those situations, following the student's lead can give you ideas of what to work on. You can use topics students are learning about in class as opportunities to work on language or speech goals. I've had many therapy activities with students that started with what they were learning about in ELA, social studies, science, or even math class. If a student is really interested in talking about a certain topic, you can use that topic as a base to build your therapy activities on if the topic is appropriate for the therapy setting and goals. You may be surprised at how many different things can be made into a therapeutic activity to work on goals.
It's okay to be human.
Sometimes, even after you've tried all these different suggestions, a session just won't get back on track. In moments like these, I try to remind myself that not every session has to go well for a student to make progress. Sometimes breakthroughs happen in a session, but not every session has to have a breakthrough for it to be building toward progress or overall change. Change happens over time. As clinicians, we're also human, and the people we work with are too. Sometimes we or the people we work with will have a session that goes off the rails because one of us is having an off day, or something else is going on. When that happens, it's okay to acknowledge that, and then try something different next time.
-Ian Quillen, M.S., CCC-SLP
