Category Archives: Inspiration

Being the client: knowing what to expect and listening to my gut

The tiniest member of the Therapy Ideas teamThis is the first time I’ve blogged since I had a baby 8 weeks ago. I’m delighted to be sharing my life with this tiny person, although he sure does change the landscape of my days. Spare moments are scarce, when I find them, I hop into bed for a nap!

I’ve been told by parents I’ve worked with that I didn’t understand particular things because I didn’t have children. In my foggy mental state I’ve reflected on a few things I’ve learnt as a new parent.

I’ve realised how dedicated some parents are. I’ve known families come to therapy sessions with their older child when their new baby was just days old. In those first few weeks I called it a successful day if I could shower and comb my hair. These families had a legitimate reason for cancelling sessions but they didn’t: they came along, took part, and supported their older child. Wow.  Continue reading

Teach Me With Pictures: pictures scripts for children on the Autism Spectrum

Teach Me With Pictures

A friend has published a practical resource for developing play and communication skills in children on the Autism Spectrum. Ruth Harris, along with two colleagues, has written Teach Me with Pictures. It’s a book of picture scripts that are ready to use – you can photocopy them or print them from a CD-ROM. Ruth has been working on the book for a while; she spoke about it at the initial Therapy Ideas Live event back in July 2011. Congratulations Ruth, Simone and Linda, it’s wonderful!

The book begins with an introductory chapter, explaining what picture scripts are, their benefits and how to use them. Continue reading

Speech therapists can learn about collaboration, facilitation and leadership skills from other disciplines

Rhiannan impro workshop dareconf

At a recent study day (Child Talk What Works consensus event) I heard Dawn Smith, Healthcare Professionals Advisor, talk about commissioning SLT services. She suggested we tell stories about the impact our services have, with compelling headlines and concise evidence. She talked about the importance of making “effective relationships … across increasingly complex systems” and said that the services thriving under the new commissioning arrangements have “transformational leaders.” It was an interesting talk. Continue reading

Ageing with autism and managing expectations in therapy


On Wednesday evening I attended the National Autistic Society’s Ageing and Autism launch event. Francesca Happé talked about the huge gaps in the research, and outlined the things we don’t know about what happens when people with autism age. As autism was first used as a diagnostic label in 1943, the children diagnosed then are now approaching their 60s and 70s.

Saskia Baron’s brother Timothy, was one of these children. In 1961 he was diagnosed with “Childhood Psychosis” which later became known as Autism Spectrum Disorder. He is now 57 years old. Saskia talked movingly about growing up with a sibling with autism, and her worries about Timothy’s future. She described how difficult it is for Timothy to let people know when he is unhappy or in pain. More positively, she talked about how she’s observed that Timothy is still able to learn new skills. Saskia agrees that early intervention is important, however, she feels it’s not justified to remove therapeutic resources in late childhood or early adulthood, as the door to learning is still open.

My clients with autism are between 3 and 6 years old, they’ll be approaching old age in 60 years! Saskia’s presentation made me think about two things, how can I support the siblings of my clients? And how can I teach my clients ways to express their pain?

This week I also had a wonderful conversation with Keena Cummins. I’m using her VERVE technique with several families and was thinking about how to manage parents’ expectations. All the children have been making great progress due to the efforts of their skilled and perceptive parents, yet these parents often express frustration that their children aren’t using more words. Keena suggested I’m clear about what I want parents to focus on:

 “During these therapy sessions I want you to focus on his playing, I’ll worry about his talking. I want you to think about how you’re supporting him to play, explore the toys, and try out his ideas. We’ll be thinking about his words later.”

This makes sense to me, I’ll try it out this week.

My favourite therapy prop: a 20 year old toy dog

dressing up dog

Last week was Speech Pathology Australia Week & talk on twitter turned to favourite toys for therapy. I love toys that can be used to work on several different targets. Meet Dog, he’s one of my favourites because he’s so versatile, and the children love him! Wikipedia tells me that Pound Puppies were sold in the 1980s, I think I was given mine for Chanukah when I was 8 or 9 years old. Who knew he’d be starring in therapy sessions more than 20 years later!

I’ve recently been dressing up Dog to work on the verb: wearing. Here’s what a therapy session might look like.

When I teach a new word, I begin by modelling it a lot in different contexts. The child and I take turns choosing items for Dog to wear, and I comment: “wow, Dog is wearing glasses. I’m wearing glasses and Dog is wearing glasses.”

Accessorising ourselves


Then we start putting on funny accessories ourselves and I keep modelling the target word: “You’re wearing goggles, you’re ready for a swim.” “I’m wearing a monkey hat, it’s warm!” Children learn by doing; in this activity they’re wearing different things, while I model the word. It’s also fun to take photos of the child wearing different accessories, and talk about what they’re wearing in each photo.

Dressing paper dolls


Next we try a paper based activity, like this doll game. We dress the dolls (while I keep modelling the target word) and then I’ll try to cue the child in to using the word himself. I’ll say something like: “My doll is wearing a yellow dress and boots, your doll is…?”

There’s an app for that

DSC_9972I found this free iPad app, which is good to end on. The child selects clothes and shoes for the doll – it’s another fun opportunity for more modelling and perhaps the child will be ready to use the word himself.

Tip: children want to keep trying different clothes on the doll. So when it’s time to talk about what she is wearing, I take a photo of the outfit and switch to the photo app. Then the child can’t change the clothes anymore and can focus on describing what she’s wearing!

Practise at home

I give the parents the paper dolls to take home, encourage them to practise the other activities as well, and remind them to talk about what they’re wearing throughout the day.

If your child is struggling to learn new words and you’d like an assessment or advice, get in touch.

Want to make changes at work but keep getting stuck? The Dare Conference can help.


The Dare conference is an exciting new event about learning how to make change, and I’m part of the team behind it. The presentations cover a range of themes that will help attendees learn skills and techniques for getting better outcomes. It’s aimed at digital professionals, I’m going to explain why the ideas are also valuable for people who work in health care (or social care, or charities, or anywhere with other people!)

At the conference people will be talking about:

  • learning from mistakes,
  • dealing with uncertainty,
  • redefining success,
  • responding to negative feedback,
  • being honest,
  • and failing to launch new projects.

When I think back to my time in the NHS, these were all huge issues for my team. Let me give you an example.

When a friend returned to work after her year off on maternity leave, she asked where we were up to in terms of the projects she’d been working on before she left. I was horrified to realise that in a year we hadn’t launched a single project. We’d got stuck – our bosses told us not to tell families about upcoming changes, we were making the same mistakes again and again, and judging our service by meaningless metrics, like number of client contacts. I’d spent my time in unproductive meetings where people responded: “no, but…” to other people’s ideas. No one was taking responsibility for change, including me.

There was also a blame culture. We didn’t respond to individual pieces of negative feedback in a thoughtful or sensitive way, so these escalated into formal complaints. Which led to everyone looking for someone else to blame instead of trying to figure out what we could learn from the situation.

If you’re facing these challenges today come to the Dare conference and learn how to get unstuck. The speakers at the Dare conference aren’t superheroes who have all the answers; they’re going to share their struggles and what they learnt along the way. I think these lessons don’t only apply to folk working in the digital community. We all need to learn how to really listen, to build on each other’s ideas and make changes, in order for our teams to be successful.

The Dare conference is taking place at the South Bank Centre in London on the 23 – 25 September. Check out who’ll be speaking and all the details here.

Are you trying to make a difference in people’s lives but experiencing barriers to making changes? This conference is for you. If you’re a health professional use the discount code ‘therapyideas’ to buy a ticket for £299 +VAT.

Help us spread the word about this event; send the conference details to everyone you think might benefit from support to make change. Tweet about it, or post a message on Facebook or LinkedIn. I hope to see you there!

The speech therapy process is like a long walk

Rhiannan on the coast path

I spent last week hiking 50 miles along the Pembrokeshire coast path. It was beautiful, stinking hot and a trip I’ll remember for years. The hours of walking gave me time to think, and I realised a long distance walk is a good metaphor for the therapy process.

A long journey

50 miles over five days sounded straightforward when I was planning the route. Factor in a heavy backpack, rough terrain and a freak heatwave and those miles were long. The therapy process can be long too. Children may need to develop skills in several areas, they may learn quickly and then take time to generalise, or it may take time to find a therapy approach that works.

It’s challenging and there’ll be tough parts

The walk seemed hardest when it was steep and hot, then suddenly easier when the path flattened off and the sea breeze began to blow. Therapy has easier and tougher parts too. At times something clicks and children suddenly get it, at other times no one is in the mood. There may be frustrations and times when we want to give up. We need to keep going and wait for the sea breeze.

Repetition makes it easier

We bought a new tent for this trip: the first time we put it up, it took about 40 minutes! The second time was faster and by the sixth night we had it down to an art. Therapy get easier too. Families get used to practising at home and find creative ways of integrating activities into each day. Children get used to how therapy sessions work, they get to know the therapist and what to expect.

Celebrate all progress

When we got to the top of a steep climb, we’d take our backpacks off and celebrate with snacks and water! It’s important to notice and celebrate progress in therapy too, however small. Remember how far we’ve come.

People may not understand

Some people we passed on the trail looked at us like we were crazy, one man even suggested we take the bus! When I was struggling, the strange looks people gave me made me feel lonely and the walking seem harder. I ignored people’s judgements and kept going. Sometimes friends and family may not understand why a child needs therapy or how the process works. Families tell me this lack of support can seem hurtful, and is one more thing to worry about. Tell friends and family how they can help you, and then keep doing what you need to do.

If you commit it’s worthwhile

I was determined to finish the walk. I had to be flexible and adapt my plan. Due to the extreme heat we took a shortcut one day, but we made it! When families can commit to therapy, and work with a therapist they trust, children make progress. All the hard work pays off when a child is able to express themselves, make relationships and blossom!

Reflecting on 3 months of independence: trying to be myself


Three months ago I left a job in the NHS and started working for myself, as an independent speech and language therapist. It’s been an adventure. First I found two lovely therapy rooms and got myself kitted out with kiddie sized furniture, toys, assessments and a laminator! Then families began getting in touch and my caseload started to grow.

I’ve been reflecting on how things are going. Two blog posts I read recently feel relevant to my situation.

You Are Not a Large Corporation A manifesto for the self-employed by Paul Jarvis, is a list of things that self-employed people can do with their new freedom. I love it! It includes:

You can let your personal values and ethics guide your work and who you work with.

You can be yourself, even if you think it’s not professional. Being authentic draws others in and can be quite contagious. Your personality is awesome enough to let shine in any and every situation.

He also talks about defining success for yourself, breaking the rules, learning from mistakes, and not having a plan.

The post made me think: I spent 7 years working in the NHS, I became accustomed to the NHS way. I’m constantly asking myself, am I doing it this way because it makes sense or because that’s the way I’ve always done it? I’m grateful that I can work in a way that reflects my values rather than having to follow rigid protocol. I’m thrilled by the progress my little clients are making, now I’m able to tailor therapy to their needs.

What about being myself, being genuine, letting my personality out? Nobody told me that I couldn’t do that in the NHS. Perhaps I didn’t have time, or keeping part of myself back was a coping strategy for an overwhelming job. But clients value seeing our personalities. I read this post (follow Dana’s blog, she talks a lot of sense.) It’s a lovely letter from a mother to her daughter’s therapists, she finishes by thanking the therapists for loving Maya:

The therapists loved Maya, despite the fact that they weren’t obligated to do so, and that expression of love gave me the hope and belief that others would see how amazing she is and love her, too.

I’m thrilled that my new role allows me to really get to know the children and their families. We see each other every week and are building relationships. I’m worrying less about being professional and instead I’m focussing on being genuine, because that’s how we connect with and learn from each other.

It’s not all roses and children magically putting two words together. When things go wrong I’m trying to practise mindfulness, remember not to dwell, and move on. Sometimes I find I’m questioning everything, including my skills and sanity! I’m new to this running a business malarkey, it can be tough.


Using “yes, and…” to facilitate change

Change diagram

I’m in a transition phase; I’ve left my NHS role and started work as an independent therapist. I find change tricky. I had an interesting conversation with Abi Roper and Tom Starr-Marshall that made me think — why is change in the NHS so difficult? And in a solution-focused kind of way, what makes particular projects successful?

Looking back, there was a pattern to my attempts at service development (try and follow along with the diagram!):
Continue reading

Check out a new resource for running language groups

The book, with the hat used in the game!

The book, with the hat used in the game!

I recently got my hands on Communication & Language Activities – Running Groups for School-Aged Children, edited by Sarah Nash. Disclosure: I was given a copy of this book by the publisher to review, I used to work in the Hackney Team and Sarah is a friend. That said, here’s what I think.

I loved the illustration on the cover, and was keen to see how the book had been structured. There’s a comprehensive and clearly written introduction, covering topics like planning the sessions, dealing with difficulties and supporting carry over to the classroom.

Continue reading