Category Archives: Thoughts about Therapy

Can I Shadow you? Pre-course clinical experience

Shadow photo

Since setting up in independent practice I’ve had almost weekly emails from people who want to train as speech and language therapists. They explain they need to gain relevant work experience and ask if they can come and shadow me during therapy sessions with my clients.  Continue reading

What influences progress in therapy?

Therapy setup

When I caught up with my former NHS colleagues recently, they asked me how my independent practice was going. I commented that I’d never seen children make as much progress. We started unpicking possible reasons for this rapid progress, was it that:

  • I see the children once a week on an ongoing basis? Or
  • The parents are particularly engaged because they’re paying for the service? Or
  • I’m able to tailor therapy to a child’s particular needs? Or
  • A combination of all three factors? Something else entirely? 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.

Speech and Language Therapy App Review: Colourful Semantics for iPad

I’ve been using my iPad in therapy for the last couple of years. I tend to use apps which aren’t specifically for speech and language therapy (like the fabulous ones from Toca Boca) as motivators and to work on language and social skills through play.

When the team at London Speech Therapy tweeted a request for bloggers to review their Colourful Semantics app I volunteered. I was given a complimentary copy of the app in order to review it.

The principle of Colourful Semantics appeals to me, as I’m a fan of clear structure, but the hundreds of small pieces of coloured paper always put me off! Watch Helen Blatchford explain how Colourful Semantics works.

This app removes the need for lots of printing, cutting and laminating, it’s all there ready to go. The app is loaded with a set of photos and the corresponding sentences. You can work at various levels: who, what doing, what, where and describe – which are all colour coded. When you start the game, a photo is presented and the child is asked a set of questions, for example: “who is in the picture?” The child responds by selecting the correct symbol from a choice of four and is given feedback as well as an opportunity to practise saying the sentence after the model.

What I like about the app

  • It can collect data about a child’s performance, the app tracks how a child is doing – what a time saver.
  • The app is visually motivating for children, and I think they’d find it fun and engaging.
  • There is a clear structure, so children would quickly learn what they’re expected to do.
  • The voice that says each sentence is a lovely clear British accent!
  • The app is customisable; you can turn the music off (I’m easily distracted,) turn the praise off (see my view on praise here) and mute the rather directive: “your turn to say it.”

Things I think could be improved

  • It seems to present the pictures in the same order each time you play, which becomes repetitive.
  • The app presents the whole sentence (the cat is eating food outside) when you’re on the simplest level and the child is practising ‘who’ – which is confusing.
  • It’s wonderful that you can add your own photos to the app, however the procedure is currently time consuming and some of the options (e.g. symbols) I required when I tried to add a picture of myself eating a bowl of soup weren’t available.

Mirla Gaz uses this helpful heuristic when reviewing apps:

“In order for me to recommend a therapy app, I need to feel that it can simplify the life of the therapist and will be a fun learning experience for children.”

This app will be a fun learning experience for children. When I compare this version of colourful semantics to the paper based one, it absolutely simplifies life for the SLT. However, in its current form, adding your own photos is not yet simple enough for me to justify the £27.99 price tag.

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.


Parents want a speech and language therapist who has time for them

Post it notes, themes

I’ve been thinking about how parents choose a therapist for their child (I’ve recently set up my private practice). What are they looking for? What do they want? I used feedback I’ve received from parents to make a list, then arranged my ideas into themes.

First there are ‘logistical’ factors. Parents want an SLT who:

  • is punctual,
  • is professional – doesn’t cancel appointments at the last minute,
  • is reliable – does what she says she’ll do,
  • gives appointments at a convenient time,
  • communicates in a convenient way, for example by email,
  • completes reports in a reasonable time frame,
  • has time to listen to them.

Next there are ‘therapist’ factors. Parents want someone who:

  • can build rapport with their child, so therapy is fun & their child likes going,
  • can facilitate progress, so their child develops new skills,
  • is flexible, if something isn’t working she’ll try a different approach,
  • is responsive to changes in the child or family,
  • is experienced,
  • is consistent (this is a big one) they want the same therapist, not a different person every block or visit.

Interpersonal factors are also important. Parents value therapists who:

  • listen to their views and respect them,
  • believe in their child’s ability to make progress and offer hope,
  • can give advice and support around wider issues such as school placements,
  • can work well with the other professionals their child sees,
  • can admit when they don’t know something and ask a colleague,
  • are transparent, with an open, honest, straightforward attitude.

A magic wand and the evidence base

I thought of two more things that don’t really fit in above: the magic wand and the evidence base. Some parents want to find an SLT with a magic wand, someone who can simply make their child’s difficulty disappear. If you find one, let me know, I’d love to interview him or her for my podcast!

Finally, there’s evidence based therapy. I’m not sure how much of factor the evidence base is for parents. Although I’ve never been asked to support my therapy plan with research papers, I have been asked: do you think this will work, how has this approach worked with other children, and which approach will have the quickest result? So some parents are evaluating different therapy options, it’s really encouraging.

When I look over this list, I’m struck by how many of these depend on a therapist having enough time. Perhaps that’s the key, parents want a therapist who they feel, has time for them.

What have I missed? SLTs, what do your families tell you they’re happy with and what do they complain about? Parents, what is most important to you when you’re looking for a therapist? I’d love to hear from you!


Organising life is hard for both therapists and parents


Rhiannan at sunrise (kind of)


London feels different at 6.15am. There’s a sense of opportunity: a new day stretching out ahead. The streets and trains are less crowded, the city feels calmer. Now I’m self employed I bounce out of bed each morning with the sunrise… just kidding! I am doing two early starts a week though, so I can offer therapy sessions before school. Surprisingly, I’ve enjoyed being up earlier than normal. I’m using the change to try out new ways of organising my day. Continue reading

Appreciating that therapy is about More Than Words

More-Than-WordsMore Than Words is a wonderful name for Hanen’s program for parents of children with autism or social communication difficulties; they’re right, it is about so much more than words. I find it tricky to answer the question: what is speech therapy? It’s so broad, and the name is a little misleading — during More Than Words I worked intensively with parents without ever targeting speech. Continue reading