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. 

At the moment I can’t see how having someone observe me carry out therapy benefits my clients, who are my customers. So I’ve been politely explaining that I don’t offer shadowing opportunities for this reason. Am I missing something? Do you deal with these types of enquires differently?

I tend to suggest that people contact their local NHS service; when I worked in the NHS we offered half day observation sessions. Back when I was looking for relevant experience before applying to train as a therapist I had lots of luck with my local volunteer centre. They matched me to a weekly Stroke club and a summer day camp for children with Down’s Syndrome. I received training and worked alongside therapists, during both of these placements.

The guidance for applying for a place on a speech and language therapy degree course says applicants need to demonstrate awareness of client needs and the skills required to work as a therapist. I wondered if I could put together a short workshop that would support the people who ask to shadow me with their applications. I could cover things like:

• an introduction to the range of clients I work with, and their needs, with video examples,
• an introduction to different types of therapy, and ways of working,
• workshop exercises to demonstrate and practise the core skills therapists require,
• a reading or resource list, particularly those written by people with speech, language and communication needs or their families,
• suggestions for how to approach therapists, to ask for observation experience,
• an opportunity for questions and answers.

What do you think? Does this sound useful? If you’re in the process of applying for a therapy degree course would you attend?

Photo by crabchick

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?

I had a think.

The role of parents

The parents I work with take an active role in the therapy process, however, when I worked in the NHS this was also the case – so it can’t be that simple. I think timing may be a factor: parents contact me when they’re ready for therapy. In the NHS they might have to wait 6 months for a block of therapy, which comes at a time that doesn’t suit them (moving house, one parent away on an extended business trip, death in the family etc.) Parents then look like they’re struggling to engage with the therapy process, when the sessions have just come at an inconvenient time.

A friend suggested that parents who access NHS therapy are often engaged at the beginning of the process but become increasingly frustrated with the lack of flexibility they’re offered. I’ve seen the opposite happen in independent practice: parents engage with the service, they then see progress, and this reinforces their work and commitment. They feel ownership of the therapy process and continue to work hard at home, which means more progress and more reinforcement, and they continue to stay engaged with the process.

The flexibility to be client centred

Seeing the children on a weekly basis must have an impact on progress, however, I think my flexibility to provide them with exactly the type of therapy they need is more important. I’m not restricted to offering blocks of 6 sessions and then a long “consolidation” period, I can get to know the children and their families and they can get to know me. I’m not limited to seeing the children in groups containing a wide range of abilities and I’m not restricted in the type of therapy I can offer depending on the child’s diagnosis or the care pathway they end up on. I’ve spent a whole therapy session negotiating with a child and his mother how and when they’ll practise at home. I’d have struggled to justify this type of session in the NHS, but without it we weren’t going to get anywhere.

What motivates a therapist?

My motivation has changed since I began working independently; I still want to support children to develop their communication skills for the best start in life, I now also need to maintain my business to make a living. As most of my clients find me by personal recommendation from existing clients, I need to provide a quality service that meets their needs. In contrast, in the NHS I was judged on my ability to meet targets, such as waiting times for initial assessments. This can lead to situations that don’t make sense to families or support progress, such as being invited to an appointment two days before Christmas, so a therapist meets her target.

How stressed is your therapist?

Finally, I wonder about the contribution of therapists’ stress levels on progress. Being my own boss has significantly reduced my stress levels, I’m excited about therapy again. I’m now able to bring my whole brain to work, I feel confident to try new therapy approaches and I notice subtle details that perhaps I missed when my workload was out of control. Could these little details account for some of the progress I’ve been seeing?

Have I missed out a key factor? Therapists, what have you found supports progress? Parents, what did you notice about a time your child made speedy progress?

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!

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!):

• I’d have an idea, then it felt like people were blocking me, I’d hear: “sounds great, but….” followed by a long list of why it wouldn’t work, or we couldn’t try it.
• I’d feel angry, frustrated and disappointed.
• I’d either: ignore the objectors and try the idea out, maverick style.
• Or start asking questions. This takes time and requires persistence.
• I’d try for quick wins to show the team that the idea was worth piloting.
• Then cycle through the process again, asking more questions and making more small changes, to try and show value.

Sometimes it worked and sometimes it didn’t! So what helped?

• The 5 Whys is a useful exercise for identifying barriers and understanding what was really getting in the way,
• using “yes, and….” (rather than “no, but…”) helped me stay open to other people’s ideas and viewpoints,
• working with allies, and
• focussing on both the end goal and the details, kept me on track.

Have you managed to push new ideas through and make changes? What helped? I’d love to hear your ideas.

We’ll be exploring this issue at the Therapy Ideas Workshop on 17 May. Join us! If you’d like to discuss whether the workshop would be a good fit for you, email me.

Godin describes a linchpin as “an individual who can walk into chaos and create order, someone who can invent, connect, create and make things happen… linchpins are geniuses, artists and givers of gifts.” He says that although we were trained to be cogs in a giant machine, we can choose to re-train ourselves to become indispensable.

Linchpins don’t wait for instructions, they make their own maps. They overcome the resistance (the lizard brain that tells us our ideas will never work and everyone will laugh at us) and get their ideas out into the world.

In a recent team meeting at work, it was easy to see the therapists whose lizard brains were in control; they suggested we stop trying new ways of working and go back to the old way! Fortunately my team also has a linchpin or two; they’re generous with their gifts and keen to make change. I’m trying to be a linchpin too; we’re starting to draw our own map, overcome the resistance, and ship our ideas.

I recommend checking out the Linchpin Manifesto (PDF link) and reading the book. We need more linchpins in the National Health Service! What do you think?