I’ve found it challenging to get back into work mode after the winter break. It’s dark when I leave the house and dark when I get home.

Here are three things that have inspired me:

• Observing the progress my clients are making. I’ve reminded myself to slow down and notice the changes in each client. One is now able to produce s clusters, another can make a choice between two options, and a third has started asking questions. Their exciting progress keeps me motivated.
• Doing a little CPD at a time that suits me, sitting at my own desk. I watched this Hanen eSeminar: Choosing Initial Vocabulary Targets for Children Who Are Late Talkers, which deserves a blog post of it’s own. It made me think about which of my children Hanen would classify as Late Talkers and gave practical ideas about the types of words to choose for targets.
• Reading beautiful books which aren’t about speech therapy. I received Erin Boyle’s book Simple Matters in the post this week. The gorgeous photography and inspiring ideas were just what I needed to get out of my winter funk. And I’m sure there are principles I can apply to therapy, for example I’ll definitely think twice about buying more plastic toys, or resources. I also had another look through Joel Henriques’ book Made to Play. Another book with gorgeous photographs and the craft projects range for simple to pretty complicated. I’m going to pick a couple and have a go.

What do you do to stay motivated through winter?

To finish this series on Becoming Independent I’m going to write about two challenges I have: resisting doing things the way I always did them in the NHS and scheduling clients.

When I started working independently I kept asking myself: am I doing this because it meets my client’s needs or because this is the way I’ve always done it? One of the things I appreciate most about working independently is the freedom and flexibility I have to offer clients what they need.

Length of therapy blocks

Here’s an example. I started out booking clients in for 6 weeks blocks of therapy, like we used to in the NHS. Then I realised I didn’t need to be constrained by this timeframe if it wasn’t working for me. Although when I reflected on it, I realised it was working. 6 weeks is long enough to make measurable progress towards goals and allows me and the family to continuously review how we’re getting on. Parents can commit to blocks of 6 weeks; it doesn’t seem like speech therapy is something they’ll be doing forever.

In most cases, I have dropped the “consolidation period” between blocks of therapy, which we used in the NHS. Although I still use it for Parent Child Interaction Therapy because I see families benefitting from it. With direct therapy I see clients on a weekly basis for as long as they’re making progress towards their goals.

I’ve cut down on paperwork. I see parents each week and we discuss targets and progress, I don’t tend to write review reports or formal programmes, they’re not normally necessary.

Scheduling

I don’t have much advice to offer about how to arrange your therapy schedule, I wanted to flag this as one of my challenges. Parents enquiring about private therapy assume they can request an appointment time that works for them, which of course they can! However, as I only work two days a week it feels like more often than not our diaries don’t match up. Some parents are able to juggle things around; move the swimming lessons or switch the day of the week they work from home. Others aren’t, and ask me to recommend a different therapist.

I’ve learnt a few things that might be useful:

• The 8.30am slot is popular, but doesn’t suit families who have other school aged children to drop off.
• The 3.30pm and 4.30pm slots are also popular but don’t tend to be productive with nursery or reception aged children who’ve spent the day at school.
• Many parents are surprised when I suggest they could drop their child to nursery/school later or pick them up earlier to accommodate therapy sessions. Nurseries/schools respond to this in different ways, some are happy to release the child for therapy and others are not. It seems to be worth a try.
• When I had more free appointments, I tried to be strategic, e.g. offering mid morning (and sometimes hard to fill) appointments to children who did the afternoon session at nursery.

In some ways things are more straightforward now I’m close to capacity: either parents can make it work, or they can’t, and that’s okay with me. I bring up my availability early in the conversation, because if Tuesday at 2.30pm is impossible for a family, I don’t want them to feel they’ve wasted their time giving me a lot of background information.

That’s it for the Becoming Independent series! Did I miss something you’ve been wondering about? Let me know.

Photo by Cygnoir.

This 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. 

I also now understand how difficult it can be to get to appointments on time. I hate being late, but it’s hard getting me and the tiny person out of the house at a set time. I’ve sacrificed the shower and hair combing to make sure we made it. As a therapist, I can’t organise my day so that families can come to their appointments 20 minutes late although I can try and schedule the appointment for a convenient time. 

As a new mother, I’ve been the “patient” or “client” which takes some getting used to. I hadn’t spent a night in hospital since I was born! I’ve struggled with breastfeeding, when I tried to access support I realised: I didn’t know what normal was, and I needed to listen to my gut.

When I started telling the midwives and then the health visitors that feeding was incredibly painful they all said a variation of: “it is at the beginning,” and suggested I give it time. My gut told me something was up, but I’d never done it before and I didn’t know what to expect, I had no idea what “normal” was. It took lots of tears (mine – not the baby’s!) blood, an infection, and me doing my own research before I insisted on a referral to the tongue tie clinic. After 4 weeks I’d found the reason for all the pain and we could begin to move on. 

As a therapist I want to remember that parents may not know what type of communication to expect at their child’s age and although, of course, there is a huge range of “normal” I can provide them with this information. I also want to give parents time to explain to me what their gut is telling them, and really listen to them. I felt frustrated, overwhelmed, and angry when my need to be understood wasn’t met. I knew the professionals I saw didn’t have a magic wand, and couldn’t make the pain disappear, I needed to be understood.

Finally, although I knew no one I spoke to would have that magic wand, I really wanted them to. I know this is how some of the parents I work with feel. My partner gently reminded me we were looking for small improvements, aiming to move in the direction of painless feeding. He encouraged me to record the progress we were making in a notebook, suggested I review it often, and broke out the bubbly when we made it! I want to be this supporter in the therapy process, and bubbly on discharge is an idea I could get behind! 

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?

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.