What goes into a speech therapy session?

As with so many things in life, the key to a really good speech therapy session is good planning and preparation so I thought I would write a post about how I plan and prepare for each session that I do.

The first thing any speech therapist will do when they see a child for the first time is assess them to figure out what the underlying difficulty is.  Assessments come in the form of standardised assessment and informal assessment. A standardised assessment is a published ‘test’ which compares a child to other children of the same age using standarised scores. Informal assessment is used either where a standardised test does not exist or will not work well for the client in question. It takes the form of activities planned by the speech therapist to elicit certain language structures or simply consists of observation of the child during play or other day to day activities. Once the initial assessment is done,  I will analyse the results and use these to guide what we will work on in subsequent therapy sessions.

Next, I come to the planning stages when I decide on our overall targets to work on over the block of sessions as well as what to work on in each individual session.  This is always based on the assessment of the specific difficulty in question and my first aim is to form a rough ‘road map’ for a block of therapy sessions.  At this initial planning stage you never know how quickly a child will pick up on different topics or strategies. Having a  good understanding of the underlying problem and a clear idea of which areas to work on and in what order it makes it easy to move on as needed to keep the client engaged.

Simple speech therapy S game

A simple speech therapy game working on S

Once I have my over all therapy road map I move onto the planning of individual sessions and this is where I use all my skills and experience as a speech therapist to tailor each activity to the specific needs of the child. Even though I may sometimes see children with exactly the same speech difficulty and consequently quite similar therapy road maps, each individual requires quite different activities as their personalities, interests and ages may be quite different.  For example, one child may work well with a board game where another would work much better with an interactive game like crocodile dentist.

In all sessions, making it relevant, fun, enjoyable and interesting is the most important challenge. This often involves making materials of some sort and modifying the rules of toys, games  and activities so that they are relevant to the session. It is important to make sure that the difficulty of the game and the rewards of the game are tailored for each different client so that they stay engaged with the task, finding it neither too easy or too hard. I know I’ve got it right if they are looking forward to the next session!  For older children toys and games are often less suitable and this is where the interests and hobbies of the child or young adult are used to guide activities.

After the planning and making materials, the next thing I do is assemble all the materials into different boxes for each therapy session.  These fit neatly into my speech therapy cupboard so that I have all I need for the day whilst I am out and about in East Lothian and Edinburgh. In each of the boxes I always have to pack a back up plan just in case a session isn’t going as planned and I need to make the activity easier or harder to keep a child engaged.

Just before each session I also have to think about the work environment in the mobile therapy room.  Sometimes it needs to be very interactive, making full use of Velcro and magnets and sometimes it needs to be quite plain if a child is easily over stimulated or has a lack of focus.  The layout of the therapy room is important to make sure that you get the most out of the session.  Sometimes this involves working on the floor and sometimes working at tables. In addition I have to remember the obvious but easily forgotten things like making sure that the therapy room is warm enough and light enough for a good therapy session.

Once it gets to the actual session, hopefully everything will go like clock work and look to a casual observer like little more than structured play or an informal conversation. The more relaxed and natural the interaction in the session, the better as it gives me the best insight into the problem, what is being taken in and what needs to be done to move forwards.  It is really important for me to stay relaxed and playful on the outside but really focus my mind on observing the child so that I can pick up on all the subtle non verbal clues that give insight into the progress that is being made.  It’s always important to remember that sometimes activities do not work as well as you had hoped and if this happens there really is no point in flogging a dead horse! At this stage the most important thing is observation, thinking on your feet and reflection afterwards to see if there is anything else you can do differently next time.

Once the speech therapy session is over, it is essential for me to write up my notes promptly. My notes detail my observations (subjective as well as objective) from the session and are a continuous informal assessment.  The observations I make of the child’s response to the activities in the session are then used to guide the planning of the next session. My observations allow me to provide guidance and activities for parents to use at home and to other professionals such as teachers, other therapists or nursery staff.  Working outside of the session is the most important part of any child’s speech therapy support as this is where practise and the the generalisation of skills happens! After all, you wouldn’t expect to become a guitar virtuoso if you only practised for thirty minutes or an hour each week with your teacher!