37. How to Pick The Best Speech Therapist

Building a Collaborative Partnership through Winning Conversations

So in my episode with clinical lead for engagement in telehealth, Lucy, we really touched on the fact that it’s less about engagement and more about collaboration. What we mean by that is that when someone turns up to therapy, whether that’s an adult or a child, you are going to get more out of therapy if you put effort into the relationship with your therapist. Sometimes that relationship is going to have to have winning conversations.
Now I say winning conversations because some people find winning conversations – we call them winning conversations at Pop – those hard conversations like where you disagree or where you go, “Oh, I don’t like that,” or “I don’t really think that that’s relevant,” or “I don’t like this activity.” So as an adult, what you might find is that you want to shy away from that winning conversation or that difficult conversation. But really what we’re asking is that we want you to come forward and we want this tool. We’ve created a tool, it’s called your playbook for how to choose the right therapist.
And we’ve created this tool because we want to facilitate winning conversations. So whether it’s for you on your therapy journey as an adult or for advocating for your child, now this can translate to almost any setting. This is advocating for yourself, and health professionals do not sit on a pedestal and know everything and dictate to you. That’s not the way that it works. Health professionals or speech pathologists are also not entertainment that’s required to engage and entice your child to do something. It’s a two-way street and a relationship. And we are on the same team and we’re collaborating and working towards your goals together.
So a big part of that is advocating for yourself and knowing how to ask the right questions and feeling comfortable and confident in maybe asking some difficult questions to your therapist. And do you know what? They’re getting paid to answer them! If they don’t know the answer right now, that’s okay. They should be able to go and find the answer for you and get back to you. So let’s go through. I really want to go through this playbook with you to show you how you might be able to use it as an advocacy tool for yourself or for your child.

The Playbook for Choosing the Right Therapist

So here we are, we’ve got your playbook for how to choose the right therapist for your family. Now you might be thinking what a funny thing to ask, but really at Pop what we’ve realised is that making the match between the family and the therapist is arguably the most important thing that we can do to predict the best outcomes. Now you might be thinking, “What?” But it is like matchmaking. We make jokes about how we’re a matchmaking service and how we need to use one of those swiping apps so we can allow parents to go, “Oh, this feels right for me,” or “This doesn’t feel right for me.” And also for our therapists on the other side to be able to say, “This feels right for me,” or “This doesn’t feel right for me.”
Because if you’ve got a therapist who aligns with your values and likewise the family, you’re really going to come together more quickly. You’re going to see eye to eye and you’re going to be on the same page. Of course, you’re going to still have to have some of those winning conversations and that’s what this tool is for. But really, that initial match is such an important part of getting great outcomes in therapy, because that is a prognosis for building rapport and ongoing success. That’s what we found.
So when you’re choosing your speech therapist – hypothetically you’re looking for a speech therapist – what questions should you ask them? So, I mean, we know that connection and collaboration with a therapist predicts outcomes. The better relationship you have with your therapist and the more you’re on the same page, the more progress you’ll get in a shorter period of time. So you could ask the question:

• How are you going to build connection and trust with my child?
• How are you going to build connection and trust with me?
• I want to know what your style is.
• What is my role during sessions?

If I’m a parent, I’m going to sit in the parent’s seat. Now, if I’m a parent, what’s my role during sessions? What do I do? What does my child do? What do you do as a therapist? How is this going to work? Instead of us bumbling along and having surprises along the way, or me as a parent having an idea of therapy and then it going a different way and I get let down. You can really ask these questions straight up.

• How do you make therapy feel safe and enjoyable?
• How do you make therapy feel child-led rather than pressured?
• What strategies are you going to use when my child becomes overwhelmed or says no?

Each therapist will have a slightly different style and those things might be – you might say, “Oh, fantastic, that’s what I do too as a parent.” Or you might say, “Oh, in our house we like to do it this way.” And so what you’re doing is you’re getting more on the same page with that therapist as you ask these questions. And that therapist is going to be so grateful that you have given them this insight into how you parent and how you’d like to collaborate with your therapist working with your child.

You could ask, “How do you tailor sessions to my child’s interests?” So this is really important, but some therapists might not have thought about that. So it’s really important for us to be working in a child-led way where the kid is actually interested in coming to therapy. How will you monitor progress? How will we review goals? So if you’re a privately paying client – NDIS has frameworks where you have to write a report and do assessments. But if you’re privately paying, there isn’t necessarily a set rule book on how to monitor progress or review goals. So you might want to know, “How am I going to see that I’m getting value for money?” “How am I going to see that there are outcomes?”

I mean, I can tell you as a therapist, I’ve been a therapist for over a decade, I can tell you that you will feel the outcomes; you will be able to dictate them back to your therapist over time. But it’s really important that your therapist has thought about this upfront and that they communicate this with you – how they’re going to monitor that progress.
What makes home practice achievable? Now, depending on where you’re accessing speech therapy, there may or may not be home practice. At Pop it’s pretty much a requirement. Now that doesn’t mean that every single family has to do their home practice all the time. What it means is that we have a home practice element that is built into our service and it will be provided to you. And you can choose to do that or not do that. But the reason why we build that in is because we know that when you get reps up and when you work a muscle more often, you’re going to get progress more quickly. So that’s why we really encourage home practice.
What makes it achievable? How can we adjust it? Like if you’re super busy, you might have five kids going in five different directions and the home practice worksheet that you were given is just too much. You can ask your speech therapist to adapt that for you and to change that. And how is it going to work into our lives? How can we make this more achievable? How can we adjust this homework?
Also, how do you involve parents and other family members in the therapy process? So, especially when you’re accessing therapy via telehealth, what if your child is accessing therapy at school? We need to know that as parents, we’re going to have contact with that therapist. When is that going to happen? How structured is that going to be? Will it be five or ten minutes of every session and a phone call at the end at a set time every week? Will I catch up with you for a whole session once a term? There are so many different models, but we need to make sure that as parents, we are involved and that we know what’s going on.
If my child is doing therapy at home, am I required to sit next to them? What is required of me? As the parent of my child doing therapy, what do you require of me as a therapist? What’s my role? Are siblings allowed to attend? Can they sit next to us? Can they join in? Those are the questions that you can also ask your therapist. At Pop we definitely encourage that. We find that we get a lot of uptake when we have siblings doing it as well. And then we have siblings who are practicing homework. Everybody wins. It’s much less work if it becomes a fun game or activity for the whole family.
This is a great question: Can you describe what successful therapy looks like? As a therapist, I would crave to be asked this question. And I would say, “Okay, yes, hypothetically, we get three months down the track, and this is what we see if we see success.” And then I would say, “Right at that point, if we didn’t see that, then these would be our two choices.” So this would give us some really good touch points. And so then we could work for three months, and then we can have that conversation. And that comes back to: how are we going to monitor progress? So those two things go together.
What might make our family a great fit for this approach or not the right fit? So when you’re talking about therapy, activities, styles, interventions, there are so many different programs that we can use. Your therapist might be using a program that you feel like doesn’t fit your family. And so you might be able to say, “I just don’t know if this is a great fit for us. Our family likes to do things in a less structured way. Is there a way that we could approach this therapy differently?” It could also be the model of care. So it suits us better to do therapy at school or teletherapy. You can do teletherapy at school, at home, at grandma’s house.
So we can always bring forward these questions and have winning conversations to help us choose the right provider and get the best results. Because at the end of the day, you come into therapy to get results and improve the quality of life of yourself or of your child once you’ve started therapy. We also have in this playbook questions to ask once you’ve started therapy.

Indicators of Fast Progress and Success

So I’ve chosen my provider. I asked all the questions above. I really want to know what successful therapy looks like. So this is the question on the page above that I probably loved the most, which is hilarious because it’s got its whole section below. And I did not create this amazing playbook. Lucy did. So, well done, Lucy!
The way that we have a look at this is we can tell you what families report when they’re reporting fast progress. They often have a strong, trusting relationship with their therapist. And we’re calling this a partnership for a reason. You are working together. This is not a “drop and go” service. Especially when you do telehealth, the parent has to work hard. And I can say that I’ve tried to start therapy – I actually had to pause it because it was so hard and I wasn’t in the right place to build the partnership. So the partnership is really important and you both equally need to be on the same page.
We then have consistent attendance and predictable routines. So that’s just a huge one. It’s like going to the gym. Are you consistent? You know, if you’re consistent, you’re going to build the muscle. If you’re not consistent, are you going to be surprised when you don’t get fit? It’s the same thing with speech therapy. We are working on the brain. The brain is a muscle. We need to work that muscle consistently and have predictable routines. Is it once a week? Is it twice a week? And then how often do we do our homework? And if we build that really strongly into our weekly routine, we’re just going to get that fast progress.
Shared decision making. So is your therapist dictating everything to you? And the thing is, they might not be a dictator. It might be that you are a parent coming to them saying, “I have no idea, I don’t know what to do, I’ll do whatever you say.” And really that’s okay in the very beginning. But also if you get a feeling that something’s not working, that is where that shared decision making and that collaboration really needs to come forward. You can let the therapist steer the ship, but only so long as you agree with how they’re steering it. If you want it to go in a slightly different direction, you need to come to that party, have a winning conversation, and then you can be shared decision making and steering that ship towards success – towards therapy success together.
Home practice that feels doable. Home practice is so important, but making it doable is an art in itself. This is probably the most common conversation that parents need to have with their therapists. Like, “Yes, we did,” or “No, we didn’t do our homework.” Can you build it into a daily routine? Not everyone has the same daily routines, but if you’ve got a preschooler and mum is at home, then let’s build something into the washing or bath time – daily routines that she’s doing with her babies. If we’ve got a school-aged kid, can we build something into the car trip to and from school? You know, how are we going to make it super doable? How are we going to give little short, sharp rewards and make it not a big fight and sitting down to do a homework worksheet every single time? We can really adapt this, make it play-based. Let’s make it fun; let’s make it a connection activity between the parent and the child. Every child loves playing games with their parent, but the parent doesn’t want to play for 30 minutes. So let’s make it work for every family.
All right. A therapist who sees the child’s strengths and communicates hope. I mean this is neuroaffirming, but it’s for every child. We really need to have therapists who are strength-based. We really need to see the superpowers in the kids that we’re working with and we need to be able to call them out on what they’re amazing at. And the fact that that’s written down – it shouldn’t baffle me – but that’s just a prerequisite of being a therapist and if you don’t feel that, then maybe your therapist is probably not right for you.
A child who feels safe, respected, and understood. Even if your child finds therapy hard and they might get upset sometimes or not want to go or it’s a bit tricky, but once they’re in there, if they enjoy that therapist’s presence, they have a nice rapport and they are feeling safe and respected and understood, then we’re really likely to get that faster progress as opposed to having a relationship with a therapist that is not that deep or strong.
So the questions that we can ask ourselves as parents to work out if we’re really on this fast progress and therapy success track is:
Do we feel like we’re on the same team with our therapist? Like, this is teamwork. Do we feel like we’re on the same team?
Does therapy feel good for my child, for me, and for our family?
If the answer is no, then maybe we can have a look at some of the things above.
Now, once we’ve already started therapy, we can also really drill down and reflect on: How does my therapist connect with my child? Each child is very individual; they’re their own person. We need to really reflect on:
Did our therapist take the time to build trust before expecting participation?
Did our therapist look for my child’s cues? So are they looking for hesitancy, stress, overwhelm, joy? And are they following that pattern as well? So does it feel like a seamless ride?
And then if my child becomes upset, is that therapist then paring it back and responding to that emotion in that situation within the session?
Does my therapist respond calmly, consistently, compassionately? We want that calm. We want to feel calm when we’re in a session. We’re not going to get progress in a stressful environment. Our child needs to feel safe.
Are we celebrating small wins? Like I said before, this is just a prerequisite of being a therapist. We are there for positive reinforcement. We are there to make it fun. What we reward gets better. We just need to keep on doing that. That is just… you do learn that at university. It’s just Therapy 101.
Does my therapist follow my child’s interests and let them bring their full selves? Can they be their full quirky self in front of their therapists? At Pop, we have a water cooler chat where we get to share these wonderful quirky moments with each other where we just get to see who these children become in front of us, and we get to see the inner workings of these beautiful children’s brains. And it’s one of the biggest privileges, essentially, as a therapist. When you crack that super special child and they get to become their full self with you, then you know that that’s where the magic happens. And those relationships are just so special. Because that child also wants to work hard for you because you’ve got that special relationship; they can bring their full selves because they feel safe.
Does your therapist allow choice? Do they encourage autonomy? And do they respect and know “no” sometimes? Sometimes we need to take “no” where it’s at and we need to move on for today.
Do we adjust tasks to help things be achievable and meaningful? Sometimes as therapists we reach too high. We need to work on the boundary of what’s hard, not what’s too hard. And so sometimes we’re going to go to what’s too hard, but how do we respond when we get it wrong and we need to pare it back?
Do we notice and act when your child needs help managing their emotions?
So questions that we can ask ourselves if we’re thinking about our therapist’s connection with our child is:
Does my child feel seen, safe, and comfortable with my therapist?
Does the therapist value connection rather than just getting through activities and ticking off the to-do list for today?
The reason why this is important, again, it’s so not wishy-washy. It’s not light touch. It’s not woo-woo. This comes back to the core foundational principle of how you get success in therapy. If you get success, you get better results more quickly, you spend less money, and you know what, you enjoy it a hell of a lot more. Because as humans, we’re social beings. And every single human craves connection.
The stronger that connection – and I’m explaining what that connection should look like in a therapeutic relationship – the stronger that connection and the stronger your therapist values that connection with you or your child, the better your results will be. So that’s why we’re going through this. And that’s why their connection with your specific child or you, that connection is going to be slightly different. And therapists know the importance of this, or they should know the importance of this. And that’s why we need to ask ourselves: Is our therapist valuing connection and not just ticking boxes through activities?
You know what? You can tick boxes and work hard and get through activities. Absolutely. You can do that in therapy. I’ve done plenty of that, but I’ve only been able to do that once I’ve built that really strong connection with that child. And then I come in and I go, “Rattle, we’re writing a narrative today,” and they go, “Okay, Ms. Heidi.” I would never ever walk in on day one and say, “We’re writing a narrative today” without having the foundations of that connection and that relationship with that child.

Navigating In-Session Dynamics and Telehealth Considerations

So once we started therapy, we can also ask ourselves and reflect on: How does our therapist involve me as a parent?
Do they invite my input and my expectations clearly early?
Do I know where I stand?
Do they model strategies? Do they help me have a go? Now, as a parent, this is going to feel uncomfortable, but the more you are involved, the better your child is going to succeed and the quicker that success will be. You are the best therapist for your child, hands down. Your therapist is like a paid consultant. If they teach you to do what you need to do for your child, you’ll pay less in therapy and get results quicker. So that’s why we want you to know this. This is the secret sauce.
Do they make home practice achievable? We’ve already talked about that. Making home practice achievable is just really specific for each family and what works for one is not going to work for the next. We really have to tweak this to get it right.
Do they provide resources and link practice to progress?
Do they educate me? Does my therapist say, “Hey, I really thought that you’d like to read this because I think it relates to your child,” or “I was looking at this the other day and I think it relates to your child”?
Do they ask about routines, strengths, and challenges specific to our family? What’s going to work for me as a parent, as a mother?
Do they problem solve with me or do I just feel direction? Now, this is a two-way street. Once again, this is not all my therapist’s fault. If I as a parent have not come and had that winning conversation and said, “Oh, excuse me, this isn’t working for me,” then my therapist might not know. They are giving direction as best as they can with the information that they’ve got.
So I’m really trying to encourage you as parents to step forward and ask those questions. Even if you find it difficult to ask these questions, you might want to write it down. You might want to send it in an email before your session and give your therapist time to prepare answers to those questions so that you don’t have to ask them yourself or confront your therapist with the questions. You definitely can text them or you can send an email with these questions to make sure that you really get that winning conversation going. Communicate in the way that feels best for you.
All right. So we can ask ourselves:
Do I feel welcomed, respected, listened to? Is my therapist listening to me when it comes to therapy for my child?
Do I understand what we’re doing and why we’re doing it? Honestly, if you don’t know why you’re doing a therapy activity or task, then that is definitely on you to ask, “Excuse me, why are we doing this? Why is it important?” And if your therapist doesn’t know the answer right now – because it could be something that they’ve learned at uni and then they don’t deeply understand why they’re doing it – ask them, “Can you go away and find out?” They should be able to tell you next time you see them. And that’s one of the most important things: we need you as parents to know exactly why you’re doing every little activity or why you’re working on certain goals. Because otherwise why are you paying for it if you don’t know why?
Do I feel confident using the strategies at home? Do I feel confident in how to do it? Does my therapist need to switch things up or change the way? Do we need to change the way that we’re modeling our service? Because if I’m not in the therapy session with my child, I might not feel confident to do the homework because I haven’t seen how it goes. My therapist can definitely problem solve that. And your therapist would definitely be able to problem solve that with you by using better communication. You could be sending videos or emails. You could work that out.
Do I feel safe, respected, and comfortable giving my therapist honest feedback about what is not working for my family now? This is a big one. As a parent, I implore you, if you are doing therapy with anyone anywhere, please give them your feedback. If you don’t feel comfortable giving your specific therapist your feedback, call the clinic; give feedback. Now that I own a clinic full of therapists, if I’m using a service – and I use a lot, I love my body work, I go to holistic clinicians, especially dentists – and I will give feedback. I will write Google reviews now, generally positive ones. If it’s constructive criticism, I will call the clinic and let them know. Because if they don’t know what their blind spot is, how are they going to get better? We really need to be able to help and work with – on the same team as – our health professionals in order to achieve the goals that we want.
So it sounds obvious, but like, next time you’re thinking, “Oh my God, I really didn’t like how she did that,” or whatever – if you think that about your therapist five or six times, you’ll just quit therapy, you know, or you’ll just go somewhere else. Do you know the wasted time and money that you will spend on then building a new relationship? It is so much easier to just have that conversation with your therapist and ask them to adapt or change or to ask them to explain why. Generally those two things are going to solve that problem.
Now, if you don’t feel safe or respected or you just feel a little bit uncomfortable asking that question, definitely go back to texting your therapist, emailing your therapist, or calling your manager or the administration at the place that your therapist works in order to try and give that feedback, to facilitate that conversation with them.
So once we’re in teletherapy, if you’re doing telehealth speech therapy, what are the considerations that we have to make when we’re already with our therapist?
A great telehealth or online therapist will help you set up the space for transitions. So they’re not just going to expect you to know what to do on the other end of the screen. They’re going to say, “All right, this is how I want you to set it up for next session. This is what it’s going to be like,” you know, da da da da da. Or they’re going to explain you through it as they go on the day. That is what a great online therapist does.
They’re going to use rituals. So if you’ve got kids – we’re working with kids – we’re going to have hello songs, we’re going to have structures that we build into our teletherapy and routines that really build that connection and give the child a sense of safety in “Oh, okay, I know what’s coming next because it’s the goodbye song,” that sort of thing.
If you are working with a great telehealth speechie, they are going to guide you to become the eyes, ears, and hands. Like I said, you are the best therapist for your child. You are on the other end. You are a speech therapist now – like if you sign up to Pop, basically you’re a speech therapist now. We do see some school-age children from school, of course, where the parent doesn’t have to be present or may not be present if the child is old enough. But in most cases, you are the eyes, ears, and hands on the other end of the screen. You are tech support; you are everything; and you are signing up to speech therapy too. That sounds huge. But actually, if you relax into that and know that that is our expectation of you, then I actually think you might enjoy it. And also how empowering to know exactly how to support your child! Like it’s really empowering. I’ve been through this journey with some of my clients for over seven years now and I’ve watched these mothers go from insecure and unsure to just fierce advocates who we joke that they just don’t need me anymore because they’re speech therapists now. The journey that you go on as a parent when your child is in therapy is hard. But yeah, you can really get those fast outcomes if you are doing the hard work because you’re the best therapist for your child.
Is your therapist focusing on observation over controlling the session? So are they sort of letting things flow and observing what happens rather than always jumping in, pushing things forward?
Commenting instead of using questions. Comments are really powerful. And using modeling to regulate that connection.
Co-creating the plan for the session with your child – that’s beautifully play-based. So an example of that is your clinician maybe asking, “Okay, what do you want to play next week?” or “How are we going to do this next week?” There are certain things that obviously your therapist needs to set out and activities that they need to do, but if we give a little bit of that choice – wow, that child can come a long way to the party if they get to choose something or have a really active participation in co-creating that plan.
The question that you can ask yourself to check if you’ve got that collaboration in a telehealth session with your therapist is: Does online therapy still feel warm, connected, and child-led? Because it might not always. And it is harder via telehealth; it’s absolutely harder. It’s something that we have been trying to crack the code on for years and some therapists can definitely do it easier, more naturally than others. And the way that we as therapists are going to get better is by having winning conversations with our clients. We want you to ask us these questions. We want to get better and we want to raise the standard. Like any therapist that you go to should be willing to answer these questions for you.
So there is a section down the bottom as well: What should I do if I answered “no” to one of these checklists? I’ve said it and I’ll say it again: please give that feedback to your provider. If it’s us, let us know. At Pop, you would be fortunate to be able to request to change a therapist if it came to that. But ideally we’d like you to have one of these meeting conversations with your therapist first. Call our office or let our administration or leadership team take that feedback on as a second option. And then you could always change therapists if you’re with us. If you are in a rural town and there is one speech pathologist, your only choice is to have a conversation with that speechie. And so we implore you: take this list, go forth, and hopefully you will build stronger connections with your speechie, and you’ll get those, you know, faster, better outcomes.
That’s our goal. We want the best outcomes in the shortest period of time. And part of the secret is to build a strong collaborative relationship between the client or the child, the parent, and the therapist. And that looks different for everybody. So good luck. Go forth!