Motivating /r/ Therapy

By Pam Marshalla

Q: I’m working on /r/ with a 4th grade boy that simply does not care about his speech. The parents are upset about his refusals and are blaming me for it! Help!

A Few Ideas for the Client

  • Let him opt out for now. Tell him he does not have to fix this now, and that he can do it later. Make it matter-of-fact and no big deal. Some kids will stay in therapy when they know they can get out. I tell them, “You will want to fix this next year, or the year after, and when you do, I will be here for you.”
  • Help them think about how fixing this sound fits into their life dreams. Humans purposefully dream, or daydream, as a way to carry their life into the future. We can use daydreaming as a way to help our client’s build their future with good speech and to assist in the carryover process.

A Few Ideas for the Parents

Help parents see that most kids balk when their parents push too hard. Tell them that you could keep him in therapy now, but that he is going to end up hating the process and hating you, and then he may never fix it.

The Child Must be Ready

Help them see that the child will do this more quickly and efficiently when he is ready. In private practice, this is easy because parents are paying for services, and they do not want to pay for things that will not be beneficial.

Growth Comes from Discomfort

Help the parents see that their child may need to be teased by a peer before he will want to take speech. This is what they probably are trying to avoid. In our politically correct culture today, many parents think that they should help their children avoid all uncomfortable situations. Teach them that bad circumstances help us grow, that humans are forced to mature when things go the wrong way. I have seen many kids ask to come into therapy as soon as another child teases them about their errors. This gives them strength when they learn that they are in charge of their own lives, and that they can overcome difficult circumstances.

Expressing Feelings

Teach parents that their child probably needs to express something about this situation. He may be afraid to change, or he may be afraid he will not be able to change, or something else along these lines. The parents and therapists need to give him space to talk about these things, otherwise he will continue to balk. He needs an open forum with his parents or with you to express his feelings about this. He may be balking simply because he does not have that outlet. Give him that outlet. “What’s going on? How come you don’t want to do this now?”

To help you learn how to talk to clients like this, I recommend the following great book; It is excellent for SLP’s who want to know how to address these types of problems in children, and it is an outstanding resource for stubborn and anxious parents like these. The book is written for parents and contains many cartoons that illustrate the entire process. It can be purchased used:

Faber, A. & Mazlish, E. (1980) How to Talk So Kids Will Listen and Listen So Kids Will Talk. New York: Avon Books.

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