In the past, I’ve provided a “behind the scenes” look at the anatomy of an AVT session geared toward parents, but what if the responsibility for running the session is on your shoulders? What does it take to actually plan and execute a successful AV session as the therapist?
It starts with knowing your stuff. Know it cold. Know it inside and out. Know it well enough so that when the child has thrown the toy to the floor and the parent has totally checked out you can still feel confident that you have the knowledge and skills to keep the session going. I always tell my students and mentees that you have so much on your mind during a session — recording the child’s output, implementing the activities, coaching the parents, monitoring your own performance. The last thing you want to do on top of all of that is be scrambling to come up with the fundamentals! No sweat, right? It’s a monumental task to be able to not only learn, but also to synthesize and apply, a mountain of information about child speech, language, and hearing development, hearing technology, speech acoustics, and parent counseling, but the time and effort you spend in acquiring this knowledge will pay off over and over again as you giant the ability to lead therapy sessions confidently. For example, one of the assessments I use is the Cottage Acquisition Scales for Listening Language and Speech (CASLLS). Knowing the developmental milestones on these charts allows me to move between goals during therapy, scaling up and scaling down (the “diagnostic therapy” principle of AVT), without detracting from the flow of the session. Remember that you can have planned the best toys and cutest activities in the world, but without this knowledge, they are useless to the parents and children you serve.
Next, you have to have a solid plan with goals covers all the bases. What are your goals for audition, speech, language, communication, and cognition? I find that professionals who are not confident in their skills tend to stick to goals from just one of these domains (the one with which they feel most confident), often unknowingly. Aim for a balance. The last thing you want to do is finish a session and think, “What did the child really have to do for conversation-wise this past hour? All we did were auditory goals” What are the child’s present levels in these areas and what are the next steps you will take? What do you want the parent to take away from the session? Is there a certain therapy technique you want to teach, or a parent education topic you’d like to cover (for example, explaining the upcoming IEP process or discussing the child’s cochlear implant candidacy)?
Then, decide what activities you will use to introduce those goals. Remember that activities should follow goals, not the other way around. As you gain confidence in planning and leading therapy sessions, you will be able to craft activities that combine goals seamlessly. But if you’re not there yet, don’t worry! It’s much better to start with one goal: one activity if it means you’ll implement it well than to try to do a multi-goal activity where you feel like you’re spinning plates. Remember, also, when considering multi-goal activities that they work best for goals in which the child already has some level of competence. For new goals, remember: just one hurdle.
Okay. You’ve prepared and planned, and now it’s showtime! What can you do “live” during the session to help it go well?
You do not have wings, so you must be unflappable. Remain calm. Remember that dealing with children’s behavior (and/or parents’ emotions) is like an escalator — they start going up, then you start going up, and nobody wins. Step off the escalator! The more chaotic the session gets, the calmer you get. As long as the child’s behaviors aren’t presenting a danger to himself or others, just keep pressing on. Usually, the issues aren’t even that great. Sometimes a minor glitch is enough to throw you off your game. Don’t let it! Just keep on going. Child throws a toy? No biggie. Bodily fluid explosion? It takes a lot to scare me. Stay cool as a cucumber. You can do it!
Keep it moving. Pacing is both so simple (you only have two options: faster or slower), yet so complex (how much? when? why? how?), and it can be a real key to keeping a session flowing smoothly. I think that new clinicians tend to err on the side of moving too slowly in therapy. You’re trying to juggle so many things, and it’s easy to get bogged down in the mechanics. You’re running on all cylinders and by the time you look up you realize it’s taken you five minutes to even begin the intro to an activity, and by this time the child is on the floor and the mom is trying hard to keep her eyes open. The same thing goes for knowing when to end an activity. You want to set it up, get playing as soon as possible, and then get out before the child gets bored. End on a high note and move along!
Don’t be afraid to make mistakes or show the parent anything less than “perfection.” This was my biggest fear and misconception when I started as a therapist. I was convinced that if I tripped up in the slightest, or if there was even a minute in therapy that was not a “wow, fireworks” moment, that parents would think I wasn’t doing a good job. Slowly, though, I learned: mistakes are great! I think that we as therapists put a lot more pressure on us than most parents ever will! Take at least this one worry off of your plate. It’s okay to make mistakes. It’s okay that every activity won’t necessarily be a winner. Learn from your mistakes. Point them out to parents, and help them learn from them, too. Try the activity a different way. Approach the issue from a different angle. And if that doesn’t work, it’s okay to call it a day on that task and try something new. Even the best of the best make mistakes. Check out Warren Estabrooks’s classic “Save the AV Session” ideas.
Be mindful of the “Talking Triangle.” Participation in the session should be equally balanced between the therapist, parent(s), and child.
Have FUN! Above all, therapy should be a joy for all involved. The beauty of extensive preparation and background knowledge before the session is that it allows you to lighten up and enjoy the session itself. You have an incredible opportunity in this session to spend time watching an amazing little person grow and learn about the world. You have the privilege of walking alongside a parent and helping coach her to be her child’s first and best teacher. Sit back and marvel at the awesomeness of this moment.