Coaching the Parent Who Doesn’t Attend Therapy

Due to family schedules, it’s usually the same parent or caregiver who is able to attend therapy with the child each week. Each session, this “present parent” receives coaching, modeling, and guidance in becoming their child’s first and best teacher. In a two-parent family, how do we as therapists also provide this same level of support and learning to the “other parent,” the one who isn’t present in the therapy session each week?

 

How often do we hear from the “present parent” in sessions:

  • “My husband just doesn’t get it.  I’m working so hard with her during the day, and he comes home after work and asks what we’ve done all day long!”

  • “My wife thinks there should be more progress by now, she doesn’t understand how the skills we’re working on in therapy will build up to using sentences.  She just wants him to talk already!”

  • “When I told her dad about the test scores, he was shocked.  He had no idea about the extent of her delays and accused me from keeping information from him!”

  • “Her mom is doing things with her at home that I know don’t match up with the auditory verbal techniques that we’re using, but whenever I try to correct her, it just leads disagreements between us!”

  • “By the time I get home, I can’t always remember how to demonstrate the goals to my partner, and then I feel awful because I know our son isn’t getting the home practice he needs!”

  • “The rest of the family isn’t on board with AVT, and I can’t do all of this at home by myself!”

 

And what might the “other parent” feel:

  • “Therapy is my wife’s job.  She’s great at it.  When I try to do the activities, I just mess them up.”

  • “I have no idea what goes on in the sessions.  I wish I could do more to help my child.”

  • “I feel like therapy is something he and our son do together, and I’m totally on the sidelines.”

  • “My wife has become an expert on hearing loss, but I’m still struggling to understand.”

  • “I have questions for the therapist, too, but I don’t want to send them through my spouse.  I’m not sure the message will get through, and I don’t want to add any stress.”

  • “I feel bad about my inability to participate in the session, so, as much as I hate to admit it, I’ve just kind of stepped back from the whole thing.”

 

What a tough situation to be in!  When we only treat the “present parent,” we put him or her under a tremendous amount of pressure.  Not only does she* have to attend and actively engage in the therapy session, she then has to go home and serve as reporter, test explainer, language model, therapy implementer, and hearing loss educator to the rest of her family.  When we neglect our responsibility to also coach the “other parent,” we’re putting too much stress on the system as well as denying that other parent their full role in their child’s growth and development.  How can we as professionals serve not only the parent in front of us, but also the parent we don’t always see?

 

I believe it’s important for everyone on the child’s “team” to be on the same page, whether or not they are present at the therapy session.  It’s unfair to the “present parent” to have to be the intermediary between the “other parent” and the therapist, always having to be the one to report goals, progress, etc.  They shouldn’t have to always be the reporter, nor should they have to be the one to field all of the questions about therapy.  Too often, the “present parent” becomes the rest of the family’s only contact with the therapist and only window into what happens during an AVT session.  This can put tremendous pressure on the “present parent,” it leads to a lot of stress, and it’s not a good solution.  As a therapist, I like to have both parents’ emails (or more, if there are step-parents or grandparents who should be in the loop, with the custodial parent’s permission) to send them weekly goals and updates on the child’s progress.  By sending email updates to the whole family from the therapist, everyone on the team is free to communicate with me, which relieves the “present parent” of the burden.  She doesn’t have to remember everything perfectly, explain complicated test results, or serve as the sole informant when making difficult educational decisions.  Parents and caregivers who cannot be in the session have a chance to connect with me to ask their questions in their own words, on their own time.  Allowing both parents to connect directly with me also relieves the “present parent” of the need to be the instructor to his/her spouse.  No one likes to be lectured or told what to do.  Sometimes, this coaching is much better received when it comes from a professional than when it comes from your wife.  Family members who are reluctant to engage in therapy or who hold misconceptions about hearing loss may be more willing to accept information when it comes from the mouth of someone with credentials, even if the “present parent” has been saying the same thing all along.  Whether it’s sending a weekly “team email” with goals and progress, videotaping sessions, videoconferencing a parent in from work, or even something low-tech like a communication notebook, it’s not too hard to keep everyone on the same page.  It’s a team effort!

 

Though the “present parent” gets most of the coaching during the session, there are ways to coach the “other parent” as well.  Parents can videotape themselves at home, give a self-report of their skills, choose their own goals for areas in which they’d like to learn more or improve, or complete a parent education checklist to identify areas of strength and weakness.  One of the many advantages of teletherapy is that I can offer evening and weekend appointments, which also increases the likelihood that the “other parent” will be able to attend occasionally.  I send a tape of each and every session to both parents, and encourage the “other parent” to watch it (even just a few minutes if time is an issue) to get a feel for what we’re working on and how we’re working on it in therapy.  This serves many purposes: it keeps the “other parent” in the loop, gives him/her a realistic view into the child’s skills and goals, gives him/her an appreciation for how much the “present parent” is doing!

 

In addition to information sharing, we can also involve the “other parent” in therapy in some concrete ways.  Perhaps there’s one specific “job” that that parent can be assigned (you are great with technology, so you can help him put on and check his equipment each day).  Maybe that parent can’t come to therapy but she can pick up new books at the library on her way home each week.  We can also capitalize on existing routines in the family and make them an opportunity for language.  In many of the families I serve, dad works outside of the home and his main interaction time with the children is bath time and bedtime at night.  If the child’s hearing aids come off for bath and don’t get put back in again, think of all that great father-language that’s being missed!  If Dad always reads the bedtime story, what tips can we, as the therapist, give him to “bump up” the language and listening content of that ritual?  Is Mom works eighty hours a week but she’s in charge of laundry at the house, how can we help her turn something she’s already doing into an interactive listening experience with her child?

 

In addition to adjusting our service delivery to help this “other parent,” it’s also important that we adjust our attitudes.  As professionals, it’s easy to fall into some incorrect “thinking traps” about the “other parent,” assuming that because he’s* not coming to therapy that he’s less involved in the child’s life, doesn’t care about the child’s hearing loss, or is the slacking half of this parenting equation.  In many families, the “other parent” can’t attend because he or she is working hard to earn money to enable the “present parent” to be present.  This is a significant contribution, too, and one we shouldn’t overlook.  There may also be cultural factors that influence the family’s decision of who should be the child’s primary caregiver and participant in therapy.  As therapists, we can help this family unit to thrive.  It is my policy to never, ever badmouth the “other parent’ in therapy.  If the “present parent” needs to vent, fine, but I like to try to present each parent, and their ability to contribute, positively, so that they can come to acknowledge the role each is playing in their child’s life**.  Each member of a family unit works together to provide for the child in his or her own way.  The more we can understand and respect the family dynamic, while simultaneously empowering all parents to be involved in their own way, the better the outcome will be for the child.

 

*Throughout this post, I use “he” and “she” interchangeably to describe the “present parent” and the “other parent.”  Both mothers and fathers can play these roles.

**An important caveat to this, of course, is in situations of abuse.  If there is any threat of danger to the “present parent” or child, all bets are off.  It is my duty to report and get them the help that they need.

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