Give Me a “WHY”

So often in therapy, I feel that we (professionals) coach parents to use specific techniques (which is great!) and expect them to just do it because we said so (not so great!).  This is not to say that therapists are being authoritative, or pushy, or bad in any way, but I do think that we generally tend to assume that if we say it, parents will do it — and the majority do.  But whyOther than the rare parent who feels comfortable enough to challenge or question the professionals, I think parents take what we say at face value because there is an enormous power differential between parent and professional. 



Yes, you read that right.  When you, the professional, walk into a room, you walk in with a lot more formal education and many more fancy-looking letters after your name than the vast majority of parents you serve.  This really took me aback at first.  When I started seeing patients, I thought, “I look like I’m twelve.  I’m not a parent.  They are going to take one look at me and laugh me out of the room!”  But it never happened.  Not even once.


I was amazed by parents’ willingness to try the strategies and techniques I modeled and explained to them.  I was frustrated when parents seemed not to “get it” or follow through with recommendations.  But I never once was challenged about what I suggested.  At first, I felt as if I had really made it as a professional, but then I realized:  this is not okay.  


The vast majority of parents were “compliant” with therapy suggestions and did what I said not because they understood WHY this strategy was important, but because I said so.  Other parents didn’t make the connection and use therapy strategies — they never told me they didn’t want to use them, they just never seemed to make the connection.  Neither one of these scenarios was good enough for me, so I started to think…


I want parents to understand not just WHAT to do and HOW to do it, but WHY it is important and how it contributes to their child’s long-term development.  Sure, a parent might be willing to mooooooo and baaaaaaa all day long for the Learning to Listen Sounds because the therapist said so, but I want them to see WHY today’s “moos” and “baas” turn into tomorrow’s competent listening and spoken language communicator.


How do you put this into practice?  The first thing to do is ask parents for their WHY.  What motivates them?  What do they want for their child five years, ten years, twenty years from now?  Then, you take that motivation and figure out how you can tie everything you suggest in the session to the parents’ long-term goal.  Here are some examples:


  • Auditory-first presentation.  We want to say it before we show it.  Just like kindergarteners do “show and tell,” in AVT, we do “tell and show.”  Talking about an object or making the animal sound before you pull it out helps your child’s brain learn to hear something and form a picture in her mind without needing a visual.  WHY?  We know that when children are little, most of what we talk about is concrete — something that’s right here, something we can see.  But as children get older, they start to talk about more abstract ideas and concepts.  A kindergarten teacher is going to give lots of gestures with her directions, but when the third grade teacher says, “Open your science book to page thirty-five,” she’s not going to be acting that out.  We want to get her brain ready for that now so that she is successful later on in school.


  • Auditory closure.  We’re going to sing the “Five Little Ducks” song, and when we get to the part where it says, “Mommy duck says…[quack quack quack quack],” we’re going to pause before the “quacks” and see if he can fill them in.  WHY?  The ability to listen to speech/singing and anticipate what is coming next today is going to help him fill in the blanks later on if a message is incomplete or unclear.  For example, if he’s having a conversation with someone and they say, “Monday, Tuesday, Wednesday, …, Friday” (let’s say a car drives by when the speaker is saying “Thursday”), he’s going to be able to fill that in because of this skill of auditory closure.


  • Ling Six Sound Check.  We do these sounds to make sure her hearing technology is getting sound to her brain.  WHY?  A young child, particularly one who does not hear well in the first place (doesn’t have an internal model of what clear hearing sounds like) is not going to be able to report to us whether or not her technology is functioning correctly.  These sounds span the spectrum of speech sounds, from low to high pitch, and give us a reasonable idea that if she can hear (detect/discriminate/identify) these sounds that all of the good talking, reading, and singing you’re doing is getting in clearly.  We know that we only speak as well as we hear, so we want to make sure the input is clear so that the output is good as well.


When you coach parents and caregivers, I encourage you to think about the long-term payoff of the strategies you’re modeling and share that with them!  Connecting today’s hard work to tomorrow’s end goal is a powerful motivator for us all.

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