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Into the Rapids

Next Step Therapy - Wednesday, July 10, 2019

 One year ago, I walked to the edge of a mysterious diving board. Without seeing the bottom- without a life jacket or a parachute, I jumped in head first…

This steep diving board launched me into the raging river that is early intervention. It’s been one year since I jumped in, and the water has not been without its rapids.

Over the course of one year, I’ve better learned how to navigate these rapids. Thanks to the support system that’s surrounded me, I’ve survived a year as an early intervention speech therapist.

It has certainly come with a unique set of challenges. I’ve had great successes; I’ve made some mistakes that I wish I could take back; I’ve connected with strangers in ways that I didn’t realize possible, and I’ve willingly thrown myself into situations that made me vulnerable and some that ultimately broke me into pieces.

So here is my best, most heartfelt advice to any new EI therapist standing on the diving board wondering just what it is that awaits them below:

Rule #1: It’s never about you-

In the world of EI, the hardest part about the new job might be learning to accept that no part of the therapeutic process, from start to finish, should ever be about you, the therapist. This rule settles into the very building blocks of the profession. From the moment you enter someone’s home, you inherently become what that family needs you to be. Whether it’s providing emotional stability, a touch of lighthearted humor, a firm shoulder to cry on, or a clear window into reality, your job is to improve the foundation of each family’s structure, using whatever tactics necessary. You can’t do this if you’re worried about what you need, or feel, or think, or want. It’s not about you.

This rule always translates into direct therapy too. If the kid wants animal noises…. Your farm animal sounds had better be on point. If the kid wants the session in a cardboard box or under the coffee table… hope you wore your stretchy pants. I’ve done speech therapy on a trampoline and in a kiddie pool. Don’t be embarrassed… the people around you will be embarrassed for you. It’s not about what you look or sound like. It’s not about maintaining a professional decorum, it’s about what works in pediatric therapy and what doesn’t.     

Rule #2: Listen to understand-

As therapists, we so often listen to evaluate. We are constantly in a state of clinical thinking. It has been beaten into us from the first day of undergrad. Observe, evaluate, diagnose and treat, but in EI often times there are moments, interactions and situations that call for a more human connection. This connection can’t be one-sided or synthetic. As a therapist, there are times when you have to listen and allow yourself to feel what they are feeling. No objective thinking necessary. When a mom vents about being exhausted or emotionally drained, she is rarely looking for a solution. She just wants to be heard- so just listen. It’s the difference between sympathy and empathy.

Rule #3: Have unconditional positive regard-

This one is possibly the hardest, as it goes against our human instincts to defend our own state of being. Interacting with families can be touchy when you’re the person pointing out their child’s weakness and delays. You’re the one coming into their home telling them that they need to change their own behavior for the benefit of their little one. Catching mom or dad on a bad day with your “suggestions” can sometimes be the tipping point for a very uncomfortable interaction. Maintaining unconditional positive regard when you’ve been on the receiving end of a parent’s verbal beat down can be incredibly hard to do. Even after you feel like your dignity and respect have been damaged, it’s still your job to have that family’s best interest at heart, regardless of what a parent said or did when they were upset. It’s not about you. 

Rule #4: Success comes in many forms-

Remember that the success for one child will never be comparable to another child.  In EI, the range of delays and disorders that you come across is vast. Not every child will meet age-appropriate benchmarks by the time they turn 3. That’s ok. Your job is not to make every kid “typical”. Your job is to help each child reach their highest achievable point of development. Know the difference. 

Rule #5: Never surrender the clipboard-

If you’ve never resorted to sitting on your clipboard and pen during your therapy session, you’re not a real EI therapist. Hold onto the pen like your life depends on it because nothing derails a therapy session faster than having to pry your Paper-Mate pen from the claws of a determined two year old. 

Rule #6: Expect it to be heavy-

If you get the impression from rules 1-5 that this job is in any way easy or simple, I’ve misled you completely. Never in my life have I experienced more emotional wear and tear as I do in this profession. Every family on your caseload has a story. Every story has its own struggles and heartbreaks, and regardless of how much you try and repel the trauma, it sticks to you. It sticks to you like sand sticks to wet feet. The hardships and pains you see every day, in a way, become your own. And after a while, it starts to weigh you down. Somedays the weight becomes too much and you just can’t carry it any further. Empathy, however necessary, comes with its price.

My best advice for these days is to allow it to come over you. In your own space, when appropriate, scream, wale, cry and gnash your teeth. Then pick yourself up, wipe off your mascara and get back to work.

Bottom line is if you don’t cry for one reason or another- you’re probably doing it wrong.   

Rule #7: Never lose sight-

Through the hurt and frustration, in spite of the mountains of paperwork and emails, never forget that not all superheroes wear capes. When you start to feel the mental and emotional toll of the job remind yourself that you are one of few who willingly choose to venture into the raw, uncensored wilderness of humanity to improve the lives of strangers who you would otherwise never know. We are frequently the anchor that keeps a family tied to hope for a better future. Never underestimate the impact that you can have on a family and never forget why it’s totally worth it.

Over the last 365 days, I’ve come to many realizations about myself and the world around me. I’ve begun to better understand my true limitations and barriers as I’ve pushed past them time and time again. I’ve struggled to understand the human condition and all that it entails. But most importantly, I’ve been forced to see reality through the eyes of strangers, and through this act, my hopes have been confirmed that this world is, and will continue to be, as good as we care to make it.    

Ashley Ahrens, MS CFY-SLP

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