I can understand your struggle, Leah, because this situation is sensitive and can be different each time depending on the family and the provider. I really like your script, though, especially how you would bring the conversation around to the daily routines. I also LOVE the strategy of asking “if I was a fly on the wall, what would I see if it were going well?” What a great way to word that question! This is a great illustration of helping the parent express the outcome she would like to see. Would you then ask the therapist to start visiting in the afternoon when the brothers get home?

“Sounds like we are at a turning point in our time together. Matthew is showing many of the skills you wanted him to have, during sessions with Allison (ST). However, when he is in his daily routines, he is not talking as much – am I correct?”

“Yes”

“Michelle, (Mom) what do you think contributes to his talking more during therapy?”

“Ummm, I don’t really know.”

“Hmmm. What is different about therapy sessions than the rest of his time?”

“Maybe that there are two adults paying attention to him. Maybe that there are no distractions when we are doing therapy, his brothers aren’t home from school yet.”

“Ok, that makes sense to me, sounds like during therapy, things are differnet for Matthew than they are during his daily life – like maybe therapy time has become sort of separate for him.What would happen if we made a shift from this idea of therapy with no distractions to therapy during one of his daily routines?”

“Oh, I think he wouldn’t talk at all, like if his brothers were home. In fact that is the hardest part for me is WHEN they get home, he goes right back to screaming and then they get mad, and we end up ordering take-out again because I don’t have time to cook dinner because they are all going crazy. He will NOT talk at all when they get home.”

“And you’d like him to talk when his brother’s get home?”

“Yes!”

“Ok. If I were a fly on your kitchen wall, what would I see if the hour of his brother’s arrival home went well, went how you want it?”

“Umm, you’d see his brothers come home and Matthew would say ‘Hi Derek, Hi Alex’. Then after the twins put their backpacks away, all three of them could sit at the table while I make dinner and have a snack together, and would talk to each other a little.”

New short term goals added. Conversation would continue.

I’ve been in this situation as an SC countless times. And countless times, I’ve struggled.