Family-Based Therapy - What Does That Really Look Like?

Another question that came up in response to my ISAD conference submission (The Right Time to Break Out the Stickers – see previous post) was around my opinion of family involvement in the therapy process.  Following are the questions and my answers.

Q: In class we are learning about how important it is to employ a “family based treatment” where not only does the SLP work with the child who stutters, but also educates the family and is interested in the family’s opinions and concerns about their child.  Did any of the speech therapists that worked with Eli also work with you and your husband to teach you what you could do at home to help Eli, or just talked to you about your questions or feelings about how Eli was progressing? Stacey

A: I’m not a speech therapist, but in my opinion, “employing a family-based treatment” is only helpful depending on exactly what you are asking the family to do. We felt that we were employed when the therapist helped us to understand the speech tools and ways we could practice at home. I begged for this involvement as I could not imagine he would ever be able to use these naturally without lots and lots of practice. Same with educating the family…depends on what you’re educating them to do…how to make fewer speech errors, or keeping them talking and engaged in the world around them. Too often the family involvement is hinged on practicing speech tools and working to transfer these into their real world. There is so much a family can do to encourage talking, to keep talking fun, to enhance communication, and to build on what the child does well and with a passion. And this can be done without risk of silence and withdrawal.

Q: Did the speech-language pathologists who treated your son ever take an approach to therapy that included the entire family system?  Do you feel this would have been beneficial?   Laura

A: One speech therapist included Eli’s brothers, dad, and myself in some of the sessions. She also had Eli bring a friend once. Was it beneficial — not really.  Is it a good idea? Depends on the focus of the therapy. Is it necessary? Absolutely. How’s that for confusing?

As a parent, I think therapy should focus on keeping the child talking, addressing the emotional aspects, and minimizing anxiety around communication. If this is the focus, then parental/family involvement is pretty crucial. If the focus is on eliminating disfluencies, then family (and teachers and grandma) can turn into the speech cops. Surrounding a child with speech cops runs the risk of increased anxiety, silence, and withdrawal.

Additional thought:  Insurance companies insist that speech therapists can only bill for time spent directly with the child or at least having the child present.  It is my understanding that they cannot bill for time spent alone with the parent.  This puts extensive communication with a parent on the back burner.  And yet, in my opinion, extensive time with parents is critical to the process.  A speech therapist can help parents create an environment where their child enjoys talking, communication is relatively stress-free and anxiety is kept at a minimum.  

So "family-based therapy” can look very different from therapist to therapist.  Again, I think it's critical to the process, but it can also be damaging, depending on what the family is being instructed to do.  I will definitely do more research around how this approach is presented academic systems.... feel free to enlighten me!

Best,
Dori Lenz Holte