When you are feeling discouraged & how to address patients with limited progress

For my therapists <3

April Blog: This was a request. Honestly we have all felt this way. Heres some tips to help

This one is for my interventionists. The ones who really care. The ones who have felt lost/ discouraged/ confused. The ones who feel like- is this really helping? Am I really making a difference?

If you are having these feelings/ thoughts- I’m going to stop you right there. YES!!! You are making a difference. BECAUSE YOU CARE ENOUGH TO THINK THESE THOUGHTS.

Some people go to work everyday and it’s a job. Maybe we all have moments in our life where the job is there for financial stability, benefits, etc. Its stable but mundane. You don’t care so much and that’s alright. BUT, some of us are luckier. Some of us stay up at night thinking of ways to engage our patients, to become successful, to achieve goals. And if you are like me, you care so so much, that you’d do anything to help your patient and their families live the best, most independent functional life they can.

At times in patient’s lives, they may hit a brick wall. Or we hit the brick wall. Maybe both. It happens. That’s ok. I’m here to give you a few outside the box ideas that I have utilized, that have been successful.

Firstly- go back to the parent. Discuss what is the parent’s goals for therapy. What is most important to them? What can we do functionally AND SPECIFICALLY that will make their lives/the child’s life easier? For us PTs, its riding a bike, getting into/ out of the car more easily, etc. Then create more lifelike interventions to mimic these functional activities. For example, if the parent wants the child to be able to play safer in gymnastics, find out what they’re doing in gymnastics and create interventions based on the skill they’re doing there. By keeping PT functional FOR THE PATIENT specifically, they should engage more during your session.

Secondly- create interventions utilizing what the kid likes to play with. Some kids are crafty. Do a balance activity while coloring. Some kids love basketball- can you find a way to work on strength while playing with a ball? I think so!

Thirdly- go OUTSIDE the box. Listen, I know Im a PT. I didn’t learn much about sensory play and various grasps like OTs did. BUT I know kids love water typically, and they love to get dirty typically. Use sensory play stuff (shaving cream, sensory beads, bottles with different objects to make sounds, paint, paint brushes) in your session. Literally go spend 10$ at the dollar store and kiddo will love it. Have them play in tall kneel, quadruped, even plain old tummy time while manipulating objects/ the toy. Its harder than you think to go back to basic functional skills.

Fourthly- Engage the parent in an embedded coaching model. I have had patients scream when I walk in the door. Still do actually lol! Sometimes what works is working through the cries. Sometimes I have parent do all the handling while I hide- im not joking. Kids feel safer with their parent compared to a stranger. So have parent do everything while you coach them through it. This will help for out of the session too- we know the parent is doing the correct handling skills now.

Fifth & final: Take some CEU courses that focus on patients like the difficult one you have. There are SOOO many courses out here guys. Look up something that can help a patient with the diagnosis/ syndrome/ whatever that your kid has. Take it and apply the techniques right away.

Those are my intervention tips. In addition my advice when you feel discouraged/hitting a wall:

1-Take time off. We work hard. We don’t take the time to sit back and think about things. But I promise you- by giving yourself a break from work- you’ll come back a better therapist, with a clearer head and new ideas.

2- Talk to your coworkers. Run some ideas by them. Let them run some ideas by you. In EI, we used to have “reflective practice” where all of us therapists got together and talked about our case- PT, OT, SLP, SI, SW. What was working and what wasn’t. I know you don’t get paid for this and your time is precious. But we can really all learn a lot from each other.

3- Change the frequency/ location. Sometimes at home, kiddo is comfy- that’s good for them, but maybe bad for us. Kid runs away, doesn’t listen, escapes to parent- haha yup we’ve all been there. I suggest changing the location. Even taking kiddo outside, meeting at the park. If you feel like your 1x/week isn’t cutting it- talk to parents about increasing the frequency. Maybe an intensive daily program for a week to push the skill over the edge! Explain why. Or re-educate the importance of following a Home Exercise Program.

Now. Here’s the tough conversation time. If you feel like you have done ABSOLUTELY EVERYTHING you can think of. If you’ve educated, if you’ve changed the location/frequency, if you whipped out the new puzzle/ new toy/ best art project ever AND you still feel defeated. If you really feel you are not a good fit for the case, IT IS OK TO DISCHARGE YOURSELF FROM THE CASE. NOW- I say that with so much love. I have had patients, where it just ran its course- no longer what I provided was the best fit for the kid (like 1-2 times but still). And that’s ok. I don’t care if the kid learns to achieve goals with me or someone else- as long as they are achieving them and the family/patient is happy- that is the most important thing. I’ve also heard of other people discharging themselves from cases that I get, and that’s ok with me haha!

I have been in business 2 + years now. I have been in Peds for 7. Sometimes, we cant get through the way we need to. I’ve seen it in every discipline. We get frustrated because we care. So try these strategies. I hope they help. You can always reach out to me. We can discuss interventions/ ways to address the kiddo/family. But if you’re feeling that you are becoming angry, frustrated, and fed up- excuse yourself. Because you may make a mistake and take it out on the kid/family. I’ve seen this too. Its just not professional and its not why you became a therapist. Refer to someone else or have them continue with HEP. Say you are moving or starting a new job. If you’re stuck with the case for the year- like in school- speak to your supervisor, hopefully they can help you switch cases around.

Remember, trust yourself. Take deep breaths. Take a session to assess rather than intervene. Talk to the parent. You got this. XOXO, Denise