Breaking Up is Hard to Do

Saying Goodbye to your Child’s Therapist

Even after goals have been reached and skills have been mastered, it can be difficult and emotional to say good-bye to a therapist. Kids Enabled spoke with experts for advice on knowing when it’s time to leave and how to make a smooth transition.

The Beginning of the End Competent therapists agree the most effective way to end therapy is to be certain that realistic goals and expectations are discussed when therapy begins. As Shahnoor Dharamsi, an occupational therapist in a private clinic, states, “The discharge process should ultimately begin at the initial evaluation, highlighting the parents’ goals and the therapist’s goals for therapy.” Parents and therapists should frequently discuss progress and the child’s strengths and weaknesses. While it’s normal to feel sadness at the thought of leaving a particular therapist, it shouldn’t come as a shock to anyone. Dharamsi encourages parents to discuss the following when initiating therapy:

• goals
• length of therapy
• outcomes of weekly therapy
• possible discharge plans as goals are met Ideally, parents and therapists need to work as a team from the outset of therapy.

When Parents Say Goodbye
Sometimes it’s the parents who choose to end therapy. For some families, financial issues dictate when a therapy needs to end. For others, the decision to focus on new activities or another aspect of the learning difference may signal a change. Vicki Clarke, a speech and language pathologist (SLP) with Dynamic Therapy Associates, Inc., says, “Parents may need to make choices between different therapies in order to fit treatment time into busy schedules. At different times of life, children may need more of one type of treatment than another.”

Parents might also initiate the end of therapy if there are personality conflicts between the parties involved. While Clark recognizes the client/therapist relationship is not always harmonious, she encourages parents to give a new therapist/client relationship at least four weeks to develop. She states, “Therapy during this initial time doesn’t always look organized and efficient. The therapist and patient spend more time getting to know each other’s expectations and preferences rather than addressing specific goals.” She emphasizes that parents have the right to discuss with the therapist or agency involved any interaction that concerns them.

When Therapist Say Goodbye
When goals are straightforward, such as written expression or articulation, and progression toward the finish line is easy to document and observe, then it’s obvious to both parents and therapists that the therapy has done its job. In this case, leaving therapy can be a cause for celebration, somewhat like a “graduation.” Nadira Shadeed, an optometrist who conducts vision therapy at Pediatric Vision Development Center of Gwinnett says, “Though the last of the child’s vision therapy program involves mixed emotions, usually the child is excited because we have counted down the days until their final therapy session.”

When goals are more focused on the process rather than the product, knowing “when to say when” can be complex and confusing. Danielle Moore, SLP with The Language Group says, “When goals focus on how a child approaches an activity, such as demonstrating that executive function skills are more age appropriate, that’s when you have to use a variety of ways to figure out what the end-result is.” She asserts that, in a case like this, it’s important for the decision to leave be a collaborative one between parent and therapist. There needs to be agreement that goals have been met and that the reasons the child came to therapy in the first place have been addressed.

Sometimes therapists feel a child’s needs are outside the scope of their professional expertise. Clark states, “Although therapists in a particular field all carry the same credentials, they can have very different specializations and skills. I have personally referred numerous patients to other therapists whose specializations better match the changing needs of the patient.” Parents should remember that just because their child has stopped making progress with one therapist, it doesn’t mean they won’t continue meeting goals with any other therapist.

Making the Transition
Florie Glusman, an occupational therapist and the owner of Sensawee Play, recognizes that therapy becomes a “comfort zone” for families, and children may be confused as to why they can’t come to “play” anymore. Many agencies will slowly decrease services so the patient gets used to the idea of less therapy. For example, a child that sees a therapist twice a week might start coming only once a week, then twice a month, then once a month and then stop altogether. Or the time of the session itself can be decreased. This “weaning” allows both the parent and child to process the idea that therapy, and the relationship with the therapist, will come to an end. Clark says, “We miss our children and they miss us, but if we’ve done our jobs well, there are more significant relationships they will develop in their lives.”

Many parents are resistant to leaving therapy because they fear what the future holds. Moore observes, “Parents are afraid to try goals on their own, or they worry that without a therapy routine they will fall out of practice of working with their child. How will they handle the challenges of their child’s learning difference without the therapist being just a phone call away?” Most therapists encourage their clients to call and “checkin,” and they are happy to create “homework” to help parents keep up with their child’s exercises. Dharamsi encourages her clients who are leaving therapy to look for activities like sports, art and scouting that might naturally work on goals and skills. She recognizes, “The goal of therapy is to help children function developmentally and socially.”

Remembering the true mission of therapy to master skills and reach developmental goals helps parents and therapists focus as a team on preparing the child for “leaving the therapy nest” and reaching potential in his home, school and community. The best time to prepare for the end of therapy is at the beginning. Everyone involved should have a clear vision of the future and the steps it will take to get there.

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