Saying Less, More Often and Ask, Don't Tell

Although my placement population is considered "pediatrics" on paper, the reality is that I work with families and not just the individual child. You can teach, coach, and make all the recommendations you want with preschoolers, but chances are, the three year old has minimal understanding of what you tell them. The reality is: your recommendations aren't high on their priority list (which probably consists of: Play, play, eat, play, play, sleep). Who can blame them? So for all those who want to work with kids, keep in mind that you'll really be working with the parents and their family as much as you get to interact with the kiddies. =)

This reality hasn't deterred me from pursuing OT work with kids. It's only made me realize the skills that I need to work on in order to work more effectively with these families to really provide family-centered care.

My placement involves working with several speech language pathologists (SLPs) in their early language groups and infant development therapists in their play groups. These groups typically have 5-6 preschool aged children and sometimes their parents are in the groups as well. The SLPs will be taking language samples and coaching the parents on skills such as being better language models for their children, while the infant development therapists looks at where the child is in their stage of development and how the parent can promote their growth (including gross motor, fine motor, languages, emotional and self-regulation components). As much as I've learned how to observe children with an OT lens while working with other therapists, I've learned a lot about how to work with families and their children. Taking care of a child with unique needs makes parenting and family life very complex!

My participation in these groups involving the therapists, parents and their children has enlightened me on what "coaching" is! Seeing these therapists put this theory into practice made me realize how hard it is! And from these observations, I've thought about how a key to effective coaching is to simply say less, but more often. This goes for both the therapist (coaching parents) and the parent (coaching their children).

Small chunks of information is easier to absorb than large chunks. Personally, I find that I am not good at explaining and this may be because I have a tendency to overload the other party with too much information at once. I find that when I am talking more, that dialogue has a tendency of either being oriented towards telling the other person what they should be doing or how their approach wasn't quite right, or asking way too many questions back to back. Forcing ourselves to do more observation, clinical reasoning and reflecting before we share our ideas can be a simple way of giving both ourselves and the other party more time to think. "Saying less" ultimately encourages us to be more concise in our explanations and way of teaching.

The "more often" piece is getting at the need for consistency in our interactions. If we just start communicating less to people in general, that wouldn't be very helpful at all! By keeping our coaching consistent, we will give the other party the reassurance that our support is there. But beware, small tidbits of information shouldn't be simply repeated over and over again for drilling purposes because that won't necessarily be constructive. One of the analogies given to us by the prof from our pediatrics course was about her experience in a swimming class. She wasn't the greatest at floating and the coach kept telling her to "Stay on top of the water! Stay on top of the water!" What's good in repeating the same thing over and over again to someone when the reason that you started saying it in the first place was because they couldn't do it?! This "say less, more often" principle needs to be paired with the effective use of pauses and variations in the support given. This is where another tidbit from my pediatrics class, "Ask, don't tell", comes in.

From my experience, asking questions can show the other party that you're considering their perspective. So long as you don't present your questions as an interrogation and bombard people and ask them in a way that genuinely tries to seek understanding, I think the "Ask, don't tell" approach can promote a safe environment for open communication. I've tried this with a client during this placement and I learned a lot about myself and my client in that one session! I could start to reflect on my word use, areas of focus and her reaction and willingness to engage in this way of treatment (vs. being told what to do, which is traditional) and how all of this can impact my future sessions. As an OT, this way of thinking when working with a client reminds me that I am not the expert in what my client can do. They are. I'm there to help them by using my OT lens to help support them in finding solutions that work for their recovery.

Asking more and talking/telling less can be helpful in all therapeutic relationships with various populations (not just kids and their families), and of course, in our personal lives as well. =)