Choosing a therapist for your child: How to find the “Best Fit.”
By Nicole Kolenda, M.S., CCC-SLP, P.C.

When a child begins going to therapy (speech/OT/PT...etc) a relationship develops between him and his therapist. It is essential that the therapist and the child develop a good rapport in order to effectively target his goals in therapy. When I was in graduate school, the first clinical goal was always “to establish a rapport” and therapy would begin at that initial session with the idea that setting up a safe environment for the client --through establishing mutual trust--would lead to successful intervention. One strategy for that initial session is to have your child bring his favorite toys/books—something he really likes and feels comfortable with. This will give important insights to his clinician and will inform future sessions.

The process of finding a therapist, yet alone the RIGHT therapist, can be daunting. There are many things to consider during this process.

1. Referral Source
   Always ask for a referral, either from a therapist who is currently treating your child (many therapists work on teams together and get to know each other's therapeutic style and skills), the referring agency/pediatrician or other parents of children receiving therapy. If the referred therapists are booked (which is a possibility), ask them (while you have them on the phone) if they have a recommendation.
   
2. Consider the training you want your therapist to have and search accordingly.
   Does your child need sensory integration therapy? Verbal manding? PROMPT treatment? Floortime? You must ask the therapist if they are trained in the technique you are seeking. Don't assume they are. Likewise, it is okay to ask the therapist any other questions you might have concerning their scope of practice.
   
3. Ask any questions you might have regarding payment before you start therapy.
   Points to consider:
   1. What is the rate per session?
   2. How frequently does the therapist bill?
   3. Does the therapist take insurance? EI? CPSE? CSE?
   4. If he doesn't take insurance, will he assist in the process? (which can be time consuming)
      
4. Consider your child's current schedule
   Sometimes the therapist you really want only has a time slot that is inconvenient for your child, i.e., it is typically your child's nap time, or it is 2 hours before he has anything else—forcing you to roam the streets because it is not enough time to go home. Once your child goes into the therapeutic session under “stressful” circumstances his therapy is immediately affected [in obvious ways]. The child missing his regular nap time will be extremely tired and cranky; the child who had to walk around for over an hour might be anxious and annoyed (wouldn't you?).
   
5. Consider your needs
   As a parent of a child receiving therapy, you inevitably will have certain needs too. Maybe you want to have frequent communication with your therapist—ask her first if she is willing to oblige. Maybe you hold monthly team meetings in your home, where attendance by everyone is expected—tell her first what is expected (remember, therapists should always be paid for their time—just because they are not “treating” during a team meeting, doesn't mean they shouldn't be compensated.) Some parents really want to “like” their child's therapists and others don't view this as important—as long as their child is progressing and having fun. If your initial contact with a possible therapist left you feeling uncomfortable in any way—it is “OK” to try another.
   
6. Location is important
   Location is another very important point to consider: If your child has to travel on a crowded bus for 45 minutes to get to his therapy (or 1.5 hours in a car immersed in traffic), you might be setting him up for failure.
   
7. Expect a period of transition
   Some children adapt to therapy seamlessly; they love their therapist and don't realize anything other than “play” is going on. Others have a more difficult time. Many children (especially the younger ones) have a hard time separating from their parents—which will eventually happen, it just takes time and patience. Some children have a hard time transitioning between therapies, which can adversely affect the beginning of the next session. Some children initially love therapy and then when they realize it is “work”, they don't want to come back and difficult behaviors ensue. Every child is unique and handles the therapy process differently, but usually in time, they realize the “schedule” and adjust accordingly.

What if you did all of the above—found a referred therapist, in a great location, with a good time slot, that has been treating your child for some time and now you feel like the therapist isn't a “ good fit” ?

1. Give it enough time
   As stated above in #7, many children need time to adjust to therapy. Sometimes this can take a couple of days and other times it can take a couple of weeks. Make sure you are giving your child enough time to warm up to the therapist and any other circumstances that might be initially stressful for him.
2. Talk about it with your clinician first —NOT the other therapists on your team.
   How would you feel if you found out that your colleagues were getting together and plotting your dismissal? Remember, it is important to discuss your concerns without being accusatory (if possible), “ It concerns me that Sarah cries for the duration of your time together. ”
3. Don't wait too long. Do not let your hesitations wait for too long, then you will be anxious and most likely, accusatory. Sometimes, as in all relationships, the therapist and the child just do not get along.

Some possible reasons you might want to find another therapist:

1. He is not implementing the therapy you want. He might be trained in it, but that also means you want him to use it.
2. He frequently cancels.
3. He cuts your child's sessions early, without reason.
4. He is moving in a month and you want to ensure you have enough transition time for your replacement.
5. He doesn't respect the other members on your therapeutic team.
6. He doesn't go along with the recommendations established at the team meetings, creating confusion for your child and instigating behavioral difficulties.
7. He talks down to you.

In closing, finding the right therapist for your child might take time and it might mean you have to go through one or two other therapists before you do find the “right fit”—and that is OK. As the parent of a child in need of therapy, you also will be his biggest advocate, and it is up to you to make sure your child is receiving the services he needs in the best environment for him to learn.