The Rights and Wrongs of a Parent Observing Therapy

The Rights and Wrongs of a Parent Observing Therapy

That awkward moment when a therapist goes to grab their next client in the waiting room: The parent hovers in their seat. Are they coming with us? Are they not? Do they want to? Should I ask them to go with us? Can I just grab the child and pretend not to notice?

So many questions…but honestly, should parents observe therapy?

The simple answer- yes and no. Helpful, right? Ok, allow me to rephrase: A parent should observe if their presence enhances the therapy experience and does not hinder it. To help make this process as positive as possible, I’ve created my own list for the right and wrong ways for a parent to observe therapy.

The Right Ways for a Parent to Observe Therapy

1. Observe with the intention of follow through at home.

Some activities we attempt to describe might be difficult for a parent to visualize. Observing the therapist in action can allow a parent to follow through with the same verbal or physical cues. It also allows them to know what to look for when correcting their child.

2. Allow the therapist to be the authority figure in the session.

It can be difficult for some parents to relinquish control, but staying in the background and allowing the therapist to run the session is less confusing for the child.

3. Blend in, unless the therapist asks for participation.

A parent should be a “fly on the wall” so to say, soaking it all in and taking pride in what their child is accomplishing.

4. Ask questions when things don’t make sense, but keep it brief.

Part of observing is understanding, so if something doesn’t make sense, a parent should ask the therapist to briefly explain.

5. Be prepared to leave the room if asked.

If a parent is becoming a distraction, or a child exhibits behaviors because a parent is in the room, they should be prepared to step outside for a moment. This is not to punish the parent or the child, but to allow them to refocus on the task at hand.

6. Leave the siblings at home.

This is a best case scenario, but I understand this might be challenging for a parent. In all honesty, the therapist’s focus in the session should be the child they are working with. I don’t want a sibling to feel bad or left out because their brother or sister gets to go play, but the therapy session is not the greatest place to create a group event.

7. Be ready to move around – a lot.

There is never a dull moment in a therapy session. Children are climbing on equipment, running obstacle courses, and taking scooter boards around the hallways. We never really stay in one spot for very long.

The Wrong Ways for a Parent to Observe Therapy

1. Observe with all the wrong intentions.

Observing with the intention of analyzing a therapist’s work ethic and technical skills:
I can feel the eyes boring a hole into the back of my head in these situations. When I was a new therapist I used to sweat like I was on mile 17 of a marathon, terrified the child wasn’t going to follow my directions while the parent was watching. These situations can be extremely stressful, especially when there are “spot checks” and the parent randomly comes back. One mother would announce, “I will be observing you today,” every few weeks or so as if I was due for my annual performance review.

Observing because a parent wants to hang out and chat with me:
This is a strange situation as well, when I’m not sure if a parent wants me to focus on them or the child, because I don’t have the super-human multi-tasking powers to do both. When a parent is talking with me, it is very hard to keep the child engaged and interactive. Therefore, the session suffers. However, some parents that talk with me the whole time still have high expectations and are confused when their child hasn’t made progress as they should.

Observing because a parent feels obligated:
I had one parent come to me and say, “His doctor says I should be observing every session!” and I could tell she felt guilty for not coming back. I extended the invitation, stating she could observe whenever she wanted, but she never followed through. One day I simply asked her, “Are you ever coming back?” and she said, “Honestly, I don’t want to. I have things I need to get done in this hour. Is that terrible?” No, it’s not terrible. It’s called being human.

2. Attempt to be the authority over the therapist.

Some days I just feel like telling a parent, “Trust me, I’ve got this.” I have dealt with all types of behavioral issues, and I usually attempt to respect the parent’s disciplinary practices. When the parent is constantly hovering over the child in the session, the child doesn’t know where to look. I might give the direction, “Go get the ball,” and the child looks over at the parent for approval.

3. Become an overly involved participant in the session.

A parent jumping in every 5 seconds is extremely distracting for me as an adult, so can you imagine how that feels for the child? Some parents sit against the wall during a session, then ask their child to run over and give them a high-five or a hug after every trial of an activity. While that is great for their self-esteem, it’s kind of a drag for the session. Yes, parents should be supportive and cheer when I cheer, but they should also make sure that their child understands that they should be attending to their therapist.

Also, suggestions are great, but most of the time I do things for a certain reason. I can tell when a parent might think a certain activity is too easy or too difficult, but it’s my job to grade the task for the “just right” challenge for their child. Plus I might be completing an activity for a different reason that it appears. Telling me to do something different makes me feel as if a parent doesn’t trust me as a therapist.

Along those lines, I also have new ideas or things that I might want to try with a child. Even with the best intentions and planning, an activity might not work out as I had planned. A parent has to be prepared and supportive as therapists try new things, because it means they are constantly thinking and adjusting their treatment strategies. I would hate to miss out on trying something with a child because I was too afraid a parent would think I was a fool if it didn’t work out.

4. Ask way too many questions.

As I mentioned before, parents should feel free to ask if something doesn’t make sense. However, question overload is the same as distracting from the session. There have been some instances when a parent questions every single activity that I attempt, which leads to long winded and sometimes defensive explanations on my end. If a lot of things seem confusing, I would recommend that a parent brings a notebook to jot down all of their questions that arise during the session.

5. Be unwilling to leave the room.

Some parents refuse to believe that their child is productive without them in their eyesight. Please trust me: sometimes they are. It’s like magic; the moment Mommy leaves the room, the behaviors disappear and I get an angelic child that follows my directions.

Other times a parent might threaten to leave the room if their child isn’t listening, but then they never follow through. This is awful as a therapist, because it just perpetuates the child’s behavior. If a parent keeps asking, “Do you want mommy to go?” enough times in a session, I am tempted to say, “Yes, please!” myself.

6. Bring lots of siblings into the session.

I know I mentioned that it was best to leave the siblings at home, but let’s say that’s impossible. In general, I dread when a sibling comes back to the therapy session. The odds of the child sitting back and not touching equipment or interrupting are basically slim to none. So at that point I’ve got a parent and at least one extra child spread out in a usually cramped therapy gym space. Couple that with the fact that the sibling wants to do what the client is doing, and suddenly it’s my nightmare. My job is to focus on the child I am working with, not to make sure I incorporate a sibling. This shift of focus takes a lot away from my therapy session, especially when I have to be the one to discipline the sibling that is distracting the client.

Also, focusing on a whole other point, a sibling in the gym forces the issue of liability. I am responsible for the child I am working with; that’s why I have a license, insurance, and all of that good stuff. However, I should not be responsible for the sibling. If they climb on something, fall and hurt themselves, the clinic might be liable. If the sibling is running around the gym unsupervised because the parent if focusing on their other child, who is to blame if the sibling causes someone else’s client to hurt themselves? I can’t stress enough that a therapy gym is not a playground “free for all” situation. Would you let your child run up and down the hallways of a doctor’s office? Probably not.

7. Be super annoyed by the therapy gym setting.

I once had a parent wheel back an all-terrain stroller into the gym one day. She couldn’t control her annoyance over the mats on the ground and the fact that we never stayed in one spot. But hey, that’s the name of the game.

It is also important for a parent to be aware of their surroundings while observing therapy. Swings are constantly in motion and other therapists’ clients might need to use equipment near where a parent is standing. Another great example was when a father came back to observe, but decided to bring a book and read it in a bean bag. Another therapist felt very strange when she had to ask if he could move.

While I always want parents to get the most from their therapy sessions, I hope they are able to do so in a way that makes the experience positive for everyone involved. The more a parent is a part of the therapy process, the more likely they are to follow through at home, and more progress is ultimately seen in the clinic.

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About TheAnonymousOT

Pediatric Occupational Therapist
This entry was posted in Insider Information, Occupational Therapy and tagged , , , . Bookmark the permalink.

13 Responses to The Rights and Wrongs of a Parent Observing Therapy

  1. Colleen Carley says:

    Thank you for this great info and makes so much sense x

    Sent from my iPad

  2. eastbayplay says:

    Love this. Thank you!

  3. pghot says:

    I had to laugh at the father chilling out in a beanbag with a book!

  4. mamanya says:

    Reblogged this on Must Read Articles and commented:
    “A parent should observe if their presence enhances the therapy experience and does not hinder it.”

  5. scoot says:

    Hi,
    I was just reading through your posts and I am learning so much. This is by far the best OT blog I have seen,
    However :), I just finished reading this post about including parents sessions and I guess I disagree with most of what you wrote.
    You seem to place parents in ‘they are kind of or could be a problem’ area.
    If you look at Lucy Jane Millers work and much research, educating and coaching parents about how their children’s bodies work is key to intervention. She has classes for parents and includes them in sessions as much as possible in her clinic.
    There is also a newish model out in early intervention. A coaching model, it removes the therapist as being the ‘expert’ and uses a team approach to therapy. Starting at the evaluation, if the plan is not parent driven, how do we get the best result, you do mention this in another post, but I think we need to take that farther. The new model actually brings parents along side the therapist, not just in an ‘observer’ role, and teaches parents how to interact with their children, how to do the exercises and how to ‘read their children and even goes so far as having the therapist be the ‘observer’ while she coaches the parent through an intervention. Cool.
    I invite and encourage parents to be a part of each session if I can and always find a room and bring them in to discuss how things went with home programming and if they have new questions.. Yes there are parents who are exhausted and just don’t want to, parents who are never going to ‘get it’, but what a waste to have the people who are with their children the lions share of the day sitting in the waiting room. I often hear ‘children do better without their parents in the room’ Well guess who they have to go home with?
    I actually think you did a bit of a disservice to the profession with that post. Sorry. OT students need to be taught the importance of educating and including parents, they need to see the research, they need to understand that most parents won’t tell you what they really think. They also need training about how to make it comfortable for both the therapist and the parent. I know how threatening and scarey bringing a parent in can be, but we are missing tons of great information and opportunity if we don’t
    (I have new research I can share with you on this that is quite eye popping)
    I can’t tell you how sad it makes me feel to see parents languishing for hours, an untapped resource, and to hear other therapists complain about the ‘interference’ parents in the session causes. I was sad to see no one challenged you on this.
    We need to evolve!!!!!
    Again, I do love your blog and what you have to share, just not this :).

    • Pat says:

      Scoot – You hit the nail on the head. As a parent of a child who just qualified for OT services, this was one of the first articles I came upon. What a sad commentary. Parents are your allies. People who are skeptical, myself included, just want to know that all of the evaluations and diagnoses are valid. It does not mean that we don’t want to help, participate, and follow through with the information gained in the OT session. And furthermore, what is so wrong about including a sibling? The family has to work together as a unit to incorporate strategies. Perhaps the reason the author has trouble dealing with parents is because they sense the negativity.

      • Scoot says:

        Right on about siblings being brought in.
        Often siblings get less time in the parental spotlight when there is a child with a disability in the home.
        What a great time to model how to include a sibling in home programming and help them feel like they are being part of the team.
        If children are young, or there are many, the parent needs support and ideas to be able to manage so home programming is carried out.

  6. maureen says:

    Some parents, like me, won’t leave the room because it is my responsibility to make sure my child is not mistreated. Until a trust is formed I would be suspicious of being asked to leave.

  7. RK says:

    Ideally, a good clinic would have observation windows, cameras, and/or headphones so parents can observe therapy sessions without interfering. I think best practice allows for the last 5-10 minutes of the session to have the parent invited back to the therapy space to discuss how the session went, the homework to work on, answer questions, etc. This way, the parent is included as an important member of the team, and strategies can also be given for incorporating siblings. However, I think there are very valid points about liability, limited space, and detriments to clients’ behavior and participation that preclude having parents attend every session and especially with siblings.

    I had a father who would come back 10-15 minutes before the end, but wouldn’t really interact with me, and instead would get on the therapy equipment! I mean, full-blown sitting on the swings, etc. While his child didn’t seem to care, it was so uncomfortable for me and other therapists since he was using equipment that others could be using at the time.

  8. Skeptical Mom says:

    I have to agree with the skeptics here!…
    My husband & I took our 23 mth old for an evaluation, we were told 2 days a week would be optimal & that parents are not allowed to observe at all. All parents are to stay in the waiting room at all times & if we wanted parental education on how to help our child at home they’d give us pamphlets & tell us when they found techniques that seemed to be working during their 30 minute sessions. If we weren’t comfortable w/ a total stranger having sole eyes on our young (non-verbal) child behind a closed door we could ask the receptionist to check on them whenever we wanted her to. … Um, what?!? (Right?!?)

    During our brief tour of the building (per our request) we saw 2 therapists chatting amongst themselves at the door of one’s office with their backs turned to a child (who couldn’t have been older than 16-18 mths old) sitting in a child size chair on a concrete floor w/ no padding/carpet/etc. of the office. This was a very long hall we had to walk down (& we stopped many times along the way) so the therapist had no eyes on this young child for a minimum of a few to several minutes. … again, what?!?!

    As a mom, this concerns me! How could anyone (who actually cares about the welfare & progress on their child…) adhere to this no-observation policy as if it’s ‘quite standard & (somehow) acceptable’?

    Anyone?

    • Hi Skeptical Mom! Hmm… sounds like an interesting situation! The blanket “no observation” policy strikes me as a little odd; I’ve never seen that as a rule. I could see how you felt the need to trust your mom gut, as there were a lot of unsettling things happening at once. And I know that if I don’t have a parent in a session, I usually end up spending a LOT more time filling them in on what we did, not just passing out educational pamphlets! (Especially after the first visit!) Also, it would be nice in that situation to have cameras or mirrors where you could observe without necessarily being “in” the session, if that’s what they were worried about. Just a question – did they do ABA therapy in the office? I don’t know the situation of the young child, but I have worked with behavior therapists that will turn their backs or withhold attention as a part of a behavior plan to extinguish certain behaviors. Again, I don’t have all the facts, just offering another perspective. I’m sad to hear you had such a negative experience, and I hope you can find a place you are more comfortable!

      • Skeptical Mom says:

        When I asked if they had cameras the lady looked at me like I was crazy & said, “Cameras?”, laughed a little, & said “All of our 9 therapists are highly trained professionals and have a great deal of experience with children of all ages from newborn to teenagers. & I can personally assure you that *your child* will be well looked after during her sessions’. We don’t need cameras for that. & they’ll report anything you need to know that happened during the sessions including how she did or challenges she had when they walk her out to you afterward.”

        … I even had a follow-up conversation with the program director on the phone today & she pretty much reiterated what we were told at the evaluation, but added that after a few weeks (after rapport was established & goals and methods were ironed out) the therapist could by their discretion invite us to watch part of a session behind a 2-way mirror if there’s any progression to show that they may have established & maybe some tips we could pick up on, but emphasized that this is at the discretion of the individual therapist so she could not guarantee we’d be able to at any point, just that she could guarantee we if it happened it definitely wouldn’t be for the first several weeks.

        All just sounds nuts to me!!

        As for the other child’s session, I don’t know anything more than what I observed & that he was w/ a speech therapist. I didn’t consider it could be a technique & I certainly hope that was the case. Looked to me like a lazy/preoccupied/bad therapist (& a potentially dangerous situation for the tot) but guess may go to show that old, “can’t judge a book by its cover” saying. … fingers crossed, anyway, as I’ve felt guilty for not mentioning my observation to the (intentionally kept in the dark/aka waiting room) mom who ended up being the lady sitting beside me. … so thanks for that alternative perspective, I’m choosing to believe it was ABA. 😉

  9. Skeptical Mom says:

    Oh & that therapist later brought the child out to his mom & siblings in the waiting room & complained to his mom that he was, “quite a handful” & that he “showed a temper a few times & wouldn’t listen to her”. She tried to get a hug from him as they were leaving and said to his mom, “but you’ll see, Ms. so & so (speaking in 1st person) is gonna win this battle of wills in the end because he doesn’t know who he’s up against.” The toddler refused the hug & hid behind his mom & made a whining pouting sound.

    Sorry, but really? & yes, I (a mom of 3) know toddlers can often be brats, but I also know they can act out when they’re ignored, trying to get attention/interaction, or a being mistreated.

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