The Rights and Wrongs of a Parent Observing Therapy

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by the Anonymous OT

rightsandwrongs

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.

 

Featured Author:  The Anonymous OT

The Anonymous OT is a pediatric occupational therapist with experience working in home health, community, and clinic-based settings. She has worked closely with children with special needs, particularly those on the autism spectrum, since 2007, and received her Master’s degree in occupational therapy in 2009. She began her website, TheAnonymousOT.com as a way to provide candid advice and an open forum for both parents and professionals to freely discuss their opinions and experiences related to the world of pediatric therapy.

 

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

  1. MaryAnn Delaney Tuttle, DPT, PCS says:

    Perhaps it is my experience for the past 30 years in home-based early intervention, but I can hardly think of an example where I would exclude a parent from a therapy session. The parent is the expert and the authority figure in the child’s life. As a PT may have good ideas and strategies to help them to help the child, but I am not going to affect a change in a child’s life by handling that child for one or two hours a week, no matter how good I think my interventions may be. A child is part of his environment and is influenced by the people and structures in his world. This idea of the bio-social context is the foundation of the International Classification of Functioning Disability, and Health (ICF-CY) promulgated by the World Health Organization, and adopted by the APTA. We as therapist cannot afford to judge the family member or exclude them because we feel they are not behaving in the manner we think is advantageous to our “treatment”. It is our obligation to find ways to incorporate adult caretakers and family members who are responsible for the child most of his life into our plan. WE must identify routines and activities where the family can integrate therapeutic techniques into their daily lives with the child. If we do not include the family member into our treatment session, how can we explore the applicability of our interventions to the child as part of his family? We must move past the home program thinking where we give a “client” or in the arena of pediatrics, the parent exercises to carry out at home. We need to know what the family’s needs and expectations are and we must work with them to find ways they can play, dress, feed, whatever with THEIR child to attain the goals they have identified.

  2. Fair points Mary Ann, but I do agree with you that your perspective comes from experience in home-based intervention. Incorporating the parent and family into the therapy process is also easier said than done (as we have all probably experienced), especially in a clinic-based setting. The point of the post was by no means a list of reasons to “exclude” a parent from therapy. That’s what we seem to fight for the most in our practice… parent follow through. However, there are certain circumstances when a parent observer might be impacting therapy, and they might not even realize it. I don’t ever tell a parent, “Hey, you are too distracting, so you can’t come back.” I would, however, like to give them the guidelines that help the process roll along more smoothly. Thanks for your insight.

  3. Tee says:

    LOVE this post :-)
    I smiled and chuckled at some of your points. As an ABA provider, we often have many of the same dilemmas with “Should the parent sit in….or not???”
    Great job arguing both sides, and explaining what it looks like to help vs hinder a therapy session

  4. Rebecca Mize says:

    Very interesting post. I certainly agree that parent participation is difficult at times. When I used to work as a pediatric outpatient clinic therapist, I found it always worked best if I asked for a few sessions after the initial session (evaluation) to get to know the child. Then, I would set ground rules for our sessions. I would leave time in my session for observation, demonstration with parent, and questions. There were some parents that preferred not to participate and others that did. Then, 5 years ago I had my life changed by twin boys (one with severe quadriplegic CP). It opened my eyes to how things really work. How do you really put all the therapy into practice? What works and what doesn’t? How overwhelmed is the parent?

    I wish I had shown the parents how to hold their child. How to break up their muscle tone so you can really cuddle with them. How to do calming therapy stretches and proprioceptive work to prepare the child with CP to actually sleep at night. How to get on the floor with them and do “therapy” for that child’s muscles. Parents can be taught because I have successfully taught my friends and family who sometimes watch the boys for me. I home school and I have managed to teach the other parents that participate in a school group together on how to help my child write, color, glue, etc.. So, I wish I had taught these things to the parents. How to do the stuff of life with their children. Of course, the parent won’t do it perfect in the first session, but over time they can learn to have a therapist’s hands too. I just wish I had passed on more of my knowledge to the parents so they could really do what I was doing in their home. When you do it every day, the results are so much better than once a week.