As a speech-language pathologist, you know that success largely depends on connecting with patients. But what if your patient doesn’t want to connect with you?

Everyone has experienced it. You’re at a cookout and someone has brought their toddler. You walk up to the toddler, crouch down, smile and attempt to start a conversation. The toddler has different plans: He looks at you and cries or even runs away. Everybody laughs, because it’s not a surprise. It’s just what kids do.

For speech-language pathologists (SLPs), a failed connection with a child cannot simply be laughed off. Speech therapy, as the name suggests, depends entirely on communication — if a child doesn’t feel comfortable enough with his SLP, very little progress can be made. “In order to be motivated and willing to participate in treatment, children must first feel that they can trust their therapist,” explained Kelly Wiley, MS, CCC-SLP, assistant vice president of clinical operations and director of therapy at Sage Care Therapy Services in Dallas. “If a child doesn’t understand the intention of the therapist or see the benefit of therapy, then the results may not be favorable.”

“Children will show limited improvement on their goals if they do not have a strong relationship with their therapist,” added Lindsey Tilden, MA, CCC-SLP, speech pathologist at the Vista Unified School District in California. “Progress requires hard work and repetition, which asks the child to be vulnerable. They need a strong relationship with the SLP in order to feel comfortable enough to take risks and try new skills.”

It’s clear that an SLP can’t simply decide not to work with a child if the two don’t connect right away — so how can a bridge be built?

Making Therapy Fun

“The best advice I can give for connecting with young children is to be friendly, encouraging and engaging,” said Tilden. “Making a good first impression is important. This means getting down on the child’s level, introducing yourself and inviting them to join to in a fun activity. It’s important as you are initially building rapport with a child to keep demands low and the activities fun and exciting.”

“In my experience, my greatest success with positive therapy outcomes is when the treatment is enjoyable and fun for the child, based on learning the child’s likes and dislikes and building a positive rapport,” added Wiley. “Finding desired play activities and utilizing play-based therapy that integrates treatment goals keeps children motivated and willing to participate because it carefully and cleverly incorporates the process of learning new skills.”

No two children are alike, however, so how can a speech therapist determine how to formulate a plan for each patient? “As a therapist, you have to ‘learn’ the child in order to gauge when to press forward or when to withdraw the activity and redirect to something more desirable,” said Wiley. “Learning how to follow the child’s lead and making adjustments assists with developing a positive rapport and building trust, and results in a productive, enjoyable experience for both the child and the therapist.”

Inspiring Productivity

SLPs do not only work with children, and it’s not uncommon for a single SLP to treat patients of all ages. However, as SLPs who work with both younger and older patients quickly discover, treating children is often an entirely different experience. “While I find working with children incredibly rewarding, there are a number of unique challenges to it,” Tilden admitted. These challenges can involve building rapport, maintaining their attention, encouraging good behavior and effectively correcting bad behavior.

Another unique challenge may arise when trying to motivate young patients — but in Wiley’s experience, it isn’t always as difficult as one might expect. “My experience with adults has been more rehabilitative, while my experience with children has been targeted mostly to providing habilitative therapy, so children are very different in their motivations,” Wile explained. “They can be motivated by something as simple as learning to independently ask their caregiver to allow them to watch their favorite movie or listen to their favorite song. The reward is automatically built into the desired outcome, resulting in positive motivation and successful therapy progress.”

Even if one young patient isn’t as easily motivated as others, it’s still crucial to find that one thing that really inspires them. “Children work hard and try their best when they are motivated,” said Tilden. “I try to keep my students motivated through exciting and interesting activities and with incentives. Whenever possible, I use games to target therapy goals; I use prizes to help with motivation, cooperation and behavior management.”

A Happy Therapist Is a Successful Therapist

While connecting with patients and helping them find motivation are pivotal in speech therapy, Wiley emphasized what she thinks is most important in creating a successful therapeutic relationship: the therapist’s own happiness. “I strongly believe happy therapists are the most productive, effective therapists,” she said. “I recommend finding a place where you enjoy working, where you are surrounded by caring, supportive coworkers who motivate you to provide the best possible care to your patients.”

Sarah Sutherland is a staff writer at ADVANCE. Contact: