2 questions

[hillview]

1) how much time do you spend with your child's therapists (OT, SLP, tutor, etc). On a session or weekly basis?
2) how much time do you spend with your child helping with homework assignments and what age is your child? How has this changed over time?

Thanks!

[Sweetum]

I can answer the first one:
In the initial days of starting therapy with a new therapist, I sit through the entire session (if allowed) or watch (if available). I spend about 5 min asking questions/talking at the end. But I'm also the type of person who thinks of questions much later, so I write them down and ask next time, either before starting therapy or at the end. I prefer before so the therapist won't feel like I am taking time beyond their time. Sometimes, if available, I also email them and add a note at the end saying that they don't need to respond on email but responding at the next session would be just fine. again, I don't expect them to work over. Once therapy is established, I usually just do the customary 5 minutes that they are mostly telling/ doing a recap of what happened and what the challenges were. Sometimes I end up having follow up questions but mostly I don't. This recap happens across all of the sessions that DS does every week. About every 3 or 4 months, I try to sit in or watch if possible and try to understand how therapy has progressed or how is responding, and that is also when I might have additional questions. Again, report time, testing time is when I end up having more questions.

ETA: DS is 5+ (almost 6)

[sste]

I think it depends alot on severity and trajectory. So when DS was in EI and we were very scared he had a global delay/severe mental handicap (he was not walking, talking, or even reliably responding to his name), I spent about 4 hours per week sitting in on the therapies so I could learn the techniques and about 4 hours per week practicing/implementing.

Now, DS is receives in school services though they said I could sit in. i have not because both OT (handwriting, visual perception) and SLP (articulation) think his problems are on the lower end, are improving briskly, and they anticipate him not needing services in 1-2 years. I def. agree with that assessment based on the progress I have seen this year.

For his anxiety therapy, I sit and am involved in the entire 60 minute session. The structure of the therapy is 12 intensive sessions where they work with the child AND perhaps even more importantly give the parent coping skills and homework to practice with the child. Unfortunately that is two hours of driving round trip plus hour of therapy but at least I found an excellent person my insurance covers. What helps too is that they are very clear that their model is 12 sessions -- with the vast majority of patients they get the problem under control in 12 sessions and then maintenance visits as needed after. If it requires more than 12 sessions they meet with the team and try a different approach I believe. Obviously that doesn't work for speech, OT where it is more ongoing services but I do think that very often the psych pieces can be dealt with in short bursts, going back as needed or back for another intensive three months when a new issue arises.

FWIW, I started to feel overwhelmed and decided it made sense for me to choose an area of "focus" for a season or two and just leave the rest on auto pilot and then switch up. So for summer/fall the intensive anxiety therapy. Then in winter I am going to work on either visual perception or maybe reading if there is a delay (there is not right now). I know for kids with more demanding needs/acuity that approach might not work. But I think we are on the milder end and with a job, 2 other kids, I fear for my sanity some days!

ETA: Our kindy had no homework thank the merciful heavens.

[egoldber]

When older DD was in speech therapy as a child, a lot.

For IT, when she was 3-6, not at all except for a check in at the end.

For her anxiety therapy, except for the initial set up sessions, not at all except for a quick check in at the beginning or end of each session. Sometimes if they have a lot to talk about or work on, the therapist and I touch base on the phone. sste, I am really surprised that you are that involved. But older DD did not start seeing a therapist for the anxiety until she was 8, so that may be the difference. Even for CBT therapy, I think the child will not speak as freely with the therapist about fears when the parent is in the room, especially if any of the issues revolve around the parents or siblings.

For homework, I was a LOT more involved with older DD than younger DD. And with older DD I have backed way off over the last few years. I try now to only provide space and be involved as needed. I don't get involved in correcting or monitoring the homework unless my participation is needed (reading a word to her to spell, etc.).

[sste]

Beth, I think it is because he is only 6. Our therapist told us the various mini interventions they have studied with preschool and very early elementary on anxiety have had a positive effect, she thinks the field is slowly moving in that direction, but there was not really a seriously studied and validated program for six year olds or preschoolers etc. She has cobbled together a mix of Coping Cats and Superflex. One big issue is that developmentally it is very threatening/uncomfortable for younger kids esp to share their feelings and apparently even more so for DS - - we have been working to get him to stop whispering feelings to me and telling me to tell the therapist!

Her approach is interesting and now that you say that about kids not talking in front of their parents I am wondering if it is designed to combat that in part. We spent the first two weeks just trying to make DS feel more comfortable with sharing feelings and to realize having negative feelings wasn't bad, didn't mean there was something wrong with him. It was shocking to me in that I could tell he really had felt that way and was so relieved that bad feelings weren't a failure. So, the parent assignment was for DH and I to share our feelings throughout the day, "I am happy because of X" or "I am feeling sad right now because of Y. It is OK to feel sad, everyone feels sad/worried/upset/whatever sometimes." DH and I dutifully did this several times per day and it really did work -- DS started mentioning his feelings. Therapist and I also share our feelings during the therapy -- we go around and each of us along with DS has to identify our current feeling on a picture card and explain why we are feeling that way. This all did seem to make him feel less stigmatized and patient-y though I admit I felt a little absurd -- at one point I was asking if there was a picture card for "overwhelmed"!

I had not realized but I very much fell into the mold of trying to make sure DS was "happy, happy" as much of the time as possible, I am a fixer in the extreme and it made ME anxious to have him unhappy. But she is right -- having some amount of sad or worried feelings is OK, normal, part of the human experience and she didn't say this outright but I suspect my trying to fix it was communicating to him implicitly that those feelings were wrong which was making him more stressed!

The next step was that she worked with him around the idea that sharing feelings makes them less upsetting. She talked to him about that, I reinforced it at home, he did the before and after how big is the bad feeling monster and saw that he really did feel better after sharing and then problem solving with us, and we gave him lots of positive reinforcement "thank you so much for sharing that feeling with us DS." What she said that caught my ear is that not only is sharing feelings helpful in terms of the child's felt anxiety it also puts the child's behavior into context for other adults -- a kid acting seemingly strangely or over-reacting makes more sense and is more sympathetic to an adult or even peers if the child can say, "I am feeling scared of X" or "I am feeling really sad right now."

Anyway, thus far in, I would say most of the "homework" is for DH and I. I do suspect that relates to age. Sorry for carrying on here but I know some in our forum don't have child CBT therapists in their areas and I figured writing all this out might be helpful to someone. As well as explaining why I am parked in therapy sixty minutes per week!!