A Confident OT: What It Looks Like & How to Get There
Three Indispensable Steps to Becoming a Truly Confident Therapist
The Long Road to Get Here
At some point in our careers, most of us turn a corner: we no longer feel like we are “faking” our clinical skills, we don’t spend hours preparing for every session, and impostor syndrome finally fades away. But what does a truly confident therapist look like? Does it involve having a solid answer to every question a parent or teacher asks us? Does it mean we are always the expert? Does it entail coming up with interventions that work the first time, every time? I’d say, unequivocally, it does not.
I remember the intense pressure of being new and working with parents. They’d ask me a question and I’d tell them everything I knew while their eyes glazed over. I just had to prove myself and that I knew things. Then at the end of the session I’d assign ten homework activities to make sure that they were really getting alllll of the therapy they possibly could. But all it really served to do was to leave them feeling even more lost and confused.
Meanwhile, I wasn’t very brave with my interventions. I’d find something that worked and stick to it. Client won’t do adult directed activities? Stick with child-led play. Child’s not engaged in social play? More parent consult. My feeling was it was best not to try something that wouldn’t work…because then what would I do?
Unfortunately, I was just spinning on the hamster wheel of new therapist anxiety. Parents and teachers weren’t really interested in whether or not I knew my stuff. They wanted to have their own experiences validated and respected and to feel genuinely supported in figuring out how to help the kids meet their goals. But I didn’t have the confidence to tell them that the situations they were trying to figure out were actually really tough, and that I didn’t have all of the answers.
And the kids, too, were trying to tell me something. They were trying to tell and show me what they needed, what did and didn’t make sense to them, and how I could help them learn better. But I couldn’t see it because I didn’t know how to truly listen to them and I didn’t have the intervention skill, confidence, or experience to respond adeptly to what they were teaching me.
The process of being a new therapist, or an experienced therapist in a new setting, is truly stressful. And while it’s totally normal to feel this way, we all want to move past this feeling as quickly as we can. We want to feel honest, calm, and present in our work, whether things are going great or our sessions are descending into chaos.
The good news is, there are things we can do to mitigate the learning curve and bring ourselves into a more confident and competent state as quickly as possible. Keep reading to explore what it really looks like to be truly confident, relaxed, and effective in our work.
What If We Just Keep Spinning Our Wheels?
Imagine you are a parent of a young child on the autism spectrum. A new therapist comes over, and you start to tell them about something that has been so impossible to figure out. You’ve absolutely tried everything. The therapist quickly spouts off a quick and easy answer. Does this make you think, “Wow, she knows her stuff!” No! More likely, it makes you shut down and feel invalidated, and like this therapist isn’t going to listen to you about how tough this really is. You’ve been around the block, and you know better than to believe that there is a quick fix to most challenges.
Now imagine you’re a teacher of 20 kids, and your one autistic student is struggling. The new OT comes in and gives you a list of 10 things that might help. You roll your eyes and wait for her to leave so that you can go back to your impossible job. When and how could you do these 10 things? And would they really help that much anyway?
But Could It Look Different?
When I talk with families now, the need to prove myself doesn’t get in the way of truly being helpful. I can listen, ask open ended questions, and validate that what they are working on is really truly challenging. I don’t show up as someone who has the answers, but rather as someone who, with the permission of the parent or teacher, has some new things we can try together and just see how they go.
I often talk with therapists about putting on a “detective hat” when doing therapy. I make a new learning activity, try it out, and see what happens. Did the child go under the table and leave? Did they tear up the activity or throw it on the ground? “What good information for me!” I think. I go back to the drawing board and restructure the activity, or I change the instructions, or rearrange the environment. I talk through my planning with the parent or teacher so that they can learn this process, too, and use it when I’m not there.
When the child has a total meltdown, I simply say to the parent or teacher, “I’m glad I got to see that. Is that what you’re seeing during your day with him?” (I learned this line directly from one of my own amazing mentors and I use it all the time. And I mean it when I say it.) The parent or teacher doesn’t actualize my old fears and say “I thought you were supposed to know what you are doing! Why did you cause a meltdown!?” Instead, they look relieved as they say “YES!! That’s what I deal with!! I’m glad you got to see it too.”
3 Steps in the Right Direction
While there are certain skills that only come with experience, there are others that you can intentionally learn in order to become more confident and effective. Here are three strategies to incorporate into your work right away:
1. Make leveling statements. Whether we try to or not, usually we come into a therapy situation in the role of the expert. A leveling statement is something that brings you and the parent or teacher back to the same level where you can really work together. When talking with a parent or teacher, try making statements like:
– “You’ve tried so many thoughtful things to try and figure this out already.”
– “It sounds like he’s really lucky to have you problem solving and working so hard to help him.”
When the parent or teacher feels listened to and validated, they are more likely to be open to your ideas, and to give you honest feedback about what they might or might not be able to try during their daily live
2. Listen before you advise. When we come in nervous and start spouting off suggestions, our ideas are often really off target and don’t respect that the parent or teacher has already had a long road to get here. Before making suggestions, try these questions:
– “Tell me what you’ve tried and how it went.”
– “What would you like this activity to look like?
– “Is it okay if I watch what’s happening now?”
You might be surprised by the answers, and you’ll certainly learn a lot from the parent or teacher’s experiences that can help guide what you say and do next. This will also help you avoid that awkward and all-too-familiar conversation where you make a million suggestions while the teacher or parent tells you why each of them won’t work.
3. Become a detective. If your goal is to develop interventions that work the very first time and never fail, you’ll miss out on so many opportunities to learn from your clients about how they think and learn, and about what is really meaningful to them. Being an anxious therapist means feeling stressed when something doesn’t work. But becoming a detective means:
– Starting with informal assessment. Before you start teaching, you want to see exactly what the child is doing now. That way, you can learn about what supports they need, and you can tell if you’re truly making progress.
– Not spending too long making your activities the first time around. You want to be willing to make changes if the child shows you that they need something different. For instance you can make a quick and dirty picture schedule (not even velcroed or laminated!) so if the child throws it or ignores it you’ll be willing to say, “Oh that must not make sense to him! Let’s try an object schedule and see what happens.”
– When things don’t go as planned, watching with interest, thinking about what is happening, and exploring it with the parent or teacher. You can ask questions like:
– “Is this what you’re usually seeing during your daily routines?”
– “Tell me what you noticed.”
– “What usually helps when this happens?”
When you watch and listen, you’ll learn so much that you might have otherwise missed, and you’ll be able to go way deeper into creating effective interventions that really help your clients and their families thrive.
But It’s Not Just About Saying the Right Words
Watching, listening, learning, assessing, and restructuring are indispensable pieces of the puzzle for confident and effective therapy. But without a whole lot of interventions in your toolbelt, you’ll still find yourself feeling stuck. To be able to do a solid informal assessment with a child on the autism spectrum, you need a deep understanding of autism learning styles. And when you design and restructure your interventions, you’ll need lots of ideas to pull from, including an understanding of how to embed visual instructions at every level (even if the child doesn’t understand pictures) and how to teach to the unique way a child with autism thinks and learns.
If autism interventions are your stumbling block, I’ve got you. In The Learn Play Thrive Approach to Autism, I teach:
How to use a deep understanding of autism learning styles to effectively problem solve challenging behaviors (this is so much more than just sensory or behavior)
How to use informal assessment to truly guide your interventions for your clients on the spectrum
How to create visual instructions and structure based on the individual child’s way of learning and their own level of understanding
How to teach your learning activities in a way that promotes independence, flexibility, and generalization
And so much more including teaching play and social play, creating effective schedules, making visual to-do lists, teaching self-care, and getting out into the community!