Top Questions About Child-Led Therapy

Child-led therapy is all about following a child's interests and allowing them to lead in your sessions. Rather than going into sessions with an adult-directed agenda, we enter the child’s world of play. Children will gravitate toward what they enjoy or what their body needs (jumping, crashing, etc). This means sessions are intrinsically motivating and meaningful for the child. It allows us to form authentic relationships with the child that are built on trust and connection which is foundational for our language models to be accepted by children. 

How do you plan for child-led therapy?

We often provide loose guidelines to help those of you that are used to planning but, when it comes to child-led therapy there really is no planning. This can make some clinicians feel uneasy because it involves a lot of thinking on your feet. For those clinicians, we recommend starting slow. Focus on getting to know the child and less on making pre-planned activities happen. Our biggest tip for homes and therapy spaces is to minimize. Store away things not being used and use the rule of 3-2-1. This rule is that you should have about  three toys/objects or activities out at a time. These three(ish) toys or activities should include: two preferred toys/activities/sensory equipment, etc. that you know the child loves or benefits from and one new toy/item/equipment that is there if the child wishes to interact with it. There are no expectations for what the child will play/interact  with, but they are all there for the child to choose from.You do not need extensive resources for child-led therapy. You do not need to spend hours planning and prepping. Take the pressure off yourself to make cute crafts or to find the perfect materials. If a child isn’t interested in toy play or engaging with you as the clinician, learn about and consider sensory-motor play, regulation, and gestalt cognitive processing. 

How do you take data during child-led therapy?

Language samples! Spontaneous language samples are our data during both child-led evaluations and therapy sessions when supporting gestalt language processors (GLPs). We score these language samples using the Natural Language Acquisition (NLA) framework (Blanc, 2012). During therapy sessions, we might take shorter (e.g. 5-10 utterance language samples) and score those to show data, progress towards goal(s) and support your plan moving forward. During evaluations, language samples need to be much longer. You would want a minimum of 50 utterances or 12 minutes of language to score. A short language sample may look like this:
Gotta go home (1)
Pigs say oink (1)
Blue (1)
Green (1)
Orange (1)
Let’s go home (2)

Stage 1 83% of sample. Stage 2 17% of sample

This data can be reported in IEPs, progress reports or to insurance to show how language is changing over time.

Some ideas for taking data…

• Use a recording device (e.g. phone, voice recorder) to audio or video record sessions to score at a later time and allow yourself to stay present. Always make sure you have permission to record.

• Type utterances into a notes app on your phone

• If you prefer pen to paper, have a small whiteboard or notebook to quickly jot down the utterances you hear and score them at a later time.

How do you balance safety and child-led therapy?

When you hear “child-led” therapy, you might assume that it is a total “free for all”. We do whatever the child wants, with no regard for things like safety. That is not the case! Safety always comes first. Child-led therapy means that sessions are not adult-directed. We do not create agendas or set expectations around what or how a child will play or engage with. We honor each child’s unique play styles, interests and preferences. We make items/toys, etc. available that we know they love, allow room to move to support regulation, and follow their lead.

However, this doesn’t mean the child can do whatever they want, if it’s not safe. If a child is doing something that is unsafe, we of course, need to set boundaries to keep them safe… For example:

If a client in a session was climbing on a play structure that was unsteady. This is a safety concern. You may let the child know “That is not safe. I will help you down from there”. 

Other things to consider when it comes to safety and child-led therapy are… 

• Is the child doing something unsafe because they’re dysregulated? For example, a child may be crashing or jumping off furniture for the proprioceptive input or dropping items down vents for the auditory input. How can you support them proactively, in a safe way?
• Gestalt cognitive processing. Gestalt language processors have wonderful episodic memories and often enjoy acting out scenes from media or past experiences with items, therapy rooms, etc. They may be doing this in your sessions or at home and it may be creating a safety concern.

What to do when you get pushback from parents or other professionals who expect planned sessions/compliance-based activities?

​Many parents and/or other professionals have only ever seen traditional therapy or compliance based therapy in the past. The idea of child-led therapy seems drastically different and sounds like it may be a “free-for-all,” but like we mentioned above, that is certainly not the case. Focus on education. It is key! It’s important to make sure family and other professionals understand what child-led therapy is and isn’t. People are often afraid or get angry when it's something that they weren't expecting and they don't understand it. Always meet people where they are at.

We know gestalt language processors are best supported through natural language modeling. Following a child’s lead, allows us to model language during the most natural, intrinsically motivating, and meaningful opportunities. In order for early stage gestalt language processors to pick up our language models as gestalts, they have to be meaningful to the child. Share resources with them and invite them into your sessions so that they can see what child-led therapy looks like. Share handouts from our GLP handbook or our blog. Stress how important trust, relationship, connection is. Child led is the way to get there...and much more fun for all! 

Want to learn more in-depth information about how to support gestalt language processors?

1. There are many free podcasts, webinars and articles to get you started. A comprehensive list of resources can also be found on our website.

2. Consider taking the Meaningful Speech course to learn more about how your child or client processes language, how you can help support them from echolalia to self-generated (original flexible) language, child-led therapy, and neurodiversity-affirming practices. Looking for something shorter? We have a 1-hour introductory course perfect for extended family, daycare or school staff.

3. Consider taking our AAC + Gestalt Language Processing course. It will teach you how to identify, evaluate and support gestalt language processors who use AAC or who you think might benefit from AAC.

4. Look for a speech-language pathologist (SLP) who "gets it" and can help you in supporting your child's language development. Check out our registry for SLPs who understand gestalt language processing and child-led therapy.

5. Are you a school-based or private practice clinician looking for intake forms for new clients/students or creative visual reminder posters for your space? Check out the Meaningful Speech Marketplace.