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Pushing Back on a Pushy Speech Therapist

Pushing Back on a Pushy Therapist

By Amalah

Hi Amy,

So I have a question. It’s kind of about my kid, but it’s mostly about money and navigating therapy options, and how those intersect.

My 3.5 year old son is in speech therapy right now for some physiological/low tone issues. His issues are not developmental, so while they are covered by insurance he is not eligible for early intervention. 

We have insurance that is good but not great.We are essentially paying out-of-pocket for therapy sessions until our deductible is met, which will not be for a while. And finances are really, really tight now–I have a baby due in a few months and my husband is on the job market. While we live in a very expensive town, we get away with it because we rent a tiny apartment and we only have one car. 

My son needs a very specialized type of therapy and there is only one practitioner in our very large urban center. She seems to do great work with my son and he likes her. But I…don’t like her. I mean, on a personal level she just rubs me the wrong way, and she doesn’t seem to “get” that affording her is a luxury for us that is difficult to sustain. 

The therapist practices in a very expensive area, and I think she is not used to dealing with people who are financially struggling. She is insisting that my son come to treatment every week, when it costs a lot of money, and necessitates me taking at least two hours off work at a time while I’m trying to bank PTO for my maternity leave. I’m already taking off time every two weeks to visit my OB, plus a chiropractor and various other appointments that come up (again, I’m the only one in the family with a car).

When I expressed to her that this was straining our finances and it was really hard for us to get there every week, her response was, “well, this is important.” She’s also made other “helpful” suggestions to us regarding our lives that were completely out of touch with our reality.

My husband and I are completely dedicated to our son and his program, but going to see her every week is a serious strain on us right now. My question is, how hard can I push back here? Do I just have to suck it up and stick with this therapist’s plan, even though it’s tough for our family, both financially and logistically? I am willing to go every other week but I don’t feel like I’m being heard or respected when I try to negotiate. Is this something that I am even allowed to do? I don’t want to jeopardize my son’s treatment but I want to keep my life somewhat manageable at least.

Thanks.

Ohhhhhh, this is such a tough situation. We’ve also encountered therapists and various practitioners like this — I’m thinking of one in particular who, despite probably helping my son in some ways, rubbed me the wrong way so strongly that I view our entire time with her as a giant, annoying waste of time and view her as someone we should have moved on from sooner. She, interestingly enough, was also someone we saw through our private insurance rather than Early Intervention (EI) or the school district, and was also pushy and oblivious to what a huge inconvenience the visits were for our family.

(My rant: She lived in a not-super-great area with horrible traffic but had zero patience for anyone who dared to get stuck in it. Her office had no waiting room so I’d spend the time sitting outside in the car with my two other boys, letting them watch a DVD. It was boring and wasted gas but there was nothing nearby to do and Lord knows I wasn’t going to risk driving a bit too far away and hitting more rush hour traffic on the way back. She wanted regular meetings with both my husband and I but wouldn’t allow us to bring any of the kids, even our youngest who was only in school for barely two hours a day, aka my most important work hours. She messed up insurance billing all the time and sent us bills she claimed were overdue, and she waited an inexplicably long time to make an important referral that ended up being what our son REALLY needed, rather than months of visits with her.)

Yes, the doctors and therapists are experts at what they do, but YOU are an important expert too:  You’re the expert on your child.

It’s hard to talk about all this stuff sometimes, lest you dare come across as being anything other than the perfect selfless special-needs parent. OF COURSE I will do whatever it takes to help my child. OF COURSE I will sacrifice time and money and get him the resources he needs. But it’s okay to admit that you need some balance and compromise somewhere between all that sacrificing (especially once you add younger siblings to the mix!). It’s also important to think independently and critically about the recommendations and opinions being hurled at you, and to make sure you’re not getting pushed into something merely because you’re scared or feel in over your head. Yes, the doctors and therapists are experts at what they do, but YOU are an important expert too:  You’re the expert on your child.

I’m curious, by the way, who told you that your son isn’t eligible for early intervention, simply because his needs aren’t “developmental.” Is his speech delayed, or otherwise abnormal and not where he should be? Are his needs anything that would be considered a disability of some kind, either physical or mental? Something resulting from your pregnancy or his birth or an illness? Because that’s all still in EI’s wheelhouse. Did he at least go through the EI evaluation process before free services were ruled out? And even if he DID, now that he’s 3.5 years old, have you reached out to the school district to have him re-evaluated? (Children typically transition out of EI at age three, and the school district takes over providing any necessary services.)  Obviously I don’t know the exact nature of his needs, but “physiological issues/low tone” were definitely terms and diagnoses I came across in our time in EI and our district’s PEP (Preschool Education Program). That might be your best shot at a second opinion and some financial relief.

If that’s still definitely not an option, then yeah, it’s time for a real heart to heart with the therapist. Tell her coming in every week is no longer going to be feasible for you, logistically or financially, and you need to amend your son’s treatment plan. Use declarative sentences and not questions for that part, so she knows it’s not something she can brush off again or push back with fear-based predictions of doom. What are some at-home exercises or activities you can do on the off week? If she really, deeply believes that dropping back to every other week would be Bad and Wrong, ask her straight-up for a discount or payment plan of some kind, at least until you hit your deductible. (Or your husband finds a job and/or you guys can start contributing to a Flex/Health Savings Account for this stuff.)

I assume, of course, that you’ve already done your due diligence and independent research on this very specialized therapy, but I’d suggest hitting the Internet before you have the talk and (hopefully) can find evidence/anecdotal data of kids and families who went less frequently and still achieved the desired results. We typically started our son’s speech/occupational therapies on a more “aggressive” weekly schedule, then dropped down to every other week or even monthly. I doubt you’re asking for anything crazy out of the ordinary here.

If nothing you say works and she remains insistent that every week is the way it HAS to be: I’d probably suck it up and personally continue going…while also REALLY shopping around for a second opinion on whether 1) this very specialized therapy really is the be-all, end-all recommendation for your son’s needs and not just the favorite course of action of whoever made the referral, and 2) there really isn’t any other speech therapist in your area who — despite maybe not specializing in it 100% — is familiar enough with it to take over your son’s case. Having a therapist who is a “good fit” is incredibly important, and I think that “fit” needs to extend beyond just your child, but to your whole family and overall quality of life. Good luck!

Photo source: Depositphotos/belchonock

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Amalah
About the Author

Amy Corbett Storch

Amalah

Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Ama...

Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Amalah. Also, it’s pronounced AIM-ah-lah.

If there is a question you would like answered on the Advice Smackdown, please submit it to amyadvice@gmail.com.

Amy also documented her second pregnancy (with Ezra) in our wildly popular Weekly Pregnancy Calendar, Zero to Forty.

Amy is mother to rising first-grader Noah, preschooler Ezra, and toddler Ike.

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Comments

  • Feel free to totally ignore this if you’ve already done it, but I want to echo what Amalah said about the evaluation through the school district. My son started going to speech therapy when he was 2 (also to a therapist we didn’t particularly like, and also at a time when money was pretty tight). When he turned 3 I asked her about getting speech therapy from the school district, and she essentially said, “Well, yeah, you can do that IN ADDITION to coming here. But he probably won’t even qualify, anyhow”. I made the phone calls for the assessment, and before even analyzing their test results they said that yes, he DEFINITELY qualified. We had gotten the referral to the speech therapist from our pediatrician, and I had assumed along the way that because his issues were just with articulation they must not have been severe enough to qualify for EI (because OBVIOUSLY somebody would have mentioned to us if there was a free option, right??? WRONG!). So, sorry if you’ve already done that and this is completely unhelpful! But I would just hate for you to echo our experiences and pay out of pocket for something that you could maybe get for free!!

    • April

      I want to second everyone on here in saying that the school sees lisps, physical and social issues that could hinder development differently than EI. A friend who is dealing with speech challenges found that physical issues that impede speech hinder sounding out letters which leads to site word difficulties. So, ask and ask and ask again! If the schools will assess him, you may end up with a lot of $ back in your pocket. Also, a lot of school-based therapists travel to you.

  • Caroline Bowman

    I have been in these kinds of situations before and the key thing here is to do all the homework Amy suggests obviously, and then to really take a moment to calm yourself completely, plan precisely what you’re going to say and stick to that. No ”is it okay if” just ”this is what we are going to do. Of course it’s really important, which is why we make very large sacrifices across all areas of our life to make it happen, but currently we will not be able to pay you weekly, so unless you’re offering to do it for free, then we will be going down to fortnightly. I’m sure you understand. Can we now discuss ways for me to do some at-home homework / increase what we’re doing to account for the week off?” Do not brook argument. Just repeat yourself as necessary and then bottom-line it. It needs to be completely free on alternate weeks or no dice. She will be forced to admit that won’t happen. Then move on. They are quite strident, a lot of these therapists, and they forget that YOU are the one in charge. You. You are not even slightly selfish, you have many, many priorities and considerations. Your new baby will need your time as an absolute priority in a few months. That’s just biology. You need to have a roof over your head.

    Chin up, stiffen backbone and stay calm! Best of luck.

    • tadpoledrain

      I just want to offer the warning, though, that if you go this route, you may find yourself without a therapist. You’re under no obligation to bring your son every week, but she’s under no obligation to meet with you every other week. I’m 100% on your side, by the way. I do think you should push back, but be researching other options at the same time, including free options through your school district, both because you want to find a therapist you think is a good fit for your family and because it doesn’t sound like this relationship is going to work out in the long run.

  • Lisa Y

    I’m a school SLP and, while we are not experts in every type of therapy, most of us will do whatever we need to do in order to meet our students’ needs, whether that means getting training, collaborating with other professionals, or just doing some research. So don’t hesitate to call your neighborhood school just because you see this private SLP as the only expert.

    Also, as Amy said, you’re the expert on what is best for your child and your family. As therapists, we can make recommendations based on our experience and clinical judgment. From there it’s up to parents to decide what is right for their children.

  • LW

    Original letter writer here!

    I wrote this letter a few weeks ago, and a few things have happened since then. First, to clarify: my son most definitely does not qualify for EI. Basically, he has inherited a facial structure that causes him to have some sinus issues and a tendency to mouth-breathe and appear slack-jawed. He has already had tubes in his ears and his adenoids removed, which helped a little bit, but since he’s had to keep his mouth open since he was a toddler, he needs to retrain his facial muscles to keep his mouth shut by default. We’ve been working with a dentist and an ENT since he was very young, and he will most likely need pretty intensive orthodontia starting in elementary school. Speech therapy was proposed as a less invasive, interim step we could start now. We did attempt to get him screened for EI but the SLP doing the assessment told us about five minutes in that he wouldn’t qualify unless he still had his lisp in another year and a half, and referred us to our current provider.

    But the biggest development is that my son started having meltdowns when it was time to go into his therapy appointments–crying hysterically and clinging to my leg. He flat-out told me that he didn’t like his therapist, which is a pretty strong statement from an otherwise very agreeable and compliant kid. I offered to go with him and shadow the appointment, and I was not impressed with how the therapist interacted with him. At one point he didn’t want to do an exercise with the therapist, and she turned to me and said, “Mom, what’s going to happen if he doesn’t cooperate?” Which is the point at which I realized my gut instinct about this provider was correct: I had spent so much time and energy helping my kid feel like he was safe and this was a fun thing for him to do, and ten minutes into the session she was already bringing up a punitive approach to get his compliance. Not cool.

    So yeah, I don’t think this is going to work out for us. I found a few other providers that provide similar services but are not as conveniently located. I have called a few of them and will hopefully find out more information in the next week or two. Hopefully, I will have some extra time during my maternity leave (ha!) to drive him around and figure out a workable plan going forward.

    • Oh MAN, it’s so discouraging when providers who work with children just AREN’T GOOD with children! : My son started speech therapy right after my daughter was born (hahaha, I had to get a family member to come drive us to the appointment to get his referral since I’d just had my c-section and wasn’t supposed to drive) so I know that’s not an ideal situation . . . but if that’s how it works out, I hope you have a super chill baby who does well on car rides and an easy labor and delivery 🙂 Good luck!

  • I don’t get why facial structure rules out services? I would have thought that anything that caused a delay or difficulty in speaking would be treated the same.

    • Karen

      For my son, evaluated at age 3.5 for what turned out to be very similar description, his problems do not interfere with his ability to learn in a classroom. And that’s the extent of our school district’s responsibility. Functional problems are not their scope.

  • Karen

    I feel your pain. My son was not qualified for services at age 3.5 for what turn she out to be something very similar (speech and eating problems due to tongue tie/facial structure) because it doesn’t interfere with his learning and it would resolve with time. Now he’s five and I’m being told by a private SLP that she needs to see him 2x a week, 40 min each way, pregnant and those bills coming, and a super high deductible too. I’m not sure how I will proceed but I may seek a second opinion.

  • PaintingChef

    Oh I needed to read this today (as I’m catching up on a month of neglected blog posts…) We are having a similar issue with our daughter’s therapist in that she wants to push my 7 year old daughter to deal with something (we adopted her out of foster care) that I know with every fiber of my being that she is not ready to deal with. And this therapist makes me feel like a HORRIBLE person for saying this. But I know my daughter better than she does. I am the expert on her, not this therapist. Thank you.