By Julie Meelia, MS CCC-SLP

Owner, Whole Child Speech and Language Therapy, LLC

“You cannot lead a child if you do not have their heart. Once a child trusts you and feels deeply connected, the seeds of inspiration are nurtured. “ – Tammy Schamuhn

I came across this quote one early mid-January morning in the throes of a busy school year as a public preschool SLP. I sat in my bed on that Monday morning and just didn’t feel ready to start the week. It was winter and we were in it. In the snow, in the time between vacations, in the green noses and coughs season of preschool. I could feel the burnt out SLP feeling creeping in. The whole school was tired.

When I got to school, I grabbed a piece of poster board from the art closet and sat at my desk with my coffee. I wrote the words of the quote out in fancy letters and posted that poster board in the basement hallway that was our therapy hallway. For the rest of the school year it served as a reminder to all of us that we need to remember to focus on hearts before goals, on connection over compliance, that we need to co-regulate with children, regardless of what is happening all around us and within us. Every single day we have an opportunity to connect and meet a child where they are, and if we get quiet enough, even without words, they tell us what the keys are to connecting. It remained up on the wall for two more years until I decided it was time for me to go. (The public school was a difficult place to work-with its never-ending paperwork and meetings, and ever-growing caseload. I often felt like stress and anxiety took away my ability to truly help people. Some people manage it well. I recently left after 4 years, when I noticed my spark dimming, to pursue a private practice adventure, on my own terms, and have never been happier, but I digress…)

They don’t teach you about real connection in grad school as an SLP. That is learned over years of successes and failures, and as the saying goes “If you’ve met one autistic individual… you’ve met one autistic individual.” Every person is so unique.

When we start our clinic rotation, we are taught that the goal of the first therapy sessions is to “build rapport”. A few weeks ago I sat with my bonus niece, (my nephew’s long time girlfriend whom I adore) who is a new grad student in speech language pathology. She was preparing for her first clinic session, and we were sitting at Starbucks talking about what exactly is “rapport” and how exactly do you build it? I sipped my ice coffee and could feel some passion about the subject coming into my throat. And I started to remember what therapy was like as a young, new clinician working with autistic individuals. I got bitten sometimes, I got scratched, I had children bolt. I’d enter the classroom to take them for their pullout sessions and they would drop to the floor. I told her what that was like and how unsuccessful I felt. But then I told her what it’s like now, and how 20 years have taught me that relationship building is more important than any therapy plan we could create.

Building rapport, for me, is building trust. In many verbal people, it’s through a lot of talking and sharing information. For many pre-verbal children, building rapport constitutes being a safe zone for them. It’s letting them come as they are, and after much careful observation and our gentle presence, they trust. It makes us their favorite people, it makes them seek us out in the school hallway, it makes them run up to our office shrieking and smiling.

It was pretty exciting to sit with my niece as she started her own therapy journey, tell stories about therapy sessions over the years, and to remember the times when I was a new SLP and starting my therapy sessions with pre-verbal children. I remember a little boy at my first school in East Providence who would run out the door of my therapy room and down the hall, and I would catch him just before the playground doors. No matter what I planned in that therapy room, it wasn’t for him. He’d run away, out the door and down the hall at lightning speed. Though I was only 24 I thought I had a pretty solid therapy toolbox. I had fun tabletop activities, I had planned and was ready! I was the SLP, and I had my shiny new SLP card to prove it. I knew what to do, didn’t I? 7 years of undergrad and grad school! Nope. It wasn’t until a couple of years into my therapy practice that I got it. Therapy doesn’t need to take place at a table. For my little bolter, he needed trust and connection and he didn’t feel either of those things with me when I knew him. He needed to move his body and he just wanted to swing out on that playground! If I could go back to 2003, we’d start on the swings. Swings didn’t need to be the reward, they were the road into his heart, and could be the therapy.

For pre-verbal children in particular, relationships are built by following their lead, which means joining in their play, in the way that they play. I think back to a little friend who happily lined up shiny teaspoons on her counter, marveling at their shininess and order. Why didn’t I join in back in 2004 instead of trying to entice her with my farm animal puzzle? Why didn’t I help her find other shiny objects to organize? Why didn’t I bring my own set of spoons to play along next to her and create play routines for her to observe, that didn’t consist of me breaking up the shiny order of her special spoons?

The old thinking looked at autism differently. The neurodiversity affirming movement is much more fun and beautiful. Two years after my sessions with the little boy who would bolt out of my sessions, I was sitting on a curb during an Early Intervention session, plopping rocks into a storm drain with a little friend whose favorite pastime was just that. I had completed a training on Greenspan’s Floortime methods that changed my therapy life. I had done co-treats with OT’s and noticed that when children were moving, that’s when they talked most. I had read lots of books on sensory integration, and ideas were clicking. Sessions were full of movement and play, and in turn, laughter and progress.

Plop, plop, plop. I’d find my new friend big rocks and small rocks and hand them over. He didn’t look at me for the first few sessions. We sat there plopping rocks for a while, and he giggled as they plopped. I giggled too and modeled “Plop!” in an exaggerated silly voice. I went to hand him a rock and his big brown eyes looked into my soul. He knew I was with him in his play. We connected because I joined in his joy of something so simple. Bingo. That’s rapport, trust, acceptance. Eventually he vocalized, and eventually he said “Plop!”. Our session was predictable, we had a timer to know how long we could “plop” for, and a visual schedule to let him know what was happening next. Life was good. When I pulled up to his driveway, he’d be standing in front of the screen door waiting for our play time.

Floortime methods and sensory techniques have brought me all the connection over these years and I cannot say enough about the value of meeting children where they are, following their lead, and focusing on connection over compliance. Some of my favorite resources: Sensory SLP, Floortime, Cari Ebert, Meaningful Speech, to name a few. There are so many others out there, and the neurodiversity affirming movement is a train that can’t/should not stop, that will carry our profession and all the families we serve so very far. If you need me, I’ll be happily swinging, crashing, plopping rocks, and connecting for the next 50 years or so.

Julie Meelia is the owner of Whole Child Speech and Language Therapy, LLC. She has been “doing this” for over 20 years and can say with all confidence that therapy should never feel like work, and that the magic happens in connection. She lives in Acushnet, MA with her (almost) 18 year old twins, black Lab, and 4 guinea pigs.