Don’t Just Build Rapport: Seek Connection
Many of us strive to connect with our patients during our speech therapy treatment sessions, but how we define connection may vary. We may also seek connection for different purposes. Maybe you see connection as a means of gaining patient or caregiver buy-in. Maybe you see it as a preliminary first step to ultimately introducing structured therapy. Perhaps you recognize that building connections with your patients can increase their motivation to participate.
I believe connection extends much further and would argue that it is an essential first ingredient in effective speech therapy. Connection allows us to know the child and family as human beings, supports safety and trust, creates opportunities for intrinsic motivation, facilitates authentic participation, and allows us to pursue meaningful progress. Above all, establishing connection means truly getting to know a child and that knowledge allows us to individualize our interventions in ways that are reflective of who that child is.
I see connection as the wheels driving our therapeutic car forward. It allows us to establish safety, trust, and intrinsic motivation, creating the groundwork for a better journey toward meaningful progress. Connection has to be honored and preserved throughout the entirety of our therapeutic experience. Connection isn’t a phase of therapy. It’s part of the therapeutic process.
Here, we will discuss the whys and hows of building connections with pediatric patients and their caregivers.
Connection Starts With Relationship
In my earlier years of practice, I primarily focused on connecting to the speech and language needs of my patients. I thought if I knew their communication profiles in and out, that I’d know exactly how to help them make progress. I inadvertently overlooked the need to know the patient as a person, and their families as important partners in the therapeutic process. While I did inspire some change, I reflect back now and see that lacking a true connection as a foundation for improvements was not nearly as impactful as the therapy I’m implementing today. My previous work sometimes led to children becoming avoidant or disinterested and families becoming confused or hesitant, whereas now I look for opportunities to build upon intrinsic motivation and a genuine desire to engage.
So what changed?
The Connection Lens
As I progressed through the years, I began to realize that knowing my patients as people, and understanding the families and environments they were a part of, was just as important as understanding their communication profiles. I started to see how individual factors could influence how a child participated, communicated, and progressed in therapy. More importantly, I began looking beyond what a child could not yet do and paying closer attention to what they could do, what they enjoyed, how they communicated, and what helped them feel successful.
I began getting to know my patients beyond their speech and language needs and started to dive deeper into things like…
Interests: What does this child love to do, play with, watch, read about, look at, or eat?
Knowing their preferences allows me to build on what captivates them while creating opportunities for joint attention, communication, and conversation. I'll do things like: make toys like a Bluey stuffy a “talking” communication partner; pick books that contain preferred characters or themes like KPop Demon Hunters when targeting comprehension-based goals; program preferred foods and locations like McDonald’s on AAC devices; incorporate preferences for order by realizing sequencing steps in rainbow order could assist with retell activities.
People and routines: Who matters to this child? Who will be communicating with them? Who knows this child well? What does their day actually look like? Where are they already successful, and where are communication breakdowns occurring? What is already mutually understood by all communication partners?
I acknowledge that I may need to wait and allow parents to take the lead, while I watch for an opening to gently chime in within a parent-child interaction that is already comforting to the child. Rather than immediately trying to change what is happening, I can start with what is already working and build from there, showing the child that I see and understand what they are already doing successfully. I incorporate family members in the goal creation process to ensure that goals reflect family values and position caregivers as active members of the team. I make an intentional effort to incorporate multiple communication partners when other caregivers are part of a child's daily life. I may do things like: use real photos of family members on AAC devices to personalize SGDs, create opportunities to communicate about the people who matter most, ask WH questions about past/future events that include the names of VIPs to demonstrate that I remember and care, and look for naturally occurring opportunities for communication within the family's routines to empower caregivers to continue our work beyond what occurs in session. I purposefully recognize parents and caregivers as the experts on their children. I regularly ask caregivers what is going well, what feels challenging, and what may need reworking.
Learning about routines also helps me identify where communication support is needed. I can teach a child to seek assistance during genuine moments of needing help, protest undesired actions, or comment to share their joy during their favorite times of day. I can help parents adapt the environment to support children in becoming more confident doers and communicators, such as modeling statements in place of questions or creating visual schedules that parallel their daily routines to ease transitions.
Putting Connection Into Practice
Let me give you an example.
I have a patient I am currently working with who is enamored by cats. Whether she is donning a Super Kitties shirt, or greeting me at the door with her “Battle Kitty” voice, I anticipate a feline-filled session for the 30 minutes we are together. As a patient working primarily on articulation skills, this child and I incorporate play, favorites, and preferred toys as means of eliciting speech sound targets. Six months after beginning therapy, she is now immediately imitating words I model and responding to corrective feedback. Her mother recently pointed out that she had not seen this level of immediate imitation in her previous years of speech therapy. She attributes this change to the relationship we have built and to the way we have reimagined what speech therapy can look like for her.
So how did we get here?
When we first met, it was very clear to me that drill-based practice would not fit this child’s profile. I took a different approach - I played with her. I learned about her favorite toys. I learned the names of all her cat stuffies. I brought books from home featuring cats. I engaged with her without explicitly prompting imitations of targeted speech sound stimuli. I temporarily prioritized relationship and observation over extracting a performance from the child.
As time went by, I started to model appropriate productions in response to words she said. I subtly modeled her target sounds as I repeated what she said in my playful Kitty voice. I created a cat-themed alphabet, using images of cats transformed into letters, to introduce letter-sound correspondence while heightening her interest in what I was teaching her.
The first several times, she showed no interest in looking at the kitty alphabet for more than a few seconds at a time, so we immediately went back to playing with slime, building a train track, or whichever other preferred item she wanted to show me while we playfully conversed and I provided repeated models of target sounds and words naturally throughout our play.
I didn't need her to engage with the kitty alphabet simply because I had decided it was time to work on it. I could introduce it, see what she did with it, and try again another time.
Fast forward to today, and she’s readily using words I’ve suggested via binary choice, modeling, repetition, and WH questions without ever prompting her with “say ___”. She's referencing words that contain the “cat letters” we've reviewed together over time.
What changed wasn't my commitment to working on her speech sounds. What changed was the way I approached getting there. By taking the time to learn what she enjoyed, how she communicated, and what made her feel comfortable, I was able to introduce challenges without making participation feel like a demand. She learned that I would listen to her, follow her interests, and respect when something wasn't working for her. In turn, I was able to gradually introduce more opportunities for imitation and speech sound practice without needing to rely on “say ___” or repeated demands for participation. To me, that is the power of connection: it doesn't mean removing challenge from therapy. It means creating the conditions where a child can feel safe enough to take a risk, try something difficult, and experience themselves as capable.
What Connection Makes Possible
This experience reflects how I approach connection more broadly. For the first several sessions, I don’t immediately suggest or structure activities around my agenda. I don’t expect the child to demonstrate their goals on my timeline; I know that will come later. I let the child lead while I watch from a variety of lenses. Taking the time to observe and learn about who the child is as a human being gives me a valuable, less intimidating entry point into therapy. When I intentionally look for what a child can already do, what they enjoy, how they communicate, and what supports their participation, I am not simply collecting information to make therapy more effective. I am communicating something to the child: I see you for more than the skill we are working on.
Connection Creates the Safety to Challenge
Connection does not mean that I will never ask a child to do something that is difficult, unfamiliar, or non-preferred. In fact, I believe the trust that develops through connection can allow me to eventually support a child through those moments.
I don’t want to use the relationship I have built with a child as leverage to force participation. Instead, I want the child to learn that I will listen to their communication, respect their needs, and support them when something feels hard.
That might mean attempting a difficult speech movement, practicing a sound that does not yet feel natural, trying a new communication strategy, navigating a communication breakdown, or transitioning away from something preferred. These moments can be challenging regardless of how connected a child feels to their therapist. But when a child knows that I am listening and that I will not ignore their communication, the challenge does not have to threaten the relationship we have built.
As our relationship develops, I can begin introducing more challenging tasks while maintaining that sense of safety and trust. Connection does not remove the challenge from therapy. It changes how I introduce the challenge and how I support the child through it.
