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Progress Ceased: Signs It’s Time to Dismiss

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So, a big part of my job as a therapy director is to be there to support therapists during both the rewarding and the more difficult aspects of therapy.  One of the more difficult aspects of being a therapist is knowing when it’s time to dismiss.  In a perfect world, the patient and/or student meets all of his or her goals and skips out of therapy with every functional skill needed to survive in this world.  Unfortunately, that isn’t always the case and as therapists we have to know when therapy is no longer beneficial.   

Here are some signs it’s time to dismiss from therapy:

  1. Progress has ceased; I feel like this is the one that seems like it would be obvious but is really the most difficult. When progress has ceased, it’s not this OBVIOUS "stayed at 50% accuracy for weeks” situation.  Often times it’s a patient who fluctuates between 40-60% for the past few weeks, the student who can say the /r/ with 80% accuracy if given prompts but struggles to generalize to conversation, essentially it’s the bump you can’t get past no matter how many things you try.  It’s important, too, to note that it isn’t that progress has ceased, it’s that FUNCTIONAL progress has ceased.  The student and/or patient may continue to make strides, those strides just aren’t at a pace that justifies skilled intervention.

  1. Intervention no longer requires a skilled therapist: People often don’t realize that when therapists look like they are just "playing a game with a patient/student” they’re really gathering data, implementing a cueing hierarchy, and creating functional communication opportunities.  Therapy requires a degree, knowledge of evidence-based approaches, and experience.  With that said, a good sign that it’s time to dismiss a client is if the therapy is no longer skilled in nature.  If you’re contemplating dismissal, think about the intervention you’ve been providing over your last few sessions and then ask if a dietician, nurse, teacher, reading specialist, or parent could do that job.  If the answer is "yes” then skilled therapy is no longer necessary.

  1. You are putting off dismissal because you know it will upset the parents/caregivers: It’s never fun telling loved ones that, despite your contact efforts, all the goals haven’t been met.  Dig down deep and you might discover your reluctancy to dismiss is because you’re worried about the reaction you’ll get from loved ones.  Give yourself a big pep talk, bring your Code of Ethics, have a large cup of coffee with you, and give the parents/caregivers a discussion that they need to hear.

  1. The progress is no longer functional and/or educationally relevant: We all have that student that we love and would hate to see go, but if they aren’t making progress and/or gains that are functional then it’s time to dismiss.  If you’re contemplating dismissal, look at the therapy you’re providing and think about how it will help that patient when he dismisses to home OR that student when in the classroom.  This is the time to do some therapy soul searching and take a hard look at the outcomes.

  1. You are on the fence: If you can’t decide what the next best move is, that’s a sign that it would benefit to get another pair of eyes (HIPAA/FERPA abiding eyes, of course). I know not every therapist has the luxury of this, but utilize your coworkers and collaborate with the teachers/other therapists.  If you have a therapy supervisor and/or director, use them to bounce ideas off of.  

Determining the next step in a treatment plan isn’t always the "black and white” decision we want it to be. Therapists didn’t go into the field of therapy because of anything other than we like to help and work with people.  It can be difficult to know when therapy is no longer functionally benefiting one of the clients, but as a therapist you did your best and you can let that patient/student fly now!

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