My Therapy Vision

By Shruthi Nayak · 5 min read

“Before I ask a child to join my world, I need to be willing to join theirs. That belief shapes everything I do — from finding joy in what matters to them to looking beyond a difficult moment and asking what this child needs to feel understood.”

When I plan therapy for a child, I think about what that child needs to communicate during an ordinary day. How will they ask for help when something is difficult? How will they tell someone they have had enough? How will they share something they love?

Shruthi sitting at her desk in her therapy room beside a stack of books on paediatric feeding and swallowing, with “Work 10 min” and “Play 10 min” picture cards on the drawer.

These questions shape my therapy vision. I want the skills we practise together to make a difference at home, in school, during play, and eventually in the adult life that child will lead.

Therapy sessions give us a focused space to understand a child, build skills, and explore what helps them learn. But communication happens throughout the day. Getting dressed, opening a snack, finding a missing toy, and playing with a sibling all offer opportunities to communicate. My role includes helping the adults around a child recognise these moments and respond in ways that support learning.

This does not mean families need to turn every interaction into a lesson or schedule constant one-to-one practice at home. It means making communication part of everyday life, with space for enjoyment, rest, and simply being together.

One way I do this is through modelling. It is easy to fill an interaction with questions: “What is this?” “What colour is it?” “What are you doing?” Questions have a place, but I also want children to hear language they can use, without always being expected to produce an answer.

If a child is trying to open a box, I might model “Help me” or “Open it.” If a tower falls, I might say, “Oh no! It fell!” Then I leave space for the child to respond in their own way. A look, a gesture, a sound, a word, or a message on a communication device can all be meaningful contributions. I want our interaction to feel like a conversation the child can join.

A front-facing rack of children’s picture books, including “Good”, “The Very Hungry Caterpillar” and “The Wheels on the Bus”, beside a framed “Whole Body Listening” poster and a “Speech Squad” block.

That same thinking guides the words I prioritise. I would often rather begin with three words a child can use meaningfully than thirty words they can name only when asked. “Help me” can give a child a way to seek support. “Stop” can help them express a boundary. “More” can help them continue something they enjoy.

“Purple” has a place too, especially if colours matter to that child. But if a child can name colours and cannot yet tell someone they need help, I want to look carefully at our priorities. I ask what a word will allow this particular child to do. Communication should give them a greater say in their own life.

I am also curious about the why behind what I observe. When a child throws a toy, becomes upset, or moves away from an activity, I want to understand what happened before that moment. Were they struggling to communicate? Was the task confusing? Were they tired, uncomfortable, overwhelmed, or asking for a break?

A behaviour alone does not tell me its cause. My first interpretation may be wrong. I need to observe, listen to the family, and adjust my approach as I learn more about the child.

A diagnosis can provide valuable context, but it cannot explain every response. If a child with autism gives an unexpected answer or does not answer at all, I do not want to stop at the diagnosis. Did they understand the question? Did they have enough time to process it? Was there too much language to hold in mind? Do they know the answer but need another way to express it?

Seven picture rules on the therapy room wall — ask before you take things, listen and respond, have quiet hands and feet, take turns, work first play later, always clean up, try your best — below four framed animal prints.

Depending on what I observe, I might simplify my language, allow a longer pause, reduce distractions, or use a picture, an object, or an action to make the message clearer. I also consider whether memory demands need support or further exploration. I choose sensory support carefully: some children may benefit from an additional cue, while others need less input. The aim is to find what makes learning accessible to that child.

Understanding a child also means taking their interests seriously. If they love astronauts, space can become the setting for our session. We can ask for help fixing a rocket, describe a planet, or take turns preparing for a launch. Their interest gives us something meaningful to share.

If they enjoy lining up toys, I may sit beside them and line up toys too. Before I ask a child to imitate me, I often begin by imitating them. I might copy a playful action, echo a vocalisation, or join a safe movement they enjoy, when they welcome that shared experience. I watch their response and respect it if they prefer to continue alone.

Therapy room shelves with storage boxes labelled by kind of play — early play, kitchen and food play, sensory play, vehicles and road play, musical toys — below an “It is OK to feel” emotions chart.

This is an invitation to connect. I want to discover what is enjoyable from their perspective and show them that their ideas matter. If I want a child to take part in my session, I first need to be willing to take part in their play.

Their strengths are part of this process. I want to notice what captures their attention, what they enjoy, what they already do well, and how they communicate successfully. Those observations help me build a starting point that belongs to the child.

I also keep the whole child and their future in view. The child in front of me will grow into an adult with preferences, relationships, and decisions of their own. I want therapy to support their ability to express those preferences, participate in everyday life, ask for support, and make choices. Independence can include using tools and receiving help; it should allow the person as much agency as possible.

Two therapists may write similar long-term and short-term goals. The difference can lie in what happens around those goals: how we interpret a child’s response, how long we wait, what we model, which interests we follow, and how we respond when an activity is difficult.

These choices shape the child’s experience of therapy and the opportunities they have to learn. My vision is to stay curious, build a connection, and make each goal meaningful in the life of the child I am working with.

When I hear “Help me” used in a moment when a child needs support, I hear more than a practised phrase. I hear a child finding a way to be understood. That is the kind of progress I want our work together to make possible.

— Shruthi Nayak