When Speech Therapy Isn’t the Right Fit (Yet)
Child hiding behind a door.
Speech therapy is an incredible tool for helping children develop communication skills, but not every child is ready for therapy at the moment it’s recommended. For SLPs working in schools, private practice, or home-based models, it can often feel like we’re caught between what we know about therapy readiness and what the system demands of us.
This post isn’t about discouraging therapy but about acknowledging the reality that there has to be buy-in, from the child, from the family, and for the therapeutic process itself. Without it, progress is slow, frustrating, or, in some cases, nonexistent. And that wastes time and money for everyone involved.
The Science of Buy-In: Why It Matters
We’re not imagining it, buy-in (or motivation and readiness for intervention) is a researched phenomenon in therapy fields, including speech-language pathology. One study by Proctor-Williams (2009) on parent involvement and language therapy outcomes found that:
Children whose parents actively engaged in the therapeutic process showed significantly greater progress in language acquisition.
Lack of engagement (missed appointments, minimal home carryover) reduced the effectiveness of therapy, even with high-frequency sessions.
The clinician's frustration increased when therapy was occurring in a vacuum without reinforcement at home.
The takeaway? SLPs know when therapy isn’t working, we’re trained to read nonverbal cues, resistance, disinterest, and avoidance yet, in many settings, we’re forced to push forward regardless.
Educational & Medical Models Sometimes Ignore Readiness
I remember explicitly learning about determining client readiness for therapy during my training. There were clear markers, behavioral, emotional, and cognitive readiness, that dictated whether a child was a good candidate for structured intervention. But once I entered the school system, that knowledge seemed to disappear. I could no longer write SOAP notes stating, "This child is not a candidate for therapy at this time due to lack of engagement, readiness skills, or family involvement."
Similarly, in medical settings, therapy is often prescribed without assessing whether the child or family wants or is prepared for it. The result? Missed sessions, wasted time, and frustration, for everyone involved.
The Hidden Cost of Pushing Therapy Too Soon
When therapy isn’t the right fit, it doesn’t just waste time, it wastes energy and resources. Many children spend years in speech therapy when what they needed was:
✔ A family-wide intervention approach rather than isolated speech sessions.
✔ A mental health professional addressing underlying anxiety, trauma, or social difficulties.
✔ A collaborative model where speech, occupational therapy, physical therapy, and behavioral support work together.
Instead, because mental health funding is so sparse, speech therapy often becomes the default catch-all for communication and social skill concerns, even when we know the child needs more.
An Example of Wasted Time & Resources
I’ve worked with children who have been in speech therapy for years without meaningful progress, not because they weren’t capable of growth but because:
They had untreated and co-existing social anxiety that made speaking in and out of therapy settings impossible.
They had family dynamics where open communication was discouraged or not modeled at home.
They were not cognitively or emotionally ready for structured language intervention and needed to work on foundational skills first.
For some of these kids, waiting a year or two for targeted speech therapy and providing the right support first would have meant needing fewer therapy sessions in the long run. Instead, the system pushes services forward, forcing therapy into an ineffective model because it looks like something is being done, even if that something isn’t helpful.
Why Private Pay Can Be More Cost-Effective
This is one of the reasons I’ve started moving toward private pay therapy. On the surface, private therapy looks more expensive, but in reality, it saves families time and money because:
✔ Families only pursue therapy when they are truly invested, with no wasted sessions, and no forced compliance.
✔ Therapy is tailored to readiness, rather than mandated by a system.
✔ We can collaborate openly with other professionals without bureaucratic red tape.
✔ Families see progress faster, rather than years of therapy with minimal growth.
Think about it: Which is actually cheaper?
5+ years of weekly therapy ($10,000+ in services) with little progress?
Or 1-2 years of highly focused, individualized therapy with full family engagement?
When we wait for the right time and invest in the right support first, therapy is more effective, efficient, and empowering, for both the child and the family.
The Harsh Reality of Family Buy-In (Or Lack Thereof)
This became especially apparent during my years working in itinerant therapy, going into homes, daycares, and early childhood settings. Many of the families I worked with came down from the Birth to Three pipeline, feeling pressured into therapy by multiple real and perceived concerns to: keep receiving government benefits, to keep the family off the radar for immigration enforcement, custody difficulties and to comply with social worker recommendations.
But without genuine buy-in, I saw it all, missed appointments, zero parent interaction, and outright avoidance. One experience still stands out to me.
The Car Chase That Changed My Perspective
When I was in my 20s, fresh into my career, I worked in Birth to Three therapy near Wrigley Field in Chicago, Illinois. There was a particular family that would confirm sessions by phone, yet every time I arrived, they would literally drive away.
One day, I finally chased after their car and cornered them at a turn. They rolled down the window just enough to talk, and I leveled with them as well as their large pitbull:
"Look, if you don’t want this, just tell me. Stop wasting my time, and I won’t waste yours."
And that was it. They admitted they didn’t want therapy and they didn’t want me in their house. Explaining this to my therapy company was another matter but the family and I were at least on the same page because without trust and honesty what else can I build on?
After about four more similar experiences, I quit that model entirely. I wanted to work where my time, and the child’s time, was valued.
Even today, I encounter parents who tell me outright, "We don’t want this. We have a private therapist." And guess what? I still can’t just say, "Okay, I get that," and move on. Because in many systems to receive other services, therapy is mandatory, whether or not it’s effective.
Final Thoughts: SLPs, You’re Not Crazy
If you’re an SLP reading this and feeling exhausted, frustrated, or like you’re screaming into a void, you’re not alone.
You’re not crazy for recognizing when a child isn’t ready for therapy and their “sessions,” are spent bribing them to join in.
You’re not wrong for feeling trapped in a system that ignores everything we know about buy-in.
And you’re not failing if you’re struggling with kids who just aren’t engaged and continuously mute and unmute you in zoom meetings.
Therapy readiness matters. Buy-in matters. And as professionals, we need to start acknowledging that, even when the system won’t.