To get the most from each therapy activity, consider taking advantage of the three teaching opportunities you have by (1) explaining the activity you are about to do and the part it plays in the overall treatment plan for the patient, (2) providing feedback during the activity, and (3) summarizing the patient's performance at the conclusion of the activity and providing direction for the future by explaining the next step that he or she is headed.

Setting the Stage. Activities afford the client a situation in which to practice their targets, and are usually planned along a hierarchy of difficulty for the client. Clients learn better when the understand and more fully appreciate what they are doing and why. Begin by describing what you wish the client to do for the therapy activity; then why it is important and how it fits into the scheme of his or her therapy plan.

Example: "Now I am going to have you share your opinion of the movie you told me you saw last weekend using your slow rate target. You have done very well maintaining your rate in reading, but a monologue is more challenging because you need to think about what you are going to say and how you are going to say it. This activity is important because in our everyday lives we are much more likely to express our opinions verbally than read aloud. Because this is more challenging I expect that you will have to focus harder on using your targets. Now, what did you think of the movie?"

Providing Feedback. Giving the client on-line feedback is important to learn to use a target appropriately, evaluate their own production, and make adjustments. At the beginning of an activity, you might flood the client with feedback, providing both positive assurance and corrective suggestions for the first minute or so. Imagine that I was a passenger in a car that you were driving; you are blindfolded. How often would you want me to give you feedback about your driving and upcoming obstacles? Would you only want to know only when a problem was approaching or would you also like to know that everything was okay? (By the way... do not try this at home!). After a minute or so, back off and see how the client does on their own. Then provide additional feedback as needed. Periodically let the client know when they've been successful.

Example. "You're off to a good start..... That's exactly right..... Good..... You're speeding up a little now... Watch it... Right!.... How is your rate right now?" [Don't hesitate to "talk over" the client as he or she is talking.]

Summative Feedback. At the conclusion of an activity put the client's performance in perspective. Share your honest opinion of how they did; respect them enough to tell them when they did not do an adequate job and explain why. (See "Giving Honest Feedback" for suggestions.) Critically analyze the client's performance, acknowledging what they've done well and providing constructive suggestions on how to improve further. Lastly, paint the bigger picture on where they are along the continuum and where they will be going next.

Example. "Hey, that was the best job you've done so far; you maintained your slow rate target very well. I noticed that you did well initially, then seemed to speed up after about two minutes. I noticed that you were monitoring yourself, because there were three occasions I heard you purposefully slow your rate again. That tells me that you are taking the responsibility to listen to yourself and make the necessary adjustments without me pointing them out to you. That's great progress. I'd like to practice that in our next session and for you to continue to work on that at home and work. It's likely going to be more difficult when we choose a topic that you have strong feelings about, so I'll plan to incorporate that into our session next week. As you continue to improve on using your target on your own, I want to move you into situations that are more and more challenging, so you'll continue to grow. I'll be looking for you to demonstrate the same kind of monitoring and adjustments you made in this activity today; but the skill I'd like you to master is pacing yourself consistently throughout the entire conversation."

Getting the most out of each activity is a therapist's obligation. Using these suggestions will make you think more about what you are doing and where you are taking your client. They also facilitate better communications between you and the client.

© Rentschler, 2004