Using Routines to Make Therapy Work

Recently, I discussed with a group of therapists and teachers how to explain the value of family collaboration in therapy visits. One challenge identified is a belief that therapy works best when delivered one-on-one between the therapist and the child, without family involvement. After all, families are busy! However, therapy should complement existing routines, not add extra stress or complications to family life and should not exist in a bubble. Children learn best through frequent interactions with familiar people and environments. Therefore, our approach to therapy needs to reflect this.

The Power of the 7 Circles

Discussions with the therapists and teachers highlighted the value in using the powerful "7 Circles" tool, first explained to them by Dr Robin McWilliam, the creator of the Routines-Based Model.

This image beautifully illustrates the limited impact a one-hour session can have on a child's overall wellbeing. The true focus is on how the child and family uses what is being practiced in therapy sessions to help them successfully participate in everyday activities (routines). 

Success isn't confined to the therapy room; it's about supporting meaningful participation in everyday life.

Shifting the Focus: Meaningful Participation

I’m always enthusiastic about sharing Dr Robin McWilliam’s definition of meaningful participation which focuses therapy on what’s most important. McWilliam offers a valuable definition of meaningful participation: finding a good fit between the demands of the routine and a child's interests and abilities. Therapy solely focused on teaching new skills reinforces a problematic idea: there's something "wrong" with the child that needs fixing by a professional. It ignores the other aspects contributing to meaningful participation:

• Environment: How does the environment impact the child?
• Interactions: How do the interactions with the important people in the child’s life impact them?
• Adaptations: How can we adapt the task to support their engagement and independence?
• Strengths and Interests: How can we use the child’s strengths and interests at this time of day?

Assessments that focus on meaningful participation, such as the Routines-Based Interview continue to be one of the biggest shifts in my practice.

This tool has supported me to highlight child and family strengths better than ever before. It enables families to share what works well and what they'd like to improve in their everyday lives.

It removes the challenges inherent in deficit-based assessment practices and supports families to confidently choose goals meaningful to them.

The result? Therapy becomes achievable, meaningful, and leads to positive change for busy families.