"Hi! It's good to see you again. Is everyone well at your house? Thanks for coming today to speech therapy. Is there anything you want to talk about - about our last time together? Do you have any questions about what we have been doing in your program? If not, do you feel you are getting better? *DISCUSSION*"
"I'm glad to hear what you think. I want to talk with you about the next step in what we do together...."
Here begins a tale about negotiating with your speech therapy patient. No matter the age, gender, the presenting conditions, the locale of your CSD services, your clinical model or even your business model - you will have the need to make deals and set commitments with your patient through your encounters. If establishing a context with the patient allows you to say "This is what I want to do", then - negotiating a plan for treatment allows you to say "Let's do this". In an ideal world, your patient does all you ask in a reasonable time period. This is not an ideal world.
The question is: Why do you negotiate? To set the path for the clinical program, and to adjust to any unexpected changes in the same program. Another question worth asking is - why make such a big deal out of negotiating? If you have determined your patient needs "A", "B" and "D", that should be enough. "It's time to work" may be the message you want to get done, but your patient may have other needs and agenda that emerge as replies to your message: "Can't we do this some other time?"; "It is too hard!"; "I'd much rather play a game"; "I need the bathroom!", or "Are you sure this will work?"
Your negotiating with the patient keeps the message of your evaluation visit fresh; namely, that a change in function that the evaluation had found, can be remedied through special strategies and techniques. Therefore: "If you can't do this for more than five minutes, then - let's work for five minutes and take a break". Or: "Remember that the speech test said, you can make this sound in everyday conversation when you _____". Or maybe: "Your voice won't improve solely with the passage of time; you need practice on deep breathing to sustain a louder voice!".
It sounds as if negotiation in the CSD clinical encounter is service after the sale. After the evaluation is done and after the course of treatment is charted; - there are continual opportunities to refine and reinforce the message: first, "I care about you. We have formed a relationship. Part of what I see as my role in the relationship is to help you grow and change. Let's keep on track, by working on the things we found will help you." And, second - "I have plenty of time to hear what you need to say. Healthcare (or education) may seem rush, rush, rush - but communication is what I do. It is the essence of my work. Tell me what you need".
