One book, dozens of therapy opportunities: What speech therapy really looks like

As speech and language therapists, some of the most effective moments in therapy don’t come from flashcards, worksheets, or even drilling sounds (though to be fair I do drill quite a lot too! needs must…😊).

By and large they happen in natural interaction — during shared attention, laughter, storytelling, and connection.

This short video clip captures that.

In under two minutes, while simply reading a book together with a three-year-old child, we naturally work on:

• Speech sounds
• Vowel production
• Early phonological patterns
• Motor planning
• Signing and total communication
• Visual cueing
• Repetition and practice
• Confidence building
• And engagement through play

To many people, it may just look like ‘reading a book’.

But underneath that moment are years of specialist training, clinical decision-making, preparation, and therapeutic skill.

Therapy hidden inside play

One of the most important parts of paediatric speech therapy is knowing how to embed targets into meaningful interaction.

Books are one of my favourite therapy tools! Why: because as speech therapists we need to prepare for our child and our sessions. And having a book gives me the structure to know beforehand what kind of sounds or words might be coming up. Then I can be prepared for providing extra support for them. As you can see in this clip, I had the sound cards just there because I had anticipated what might be coming up!

A single story can provide opportunities for:

• Speech sound practice
• Vocabulary development
• Sentence building
• Turn-taking
• Symbolic understanding
• Attention and listening
• Gesture and signing
• Motor speech cueing
• And social communication

In this clip, I follow my little one’s interests while carefully weaving in her individual therapy targets.

It looks relaxed and spontaneous — and it is — but it is also highly intentional.

Catching opportunities in the moment

One lovely example in the clip is when she says ‘yes’.

She is now starting to say the final /S/ sound, so I immediately model and draw attention to it using the ‘snake sound’ visual cue, giving her positive feedback that she can now also try using this sound at the start of words.

My gently shaping the word ‘yeSSSS.’ gives her:

• Auditory feedback
• Visual support
• And an achievable opportunity to try again

A few seconds later, we naturally practise it again.

That’s responsive therapy.

Speech therapists are constantly listening, analysing, adapting, and deciding:

• When should I model?
• When should I pause?
• When should I repeat?
• When should I let it go?
• How can I keep confidence high while still targeting speech?

These decisions happen in seconds.

Working on speech without ‘stopping the play’

Another moment in the clip focuses on the word ‘out’, where the vowel sound is one of her speech targets.

Then we move into practising the word ‘open’, a word she has previously found difficult.

Within this one word, we can support:

• Sequencing
• Motor planning
• Lip shape
• Vowel production
• And speech sound accuracy

We also briefly practise the /K/ sound — a sound produced at the back of the mouth which can be particularly tricky to produce.

Instead of explaining it verbally (which is often too abstract for young children), I use:

• Visual demonstration
• Exaggerated mouth movements
• Gesture/sign support
• And playful modelling

Children learn through seeing, hearing, doing, and experiencing.

That is why Speech Therapists use multiple layers of cueing simultaneously.

Why I use signs alongside speech

Throughout the clip, I also use signs such as ‘book’ and ‘pig’.

Using signs does not stop children talking.

In fact, for many children, signs:

• Reduce frustration
• Support understanding
• Increase participation
• Reinforce vocabulary
• And help bridge the gap while speech is developing

Communication always comes first.

Speech is only one part of communication.

When children feel successful communicating, they are far more likely to keep trying.

The skill behind ‘natural’ therapy

One thing I often hear from parents is:

‘You make it look so easy.’

That is actually one of the biggest compliments a therapist can receive. (Though we also often feel we need to justify our very existence with these thoughts because we don’t just play/just read but we know it can look like that!) 😊 this is the reason for this blog…

High-quality paediatric therapy should feel warm, playful, responsive, and natural.

But underneath that natural interaction is:

• Clinical knowledge
• Phonological analysis
• Motor speech understanding
• Language development expertise
• Sensory awareness
• Relationship-building
• And careful session planning

Before this session even began, I already knew:

• Which speech patterns to target
• Which words would likely appear in the book
• What visual cues might help
• Which signs to model
• And how to adapt depending on the child’s responses

That preparation allows therapy to stay child-led without losing therapeutic focus.

Following the child while leading the therapy

The best therapy is rarely rigid.

Children do not learn communication through pressure or endless correction. They learn through interaction.

That is exactly what this short clip demonstrates.

One book.
One conversation.
Hundreds of tiny therapeutic decisions.

And all within a joyful moment shared together.

Because good speech therapy should never feel like hard work for a child.

It should feel like connection, confidence, success — and fun.

If you’re concerned about your child’s speech and language or wondering whether they might benefit from speech therapy, feel free to get in touch.

Sonja McGeachie

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Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.