Treatment plans start and treatment plans end. Sometimes, though, the letting go of what is familiar, comfortable, and dare I say it routine is genuinely hard. And sometimes we delay that ending longer than we should.
I evaluated this client in the fall of 2023 when she had just turned four years old. She presented with a phonological process disorder. Multiple error patterns, no awareness of the distinctions between her productions and the targets. We got to work with twice-weekly 30-minute sessions, games of her choice, minimal pairs, oral motor work, mirrors, and shaped target sounds. She was brilliant. She responded to everything.
When I Closed the Practice
About a year ago, I closed my private practice and gave each family six weeks of notice. Every client received a discharge report so they could find a new clinician. Three families asked me to continue seeing their children privately. I agreed, and those sessions became weekly in-home visits on a private pay basis.
One of those families was this little girl's family. And she continued to make beautiful progress. By fall of 2025, she was six years old, thriving academically and socially in kindergarten, with no evidence of speech sound errors. The Arizona-4 results confirmed what her teacher reports and my own session notes had been showing for months.
She did not need me anymore.
The Cushion Pattern
What I had not accounted for was something I started noticing quickly after we transitioned to in-home sessions. When I arrived, mom would usher me in and then disappear to handle household tasks. Laundry, phone calls, kitchen cleanup. My client and I would work together on the floor or the sofa, and when my watch alarm went off at the 45-minute mark, I would have to wait for mom to resurface before I could debrief on the session and head out. That waiting often turned into an additional ten minutes of unscheduled time.
Therapy had become what I privately started calling a cushion. A reliable weekly block of time that held the child and freed up the parent. And because my client and I had genuine rapport, because she still loved our sessions, and because mom kept saying she "just could not do without" the visits, I kept coming. Month after month, past the point where the clinical evidence supported it.
I was not serving this child's speech anymore. I was serving this family's comfort. And I had been avoiding the conversation that would change that.
The Coffee Date
A couple of weeks ago, I asked mom to meet me for coffee. She chose an adorable little shop and we sat down together. I said it simply: her daughter does not need me anymore. She is thriving academically and socially with no evidence of speech sound errors.
Mom looked at me and said, short and sweet: "I know."
We smiled. We laughed. We shared a few of the memories from two years of working together, because there were genuinely good ones. And when we hugged goodbye in the parking lot, I told myself something out loud: it is okay to be the first one to let go.
What This Is About Beyond the Story
Every SLP who has been in this field long enough has a version of this story. The client you kept on the schedule past the point of clinical need because the family loved the sessions, because the child loved you, because discharge felt like loss rather than success.
Discharge is the goal. The whole structure of what we do is built toward the moment we can say: this person does not need me here anymore. That is not a loss. That is the work completing itself.
And sometimes being the one who names that truth, even when no one asked you to yet, is the most caring thing you can do for everyone involved.
