PROGRESS ISN'T ALWAYS VISIBLE

Progress, what is it? What does it look like? How do we know we’ve reached it? Are we somewhat obsessed by it, or is the motivation for it coming from somewhere else, fear maybe?

I made progress this week, it was clear for me to see, tangible for me to explain. I went for a walk, just myself and my dog, the first in over 6 weeks. It was short, flat, close to home, but I was comfortable, I accepted a break when my body needed it, and the sense of joy that came from throwing the ball for my dog was one worth noticing. I could return home and explain it, have a conversation about my progress that could be easily understood, a shared language, based on what we could see. It struck me that now my body was mobile, this type of progress had a clear, visible outcome that could be measured and noted. Prior to this week, this type of progress wasn’t quite as visible, yet over the past 6 weeks it was there.

As a qualified Speech and Language Therapist outcomes and progress have been a significant part of my world. At one point in my career I held a role in data entry for annual reports and service delivery outcomes, of which informed local and UK wide clinical practice and commissioning. I am very familiar with the value of progress in its numerical form. Progress using numbers could be beneficial in understanding a child’s abilities via various assessment methodologies, establishing baseline measures, using comparison to norms and standardised measures over time. I was trained to measure behaviour, notice, observe, and even repeat assessments in order to comment on progress, it can be a valuable part of healthcare and life. It is never the complete picture, and many of my skilled experienced colleagues also knew this.

As a parent I do my utmost to hold this in one hand, whilst in the other holding the individual experience and its value, to step back and witness more, to ask questions that uncover answers beyond a number or score. Past experiences are never wasted, we take them with us wherever we go next. I spent many years training Speech Therapy students to consider what evidence based practice really means, what it really is and is not. I noticed a growing shift towards one focus, "Is there any evidence base for this intervention?", which meant, is there a randomised control trial on this?, and becoming preoccupied by that, as opposed to asking, "what level of evidence is there currently?" and seeing value in all levels of evidence, including individual case examples. From there keeping in mind three key points 1) level of evidence, 2) clinician experience (eg this intervention may work for some children, but in my experience it didn't work for this child with this experience), 3) parent AND child opinion (does this child and this family even want to consider the intervention being put in front of them, if not, discuss why, respect differences, explore a dialogue, and find a way forward that is collaborative). Dr Naomi Fischer recently defined ‘responsive choices’, which I believe to be essential, human beings are not machines, therapeutic and educational roles are not the same as working within the medical model, systematising progress through numerical outcomes simply doesn’t tell the full story.

 As I make improvements with my back, I’m reflecting on the concept of progress. From a medical perspective, progress can be functional, physical, monitored via markers or instruments, and that is valuable information, a behaviourist perspective can similarly utilise observation and recordable outcomes, yet with emotions being the drivers of much of our experience as human beings, there’s potentially a piece to progress that’s being overlooked in the pursuit of ideals based on pace, achievement, comparison, and superiority. When an individual experiences such places as comfort, nervous system safety, enjoyment, curiosity, belonging, progress is inevitable. We don’t need to force progress, whether it's educational, health, or personal, it’s a natural byproduct of being in connection with other people.

So what does progress look like to me? It used to focus in on numbers, tangible and visible steps to move in one direction, and that was forwards. Yet as I write, progress looks untidy, involves changes in direction, it’s sometimes hard to explain because there’s also a feeling being involved. On this day it’s contentment, I've walked my dog again, whist other days it's a feeling of discouragement, a need for more pain relief and rest. Neither are right, neither need a standard to reach but the one that’s purely my own.