Build Rapport With Older Students in Speech Therapy

In secondary speech therapy, both middle and high school, rapport is a foundation. The "3 Pillars of Adolescent Therapy" describe motivation, resilience, and rapport (Abendroth & Whited 2021). In the next few posts I will write about each one. Today the focus is Building Rapport.

Advertisers refer to the "know, like, and trust" factor someone needs before they will buy a product. Getting buy-in from teens in speech therapy requires this as well. Before students practice speech sounds, answer comprehension questions, or role play conversations, they must feel like it is a safe space to be a risk taker.

For middle and high school students in speech therapy, especially those who are neurodivergent or have experienced repeated academic failure, offering responses can feel risky. Strong clinical rapport often determines whether they will participate in therapy activities at all.

Think of Rapport as your Clinical Superpower

Rapport is often treated as something you either “have” or "don't have" with a student. Instead of a fixed mindset, think of building rapport with adolescents as a clinical skill that develops and can improve.

Pattison & Powell (1989) define rapport as "establishing and maintaining an interactive and harmonious relationship." It is an ongoing process.

In our Three Pillars article, we explain that rapport requires three things:

• Professional balance

• Strengths-based perspective

• Client-centered approach

Research shows that rapport in speech therapy is an ongoing effort. It results in greater cooperation and fewer off-task behaviors. Having a client-centered approach means rather than the therapist controlling the sessions, activities, and goals, the student (or client) has agency in what they are working on and how.

Understanding Adolescent Perspectives in Speech Therapy

Progress starts with building a positive rapport. Middle and high school students value fairness, authenticity, and agency. When students have off-task behaviors, this can be viewed through a strengths based perspective rather than a disciplinary lens.

Students want to participate, but may be bored, unsure of the answer, or want to "save face," so they use their conversational turn to change the subject or make a joke. Research repeatedly shows that students who feel trusted and respected show fewer off-task behaviors and make more progress.

Secondary students also notice when adults are trying too hard, when expectations feel arbitrary, and when speech therapy materials feel childish. I have definitely caught myself (and been called out) for all these things, so don't get discouraged if you feel like it is hard to connect with your older students.

Finding the "goldilocks" level of activity (not too childish, not too hard, but just right) is one of the trickiest things about adolescent speech-language services, in my opinion.

Practical Rapport-Building Strategies for SLPs

So where to start? As you get to know your students, prioritize being predictable, calm, and respectful.

1. Let Students Be the Expert

Students already know their interests, strengths, and boundaries. Rapport grows when we allow them to lead by selecting topics, choosing activities, or showing genuine interest in their hobbies.

Offer meaningful choices in speech therapy sessions with topic selection, format, or order of tasks. Choices communicate agency, or feeling like you have decision making power, which is a big component of adolescent engagement.

2. Use Conversational Language in Speech Therapy

Clinical language has its place, but rapport grows when you talk to your students in a client-centered way, not like little kids. So leave the sign song voice at the door and speak with students, not at them. In most cases, you don't need to micromanage turn taking with secondary students, just let the conversation flow.

3. Predictability to Support Neurodivergent Students

Consistent session routines reduce anxiety and resistance. When students know what to expect, cognitive energy can shift from self-protection (fight or flight) to learning. It seems like our schedules are always fluctuating in schools, but try to maintain schedules (with neurodivergent students in particular) whenever possible.

4. Clarify Goals

Adolescents value dignity and feeling like they have a say in the therapy process. Students often decide how they feel about speech therapy in middle school or high school within the first few sessions, but it is an ongoing balancing act.

To start, explain why they are there and ask for their input. One SLP I know has her older students state their IEP goals at the beginning of each session to reinforce what they are targeting. While I am not that consistent (and do more whole class push-in services), it is a good idea.

5. Practice Neurodiversity-affirming speech therapy

In speech-language therapy, neurodiversity affirming therapy means accepting how students communicate, not reshaping them to fit neurotypical expectations. SLPs should not target eye contact goals or force speech fluency.

Neurodiversity-affirming clinicians accept multimodal communication preferences and educate neurotypical peers about communication. Targeting self-advocacy is a great starting point, or check out this article about neurodiversity-affirming practice.

If you are new to neurodiversity-affirming therapy, grab my free neurodiversity pack to use in IEP meetings or with students.

Common Rapport Mistakes to Avoid in Secondary Speech Therapy

Even well-intentioned clinicians can unintentionally damage rapport…and I have definitely made these mistakes myself at times.

If you are having difficulty building rapport in speech-language sessions with middle and high school students, are any of these barriers present?

• Using childish (babyish) graphics, clip art, or activities

• Overly enthusiastic praise (sing-song baby-ese voice) for basic participation

• Forced participation

• Discipline-heavy interactions

• Trying to be “cool” instead of being consistent

• Micromanaging interactions (e.g., forcing eye contact, which is not neurodiversity-affirming)

• Disclosing too much of your personal life (do not share phone numbers, social media handles, or interpersonal relationship troubles with your students).
  

When Rapport Is Hard

Not every student connects immediately. I definitely have students who test my patience, and other students are just burned out on speech therapy. Some neurodivergent students have experienced bullying, educational trauma, or have learned that school spaces are unsafe.

If you are feeling discouraged by students who are hard to connect with, you are not alone. Email me at info@ddvspeech.com if there are specific situations you need help navigating.

First, acknowledge tough sessions and reset the next week. Second, present expectations using a client-centered model (rather than a therapist-centered approach). Third, continue each week to offer consistency and respect.

It is possible that your students feel like you are patronizing them and you may not even realize it. Be open to improving your approach by talking to teachers, parents, and the student.

Why Rapport Improves Speech Therapy Outcomes

As I mentioned, positive rapport correlates to progress. Strong rapport leads to increased self-advocacy and carryover because there is ownership over goals. Particularly for neurodivergent students, having a better understanding of Autism (or stuttering) can help students feel validated.

Free Handouts for Middle & High School Speech Therapy

Are you looking for ready-to-use, neuro-affirming speech therapy handouts that support strengths and self-advocacy with secondary students?

Grab your FREE Neuro-Affirming Handouts for SLPs

This free, printable resource contains handouts in parent-friendly language about neurodiversity and an iceberg graphic to represent visible and invisible traits. Use these at IEP meetings or parent conferences with confidence.

Final Thoughts: Rapport Is Essential

You do not need perfect sessions, but students need consistency, respect, and trust. Rapport is an ongoing process that will continue to grow as you work with older students. If you are struggling with a particular case or situation, please email me at info@ddvspeech.com for support.

SLP & SLP-A Gift Ideas

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SLP Coloring Book