Behind the Scenes: What Actually Happens in a Speech Therapy Clinic for Cognitive Rehabilitation

Gina Britt
6 days ago
6 min read

Updated: 10 hours ago

As an SLP of 14+ years I have given my share of cognitive rehabilitation in a clinic setting! I am here to make the process feel less intimidating for SLP's, clients and caregivers.

Let me pull back the curtain and walk you through the entire process, so you know exactly what to expect when you begin cognitive rehabilitation at a speech therapy clinic.

This post is all about the speech therapy clinic

☎️ The First Phone Call: Setting the Stage

Before you even step foot in the clinic, there's usually an intake phone call. This isn't just scheduling—it's information gathering. The clinic will ask about:

What challenges you're experiencing (memory problems, difficulty organizing tasks, trouble following conversations)
When symptoms started
Any medical history relevant to cognitive function (stroke, TBI, concussion, neurological conditions)
What goals matter most to you

This conversation helps the clinician prepare for your first session and ensures you're matched with someone who specializes in your specific needs. Not all speech therapists work with cognitive rehabilitation—some focus on articulation or swallowing—so this matching process matters.

The Initial Evaluation: More Than Just Tests

Your first appointment will typically last 60-90 minutes. Here's what happens:

The Interview Portion

Before any testing begins, your clinician will have a detailed conversation with you (and often a family member, if appropriate). They want to understand:

What's happening in real life—not just symptoms, but how they're affecting your work, relationships, and daily routines
What coping strategies you've already tried
What your day-to-day demands look like (job requirements, family responsibilities, personal goals)

This matters because cognitive rehabilitation isn't about improving test scores. It's about helping you function better in your life.

The Assessment Tools

Then comes the formal testing. Depending on your needs, the clinician might assess:

👉🏻Executive Functioning:

Planning and organization skills
Problem-solving abilities
Mental flexibility (switching between tasks)
Impulse control and self-monitoring

👉🏻Memory:

Working memory (holding information while using it)
Short-term recall
Prospective memory (remembering to do things in the future)
Strategy use when trying to remember

👉🏻Attention:

Sustained attention (focusing for extended periods)
Selective attention (filtering out distractions)
Divided attention (multitasking)
Processing speed

👉🏻Language-Based Cognition:

How well you organize your thoughts when speaking
Understanding complex verbal information
Reading comprehension when material gets dense

Don't be surprised if some tasks feel easy while others are surprisingly difficult. That's exactly what the clinician needs to see—where the breakdowns are happening.

The Results Session: Your Personalized Roadmap

About a week later, you'll return for a results session. This is where everything comes together.

Your clinician will:

Explain what the testing revealed in plain language (no jargon overload)
Connect the dots between test findings and your real-world challenges
Present a treatment plan with specific, measurable goals
Recommend a treatment schedule (usually 1-2x weekly to start)
Discuss what success looks like and how progress will be measured

This is your chance to ask questions: How long will this take? Will my insurance cover it? What will we actually DO in sessions?

A good clinician will be honest about timelines (cognitive rehabilitation is not a quick fix) and realistic about outcomes.

What a Typical Treatment Session Looks Like

Once you start therapy, sessions usually last 45-60 minutes. Here's the general structure:

Check-In (5-10 minutes)

You'll talk about how the week went—what worked, what didn't, and any new challenges that came up. This isn't small talk; it's data collection that shapes what you'll work on today.

Skill-Building Activities (25-35 minutes)

This is the heart of the session. You might work on:

👉🏻For Executive Functioning Deficits:

Breaking down complex tasks into manageable steps
Using planning tools and calendars effectively
Practicing self-monitoring during problem-solving tasks
Developing strategies for managing time blindness

👉🏻For Memory Issues:

Learning and practicing memory strategies (visualization, chunking, spaced retrieval)
Using external memory aids effectively (smartphones, notebooks, systems)
Working on attention control to improve encoding
Practicing recall techniques for work-related information

👉🏻For Attention Challenges:

Building sustained attention stamina gradually
Practicing refocusing techniques when distracted
Working in increasingly distracting environments
Learning to recognize when attention is slipping

A good cognitive rehab clinician uses tasks that mirror your real life: planning a work project, managing a medication schedule, following a multi-step recipe, organizing financial documents, or having a conversation in a noisy environment.

Strategy Development (5-10 minutes)

You'll work with your clinician to develop specific strategies you can use at home or work.

👉🏻This might include:

Creating systems for managing paperwork
Setting up smartphone reminders strategically
Developing routines that reduce cognitive load
Identifying triggers that make symptoms worse

👉🏻Home Practice Assignment (5 minutes)

You'll leave with something specific to practice before your next session. It's targeted practice of the skills you learned, applied to your actual life.

What Makes a Clinic Well-Equipped for Cognitive Rehabilitation

Not all speech therapy clinics are created equal when it comes to cognitive rehab. Here's what to look for:

👉🏻The Right Technology

Computer-based cognitive training programs (when appropriate—these are tools, not the whole treatment)
Apps and digital planners for practicing compensatory strategies
Video recording capability for self-monitoring work

👉🏻A Quiet, Low-Distraction Environment

Cognitive rehabilitation requires focus. The clinic should have private treatment rooms with minimal background noise, good lighting, and a comfortable setup.

👉🏻Functional Materials

Look for clinics that use real-world materials: actual calendars, bills, grocery lists, work-related documents, medication schedules.

👉🏻Flexibility in Treatment Location

Some clinics offer the option to practice strategies in different environments as you progress
Try meeting at a coffee shop to work on attention in distracting settings, or doing a session at your workplace to address job-specific challenges.

How Progress Is Measured

Every few months, your clinician will formally reassess your progress. This might involve:

Re-administering some of the original tests
Reviewing goal attainment scaling (rating how close you are to your specific goals)
Collecting feedback from you and family members about real-world changes
Analyzing your self-monitoring logs or strategy use

Be prepared for progress to feel uneven. Some weeks you'll feel like a rockstar; other weeks you'll feel stuck. This is completely normal in cognitive rehabilitation. Your clinician will help you see the bigger picture and celebrate incremental wins.

The Transition: From Clinic to Independence

Eventually, the goal is to graduate from clinic-based therapy. This transition usually happens gradually:

Sessions might spread out (from weekly to biweekly, then monthly)
You'll take on more independent practice with less coaching
Follow-up "check-in" appointments help you maintain progress
You'll have a plan for what to do if symptoms worsen

A good clinician won't keep you in therapy longer than necessary. They'll empower you to manage your cognitive challenges independently.

Questions You Should Feel Comfortable Asking

If you want to be extra-prepared for your session get this FREE LIST of questions to ask your speech therapist in the shop

This free resource helps you walk into your first appointment feeling prepared, confident, and informed. Use these questions for your speech therapist speech therapy resource

during initial consultations, evaluations, parent training sessions, or anytime someone needs guidance on what questions matter most.

No more forgetting what you wanted to ask. No more leaving an appointment wishing you'd spoken up. This simple, professional checklist gives you (or your clients) the tools to take an active role in the therapy process from day one.

With a click of this button you can have:

For Parents: 10 essential questions about generalizing skills, home practice, prompting strategies, and supporting your child's progress

For Clients (Adults/Teens): 8 critical questions about treatment frequency, home expectations, family involvement, and research-based outcomes

Throughout this entire process, don't hesitate to ask (more questions on the worksheet above):

"Why are we doing this specific activity?" (You should always understand the purpose)

"How does this relate to my real-life problems?" (Treatment should feel relevant)

"What should I expect in terms of improvement?" (Realistic expectations matter)

"Are there other approaches we could try?" (Good clinicians are flexible

"How will I know when I'm ready to stop therapy?" (You deserve a clear roadmap)

"What can my family do to help?" (Support systems are crucial)

When Clinic-Based Therapy Might Not Be the Right Fit

Clinical speech therapy for cognitive rehabilitation is powerful, but it's not always necessary or the best option. You might be better served by other approaches if:

Your challenges are mild and manageable with apps or self-help strategies

You need more intensive therapy than outpatient clinics can provide (like day treatment programs)

Environmental accommodations (at work or school) would address most issues

Your primary need is medication management or medical intervention rather than strategy development

The Bottom Line

Speech therapy clinics that specialize in cognitive rehabilitation offer something you can't get from apps, books, or well-meaning advice: individualized assessment, targeted treatment, and expert guidance as you rebuild cognitive skills or develop compensatory strategies.

The best clinics don't just run you through exercises—they partner with you to understand your life, identify what's breaking down, and build sustainable solutions that actually work when you walk out the door.

If you're considering cognitive rehabilitation, now you know what happens behind those clinic doors. It's not mysterious or scary—it's practical, collaborative work toward getting your brain working better for the life you want to live.

Have you experienced speech therapy in a clinic setting for cognitive rehabilitation? What surprised you most about the process? Share your experience in the comments below—your insights might help someone who's considering taking that first step.