During my observations and on my OT fieldworks, there are always clients who don’t want to do therapy. They come in all shapes, sizes, and ages, and trying to get them to participate in treatment can be like pulling teeth. It seems like no matter what you say or what you do, they are determined to remain in bed or in their rooms.
Earlier this summer I was working with a 93 year old woman in a SNF. She had a severe cough that racked her body as she lay in her hospital bed, complaining of various aches and pains. When I first asked if she would come to the therapy gym for an occupational therapy session “to build up her strength,” she refused to get out of bed and said repeatedly that she didn’t feel well. After a few minutes of my coaxing and her refusal, I was going to just give up. But then, in an effort to simply get her talking (and with the hopes of leading the conversation in a therapy-related direction) I started asking her questions about what she did for a living. It turns out that she had been a hairdresser for over half of her life, and that she spent almost all of those years standing on her feet and doing hair! Using this new knowledge of a valued occupation as motivation, I asked her if she could stand up for me so we could get to her wheelchair and visit the beauty shop that was just around the corner in the SNF. She agreed, and off we went!
During our nearly hour-long session, I also learned that she loved gardening and being outside and that she had been raised on a farm. As I wheeled her outside in the sunshine, she pointed out the different types of plants growing around the building, and smiled as she told me about her childhood spent on her family farm. From the minute I helped her into the chair to the minute we got back in bed, she didn’t cough once. (For the record, it wasn’t just a leisurely stroll; she had a wheelchair positioning goal!)
This encounter was a lesson in the motivating power of occupation and how introducing meaning into a treatment can take an unsuccessful session in a totally different direction. And while many of the strategies below have been helpful to me as I’ve worked with clients of varying ages and in various settings, it’s important to note that none of them will work if you haven’t laid a good foundation for treatment. Specifically, if you are working toward goals that are not meaningful, relevant, or achievable, you’ll just be wasting your time and theirs.
Remember that occupation = motivation. Your goals for a client should always be client-centered and occupation-focused. If you have a hard time getting clients to participate in your treatment sessions, take a look at your goals or intervention approach and revise to ensure that each one focuses on enabling a client to maximize participation in or return to meaningful occupation and incorporates occupation.
Once you’ve engaged in a process of self-reflection related to your goals and intervention approach, use the tips below to help motivate those “difficult” clients! Continue reading