Reflecting on the use of the 'Client centredness' approach in Treatment.

Client centred treatment is very important to me, as I believe this is the basis for developing a trusting, committed and motivated client-therapist relationship, as well as client centred goals. The client should, therefore, be involved in treatment-goal selection, whilst educating the client about their participatory role in the goal-setting process because of our role as Occupational therapists.

Using a client-centred outcome reinforces partnership, demonstrates joint goal setting and enables evaluation of client satisfaction. 

Client-centred therapy allows the therapist to determine who the client is, what their interests are and gather information about their context, values and culture.
It empowers the client to engage in functional performance to fulfil his /her occupational roles in a variety of environments. There may be a difference in client verse patient objectives and this may therefore cause confusion.  If the client’s goals are unrealistic, the therapist should clarify their needs and provide understanding to the client to set realistic goals. These negotiated, client-approved goals should be given priority and are at the centre of assessment, intervention and evaluation. Throughout the process the therapist listens to and respects the client’s values, adapts the interventions to meet the client’s needs and enables the client to make informed decisions. 

Client centeredness should not only involve the client but the caregiver and the client’s family too. 

I feel as though I could have included the client and his needs more into the intervention planning when preparing my sub programme. I understood the client’s main aims/needs, which was to be more independent in his ADL’s post discharge, in order to relieve some of the pressure off for the caregiver, his wife. However, I feel as though I should have been proactive with including the client in my goal-setting process and discovering his personalized needs before discharge. As we are still learning and are very new to treatment and setting client goals, I feel we will be more confident in setting goals with the client, in the future. As we too will feel more confident in our goal setting.

When analysing my sessions, I felt that I thought through my treatment sessions concisely and put in effort to analyse the activities as a hemi patient would need to perform them. However, I feel as though I could have researched, even further, on the normal movement patterns required for hemi-dressing and bed mobility activities, to implement a more effective and objective session. When reflecting on the bed mobility session, I had forgotten to include a motivation for sitting up on the side of the bed, even though I had planned for it (Drinking some water using the hand over hand method) and included it in my write up. Including a motivation and an activity to perform on completion of the task encourages the client to perform the steps. 

My supervisor advised me to use NDT to prepare the client before each treatment session. She also got us to research NDT and this really helped me prepare to do this as a warm up, before my second treatment session. The therapist should always use the Bobath normal movement patterns approach when analysing a client's activity performance and ensure the principles of this approach are taken into account for all activities. Mrs X also taught me to not over praise the client and to only praise when it was performed completely correct. My supervisor also taught me the importance of Carry Over. For example, getting the client to practise the new method and formulating a Discharge preparation Programme or Activity pamphlets for him to take home, to ensure the new, safer and easier methods will be remembered and implemented. Mrs X showed me how you can turn bed mobility into a table top activity which adds a bit more meaning. The client stated that he had learned something new in both the treatment sessions I implemented. I am feeling very grateful to be in a profession that can help others in every way possible. I am also starting to get job satisfaction from treatment as opposed to only performing assessments last year.

After reflecting on my supervisor's feedback, I am going to research more on the normal movement patterns of the activities I perform for treatment next week. I will also research more about NDT and the key points of control. I will therefore be more confident in implementing my therapy session. I will also make certain that I include a method for a definite Carry over in my intervention strategies when preparing my sessions.

I unfortunately did not get to perform my treatment session with my C3/4 Incomplete SCI injury on Wednesday as he was being prepared for a catheter surgery that afternoon, for most of the day and he had physiotherapy and OT. I look forward to doing the activity with him on Monday and discussing our Treatment goals for the next few weeks.

References:

1) Parker, D. (2012). AN EXPLORATION OF CLIENT-CENTRED PRACTICE IN OCCUPATIONAL THERAPY: PERSPECTIVES AND IMPACT. https://etheses.bham.ac.uk/id/eprint/4432/1/Parker13PhD.pdf.

2)  Law, M. (1994).4174_Canadian_Journal_of_Occupational_Therapy. Client Centred Practise: What does it mean and does it make a difference? https://www.researchgate.net/journal/0008-.
3) Veličković, T. 2005.Basic Principles of the Neurodevelopmental Treatment. bioline.org.br/pdf?me05016 · PDF filebioline.org.br/pdf?me05016.
4) Wound Source. (2019).Edema.https://www.woundsource.com>edema