What does "client-centered" mean to me?

It is a truth universally acknowledged that in all matters OT the client comes first. And rightfully so. South Africa is a diverse melting pot of cultures and along with this comes a multitude of cultural expectations and beliefs about roles and values. These factors are what makes client-centredness vital in this day and age. A generalized treatment plan that does not offer uniquely tailored treatment that focuses on the individual needs of the client and their manifestation of a disorder, does the client a great disservice. “Tailoring” and client-centredness are one in the same to me. The best way I can explain the concept is this way: Never have I ever found a pair of pants that I haven’t had to tailor to my height (or lack thereof). I’ll find a great pair, only to have to chop off a third so that they don’t drag on the floor. Client-centredness is much the same. That one pair of pants will never fit every body-shape, just as that one treatment approach will never work in all contexts. So, I’m not just an OT… I’m a tailor, here to customise your treatment, bedazzle your life and achieve that perfect fit for your home.

Now that fieldwork is well underway, I’ve managed to obtain a holistic assessment of my client and his functioning. I now find myself at a pivotal crossroads: deciding “where to” with my client’s treatment. This conundrum brings me back to first year OT lectures, where we learn that the client is more than a diagnosis- they are a person with values, roles, needs and fears that are individual to their specific context. This is the foundation of client-centered practice. Across health professions, we’ve moved away from the Medical Model and into practice where the client is integrated into the rehab team. Decisions about your life, should include your opinion and your goals. To me, client centredness implies that the client is no longer a spectator on the field of recovery, one who is blindly popping prescriptions and racing through repetitions, the client is an active player who is consulted and included in the team effort to win the game of rehab.

This week, when deciding on treatment I looked at what Client A’s premorbid occupational choices were and what his current functioning is. This narrowed down my activity choices, but the final say is always with the client and that all-important question: “What would you like to be able to do?”. We decided on dressing[1], as he doesn’t want to rely for help with this. With my super OT reasoning powers, I tried to make the activity as therapeutic as possible by using it to tackle his dynamic sitting balance[2]. Overall, it was a success, and we both came away having achieved something. My new client, Client B, is a quadriplegic mom of two. She’s been wonderful to work with and we’ve been able to have lengthy discussions about what she wants out of therapy. Though some goals are more optimistic than others (but not all together unobtainable!), there were many goals that she prioritized that synced perfectly with what I’d envisioned working on with her. Even if this wasn’t the case, negotiation with the client and throwing around ideas for alternative activities would easily ensure a goal can be reached. The key is to seek the client’s opinion. After all, their compliance is the only way that you succeed at treatment. Client B and I decided to work on feeding and grooming in our treatment sessions[3] (whilst treating static balance), as currently she requires maximum assistance from nurses. I’m really excited to be working with my client on something that’s very important to her and that could change the way she sees herself, no longer as a "dependent" but rather as someone in recovery.

At first, Client B’s diagnosis of quadriplegia intimidated me, I felt unsure of where I’d be able to fit into the rehabilitation team and was slightly rudderless- not quite sure how to approach treatment. However, my supervisor pointed out that with a good assessment I’ll have a clear understanding of what is needed, so there’s no need to feel hesitant. My fears were, as it turns out, unfounded, as this is a great case with clear direction of where we can go with treatment. I’ve done some research and found many activities[4] that sync with my client’s goals, so her diagnosis is definitely not as scary, and I understand just how much potential she has. I find my client very easy to identify with and have a thorough understanding of her roles and home life. Having an in-depth understanding of context accompanied by an eager client who feels like their needs are taken into account, makes for great rehabilitation, and I can’t wait for our next treatment session.

I’ve learnt this week that being nervous isn’t helping anyone, least of all me and my client. There are very few things in life that will be within my comfort zone and I’m not going to become a great OT until I find confidence in adapting on-the-go and accepting that things will never ever go 100% according to plan. My own personal challenge in the next few weeks of fieldwork is to become more malleable with my treatment sessions, as being competent at adapting also demonstrates a good understanding of what is needed and what is going wrong. I know that this was an obstacle I faced during the week, as my supervisor noted that I seemed unsure when treating. I wouldn’t have been confused or anxious if I had done an internal inventory of what was right, what was wrong and then quickly adapted my approach. Instead, I wanted to stick to my script and was thoroughly lost when my client didn’t respond the way I expected him to. Lesson learnt: Don’t panic. Breathe. Start again.

So yes, it is a truth universally acknowledged that in all matters OT the clients come first- and we as (fledgling) therapists wouldn’t have it any other way. This tailor is ready to work with her clients on their brand-new outfits, ensuring there is consensus about style, noting concerns about fit and in the end, making sure that they leave feeling good and knowing that they got exactly what they wanted (and needed).