Debora A. Davidson, PhD, OTR/L Clinical Occupational Therapy Editor

Debora A. Davidson, PhD, OTR/L, Clinical Occupational Therapy Editor

Regardless of each client’s unique needs and goals, there are some universal truths to doing effective therapy. For example, there is the notion of the “just right challenge,” which requires the OT to have solid skills for activity analysis and matching tasks with clients’ abilities and level of motivation. Another principle is client-centeredness, which requires a sense of the client’s interests, preferences and values. These are critical to effective intervention, and I’ll probably write about them at some later time. Right now I want to explore the issue of timing as an essential ingredient of therapy.

OTs typically enter peoples’ lives at difficult times: an injury, illness, disability or other setback has disrupted someone’s life. They do not want to need help with their everyday activities but may be preoccupied with pain, fatigue, worry or self-consciousness. We step in during rough times and ask them to learn, take risks and push themselves beyond their comfort zones.

Therapists use a variety of approaches in interacting with patients. Sometimes we present a challenge and wait for the client to figure out a solution. At other times we may actively instruct. The therapist knows when to offer words of encouragement, remain in the background or point out errors to show the client how to correct the problem.

An OT continuously makes skilled, considered decisions, choosing among many options, observing results and making adjustments based on the client’s responses. Timing these interactions to match the client’s changing condition amounts to an elegant improvisational dance. I would say this is one of the key reasons that, in the hands of an expert OT, even the most ordinary activity can be a powerful medium for therapeutic progress.

Good therapists know what to do and how to do it; great therapists also know when.

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