Sometimes you have that client who just isn’t making progress with therapy. Maybe they made progress initially and then plateaued or maybe they never really made much progress at all. Before assuming therapy just isn’t going to work and discharging the client, ask yourself the following questions:

Are we working towards my goals or the client’s goals?
It is easy for us as therapists to get so focused on what we think the client needs to achieve that we forget about what it is they think they need to achieve. Not all clients have the same values or the same objectives for therapy, and if we are pushing them towards something they don’t care about simply because we think it’s important, then they won’t put forth the same level of effort and may make little or no progress towards the goal.

Is there something I am missing?
Do another screen or evaluation of the client. Perhaps it has been a while since the initial evaluation, or perhaps you missed something that could explain the lack of progress. If you get the feeling something it off with the client but you just can’t figure out what, don’t be afraid to suggest a return visit to the referring provider for further workup. It’s possible there is something else going on outside your scope of practice that the referring provider could help identify.

Am I using the best intervention approach for this particular client?
Sometimes when we learn a new technique or approach we get so excited that we want to try it with everyone. Or maybe it’s an old approach, but because we have seen it work so many times before, we are sure it will work with everyone. But there is a reason there are so many different intervention approaches–not every approach works for every client. Perhaps, this is one of those instances where your great idea just isn’t a good fit, and that’s okay. Try another approach or technique and see if that makes a difference.

Would another therapist be a better fit for this client?
Remember the therapeutic relationship between client and therapist? That relationship, like any relationship, takes two people to work and function efficiently, and sometimes you and the client just aren’t a good fit for each other–and that’s okay. It doesn’t mean you aren’t a good therapist, and it doesn’t mean they aren’t a good client. It just means that the two of you don’t fit well together as a team to meet the client’s goals. If you work in a setting with other OT colleagues, suggest that your client work with a colleague for a few sessions to see if that changes their progress. Or, you can suggest another therapist at another clinic that your client might want to try working with instead.

Has the client reached their maximum rehab potential?
Sometimes a client has simply made as much rehabilitative progress as they will realistically be able to. You can’t fix decades worth of injury or damage or replace amputated limbs. That doesn’t mean the client can’t continue to improve their function, though, or that they can’t continue to become more independent. It simply means you need to shift your focus. Instead of continuing to push rehabilitation, perhaps it is time to shift your focus towards adaptation, compensation, and modification. This simple shift just might be what your client needs to start progressing again.

All clients reach a point when they need to discharge from occupational therapy services, but by asking yourself these five questions when progress stops, you may just find a way to get your clients over the hump and back to making progress so they can meet their goals and return to the life they miss.