Many new therapists are surprised to learn just how frequently clients will refuse therapy. This refusal may come in the form of an outpatient client cancelling or simply not showing up for sessions, or it may come in the form of a SNF patient flat out refusing to participate in therapy. Now the thing is, technically, the purpose of therapy is for the benefit of the client, not the employment of the therapist, so a client has every right to refuse therapy and should be allowed to refuse therapy if they wish. But that doesn’t mean such refusals come without consequences. Particularly in a SNF setting, continuous refusals of therapy may make the client ineligible to continue to receive therapy services. And no-shows and last minute cancellations in an outpatient setting prevent other clients from receiving services in that time slot. Not to mention, refusals decrease therapist productivity and can lead to difficult conversations with your manager. So how can a therapist encourage clients to participate in therapy while still respecting their right to refuse services?

Be client focused.
The biggest way to encourage client participation in therapy services is to be client focused. If you are addressing client goals and concerns in a way that they can clearly see the benefit of treatment, clients will be much less likely to refuse therapy or skip sessions. This may seem like a simple concept, but it is easy for us as therapists to get distracted by what we think a client needs to work on (or even what their family says they need to work on) and forget about making the sessions relevant to the specific client. So if you are getting lots of refusals, take a step back and self evaluate your treatment approach. Is there anything you could change to make the interventions more applicable to the client?

Use occupation based interventions.
If a client is receiving both occupational therapy and physical therapy services at the same time, they can sometimes feel like it’s not an issue to skip their session with one discipline since they “already exercised” with the other discipline. As occupational therapists, hearing something like this should be a warning to us that we need to stop and make sure that we are being distinctive enough that the client clearly sees the benefit of OT. And I don’t just mean because we work with their arms and PT works with their legs. As OTs, we should remember our roots and what makes our profession distinctive–occupation based interventions–and use this approach on a daily basis. Yes, there are times when repetitive exercise is the most efficient approach, but there are also times when putting away canned goods is just as beneficial physically while at the same time being much more appealing to the client. And, after all, who is going to refuse “helping you with something.”

Give choices.
Humans like to have autonomy and make choices. But clients who are coming for therapy–particularly those in a SNF or LTC setting–probably don’t have a whole lot of autonomy on a daily basis or get the option to make a lot of choices. So rather than letting their choice be whether to participate in therapy or to refuse, give them some choices during the actual session. The beauty of rehab is there a lots of different intervention strategies and approaches available. So give your clients the choice between two different tasks or activities that will both produce the results you are looking for. For example, suppose you want to work on upper extremity range of motion. You could give you client the choice between helping you fold a load of clean sheets and towels, or playing a game of balloon volleyball. Both will achieve your desired outcome, but to the client, they are completely different activities.

Refusing therapy is definitely within the rights of each and every client, but just because it is a right, that doesn’t mean that it has to become the norm. If you are struggling with frequent refusals and cancellations, take a moment to stop and self evaluate. Perhaps, by shifting your focus, changing your interventions, or giving choices, you can decrease your refusal rates and help your clients to achieve the success they desire.

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