Being Client-Centred When the Client is Cognitively Impaired

Abstract

Canadian occupational therapists aspire to be client-centred. As a profession we continue to debate what this means. The question of how to be client-centred becomes more acute when the client has cognitive deficits, and capacity, including the legal right to consent to treatment, is called into question. Further, in current literature and law, capacity is described as situational (i.e., specific to the time, circumstances and question being asked) and thus, difficult to determine. In this discussion, the author will explore two strategies, graded decision-making and advocacy, for practicing in a client-centred manner with cognitively impaired clients.

Discharge Decision-Making, Enabling Occupations, and Client-Centred Practice

“…The therapists and health care teams may use these strategies under the guise of "negotiation," to help achieve their desired goal and retain a belief that the decision was a client-based one, while still being able to practice within the sometimes extraordinary limitations and time constraints of their practice settings (Moats, 2006). The findings of this study support the understanding that clientcentred decision-making with this population can be a coll a bora tive , n ego ti a ted process su ch as that propo s ed by Hobson (1996Hobson ( , 1999aHobson ( , 1999b, Falardeau and Durand (2002), and Moats and Doble (2006), with va rying degrees of involvement of the client, the family and the professional. However, as professionals with an ethical obligation to the original client, occupational therapists need to move beyond simplistic approaches toward a more meaningful way of interpreting client-centred processes with older people.…”

“…Collopy (1988) noted that attitudes toward cognitive impairment tend toward an "all or nothing" global approach to autonomy. Hobson (1996Hobson ( , 1999b advocated for graded decision-making. Hobson (1996Hobson ( , 1999b advocated for graded decision-making.…”

Experiences with the COPM and client‐centred practice in adult neurorehabilitation in Taiwan

“…Benefits identified in the case study were that the use of the COPM ensured self-directed therapy; the therapist felt that responsibility for the intervention process and the outcome were fully shared with the client. The COPM has been used as an outcome measure for clients with traumatic brain injury (Trombly et al, 1998), cognitive dysfunction (Hobson, 1996), and for assessing the efficacy of pain management programmes (Carpenter et al, 2001). The scoring of the COPM is found to be responsive to changes in perceived occupational performance over time (Law et al, 1994;Bodiam, 1999;Wressle et al, 1999).…”

Barriers and bridges to client-centred occupational therapy in Sweden

“…Challenges for the therapist occur because of a lack of knowledge about client-centred practice [4], an unwillingness to give more power to the client [9], and a reluctance to take risks when clients and therapists have different goals [10]. Therapists should shift their focus from the client's performance components to the client's occupation and participation in society [11].…”