Kickstarting Dialogue Between Client and Therapist

In Practice

I often start the COPM by giving a description of occupational therapy and together with a client define the three occupational performance areas.

The COPM is always the very first thing I do with the client, as I feel it’s the best way to start the partnership dialogue between client and therapist. It lets clients know that you hear them and consider them to be the experts in the occupational performance areas (e.g., what difficulties or barriers are present in their current lives).

I often start the COPM by giving a description of occupational therapy and together with a client define the three occupational performance areas. I find this helps a client to get started.

Although performance components or environmental issues may often come out in dialogue during the COPM interview, I usually follow the COPM with further assessment to identify potential performance components or environmental barriers to function. This way, as I write the problem list, I have the occupational performance problems as indicated by the client in the COPM, and components/environmental issues from further assessment (which is what intervention and expected outcomes will be directed towards).

As intervention is completed I then have two sources of outcome measurement, the client’s reassessment of satisfaction and performance values through the COPM, and the completion of expected outcomes.

Barbara

Barbara is a 56-year-old woman who was admitted to hospital because of depression. She lives with her husband and does occasional bookkeeping for a local business. They have two sons who are grown and have their own families. Barbara stated that she couldn’t cope and was spending entire days in her room reading and worrying about everything. She avoided leaving the house, so rated comfort with going out to shop and doing other activities as important. Barbara also wanted to explore what she could do for leisure as well as go on outings with her husband. Her trips with her husband had become difficult for her because he often shouted at or criticized other drivers.

At reassessment, Barbara was very satisfied with her performance on her goals, so occupational therapy was discontinued.

This table illustrates the change in Performance and Satisfaction for each of the prioritized occupational performance problems. (you may need to scroll horizontally to view all the data)

Occupational Performance Problem Time 1 Time 2
Performance Satisfaction Performance Satisfaction
Ability / comfort to get out to shop / do other activities 3 1 8 8
Finding activities to do during my days 2 1 7 8
Pursue outings with husband 1 1 7 9
Total Scores: 6 3 22 24
Average Scores (Total Scores / number of problems): 2.0 1.0 7.3 8.3
Change Scores
(Time 2 – Time 1):
Performance Satisfaction
+ 5.3 + 7.3

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