Innovative and evidence-based wellness articles, to improve client outcomes

Updated: Nov 8, 2020

As occupational therapists, we develop a list of 'tips' to help our clients attain their desired outcomes. Over the past few years, I have become more involved in the field of positive psychology. There, these strategies are recognised as concepts that have been fully investigated, with a strong history of success when implemented in the clinical setting.

I have compiled a list of strategies that can be employed by the clinician, that go a step beyond your typical approach in the clinical setting. I have chosen a few of my favourites to share with you. Each on its own is not a panacea, but can offer alternatives to meet the individual needs of the client. The bonus is that the more you engage in these practices, you as the clinician will also reap the benefits, resulting in fewer symptoms of burnout and more enjoyment in the workplace.

1. Active listening

It has been shown that, when you allow the client to speak about their issue for 92 seconds, uninterrupted, they will tell you everything you need to proceed with the treatment sessions.

The client perceives this as being 'seen and heard', which results in immediate trust-building, a key ingredient to adherence - and ultimately a more successful outcome. You also get described as an 'amazing listener'. Win-win! So settle in, it’s only 5% of a 30-minute treatment session. In western culture, it is acceptable to maintain eye contact at least 60% of the time and still be effective.

2. Emotional contagion

The definition is 'the phenomenon of having one person’s emotions and related behaviours trigger similar emotions and behaviours in other people, either consciously or unconsciously.'

In everyday language, your co-workers and your clients are picking up on your mood and attitude. Depending on your behaviour, these 'vibrations' will have a direct impact, either positive or negative. When we are in the professional setting, it is important to take a minute to shake off the negative attitude before any interactions. Since we are all human, a realistic way to manage a bad day is to take a minute before we walk in the door, to acknowledge how we feel to ourselves or a trusted co-worker. Saying out-loud what we are experiencing allows us, at least temporarily, to rid ourselves of the negative and reframe our thought patterns, to bring a more positive attitude into the clinical setting.

3. Empathy

This is one of the most effective tools we have as clinicians and, when used effectively, can significantly reduce clinician burnout.

Empathy is about focusing on the patient’s perspective, staying out of judgment and acknowledging the person’s emotions. In a nutshell, this keeps you 'out of the patient’s story' and allows the healing to begin. When you are being empathetic, you seek to understand the patient’s perspective - but the secret is, you don’t have to agree with their perspective. By actively listening and allowing the client to feel seen and heard, you are instantly building trust. This improves adherence, right at the first encounter, when patients are at their most vulnerable.

4. Flow

The concept of flow, often referred to as 'being in the zone', was first described in the literature by Mihaly Csikszentmihályi PhD, in 1975. In order to achieve flow, three components need to be in place:

  • Clear goals

  • Immediate feedback

  • An existing balance between the challenge of the activity and the person’s potential for success with that specific activity

Flow can be accomplished in the clinic and within the home exercise program, when the occupational therapist introduces an activity or exercises that provide a specific and individualised purpose to the patient.

The introduction of a customised activity increases the client’s intrinsic motivation; they focus better on an activity that is meaningful and purposeful to them.

In turn, this also increases adherence. To create a 'flow' environment, set the long-term goal first (e.g. to return to playing an instrument). Then proceed to set many short-term goals (attain needed range of movement, coordination, etc). All of these goals can then be used to measure progress. Since flow is attained during some sort of intervention, provide tasks that are engaging without being tedious or too difficult. In a busy clinic, or when treating someone with limited access to therapy sessions, this is highly effective when made part of the home program. For example, if the client’s goal is to return to oil painting, instruct the client to begin painting in ten-minute intervals, with instruction to add five minutes to each painting session, as tolerated.

5. Post-traumatic growth

Positive psychological change, resulting from adversity and other challenges, producing a higher level of functioning.

Sometimes referred to as 'benefit finding', this growth occurs because of the unexpected injury; the client believes they are stronger and better, as a result of what they have experienced. Anecdotally, I will introduce this concept when I witness a client having difficulty improving as a result of a negative mindset regarding the injury or situation. First, I ask them to consider accepting the injury or event has happened and then to acknowledge that the current situation is temporary and will improve. Second, I encourage them to look for changes that, in future, may be interpreted as positive. This approach helps to reframe the client’s outlook to one of a growth mindset, as based on the work of Carol Dweck. When I am reviewing the final home program, I query the client about what changes they have experienced. It is rewarding, for both the occupational therapist and the client, to acknowledge the positive change that is a result of this negative event or injury.

6. Shared decision-making

A process in which both the client and the occupational therapist contribute to the decision-making process; an essential ingredient to client-centred care.

It prioritises the client’s values and goals and allows the person to feel in control of the situation. The client expresses their desired outcomes as the main focus of the rehabilitation program. Once established, the clinician contributes their expertise regarding the best way to attain the client’s goals. Only with the client’s consent can a mutually agreeable plan be declared. The discussion results in a clear outline for both the client and therapist, allowing both parties to work toward the same goal. This approach also quickly builds trust and will promote adherence to the treatment plan. An example of a way to implement shared decision making into the everyday dialogue is to explain the reasoning for the next step, and to add “and if you are in agreement, I would suggest we proceed with x, y and z”.

7. Strength-based treatment approach

A widely used and highly researched approach in the field of positive psychology. It is also referred to as 'strength-spotting'. It directs the attention from the pathology/injury and focuses on the promotion of health within the context of the injury. This creates what is known as the ‘Rosenthal Effect’, after the Rosenthal-Jacobson study completed in 1968, where it was shown that higher expectations lead to an increase in performance.

A strength-based approach shifts the focus to what is important to the client and helps to redirect maladaptive attitudes prone to a person who has undergone an injury or trauma.

Strength spotting can be initiated during the initial evaluation, through use of the occupational profile, by asking about the client’s interests, talents and competencies. I open the dialogue on the first visit by asking “So, what do you do for fun? What brings you joy?” I don’t move onto the next question until the client gives me a concrete answer. By emphasising what matters most to the client and by acknowledging what strengths the client is utilising to attain their goals, the client’s motivation for success becomes intrinsic, allowing the person to feel they have control of their situation. This approach also leads to better adherence with the rehab program and, ultimately, a positive outcome for both the client and the clinician.

Reference list

  • Langewitz et al. (2002). Spontaneous talking time at start of consultation in outpatient clinic: cohort study. British Medical Journal, 32, pp 682-683

  • Cuff et al (2016) Empathy: A review of the concept. Emotion Review Vol. 8 No. 2, 144-153 DOI: 10.1177/1754073914558466

  • Riess, H (2017). The science of empathy. Journal of Patient Experience. vol.4(2) 74-77

  • Reid, D. (2011). Mindfulness and flow in occupational engagement: presence in doing. Canadian Journal of Occupational Therapy, 78, 50-56. DOI:

  • Csikszentmihályi, M.; Abuhamdeh, S. & Nakamura, J. (2005), "Flow", in Elliot, A. (ed.), Handbook of Competence and Motivation, New York: The Guilford Press, pp. 598–698

  • Jacobs, K. (1994). Flow and the occupational therapy practitioner. American Journal of Occupational Therapy. 48. 11. 989-996

  • Vranceanu, A, et al (2009) Integrating patient values into evidence- based practice: effective communication for shared decision- making. Hand Clinics 25, 83-96 DOI: 10.1016/j.hcl.2008.09.003

  • Linley et al (2010). Using signature strengths in pursuit of goals: effects on goal progress, need satisfaction, and well-being, and implications for coaching psychologists. International Coaching Psychology Review.Vol 5, No. 1, March

  • Rashid T. (2015) Positive Psychology: A strength-based approach. The Journal of Positive Psychology Vol. 10, No. 1, 25-40

  • Xie, H (2013) Strengths-based approach for mental health recovery. Iran Journal of Psychiatry and Behavioral Sciences, 7 (2); 5-10, ID: 24644504

  • Mitchell, Terence R.; Daniels, Denise (2003). "Motivation". In Walter C. Borman; Daniel R. Ilgen; Richard J. Klimoski (eds.). Handbook of Psychology (volume 12). John Wiley & Sons, Inc. p. 229. ISBN 0-471-38408-9.

  • Dweck, C (2006) Mindset: the new psychology of success. Ballantine Books

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