When Therapy Holds You Back

“He’s been in OT for a year and we don’t see improvement,” she wrote. “My husband thinks we should quit.”  I can understand why she’d feel this way.  The story she shared, of her own child slapping her face and neck until she held him to stop it, must have felt like a desperate, something-has-to-change-now moment in the life of any parent.  
I wanted to reach out and help her, but there was so much I didn’t know.  I’d read the post in a free Facebook group, and I wasn’t her occupational therapist (OT).  I hadn’t even seen any part of her story in the year leading up to this moment of crisis.
As is always the case in Facebook communities, people jumped in with supportive words for Mom, critical words about the therapist, and their best advice.  Things that helped them, which may or may not help in this situation.  Words of hope for the family’s future.
I was still thinking about this the next day, however.  What will be their next move?  And what about that OT?  You see, I’m an OT.  Much as I’d like every family’s story to go something like, “my OT is amazing and she’s changed my child’s life!!!” - too often that just isn’t the story.
Therapists, we need to face an unsettling truth: If we aren’t helping a family move forward on the things that matter most to them, we’re holding them back.
We need to recognize two very important things about this story, and the story of each child and family who crosses our path:

  1. We are only seeing a very small part of the story.
  2. It is their story, not ours.

Parents reading these statements will know them to be true immediately.  Therapists also will most likely nod their heads.  Yet I challenge you, my colleagues, to examine how you apply that knowledge.

Think of the last three goals you worked on with a client.

Now, imagine your client’s parent telling their best friend a story:

“We worked with the OT every week.  Now [child] can [your OT goal], and we’re so happy because I know we’ll be able to [whatever is most important to them]!”
If you’re having trouble seeing that story play out, chances are you’re working on the goal you think you should be working on, not the goal you actually need to be working on.
We think we should work on something we can see and measure in the clinic.  Yet no one’s life was ever changed by being able to stack 8 blocks, or stand on one foot, or point to a picture of what he wants.  Any of these might be important steps on the road to their success, or they might be distractions from something that matters more.
How can we find and focus on the thing that matters most?  Here, we need to turn to parents.  We are all part of this.  The thing that matters most is the one thing (yes, it really can be just one) that stands in the way of your other goals.  The one goal that, if you attained it, would help other goals fall into place.  To identify it, you will need their help, and they will need yours, because - here’s another truth:

          Parents are only seeing a small part of the story, too.
They have seen much more than a therapist or a teacher sees, but if this child’s story is only 3, 8, or even 15 years in, there is still more to be told.  Finding and focusing on the one thing that matters most is a challenge for parents, too.  Our skills as therapists are best applied here.  Help them find and focus on what matters most, and help them break it down into the one small piece they can do today, successfully.
The future is created from the present.  Today's present and tomorrow's present and the next day's present.  

What are you doing today, to help that family move forward on the things that matter most to them?

I ask myself this question each day.  It’s not easy to answer, but like all things it gets better with practice.  If you’d like to practice with me, I’m hosting a free online chat this Saturday, June 24th, at 1:00pm EDT.  I’ll go deeper into the one question we need to ask to stay focused on what matters: “What does success actually look like?

I look forward to talking with you about what really matters.
Laura Hackle, OTR/L