From Persuasion to Coercion – Addressing Client Fears About Occupational Therapy Participation

We have all encountered the situation when a client does not want to get out of bed or participate in therapy. In our minds, we often have a plan for what we would like to work on with the client. Of course, OT is a collaborative process with the client, and we should meet them where they are.

I recommend reading an interesting article titled, “From Persuasion to Coercion: Responding to the Reluctant Patient in Rehabilitation”. Link

“At a practical level, physical therapists will use a range of strategies and treatment pressures to get people moving, including persuading the patient, offering incentives, inducements, possibly threatening or coercing, and sometimes even explicitly overriding the patient’s wishes.”

It discusses the ethical dilemma of when to accept the client’s request of refusal to therapy and when to “persuade” them into participation.

We should often use sympathy and empathy in our practice. Take a second to think about the client’s perspective.

Some of your client’s greatest fears of therapy may include:

  • The therapist not knowing what to do with them.
  • The therapist not understanding their limitations.
  • Therapy will be very painful or hard and not being able to move the next day.
  • Not feeling ready to mobilize and causing more harm than good.
  • Having a fall during therapy.
  • Fear of the unknown.

How would/could you address these fears if they were presented to you as a practitioner?

Strategies I recommend:

  • Continued knowledge and education
  • Timing therapy with nursing
  • Building rapport with the client
  • Ask for assistance when needed or use alternative equipment to build client confidence
  • Therapeutic use of self
  • Being an empathetic & attentive listener

When in doubt, remember to abide by the AOTA’s Code of Ethics:

Download AOTA’s PDF

The profession is grounded in seven long-standing Core Values:

  1. Altruism
  2. Equality
  3. Freedom
  4. Justice
  5. Dignity
  6. Truth
  7. Prudence

The Principles and Standards of Conduct that are enforceable for professional behavior include:

  1. Beneficence
  2. Nonmaleficence
  3. Autonomy
  4. Justice
  5. Veracity
  6. Fidelity
Jeff is a licensed occupational therapist and lead content creator for OT Dude. He covers all things occupational therapy as well as other topics including healthcare, wellness, mental health, technology, science, sociology, and philosophy. Buy me a Coffee on Venmo.