Client-Centered and Evidence-Based Practice

The client centered model is a clear departure from the medical model for the client seeks out professional services as needed and he directs his own progression toward fulfillment, self knowledge, growth, and self actualization through occupational engagement and mastery. Client-centered concepts were inherent in the movement towards a community-based model of practice in the 1960’s when large numbers of patients with ongoing health conditions moved out of institutions. The most significant components of an effective therapeutic relationship include a therapists ability to show genuiness, acceptance and empathy coupled with the clients ability to perceive these expressions generated by a therapist. Maslow, who is known for the theory of hierarchy of needs, focused much of his research on the nature of the self actualizing person. His theory suggests that man is internally and externally driven by various forces to satisfy his needs and reach a sense of self fulfillment. Integrated into client-centered thinking, is the practice needs to be evidence-based, so that occupational therapists can justify what they do, and how they do it. The evidence-based practice allows the occupational therapists to provide evidence to their client and sources that reimburse, to prove that occupational therapy really works. 

Forming a collaborative partnership with client entails:

• Respect 

• Genuineness 

• Nonjudgemental acceptance 

• Nondirective style 

• Self Actualization

Six Principles of Client centered practice:

• Client autonomy and choice: client has the right to direct his own therapy 

• Respect for diversity: therapist should develop an attitude of unconditional positive regard. 

• Therapeutic Partnership and Shared Responsibilty: Both therapist and client come to the table as equals. Therapist expertise about theories and techniques, clients expertise regarding the disability or illness as a lived experience. 

• Enablement and Empowerment: Enabling means using our OT knowledge, skills and techniques to assist client in doing something he wants to do. Empowerment: Often means letting of control and trusting that the client will carry out the plan of action. 

• Contextual congruence: Recognizing environmental conditions and demands: Context are external or environmental considerations that influence the performance of an occupation. 

• Accessibility and flexibility: Approach each client as an individual with a unique experience of a health condition and a different configuration of contextual factors that influence his or her problems with occupational performance.