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Research Papers

Implementing a client-centred approach in rehabilitation: an autoethnography

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Pages 997-1004 | Received 01 Jun 2011, Accepted 03 Oct 2011, Published online: 15 Nov 2011
 

Abstract

Purpose: Client-centred practice is widely considered a key element of rehabilitation. However, there is limited discussion of how it should be implemented. This study explored how client-centred practice was operationalized during a clinical trial of innovative goal-setting techniques. Method: This study drew on principles of co-autoethnography. The personal experiences of three clinical researchers were explored to identify insights into client-centred practice, and seek understanding of this within the broader socio-cultural context. Data were collected through group discussions and written reflections. Thematic analysis and coding were used to identify the dominant themes from the data. Results: The primary way that client-centred practice was operationalized was through listening in order to get to know, to uncover and to understand what was meaningful. Four strategies were identified: utilizing mindful listening, allowing time, supporting clients to prioritize what is meaningful and viewing the therapists’ role differently. Conclusion: While technical competence in rehabilitation is important, our study suggested a starting point of ‘being with’ rather than ‘doing to’ may be beneficial for engaging people in their rehabilitation. We have highlighted a number of practical strategies that can be used to facilitate more client-centred practice. These approaches are consistent with what clients report they want and need from rehabilitation services.

Implications for Rehabilitation

  • At face value, clinical practice may appear to be client-centred. However, critical reflection of existing practice suggests that in reality, it is not well operationalized.

  • Prioritizing getting to know the client, their story and what is meaningful to them appears fundamental to client-centred practice. A number of strategies may facilitate this process, including mindful listening on the part of the clinician and allowing time.

  • Structures and processes need to be instituted to support implementation of client-centred practice.

  • Autoethnography is an approach that may support clinicians’ to reflect on their practice.

Acknowledgements

The authors acknowledge the contribution of Dr William Levack for his assistance in reviewing and refining the manuscript.

Declaration of Interest: This study was funded by the Health Research Council of New Zealand.

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