When Your Client Doesn't Want to Collaborate

man with face hidden in his handsIt might be a unanimous best practice to listen, listen, listen to what the wheelchair user says during an ultralightweight chair evaluation, and to make the user the center of the eval process.

But what do you do if a user is too stunned, scared, stressed or sad — maybe all of the above — to contribute to the conversation? What if he or she refuses to participate?

Focusing on the Present

“We saw that a lot in rehab,” said Angie Kiger, M.Ed, CTRS, ATP/SMS, Clinical Strategy & Education Manager for Sunrise Medical. “With pediatrics, we saw that from the families, but also from the teenagers who were selecting their new chairs.”

Kiger suggested talking with other members of the client’s healthcare team: “A lot of times, we would lean on the social workers to help discuss things with [the clients]. I wish the social worker or a psychologist was a part of the CRT provision process. Because they’re going to be able to help us discuss these things.”

She recalled meeting with a team whose patient was a girl who had nearly drowned. “When the physician said, ‘What are your goals?’, the mom said, ‘I would like my daughter to walk out of here,’” Kiger remembered.

In those cases, Kiger said, it can be helpful to keep conversations rooted in the present, while focusing on the immediate situation. “I absolutely respect that, and I will hope with you and I will pray with you that that is what’s going to happen,” she said of the mother who wanted her daughter to walk again. “However, when it comes to looking at her equipment and what’s happening with her right now, I need to best set her up for success so she can continue to work on rehab.”

Kiger added that she has told other clients, “I would love for you not to need this manual wheelchair. But if you want to get to that point, we have to look at you today. This is what you need, and we have to pick out the best one for you right now because I want to set you up for success, too.”

Taking It Slowly

Lisa Cordero, PT, ATP, National Seating & Mobility, said she tries to meet clients where they are, while talking very practically of small mobility goals. “We’ve been in those situations when we’ve said to the person, ‘Well, you may say you’re not getting out of bed again, but you still have to think of how you’re going to get from point A to point B,’” she said. “Try to ease them into that situation of, ‘Well, you still have doctor appointments. You may find that a family member needs you, and you need to be able to participate in something with that family member. You may not look at this as a way to get back into every activity you did before, but we want to set you up to be successful, to be able to participate in some of these smaller activities as a stepping stone to maybe being more open to being more mobile and more independent in other aspects of your life.”

Empathy, Cordero added is key in these conversations. “It’s overwhelming for them, and it’s hard to put yourself in that position,” she acknowledged. “I try to think to myself, ‘If this were me and my whole world was turned upside down, some of these questions would seem asinine.’ But it’s trying to pull someone out a little bit to let them know there is life beyond what they’re seeing right now.”

She tells clients, “People still want your interaction, and they still want you participating in your life. Let’s take it one step at a time. We don’t have to build you a chair right now to play basketball in. We need to build you a chair right now that you can manage and that we can adjust with you as you change and that can help you become more mobile and independent as your abilities change.”

Kiger sometimes tells clients about a personal goal of hers, and how she depends on her circle of family and friends to help her: “Give them an example: ‘I have this long-term goal for myself, and I love when my family members and my friends support me in it, and as your therapist, I’m going to do the same thing. I’m going to support you. But the reality is, we’ve got to think about today.”

And of course, reluctant clients need to be treated with kindness. Kiger added, “You do have to approach it with grace and respect.”

This article originally appeared in the Apr/May 2020 issue of Mobility Management.

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