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The Rights of the Client and Clinician

July 16, 2013

baseball-players-pitcher-baWhether we work in a hospital clinic, a school, or a private practice, it cannot be denied that the role of clinician brings an air of expertise and authority with it.  However, the client has power too: the power to be there, to facilitate therapy, to determine the path of therapy, and more.  As Max De Pree puts it in in his book Leadership is an Art, the world’s greatest baseball pitcher would need to slow his throw to an unskilled catcher.  As far as who is the pitcher and who is the catcher, this will really depend on the clinician-client relationship.

Looking further at this relationship, De Pree establishes eight essential rights between ‘pitchers’ and ‘catchers’.  I will try my hand at applying them to the power sharing relationship between SLPs and their clients:

1.  The right to be needed  — This is much easier for the clinician than for the client.  We feel we are needed because the client comes to us, seeking an understanding.  But can we deny that we need the client as well?  Without the client we wouldn’t have a job, we wouldn’t have feedback, we wouldn’t have their motivation to improve, and we wouldn’t have a life in which our efforts make sense.  What are you doing to make your client feel needed?

2.  The right to be involved — We are taught in our classes to take the circumstances and input of the client into account.  De Pree suggests having both a system of input and a system for response; we can’t only ask our clients questions and write down their answers, we need to make their involvement genuine.  Acting with and on behalf of our clients, we can make our product – the therapy and results – more meaningful for them.  How is your client (or their parent/spouse) involved in the therapeutic process?  Does every action you take for the client have the spirit of their involvement?

3.  The right to a covenantal relationship — What sort of relationship do we hold with our clients?  The foundation of course is a professional relationship, with signatures and consents giving permission for this and that.  Beyond this is a more complicated relationship.  What underlying commitments do we have for one another?  We are not in competition; instead we are both working to overcome a communication challenge, the same way that a pitcher and catcher work to outwit the player at bat.  Come to an agreement beyond the paperwork: “I will do this for you, to help fulfill the goals we have developed together.”

4.  The right to understand — When you’re on your third revision of your assessment report, it sure may be annoying, but one of the purposes is to foster the best understanding possible for your client.  There is a need for both the client and the clinician to fully understand the competition (what we are up against) and the path we are walking together.  If your client (or their parent) is looking lost throughout a session, they may not feel comfortable in the environment yet.  You need to help them understand the clinical stage and process in which you both play a role.  An actor won’t feel in place until they can comfortably live their role.

5.  The right to affect one’s own destiny — Assessment, treatment, and evaluation involves more than the clinician.  At every step of our work with the client, they have (and deserve!) the right to influence our actions and future paths we take.  Of course there are necessary boundaries, such as scope of practice, our skill sets, and facility policy, but we should work to create flexibility within them.

6.  The right to be accountable — Are you frustrated that your client hasn’t been practicing at home?  What have you done to help them understand the importance of home practice in seeing improvement?  What about when we see no progress from our own efforts; are you willing to admit your mistakes and change direction?  Strive to develop a working partnership, in which motivation and hard work is shared with the clinician, and success rests with both of you.

Capture7.  The right to appeal — When creating our treatment plan for our clients, my partner and I were definitely open to input from both of our clients’ parents.  How would we feel if today, after nearly a month of treatment, the parents’ turned our plans on their heads and demanded sweeping changes?  Though I doubt this would actually happen, we have made it clear that channels are always open to express concerns or requests for change.  We have not needed to deal with huge requests, but I wonder how we would handle it if we did.

8.  The right to make a commitment — Are you creating a rational argument for why you are treating someone?  We need to rationalize it to ourselves in order to plan treatment, but are we rationalizing our actions to the client?  In order to harness their motivation, we need develop and share goals with them, otherwise they are acting just because the clinician says so.

We’re throwing a lot our clients’ way.  Are you reading the signals they’re sending back?

Bib: DePree, M. (2011). Leadership is an Art. Crown Business.

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