Whether you’re seeing an Occupational Therapist (OT) for daily life solutions, a speechie for help with communication, a physio for your movement, or a dietician to make the most of your nutrition, allied health appointments can truly add value to your everyday life.
But how can you make the most of your appointments, stretch your funding to extract all the value, and really understand where you are and what you can achieve?
It’s time to think strategically about therapy and take control of your appointments.
We spoke with Catherine Daly, an OT and mental health adviser from Occupational Therapy Australia who also works in private practice at What About Play Occupational Therapy and Child and Family Psychotherapy, as well as Clare Batkin, an experienced OT and owner of clinical education business, Your OT Tutor, about how to prepare for success with therapy, keep up the momentum, and know when to take a break or finish up. Clare has also engaged in allied health sessions as a client, accessing therapy for her own children, which gives an extra layer of insight to her feedback!
Perhaps you’ve been recommended a specific therapist, or you’ve been matched with one who’s part of a wider organisation. Realistically, it’s going to take time to get to know each other and how you both like to work to make the most of each session.
Be prepared to fill out a fair bit of paperwork ahead of your initial session – this will help your therapist understand as much as possible about you before you meet – and set aside some time to read through all the information they’ve provided to you, as this can help you be ready and prepared for your session.
Clare says therapists should have lots of systems in place to make appointments run as smoothly as possible.
“Hopefully, you will have a clear understanding of why you are attending the appointment (i.e. what skills the clinician might work on, what help they can/can’t provide), so prepare a list of questions, goals or what you are expecting to achieve, so you don’t have to rely on your memory if you are put on the spot,” says Clare.
“Having said all that, sometimes the first appointment, especially for children, may just be about observing and building a connection with the child (rather than bombarding you with questions straight away). Discussing ‘what to expect’ during the first appointment with the specific clinic you are attending will help you understand what may be covered and how to prepare.”
Catherine says you should also go easy on yourself if any feelings come up – getting ready to start therapy or work with a new allied health professional can be nerve-wracking.
“It can be challenging to consider engaging in therapy. You may therefore feel nervous, uneasy, and overwhelmed about what to expect,” says Catherine. “Know that these feelings are normal, and your therapist will understand the challenges you may be facing in making and attending the appointment. You can also bring a support person (family member, carer, friend) with you if you wish.”
Catherine says there’s a lot to cover as you get to know your therapist and they get to know you. They may offer you choices about where your appointment can take place – in their clinic, or your home or another safe space for you (remember that most therapists will charge travel time if they’re coming to you).
“In the first session, they will discuss how they manage your privacy and confidentiality, including the limits to this around safety and risk. Therapy service agreements and expectations will also be made clear,” says Catherine.
“Your therapist may then ask you about what brought you to therapy, and what your main concern is. Part of this may involve telling your story and history to them. They may also engage your support person in this conversation to help make sure they have all the relevant information about your particular circumstances.”
When accessing therapy, you should expect to:
If you’re a National Disability Insurance Scheme (NDIS) participant then of course, you’re all over goals! You might even have heard of the goal-setting acronym SMART – which stands for setting goals that are:
However, when it comes to allied health therapy, sometimes it’s helpful to be more flexible with your goals. Clare says some therapists will go with SMART goals, while others use more generic goal setting, which can be ‘just as effective’.
“There should be an outcome that you are working towards, that has been named, and with some sort of timeframe in mind, but if it is not in the ‘SMART’ format it doesn’t necessarily mean that it’s not good enough,” says Clare.
“Often, the most effective approach combines both short term and long term goals. The long term goal might be something worked on over a term or year, while short term can be the smaller stepping stones that happen in each session, or over a few sessions.
“The short term goals can help you see the progress you are making (even if the long term goal seems overwhelming).
“Most therapists will have a goal-driven approach and will work collaboratively with you to set goals. If they don’t have goals, there’s a risk you’ll just continue therapy forever, with no end point in mind, so they are essential to include.”
Catherine agrees that while SMART goals can be helpful, staying on track with goals that are relevant and useful to you is the most important factor.
“It may be more useful for you and the therapist to work together to define your goals and explore ways to track this,” says Catherine.
“Sometimes, psychosocial or emotional goals are hard to contextualise into a SMART goal format without clarity. This process should be part of your initial assessment, and then in ongoing reviews and assessments.”
Allied health therapy isn’t like getting a yes/no answer or a diagnosis or popping a pill. It can be like going on a journey where there are many twists and turns on the way to your destination. And, sometimes, there is no destination – the whole point is the journey!
So how do you know when therapy is working for you? Catherine says it’s important to look at the big picture.
“Therapy is not just about reaching arbitrary outcomes, but about developing capacity, maintaining health and wellbeing, understanding your limitations or constraints, finding meaning, and/or feeling connected,” she says.
“Individuals may have different markers for the success of therapy, and this should be discussed with your therapist regularly as part of a review/feedback process.”
Clare says you should be able to tell by the way you feel, both in attending the sessions and how you’re communicating with your clinician.
“You’ll know if it is working if you are seeing progress towards your/your child’s goals, and it’s not something you’re dreading each week,” says Clare. “You should feel like you can have open communication with the therapist, and that you have confidence in the recommendations they are making.”
“You’ll feel like there is progress, that your therapist is really listening to you and collaborating with you in the overall therapy plan, and you’ll feel you can trust them and their expertise.”
Perhaps you’re co-parenting with someone who doesn’t believe your child needs allied health therapy. Or your close friend is quite negative about your sessions, and you’d really like their support. According to Catherine, there are ways to help bring others along on the journey.
“This is tricky, and it is something to consider as part of the therapy process. Individuals are always at different seasons and points in their understanding or acceptance of a concern,” says Catherine.
“Your therapist should have a clear discussion about how you as a team can approach this, what level of information/approach feels comfortable to different family members, and how to have a consensus for therapy.
“Part of this is also acknowledging the grief/loss and adjustment that some individuals may feel when there is an unexpected or challenging health concern. This needs to be considered within the process of therapy.
“In addition, following a thorough initial assessment period, your therapist should provide feedback to the individual, the family and supporters about their understanding of the ‘problem’, how it is being perpetuated, how to navigate it and make sense of it, and what this means for the person/family in terms of their occupation and their function, as an example.”
You might have thought homework’s only role was for academic study, but continuing to work on yourself outside of therapy appointments is vital. It’s unlikely you’ll be able to achieve all you want just in sessions, so practising new skills outside of appointments will be key.
Clare says it’s all about translating your skills to your everyday.
“Therapy will always work better if you can apply the strategies you are learning in your sessions in your real life,” says Clare.
“Therapists should be setting the expectation from the start that they can’t ‘fix’ everything if you are coming to clinic sessions only and not applying the strategies outside sessions.
“For children – and many adult clients – therapists may use some sort of coaching approach (at some point) to help clients or families build skills to carry on what they are learning outside of sessions, and to eventually build the skills to problem-solve their own solutions in the future (i.e. a ‘self-management’ approach).
“You should work with the therapist to work out the perfect amount of ‘homework’, so that you aren’t feeling overwhelmed with too many things to get through, or ‘underwhelmed’ because it isn’t challenging enough or not adding in anything new.”
And remember, you’re in control of the homework too – it’s up to you and your supporters to let your therapist know if it’s working for you or if you need a change.
“This is where the collaborative approach is important, and that you can feel welcome to speak up if things aren’t working,” says Clare. “Remember that therapists can’t change something if they don’t know it isn’t working for you – they will probably go with something that works for the majority, but they will rely on your feedback to tailor it, so it is perfect for what you need.”
Of course, it’s natural to think our success will look like a single, unbroken straight line, angling up, up and up to a better life! But that’s not always reality.
“Sometimes, you may feel as if therapy is not working,” says Catherine. “This is part of the process and should be explored with your therapist.”
Clare agrees the journey won’t always be easy.
“It is normal to have bad days or sessions,” she says. “When these happen, take some time to reflect on why. Is this just a one-off day, because there were lots of other things happening at the time, or is it a pattern that is starting to emerge?”
“A pattern/series of bad days could indicate that the therapeutic relationship is getting off track – this could be addressed through being open about your concerns and seeing how the therapist responds to adapt their approach. Or it could be that you are experiencing a bit of therapy burnout, and taking a break is needed to reset.”
Clare says this is why goals are so important – because they help map out your therapy journey.
“If you don’t have any clear goals for each session (or series of sessions), this can also contribute to you feeling like you aren’t making progress – even if you are,” says Clare. “It’s just that the steps are small and slow towards a big, long term goal.”
“Reflecting back on the progress you have made can be helpful for maintaining your motivation, even when you think you’re not improving or you’re going backwards.”
Ever had a bad haircut and decided to find a new hairdresser for your next one? Allied health therapy can be the same. If you’ve tried allied health in the past and hated it, it’s not a sign to give up on therapy all together – it can be a sign you need to find a therapist who better gels with you.
Catherine says the qualifications and specialties of your therapist matter, and it’s also important to remember that while therapy should feel safe and engaging, at times it can be tough too.
“While it is important to feel comfortable, heard, and validated in therapy, it is also important to know that therapy can create a bit of unease as you work through the conflicts/concerns you have,” says Catherine.
“A good therapist can contain the fears you may have and discuss this with you, as you ‘stretch’ yourself to navigating difficulties.
“Therapists have a broad range of skills, interests, and specialisations. Sometimes, your therapist may suggest that your needs are better suited to a particular therapy approach. Know that your therapist will discuss this openly with you and support you to access this.”
Clare says if you have misgivings, it’s important you discuss them with your therapist, even if it’s tempting to just give up or to find someone new, because there can be lots of little things that might be holding you both back.
“Don’t leave without bringing it up first – sometimes, it could just be that the therapist didn’t realise a different approach was needed, or that they weren’t explaining their justifications clearly enough, or that it just wasn’t working for you,” says Clare.
“Sometimes, that feedback is enough for them to change their approach and sessions start working, but sometimes it will just be that you are not a good fit for each other.”
She stresses that it doesn’t mean everything is lost! It just means you might work better with someone new.
“Use this experience as a learning experience to help you when choosing the next clinician,” says Clare.
“Depending on where you live, there may not be too much choice, with many clinics having long waiting lists. But if you need to move on, write a list of what didn’t work, and what you are looking for in your next clinician.
“Is it the timing of their appointments, their expectations about how much ‘homework’ you do, or how included you feel in the decision-making process? Write a list of your preferences and keep these in mind when searching for your next therapist.”
This is one for the parents or caregivers who can’t attend every appointment. Some appointments might take place while your child’s in school, or your therapist might recommend no audience so your loved one can focus.
But when you’re not in the room, how can you stay across everything that’s happening in therapy?
Catherine suggests scheduling regular feedback sessions or shared communication – which benefits both the participant and the therapist, and Clare says your therapist will likely have a good solution for keeping everyone up to date.
“It could be that all parents/supporters are CCd into emails that provide regular updates of therapy plans and progress, or having a regular meeting where all stakeholders are invited may be beneficial,” says Clare.
“Ensuring that any strategies that are recommended for outside sessions are accessible to all is also important – e.g. the therapist could provide handouts, or short video summaries of what to do.
“Just remember that any communications or resource prep that happens outside of face-to-face sessions generally needs to be charged for (unless it is already factored into the hourly rate of the session), so chat to your therapist to ensure everyone’s expectations are aligned.”
Everyone is trying to make the most of their NDIS funding and get value for money from their plan. Fortunately, good communication with your therapist can help you both find a solution to squeeze every last drop from your therapy budget – after all, this translates into potentially life-changing skills for you.
Clare says you could consider reducing the frequency of your sessions – for example, seeing your therapist fortnightly instead of weekly, but with the understanding you’ll be your own therapist and continue with homework outside of those sessions, so you keep progressing.
Otherwise, consider working with a student who’s an allied health assistant working under supervision, as their hourly rate in the NDIS is significantly less than that of a therapist.
Or look at where sessions are happening.
“If sessions are happening at home, consider if there is an option to do some appointments at a clinic – you’ll need to make your own travel arrangements, but it could save on travel costs the therapist would otherwise need to charge,” says Clare. “Or, for some clients, telehealth appointments could be possible rather than a therapist charging to physically come out to your home.”
“Not all options will be appropriate for each client, but you could speak with your therapist to see what may be appropriate for you if you are needing to stretch your funding further.”
Catherine agrees that talking to your therapist, including asking whether you could access small group sessions with shared cost, or brief review sessions, are ways to extend your budget. And she suggests harnessing the power of a therapy break to not only save money, but also support your development.
“It’s normal to have breaks and pauses in therapy to enable you to consolidate any approaches or interventions,” says Catherine. “You and your therapist should plan and make use of this as part of your therapy journey.”
“There are seasons in individuals’ lives, and the timing of therapy should be considered as part of the therapy process.”
