How to keep clients motivated in their rehab when services are disrupted during seasonal breaks

By Laura Gregory, clinical director, Traumaticus

From your experience, what are the most common challenges clients face when rehabilitation services pause during seasonal breaks?

Their mood may reduce further because they don’t feel able to engage in the festivities or they don’t want to take part because of what they are going through and there may be an increase in anxiety because they feel they can’t contribute in the way they once did or because of the change in routine (no therapy, no case manager, no rehab).

They may find themselves surrounded by people that don’t understand what they are going through as it may have been sometime since their injury and people who don’t see them often may be shocked or not understand why they’re not “back to normal”.

This can have an impact on how they view themselves and their recovery.

There can be a myriad of things that happen when there is a break in rehab because the focus on getting better has shifted.

How do these interruptions typically impact motivation and progress?

That very much depends on the person. In our experience there can be a loss of motivation or withdrawal from services altogether after the break.

This could be because they feel there has been a breakdown in support or because they feel they’ve taken a step back in their recovery.

It can be very tough to get back into rehab after a break because let’s face it, it’s really hard! If the momentum is lost it can be really tough to get going again especially if the perception is that there will be a dip in progress.

They may be worried that the exercises will hurt again or trigger them again because there has been a gap where they may not have been doing anything.

On the other hand, you may get the complete opposite where the person is raring to go because they can think about and focus on something else again.

Solution-Focused Approach

How do you help clients identify their own resources and strengths to stay motivated during downtime?

We would encourage people to focus on what’s possible in the downtime, not what they can’t do or won’t be doing.

We would ask them to focus on small goals that they can achieve or work towards and what they would notice about themselves when they got there. They would identify these goals as they know what they are capable of.

We would collaborate with them to make a plan for coping with the break and what they need from us to be able to achieve that and what they need from themselves and the people around them. We would also get them to think about what they’re looking forward to when they start their rehab again, anything they want to try.

I would also ask them, if they were worried about going out or being with loved ones “if you went to the activity, what would you notice about yourself afterwards that would tell you it was a good thing to do?”

This encourages them to think about what they might like to happen instead of thinking about how difficult it will be to get out of the house and how cold it is outside and talking themselves out of it before they’ve even started.

If I can get them to engage their imagination towards after the activity, they can think about all the things they will have achieved.

We are very good at talking ourselves out of things with all the what ifs in our heads. I would also be asking them questions about how they have coped in the past and what tells them they can get through this, exploring what keeps them going on an everyday basis.

Practical Strategies

What simple, actionable steps can clients take at home to continue their rehabilitation independently?

Having a plan and a routine as much as possible can be helpful. One that is flexible enough to allow for change or diversion if something happens.

Try to stay in the moment and focus on what is happening, not what might happen, this can help people stay grounded.

All of this depends on the type of person you are working with of course.

Generally, people come with their own solutions and their own knowledge about what works for them and it is about being thoughtful in mining this information from them so that they may then use it to create their own steps.

Long-Term Perspective

Have you seen any positive outcomes from these breaks—such as increased self-reliance or creativity in rehabilitation?

Yes! People have realised that they can do things for themselves because they have had the space to think about what they are able to do.

They have been able to organise the people around them to help them. Sometimes just being able to have a rest and reorganise has been helpful to them. Rehab is extremely challenging and having a break can be restorative.

I have a lot of examples of people who were dreading the holidays because it felt like a void and because they then did things over the break to help themselves, they have then come back more motivated to continue and consolidate all the learning they’ve done.

An awful lot of people who come back to us after the break who are very motivated are usually feeling good because something good happened over the break, an environmental change or happy news or a breakthrough in their exercises.

They made a cup of tea for the first time in 6 months or they were able to play with their child without getting tired.

They bring these successes to us and we celebrate them together because the very first question we always ask is “what’s been different, what’s been better?”

What advice would you give to case managers or therapists planning for seasonal interruptions?

Being curious and asking questions to help people make a plan of what they’re going to do over the break or what they can do over the break.

Look for small, realistic things that can be done given their rehab progress so far. Giving the client all the power by asking them what they think is possible, rather than you telling them what to do.

Questions that are helpful:

• Instance and exceptions questions – helping people clarify existing strengths, identify times when they’ve been in this situation in the past and coped with it or when times like these haven’t been an issue. What were they doing? How did they cope? Who did they have around them? What skills did they use? What did they notice about themselves?
• Best hopes questions: What are they hoping to get from the break? What will be useful for them to focus on? What will that look like for them?
• What’s already working for them and how can they build on this even a little bit
• What would they like to be telling me when they see me again after the break