Just Right Challenge and Rapport in Pediatric Occupational Therapy

What is Rapport? 

Rapport is defined as a harmonious relationship in which people understand each other's feelings or ideas and communicate well.

How to Build Rapport in Occupational Therapy?

Since we are using play or toys, we can almost always find something to make sure the child is having fun.  One of my favorite tips for working with children (especially if they are nonverbal) is to get into their world.  “Join them where they are” and mirror their actions.  I just LOVE using mirroring to build rapport.  Part of building rapport is for the child to learn we are a safe person and a safe place, you need to build trust.

Using the Just Right challenge and Occupational Therapy Activity Analysis to Build Rapport

As pediatric occupational therapists, we are always using activity analysis is to make sure we are presenting the ‘just right challenge'. The ‘just right challenge' in occupational therapy means grading or adapting an activity to be not too difficult that it feels unachievable and not too easy that it is not beneficial. 

While we learned activity analysis in OT school as a very important treatment technique, it is also paramount in building and developing rapport. We can do this by very carefully increasing the demands of play activity to where the child is still successful and doesn’t even realize they are “working” or “doing therapy”.

I recently read a Facebook group post like this “How do you deal with very aggressive children? I have a client with ASD who becomes very physically aggressive when he doesn’t get his way.”  So many other OTs suggested she step back and build rapport so the child knows OT is a safe place, but how?

Rapport is easier to establish if a client is new to you, has not been to OT before, and is new to your facility.  But what if a child is not new and you are dealing with difficult behavior?

First, for a few sessions, I suggest placing as few demands on a child as possible.  Preferably none.  They make choices, you play.  You observe what they are doing.  That doesn’t mean they have full control of the activities.  But they can make choices from what you present or you use their preferred activities.  And they have to be easy activities!

Then you formulate a plan to work on the child’s goals from what you observe.  Consider those sessions a progress note, or a mini eval.  It is valuable time spent.  Do not feel pressured to have a “productive” session.  What will you achieve if the child becomes aggressive?

Then and only then can you start to move toward activities to meet the child's goals.  Slowly. Have I said SLOWLY yet?

Rapport in School based Occupational Therapy

What if you are a school based OT?  You push in.  Observe, watch.  Help the child with what is going on in the classroom.  See if you can have your session during lunch, or at recess, art class, etc. 

If you are not using play or toys in your OT practice, well, I would like you to examine your treatment techniques.  Are you only using paper and pencil tasks in a school based setting?  Please be more creative.  Want to ONLY use school items to stick with school “function”?  You can do “play” activities with pencils.  Hold the paper on the wall, have them lay on the floor, or use paper clips for fun in-hand manipulation tasks.  If you are not using some type of play in your practice I will ask questions until you do! 🙂

According to AOTA, as a school OT, your role is to support a student’s ability to participate in desired daily school activities or “occupations.” They help children to fulfill their role as students by supporting their academic achievement and promoting positive behaviors necessary for learning.   That is NOT just paper and pencil tasks.