RESEARCH QUESTIONS: What are clients’ preferences for communication styles? What is their communication experience with their therapist?

RATIONALE: Previous researchers stated that “success or failure in the helping process is a function of the interaction of both patient and therapist variables.” Precisely evaluating client–therapist interaction is critical to understand both therapists’ and clients’ perspectives; however, an appropriate and reliable assessment remains lacking in occupational therapy.

METHOD: This study used a quantitative study design with a single group of participants. After clients received three treatment sessions after referral, they were invited to fill out the Clinical Assessment of Modes (client version; CAM–C) to show their perception of therapist mode use. The paired therapists were then asked to fill out the Clinical Assessment of Modes (therapist version; CAM–T) to represent their self-identified mode use.

SETTING: Inpatient and outpatient units at a large urban hospital

PARTICIPANTS: All new rehabilitation referrals admitted from September 2012 to May 2013 were invited. There were 110 patients and 38 therapists enrolled in this study. The mean age of clients was 50.14 yr. The majority of enrolled clients were diagnosed with stroke (15.5%) and fracture (14.5%); 51% were men.

MEASURE: The CAM is a set of questionnaires aimed at measuring therapeutic mode use (a specific approach to therapeutic communication) during therapy. The CAM–T and CAM–C contain the same items but were designed to be used from different points of view. Each is scored on a 5-point ordinal scale with the range from 1 = never to 5 = very frequently. A higher score for a given mode indicates that a specific approach to communication was used more frequently than others.

ANALYSIS: We compared the item hierarchy generated from Rasch analysis to identify client and therapist perception of mode use and to examine the differences.

RESULTS: Clients expected therapists to use more of the Instructing mode, such as demonstrating how to perform a task, explaining the rationale for doing something, and providing corrective and professional feedback on clients’ performance. However, therapists identified that they used the Empathizing mode the most. They validated clients’ negative emotions and frustrations and made summary statements to reflect clients’ affect and thought processes.

CONCLUSIONS: The CAM is a theoretically based assessment, and it provides therapists an excellent chance to enhance their communication approach based on clients’ needs.