Communication during goal-setting in brain injury rehabilitation: What helps and what hinders?

Abstract

Introduction Setting goals with individuals with acquired brain injury may be challenging due to impairments in cognition and communication. The purpose of this study was to explore how occupational therapists' communication behaviours during goal-setting with individuals with traumatic brain injury facilitated and hindered this process. Method This exploratory study used a conversation analysis inspired approach and frequency calculations to analyse and interpret videotaped goal-setting sessions. Sequences of dialogue leading to, and distracting from, problem identification, a key step in goal-setting, were identified and analysed. Specific therapist behaviours that facilitated or hindered problem identification were subsequently distinguished. Results Acknowledgements and affirmations, open-ended questions about specific tasks and reflective listening, were found to lead to problem identification by the client (facilitators). Instances of disconnections were characterized by a single theme, ‘lack of uptake.' Examples of these hindrances to goal-setting included, abrupt topic shifts, lack of acknowlegement and failure to explore what the client said. Conclusion Clinicians should consider their language use during goal-setting interviews and aim to utilize conversational behaviours that are facilitative whilst minimizing those that distract to optimize their client's engagement during the problem identification phase of goal-setting.