The relationship between a therapist and his or her client has been recognised to be an important determinant of the success or failure of occupational therapy. The purpose of this qualitative study was to explore clients' perceptions of the relationship that they formed with their occupational therapist in the context of rehabilitation. Twenty clients with varied health problems were interviewed.The analysis of data revealed three main categories, therapist role, power and connection, as pertaining to the characteristics of the client-therapist relationship. From these categories, seven different relationship dimensions were identified and arranged hierarchically. The dimensions were described as concern, direction, fellowship, guidance, coalition, detachment and rejection. Relationships were generally experienced as positive; however, there were also examples of negative and detrimental experiences.The findings are discussed in relation to the definition of the therapeutic relationship and to client-centred practice. Occupational therapists are encouraged to consider their own attitudes, needs and boundaries when it comes to establishing close connections and to share power with their clients. Furthermore, therapists must explore which form of relationship and participation each client prefers in order to establish an effective collaborative relationship.

Breast cancer diagnosis generally causes a disruption of occupational life. The purpose of this study was to explore the role of occupational participation and environment in the perception of health and well-being of Icelandic women with breast cancer. Eighteen women were interviewed using the main areas from the Occupational Performance History Interview as a guideline. An inductive analysis revealed seven categories that were organized under two main headings: occupational participation and environment. The categories were labelled "maintaining control and stability", "experiencing sense of self-worth", "enhancing self development", "access to information", "support and care", "refuge in community", and "rehabilitative opportunities". Through occupational participation the women were able to regain control of life and a sense of competence and development. Information, emotional support, safety, and stimulating environments were crucial in alleviating distress and facilitate satisfactory coping with the cancer experience. The results support that occupational participation in a safe and supportive environment has powerful restorative properties. Rehabilitative and supportive services should be based on a holistic perspective and emphasize the healthy aspects of a women's life. Furthermore, occupational therapists need to widen their approach when working with women with breast cancer and focus on their needs as occupational beings.

Palmadottir G. Client perspectives on occupational therapy in rehabilitation services. Scand J Occup Ther 2003; 10: 157 Á/166.The purpose of this qualitative study was to explore clients' perspectives on the outcome of occupational therapy practice in rehabilitation and, furthermore, to look at certain components of practice and explore whether and how they may influence clients' practice experience. Data were gathered through open, unstructured interviews with 20 adult clients after discharge from rehabilitation institutions in Iceland. Analysis of data was performed using both the constant comparative method and the coding procedures of the grounded theory approach. Results emerged around three interwoven categories: balance and enjoyment, enabling everyday life, and building a new future. Although mainly positive, people did also offer some negative points of view. Positive outcomes of occupational therapy are experienced at different levels and enhanced by organization of the therapy process, purpose and meaning of occupations, and the relationship between client and therapist. It is concluded that occupational therapists working in rehabilitation may have to pay more attention to their clients' occupational issues and needs and involve them more in a goal-directed therapy process. Occupations used in therapy should be more balanced to meet the different needs of men and women and reflect the whole occupational spectrum of each individual.

Introduction The increase of mental health problems calls attention to the need for a quality health care provision that meets the complex needs of this group. The purpose of this study was to examine mental health clients’ perceptions of the care they received in a hospital environment, focusing on how it was reflecting the main principles of client-centred practice. Method A mixed explanatory sequential design was used and data gathered with a self-report instrument and in-depth interviews. Thirty participants, discharging from a hospital ward, responded to the instrument and six others were interviewed after being discharged. Results In general, participants evaluated the care they received as being rather client centred. Staff attitudes and support and clients’ participation in decision-making and goal-setting were the two aspects that were most congruent with client-centred practice, while staff interactions with significant others and the process and outcome of service were least congruent. Exploration by interviewing revealed the complexity of client-centred practice and the influence of contextual factors. Conclusion Some aspects of client-centred mental health practice seem to be more easily achieved than others. At the contextual level, professional culture, work habits and power structure may be some of the limiting factors.

The purpose of this qualitative study was to explore the experiences and occupational lives of Icelandic women with breast cancer. In all 18 women were interviewed using the Occupational Performance History Interview as a guide. The women employed different modes of interpreting and responding to the cancer event with occupational participation being the central vehicle to resist the illness. Adjustment to breast cancer survivorship was characterized by permanent changes in the women's lives with both positive and negative consequences. When working with women with breast cancer, occupational therapists should focus on their needs as occupational beings.