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This is a moving account of attempts to help Max, a 10-year-old boy, come to terms with his hemiplegic cerebral palsy and its impact on his life as it unfolds - or at least to help him to bear his pain about it a little. The first presented session is the third assessment session, and it seems that the therapist had already made a warm engagement with Max in the first two assessment sessions, as Max easily acknowledged his wish to continue to come for treatment.
As requested, I will focus particularly on the use of the Goal-based Outcome Measure (GBOM) at the start of treatment and at the six-month review, and the related communication between Max and his therapist.
The therapist introduced the GBOM at the end of the assessment, in the third session, in accordance with the guidance from Law (2009). This guidance also gives advice on the collaborative working up of goals, with therapist and young person as equal contributors with diverse tasks. The therapist’s role is to scaffold and help articulate the young person’s concerns into realistic goals for change, not least because young people often cannot imagine how things could change, or that they could change.
However, in the session reported, the therapist stopped at allowing Max to write down sentences briefly capturing how he felt, without the crucial envisaging of change. From my reading of the material it seemed that the clinical difficulty here, which bedevilled the attempt to use a patient reported outcome measure, was that the therapist her/himself was still in the early stages of helping Max put into words his feelings about his cerebral palsy, be they his fears, his hopes, or his despair. This tentativeness hampered the therapist to such a degree that s/he miscommunicated and inadvertently gave Max the impression that they could set as a goal the removal of his disability altogether. It makes for painful reading to see his hopes briefly raised, then dashed. If the therapist needed more time before setting goa