“They just weren’t engaging today.”

We've probably all said some version of that.

But lately we've been thinking about how enormous that sentence actually is.

What does not engaging mean?

Did they walk away from the table? Say no? Stop talking? Start talking about something completely unrelated? Hide under a chair? Do the activity for thirty seconds and then disappear?

Or did they engage beautifully, just not in the thing we had planned?

Sometimes we decide what engagement should look like before the person arrives

This one catches all of us.

We've got a picture in our head of the session. Sit here. Look at this. Follow this instruction. Complete this task. Move onto the next one.

Then the client comes in and does none of those things.

And our brain can very quickly go, they're not engaging.

But person centred care asks us to pay attention to the person's needs, preferences, values and circumstances too. That does not mean the client decides every clinical decision. It does mean participation is something we work towards with them, not something we simply demand from them.

We would get more curious about the moment before the no

Jess and Robyn talk about this a lot with regulation.

We tend to notice the big moment because that's the bit we can see.

The child leaves the activity. The adult shuts down. Someone says no. The conversation stops.

But what happened thirty seconds earlier?

Did we add another instruction? Did the environment get louder? Did the task become harder? Did we move from something familiar into something new? Did we keep talking when the person actually needed a second to process?

We are not trying to find someone to blame. We are trying to notice the pattern.

The car radio comes back again

We keep coming back to this example because it makes sense in real life.

Imagine you're driving somewhere unfamiliar. The radio is loud. Someone beside you is giving directions. Someone in the back is asking you a question. Then your phone starts ringing.

At some point you are probably going to say, can everyone just stop for a second?

You have not suddenly become uncooperative.

Your system is telling you there is too much coming in.

Sometimes a person leaving our activity, getting silly, refusing, going quiet or changing the subject might be giving us useful information about the demands in that moment.

It is not the only possible explanation, which is why observing rather than assuming matters.

And sometimes the activity is just boring

Can we say that too?

Sometimes we can build a whole theory around why someone isn't participating when actually the activity has absolutely no meaning to them.

We all do this as adults.

Give us a task that feels pointless, repetitive and disconnected from anything we care about and watch how quickly our own attention starts looking for the door.

That does not mean therapy needs to be entertainment every second.

But knowing what matters to the person can help us find a better doorway into the same goal.

AHAs can notice things AHPs might never get to see

This is where we think the AHA role can be incredibly valuable.

An AHA might see the client at a different time of day, in a different environment or more frequently than the treating AHP.

You might notice that engagement always drops after school. Or that the client does better when the parent waits outside. Or that one type of instruction consistently works better than another.

Those observations are useful.

The AHA does not need to decide what the pattern clinically means. Bring the observation back to the AHP and let the team think about it together.

AHPs, ask for more than “Did they engage?”

If you're supervising an AHA, you can make these handovers so much more useful by asking different questions.

• When did you notice their participation change?
• What was happening just before that?
• What seemed to help?
• Was there anything they kept coming back to?
• Did they respond differently when you changed the environment, instructions or task?

Now you're getting information you can actually work with.

And you're also showing the AHA that careful observation matters. They are not just there to get through a list of activities.

We also need to be careful with the word compliance

A person doing exactly what we asked is not automatically the same thing as meaningful engagement.

Someone can complete a task while being completely disconnected from it.

And someone else can look messy, move around, ask questions, need breaks and still be very much involved in their therapy.

Participation can look different across people, ages, communication styles and environments.

That is why we need the person in front of us, not just our idea of what a good session is meant to look like.

Before we ask why someone is not engaging with therapy, it is worth asking what we are calling engagement in the first place.

We're really curious about this one. If you're an AHA or AHP, what is something a client has done that initially looked like disengagement, but later made much more sense once you understood what was happening around them? Add it below. Those little real life examples are often where the best learning happens.