There is a phrase that sounds really sensible until you're actually sitting in a session with a real person.

Just follow the therapy plan.

Of course we need a plan. We need goals. We need to know why we're doing what we're doing. But the person walking through the door hasn't read our beautifully organised therapy plan. They might be tired. They might be overwhelmed. They might have had a terrible morning. They might take one look at the activity you have prepared and decide absolutely not.

And suddenly something that looked very straightforward on paper isn't straightforward at all.

This is where it can get uncomfortable

If you're an AHA, this can be the moment where you start wondering how much you're actually allowed to change.

Do I keep trying because this is what the therapist asked me to do? Do I make it easier? Do I change the activity? Can I switch to something completely different if I am still working towards the same goal?

And if you're the AHP who delegated the session, you're sitting on the other side of this. You want the plan followed for a reason, but you also don't want your AHA pushing through an activity that clearly isn't working just because it was written down.

This is one of those areas where we think allied health teams need more conversation and less assumption.

A plan is not a script

We don't think a good therapy plan should feel like a script where every line has to happen in exactly the right order.

Think about cooking from a recipe. If it says bake something for thirty minutes but you can smell it burning at twenty, you don't sit there thinking, well, the instructions said thirty. You notice what is actually happening and respond to it.

Therapy is obviously more complex than baking a cake, but the idea is similar. We need enough knowledge about the goal and the boundaries of the session to notice when something needs adjusting.

That does not mean changing the clinical goal. It does not mean making decisions outside your role. It means understanding what parts of the session are flexible and what parts are not.

The therapist has a role here too

Sometimes we put all the pressure on the AHA to know when to adapt, but this starts much earlier.

If we're delegating a session, have we actually talked about what to do when Plan A doesn't work?

Have we said, "If they are too tired for this, try this instead"? Have we explained which part of the activity matters most? Have we talked about when we would rather the AHA stop and come back to us?

Those little conversations can make such a difference because now the AHA isn't standing in the middle of a difficult session trying to guess what the therapist would want.

And for the AHP, it means you're not expecting someone to read your mind.

Sometimes the goal is still happening, it just looks different

This is probably the part we love talking about most because allied health can get very attached to what an activity is supposed to look like.

Maybe the plan was a tabletop fine motor activity and the person can't sit there today. Could that same skill be explored standing up? On the floor? Through something they are actually interested in?

Maybe the planned activity lasts three minutes instead of fifteen, but you learn something incredibly useful about what helped that person stay engaged.

That information matters too.

The handover afterwards matters just as much

If you did change something, tell the therapist what happened. Not because you're confessing that you went off plan. Because that information helps the team make better decisions next time.

Instead of saying, "We didn't get through the activity," you might say, "They became really frustrated when we started at the table, so I moved the same task onto the floor and they stayed with me for another eight minutes."

That is useful information. Now the therapist knows what happened, why you adapted, and what changed afterwards.

And over time, those conversations are where confidence grows. The AHA gets clearer about what they can adapt. The AHP learns more about what is happening between their own sessions. The plan gets better because the whole team is feeding information back into it.

The goal can stay the same even when the path towards it changes.

We'd love to hear how your team handles this. When a session isn't going to plan, how clear are the boundaries around what can change? Tell us in the comments because we think this is one of those conversations allied health teams need to have more often.