People need to know why they should care about what I do. So I do not start by talking about how to put on a bra with one hand. First I write about clothes that do not fit because at my age my breasts are closer to my waist than I ever thought possible. I write about how I would feel about saying "I'd love to come to dinner if you hook my bra when I get there." I live alone so donning a bra enhances my social life. Describing how a problem affects my life reveals what motivates me.
Having a stroke taught me why therapists and clients have a different point of view. Therapists must write goals for Activities of Daily Living (ADLs) because this is how they get insurance companies to pay for our care. They must also think about deficits because how they treat one deficit, like muscle weakness, is different from how they treat another deficit, like visual neglect. As a stroke survivor, improving dressing skills and grip strength are methods not goals.
Therapists need to link functional goals to personal anchors. An anchor is anything people want so much that they are willing to work hard to get it and keep it. For example, "don pants so you can sit on the patio and feel the sun on your face" links a mundane ADL to a valued activity for a client who has been kept inside for three months. Clients should tell OTs what they really want and stop worrying it may sound trivial to an able-bodied person who can take things for granted. For me OT's motto of Living Life to Its Fullest means turning "I should" into "I want to."