Therapy Without Purpose is Just "Activity"

Why All Therapy for Children Should Be Goal-Directed and Interest-Led

“Therapy just for therapy’s sake” is a misalignment of both professional intent and ethical practice. While routine can feel comfortable, it does little to serve the developmental, functional, and emotional needs of the child unless it is anchored in meaningful goals, relevant occupations, and driven by the child’s interests.

Therapy for children should never be a tick-box exercise, a routine session, or a generic set of activities repeated week to week without meaningful purpose. At its best, therapy is a dynamic, personalised process that empowers children to build skills, develop confidence, and participate more fully in their worlds. That’s why goal-directed, interest-led therapy is not just preferred — it’s essential best practice, as supported by leading clinical frameworks and contemporary research.

Why Goal-Directed Therapy Matters

Goal-directed therapy ensures that intervention is functional, measurable, and person-centred. Goals provide a therapeutic roadmap that aligns with what matters most to the child and their family.

This aligns with the:

• ICF Framework (World Health Organization), which encourages professionals to focus on activities and participation (not just impairments), and on the child in context — school, home, and community life.

• Person and Family-Centred Practice principles, which assert that the individual themselves facing challenge, and in the case of children and young persons - parents and caregivers - are essential partners in goal development and decision-making.
  

"When therapy goals reflect a child's and family's priorities, engagement increases and outcomes improve"

— King et al. (2004), Client-Centred Goal Setting in Rehabilitation

The Risk of Therapy Without Clear Goals

Without clearly articulated goals, therapy risks becoming a disconnected series of activities with unclear relevance or purpose.

This may lead to:

• Lacks relevance to a child’s daily life - reduced motivation in the child

• Feels repetitive, boring, or confusing to the child

• Leads to poor engagement and limited skill transfer - limited generalisation of skills into daily life

• Frustration for families who are unsure what progress looks like

• Clinician drift, where sessions lose focus and impact, too much focus on changing 'urgent' issues

• Risks reducing the child to a diagnosis or set of deficits, rather than a whole person with potential

Clinical guidelines like the National Disability Insurance Scheme (NDIS) Practice Standards (Australia) and NICE Guidelines (UK) emphasise that therapy should be outcomes-focused and evidence-informed, with regular review of goal progress.

The Power of Interest-Led Engagement

Engaging a child’s interests is more than a motivational tactic — it’s a neurological and developmental imperative. Interest activates intrinsic motivation, strengthens neural pathways for learning, and supports emotional safety and regulation.

While goals provide the “what” and “why,” interests provide the “how.” When therapy is built around a child’s passions — be it dinosaurs, drawing, Minecraft, or music — it becomes inherently more motivating, engaging, and effective.

Interest-led therapy supports:

• Deeper emotional investment from the child

• Increased participation and reduced resistance

• Improved generalisation of skills into everyday settings

• A more joyful, collaborative therapeutic relationship

Interest doesn’t mean abandoning structure — it means weaving therapeutic tasks into meaningful, intrinsically motivating experiences. This honours the child’s autonomy and fosters a sense of agency in their own learning.

Evidence supports that:

• Children are more likely to initiate, persist, and generalise skills when they are meaningfully engaged (Koenig & Rudney, 2010).

• Using play-based, interest-led strategies improves attention, emotional regulation, and participation (Barton & Smith, 2015).

• Interest-led tasks promote co-regulation and rapport — crucial foundations for therapeutic alliance and success, especially in neurodivergent populations.

  
  

  

  
  

This is supported by the DIR/Floortime Model and SCERTS Framework, which both emphasise following the child’s lead to build developmental capacity through emotionally meaningful interactions.

"Best Practice" Is Personalised Practice

Therapy should never be a passive process the child is subjected to — it should be a collaborative, dynamic relationship between child, family, and clinician. This is at the core of:

• The Canadian Model of Occupational Performance and Engagement (CMOP-E)

• The Occupational Performance Coaching (OPC) approach

• The Routines-Based Model (McWilliam)

These approaches all agree: when therapy builds on real-life goals, daily routines, and child-specific interests, it becomes not just more effective — but more ethical and respectful.

Therapy that isn’t clearly goal-directed and rooted in the child’s interests is at risk of being ineffective, inefficient, and disengaging. The research is clear: therapy works best when it’s purposeful and personalised.

Let’s move away from therapy as a service done to children and toward therapy as a process co-created with them. Because if it doesn’t matter to the child, it won’t make a difference in their life.

Key References & Frameworks:

• World Health Organization (2001). International Classification of Functioning, Disability and Health (ICF)

• King, G., et al. (2004). Goal setting in paediatric rehabilitation: A review of the literature. Child: Care, Health and Development, 30(5), 381–394.

• Koenig, K. P., & Rudney, S. G. (2010). Performance challenges for children and adolescents with difficulty processing and integrating sensory information: A systematic review. American Journal of Occupational Therapy, 64(3), 430–442.

• Barton, E. E., & Smith, B. J. (2015). Engaging Young Children with Autism Spectrum Disorder in Interest-Based Activities. Young Exceptional Children, 18(1), 3–17.

• Prizant, B. M., et al. (2006). The SCERTS Model: A Comprehensive Educational Approach for Children with Autism Spectrum Disorders