A 54-year-old female childcare worker with 1-year history of lower back pain was diagnosed with degenerative spondylolisthesis and received a L4-L5 spinal fusion with instrumentation (interbody device, screws, rods). She was transferred from the hospital to a skilled nursing facility and evaluated by an occupational therapist. Information from evaluation revealed the client lives alone with a history of depression and anxiety, obesity, and COPD. The client was deconditioned and weak with poor motivation to get out of bed but upset and stressed about her disability. The goal was for the client to successfully return home alone safely and resume work as soon as possible. Client rapport was built by discussing her love of children and her job at a childcare, as well as by verifying her goals for increased independence, and reviewing the treatment plan, rehabilitation process, and the benefits of activity.