Following neurorehabilitation, many patients show limited benefit, generalization, or maintenance of gains over time. Some of the reasons that account for modest outcomes are discussed with particular reference to the differences between patients' needs and aspirations, the nature of patient-clinician interactions, and patients' rehabilitation readiness. The role of a more client-centered approach is reviewed, as well as the importance of facilitating patients' capacity to identify problems, develop goals, consider options, and make choices. It is proposed that effective outcomes depend on the clinicians' success in harnessing patients' intrinsic motivation to change.