The authors compared changes in client performance on three goals poststroke after the Cognitive Orientation to daily Occupational Performance (CO-OP) intervention or standard occupational therapy (SOT) to determine the magnitude and direction of change.Eight people living in the community following a stroke were randomly assigned to receive CO-OP (n = 4) or SOT (n = 4). CO-OP is a 10-session, cognitive-oriented approach to improving performance that uses client-driven cognitive strategies. SOT was therapist driven and combined task-specific and component-based training. Goal performance was measured by the therapist-rated Performance Quality Rating Scale (PQRS) and the participant-rated Canadian Occupational Performance Measure (COPM).Using Mann-Whitney U test, we found that CO-OP participants showed significantly greater improvement in performance (PQRS, p = .02; COPM Performance, p = .02) compared with SOT but no improvement in satisfaction (COPM Satisfaction, p = .38).The CO-OP group demonstrated larger performance improvements than the SOT group. Because of the promising results, an investigation using a larger sample is warranted.