Introduction Occupational performance coaching modified for stroke survivors is a promising new intervention to improve occupational performance post stroke. In the intervention, following client-centred occupational goal-setting, clients are led through strengths-based problem-solving and experimentation. Emotional support, individualized education and goal-focused problem-solving are hypothesized as key elements. Examination of clients’ experiences is necessary to better understand how occupational performance coaching modified for stroke survivors works, and improve its potential effectiveness. Method A descriptive qualitative study was embedded in a pilot randomized controlled trial. Semi-structured interviews were completed with seven participants in the treatment arm who received occupational performance coaching modified for stroke survivors. Qualitative content analysis was used for analysis. Findings Three categories were identified related to participants’ experiences of occupational performance coaching modified for stroke survivors: (a) the coaching was helpful; (b) the coaching provided opportunity for insightful reflection and (c) a different approach was preferred. Findings also lend support to the critical role of hypothesized key components and theorized mechanisms of action, and demonstrate the overarching role of the therapeutic relationship and the contribution of personal characteristics. Conclusion The revised theoretical understanding of occupational performance coaching modified for stroke survivors provides a valuable framework for communicating the actions that occupational therapists take in enabling occupation and emphasizes the role of the therapeutic relationship in client-centred approaches to improving occupational performance post stroke.