Therapeutic use of Occupation

Therapeutic use of Occupation

Interventions in occupational therapy use occupation (that is, any activity which is meaningful to an individual person) in order to achieve a particular therapeutic outcome. The same activity could be used by different therapists but in different ways to achieve different therapy goals. The same activity could be carried out by the SAME therapist with different clients in order to achieve different goals!  To illustrate this point, consider gardening; an occupation which many people find meaningful.

The activity of planting seeds in a greenhouse. For one therapist, this could be creating repetitive upper limb and grasp movements in the low-tone limb of a stroke patient, to therapeutically restore neural connections for motor movement via neuroplasticity theory. For another therapist this could be teaching a learning disabled patient new skills in communicating with others and managing frustrations appropriately, in order to make successful socialising in the community and gaining employment more likely, via behavioural theory.

The same activity, but carried out with different end goals that the therapist wants the patients to achieve, and therefore different clinical reasoning behind it.

gardening-otter-in-wellies

In this sense, it is not what you do, but why you do it.

 

Interventions can be grouped according to the type of goal they’re achieving:

  • Preparatory
  • Purposeful
  • Occupation-based

 

Guide to models of reflection – when & why should you use different ones?

Guide to models of reflection – when & why should you use different ones?

“Difficult, but important”

Reflection is an important yet ethereal skill that all Occupational Therapists need to master.

Part of completing a reflection is an inner sense of discomfort (in fact the first stage of reflection as described by Boyd & Fales 1983) so it’s no wonder many people put it off and may even try to get by without it, perhaps carrying out token reflections just to comply with CPD or course requirements. To begin with, reflecting on your actions is something that requires conscious effort after the event but eventually, according to Johns (2000), it will become an automatic thought process even when you’re in the middle of experiencing the event. When deciding which model to use, it can helpful to find out what learning style you are according to Honey & Mumford. You can relate these to the knowledge types shown in Carper/Johns’ reflective models.

Below is a rough guide to the different models of reflection out there, and which situations they’re best geared towards. They are ordered (in my opinion) from the easier ones for the beginner who is trying to break down and evaluate a situation, to the more complex ones that build on the basics and hope to elicit a change in your personal beliefs and challenge your assumptions. Gillie Bolton suggests exercises for creative ways to reflect in her book Reflective Practice: Writing and Professional Development (chapter 4).

otter reflection
What?  So what?  …Now what?

Like  Inception, you’ll naturally find yourself going deeper with your analysis of an event the more experience you gain with reflective models. Enjoy the ride!

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Gibbs reflective cycle (1988)

Gibbs reflective cycle OT

Good for: Good old Gibbs. Basic, good starting point, six distinctive stages. Makes you aware of all the stages you go through when experiencing an event.

Criticisms are: superficial reflection- no referral to critical thinking/analysis/assumptions or viewing it from a different perspective (Atkins & Murphy 1993). Does not have the number or depth of probing questions as other models.

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OT Models: Applying theories in practice

OT Models: Applying theories in practice

The OT process is when we apply the theories of occupation in an ordered way to a practical situation. Many different models of the OT process have been developed, and they each attempt to guide a therapist through the stages of applying occupational theory to a practical client situation. Some models may be more useful in particular situations or with particular clients than others.

Part of the artistry of an being an OT, and the difference between being a technician and a professional, is being able to adopt a holistic approach and use a model most appropriate to the individual client’s unique blend of problems in order to achieve a positive outcome. Technicians follow instruction in order to carry out processes whereas professionals use a blend of artistry with science to determine the best model and interventions for each unique patient.

oshawott process
Oshawott: The pokemon otter’s process through the game

Some examples of OT process models are below:

  • PEOP   Person-Environment-Occupational Performance
  • CMOP-E  Canadian Model of Occupational Performance & Engagement
  • MOHO   Model of Human Occupation
  • MoCA  Model of Creative Ability
  • Biopsychosocial model
  • Max Neef model
  • Capability approach
  • Medical model
  • Kawa (river)  model
  • Social disability model
  • European Conceptual Framework for Occupational Therapy
  • EHP  Ecology of Human Performance
  • OA   Occupational Adaptation model
  • OPM(A)  Occupational−Performance Model (Australia)

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Therapeutic use of self

Therapeutic use of self

You may have come across the term before, you may not, but if you’re an OT you’ve probably utilised it without realising already. Therapeutic use of self  is a useful technique employed by occupational therapists in order to engage clients and therefore illicit a better outcome during the OT process. Essentially it’s being aware of yourself (your verbal language, body language, which personal information you choose to share…) when you’re interacting with a client, and using your own personality  & interpersonal skills in order to build rapport and ultimately make the client feel at ease, motivated, and  that they can trust you.

otter friend making a connection
Making a connection

In order to use yourself therapeutically, you must first be aware of your interactions with a client to then be able to adapt them to suit the style of the client. It can be useful to consider some models in order to structure your thoughts, and provide guidance for an occupational therapy student who is just beginning to reflect on their own therapeutic style.

Taylor (2008) has recently proposed the Intentional Relationship model, which categorises the six therapeutic modes -or types of client-therapist interactions- into six categories.

The modes in the  Intentional Relationship model (IRM) are: Read more

Article review: “The Model of Human Occupation’s usefulness in relation to sustainable development” by Wagman (2014)

Article review: “The Model of Human Occupation’s usefulness in relation to sustainable development” by Wagman (2014)

This article considers the role occupational therapy can play in sustaining earth’s resources, and what the barriers to people recycling may be. The ability to carry out an occupation can be impacted by climate change, and occupations themselves can also affect climate change by either contributing to or helping preventing it.

recycling otter

Where acceptable to the client, occupational therapists should encourage occupations to be achieved using environmentally sound methods. The  occupational therapist may need to work with professionals who have knowledge int his area since it not an area of expertise for OTs themselves. The authors suggest using the Model of Human Occupation (MOHO) as a good starting framework for occupational therapists who wish to incorporate an environmental perspective in their interventions.

Some aspects of MOHO and the ways they influence sustainable practice are: Read more

Occupational models: VdT MoCA (Vona du Toit Model of Creative Ability)

Occupational models: VdT MoCA (Vona du Toit Model of Creative Ability)

The catchy Vona du Toit Model of Creative Ability (or  VdT MoCA for the remainder of this article) is a new kid on the occupational block. Developed by a South African lady called -you guessed it- Vona du Toit in the 1960s, it was subsequently commonly used throughout South Africa. It was introduced to the UK in 2004 where it has been gaining popularity ever since. Patrica de Witt (2014) has updated the model in her recent chapter of the book Occupational Therapy in Psychiatry and Mental Health. Wendy Sherwood is a UK OT who is a big advocate of the model and its expansion in the UK. Because of its novelty, MoCA does not have a lot of literature or evidence base surrounding it yet.

The model was previously known by a few different names until frustration at this confusion caused it to be officially named the “VdT MoCA” in 2010. This is an example of a step in the right direction as a lack of uniformity around occupational therapy terms is something that plagues the discipline in general, and holds back its credibility with other professions as well as preventing appropriate critical comparison of theories and evidence.

The first thing to note is that the word creative as used in the model does not refer to artistic ability, such as our friend below is demonstrating.

Creative otter
Remember, creative = not creative

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Article review: “Biopsychosocial Model – The integrated approach to health and disease” by Havelka, Lucanin & Lucanin (2009)

Article review: “Biopsychosocial Model – The integrated approach to health and disease” by Havelka, Lucanin & Lucanin (2009)

In this article, Havelka et al point out that the biomedical model was a valid model while infectious diseases caused by one factor prevailed and were the main healthcare problem for humanity, but now that chronic, lifestyle & non-infectious diseases with multiple influencing factors are the main health issue it is no longer effective or appropriate as the default model for healthcare. They are in favour of the biopsychosocial (BPS) model and say its implementation is taking too long. Their criticisms of the current biomedical model are:

  • the dehumanisation between healthcare staff and patients
  • continual improvement of increasingly advanced medical techniques leading to a rise in expenditure where only rationing of healthcare would allow for the continuation of technology-led healthcare (as opposed to psycho-social led)
  • reductionist i.e. reduces people to the smallest component -their cells- and separates mind and body in order to do this despite evidence to the contrary

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Article review: “The ideal of biopsychosocial chronic care: How to make it real? A qualitative study among Dutch stakeholders” by van Dijk-de-Vries et al (2012)

Article review: “The ideal of biopsychosocial chronic care: How to make it real? A qualitative study among Dutch stakeholders” by van Dijk-de-Vries et al (2012)

Chronic conditions (such as COPD or diabetes) are increasing in Western countries like England and Holland. These long-term conditions need the patient to be active in managing their condition in order to achieve reduced financial healthcare burden and better quality of life for the patient.

In this way, evidence shows that a biopsychosocial model would benefit patient well-being and produce these financial improvements. However provision of care that starts from the medical, emotional or social needs of individual patients does not fit in easily with the current Dutch health care system.

So the biopsychosocial model is a great idea – how to implement it? Read more

Article review: “The role of mental health professionals in multidisciplinary pain rehabilitation programs” by Townsend et al (2006)

Article review: “The role of mental health professionals in multidisciplinary pain rehabilitation programs” by Townsend et al (2006)

Townsend et al (2006) write that traditional roles of psychologists are being challenged by the Multi-Disciplinary Team (MDT) treatment now required in order to treat patients with chronic pain according to the biopsychosocial model.

MDT of otters
MDT: Team Otter

Treatment of chronic pain was traditionally carried out according to a biomedical model- a patient after a car accident was treated for chronic pain syndrome but not assessed for PTSD, for example. Research has shown the efficacy of a biopsychosocial model in treating  pain, where social and psychological factors as well as biological are taken into account. Turk (2002) reported patient benefits of the biopsychosocial approach (with regards to chronic pain) as increase in functional ability, fewer disability claims, and less illness caused as side effects of medical treatment or examination. Where treatment ie pain reduction is not possible, the MDT will aim to maximise the patient’s functioning.

Townsend et al describe a case study about a patient Ann who underwent intensive 3 week programme with a MDT to cope with her lower leg pain and end dependency on pain medication. In the case study, the OT’s role in the MDT was to incorporate the various pain control strategies into activities of daily living (ADLs), using for example pacing techniques and appropriate body mechanics. They could possibly have been involved with the functional assessment and assisted with outcome measurement.

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Article review: “Community Dwelling Elderly Women and Meal Preparation” by Eckel (2012)

Article review: “Community Dwelling Elderly Women and Meal Preparation” by Eckel (2012)

The researchers sought to identify which tasks in meal preparation were the most demanding for elderly women, and how they overcame these to continue preparing meals as they aged. Meal preparation was meaningful to the women as it was an important part of their self-identity.

prepping dinner of sea urchins.jpg

The COMP model was used to identify which tasks were important to the women. The PEOP model was then used by the researchers to carry out activity analyses for the chosen tasks.

They found that the difficulty in completing tasks as the women aged was not just due to biomedical functioning decreasing, but also environmental barriers. Often the women had carried out tasks habitually for a long time and when their physical functioning declined slightly it id not occur to them to change the environment to facilitate easier task completion. In this way the environment had become disabling since if it was altered the women would be able to carry out the tasks even with their decreased functioning.

This shows an example of the biopsychosocial (BSP) model in practice as it highlights the social/environmental factors affecting individuals (and influencing their physical functioning) as well as the traditional physical/medical factors according to the biomedical model, and highlights how other factors can influence or cause biomedical problems rather than them be the starting point.

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Sources:

Eckel E (2012) ‘Community Dwelling Elderly Women and Meal Preparation’ Physical & Occupational Therapy In Geriatrics 30(4) pp 344-360