OT as parents??

Monday was a very interesting session. We talked about the different roles that OTs can have in the client-therapist relationship, such as collaborator, ally, mentor, parent, friend, advocate etc. Two that were somewhat more debatable or maybe controversial were parent and friend. People I think were generally cautious about using the term "friend" and my opinion was that it's good to be friendly, but not to actually become friends. That's not what we're there for, it can create conflict of interest, dependency on the client's part (I'm thinking of people who are particularly vulnerable to this - people who are socially excluded/isolated in some way) and maybe loss of professionalism. Not to mention illegal - not in our scope of practice! I think some elements of friendship are desirable in the therapeutic relationship, like being honest, warm, collaborative, listening, friendly and personable... But the role of "friend" I think we should avoid. Certainly in my study of/work with complex populations with complex needs, they can be quite vulnerable to exploitation (not that OTs would deliberately but it's sort of a subtle unconscious process) in that someone interested in them and in helping them comes along and they start thinking "Oh yay I finally have a friend who cares" but then the therapeutic relationship comes to an end one day, as it must, and then they are disappointed and "rejected" and all that. It's just not sustainable and being your client's friend is not the answer. We must help our clients to find/make friends in the context of activities and groups out in the community, help them find their solutions, not to BE the solution. How many clients can we realistically befriend anyway?

The other thing was parent. I recognised many aspects of the parental role and I agree some people almost need parenting, or re-parenting, to be un PC. Some people have never had a real parent, or one who fulfilled the role well. Nurturing, caring, providing rules, boundaries and structure, encouraging, those are all good things to certain clients in certain situations. I think even parenting can be "client-centred" in a way, because you are working for the ultimate good of the client. But I guess the adage that "Mother knows best" must be examined in terms of the OT role, especially vis a vis client centred practice. Does the OT know best? Does the client know best? Is there an absolute answer, a truth, a "right way" or "best way"? All very interesting thoughts.

ps I was really amazed at how differently others defined or regarded "parent". To me, parent is all about control and punishment, but to some others, it's about nurturing and tenderness! It's not cultural, because I'm sure some of my childhood friends think the opposite of me, and some kiwis must agree with me. Just goes to show how everything is relative. That is why we mustn't jump to conclusions or assume anything.

Artistry

We've just been talking about "Artistry", what it is, who has it, how do you get it? I think it's a bit like, maybe a wee bit lower than "genius", which is a hard-to-define but easy-to-spot extra something. Not many people have posted their comments yet on the forum, but so far two of us agree it's something that comes with time and experience, you're not born with it. But then, in some other realms, maybe you can be. I thought of a video we were shown last year in class. I think this guy has artistry, and one could argue although he put a lot of time and work into it, he was also born with a special something that the next guy didn't get. Talent, perseverance, passion, commitment etc. He's only young, but I don't think that takes away from his artistry. If not all experts automatically gain artistry (not the automatic linear process from novice to expert), then maybe artistry lies on a totally different plane/scale/spectrum to the other "stages". Anyway, I'm putting up this video with an interview cut into the celebrity stunt one. Enjoy!

Better late than never!

Got myself a slot to interview an OT for last week's course work on Novice/Expert - hope this isn't too late but I thought it would be good to do the exercise and get some practice examples since I don't have access to OTs around me quite that readily. Thanks heaps!! :)

Thinking about assignment

Just started thinking about the assignment recently so dug out the old FW journals to have a look in. It's hard when I'm not in practice, to have to come up with "practice examples" or examples of this or that sort of reasoning. I'm sure there are there somewhere, only that I haven't got that big a store of practice experience to draw from, plus I might not even recognise them as examples of whichever type of reasoning they really are! I sure hope something pops out at me because otherwise I'll be stuck for my assignment.

Other thing is that I managed to locate a copy of Rogers & Holm from first year!!! I knew I had it somewhere but it took a bit of sleuthing to find it. Problem with paper articles is that the ones I think are useful to keep, I may not look at but the one article I eventually need to refer back to probably wasn't deemed (in my undergrad mind) interesting enough to file separately from all the other papers of the semester in my special "articles folder"! Well that just proves you can never predict what you'll want to go back and have another look at.  I'm sure clinical reasoning was not too high on my list of interests in first year, probably didn't really know what it was :p

Narrative (reasoning)

Wow narrative vs narrative reasoning is a rather confusing concept. Ok I get narrative, as in my own narrative and my client's narrative. That's a bit like the "illness stories" I have been reading about in Arthur Frank's work. Narrative as a story, okay. But narrative reasoning? The group session this week made me think about whether narrative reasoning is part of, subsumed under the 3 track, or is it an alternative model to explain reasoning? Or...

I get the New York Subway example, and I also thought of an example of my own from placement - when I was doing paeds, and I was working with a boy with autism, who was a bit sensory defensive (is that the term?), anyway he hated getting shaving foam on his fingers and one day when I came up with an idea to use his love of animals to try and help him engage and challenge his defensiveness and try to overcome it. When we got to the part where we were supposed to do the shaving foam (because we used to do a series of short activities, all represented in a visual schedule, which he liked), I sprayed it in a thick line instead of just everywhere, and told him that was a river, then I produced a huge bucket of tiny plastic animals and said well here are the animals and they want to cross the river so shall we help them? The boy started off gingerly but he warmed up and seemed to really enjoy lining them up in the "river" and almost seemed to forget the shaving foam was all over his hands. The animals didn't end up "crossing" the "river" but instead he helped them to "swim" all along up and down the river and ended up having a grand old time!

I think that's what meant by narrative reasoning?

Practical examples from practice

After participating in some online tutorials and of course the ongoing work on moodle, a lot of which involves contributing to a forum, I started to think that maybe it would be easier to analyse my own clinical reasoning if I were in practice, even if only so that I had more examples to draw on to analyse. When it comes to thinking of examples from practice, I only have my placements to think about and I find it quite hard to come up with some off the top of my head. It must be partly due to the fact that I have simply forgotten some of my fieldwork experiences (and here, my old fieldwork journals are going to be useful to jog the memory) but it could also be due to the fact that I don't realise I have had the experiences, as in, true to the novice model, I haven't registered salient bits of encounters with clients. Hmmm. There must be a wealth of only subconsciously registered information which I may only be able to access under hypnosis! Or maybe not.

I'm glad they mix up students and therapists. I really enjoy reading real life examples, not only do they help to explain concepts (I'm a true kinesthetic) but they are interesting from the point of view of "what happens out there" as well.