Some excerpts from my OT mental health fieldwork (inpatient geriatric psych ward) journal, a decade ago:
I did a group called “Transformation” and it had to do with drawing past and present and future, and discussing things to do to help ensure the future as they depicted it.
One sharp lady drew an embryo for past, a stick lady for present, and a casket for future. She cackled about it, but when I asked her what she wanted to do before the casket, she got thoughtful and had several things she wanted to work on.
Another HILARIOUS lady said she wanted to have “quar triplets” …lots of babies.
Another lady drew a smiley face for past, sad face for present, and smiley face for future.
Another lady didn’t draw anything, but verbally stated she would get better by eating right, taking vitamins, and “coming to groups”…lol. I liked that answer.
Also: Last night I watched a friend have his debut performance at a VFW (veterans of foreign war). I think I was the youngest one there by about a thousand years, but everybody was in great costume. There was a few old ladies SHAKING IT UP on the dance floor, although really their shaking was more like quivering…barely moving. Loved that they didn’t care.
And an old man taking it down to the floor….getting back up was a little precarious, a woman next to me who knew I was in OT school whispered, “That man may need your services in a minute.”
One of my favorite moments of day:
Male patient with severe dementia: I don’t remember. I’m 88, you see.
Me: You don’t look a day over 87!
Patient: ::genuinely laughs:::
Also, one of my patients who was psychotic kept hearing things in his head…including calypso music! You try interpreting the word “calypso” from someone with dysarthria!!
I also very much loved and appreciated the sentences my clients would write while taking a cognitive assessment. See here:
Pediatric OTs or parents: If you’re working with a child who is highly intelligent but has poor handwriting and one of the reasons is that they are bored/don’t care about sizing rules….this “lava paper” (game paper) is for you.
I haven’t posted about OT in a loong time here! But this situation arose the other day and it got me reflecting.
My friend and I were leaving a restaurant.
A white-haired woman was slowly headed towards the sidewalk in front of the restaurant. She had the panicked look of someone who is scared of falling. Another lady was holding her hand, helping steady her as they walked. A white-haired man waited at the curb for them.
As the unsteady woman reached the curb, requiring her to step up, she hesitated.
The man at the curb said to her, neutrally but with slight impatience: “It’s not a mountain.”
As I walked past, I chimed in: “It FEELS like a mountain.”
The woman instantly cried out, “YES! THANK YOU!” in a relieved tone. She felt validated/seen.
I am about to start teaching psychosocial OT/mental health to incoming Occupational Therapy Assistant (OTA) students, for the third time now, and one thing we circle back to again and again is validation of feelings of their clients.
Yes, maybe a curb is not a mountain, maybe other people have it worse, blah blah blah. But people crave validation. Especially people in pain or fear. It doesn’t mean we are agreeing with them. It just means we hear them, see them. Often, once a person feels validated, they’re then more willing to hear alternative points of view, or to move on.
The day I first introduce validation as an important component of therapeutic use of self with clients, I have them watch this brief clip from the incredible animated movie “Inside Out.”
In this sweet, sad clip, we quickly see the outcomes of invalidating versus validating feelings. Even children can understand the concept once it’s discussed using that clip as an example.
I love the concept of “therapeutic use of self” and address it in a blog post here as well: https://missawesomeness.com/therapeutic-use-of-self-in-ot
My first children’s picture book is finally out on Amazon as of mid-June 2018! The Centipede Who Couldn’t Tie His Shoes.
So far it’s only on Amazon, but hopefully soon you’ll be able to find it in libraries and some local San Diego stores. I’m also aiming to get it in some therapy catalogs and online therapy stores. If you are interested in having a local (to you) bookstore or library carry it, please contact me on gmail (it’s just my name, karen.dobyns) and I’ll e-mail you the PDF of what’s called a “sell sheet,” which has information the store would need in order to look into it. 🙂
It’s unbelievable how much work goes into creating a book in terms of technical details, and now it’s time to focus on marketing. I had noooo idea there was so many pieces to it, but I’m learning, and it’s a fun journey. I’m hoping to inspire more OT practitioners to write and/or illustrate!
I’m just starting to get Amazon reviews – I’d love you forever if you write one, and feel free to have some actual criticism in there, I know the book is not perfect! It’s actually good to have some 4-star or even occasional (gasp) 3-star reviews, that’s more realistic than everyone saying it deserves 5-stars.
Right now Dr. Anne Zachry is hosting a book giveaway on her blog, Pediatric OT Tips, if you want to check that out.
And Tonya of Therapy Fun Zone just wrote a review on my book as well, as well as directions for an adorable jellyfish craft that uses shoe-tying skills with two different colors.
Wow, I haven’t updated my blog in over a year! Yikes! How horrible is that! The end of 2016 and most of 2017 were pretty challenging but I think I’m ready to start blogging again/cleaning up and updating my website.
For now I am just excited to say my first children’s book is coming out soon. Click the “books” tab above or go here for some information – more to come soon. https://missawesomeness.com/books/
I am now teaching a mental health/psychosocial course to occupational therapy assistant (OTA) students at a local community college. This week we’ll be looking at the concept of “therapeutic use of self” when working with a client/consumer/patient/your preferred term here. How we can respond to behaviors in various ways, and “therapeutic use of self” is always powerful. The following memory came to mind….it took place on a locked geriatric psych ward, over 5 years ago. I was an occupational therapy student on my Level II fieldworks. I wrote up this memory back when I was a student, so here I’m just slightly modifying the original writing.
“I had a patient, an elderly man, who had expressive aphasia. For the most part, he could only seem to say a single word – a curse word. He would vary the tone of this curse word, so if he said it kindly it was a good thing. He usually used it neutrally. One day, I came across him in the hall, sitting in his wheelchair, and realized by the wetness of his lap, and mostly empty cup of ice, that he had spilled it in his lap, although he didn’t say anything.
I told him I’d get him a towel and some more water, and started to hurry off to do so. He became agitated and clearly and loudly said “WAIT! WAIT!” (which was surprising since I had really only ever heard him say his curse word), and tried to grab at me. So I stopped and retraced my few steps. I stood calmly in front of him for a minute, saying nothing, but clearly present. He just looked at me. Finally, about a minute later, when I sensed he was calmer, I said slowly and calmly, “May I get you a towel?” He nodded yes. When I got back, I said calmly, “May I get you more water?” He nodded yes. I’m proud I realized his agitation was (probably) coming from wanting some control and trouble processing, so I’m glad I did what I did, once I realized I was operating too fast for him.
I was in a rush initially because stuff like that is a big productivity-sucker – technically for stuff like that I should mention it to an aide, instead of doing it myself, because I was solely based on billable units (meaning that I’m expected to reach a certain level of “productivity” by treating clients, and anything that doesn’t count as treatment is threatening productivity and therefore how much money the hospital takes in.) But I think it’s good to do it myself anyway for many reasons, including, most importantly, ethical and empathy reasons.” (The whole productivity vs ethical actions is a can of worms in itself!!!)
Does your child get upset easily over small and easily fixable things, like a ball rolling under a table? It may be because he doesn’t realize he has any power to fix the problem. Luckily, you can teach him to feel more empowered. I introduce to you the PSST Method!
Download the PDF of this here: The PSST! Method: Teach Your Child How to Problem Solve
Or just read on.
The PSST! Method: Teach Your Child How to Problem Solve
Children who feel confident in their problem-solving abilities can better tolerate and handle unexpected events. All children of any age can benefit from learning problem-solving skills. Adjust your language or extent of experimentation based on your child’s age/ability/tolerance level. The steps stay the same. (Ideally, use them all in order. But using any is great.)
SAMPLE PROBLEM: Young John’s ball just rolled under the couch. John scrunches up his face, ready to cry. Daddy jumps up to go grab a broom handle and solve the problem.
WAIT! John needs to learn the steps BETWEEN the problem and a successful solution.
- Pause. Just briefly. See if the child will attempt to problem-solve. If not, proceed to step two. Eventually, your child may make the attempt.
- Frame the Problem. “Wow, the ball rolled under the couch, and we can’t reach it.” You can also provide “emotion” and “help” words. “Your face is turning red and you look really frustrated. You can say, “Please help me solve this problem.”
- Play “Dumb.” Whether you instantly have a solution or not, you can pretend you’re not quite sure what to do. Crinkle up your forehead and look thoughtful. “Hmmm….”
- Think Out Loud. Most adults problem-solve in their heads. If you can role-model the problem-solving process, you’re giving him valuable insight, and showing that it’s not magic. “The ball’s is under the couch. We have to get it out somehow…maybe we can try…” With an older child, you can ask them if they have any ideas.
- See What Happens. You may know that your hand won’t fit or his arm can’t reach, but he doesn’t. When it’s feasible to experiment (not a safety hazard or massive inconvenience), try it out. He learns a lot more that way. “Let’s see if your arm is long enough. Can you lie down and reach for it?”
- Repeat Steps # 4 (Think Out Loud) and #5 (See What Happens), until problem solved. “That didn’t work because the ball’s too far away, will my hand work? …No, too big. Hmm, maybe something small but long to help us get the ball.. see if this will work…no….hmm…let’s see if we can find something…oh, let’s try a broom handle!”
- Frame the solution. “The ball rolled under the couch and we were really frustrated and we didn’t know what to do. But we tried lots of ways to solve the problem and now we have our ball back. We are great problem-solvers!”
Repeat this process regularly. As he becomes more proficient, you can take more of a back seat to the problem-solving process.
Bonus: Consider sprinkling “What If’s?” into your conversations/play time. “We solved that problem! What if the ball landed in a tree? Or this hole? Or under the bed?” Talking is great, acting it out is even better. Play a game called “Problem-Solving Superheroes” where you deliberately practice these kinds of things.
Good luck – let me know how it goes!
PS: This method may seem obvious to you – but many caregivers would benefit from the reminder.
See flyer here:
My lovely friend Beth has been working on practical adaptive equipment – creating it at a fraction of the cost of commercial design. I copied the following text from the flyer: “I want to customize or build adaptive items for children with special needs. My dream is to have a workshop where families, teachers and designers can meet. Footrests, booster seats and supportive seats can be purchased from special needs catalogs but they are generally hundreds of dollars. I make most items out of extra strong cardboard, plastic, fabric and foam. They are inexpensive, light-weight and last a long time. I took cardboard construction classes at the Adaptive Design Workshop in New York City. The founder, Alex Truesdell, won a McArthur Award for her work. Many students who take the class are interested in starting their own workshops. It really helps to have experience building things.
What products do your kids need most? What features do you need that you can’t find? What do you want but can’t afford? I would love to hear your ideas. I’m not in business yet. I just learned that product liability insurance costs a minimum of $3500 per year. (On top of general liability insurance.) I may have to find or create a position at an existing company or organization that already serves the special needs population. Apparently, the price of insurance is stopping many of my fellow students. Connections are welcome!”
Her contact information is provided in the flyer. If you have any interest in adaptive design, or want some ideas or to know more about her work, you should definitely connect with her.
Retrogenesis is the process of people with Alzheimer’s/dementia reverting back to childhood stages..as dementia progresses and more brain cells are ruined, the earlier the stages…I wrote what’s below in 2008. Just stumbled across it again. I’m not a poet, I realize it’s not a masterpiece, but I like some of the concepts…body flowing forward, mind flowing backward. And tabula rasa, at beginning and end. Okay, not exactly, but you get the general idea. 🙂 Maybe it will give you something to think about.
When you look at me
What do you see?
An old woman
Or a young lady?
I am both.
My body flows forward
My mind flows backward.
I feel young
Others say I’m old.
That old lady in the mirror strains to see
But that is not me.
I don’t understand why my body fails
When my mind tells me I am so able.
The walker in my hands cannot be mine
I walk with a youthful upright stride.
My mind crackles with static;
time becomes dynamic.
One minute here, one minute there.
I am falling through time
One year two year three year four.
Thirty years forty years fifty years and more.
Now I’m back in childhood, happy and serene.
The years tick back to infancy
as my slate gets wiped clean.
The tabula rasa, beginning and end.
Description: Many people with dementia demonstrate a pattern of behaviors that are perplexing and risky. It turns out there is often a trigger causing the issue. Occupational Therapy (OT) Practitioners are great at investigating the issue, then finding & removing the trigger, therefore extinguishing the behavior.
(I am on a Gerontology Listserv for Occupational Therapists (through the American Occupational Therapy Association), and I’ve gotten to read some really interesting posts lately by OTs about behavior in dementia they have encountered in practice, and how even bizarre behavior typically has a trigger that can be figured out.)
Example 1: There was a woman who kept on climbing on her chest of drawers and was at a high risk for falls, obviously. The OT assessed the situation and found out it mostly happened in the afternoon, and observed the woman. It turned out the woman’s roommate had a crystal in the window and around 2pm the sun would hit it in such a way as to make a kaleidoscope of dazzling colors on the chest of drawers. This was the trigger for her climbing. The crystal was moved and the problem was solved.
Example 2: An older man who fell constantly. The OT did research and discovered he loved biking. She also discovered that he needed a lot of vestibular input and sensory integration-based interventions, or he’d start trying to self-stimulate and would end up falling.
Example 3: A man always groped his caretaker at nighttime during bath time. It seemed like a huge problem, but the OT discovered that historically, the man had always bathed with his wife at night before lovemaking. By moving the bath to the morning, the problem was solved.
Basically, the OT is often an investigator. There were other stories involving men urinating in potted plants and the like. I really liked the discussion because they talked about validation theory, retrogenesis, behavioral triggers, and more. It’s amazing to me.
*I originally wrote this way back in 2008…just stumbled across it again.