Therapeutic use of self in OT

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!!!)