Thinking OT

Thoughts from Harrison Training and the occupational therapy world

Posts Tagged ‘narrative

We make sense of the world depending upon our experiences of it.

leave a comment »

There are a great couple of posts over at the A Voice In The OT Wilderness blog.

Part one is here.

Part two is here.

The story revolves around a conflict arising from a client’s non-compliance with a specified art exercise.  When asked to create a collage, one user, instead, created a 3D model.

This was used by one observer as evidence of that client’s “defiance” – a chilling thought redolent of One Flew Over The Cuckoo’s Nest.  There was a fascinating reason however for the deviation between the expectation of the observer and the interpretation and actions of the client.

The story reminds us that although we might be absolutely clear about communicating what we are asking clients to do, they, being the recipient of the message, receive the message and interpret it through their own filters.

Those filters are, in turn, shaped and coloured by their life experiences.

Go to Allie Hafez’ A Voice In The OT Wilderness blog now and read the story for yourself.

Advertisements

The Meaning In Occupation

leave a comment »

The Meaning of Occupation? Just Doing.

The “What is Occupational Therapy To You?” post last week attracted quite a bit of attention both within the occupational therapy sector, but also from non-OTs.

You can follow the discussion there and see that the conversation in the comments.

I thought, when I wrote the article, that I was talking about that old chestnut of an argument, “What is OT?”  Readers however were more interested in the question “What do you DO?”

Jouyin Teoh, a blogger at OT on OT challenged us to drill down further and focus on the “occupation” within occupational therapy. 

When we talk about occupation within OT we use it in a sense that has no sense outside of our spheres.  To the rest of the world your occupation is “Yer job” and nothing more.  The common misconception that occupational therapists are people who only help you get back to work makes perfect sense accordingly.

When we consider “What do we do to give our lives meaning ?” then we are far more aligned to the client and their world view. 

So how can we open up this idea of occupation as just doing or being?

Quite by accident I followed up last week’s “What is…” post with an article looking at occupational therapy issues on Flickr . The thought occurs to me that we could share and celebrate what it is that we do by way of photography.

To that end, I have set up a Flickr Group page called “Occupation… just doing“.  I have seeded it with some photos of varing quality from my own collection.  These are photos of doing, or being, even the mundane things, which give meaning to our lives.

Why not share some of yours?  Take photos, whether on your mobile phone or dedicated camera, of you, or people you know, just doing things.  Let’s celebrate these things we do and get a broader understanding of what it is that we do, when we do what do.

This is not a competition, and there is no need for excellence.  This is simply about sharing and celebrating the joy of occupation.

What Is Narrative Medicine?

leave a comment »

As I was reviewing the Mayo Clinic’s various social media channels (see my earlier blog post here) I came across this blog post by former patient/client Jillayn Hey.

Click through on the picture to read the blog in full

That in turn led me to this interview of Lewis Mehl-Madrona and his thoughts on Narrative Medicine.

The article suggests that “Narrative Medicine…asserts the importance of an individual’s whole life story to the person’s health-not just the medical history, but a story that includes ancestors and friends, interests and spiritual orientation.”

Given that the subtitle to this blog is “Thoughts, observations and provocations from the occupational therapy world” I thought this would make for good debate.

To what extent do we agree the premise?

The narrative movement can be seen in many disciplines other than medicine.  Another example can be found in narrative mediation, for example, as a dispute resolution process.

Allow me to break out of the OT silo for a moment, and look over to see what they do there.

Within narrative mediation the conflict that disputants find themselves in is held up as being a story that they are involved in.  Referring to the dispute, or, here, the question of illness or wellbeing, as a story is not intended to diminish how real that situation is.

The “Story” label, however, allows mediators, or maybe practitioners, to deconstruct the story.

  • Who are the players in this story? 
  • Who else is effected by it?
  • What is the plot? 
  • Crucially, what is the outcome?
  • How are we using language to tell this story?
  • How else might we re-tell the story, perhaps to a different audience?

A powerful part of narrative mediation, and I can see no reason why it would not have an impact here, is to set up the problem – the dispute or illness – as an entity within the story.  that in turn enables us to ask questions such as

  • How did this thing called conflict lead you to feel or react?
  • When conflict was around, did you notice anything different?
  • How did the pain invite you to respond to others?

That line of questioning can be developed further

  • What was your relationship like before conflict arrived on the scene?
  • How did you imagine your career progressing before the illness?
  • Can you think of a time when the illness didn’t have stop you from doing something?

and further still by asking

  • Am I right in thinking that you would rather this conflict was not ongoing, that you would like to see an end to it?
  • If so, what other ways might you react when conflict appears? What might you do differently?

and so on.

As the dialogue is developed, conflict, or illness, is first recognised as having an impact on our lives and behaviour.  We then go further and look at how we can explicitly recognise the grasp that it has upon us and how we can start to loosen its grip. 

In the words of Winslade and Monk, authors of Narrative Mediation, we then allow room for alternative, newly created and more helpful narratives, or stories to be constructed by ourselves and retold to others. 

In the words of Jillayn Hey herself “Through telling our personal stories of illness and disease, we assist in creating a new story of wellness that facilitates healing and in turn directs a person towards recovery.”  Note how Jillayn explicitly speaks of her new wellness.  In doing so she brings her new symptoms of being well to the foreground.  If she had not done so, then the grasp, or the narrative, that her former condition had on her own expectations of what it is to live day to day might have continued and therefore limited her activities and perceptions.

What are your thoughts?

Creative Writing As A Therapeutic Intervention – An Introduction

with one comment

Picture accredited with thanks, to Pingu1963 Flickr Creative Commons

Earlier posts have started to touch upon the idea of art as a vehicle for therapeutic intervention.

Writing can work as such an intervention, bringing many benefits to clients such as;

  • Creating and expressing meaning
  • Developing ideas
  • Experimenting with new perspectives
  • Self esteem
  • Building trust within a group through sharing writing.

There are many more advantages but the above illustrate a few of the areas where profound change can be seen.

When we write, and particularly if we are writing a creative or fictional piece, then we give ourselves room in which we can say whatever we want.  Much writing is thought to be semi-autobiographical.  That is no bad thing for our purposes.  By encouraging and enabling creative writing we can create an outlet for clients to explore ideas or emotions that they might otherwise not feel able to.

Perhaps a client is anxious about causing offence, or revisiting an area that has been addressed many times before.  By creating and developing characters within a creative piece  the client can then explore and work through ideas using those characters as the protagonists.  There is no reason why a client could not set up dissenting perspectives between two characters within the one story.

The self-esteem that can be derived from having created a piece of writing is incredibly rewarding.  Don’t believe me?  Try it.

Furthermore by carefully encouraging authors to read out, or otherwise share, their writing, it will be possible to see trust grow within groups.

I have already touched upon the core need for us all to be able to create and express meaning in our lives here.  Creative writing is such an obvious way to do so that it is easily overlooked.  Many of us, for example, will not have done any creative writing since leaving school.  Perhaps we ourselves should take up creative writing and not just leave it in the intervention tool box.

As an aside there is an element of storytelling theory that states that communication works on two planes, namely the plane of experience and the plane of meaning.

The former is our collection of perceptions and experiences.  This shapes how we communicate what has happened, or is happening, to us – essentially how we tell the story.

How we tell the story, namely the meaning that we give to it, can reflect back and retrospectively shape the plane of experience.

Let me give you an example.

A mother, let’s call her Alice, overhears another couple of mothers gossipping about Alice and her sick young child.  She overhears them talking about her, how she is not coping and needs help. They do not know that Alice is stood nearby and can overhear all that they say.  Alice is furious that these other parents have nothing better to do than talk about her and her son.  She goes home, distressed, and recounts the situation to her husband who, subsequently shares her indignation and anger.  He resolves to sort this out right away…

Here the experience has shaped the story-telling.  The experience is then passed on and shared.

Now, let’s try that again, with the same events, but with different meanings attributed to them.

A mother, let’s call her Alice, hears a couple of other mothers talking about her and everything that she does for her sick child.  Between them they are trying to think if there is anything that they can do to help lighten the load, for a short while at least.  They do not know that Alice is stood nearby.  Alice is surprised that other parents had realised just how much extra she had to do in caring for Joel and is touched, even a little embarrassed, that they should find her efforts as a mother to be remarkable.  She goes home, feeling emotional and confides in her husband…

Here the meaning that has been attributed to the same events is radically changed within the retelling.  As a result, the story telling has totally changed the experience not only for the listener or reader, but for the story teller as well.

If you are attending the Creative Writing as a Therapeutic Intervention course on 10th February then please let us know how you feel you might be able to implement these approaches in your work.

If you are already working with writing, whether journalling, or creative writing, then again please let us know what your experiences are.

Neil Denny