Thinking OT

Thoughts from Harrison Training and the occupational therapy world

Posts Tagged ‘storytelling

What Does Occupation Mean? This.

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The Chilean miners stranded down their mine gives an example that OTs can use to communicate the value of occupation.

In a recent BBC article, here, Dr James Thompson, a psychology lecturer at University College London made the point that the priority was not to send anti-depressants to manage a situation but rather that;

“What they need is food and supplies and then systems building up and then to be given tasks to keep them busy.

“Maybe send down some equipment to give them something to do and to keep them involved.”

What a succinct and dramatic way of demonstrating the therapeutic role of occupation.

Written by harrisontraining

September 9, 2010 at 10:51 am

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

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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.

What Is Narrative Medicine?

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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?

Social Media in Clinics and Hospitals

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Our last blog looked at why should we bother with social media in occuaptional therapy.  We examined the benefits of re-telling, or passing on stories.

We also promised to turn our gaze to the Mayo Clinic.

The Mayo Clinic was the source of the YouTube video of a couple playing the piano together.  It is a wonderfully uplifting film clip, and just the tip of their media iceberg.

Here is their dedicated YouTube channel, their Sharing Mayo Clinic blog, and, inevitably their Facebook page, with more than 15,000 fans.

This is a remarkable effort, and one that has apparently been recognised through their nomination to receive a Webby Award, the Oscars of the internet world.

Why do they do it and what does it achieve?

Well, the introduction to their blog states this;

“A blog with stories from patients, families, friends and Mayo Clinic staff”.  Stories again.  The stories humanise what could be an intimidating organisation – both in its size and also its nature.

But staff blogging?  Many here believe that is a serious no-no within healthcare, but at the Mayo there is no such disapproval.  That is not to say that they do not care, far from it.  They have a strong social media policy in place though, you can read it here.  When organisations have policies and guidelines such as these then obstacles to communication can be managed.  Staff can be encouraged and developed in social media skills, and given the tools to get the organisation’s message out there, namely that they care, that they are human and relate to their clients as humans too.  That is powerful and much better than simply prohibiting staff from engaging with online communities that might come into contact with the clinic.

And look at that Facebook page.

One reason for prohibiting social media interaction is that someone might say something bad.  On the Facebook page, people do raise objections on cost, interference in sociol-political campaigns and even a veiled attack on competence, which is perhaps inevitable.  It is not an issue though, the Mayo Clinic has built up such a loyal following around it, that the less favourable comments do not stand out and you have to look pretty hard to find them.

Oh, and they even have their own Second Life area as pictured above.

What similar systems, where patients, clients, families and staff are encouraged to speak out have you seen in the organsations you work in?

Social Media in Occupational Therapy. Why Bother?

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Here at Harrison Training, we are discovering more fascinating OT blogs every week.

Today we came across Kara, a newly qualified occupational therapist in America, and her very personal and intimate blog “Be the change you wish to see in the world”

This particular post, “Another chapter in my book of life” impressed for several reasons, the first of which is this;

Many of you may have seen this already, judging by the massive number of viewings this clip has had, but it bears repeating because it is so charming.  It also demonstrates one of the powers of social media within occupational therapy.

The YouTube video is so evocative in setting up a vision, an aspiration of what older adult life can be like.  In doing so, it challenges our preconceptions about older people, their needs and what we might expect for ourselves in the years to come.

Other reasons for the success of the “Another chapter..” post by Kara, and social media generally, is that Kara talks about why she is passionate about her work.  She can pass on the YouTube video and in doing so relay that story but she also uses social media to pass on other memorable stories… The dead body of Mussolini hanging upside down from a tree, anyone.

But so what?  Why bother?  What is in it for Kara?

Probably nothing tangible, nothing that can be counted in pounds and pence, or dollars and dimes, or at least not yet.

But we all have a need to tell these stories, to hand them on.

In doing so, isn’t she honouring the gifts that her clients have to offer?

Kara is adding to the occupational therapy and healthcare community by sharing optimistic viewpoints but also, elsewhere on her blog, sharing challenges that she is facing.

Maybe we’re just being overly sentimental here, but we believe that social media has a critical role to play for all of us,  in our work and development as OTs and health care professionals.  We need the OT community to be fully effective so that we can support and encourage one another.  After all, there may be trouble ahead.

There are also benefits for our clients.  In a second article, next week, we will look at the Mayo Clinic from which this video stems, the work that they are doing with social media, some of the downsides but also the benefits.

Creative Writing As A Therapeutic Intervention – An Introduction

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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