It is a truth universally acknowledged that assessment
skills are the foundation of any good psychiatric OT and that without good
assessments, there can be no successful treatment.
At the moment, I’m knee-deep in my psychosocial fieldwork
block. Assessment findings are piled high, treatment plans are whizzing about,
irritating my ears like flies in a swamp. Constant thoughts are evolving about
how I can help. Lists with scribblings of what is to be done.
I’ve had three
sessions with my clients to build a case, understand and treat them.
Psychosocial block assessments are far more convoluted than physical ones.
Behaviour can’t be explained in the same way that a contracture in a physical
rehabilitation clinic can be. So I have to watch my clients like a hawk and internally
ask countless “why’s”. Why do you speak this way? Why do you hold yourself like
that? Why do you think like this?
With both of my clients, I aimed to have my
assessments done and dusted by the second session, allowing more time for
treatment. The reality I face is that OT cases can never really be placed into
a nice box with a bow on. The complexities of psychiatry don’t allow for this.
As a result, every session I have done has been one of mixed methods. Plan to
teach a skill, watch, and whilst the client learns, you learn about the client.
I’ve been very lucky in that both of my clients are very
open to the activities that I’ve presented them with. Assessment is made far
easier when clients are willing to participate, at least formal assessments
are. Read this, check the boxes, I’ll count the scores. Assessment finding are then
neatly filed away. Informal assessments are my go-to. I don’t like handing
clients paperwork, as I feel I get a far more accurate assessment if my client doesn’t
feel like they’re being tested. Thus far, I’ve assessed through crafts that
require my client to use what they’re making as a way of introducing themselves
to me. This worked very well, as through the craft many cognitive and motor
planning skills are tested, and by using the craft as a reflection of self I
get a great view of how the clients see themselves. One challenging part of
assessment during this block involves how high functioning my clients are.
Assessments reveal problems and problems are what I treat, but not having overt
“problems”- as is the case with my high functioning clients- makes assessment
findings and subsequent treatment rather tricky.
What next, then? I’ve dug deeper.
Using treatment to address underlying problems or as a means of getting the
client to identify deeper rooted problems, which has worked very well. I think
this is largely due to the nature of substance abuse- a means to cope/bury/overcome/rebel
against a deeper issue. Therefore, what you see is never what you get.
For treatment, I’ve tried to be as realistic as possible
with the activities I choose. I want these activities to be something that my
client can apply in their context or address a concern that they will face in
the future. This week, I’ve focused on vocational preparation for both of my
clients, as both are unemployed, and work will be a great way for them to use
the time that would’ve elsewise been spent using substances. The resultant
sessions involved job searching online, compiling CVs, and role-playing
interviews. These sessions went far better than expected, with both clients
seeming far more upbeat, motivated, and thoroughly enjoying the session
content. I was expecting boredom! So that was a win for me. A new direction for
me in my subsequent sessions, will be refocussing treatment to relapse
prevention sessions. I’ve had to do a lot of investigation into relapse
prevention programmes and have had to consult with staff at the facility to
find out about what they teach the clients, so that this can carry over into my
sessions. Through research, I've found that "the cornerstone of relapse prevention is the identification and modification of deficits" (Witkiewitz, Marlatt, & Walker, 2005) , therefore, assessments of these deficits in coping skills or self-efficacy have to be known before treating them. Here, the link between a good assessment and then intervention planning, is clear. These will be far more challenging sessions as both the client and I
have to tackle the reality of relapse and that as easy as it is to “just say
no!” now, the outside world is a scary place for a person in recovery.
Overall, I’ve felt that I’ve been able to ascertain a
holistic impression of my clients from the assessments and interventions I’ve
conducted so far. I’d love to grow in my abilities to assess a group rapidly
and respond with appropriate intervention based on these findings in that same
group session, and hopefully with practice I’ll be able to perfect this.
A big
part of the success of my sessions has been that the clients (appear) to enjoy
what they’re doing. My job now is to keep up that excitement through finding
even more creative and fun activities- a nice excuse for forage the internet
for hours.
The following are videos that formed the basis of my sessions on conflict management and vocational preparation with clients.
Using videos has been a fantastic way to get through to my clients, as explaining hypothetical scenarios is not nearly as hard-hitting.
In my research into relapse prevention I found this clip, which tackles the reality of relapse and looks at factors that can be beneficial for prevention:
Until next week,
Kaylee
References:
Cape Fear. [capefearcommunitycollege]. (2013). The Bad Interview. [Video File]. Available at https://www.youtube.com/watch?v=kriVD9-9A8U&t=202s
Kitchen Nightmares. [KitchenNightmares]. (2018). Gordon Ramsay Gets Caught In The Middle. [Video File]. Available at https://www.youtube.com/watch?v=Joh3L_bGqfo&t=182s
Witkiewitz, K., Marlatt, G. A., & Walker, D. (2005). Mindfulness-based relapse prevention for alcohol and substance use disorders. Journal of cognitive psychotherapy, 19(3), 211.
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