S is for Story...

 

Storytelling and Story making are my subject for today.

Occupational Therapy (OT) is a ‘doing’ not a ‘talking’ therapy, but ‘storytelling’ and ‘story making’ can be an important part of the process of change for individuals.

OTs see people as ‘occupational beings’, ideally fully engaged in the world of activity with a balance of work, rest and play. Illness, disability or old age can disrupt this balance, sometimes suddenly and catastrophically, sometimes gradually and imperceptibly. The strategies that someone used earlier in their life to overcome problems may no longer be viable.

OTs can help someone envision a new possible self. Story telling and story making may be used explicitly, or the OT may be alert to naturally occurring opportunities. Storytelling occurs very naturally during the ‘doing’ of activities, therefore it naturally happens in group based interventions. This can be facilitated into a discussion that allows consideration of new possibilities that are continuous with the previous occupational life of each person. One individual described the process as “recycling the old me into the new me” (Clark in Zemke & Clark 1996).

Storytelling provides valuable insight into an individual’s previous life, what they valued and why. This provides resources that can be used in the building of a new self-identity and future.

Story making uses these insights and may include ‘coaching’ and encouragement to develop what has been learned to develop a new occupational being. This process moves beyond the basic activities of daily living that often become the focus for rehabilitation and into the domains that make someone value their life and includes activities that promote health and well-being.

For anyone interested in learning more about this complex and fascinating process, a couple of key texts to begin with are:

Clark FA (1993) Occupation embedded in a real life: Interweaving occupational science and occupational therapy. American Journal of Occupational Therapy 47:1069

Clark F, Ennevor BL & Richardson P (1996) A Grounded Theory of techniques for Occupational Storytelling and Occupational Story Making in Zemke & Clark !1996) Occupationall Science: the Evolving Discipline. USA.

I is for Individual

 

Individualisation of the information and new insights gained during Lifestyle Redesign® programmes enables positive changes to be made in people’s lives. Some programmes are delivered individually, such as the pressure ulcer prevention studies I learned about during my study visit, others are delivered as group sessions, such as the weight management programme I followed. All are based on an overall pre-prepared programme

The skill of the therapist enables the content to be individualised in either setting. The methods used include didactic presentation of information e.g. about occupational self analysis, peer exchange (in an individual session this might take the form of discussion), direct experience or doing something- perhaps the short term goal for that week, and lastly personal exploration or reflection about the experience and it’s relevance to one’s self.

The therapists were skilled in guiding individuals through a process that incorporated all these factors, but still allowed individuals to follow the process in a way that was relevant to them. For example, in the weight management group, individuals set a short term goal each week, these were very varied, from becoming involved in the family’s grocery shopping, to walking 5000 steps each day using a pedometer, they were relevant to the overall goal and most importantly were relevant to the individual’s daily routine at that point in time. In the pressure ulcer prevention study, the programme was delivered individually and although the therapists aimed to deliver the prepared programme, there had to be a great del of flexibility in this due to the changing and often challenging circumstances of clients lives.

Where occupational therapists are not providing an actual pre-prepared programme, it is still possible to use many of the methods used in explicit Lifestyle Redesign® programmes for the benefit of clients, this might include using a process of occupational self analysis, or being open to including and using a more ‘narrative’ approach. Once the underlying concepts are understood, they can be brought into many situations and interventions.

Process skills for therapeutic group work

 

In the last Communication Skills class of my visit, we looked in more detail at the role of the leader in therapeutic groups.







History of therapeutic group work in OT
We also had an overview of how therapeutic group work and the theory that underpins it has changed and evolved over the years, moving through what could be described as a 'project' era (1920s-30s), a 'socialisation' era (1930s to 50s), a 'group dynamics-process' era (1950s), 'psychodynamic' era (1960s), 'adaptation' era (1970s -90s) to the present 'wellness' era that began in the 1990s.


Leadership Skills
Leadership in a therapeutic group requires a high level of skill if the group is to achieve it's goals as a group and for individuals attending it. Skills include: active listening, observing cues and clarifying meaning, giving and receiving information and 'reality testing'. The leader needs to understand some of the processes, such as transference, that can occur and strategies to deal with them. The leader provides a powerful 'model' of behaviour and needs to ensure they present a positive model at all times.

PARS- process skills
We moved on to discuss ways of gathering information about the 'process' occurring in a group that, if well facilitated, enables the group to progress and achieve goals. A model developed in the field of counselling was introduced and we watched a really good DVD- unfortunately you have to buy it, but the link below will take you to an article about it.
http://libres.uncg.edu/ir/uncg/f/J_Benshoff_PARS_1999.pdf

                                     PARS- a way to 'illuminate the process'.

                                              P- processing

                                                 A- activity

                                                    R- relationship

                                                       S-  self

 The examples given- building a shed and 'group juggling'- illustrated how once the activity is completed, the full therapeutic benefit is gained by skillful facilitation of a process of reflection on the activity, how the group worked together, how individuals worked etc. This reflection can then be developed into understanding of an issue and then to how what has been learned can be applied within the group, but more importantly, outside the group in future situations.

PARS model- overview

	Activity	Relationships	Self
Reflecting	Reflecting/ Activity	Reflecting/ Relationships	Reflecting/ Self
Understanding	Understanding/ Activity	Understanding/ Relationships	Understanding/ Self
Applying	Applying/ Activity	Applying/ Relationships	Applying/ Self

 I felt that this model fitted well with the concepts of 'story telling' and story making' that are explicitly part of the Lifestyle Redesign approach, and present in all occupational therapy interventions whether explicitly or implicitly.

Schwartzberg, Howe & Barnes Chapter 5- The  Leader in the Therapeutic Group-  was the reading material for this class (see Books tab at top of page).