Vol. 23 Issue 2
Person to Person
A Personal Look at Therapeutic Use of Self
I have been an OT for nearly 20 years (18 years plus a 2-year medical leave), in Northern and Southern California, Salt Lake City and Phoenix. I have experienced the joys and challenges of working with clients with a wide variety of diagnoses.
I use my life experiences, both good and bad, to benefit the client: therapeutic use of self. The human condition can be both joyous and wrought with suffering. The older I get, the more I know this to be true.
Seven weeks ago, I returned to work after a two-year medical leave; not long after, I received positive feedback from a facility (SNF) case manager about how well I have worked with the clients.
My primary site of work is a variety of SNFs. Often, we(myself and a rehab tech/aide) work in the rehab clinic on strengthening and coordination using standing or sitting activities. Even though I strongly believe in the ADL component of treatment, I am not always able to do self care at bedside or bathroom sink.
I try to include a self-care component in the clinical treatment, such as removing a sweater, putting on a jacket or, most often, removing and replacing shoes and socks (after checking their precautions). This, as far as I am concerned, is the most challenging part of LE dressing.
Sometimes the clients are shy about showing their bare feet, so I remove my shoes and socks also, to relate and demonstrate. I even taught my rehab tech/aide to do so.
If the client is hemiplegic, I do it with one hand (the same one the client can use).
I have had four bunion and hammertoe surgeries, so my feet have several noticeable scars (I call them "funny feet"). While removing my shoes and socks, I show them my scars, and let them know that I am human and have had orthopedic challenges also. This helps them to be less self conscious and often they work harder to show me that they can do it.
Over two years ago, I was struck by a van while crossing the street in the cross walk, and sustained a compression fracture of L3, a right wrist perilunate dislocation, a scaphoid fracture and three torn ligaments. I had to have reconstructive wrist surgery and now have a 4-inch scar on the dorsal side of my wrist, a 2-inch scar on the palmar side of my wrist, and my wrist extension is still quite limited. I was on Social Security for a year or so, and was struggling financially as well as physically.
When my clients complain that therapy is too hard, I tell them about my accident. I share what it was like for me to learn to use a chopping knife again, to write again, to open a can holding the wind-up can opener backwards (because I couldn't turn my wrist to wind it).
I tell them about my back pain and how I had to build up my tolerance in order to be able to walk to the corner and back, and a little further each day, and how it took 3 months to be able to get into the tub (because of my back pain and difficulty weight-bearing through my right wrist).
I let them know that I understand. It is hard. I take my neoprene wrist band (or, on painful days, my wrist splint) off and show them my scar and limited range of motion.
I let them know that, yes, it is difficult getting better, but I also hold hope for them because I have come so far.
I understand that not everyone has gone through what I have gone through; however, there are other challenges we clinicians (and OT students) have faced in our personal lives. Some of us have lost our parents or a child, had a divorce or been widowed. Others may have dealt with an eating, drinking or shopping habit; others (myself included) may be carrying excess weight. We, or a family member, may have any of the many medical diagnoses for which we provide rehab.
Most of us have suffered one way or another, and know what it is like to be in pain, to be depressed, to be angry, to feel like quitting or to have lost hope. We can use these experiences, and the feelings that go with them, to help our clients. I remind my patients that they have strength inside of them, from having lived so long (the senior population) and gone through whatever they have gone through already, that they can do this (rehab).
Of course, you have to use clinical reasoning and determine if it is the appropriate time or topic for sharing.
On a brighter note, I also use my interests (sewing, quilting, photography, cooking, swimming, scuba diving, writing, graphics, traveling and music) to relate to my clientstherapeutic use of self again.
As part of my getting to know my clientswho they are and how they are different than the next clientI ask them about their work, their families, their interests and activities, and their roles. If I happen to have done (or read about) what they tell me about, we talk about it and I relate to them.
If not, I ask them questions to give them an opportunity to be in the role of "teacher" or "wise one." I find out more about them and at the same time, I can assess their cognition and memory. Often, they sit up taller and have a more positive affect because of these conversations.
After all, isn't it the human contact and the opportunity to help someone overcome a challenge that makes this such a rewarding career? Though our clients look like "patients" in their hospital gowns, when we find out who they are inside through purposeful activity, occupation and roles, we see their inner selves, their spirits. Aren't we blessed to learn from our clients about life, overcoming hardship and perseverance?
I certainly thought about my hard-working clients when I was working hard to recover, and about my crabby ones (how not to be) when I was trying to be appreciative of my family's support.
So I encourage you to use your self, your experiences and your feelings with your patients, and enjoy the human connection.
Jacqueline Thrash, OTR, has nearly 20 years of clinical experience in California and Arizona, in acute care and outpatient, rehab, SNF, adult day treatment, and home health. Reach her online at www.livingskillstherapy.com or by email at firstname.lastname@example.org.