The Psychology of OT: Nurturing Hope

By Jacqueline Thrash, OTR

Rehab therapists nurture hope until our clients can see it for themselves.

When we get a new OT client, it is often as a result of an accident or injury, an exacerbation of a present illness, or a new illness. Our clients are often hurting, physically and/or emotionally, and can be overwhelmed with this new or reoccurring negative health situation. In addition, they often have weakness and loss of endurance.

Our clients have roles which have been disrupted: spouse, parent, grandparent, child, sibling, worker, wage earner, etc.

Our clients may be fearful, anxious, self-doubting, and feel despair and hopelessness. They may feel either acutely or chronically depressed in response to their losses. They are most likely going through the five stages of grief described by Elizabeth Kubler-Ross (denial, anger, bargaining, depression and acceptance). These are all psychological aspects of their medical condition.

When clients come to us, they may be feeling lost and overwhelmed. They often look to us with fear and hopelessness in their eyes. It seems they are begging us for an answer, for help.

I remember the first time I recognized this look; it was early in my career. My client had a stroke in both hemispheres simultaneously, and couldn't talk or move at all. He gave me this look. Wow. It was then that I knew the importance of my role as therapist.

The spirit is amazing. For any of you who have seen a loved one's body after death, you know that it is the spirit that animates the body. With the human spirit, all things are possible. It is a gift from our creator.

However, the physical body has limitations. When people get sick or injured, they cannot do what they could do before, and this is very scary for them. This inability gives them a glimpse of the downward decline toward death. It is so scary that many people quickly put it out of their minds.

Then we come along, OTs: skilled, knowledgeable and caring. We have been trained for both physical dysfunction and psychosocial OT, and can very well handle the psychological aspects of the client's interruption of role.

We as therapists and spiritual people recognize the resilience of the human spirit, as well as the physical limitations of the body, before and after illness or injury. We know what can be done. We know how to do it. That's what we do—we analyze how things are done so that we can teach or re-teach others to do the same things.

In knowing the limitlessness of the human spirit, the process of activity analysis and reproduction of activity, and how physical and mental illnesses affect occupation, we are qualified to nurture hope for our clients until they can see it for themselves. It is almost as if hope is a little baby chick cupped in our hands: fragile, young and tender (and fluffy). We hold it gently and carry it while the client is recovering.

Eventually, through our and the other team members' skills and empathy, the client regains his abilities, and therefore can see and believe in hope again. At that point, we pass this little yellow chick to him and say, "I kept this safe for you." It is beautiful.

We use many techniques to nurture and cultivate hope. We use our knowledge of anatomy, physiology and the disease process to educate the client. This takes some of the fear of the unknown away, because we are giving them specific and factual -information. We take a baseline of function, write measurable goals and discuss the plan of action with the client. We help them see where they are, and where we are going. We use both abstract encouragement and measurable progress to encourage our clients. "Look, yesterday you could not lift your arm, and today you were able to." We can also paint the picture of recovery for our clients, making it less fearful. Here's a framework of what I use:

In the acute hospital the doctor and his team save your life, and when you are strong enough you go to rehab. In rehab (or SNF), therapists work you intensely to help you regain your strength and abilities to walk, do your self care, swallow, etc, and then you are discharged to home. Home therapists come out and follow through with what you were working on in rehab, help you get -adjusted to your home again, and make sure it is safe. They can get you the equipment you need to take a bath easier. When you are well enough or able to leave the house (and go down the stairs), you might go to outpatient therapy.

This is like giving a map to a hiker. It gives him a sense of what the journey is going to include. Then I explain that we therapists are like guides on this journey. Metaphorically, the client decides where to go, such as the Mojave Desert. We go along and tell him what plants he can eat, which ones are poisonous, and which is the best way to go to cross the terrain. We tell him what animals are dangerous, and which ones to stop and look at.

I explain that we guide people through their recovery, and that it is important that they are actively involved. Without their will to recover and hard work, we cannot accomplish anything, but with their hard work and our hard work, we have a great chance of meeting our mutual goal: their recovery.

There is so much to see on the journey through the desert: cactuses, flowers and sunsets. There are challenges to be faced (the blazing sun, the cold night, the poisonous animals), but we find joy in meeting these challenges. I share their journey with them, as their guide. I treat them like human beings, and laugh with them when it is appropriate. Even yesterday I cried with a client.

So I nurture the hope and give it lovingly back to them when they are able to carry it for themselves. This is my joy.

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 thrash@pinkiemae.com.