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Psychosocial Level 1 Fieldwork Experience

A Critical Reflection

Spring 2024

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The Site

What a typical day looks like:

Morning chat/reading the chronicle with coffee and tea
Brain game
Movement activity
Video of performances by different artists or musicians (related to the theme of the day)
Lunch (meal provided to participants)
Leisure activities/free choice

About the site:

Adult day respite program for older adults with dementia
Services are provided across multiple cities within the County

Location #4 runs group from 10am-2pm
Groups attendees changes depending on the day

Aim is to offer caregivers respite from the mental and physical demands of caregiving, while their loved one is provided opportunities for social, cognitive, and physical activity to enhance their quality of life

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Case Study

Curious and open-minded
Philosophical and wise
Creative
Musicality
Adaptability
Patient

Listening to music (especially music from the 60s and the Beach Boys)
Dancing
Talking with friends and peers

Self care/hygiene
Progression of dementia

Julia Good

Strengths

Occupations

Challenges

Julia is a vibrant, witty, and enthusiastic personality and is an active participant in the Friday group at the site. You will often find her cracking a joke/making a witty comment or imparting her wisdom to the group, providing both an intellectually stimulating and enjoyable conversation. It seems she really values socializing/conversation and has a deep passion for cultivating well-being.

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Impact of environment/context/policies

Impact of Environment on Occupations:

Located in a suite of an office building, the small space limits the participant’s occupational opportunities related to leisure and physical activity. However, staff are very mindful in how they set up and use the space to create a welcoming and home-like environment (i.e. the type of chairs used, color contrasting, minimal decor, etc.)

Context:

Since this is an adult respite day program, there is a stronger emphasis on caring for the participants and ensuring their safety while caregivers take some time for themselves. Many of the social and leisure occupations are done seated, which can have both positive and negative impacts on occupation.

I.e. oculus headset

Policy:

No sharing food (for sanitary reasons)

Participants are instructed not to share their lunches. However I observed this experience enhanced and helped develop relationships with other participants.

“When analyzing the environmental, contextual, and policy-related factors of this site, I identified many different strengths and limitations that made an impact on individual and group occupations. In terms of environment, the space at this site was pretty limited which definitely impacted the occupational opportunities available. However, the supervisors were really intentional about how everything was set up in order to encourage participation, maintain safety, and increase feelings of comfortability. For example, they had this one communal space that had many different types of comfortable chairs and these chairs were situated in a semi-circle so that everyone was able to engage with each other as a whole group. The context is important to note because as a respite day program, their main goal was to keep the participants comfortable, safe, and happy. Being that this is the case, this also contributed to the limitation of the amount of occupational opportunities as well as the quality of their experiences. For example: many of the participants enjoyed using the oculus headset that was available at the site, however they were only allowed to use this tool seated which definitely limits the quality of the experience in terms of the 360 views they would be able to see. However, this was a safety issue so it is easier for them to be seated. Finally, some minor policies did play a role in impacting occupation such as their no sharing food policy which I observed was beneficial to building relationships in this space. However this was again implemented for safety and sanitization purposes”

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Review of the Literature

Barriers to Practicing Client Centered Practice

The therapist and client have different goals
The therapist’s values and beliefs prevent them from accepting the client’s goals
The therapist is uncomfortable letting the client choose their own goals
The intervention is dominated by the medical model
The therapist has difficulties taking risks in order to support client goals
The therapist has difficulty facilitating the client’s identification of their goals

See table 2 for full list and order. (Sumsion and Smyth, 2000, p. 19)

“Client-centered practice recognizes the autonomy of individuals, the need for client choice in making decisions about occupational needs, the strengths clients brings to a therapy encounter, the benefits of client-therapist partnership and the need to ensure services are accessible and fit the context in which a client lives.” (Law et al.)

Challenges and Gaps in Practice Implementing Client-Centeredness

“They [the participants] felt that in the face of complexity and extreme distress, teams welcome the (false) “safe certainty” that the medical model appears to offer” (Cooke et al., 2019, p. 203)

Conflict, Compromise and Collusion:

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Critical Incident

Challenge

In this moment, I had an opportunity to both facilitate further discussion regarding what other activities she was interested in doing and advocate for her to participate in a more meaningful leisure activity. I also had knowledge of her love for listening to music

Instead of finding and advocating for a more meaningful activity for Julia to participate in, I decided to follow the supervisors’ suggestion and color with Julia

Results

I could have improved the outcome of this situation and enhanced Julia’s quality of engagement in a leisure activity by engaging in discussion with Julia and actively listening to how she was feeling in the moment/what was of interest to her. I could collaborated with supervisors to provide her with more choices. (See next slide for full discussion)

Potential Solutions

Following lunch, participants are encouraged to engage in a leisure activity of their choice. Julia, seemingly unsure of what activity she wanted to do, was encouraged by my FW supervisors to do coloring. Julia subtly hesitated then agreed to go color. I was encouraged by the supervisors to join her since she was the only one doing this activity.

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Reflection and Discussion

🚫 Client-centeredness 🚫

Remaining client centered is perhaps one of the most important practices within occupational therapy. In this instance, I fell short of remaining client centered in the following ways:

🚫 Providing choices/Autonomy and enablement of meaningful leisure occupation

Took away client power/right to receive info to make a decision by not advocating to supervisor and not providing other leisure activity options
Julia is the expert, and even if unsure of what activity she wants to do, I need to give her the time and space to engage in what is meaningful to her

Done through active listening and open/honest communication

🚫 Facilitating engagement in a leisure activity that aligns with her interests

By choosing to dismiss her hesitation (even if it was subtle), I did not respect the importance of Julia’s personal interests which can negatively impact her experience at the site and her overall well-being

Barriers to implementing client-centered practice

Limited leisure activity options available
Not wanting to take risks for client benefit
being uncomfortable with confronting supervisor or asking them to do something different outside of what they usually do
Being unsure of how to start the conversation around asking if she would rather to something different

“The term client-centered practice is popular in many areas of health service, but using the term does not necessarily translate into a truly client-centered practice”

(Law et al., 1995, p.250)

“This quote I thought was really powerful *read quote* there were numerous times where I felt I did a really good job of remaining as client-ceneered as a possibility could. However, going through these experiences and having the opportunity to reflect back on critical instances like this one was a really good growth opportunity for me. We talk about client-centeredness so frequently but it is so important to continue to check in remind ourselves about what that really means. So in this situation, I was able to reflect back and see that I chose my own comfortability over advocating for Julia and giving her choices that she should always have. In the moment, some of the barriers that were weighing on me and impacting my ability to remain client-centered were *read lists* Something I could have done better is taken a moment just to check in with Julia and ask how she is feeling about coloring and if she would like to do something else. If she was still unsure I could have helped her brainstorm through storytelling or encouraging her to share what was meaningful for her to do as a leisure activity.

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As a profession, we as OTs need to show up in spaces/programs like these as this population is greatly at risk for occupational deprivation. In addition, we can bridge the gap between respite care and home life by providing tools, resources, and education in different areas to support these individuals occupational performance and overall wellbeing
There is always room for growth. From my experiences at this site, I learned how to navigate remaining client-centered in a somewhat restricting environment

This will be an extremely important skill for future practice as I will need to constantly be advocating for my clients, my profession, and be collaborating with other disciplines to best support the client (even amongst different opinions and values)

Conclusion and Implications for Future Practice

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Thanks!

Questions about my experience?

jasmine.henley@students.dominican.edu

+1 (707) 486-9672

Please keep this slide for attribution.

CREDITS: This presentation template was created by Slidesgo, including icons by Flaticon, and infographics & images by Freepik.

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References

Cooke, A., Smythe, W., & Anscombe, P. (2019). Conflict, compromise and collusion: Dilemmas for psychosocially-oriented practitioners in the Mental Health System. Psychosis, 11(3), 199–211. https://doi.org/10.1080/17522439.2019.1582687
Law, M., Baptiste, S., & Mills, J. (1995). Client-centred practice: What does it mean and does it make a difference? Canadian Journal of Occupational Therapy, 62(5), 250–257. https://doi.org/10.1177/000841749506200504
Sumsion, T., & Smyth, G. (2000). Barriers to client-centredness and their resolution. Canadian Journal of Occupational Therapy, 67(1), 15–21. https://doi.org/10.1177/000841740006700104