Hi there, I'm a Mental Health OT from Australia and work with clients who find it difficult to engage and identify their goals daily. Sometimes just engaging with the person and building rapport for a couple of sessions is enough for them to feel safe to work with you on re-engaging and devising personal goals that require some level of functional ability: thereby making physical therapy more meaningful (?).
Occupational dysfunction often occurs previous ability, stability) across many domains due to depression, poor motivation, grief (loss of pet) and other mental health issues, in addition to aging and loss of general function. A good general screen is the DASS (Depression, Anxiety and Stress Scale) to inform treatment, or maybe a cognitive screen to ascertain whether she is able to formulate appropriate goals due to low mood and requires more support to identify them? Perhaps there are some personality vulnerabilities present that compound her current presentation of "rejecting" (or testing) you, then wanting more input. If her goal of being "normal" is strongly held then assistance to manage depression symptoms and education re same may assist her to return to a state that is more comfortable for her? I'm not sure how your system works or whether there is provision for OT's to work in this way? Felicity Fay Mental Health Occupational Therapist -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of [EMAIL PROTECTED] Sent: Friday, 31 October 2008 11:31 AM To: [email protected] Subject: OTlist Digest, Vol 43, Issue 44 Send OTlist mailing list submissions to [email protected] To subscribe or unsubscribe via the World Wide Web, visit http://otnow.com/mailman/listinfo/otlist_otnow.com or, via email, send a message with subject or body 'help' to [EMAIL PROTECTED] You can reach the person managing the list at [EMAIL PROTECTED] When replying, please edit your Subject line so it is more specific than "Re: Contents of OTlist digest..." Today's Topics: 1. Re: D/C'd Patient For Lack of Goals (McLaughlin, Jennifer) 2. Re: Best Practice (Ron Carson) 3. Re: D/C'd Patient For Lack of Goals (Ron Carson) 4. Re: D/C'd Patient For Lack of Goals (Joan Riches) 5. Re: D/C'd Patient For Lack of Goals (Ron Carson) ---------------------------------------------------------------------- Message: 1 Date: Thu, 30 Oct 2008 11:39:15 -0400 From: "McLaughlin, Jennifer" <[EMAIL PROTECTED]> Subject: Re: [OTlist] D/C'd Patient For Lack of Goals To: <[email protected]> Message-ID: <[EMAIL PROTECTED]> Content-Type: text/plain; charset="us-ascii" Possibly a referral for depression screening or treatment. Sounds fairly typical with lack of engagement and participation in daily occupations. If she is unable to identify goals she may need medical assistance to get to a place to be able to identify goals. Just my humble thoughts. Jennifer McLaughlin, OT/L Geriatric Rehab specialist The information contained in this message may be privileged and/or confidential and protected from disclosure. If the reader of this message is not the intended recipient or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately by replying to this message and deleting the material from any computer. Thank you. ------------------------------ Message: 2 Date: Thu, 30 Oct 2008 20:05:12 -0400 From: Ron Carson <[EMAIL PROTECTED]> Subject: Re: [OTlist] Best Practice To: "[EMAIL PROTECTED]" <[email protected]> Message-ID: <[EMAIL PROTECTED]> Content-Type: text/plain; charset=utf-8 Chris, I'm going to reply, but I need to take a break ... Ron -- Ron Carson MHS, OT ----- Original Message ----- From: [EMAIL PROTECTED] <[EMAIL PROTECTED]> Sent: Wednesday, October 29, 2008 To: [email protected] <[email protected]> Subj: [OTlist] Best Practice Ron>> And, I do not think? a? therapist? can? mentally? switch? from? Ron>> component? level? to occupation? level? treatment. Maybe I'm Ron>> wrong, but I think it's one or the other. cac> But in your case study you are switching back and forth from the cac> component level to eventually the occupational level.? Standing cac> tolerance=component level (cardiovasular, quad strength, static cac> standing balance).? Ambulation=componet level (cardiovascular, quad cac> strength both concentric and eccentric contractions, dynamic cac> balance).? All of this was leading to the individual's personal cac> occupational goal. cac> In my case study I was switching back and forth from the component cac> level to eventually the occupational level.? Estim to the digit cac> extensors=component level (facilitation of the neural pathway to cac> enhance neuroplasticity which in turn leads to digit extensor strength cac> and control).? All of this leading? to the individual's personal cac> occupational goal. cac> Chris Nahrwold MS, OTR cac> -- cac> Options? cac> www.otnow.com/mailman/options/otlist_otnow.com cac> Archive? cac> www.mail-archive.com/[email protected] ------------------------------ Message: 3 Date: Thu, 30 Oct 2008 20:10:08 -0400 From: Ron Carson <[EMAIL PROTECTED]> Subject: Re: [OTlist] D/C'd Patient For Lack of Goals To: Joan Riches <[email protected]> Message-ID: <[EMAIL PROTECTED]> Content-Type: text/plain; charset=windows-1252 Thanks Joan and Jennifer: Because the patient is on HH, she is already receiving a plethora of services; everything from social worker, RN, aide to PT. You know the question of "why" was never answered, either by the patient, her family or myself. When I earlier mentioned mind mapping, it was because of this patient. I think something psychiatrically happened to her but she refuse my suggestion for a psych eval. One of the things that was even odder and leads me to think that maybe "I" was the problem is that the patient was doing well in PT and she took a bathe with the assistance of the aide. But, I swear, this patient would NOT verbalize wanting to do anything on her own. The only thing she said, especially in the beginning is that she wanted to be "normal". Ron -- Ron Carson MHS, OT ----- Original Message ----- From: Joan Riches <[EMAIL PROTECTED]> Sent: Thursday, October 30, 2008 To: [email protected] <[email protected]> Subj: [OTlist] D/C'd Patient For Lack of Goals JR> Ron JR> In a case like this I think that an OT eval may be the most effective JR> part of our offering. I am left with the question, "What referrals have JR> you offered to this family?" You have gathered valuable information. JR> This is certainly an extreme case of occupational dysfunction due to JR> ......what?? JR> If you have read English novels you may have run across similar JR> descriptions of 'invalid' (emphasis on the first syllable) upper class JR> women. It is an interesting brain twig to then put the emphasis on the JR> second syllable. Thanks for all the brain twigs now and in the future. JR> Joan Riches B.Sc.O.T., OT(C) JR> Specialist in Cognitive Disability JR> Riches Consulting JR> High River, Alberta, Canada JR> 403 652 7928 JR> -----Original Message----- JR> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On JR> Behalf Of Ron Carson JR> Sent: October 30, 2008 7:08 AM JR> To: [email protected] JR> Subject: [OTlist] D/C'd Patient For Lack of Goals JR> Yesterday, I d/c'd a patient because she is unable to verbalize ANY JR> OT-related goals. It was a very strange and difficult case and I'm not JR> 100% comfortable with the d/c, but it seemed to be the best choice. JR> I'm VERY interested to hear others' opinions. JR> I evaluated a patient last week. Without going into a lot of detail, JR> the patient has mild arthritis, recently fell and had kyphoplasty. She JR> had been very active until about 5 years ago when she "suddenly" JR> became very sedentary. There assorted history and eval findings, but JR> this is basically a women who has disengaged from life. She JR> essentially lives on her couch and that's about it. JR> When I evaled her last week, she was unable to identify ANY OT goals. JR> Against, my better judgement, I "made up" a couple goals and scheduled JR> her for only two visits. JR> At the end of my second visit, I indicated that I was d/c'ing the JR> patient for lack of goals. The patient was OK with it but the husband JR> talked and asked me to stay on. After a long conversation with the JR> patient, one in which I was apparently "mean", the patient agreed that JR> she wanted me to come back. So, I signed her up for 5x/week therapy. JR> On the next visit, I was told that the patient "did not like me" JR> because I was mean. I promptly apologized to her, expressed my concern JR> and methods and asked for forgiveness, which she readily gave. After JR> that, I again started talking about the patient's life and goals. Her JR> son had mentioned that the family had a pet that died and that was JR> sort of "the beginning of the end" for the patient. The son had JR> mentioned possible pet ownership which I followed up on, but the JR> patient denied wanting it. JR> I came back two more times, with each visit focused on identifying JR> goals. We did a mini life review but no matter what avenue I took, the JR> patient denied any goals. So, I reluctantly told her that in the JR> absence of goals, d/c was the only option. She agreed and said she JR> was sad because she was "starting to like me". JR> She and I agreed that my time had not been wasted but that continued JR> visits would be a waste. JR> Without doubt, this is one of the hardest and strangest cases I've JR> ever had. I've never met a person who was so unmotivated and yet able JR> to articulate the same. JR> I know all the bases are not covered in this message but it hopefully JR> provides enough information to peak everyone's interest. JR> Thanks, JR> Ron ------------------------------ Message: 4 Date: Thu, 30 Oct 2008 19:04:50 -0600 From: "Joan Riches" <[EMAIL PROTECTED]> Subject: Re: [OTlist] D/C'd Patient For Lack of Goals To: <[email protected]> Message-ID: <[EMAIL PROTECTED]> Content-Type: text/plain; charset="us-ascii" So work at not feeling so badly, Ron. Have you never heard the saying 'when all else fails refer to OT'. Because with all our angst about not being appreciated lots of folks know that OT expertise means we do make a difference many times when 'the others' were stumped. Sounds like you were a sacrificial lamb in this case. The fact that you are suffering because you worry about not helping this woman shows what a good OT you are. Special blessings, Joan -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: October 30, 2008 6:10 PM To: Joan Riches Subject: Re: [OTlist] D/C'd Patient For Lack of Goals Thanks Joan and Jennifer: Because the patient is on HH, she is already receiving a plethora of services; everything from social worker, RN, aide to PT. You know the question of "why" was never answered, either by the patient, her family or myself. When I earlier mentioned mind mapping, it was because of this patient. I think something psychiatrically happened to her but she refuse my suggestion for a psych eval. One of the things that was even odder and leads me to think that maybe "I" was the problem is that the patient was doing well in PT and she took a bathe with the assistance of the aide. But, I swear, this patient would NOT verbalize wanting to do anything on her own. The only thing she said, especially in the beginning is that she wanted to be "normal". Ron -- Ron Carson MHS, OT ----- Original Message ----- From: Joan Riches <[EMAIL PROTECTED]> Sent: Thursday, October 30, 2008 To: [email protected] <[email protected]> Subj: [OTlist] D/C'd Patient For Lack of Goals JR> Ron JR> In a case like this I think that an OT eval may be the most effective JR> part of our offering. I am left with the question, "What referrals have JR> you offered to this family?" You have gathered valuable information. JR> This is certainly an extreme case of occupational dysfunction due to JR> ......what?? JR> If you have read English novels you may have run across similar JR> descriptions of 'invalid' (emphasis on the first syllable) upper class JR> women. It is an interesting brain twig to then put the emphasis on the JR> second syllable. Thanks for all the brain twigs now and in the future. JR> Joan Riches B.Sc.O.T., OT(C) JR> Specialist in Cognitive Disability JR> Riches Consulting JR> High River, Alberta, Canada JR> 403 652 7928 JR> -----Original Message----- JR> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On JR> Behalf Of Ron Carson JR> Sent: October 30, 2008 7:08 AM JR> To: [email protected] JR> Subject: [OTlist] D/C'd Patient For Lack of Goals JR> Yesterday, I d/c'd a patient because she is unable to verbalize ANY JR> OT-related goals. It was a very strange and difficult case and I'm not JR> 100% comfortable with the d/c, but it seemed to be the best choice. JR> I'm VERY interested to hear others' opinions. JR> I evaluated a patient last week. Without going into a lot of detail, JR> the patient has mild arthritis, recently fell and had kyphoplasty. She JR> had been very active until about 5 years ago when she "suddenly" JR> became very sedentary. There assorted history and eval findings, but JR> this is basically a women who has disengaged from life. She JR> essentially lives on her couch and that's about it. JR> When I evaled her last week, she was unable to identify ANY OT goals. JR> Against, my better judgement, I "made up" a couple goals and scheduled JR> her for only two visits. JR> At the end of my second visit, I indicated that I was d/c'ing the JR> patient for lack of goals. The patient was OK with it but the husband JR> talked and asked me to stay on. After a long conversation with the JR> patient, one in which I was apparently "mean", the patient agreed that JR> she wanted me to come back. So, I signed her up for 5x/week therapy. JR> On the next visit, I was told that the patient "did not like me" JR> because I was mean. I promptly apologized to her, expressed my concern JR> and methods and asked for forgiveness, which she readily gave. After JR> that, I again started talking about the patient's life and goals. Her JR> son had mentioned that the family had a pet that died and that was JR> sort of "the beginning of the end" for the patient. The son had JR> mentioned possible pet ownership which I followed up on, but the JR> patient denied wanting it. JR> I came back two more times, with each visit focused on identifying JR> goals. We did a mini life review but no matter what avenue I took, the JR> patient denied any goals. So, I reluctantly told her that in the JR> absence of goals, d/c was the only option. She agreed and said she JR> was sad because she was "starting to like me". JR> She and I agreed that my time had not been wasted but that continued JR> visits would be a waste. JR> Without doubt, this is one of the hardest and strangest cases I've JR> ever had. I've never met a person who was so unmotivated and yet able JR> to articulate the same. JR> I know all the bases are not covered in this message but it hopefully JR> provides enough information to peak everyone's interest. JR> Thanks, JR> Ron -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] No virus found in this incoming message. Checked by AVG - http://www.avg.com Version: 8.0.175 / Virus Database: 270.8.5/1755 - Release Date: 10/29/2008 5:27 PM ------------------------------ Message: 5 Date: Thu, 30 Oct 2008 21:31:04 -0400 From: Ron Carson <[EMAIL PROTECTED]> Subject: Re: [OTlist] D/C'd Patient For Lack of Goals To: Joan Riches <[email protected]> Message-ID: <[EMAIL PROTECTED]> Content-Type: text/plain; charset=windows-1252 Joan it so funny you mention sacrificial lamb, because that's exactly how I felt. It seemed that no matter what, I could not "connect" with the patient. But in the end, we both agreed that OT had been very helpful. The whole experience was just strange! I like your saying! Here's one that I made up: OT - the Other Therapy! Sort of goes hand in the hand with your statement! Ron -- Ron Carson MHS, OT ----- Original Message ----- From: Joan Riches <[EMAIL PROTECTED]> Sent: Thursday, October 30, 2008 To: [email protected] <[email protected]> Subj: [OTlist] D/C'd Patient For Lack of Goals JR> So work at not feeling so badly, Ron. Have you never heard the saying JR> 'when all else fails refer to OT'. Because with all our angst about not JR> being appreciated lots of folks know that OT expertise means we do make JR> a difference many times when 'the others' were stumped. Sounds like you JR> were a sacrificial lamb in this case. The fact that you are suffering JR> because you worry about not helping this woman shows what a good OT you JR> are. JR> Special blessings, Joan ------------------------------ -- Unsubscribe? [EMAIL PROTECTED] Change options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] Help? 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