Hi Diane!

Me, I'm quite impressed with your work with your patient - you may not have 
conveyed to us all that you do and I guess this is because some of it happens 
"silently" - but you seem to have established a great working relationship with 
him. You've together found out a lot about his motivation. He actually is 
loosing weight - he keeps weights in his room - he wants to go on about his 
training, weight loss and independence. For a person whose problems stem from 
serious overweight this is really something!!

So I hope you congratulate yourself about these achievements and don't start 
questioning everything you do as a result of our probing here. Consider the 
opposite: Him not being motivated to loose weight, work out, or much engage in 
changing his situation, the isolation included.... Even if you'd then succeed 
in some improved independence - ie from him learning some good ole OT tricks 
and lots of adaptive equipment and environment changes - my guess is he would 
soon either die from complications to his lifestyle, or suffer a very low 
quality of life.

It's not that I disagree with what Ron and Chris said - it's just that there's 
more to it IMO - like establishing 'rapport' with patient, digging into 
motivation (like what actually 'moves' the patient), considering overall QOL 
etc. You seem to really have gone there, and I suspect this has guided your 
choice of intervention in more ways than meet the eye!

Off my soap box for now:-)

Warmly

susanne, denmark


PS: A few abbreviations I didn't understand: PN, therex, RW. Could you 
elaborate?



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