The way to a client’s heart…

This week’s blog is going to be about me reflecting on my assessment and treatment skills in psychosocial block thus far. It has been approximately 3 weeks of prac and I have had the chance to assess and treat 2 patients in that time.

I have noticed difficulties in both these aspects, especially in the psychosocial setting as treating a mental illness is very abstract. It can’t be seen or touched so a lot of assessment findings are observation based and there needs to be a certain degree of patient participation to be able to do assessments. This is particularly difficult with mentally ill patients due to the lack of insight, or in other words, them believing they do not have a mental illness. Obviously people who think they have no mental illness don’t understand why they are in hospital, don’t want to take medication that stabilises them and often don’t want to work with the OT or any therapist because they think it is a waste of time. Herein lies the challenge of assessment and treatment. But on a more personal note…

With regards to assessment, there is standardised and non-standardised assessments. I feel very comfortable and competent administering non-standardised assessments as they are easily turned into an activity. However, the findings can be somewhat tricky to deduct as there is no standard or criteria to follow to interpret your findings.

 Whereas with standardised assessments, there is a criteria that informs you of the outcome of the assessment. When doing standardised assessments, I feel very formal and stiff when administering these assessments, and the clients often become evasive and defensive when they see or feel a formal assessment being administered. Especially the MMSE (Mini mental state exam) that assesses all the basic cognitive aspects, it asks simple questions that if the client thinks they have no mental diagnosis, they feel insulted and become resistant to therapy.

I think the biggest aspect that I need to work on is my approach. I have not yet mastered a by the way approach needed to work with these clients. In my understanding, a by the way approach is a way of getting the clients to participate by doing an activity or assessment, and inviting them to do it with you. Sort of like “I found this really cool quiz online, why don’t you and I do one for fun?” kind of thing. I think the reason this doesn’t come easily is because I am a VERY straight forward person and I feel like I am playing mind games with clients because of this approach.

All in all, I am able to gain the necessary information from assessments and highlight the issues of concern, but this does take at least 2 sessions with the client to gain a holistic picture.

With regards to treatment, I have only done 2 treatment sessions so far, and one failed miserably. The first session was about trying to get the client to engage in IADL activities such as meal preparation and clean up. This was particularly important as the client wants to move into a home of his own after he is discharged as he wants to start a family. I did not have much success with assessment activities as the client did not engage. However, when the topic of food came up, I got quite a positive reaction. So we had a build a burger session where the client had to cut up all the ingredients, make the burger and then clean up after himself.

This was quite successful, however I could have improved the session had I let the client actually fry the chicken and bacon for his burger by himself, rather than pre-frying it. I guess you could say I was a bit scared of the unknown aspect a hot stove plate could add to my session, as I already felt I was pushing it with a sharp utensil. But I have learnt that these hazards cannot be avoided in day to day life and that exposing a client to these hazards in a controlled environment, and taking the necessary precautions, can be beneficial and will likely give the client a greater sense of achievement if the activity is done successfully.

The second treatment session was with my newest client. He is still psychotic, but very intelligent and very self-aware. His diagnosis changed from Schizophrenia to schizoaffective disorder, bipolar subtype. This means he has symptoms of schizophrenia, but also of bipolar. His demeanour has changed significantly since his medication was changed to accommodate the change in diagnosis. I planned a treatment session that was leisure based as the client became very aggressive and abrupt when being formally assessed. He mentioned he had begun to lose interest in people and had a hard time controlling his emotions. As a result, I decided to play Jenga with the client. Jenga with coloured blocks each representing an emotion that the client would have to portray for me to identify and then identify the emotion I was portraying when it was my turn.

The client did not do very well in the activity and actually got up and left after 3 turns. I think it was a bit too soon to address emotions as he is still psychotic. After seeking advice from my supervisor about what to do to get him to participate in my exam session as he is my exam client, she said I should ask him what he would like to do.

After MUCH inquiry, and a lot of questions as he was resistant to seeing me again, I found out he loves subs, as in the sandwich. So I plan to make a fully loaded sub with him for my demo next week, and he seems quite excited to make food. I guess what they say is true - the way to a man’s heart is through his stomach. Hopefully this will help with our relationship so that future sessions are more beneficial for him.

I still have a lot to learn with regards to assessments and treatment skills, and under the calm guidance of my supervisor, I feel myself gaining confidence and not feeling so hopeless when I am unable to get through to a client. I have however learnt a very valuable lesson over the last 3 weeks. When in doubt, food is always the answer.

References:
Image: light bulb GIF by Reactions (@sypher0115) | Find, Make & Share ... (2019). Retrieved 17 August 2019, from https://www.google.com/imgres?imgurl=https%3A%2F%2Fthumbs.gfycat.com%2FInformalTallChinesecrocodilelizard-size_restricted.gif&imgrefurl=https%3A%2F%2Fgfycat.com%2Finformaltallchinesecrocodilelizard-light-bulb-idea&docid=IDGMa6MM7Iji3M&tbnid=aq30nA2HADeSgM%3A&vet=10ahUKEwiur6nNyYrkAhUE1BoKHXBnAs4QMwiCASgCMAI..i&w=500&h=375&bih=720&biw=1707&q=lightbulb%20gif&ved=0ahUKEwiur6nNyYrkAhUE1BoKHXBnAs4QMwiCASgCMAI&iact=mrc&uact=8
Mini-Mental State Examination (MMSE) - MedWorks Media. (2019). Retrieved 17 August 2019, from https://medworksmedia.com/product/mini-mental-state-examination-mmse/
Be Positive Confidence GIF - BePositive Positive Confidence - Discover & Share GIFs. (2019). Retrieved 17 August 2019, from https://tenor.com/view/be-positive-positive-confidence-optimistic-cuteness-gif-8220989
Eat Food GIF - Eat Food - Discover & Share GIFs. (2019). Retrieved 17 August 2019, from https://tenor.com/view/eat-food-gif-8019774