Hi Pat: I see your situation somewhat differently. In fact I find your situation a completely fascinating albeit highly challenging one. Most certainly this is easier said than done. Anyhow, given the amount of daily time the clients spend with you and if you think it is worth your investment in time do you think it would be helpful to spend anywhere from 90 minutes up to develop a mutual support group of your clients. If you would like to explore this suggestion I would also like to suggest you explore the narrative therapy approach. Narrative therapy has typically been the in the domain of Social Workers but I find it an extremely useful and productive approach. I am not trained in it but do use some of its ideas in groups I work with. More frequently narrative therapy is done on a one-on-one basis but it contains extremely powerful ideas which apply to any group, particularly when group members have as much in common as your group does. In my experience most groups in general and support groups in particular have a tendency to run out of time just when its process gets group members going. You most certainly do not have the constraint of time. And if the narrative therapy model does not fit in with the insurance provider/payer you can certainly incorporate its basic ideas into a support group format.
If this suggestion gets your interest you may want to do a web search for narrative therapy. The idea originated in Australia and there is an excellent website which could prove most helpful. And there is published work as well. If you do decide to take this up I would truly appreciate your sharing how it goes. I may be completely off on this but I think of your position as an exciting one. To my mind having a group of clients for 5-6 hours a day on a daily basis, while highly challenging, can prove to be a great experience both for the facilitator and for the group's participants. Good luck and do keep us posted!!!! Best, Biraj Khosla OT - Reg. (Ont.) Toronto, Canada ----- Original Message ----- From: David Harraway<mailto:[EMAIL PROTECTED]> To: OTlist@otnow.com<mailto:OTlist@otnow.com> Sent: July 28, 2006 8:24 PM Subject: Re: [OTlist] Pat's List Can I say what is no doubt a very obvious thing; but is offered in the spirit of sympathy? This situation sounds incredibly stressful! When the people that we are working with in therapeutic partnership make choices to go completely their own way (like your plotting group members have) and try and manipulate the system it can be intensely disruptive to the basis of that relationship i.e. "trust". I've been in this situation several times and as therapists we are torn between admiring the person for fighting back at what is essentially an unfair and inflexible system ("a guilty system recognizes no innocents") and our frustration at not being able to somehow get them to realize that what we are offering them (our therapy) is worth their taking on. The only way I found through, and to survive as an OT ie not burn-out, was to come back to being grounded in my professional ethics and core values. I think it's important to be completely honest all the way along with people, although you obviously also appreciate that your group members have perspectives which are shaped at least in part by the pain and hopelessness they are feeling. Perhaps the psychologists they also see might be able to share their insights. What about the group compiling their autobiographies or personal histories? Everyone has a story to tell if you can get them to open up, and the telling of it can be the most life affirming thing for some people. Many have never been asked previously to do such a thing - you could do this in the context of a physical activity eg during turn taking games. Wishing you well with this tricky situation Pat! Pat wrote: > Getting them to develop goals probably wouldn't be too difficult, getting a > great many of them to work toward those goals is another > story. Unfortunately I have a lot of patients who don't want to be > there. If worker's comp approves the program and they don't comply, they > lose their benefits. A LOT of my patients just want to sit home and > collect the checks. They show up, but don't put much effort into the > program. I try hard to find fun things so that they will participate > without a battle. > > We do PPTs before the program, halfway through, and again after it ends. I > actually had a couple patients get furious with me when I pointed out how > much they had improved. They insisted that they were NOT better and said I > better not tell their doctor that were because they might get sent back to > work. Last week I overheard a couple patients plotting to do worse on > their PPTs so they wouldn't have to go back to work. I told them that if > they didn't show improvement I would get them another 30 days, and another, > until they did (not true, 30 is the limit, but they don't know > that). Sometimes they don't even realize they are getting physical > activity. One patient who claimed to hurt so much she couldn't even pick > up a tissue was participating 100% in a spirited game of badminton (using a > punching balloon).. whacking the heck out of that balloon. Another one who > said he couldn't walk without crutches was putting 100% of his weight on > his injured ankle while going for the balloon, and displayed no pain > behaviors. (He had a crutch in one hand and the racket in the other). You > can see why I am always on the lookout for new, fun activities. > > > At 06:53 AM 7/27/2006, you wrote: > >> Caryn is thinking 'occupation' and underlying Pat's concerns I sense >> 'meaningful'. Life consists of many things which we do 'over and over' to >> support and facilitate our valued occupations. This is a perfect example of >> the gap between theory and practice when one is faced with an existing >> program which focuses on the physical components. Here we have an OT who >> senses the lack and is appealing for help to work with her clients on their >> overall occupational dysfunction. Thank you Pat. The COPM might be a one >> place to start. It sounds as though these people would be able to do a lot >> on their own and/or helping each other to consider the questions and develop >> truly occupational goals. As it is an OT instrument it would not be >> infringing on the areas that other team members seem to have appropriated >> for their own. >> Wow, a real life case example for the group. What a fantastic opportunity to >> work together and hopefully follow the story through. >> Joan >> >> >> >> >>> -----Original Message----- >>> From: [EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]> [mailto:[EMAIL PROTECTED] On Behalf >>> >> Of >> >>> Caryn Carson >>> Sent: Thursday, July 27, 2006 2:59 AM >>> To: OTlist@OTnow.com<mailto:OTlist@OTnow.com> >>> Subject: Re: [OTlist] Pat's List >>> >>> Just curious, but why don't you have them doing what they do in the >>> office? If they are accountants, why not have them doing accounting, if >>> they are financial analysts, why not have them doing that? I am sure >>> they could provide you with their own material even. This would seem so >>> much more relevant than doing a puzzle. I am at my computer a lot, so I >>> would want to know how to sit at my computer and be able to work without >>> the pain, or at least how to minimize it. >>> >>> Caryn >>> >>> Pat wrote: >>> >>> >>>> It's not a question of need, that's what the program is. These are >>>> >> workers >> >>>> comp patients, and the insurance pays for the full program.. a LOT of >>>> >> money! >> >>>> At 08:33 PM 7/26/2006, you wrote: >>>> >>>> >>>> >>>>> Pat, do you feel that you NEED to see each patient for 240 hours? >>>>> >>>>> ----- Original Message ----- >>>>> From: Pat <[EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]>> >>>>> Sent: Wednesday, July 26, 2006 >>>>> To: OTlist@OTnow.com<mailto:OTlist@OTnow.com> <OTlist@OTnow.com<mailto:OTlist@OTnow.com>> >>>>> Subj: [OTlist] Pat's List >>>>> >>>>> P> Variety!! they are there for 240 hours... and we play the same games >>>>> >> and >> >>>>> P> do the same activities over and over and over and.... >>>>> >>>>> P> At 07:45 PM 7/26/2006, you wrote: >>>>> >>>>> >>>>> >>>>>>> Pat, I certainly can't add anything to what you've typed. What do you >>>>>>> think is missing? >>>>>>> >>>>>>> ----- Original Message ----- >>>>>>> From: Pat <[EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]>> >>>>>>> Sent: Wednesday, July 26, 2006 >>>>>>> To: OTlist@OTnow.com<mailto:OTlist@OTnow.com> <OTlist@OTnow.com<mailto:OTlist@OTnow.com>> >>>>>>> Subj: [OTlist] Pat's List >>>>>>> >>>>>>> P> Hi Ron, >>>>>>> >>>>>>> P> The main goal of the program is returning the patient to the >>>>>>> >> highest >> >>>>>>> P> possible level of function, and if possible, getting them back to >>>>>>> >>>>>>> >>>>>>> >>>>> work. It >>>>> >>>>> >>>>> >>>>>>> P> is not at all like work hardening/conditioning though... the level >>>>>>> >> of >> >>>>>>> P> exercise is much less. I work a lot on strengthening and >>>>>>> >>>>>>> >>>>>>> >>>>> conditioning, and >>>>> >>>>> >>>>> >>>>>>> P> also on increased positional tolerance - sitting, standing, and >>>>>>> P> walking. It's a full body/mind program, so they don't just >>>>>>> >>>>>>> >>>>>>> >>>>> concentrate on >>>>> >>>>> >>>>> >>>>>>> P> the injured area. I do give them some exercises specific to their >>>>>>> P> particular injury though. I do things like art, crafts, and games >>>>>>> >>>>>>> >>>>>>> >>>>> to work >>>>> >>>>> >>>>> >>>>>>> P> on sitting tolerance... it occupies the patient's mind and works to >>>>>>> P> distract them from their pain. I also have them do more active >>>>>>> >> games... >> >>>>>>> P> darts and modified volleyball and badminton (we use a punching >>>>>>> >> balloon >> >>>>>>> P> because it's large and moves slower) for standing tolerance. We >>>>>>> >> even go >> >>>>>>> P> for walks outside, weather permitting. We also have aquatics. I >>>>>>> >> try to >> >>>>>>> P> find things that will get them involved and laughing, even playing >>>>>>> >>>>>>> >>>>>>> >>>>> games I >>>>> >>>>> >>>>> >>>>>>> P> picked up a baby showers like races where they have to walk across >>>>>>> >>>>>>> >>>>>>> >>>>> the room >>>>> >>>>> >>>>> >>>>>>> P> with a potato between their knees and drop it in a cup without >>>>>>> >> using >> >>>>>>> >>>>> their >>>>> >>>>> >>>>> >>>>>>> P> hands (if you are a man, don't ask). I try to make it as fun for >>>>>>> >>>>>>> >>>>>>> >>>>> them as >>>>> >>>>> >>>>> >>>>>>> P> possible. >>>>>>> >>>>>>> P> I do team building exercises with them, and we sometimes have >>>>>>> >> sessions >> >>>>>>> P> where they will do collages depicting how they feel now on what >>>>>>> >>>>>>> >>>>>>> >>>>> side, and >>>>> >>>>> >>>>> >>>>>>> P> their goals on the other side, and then we discuss why they chose >>>>>>> >> the >> >>>>>>> P> pictures they did. this population is dealing with a lot of >>>>>>> >> depression >> >>>>>>> P> and tend to isolate themselves, so I do activities where they have >>>>>>> >> to >> >>>>>>> P> interact and work together toward a common goal. For the most part >>>>>>> >> the >> >>>>>>> P> counselors and psychologist deal with the mental/emotional part of >>>>>>> >> the >> >>>>>>> P> program though. >>>>>>> >>>>>>> P> Pat >>>>>>> >>>>>>> P> At 04:15 PM 7/26/2006, you wrote: >>>>>>> >>>>>>> >>>>>>> >>>>>>>>> Hello Pat: >>>>>>>>> >>>>>>>>> In response to your below message, I would like to know a little >>>>>>>>> >> bit >> >>>>>>>>> more about the nature (i.e. goals) of your program. Maybe a >>>>>>>>> >> little >> >>>>>>>>> more info will better help us. >>>>>>>>> >>>>>>>>> Thanks, >>>>>>>>> >>>>>>>>> Ron >>>>>>>>> >>>>>>>>> >>>>>>>>> >>>>>>>>> >>>>>>>>>> I work in a chronic pain clinic. The patients are there 40 hours >>>>>>>>>> >>>>>>>>>> >>>>>>>>>> >>>>> a week >>>>> >>>>> >>>>> >>>>>>>>>> for six weeks (which usually stretches out because they have to >>>>>>>>>> >>>>>>>>>> >>>>>>>>>> >>>>> make up >>>>> >>>>> >>>>> >>>>>>>>>> absences). I have the group for 5-6 hours a day. The rest of >>>>>>>>>> >>>>>>>>>> >>>>>>>>>> >>>>> the time >>>>> >>>>> >>>>> >>>>>>>>>> they are doing biofeedback, acupuncture, pilates, yoga, nutrition >>>>>>>>>> >>>>>>>>>> >>>>>>>>>> >>>>>>>>> class, or >>>>>>>>> >>>>>>>>> >>>>>>>>> >>>>>>>>>> are in a counseling session. I am always challenged to come up >>>>>>>>>> >>>>>>>>>> >>>>>>>>>> >>>>> with a >>>>> >>>>> >>>>> >>>>>>>>>> variety of activities for them! They are there for a wide range of >>>>>>>>>> injuries so I try to find activities that will fit everyone. >>>>>>>>>> >>>>>>>>>> In the past I have posted to this group looking for suggestions but >>>>>>>>>> >>>>>>>>>> >>>>>>>>>> >>>>>>> didn't >>>>>>> >>>>>>> >>>>>>> >>>>>>>>>> get much response.... if anyone cares to make some suggestions >>>>>>>>>> >>>>>>>>>> >>>>>>>>>> >>>>> and start >>>>> >>>>> >>>>> >>>>>>>>>> another thread that would be great! >>>>>>>>>> >>>>>>>>>> Pat >>>>>>>>>> >>>>>>>>>> >>>>>>>>>> >>>>>>>>> -- >>>>>>>>> Unsubscribe? >>>>>>>>> [EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]> >>>>>>>>> >>>>>>>>> Change options? >>>>>>>>> www.otnow.com/mailman/options/otlist_otnow.com<http://www.otnow.com/mailman/options/otlist_otnow.com> >>>>>>>>> >>>>>>>>> Archive? >>>>>>>>> www.mail-archive.com/otlist@otnow.com<http://www.mail-archive.com/otlist@otnow.com> >>>>>>>>> >>>>>>>>> Help? >>>>>>>>> [EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]> >>>>>>>>> >>>>>>>>> >>>>>>>>> >>>>>>> >>>>>>> -- >>>>>>> Unsubscribe? >>>>>>> [EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]> >>>>>>> >>>>>>> Change options? >>>>>>> www.otnow.com/mailman/options/otlist_otnow.com<http://www.otnow.com/mailman/options/otlist_otnow.com> >>>>>>> >>>>>>> Archive? >>>>>>> www.mail-archive.com/otlist@otnow.com<http://www.mail-archive.com/otlist@otnow.com> >>>>>>> >>>>>>> Help? >>>>>>> [EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]> >>>>>>> >>>>>>> >>>>>>> >>>>> >>>>> -- >>>>> Unsubscribe? >>>>> [EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]> >>>>> >>>>> Change options? >>>>> www.otnow.com/mailman/options/otlist_otnow.com<http://www.otnow.com/mailman/options/otlist_otnow.com> >>>>> >>>>> Archive? >>>>> www.mail-archive.com/otlist@otnow.com<http://www.mail-archive.com/otlist@otnow.com> >>>>> >>>>> Help? >>>>> [EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]> >>>>> >>>>> >>>>> >>>> >>>> >>>> >>>> >>> -- >>> Unsubscribe? >>> [EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]> >>> >>> Change options? >>> www.otnow.com/mailman/options/otlist_otnow.com<http://www.otnow.com/mailman/options/otlist_otnow.com> >>> >>> Archive? >>> www.mail-archive.com/otlist@otnow.com<http://www.mail-archive.com/otlist@otnow.com> >>> >>> Help? >>> [EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]> >>> >>> -- >>> No virus found in this incoming message. >>> Checked by AVG Free Edition. >>> Version: 7.1.394 / Virus Database: 268.10.4/401 - Release Date: 7/26/2006 >>> >>> >> -- >> No virus found in this outgoing message. >> Checked by AVG Free Edition. >> Version: 7.1.394 / Virus Database: 268.10.4/401 - Release Date: 7/26/2006 >> >> >> >> -- >> Unsubscribe? >> [EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]> >> >> Change options? >> www.otnow.com/mailman/options/otlist_otnow.com<http://www.otnow.com/mailman/options/otlist_otnow.com> >> >> Archive? >> www.mail-archive.com/otlist@otnow.com<http://www.mail-archive.com/otlist@otnow.com> >> >> Help? >> [EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]> >> > > > > -- Unsubscribe? 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