Study on the effects of occupational therapy

Occupational therapy (OT) is about helping people of all ages conduct and improve their ability to perform their daily activities that occupy their time in their environment (Hussey, Sabonis-Chafee, & O’Brien, 2007). The environment to which individuals may wish to perform tasks could be in home, work, school or community settings (Hagedorn, 2000). The roles of occupational therapists (OTs) are to work with individuals to help them achieve a fulfilled and satisfied state in life (Crepeau, Cohn, & Schell, 2009). Activities or interventions may be used to achieve functional results that promote health, prevent injury or disability so that individual may become independent as a result. OTs work with a range of people that may have conditions that are mentally, physically, developmentally, socially or emotionally disadvantaged (Crepeau, et al., 2009). Therefore they help individuals to develop, recover or maintain their skills to be able to conduct activities that they deem important.

The reason why OTs wants to find out about a person’s occupation is to determine what is important to the individual and how they may conduct these occupations and how all these occupations contribute to the greater good of health. A person’s occupational performance is influenced by their health and the need for personal satisfaction in what they do (Crepeau, et al., 2009). This is why OTs may conduct interviews before implementing interventions. It is a way for OTs to collect informed information regarding to the needs of individuals and what they find important in their lives. The initial interview would be about gathering basic information about the individual and going through name, age, occupation and what important roles they have in their lives. As OTs, it is very important that focus is client-centred and allow clients to evaluate their performance and the importance of roles in their lives.

The Person-Environment-Occupation-Performance (PEOP) model is a client-centred model that is used to improve the performance of individuals in their daily lives (Christiansen & Baum, 2005). The model was developed in 1985 and was first published in 1991. The PEOP model includes the interactions of occupation, performance and participation that are involved between the person and environment when they carry out their activities in their daily lives. The model talks about the personal factors and environmental factors that support enable or restrict the performance of individual to their activities, tasks and roles that are present in their lives. In the PEOP model, OT intervention is a method of using a wide range of client-centred strategies that connect the individual or group to develop or use sources that enable them to successfully perform necessary and significant occupations. It takes into account that satisfaction of performing occupations is related to the individual or group goals and environmental factors that may or may not inhibit participation.

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The PEOP model has four major components. These four components are occupations, performance, person and environment (Christiansen & Baum, 2005). It describes what people want or need to do in their daily lives (occupation), the act of performing the occupation (performance), and how psychological, physiological, neurobehavioral, cognitive and spiritual factors (person) combine with the location the occupation is conducted (environment) influence success. The individual ability or skills is what determine whether the individual is competent to do what they must to meet personal needs. The individual must make use of resources that are available within the environment to effectively meet these needs. The model also has the belief that the situations where people feel success also help them feel good about themselves. Therefore it acts as a motivator to allow individuals to face challenges with confidence. It is said in Christiansen & Baum, that “fulfilment comes both from feelings of mastery as well as the accomplishment of goals that have personal meaning” (Christiansen & Baum, 2005). This indicates that individual will feel more accomplished doing occupations that they like doing and is important to them, rather than something they don’t find important.

According to Henry & Kramer, interviewing is “a shared verbal experience, jointly constructed by the interviewer and the interviewee, organized around the asking and answering of questions” (Crepeau, et al., 2009). Asking good questions is not a natural phenomenon and requires practice (Miller, 2009). This is why communication skills are essential in interviewing. Interviewing requires three key elements, questioning, active listening and interpreting body language (O’Toole, 2008; Williams, 1997). The aim of an interview is to collectively obtain information, offer advice, support and discuss treatment (Williams, 1997). Through the process, OTs is able to establish and maintain a relationship with the client. It is important in any interview to be prepared and consider that the location where the interview will take place will set the mood. If the interview is conducted in an office, it can give feeling of formality and if the interview is conducted in a clinic, it can be associated with illness. Individual’s response to these different settings may be associated to previous experiences that they may have encountered in the past. Their reaction can vary and as an interviewer, awareness should be recognized. The location of the interview can also give the purpose of the interview so it is important that suitable location be chosen. There are three phases to an interview; phase 1 is the introductory phase, phase 2 is the working phase and phase 3 is the termination.

Effective communication requires mutual understanding from both interviewer and interviewee. Health professionals must ensure that clients understand the meaning and purpose of interview and why it is conducted. The interview requires that information be shared, there is a goal to reach same understanding, understanding of background and culture, a willingness to understand points of view, respect for self and other and show empathy when appropriate (Higgs, Ajjawi, McAllister, Trede, & Loftus, 2008).

Communication skills required in an interview include verbal communication, non-verbal communication and active listening. An example of verbal communications is the effective use of speech to ask appropriate questions and the structure of language used (Williams, 1997). The structure of the language is the way that words are put together to form sentences to give information or seek information. Verbal communications are ways of individuals expressing their ideas, concepts and emotions, give description, provide information and solve problems (O’Toole, 2008; Stein-Parbury, 2006; Williams, 1997). Non-verbal communication is communicating without using words to express oneself. These could include eye-contact, facial expression, body postures and behaviours, voice and volume alterations and physical space (Egan, 2007; O’Toole, 2008; Stein-Parbury, 2006; Williams, 1997). Active listening requires interviewer to actively listen and give verbal and non-verbal responses to show that they are listening. Interviewer can use non-verbal responses known as SOLER to engage in the interview. SOLER stands for sit squarely, open posture, lean toward the client, eye contact and relax. Prompts can also be used in non-verbal response to encourage interviewee to talk further or know that you are present. Verbal response includes using the three R’s; restatement, reflection and re-clarification.

Phase 1 of the interview is the introductory phase. This is where introductions and purpose of the interview is explained. Permission was asked to use client’s first name to be more comfortable and to create a relax environment. In this phase of the interview, the client and interviewer is sitting squarely facing each other in a small quiet room. The client is actively listening to the information told. Her actions included eye-contact, sitting squarely, using prompts such as nodding and ‘yep’ as indications. There was a bit of closed postured, clasped hands and fidgety shown by client at the start that could be attributed to nervousness and uncertainty of interview. As the interviewer, verbal communication is essential in relaying the information about the purpose of the interview. This is where effective verbal communication comes into play. Effective use of speech was present but the structure of language needs to be improved. After explanation of what an OTs does, interviewer asked “Do you kind of get what I’m trying to say?” in an uncertain voice. Interviewer could have rephrased it in a more confident reassurance voice and asked if the client understood the information and whether she’d like to ask any questions. The style of language used here could be differences between social contexts. The use of formal language may not be used frequently in daily lives which make the interviewer structure of language seem a bit informal when asked. Being unsure of your own questions also leads client to perceive that it was okay to agree since it is an uncertain question. The object of an interviewer is to be confident and be able to express clearly and concisely the questions asked. Interviewer showed facial expressions and hand gestures while explaining. This could be an indication of nervousness or a habit that the interviewer may possess. Even though eye-contact was made with client, SOLER was not effectively used. At the start, interviewer is sitting squarely, leaning forward and maintained eye-contact but was not in an open relaxed posture. This was attributed to nervousness as interview progress; interviewer became more open and relaxed.

Phase 2 of the interview is involved in asking relevant questions to get a clearer picture of client’s occupation and history. It is where most information is collected and requires the use of a range of communication skills. SOLER was maintained throughout the interview by the interviewer and verbal prompts was used at appropriate situations to verify information that client had said. Nodding and hand gestures were used quite often to encourage client to continue talking and sharing information. In an interview, a range of questioning style is used. An example of an open question is “How do you feel having to travel one and half hour to get to uni?” These types of open questions allow clients to elaborate more on details and give indication to their emotions. Even though closed questions are not desirable, interviewer did make use of them. One of such is “How long do you drive to uni?” There is only one answer possible and does not make use of client views or feelings in this situation. Probing questions was also lacking in this interview, interviewer did not make use of this questioning style to seek out specific information. One example that is viewed is “Is that the only problem you have as being a student?” The question is used to question client whether the particular problem given was the only one present to being a student. Reflective questions was used to reflect a topic back for clarifications, “So far you’ve told me that you are a student, girlfriend and you also like to keep active, is there any other activities that you enjoy doing?” Some bad examples of questioning styles that should be avoided that was used in the interview was multiple and leading questions. “Do you have any other career path you want to take after studying this degree? Or do you want to just find a job afterwards and be happy with that?” The questions does not allow client to answer and also leads them to answer in a certain way that you have asked.

Non-verbal communication skills is seen in eye-contact, facial expression, gestures, body postures and head movements. Throughout the interviewing process, eye-contact was maintained in client and interviewer. In some culture, eye-contact is not seen as appropriate when talking to elders (Crepeau, et al., 2009). Eye-contact can also become uncomfortable if used with strangers and you are expected to maintain focus for a period of time. As OTs, it is appropriate to keep an open view of clients and know that depending on their culture and values, they may conduct and act in different ways. Facial expressions on the other hand are what characterise a person. It is an important aspect of expressing emotions and expressing how we feel. Client used smile as a positive feedback when talking about her family and boyfriend. It is indications that these are the things that the client values and find enjoyment in. When she was unsure of her answers, her eyebrows would be raised upwards. Facial expression belongs to individuals and each person has their own way of expressing themselves. Gestures are also a form of communication and are seen in the movement of head, hands and body parts. It just acts as ways that individual may use these parts to emphasise and reinforce information. Body postures refers to the position of the body and limbs (Williams, 1997). The postures adopted by the client was slightly leaned forward back with arms placed together in front of her laps. The interviewer on the other hand has her body leaned forward towards the client and arms resting on legs to cater for the book in front of her. The importance of postures can give indications to individual emotions. A slump shoulder and crossed arms could indicate lack of interest or boredom.

Phase 3 is the termination where information is summarized and clarified, client is thanked and ending of interview. Interviewer successfully used all mentioned techniques in this last phase but the language and structure of speech used could be improved. This could come with practice and experience. The voice used in the interview also gives indication to the emotions that is conveyed by clients and should be picked up when possible. The rate of speech or tone of voice express emotion and convey information about attitudes to certain things. Each individual have their characterised voice that distinguished us from someone else. It is with our voice that we can allow our emotions and feelings be conveyed.

Interviewing requires multiple communication skills and practice to execute a good interview. Communication skills are not always verbal but include the non-verbal communication that is expressed through facial expression, gestures and eye-contact. Each individual have their own way of expressing themselves whether verbally or non-verbally. It is a good interviewer that is able to pick up on cues to allow them to adjust to client when interviewing. Interviewing requires interviewer to actively listen, question and empathize with clients. Through the use of PEOP model, the interview is able to be carried out and informed information is collected on the person, occupation, environment and performance.