Nov 8 / Niccole Rowe, BA COTA/L , Founding Partner

Fighting the Fear: Empowering Our Clients in Vulnerable Situations

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I recently had an experience that impacted my approach with the clients that I serve. I always think it is interesting how sometimes something seemingly unrelated to OT or my job can make a light bulb go off in my brain related to OT practice!

Leaving on a jet plane...
In October, I had the pleasure of attending the Occupational Therapy Association of Colorado’s recent conference. OTAC puts on a great conference in a beautiful setting. I loved how many OTAs were at the conference. That is a whole other blog post for another time! My light bulb moment came on one of my flights home. I would not say that I am afraid of flying. It feels more like something I have to deal with for some of my more valued occupations (travel and adventure!). The worst part to me is the landing. I usually feel nervous and if there is some turbulence then I end up feeling anxious, sweaty, and a bit sick to my stomach. I happened to be seated in the middle seat of this flight. The cabin was darkened as it was a red eye with almost everyone having their windows closed too. The pilot had announced the beginning of our descent with almost everyone still quietly sleeping or trying to. I was awake but happy to continue to try to sleep.

I started to realize that I wasn’t going to be able to open the window which always helps me feel calmer during a landing since I can see where we are. I don’t always have a window seat but usually, I can see out somewhere. I started to sweat a little. How was I going to be able to know when we hit the clouds? This always helps me know when turbulence might happen. How was I going to know when to expect the final bounce of landing?  

I was definitely sweaty and feeling nervous at this point. As we descended, we began to hit some turbulence. As the plane bounced around, I was beginning to feel more and more anxious. I was doing some breathing for coping (Yay for OTing myself), but I was really struck by how out of control I felt. The lights were out. I really couldn’t strike up a conversation for distraction. I was expected to stay in my seat. No one was really telling me what to expect anymore. Then it hit me, “This is what a lot of the clients that I work with must feel like.”
Connecting to the client experience
In acute care, the clients I see are often facing unexpected challenges that can be very unknown and scary.

Sometimes they aren’t really even sure what is causing the signs and symptoms that led to their hospitalization
Here is what really resonated with me when I began to think more about connecting my experience to our client’s experiences:

  • Feeling alone: I was surrounded by people, but I felt like I was the only one going through this scary experience. (Let me acknowledge this was irrational on my part, but I did experience feeling lonely) Our clients are often surrounded by healthcare practitioners and even friends and family, but they may feel isolated and lonely in their journeys through their health challenges. I also think about caregivers as well and how that can be such a lonely role for a family member or a parent of a child who is receiving OT services.
  • Being physically stuck: Unless I was willing to cause a huge disturbance, I was not going to be able to get up and move around to help ease my mind or be distracted. I couldn’t open a window to see out. Many times our clients must rely on assistance to even sit on the edge of the bed.
  • Feeling uninformed: I knew we were descending, but no one was telling me what to expect or what might be normal. Again, this is a bit of an overreaction on my part, but this popped into my head when I was thinking about what would make me feel better. Many times, our clients are waiting to hear more about their medical status from physicians or tests. Or it could be that health literacy is affecting their understanding. Even in occupational therapy, how many times do we provide treatment and not help the client understand the why of what we are doing?
  • Being unable to alter the environment: Similar to not being able to move around, I had a very limited ability to impact my environment. I could turn on the personal light, but I felt the social constraint of “bothering” those around me. I couldn’t impact the turbulence or help the process of landing happen more quickly. I will be honest, I felt a lack of control and felt powerless to some degree. Our clients may need to rely on others to alter the environment which means the client can feel like a burden or be frustrated about not being able to change things themselves. The familiar comforts of home are often not present in acute care (or skilled nursing/inpatient rehab) and this can really impact the client.
  • Feeling overwhelmed and frustrated: All of the other factors combined to really trigger a stress response and begin to activate my sympathetic nervous system. This can also happen to our clients.
Applying to OT practice
I had the benefit of knowing that my stressful situation was productive. I knew that tolerating the flight was bringing me closer to home and seeing my family. I had flown before so I had some reference information. I also knew it was time limited. These are all things that were helpful to me to tolerate the situation and to tap into some effective tools to cope.

How has this changed my OT practice? It has increased my desire and efforts to set the intention for myself and to acknowledge to every client that I work with that the therapeutic relationship is a partnership. I want to share in the power dynamic so that the client feels seen and empowered. I want the information to be bidirectional so we both are giving and receiving to facilitate improved decision-making toward the most effective treatment and approach to use for that session. In short, I want to address all those variables above.  

Here are some suggestions that I think help combat the factors I listed above:

  • Seek out the opinion and experiences of the client: During the session, I encourage the client to talk about their struggles and wins for that day. I use reflective listening to check in and affirm with the client the emotions they may be feeling. I also seek their thoughts about what is going well or not so well even during the OT session. This helps the client feel seen and heard. Hopefully, this helps them feel less alone.
  • Set aside your agenda: As OTs and OTAs, we have a plan of care we are working towards with the client. It can be easy to use this plan to begin to cookie-cutter the process. We go into a session knowing what we need to accomplish for the day to help the client. The issue is that we could forget to be client-centered. I want to go into each session with a curious mind instead of being attached to a very specific plan. We also sometimes use the information we have on the client to pre-determine the way a client might behave during OT. We need to review the relevant information and use it to be aware and safe, but as much as possible go into a room without preconceived notions about a client. Be curious and work with the client to form the plan for the day. I find that is when the magic of OT really gets going!
  • Choices, choices, and more choices: As much as you are able, partner with the client to give them choices and a sense of control over what is happening during the OT session. We want to work towards goals and treatments that are relevant to the clients’ lives. Giving the client choice during the session helps promote that relevance. It also helps the client feel empowered and more in control.
  • Information is power: It never feels good to be out of the information loop. None of us like when decisions are made for us or when we must make decisions with limited information. During the OT evaluation and treatments, we want to help the client fully understand the purpose of OT related to their current and future circumstances. Too many times, OT might be the discipline that plays games or seemingly helps the client bathe. We know the skilled service that we are providing in those situations, but we may not work with the client to understand the purpose and benefit of our treatment session. Sometimes, the client has a hard time determining that they are making progress in their recovery. As OT practitioners, we can help the client to track and review measurable, concrete data about their performance.

My own vulnerability in a situation opened my eyes to the needs that the clients I work with have in their most vulnerable moments. It has made me even more committed to setting myself and my own agenda to the side to truly listen to the clients that I serve to help them feel seen and heard. To help them clarify their own wants and needs, celebrate their strengths, and grow through their challenges. 

Written by Niccole Rowe, BA, COTA/L
Founding Partner 
Aspire OT

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