INTERVENTIONS
Mindfulness and Relaxation Coping Skills
In recent years, mindfulness has been widely used as a technique in psychiatric practice. Mindfulness is a technique that focuses on the present in a nonjudgmental way attending to what “is.” On my Level 1 clinical placement, working on an in-patient psychiatric unit, I often used mindfulness as an intervention approach. In fact, I created a resource on mindfulness for the unit which I have attached below!
On placement, my preceptor and I mainly used mindfulness apps, basic deep breathing, and muscle relaxation techniques. These are simple to learn and use in therapy, but more sophisticated techniques involving practices such as yoga could be used and often involve certification.
Progressive muscle relaxation is a technique used to enhance personal self-control and reduce arousal levels (Lopata, Nida, & Marable, 2006). This technique encourages the individual to focus on specific muscle groups, tighten them, and then slowly relax, thus affecting the autonomic nervous system and decreasing arousal (Wang, Luo, Kanb, & Wang, 2015). Within the progressive muscle relaxation training, clients are instructed to breathe slowly and evenly. Whereas some meditation techniques place primary focus on the breath, progressive muscle relaxation emphasizes the contraction and subsequent relaxation and releasing of tension in the muscle groups throughout the body. In addition to populations with depression and anxiety, the technique has been shown to decrease functional disability and improve quality of life in persons with schizophrenia (Wang et al, 2015), yet it is important to consider client readiness for therapy.
It is important to note that although most individuals are able to learn relaxation techniques, some clients in acute phases of illness, particularly those with psychosis, may be less able to focus on the relaxation process. I experienced this on placement, as some clients were too unwell to engage in mindfulness interventions. Therefore, clinical judgement should always be used in selecting clients for group activities that involve quiet meditation and relaxation. In addition, clients with histories of sexual abuse and issues with body image may initially feel unsafe practicing relaxation in a group atmosphere. Intervention should consider the client’s need to practice the techniques alone and with the therapist before joining a group.
Motivational Interviewing (MI)
Motivational interviewing is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence.
Motivational Interviewing:
Assumes that people are ambivalent about change - and must work towards their own decision concerning the change.
The aim is to produce an internal drive to change, using non-confrontational techniques
To effect change - evidence of the negative consequences of the behaviour are elicited from the client, so that the client sees and accepts the advantages of change
5 Principles of MI
•Express empathy (reflective listening)
•Develop discrepancy
•Roll with resistance
•Support self-efficacy
•Avoid arguing
The goal of MI is to help evoke a sense of motivation from the client, with regards to a certain aspect of their life. During MI, the .therapists role is to bring out motivation that already exists within the client, not to convince them they should change. The process of learning motivational interviewing and delivering an interview involves a step-wise process and a philosophical way of thinking. Before a therapist can begin interviewing a client, they must ensure they adopt something known as MI spirit. MI spirit is broken down into four components: collaboration, acceptance, evocation, and compassion. By adopting the four principles of MI spirit, a therapist can bring about meaningful change through a client. In order to deliver MI, a therapist should be properly trained in delivering the intervention.
Learning MI can benefit every OT in any practice context because it teaches you how to be a compassionate and empowering conversationalist. MI adopts a client-centered approach and embodies a humanistic frame of reference. Once MI is learned, it can be used in all conversations that a therapist engages in, whether they be personal or professional. In order for OT to be holistic and client-centered, they must be able to listen to clients, and also evoke desired change from the client, rather than telling them what kind of change they should strive for. MI allows therapist to use this
Expressive Approaches
This semester we had a OT 884 lab on expressive approaches. The lab session consisted of 4 stations including: mandala art, sculpting, pastels, and a rhythm circle. Reflecting on this lab, I have learned occupational therapists can use a wide range of creative and expressive therapies, such as art, music, and dance as forms of therapy for a range of clients with mental illnesses. On my Level 1 clinical placement, working on an in-patient mental health unit, I understand that occupational therapists working in mental health settings are well positioned to work collaboratively with clients in providing these therapies.
Cognitive Behavioural Therapy (CBT)
The College of Occupational Therapists of Ontario (COTO) defines psychotherapy as follows: Psychotherapy refers to planned and structured interventions aimed at influencing behaviour and function, by psychotherapeutic means. Psychotherapy is delivered through a therapeutic relationship to change an individual’s disorder of thought, cognition, mood, emotional patterns, perception, or memory that may impair the individual’s judgement, insight, behaviour, communication, or social functioning as it relates to the performance of daily activities.
Psychotherapy concentrates on the client’s emotional problems for the purpose of changing defeating patterns of thought, emotion, and behaviour. Psychotherapy through a therapeutic relationship aims at promoting positive personality change, growth and development, and re-organizing the personality. Psychotherapists frequently work with a variety of theories or combinations of theories and may use one or more procedures or models to try to achieve desired results. Psychotherapy intervention can be delivered in individual, group, family, or couple formats. Psychotherapy may be a long-term intensive process that identifies emotional issues and their cause with a focus on a deep, fundamental process of change, and the development of insight about thoughts, feelings and behaviours.
In the future, as an OT who is interested in offering CBT to clients, I recognize that I must successfully complete training in psychotherapy and additionally demonstrate competence prior to practicing psychotherapy.
Psychoeducation
Psychoeducation involves the process of teaching relevant principles, knowledge, and skills to clients. This intervention approach aims to provide resources and education surrounding the client’s illness. This approach aims to reduce the stress and impact of the illness on the client and family members so they can:
Better understand how to cope with the illness,
Employ coping strategies to address symptoms
Access resources
The use of psychoeducation is suggested as evidence-based practice in mental health OT. Often it is used in conjunction with skills training and a client-centered approach ie. ‘lecture’, role-play, behavioural reversal, homework.
Psychoeducation Topic Examples
Illness and Symptom Management
Sensory strategies
Life Skill/ADL training groups
Crisis Management
Coping Strategies
Social Skills Development
Education and employment
Goals of Psychoeducation
Ensuring clients’ and their relatives’ attainment of “basic competence”
Facilitating an informed and self-responsible handling of the illness
Deepening the patients’ role as an ’expert’ in their experience of mental illness
Optimal combination of professional therapeutic methods and empowerment
Improving insight into illness and improvement of treatment adherence
Promoting relapse prevention
Engaging in crisis management and suicide prevention