Objectives of Occupational Therapy in Mental Health I) To help establish an atmosphere conductive to recovery (containing minimal anxiety & maximum support) by utilizing individual & group activity program. A) to establish a feeling that living with others is less threatening & a less forbidding experience. B) To develop tolerance & respect for individual needs & difference. C) To facilitate normal interests & relationships. D) To create awareness that new pattern of behavior & relationships can be learned. E) To support & contribute to the efforts of the total hospital staff in carrying out therapeutic objectives. F) To know & understand oneself & the influence of one s needs & drives, in a relationship. II) To augment or supplement formal psychotherapy &/or therapeutic efforts of the hospital staff on behalf of the individual. A) To provide opportunity for the satisfaction of the basic emotional need for security to be love, accepted, & to belong by means of activities or the relationships developed around activities. 1) to satisfy needs for immature experience or expression such as:- a. dependency b. infantile aggression,destruction or control c. smearing, infantile play. 2) To provide ego support and opportunity for growth through: a. specific encouragement of the development of respect for self.
relations to others. 1) To increase awareness of ones value and 2) To provide opportunity for meaningful discharge of responsibilities to oneself and others. 3) To facilitate realistic perception and acceptance of ones assets and limitations. others. B) Creation of situations which provide 1) Narcissistic gratification 4) To create opportunities for attainment of respect from 2) Masculine or feminine identification. 3) Feelings of prestige 4) Creative expansion. C) Encouragement of self-care. 1) To structure situations which encourage the carryover of activities of daily living into the Occupations Therapy situation. 2) To provide opportunity for the patient to practice these skills in relation to activity programs and the group. 3) To cooperate with nursing service. D. To alleviate tensions and anxieties which interfere with therapeutic goals (emotional growth) through, 1) Failure 2) hospitality from others 3) loss of emotional control (set limits) 4) Procedures which provide opportunity for constructive a) Outlets for excess psychomotor energy b) Obsessive compulsive performance c) Symbolization. d) Propitiation of guilt e) Opportunity for control and successful competitiveness.
E. To give opportunity to explore new patterns of relationships and techniques for solving the problems involved in more effective living with others. 1. Experience in more effective methods of communication(i.e. creative expression, symbolic uses of product, etc). 2. Group interaction and tolerance of others. 3. Expanded concept of living. a. To increase ability to recognize potential b. To encourage willingness to try it out. c. To improve skill in utilizing opportunity. III To assist patients to undertake appropriate economic and to social responsibilities. A. Activities of daily living at appropriate level B. Acceptable work tolerance and habits. C. Opportunities for reality testing situations such as: 1. Use of initiative 2. Responsibility 3. Response to authority, instruction and criticism 4. Give and take with co-workers. D. Pre-vocational exploration E. A vocational interest which may facilitate social relationships. F. Encouragement of social skills through 1. Orientation in social customs and techniques. 2. Participation in a. Conversation. b. Recreation.
diagnosis. OCCUPATIONAL THERAPY RESEARCH ACADEMY IV. To provide factual data for use in evaluations and A. Through activities to elicit material which will aid in diagnosis or contributes to better understanding of the patients problem 1. To recognize and select for reporting significant material occurring spontaneously or within treatment structure. 2. Upon request by the psychologist and/or psychiatrist, to structure special situations for the purpose of obtaining material for projective interpretation. B. To observe and report, for use of the psychiatric team the patient s 1. mood 2. relationships 3. method and manner of performance. V. To contribute to and cooperate with other staff members and between hospital and community living. A. To be aware of the social and economic structure of the community. B. To understand fully the social,vocational and economic goals of the patient. C. To utilize opportunities in the occupational therapy situation which will contribute to the attainment of the vocational counselor s and social worker s goals for the patient. D. To provide opportunities for patients to have meaningful contacts with persons and groups in and from the community. 1. Volunteers 2. Patient participation in outside organization. 3. Patient attendance at community events. 4. Special trips.
PREFACT TO FORMULATIONS ON PSYCHIATRIC CONDITIONS These formulations have been prepared as a guide for the occupational therapist treating four selected categories of patients : The Schizophrenic patient. The paranoid patient. The depressed patient, and the manic patient. They should be evaluated in practice and revised as changing concepts and increased clinical experience indicate. The format used was as follows:- Definition This defines the category to be dealt with. Aspects of Dynamics applicable to occupational therapy It was vital to agree upon a working hypothesis. Obviously it could not be in accord with all schools of thought. An effort was made to be electric in preparing these statements but the primary concern was to include ideas which would serve as a useful point of reference to occupational therapists. 1) Basic Personality Structure This describes the kind of person in both his pre-psychotic and psychotic states. The personality structure does not change although at many points it may be at variance with what is seen in the person s behaviour following the psychotic break-through. 2) Emotional Needs Focuses attention on specific problems indicated in the etiology and personality structure. 3) Characteristic behaviour pertinent to occupational therapy
Focuses attention on specific behavioural problems with which the occupational therapist must dealt. It indicates limits for what may be possible in the occupational therapy situation just as the emotional needs indicate what is desirable. In practice, the interpersonal relationship and characteristics of suitable activities are very closely inter-related. They have been presented separately to permit a more specific consideration of the factors involved in each. Any attempt to set down specific techniques and procedures in occupational therapy in the treatment of psychiatric illness is fraught with problems since human beings do not exist within a vaccum but are interacting person. The formulations presented here can be meaningful only if certain basic concepts are kept constantly in mind. 1. Each individual brings to any situation his past and present experiences. He brings the part of him which may be said to function normally which perceives and acts upon reality in a more or less constructive, purposeful manner and the part of him which perceives and acts in a more or less distorted or unrealistic way.personality development and pathology have many variables and complexities. The concept of the whole person includes that which is well and that which is sick with all the shades in between.it is particularly important to bear this concept in mind when considering the formulation on the schizophrenic patient. In the process of regression the total personality or the whole of the person does not regress from one developmental stage to the next lower and clearly defined stage or as a total unit. Rather from a certain aspect of the patients feelings, thinking and behaviour may be perceive as operating at various levels with in various stages concurrently i.e. the patient may think, feel and behave partially as an adult while at the same time he may manifest infantile oral needs, and indulge in adolescent sexual acting out. 2. While the formulation describe techniques for modifying or changing behaviour and feelings in apparently clearly defined categories. It must be recognized that these categories or behavioural classification have no clear cut boundaries and that there
always exist varying combinations of these although certain behavioural characteristic can usually be recognized as predominating. 3. Every individual has a basic need for the security of being loved, accepted and belonging, frequently this is manifested by other needs more specifically related to the individual s social and object relationships. Anxiety occurs when attempts to satisfy these needs are unsuccessful and the means any person uses to allay anxiety will be determined by the nature of frustration in his interpersonal experiences. Behaviour in this sense then may be said to be the attempts of an individual to allay anxiety, and to secure for himself some measure of satisfaction of his basic emotional need. 4. Behaviour is not always a direct index of feeling and often masks the underlying feelings and needs. The formulations are presented as a guide to the therapist in helping the patient find satisfaction of his needs and possibly to modify or change his felling and consequently his behaviour. In applying the techniques and procedures described one must recognize that for all persons there is a fundamental resistance to change, even for the better. Change is perceived ad a threat to security since it involves a shift or deviation from the familiar concept of the self and therefore is uncomfortable. 5. Occupational therapy has several fundamental functions in psychiatry.although the formulations deal with techniques procedures and concepts related to occupational therapy as a specific psychotherapeutic measure, they are not limit ed to a this use of occupational therapy. They can provide a general frame of reference in situation s where occupational therapy server other functions. 6. The therapist s personality is the most important tool in any therapeutic settings. While the use of activities if is a differentiating make of occupational therapist activities are effective only to the extent that the occupational therapist as an active participant in the treatment situation is able to bring to it a genuine warmth, understanding,flexibility & objectivity. Implicitly in a satisfactory therapeutic relationship between therapist and patient is therapist s awareness and understanding of himself as a human being, with recognition and understanding of his needs and feeling in interpersonal relationship. He must be able to differentiate his needs from the needs of his patients, and meet his needs satisfactorily outside the treatment setting. Since the occupational therapist s feeling are an important factor, treatment formulations cannot
be rigid. He must be comfortable in whatever techniques he work within them if they or the situation cannot or should not be changed. 7. For all the patients, the introduction to the occupational therapy clinic has an important bearing on treatment.treatment begins with the first contact between patient and therapist. This initial contact sets the stage for future working together. It is important that this contact or interview be as well planned as subsequent treatment sessions. Such planning requires that the therapist have sufficient information concerning the patient s needs, problems and relationships. Introduction of the patient to the therapist and the occupational therapy situation should be planned for a time when the therapist is free to give him uninterrupted attention and should include a brief explanation of what is expected of the patient as well as what the patient may expect. however the extent of the orientation will depend on the patient s tolerance. While information about the patient is available from many sources, it is essential that both the therapist s objective observation and his intuitive grasp of the patient s feelings and reactions be used to determine the level at which the patient is able to participate in interpersonal and activity experiences. When prior information is not available the therapist must rely on his own observations and examinations concerning the patient s needs and problems. These should be validated with clinical information as it becomes available. Many times the nature and extent of clinical information and interdepartmental planning determine the extent of therapist endeavor. However, lack of such information and planning does not preclude the use of specific techniques and procedures described in these formulations. Also implicit in the formulations is the premise that the structure and function of the occupational therapy situation contribute to the therapeutic occupational therapy situation reflect the personality of the occupational therapist and elicit feelings and response from the patient. Use of the material in the formulations, should personnel ratio, However, it is felt that the structure of the situation must permit the occupational therapist to give adequate individual must permit the occupational therapist to give adequate individual attention to patients during the introductory phases of treatment not be limited by any specific patient/occupational therapy
8) Recent developments in the use of drugs for the psychotic patient have brought about many clinical changes in the patients overt behaviour. It is recognized that in many instance some of the exaggerated behaviour indicated in the formulation may no longer be seen. However, while the patient under drugs may no longer manifest anxiety, there is at present no indication that the basic needs and feelings have changed. Since we are dealing with feelings, the techniques and procedures described for dealing with them remain valid although some of the devices for managing exaggerated behaviour may not get necessary. 9) One of the tools which the occupational therapist employs is the interaction of patients. Social interaction cannot be indicated in the artificial breakdown of an outline. Individual feeling and behaviour in response to the therapist have been emphasized since it is felt that understanding of these is the core of understanding group interaction. The use and function of the group as an important psychotherapeutic measure are recognized since group formation and interaction influence patient and therapist response. Using the group to advantage involves understanding of human behaviour as well as skill with group processes. 10) It is important to differentiate between the patient s needs and his style of indicating his needs since frequently there is a dichotomy which is perceived as confliction needs, i.e. the patient may apparently want to be punished but actually need to be supported and reassured, or he may behave in an independent removed manner, and have an need to be dependent in an almost infantile way. Conflicting needs and behaviour make it necessary to determine prescriptions at any given time in the therapeutic process and to adjust the interpersonal situation accordingly. Needs do not exist in isolation. Therefore, while the therapeutic process may at any given time emphasize a particular need, it is implicit that other needs exist and must be dealt with in turn or simultaneously. When activities are used in addition to relationships to help the patient find more satisfying, constructive means for gratifying his needs, the conflicts between needs and behaviour
may become more apparent. More than one activity can offer opportunity for the expression of the same needs and drives. Activities must therefore be evaluated in respect to opportunity offered for direct expression or sublimation of a particular need. Activities have many different attributes, some of which are apt to be contradictory from the pint of view of their value to a patient. The extent to which an activity can satisfy a particular need and the extent to which it can at the same time provide opportunity for gratification of more than one emotional need will determine selection. A familiar activity may be contraindicated for any patient because of his emotional association with it. Moreover, previous association with an activity may encourage or perpetuate conditioned pathological responses or behaviour. On the other hand, familiar activities may be used to therapeutic advantage as bridges to new or more constructive experiences. Finally, occupational therapy as a psychotherapcutic measure can achieve maximum effective only if there is the meaningful communication contingent upon a mutual appreciation and under standing between all disciplines in psychiatry. This concept has been basic to the writing of these formulations. It is hoped that its will be basic to their use.