Graduation

VC Medal

*brushes dust off neglected blog*

That’s better. I’ve definitely not had much blogging-mojo in recent months. Perhaps this blog has served its purpose to some extent, although my hope is that I will still write the occasional post.  And here is one today! The title is, ‘Graduation’ although I suspect it may be a bit of a general reflective ramble.

When I started this blog it was the result of a conversation with my academic tutor about preparing myself for a career in research by having a space to regularly write and play about with ideas. It also was suggested that it could be a valuable place to explore the experience of being an occupational therapy student who had extensive experience of engagement with mental health services as a service-user. The idea was that the blog would be relatively anonymous and I could test the water of being a bit more open about my background, with the understanding that if it all went horribly wrong I would have a better understanding about the level of openness I could afford with colleagues. Fortunately it’s been a very positive experience and I’ve gained many connections, and even some wonderful friends, who knew me initially as ‘pd2ot’ before getting to know the ‘in real life’ me, with whom there has been an amazing level of acceptance. This has definitely translated into other situations as I tend to be much more open about my own history of mental health problems as I feel comfortable now about its value in my career as an occupational therapist/researcher, I also don’t worry about the anonymity any more (but I still like the ‘pd2ot’ name so hold onto it for that reason alone!).

This week I attended my graduation ceremony, following completion of my undergraduate degree in occupational therapy. The day was an amazing mix of nerves, excitement, happiness, sadness and pride. It prompted me to think about my starting point and the ‘journey’ I have been on (sorry, I hope this doesn’t come across as too ‘look at how far I have come, aren’t I amazing?’ as I hate that stuff, and equally I’m feeling reflective and want to validate the amount of effort I, and a huge number of supportive people, have put into me getting to this point). The other wonderful thing about the day was seeing so many of my cohort again, and beginning to understand just how much graduating meant to us all. It was a challenging three years and I don’t think anyone sailed through it untested, indeed many had massive hurdles to overcome along the way. I’d really love it if lots of people wrote down their ‘this is how I was at the start, and this is what I faced all the way through, and here I am now having learned x, y and z about myself’, but maybe I’m just nosey!

So yes, graduation! Well the picture above is the ‘Vice-Chancellor’s Medal for the Faculty of Health and Life Sciences’, which I won for my degree results. I was shocked when I found out, in fact I emailed a member of staff to check they’d got the right person… I guess I still lack a bit of self-belief! On a practical level I was a bit oblivious to the potential for there being prizes as the focus of my degree had never been about chasing marks. Due to previous experiences of university my only aim was to complete the degree in a good state of well-being. Of course, I always tried to produce work I was proud to hand in, but I actually has quite low expectations of the marks I needed to achieve. It was all about ‘just getting through’ and there were several points in the course where I questioned if it were possible. So yes, winning prizes wasn’t on the agenda! The other more tricky part to this is my past experience of being known for academic achievement. I have never had a good experience of getting good results in things. For this reason I decided that I would never discuss my marks with other people during this degree, and other than with very close, mostly non-uni, friends I kept that vow. So when I was told about the prizes I’d be receiving I realised that made it all a little more public! I can’t say being in the limelight for academic achievement felt at all comfortable, but it was manageable and nothing awful happened.

The part of the day that I’m probably most proud of though was being asked to give the ‘Student Vote of Thanks’. This involved reading a speech to a capacity-filled York Minster full of students, family, friends and academics. No pressure! I suspect anyone would have been a bit nervous, and I definitely was. However as I returned to my seat at the side of the stage after, I think, making a reasonable job of it I had one of those ‘Wow, I’m not sure anyone 5 years ago would have predicted that happening’. When I was part of a therapeutic community and beginning to engage in The Real World I had a real problem with being seen. When I left the therapeutic community I immediately commenced an Access to Higher Education Diploma and I remember that when faced with giving a presentation to one tutor with a video camera I really struggled. It took several weeks of my therapy time to discuss the issues around it and devise a plan of how to face it. I was incredibly uncertain of how I could continue into higher education and repeated experiences like that. So yes, four years later and there I was making a speech to, and definitely being seen by, over one thousand people. And in that moment, it felt OK to be me.

There are far too many changes to list here, but I think I feel content in the knowledge that completing my undergraduate occupational therapy degree has completely changed me. I feel so fortunate to have done it at a university that was the perfect mix of challenging and nurturing and I know that there were a lot of lecturers, tutors, friends, family and therapists who played their part in making sure I arrived at this point in one piece. (I have this image of lots of people around me ready with sticky tape to hold me together at the tough points and then some good quality furniture polish to give me a good clean up at the end… but hey, my brain is a little worn out at the minute!)

So to everyone who’s been there along the way (including all those on Twitter and here), thank you!

I have news.

mortar-board-graduate-capI am nearing the end of my undergraduate degree and I can’t quite believe it’s almost over! I’ve grown and changed so much during the three years and am excited about the future ahead of me. Which brings me to my news… I’ve recently received an offer to commence a clinical doctorate and I can’t wait to get started. I’ve always been keen to commence a research career and at the same time have loved my practice placements, so this feels like a perfect opportunity.

I haven’t fully decided what will happen to this blog in the next few months, I certainly don’t post as much as I used to and I feel that it’s served its purpose in many ways. Equally I like that the space is here should I wish to use it… Perhaps I need to re-brand as ‘pd2ot2phd’ 😉

The Challenge of Language

klavesniceLanguage, and specifically the meaning of the words we choose is something that fascinates me. In healthcare it feels very important that we pay attention to the words we (as service-users/patients/clients, carers or professionals) use. There may not be a way of agreeing words that are acceptable to everyone but in exploring the words chosen, a dialogue about the implications and meaning can occur; allowing reflection, insight or understanding to develop.

I remember reading this post by Lisa Egan and it causing me to reflect. As I read I thought, “Yes, she’s absolutely right, I hadn’t considered it that way before” and yet while I fully accepted her reasoning and argument it didn’t feel ‘right’ for my own situation. That was something Lisa was clear about – how a person identifies it entirely up to them. So, I decided to write this post to explore why for me I felt it was important to refer to myself as a person with ‘x’ condition. Also, as is typical for me I wanted to explore the occupational perspective.

I recently read a chapter of an occupational therapy textbook that referred to someone as ‘suffering from [a mental health condition]’ and a ‘personality disordered individual’. I had a strong response to it but those two examples highlight two different issues. I’ll deal with the ‘suffering’ one first…

Suffering the use of the word suffering.

Well, no, actually I don’t ‘suffer’ the use of the word. It upsets me and I feel irritated, but I don’t think I am suffering. In an old post I explored this concept a bit more – wondering about the potential for it to put the person with the condition they were ‘suffering’ with into a helpless and passive role. I also wondered if the widespread use of the word for everything from ‘suffering from a cold’ to ‘suffering with schizophrenia’ had lead to it being used without question. I recently heard a news story on BBC News that emphasised just how routine this use of suffering has become. The feature was discussing a new medical test that could diagnose several conditions that had not yet shown symptoms that a person was ‘suffering’ from. Well, if the person is unaware of their illness I really question that they could be suffering. It could be argued that everyone knows that when ‘suffering’ is used it is actually shorthand for ‘is living with’, ‘is experiencing the symptoms of’ or some other form, but I question how damaging it could be in suggesting an acceptance of powerlessness to the condition. Also, what about the times when people really do feel their experience is of extreme suffering – will we be unable to hear their distress due to the normalising of the word? My final issue with it is the level of (often unquestioned) assumption by the person using it. The experience of illness, injury and disability is an incredibly personal one – the only person who can say they are suffering is the person who has that condition, and therefore experience.

Being ‘bulimic’.

I have recovered from anorexia, bulimia and borderline personality disorder (BPD). When I was unwell I often referred to myself as my condition. At the times I was fighting the urge to binge or purge and would then find myself eating vast quantities of food I would often say to myself with disgust, ‘I’m bulimic, it’s what I do, it’s the only thing I’m any good at’. So yes, I would probably have happily accepted labelling myself with diagnostic conditions as it felt so closely tied up to my identity at the time. Was it helpful? Probably not. I’ve written before about the meaning the eating disorder held for me, and how it really was a valued occupation and so it fits that ‘being bulimic’ was my occupational identity. Given that in society we often base our identities in the occupations we engage in (I’d describe myself now as an occupational therapy student and a rower as they are the two most significant occupations I engage in), it fits that at that time I was ‘a bulimic’ as the occupations related to having an eating disorder took up the majority of my day. My earlier explorations of occupations that were self-defeating helped me understand why they were so powerful for me and this realisation then makes me wonder about the effect of viewing myself as a bulimic occupational being. It feels congruent to how the experience was, and for that reason I can really understand why other people who are ill may refer to themselves as their condition, but I also think it was quite dangerous as it meant I had little reason to change. I had an identity, albeit not a desirable one but it was something, and all I had.

The issue of being ‘personality disordered’ is a little bit different. My main objection to this is to do with the level of stigma associated with the diagnosis. In my mind it evokes memories of professionals who use the term pejoratively and with a tone of hopelessness (‘personality is fixed; change cannot occur’). There is perhaps need for a separate blog post about the right name for BPD, but in the context of this one I really do feel that being a person with BPD is more helpful. There can be a tendency for people to become lost behind the stigma of the diagnosis and consideration of language choices can be a good starting point in preventing this.

Is there a ‘right’ choice of words to use?

Probably not. I think there are some uses of language to be avoided, but another person might not find the same things as unhelpful as I do, and equally may not like the words I use. Like many things I believe we need to listen (properly) to the person whose experience it is, question, reflect and be prepared to challenge our own views.

The ‘Perfect’ Recovery

wisdom-92901_640I usually fiercely deny that I am a perfectionist about anything, because my self-expectations are often much lower than people assume, however I’ve recently realised how much pressure I was putting on myself to have the perfect recovery.

‘Recovery’ is a pretty contentious term, and I suppose one that I hadn’t given sufficient thought to. I suspect it’s something that each person will have their own definition of, from a life totally free of symptoms, to something  more akin to a life that allows a satisfactory level of function for that person. As for what I thought, and perhaps what I now think, well, that’s the purpose of this blog post.

When I completed my time at a therapeutic community (TC) I was very worried about my ability to keep on making the level of progress I had made over the preceding twelve months. I was scared that without the high level of support a TC provides that I wouldn’t be able to cope with difficult emotions without using self-harm or an eating disorder to manage. I also believed that if I slipped at any way at all I wouldn’t be able to get back up. However, as I’ve discussed in previous blog posts , having meaningful occupations to engage with was central to my continued recovery and my progress actually continued quite quickly to a point where I felt I was ‘recovered’. It had been months since I could have been diagnosed with Borderline Personality Disorder (BPD), and while I still had some ‘symptoms’ (I had problems with dissociation and a poor sleep pattern) I was managing a very different life and one I was very happy with – in fact I felt I’d achieved the oft quoted ‘life worth living’ that Dialectical Behavioural Therapy aims to facilitate. I also felt very sure that that could be maintained with a life full of occupations that fulfilled and empowered me, as well as providing challenge, fun and restoration.

When I commenced my training to become an occupational therapist just over two years ago I know I felt I had something to prove. While my university have never been anything other than supportive and accommodating, I had a huge internal motivation to complete my course without any adjustments or help. I felt I needed to be perfect, not in terms of academic achievements, but in terms of health. During my second year I realised I wasn’t superhuman and had to accept some support to allow me to complete my placements in a way that allowed for a continuing poor sleep pattern and to attend ongoing therapy, but still I was determined that so long as all my assignments were completed without extensions then I was still doing ‘OK’. Did I still feel ‘recovered’ at this time. Yes, I think so.

In the Autumn third year began. After a long summer and my time in Moldova I had changed quite a lot and I initially struggled to adjust back to university life. But soon I was enjoying the work and the opportunity to have much more autonomy and independence in my studies, rather than completing the heavily structured modules we had in the first two years. And then I crashed. My mood dipped and I found it very difficult to engage in any of the occupations that kept me healthy and functioning. Apparent competence meant that I put on a reasonable ‘show’ of being ok to those around me, but I wasn’t. I ended up taking a few weeks off university and am now just returning to my studies. I now will be breaking my own ‘no extensions’ rule, and surprisingly it feels OK. This happened because I began to understand that I didn’t have to have a perfect recovery. I had felt that my history of BPD meant I had to prove I was 100% ‘fixed’  (this was an entirely internal feeling and not imposed by anyone else) but with the support (and most importantly acceptance) received from university tutors I suddenly realised that it was ‘OK’ to ‘not be OK’, and in doing so I began to get back towards feeling recovered.

So, for me, what is recovery? I seem to have a definition that doesn’t relate to being free of symptoms (for me some symptoms are acceptable – poor sleep or trauma-related problems, while eating-disordered behaviour, persistent low mood or self-harm would not be), but rather one that involves the level to which I can participate in the occupations I wish to. My ‘norm’ is being tired and having variable emotions related to past experiences, but so long as I can motivate myself to row, attend university and complete necessary work, look after my flat and my own self-care then I feel things are fine. When I can’t manage those things I don’t feel recovered.

I suppose this understanding is unsurprising from someone who studies the value of occupation in improving health but I’m not sure I’d been aware of how much I used occupation as a marker of health before. I had previously believed I needed to have a perfect recovery, but now understand it’s OK if it’s not always a straight path. I used to feel terrified of ‘losing’ valued occupations through low mood, lack of enjoyment or motivation but now realise that my ‘occupational health’ may dip and it can also be restored.

Transcript: #OTalk “When Occupational Therapy Goes Wrong” (17 September 2013)

Here is the transcript and summary of last night’s #OTalk on ‘When Occupational Therapy Goes Wrong’. Big thanks to @clissa89 for collating the tweets so efficiently and to everyone involved in the chat – it was such a valuable discussion.

OTalk

This week’s #OTalk, hosted by @pd2ot, provided a space to reflect on and learn from experiences of occupational therapy “going wrong”. I (@clissa89) found this conversation valuable and thought-provoking. Below are a selection of tweets from the chat. The full transcript can be read here: (link/PDF).

Resources:

https://pd2ot.wordpress.com/2013/09/11/when-occupational-therapy-goes-wrong/

https://pd2ot.wordpress.com/2012/05/21/ot-is-for-thick-people/

http://shamelessotgeek.wordpress.com/2013/09/17/when-occupational-therapy-goes-right/

http://shamelessotgeek.wordpress.com/2013/08/11/dearmentalhealthprofessionals/

 

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When Occupational Therapy Goes Wrong.

tick-or-x-button‘When Occupational Therapy Goes Wrong’ is the title of the #OTalk Twitter chat I’m hosting on Tuesday 17th September at 20.00 BST.  If you’re new to Twitter chats and want some help to get started please feel free to contact me (@pd2ot) or the OTalk/occhat team ( @OTalk_Occhat on Twitter, or browse the main blog). Due to the nature of the discussion it is important that all participants are mindful of professionalism, especially confidentiality. The full Health and Care Professions Council Guidance for Social Media can be accessed here.

The idea for the talk originated on Twitter through a somewhat playful discussion about unhelpful experiences of occupational therapy. My own initial experiences of receiving occupational therapy as a service user were far from positive (I explored the issues I faced in ‘OT is for Thick People’ ), but I then went on to experience some great treatment.  Rather than the chat being a space simply to vent frustrations, my hope is that service users and professionals can unite to explore times when occupational therapy has ‘gone wrong’, gain understanding as to why  the quality of the service delivered/received was less than ideal and work out how  things could have been different.

We really welcome contributions from service-users, carers, students and professionals (and any combination of the four) for this chat. Here are some questions to prompt some reflection before the chat.

Service-users and Carers

What has been your experience of occupational therapy?
Have you ever felt your occupational therapy ‘went wrong’, or observed it happening to the person you care for?
What sort of things have been unhelpful?
What would you have preferred to happen?
Have you ever had a better experience? What made it more positive?

Students

Are there any specific challenges for students, not common to qualified staff, that have meant occupational therapy ‘went wrong’ in the practice environment?
How did you overcome these challenges? Or how would you approach things differently in a similar situation?

Professionals

What type of things do you think are included in ‘occupational therapy going wrong’?
What type of things do you think service users and carers include in ‘occupational therapy going wrong’?
Have staff shortages, service policies, limits on resources or intervention duration, politics or any other external factors ever meant that you were unhappy with the type of occupational therapy intervention provided?
Have you felt you lacked the experience, support or knowledge to prevent ‘OT going wrong’?
Have you managed to overcome these challenges? How did you do it?
Have you had to be creative in your approach to manage the challenges?
How are you checking you’re ‘getting it right’? Outcome measures? Service-user feedback?
What have you learned from times when things have gone wrong?

We’re looking forward to hearing your views during the chat using the #OTalk hashtag. If you’re unable to join in during the live hour please tweet anyway as all tweets will be collated into a grabchat 24 hours after the chat. Comments are also very welcome on the blog post.

Remember, from every ‘what went wrong’ we hope to use the experience to improve the quality of occupational therapy provided or received.

Day 27 – my final working day

Thursday

Today was my last working day in Moldova. We had seven young people in attendance at the Centre as well as my supervisor who had, very kindly, broken her vacation week to be there for my last day. This actions exemplifies my experience of being a volunteer here – I have felt so valued every step of the way.

Our first activity was making a crafty name card for each person as we were planning a ‘gourmet sandwich making session’ in the afternoon and wanted a way to mark up each sandwich. This was an interesting one for me as my supervisor was absent at this point and as it wasn’t ‘my’ activity I was getting my instructions from another member of staff. She knew a few more English words than I do Romanian and with a combination of the two I got my instructions to help run the task. It gave me an insight as to what it may have been like to be a participant in the tasks I ran. After this we spent some time outside playing party games to celebrate (but in a very sad way, I was assured) my leaving.

After lunch we had a ‘reflective session’ where we viewed all the photos I’d taken at the Centre to a backing of our Latin Dance music. I think everyone enjoyed seeing all we’d done and it really did emphasise just how many experiences we’d had this Summer. I also felt quite sad seeing photos of the clients who were absent this week due to the lack of alternative travel options during the bus driver’s holiday.

Then it was time for our Gourmet Sandwich session. We had some ‘recipes’ from magazines and each person selected the one they wanted to make. The available staff provided some assistance and it was then I really got thinking about one of the cultural differences I’ve noticed here….

Perfectionism.

I’ve been attending some Zumba classes while I’ve been in Moldova and been very aware of a different approach to the class. In the classes I take in the UK an instructor may highlight a particular piece of footwork before each song but essentially the aim of the session is to get moving and keep moving. Working hard an having fun are key, if you get the steps right it’s a bonus. In the classes I’ve attended here the instructor runs through each track without music, breaking down the steps and showing good technique. If anyone makes a mistake in this marking stage, the instructor repeats the step. To me it has felt a little frustrating. While I am a dancer, I do not consider Zumba a dance class; I just want to dance about for an hour, get my heart rate up and I’ll figure the steps out as we do it. I do admire such attention to detail though and it fits with some of the Soviet style approaches I’ve observed. Anyway, back to my point. I also have experienced this approach on placement. When I’ve been working with the young people, as is normal for me, I’ve been getting to do as much of the task as they are able to do independently and help as little as is needed. Some of the other staff help those they are working with a lot more. As I result their finished products are neat and ‘perfect’, whereas the ones belonging to the clients I’ve worked with are often a little wonky or not so neat. It doesn’t bother me in the slightest – I want to see my clients produce their work, not mine, but I do wonder if the other staff have had any feelings about me allowing such ‘imperfection’.

During this task the manager of the centre came to present me with a report on my placement and the most touching thank you gift; a beautiful framed quotation surrounded by paper flowers. It was so special and meaningful, and feels quite strange to feel so valued during such a short placement, especially as the Centre has numerous volunteers (many of whom are Occupational Therapy students) throughout the year.

The party vibe continued with a late afternoon snack of the sandwiches and chocolates I’d bought. Moldova certainly has good chocolate products that I will miss! When the young adults went home the staff and I shared some freshly baked pizzas. It was lovely to sit together and have time to say goodbye and thank you properly. Usually, when I’ve been on placement in the UK, service demands mean that endings are a bit rushed and unplanned. This is totally understandable and not a big problem but it definitely made me appreciate how lucky I was to have a whole leaving day.

We then locked up and went our separate ways. Definitely the saddest ending to a placement. Going through the photos reminded me of just how much I’ve enjoyed working with each client in the Centre. The staff team were also brilliant, and unlike when I leave a UK placement, I know it’s unlikely our paths will cross in the future. Although, maybe I’ll come back to Moldova to spend some more time and at least we have the wonders of Facebook and email to keep in touch.

I also had a phonecall from the director of the company that organises the placements here thanking me for all my hard work. He said he felt I was one of the best volunteers they’d had at the Centre. Quite a compliment given all the good things I’ve heard about other volunteers. I told him it wasn’t hard work at all, but simply a pleasure and privilege to get to spend my days with the clients and staff here and that he and his team had made it so easy to be here and immerse myself into life at the Centre and in Chișinău.

It feels quite unbelievable that I’ve ‘only’ been here for four weeks. I suspect the range and nature of experiences, as well as the amount of personal growth that has happened, is why it feels much longer. When I first had the idea to arrange something like this I initially dismissed it as ‘that’s the type of thing other people do’. I wonder if that means I’m another person now, or perhaps that I already was that person but didn’t have the confidence in myself.

I have a full day in Chișinău tomorrow as I leave for the airport at 7.30pm. I’m hoping to spend the afternoon with my host and will use the morning to capture a couple of photos I’ve been meaning to take all month. I’ve just packed up my stuff and I have a lot more space as the majority of my baggage consisted of items for placement and toiletries. I have a few more blog pieces in mind, based on this trip, so I will aim to write them in the next week.

But for now, la revedere!

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