UNIT II Aspects of Professional Reasoning


If one, as an observer, were to witness effective interaction between an occupational therapist and a client, it may look like nothing special. From the outside, it might simply look like a conversation between two or more people who know each other to some extent (sometimes quite well, sometimes as new acquaintances). It would bear features of a constructive or purposeful exchange, with giving and receiving of information, discussing that information, and reaching conclusions or making agreements. Although purposeful, warmth would be observed, along with other emotional responses—concern, compassion, empathy, thoughtfulness, humor, understanding, and gratification.

Case Study 11-1

I could sense that he was holding back. His manner seemed guarded, reluctant. My questions about his medical history were met with one-word answers and brief eye contact. He had told this story over 20 times to a bunch of different profession als. The referral from the physical therapist indicated that he had received a number of interventions, such as casts, injections, and mirror therapy, to improve the movement in his affected arm since his stroke, but he felt that none had worked. He had recently been prescribed exercises to do daily. I asked him to tell me about how the exercises were going. He explained that he thought he was getting stronger but was frustrated it wasn’t yet making a difference in what he did every day, like getting up and dressed in the morning or making his lunch. He said, “My wife still needs to help me with these basic things while she is running the whole household. And I can’t contribute.” He shook his head as he said, “Doesn’t she have to do nearly everything now since the stroke? How is a man supposed to get on with things when he has to have help with every little thing?” The look of frustration on his face was clear; his voice was wavering. I kept eye contact and nodded as he spoke. Then I stopped asking questions. I leaned for ward, tried to keep a calm and steady tone of voice, and said that I could see that he had had to deal with some big changes and it must be hard to adjust to that. I recounted my understanding—that he was frustrated that he often needed help and couldn’t give back to the family in the way he wanted to. I checked that I had it right. He nodded and said, with re solve in his voice, that he wanted to be able to “pull his weight and not be a burden.” I commented jokingly that I suspected his wife would love some help with the housework! He smiled and said that housework had never been his forte before, but “wouldn’t that get me some brownie points!” We both had a quiet chuckle. I said that we could talk about what activities he wanted to do at home, I could visit the house and look at how we could change the setup of the kitchen or the laundry so that he could use his current abilities to do more around the house. To help him make progress more quickly, we could even work out how he could incorporate the move ments he was practicing in his exercises into his daily tasks. As I spoke, he sat up straighter in his chair and started nodding. I could see that we were finding a way forward.

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