A Conversation with Marget Wincent, OTR
Did you know that the cluster of attitudes and skills that fall under the umbrella of “self-determination” have been shown to be one of the strongest predictors of success for people with disabilities’ attainment of their transition goals? It’s as necessary to quality of life and independence as the other basic ADLs we traditionally focus on and, like grooming and hygiene, it’s a teachable skill set.
I have a hunch (and some research to back it) that most occupational therapists do not explicitly and systematically pursue self-determination as part of everyday clinical practice. Like a lot of the more psychosocial goals, I think we often expect clients to just pick it up by osmosis because we’re so nice and we offer opportunities to choose whether to work on putting on socks or learning to button first. While this is essential to building self-determination, it’s hardly sufficient.
Or we expect other team members to do the job. I have honestly never seen this happen, but even if another professional was working on it, self-determination must be practiced across all settings if it is to develop. If we aren’t actively helping in the effort, our clients are deprived of prime opportunities to acquire this essential skill set.
What is sufficient intervention for building self-determination? It includes (a) presenting and supporting the integration of certain knowledge, attitudes and abilities, and (b) preparing the social environment to receive and reward (and appreciate) the client’s growing assertiveness.
The knowledge needed includes:
• That there are choices to be made
• What’s possible– what are the choices in any given situation?
• Identifying and understanding one’s own emotions / thoughts as they arise
• Identifying problems and options for their resolution
• Considering oneself worthy and capable of making choices and decisions
• Owning one’s personal strengths and limitations in general
• Being aware and considerate of others’ perspectives and needs
• Assuming responsibility for making personal choices and decisions
• Assuming responsibility for identifying and resolving problems
• Being comfortable with asking for help, owning errors and limitations
• Comfort in setting limits and refusing
Behaviors needed :
• Choosing or deciding in a thoughtful and timely manner
• Making one’s wishes known effectively
• Asking for assistance effectively
• Describing one’s preferences and needs assertively
• Self-management skills for coping with emotions
• Effective and polite refusal/limit-setting
In addition to teaching and supporting the development of the requisite knowledge, skills and actions, we need to make sure that our clients are supported (and not punished) for their efforts toward self-determination. People with disabilities are consistently rewarded for compliance. They often learn to just agree with whatever others suggest, resulting in learned passivity and a high tolerance for frustration. These patterns may make life easier for others, but ultimately leave the client vulnerable, unable to direct their own lives, and unfulfilled.
Family members, teachers, caregivers and health professionals should be brought on board to help support each client’s fledgling and ongoing actions toward self-determination. They will sometimes find that a more independent and self-directed person is more complex and less consistently easy to deal with, so it’s important to facilitate their appreciation for how important self-determination is to attaining a richer, more satisfying, and safer life. They need to know what the client is learning and practicing at each phase so they can respond supportively. Of course not every request or choice can be accommodated, but you can offer suggestions for ways to respond that reflect respect and validation in any case. (And reminders of why learning habits of self-determination is basic to acquiring independence, working, keeping safe in the world, etc.)
It is never too late or too early to facilitate the path toward increased self-determination, and clients of all sorts can benefit. Occupational therapy includes psychosocial skill development. Self-determination is evidence-supported and foundational to living life to its fullest. It’s right in our wheelhouse. Let’s do it!
References and Resources:
Increasing Student Success through Instructional Self-Determination
National Gateway to Self-Determination
Self-Determination: Supporting Successful Transition
Click HERE for the Podcast Join me for a conversation with Mandy Chamberlain, MOTR, owner of Seniors Flourish, a web-based source of inspiration and information for OT practitioners serving older adults. Mandy’s enthusiasm for her clinical work is energizing. Her deep understanding of ways to […]
I feel very fortunate to have come of age as an occupational therapist in the 1980s. Granted, the fashions and hairstyles were questionable (what were we thinking?), but it was just before the corporatization of health care, and community mental health care was robust. Because of the lucky timing I was able to work with interesting clients in a range of settings. Without the pressures of today’s demands for “productivity” I had time and opportunities to actually converse with and observe my colleagues during and between sessions. We had team meetings several times each week, and in most places I reguarly had scheduled supervision time with an advanced practitioner who gave me feedback and counsel regarding my work.
As I’ve matured, I recognize that these gifts of time and teaching were essential to my development as a therapist and educator. I can still recall interactions that were pivotal learning moments. I carry within me the words and examples of many people whom I admire. They strengthened my skills, kept me humble, and gave me the confidence to think independently.
I am sad for occupational therapists who have not had the opportunities that I did for mentorship, teamwork, and role modeling. I know that nowadays sometimes even fieldwork doesn’t provide much individualized supervision for students. Today’s OT practice can be a lonely situation.
Your career as an occupational therapist or occupational therapy assistant is something that you probably worked hard and made sacrifices to achieve. If you feel that you need the support and guidance of OT colleagues or a mentor, I strongly encourage you to create that opportunity. You will most likely find that your daily work is more exciting and satisfying if you do. Your creativity will reawaken, and you’ll feel less isolated and drained. You’ll also probably recognize how very important your work is, once you reflect on it with someone who “gets it”.
If you don’t have someone in mind to connect with, you might start by joining your state OT association. Continuing education events are not just for gathering CEUs! They are rich opportunities for meeting up with people who have compatible interests. After the session, exchange contact information and continue your new friendships via coffee dates, Skype, or online.
If you’re looking for a deeper professional relationship, I suggest hiring a consultant. Throughout my career I have done so with great benefit. In my first mental health OT role I was hired into an agency where all of the OTs were new grads. The agency paid a wonderful, experienced OT practitioner to provide us with 2 hours of supervision every other week. This person remains my dear friend and mentor, and I am grateful for all that she has done for me. Two years after starting Bright Futures I hired a consultant in Australia who specializes in private practice development. Her advice, information and support were instrumental in moving us to the next level of growing our business, and I prize her friendship to this day.
Locating a professional consultant who fits your needs and style may be a challenge; it’s kind of like finding a good therapist. I am available for hire as a consultant or to help you locate someone who fits your specific needs. I have a client-centered approach in which my consultees determine the purpose, frequency and duration of our meetings.
If the idea of paying someone to serve in this role is off-putting, let me explain why it works.
6 reasons to hire a professional career consultant:
1) Professionals with advanced skills make the best mentors/consultants. They are busy people, and their time is limited and valuable. By having a formalized, business-based arrangement you are assured of their full and regular attention and expertise.
2) Your career is precious. You worked hard to attain it, and you spend a lot of hours each week doing it. Don’t you deserve to be fulfilled by it? Isn’t that worth some investment of your time and money?
3) What will be the most deeply and sustainably satisfying use of your limited funds and time? Something that provides quick relief from the boredom and stress of a career that is draining, or something that can improve your actual workday and potentially transform your entire career path?
4) Authentic occupational therapy is complex and nuanced, and its mastery can be a lifelong process. The nature of today’s work culture has deprived many OT’s of their right to receive quality mentorship and mutual support during the formative first years of practice. It’s never too late to gain from having that kind of relationship.
5) Over time our personal and career needs and desires change. Sometimes new opportunities just present themselves effortlessly, but we can’t always count on it. Consultation can help you to identify next steps and avenues to plan and attain a new and interesting career trajectory.
6) You may have a desire and ideas for developing a unique, niche-based private practice that fills unmet needs in your community. You probably had some basics about developing a practice in your OT curriculum, but you were pretty focused on getting to fieldwork and it was mainly introductory. Now you are ready, and a good consultant can provide the information and resources you need to make it happen.
Are you ready to obtain the support you need in order to make the career you always hoped for? Or at least ready to explore the idea? Let’s talk! You can reach me at: firstname.lastname@example.org or 636-399-8910.
Authentic Occupational Therapy emerged from my realization that all OTs learn the history and philosophy that are the basis for classical occupational therapy, but many never get to experience the fullness of that kind of rich practice in real life. I know this because […]