The Canadian Occupational Performance Measure (COPM) is an opportunity for an occupational therapy student to guide a figurative client (Daphne) through her daily routines. These activities lie within the dynamic intersection of Daphne’s environment, person, and occupation. To professionally guide a prospective client through the process, an imperative aspect of completing the COPM is studying and contemplating the utilization of enablement skills. 

      Engagement is a cornerstone of occupational therapy. In this context, engagement is the catalyst for purposeful and meaningful action demonstrated by the client’s participation. To engage the client in the therapeutic process, I helped enable the client to express their emotions, ideas, thoughts, and opinions by asking them client-focused questions directed to their needs regarding comfort. Considering the Canadian Practice Process Framework model depicts the two contact points that frame the client-centered experience as the “initiation” and the “ending,” I prioritized this skill when entering the room. Further, in this assessment, the initiation drew-in the occupational therapist (OT) and the client to a productive, ‘occupied’ state that establishes their partnered ‘becoming’ within the client-centered model and thus, our engagement. My intention is to initiate a connection by engaging the client in an introspective, power-shared process based on information attained via direct consulting with the client. The overall quality centered on the inclusion of the following: 

• announcing my presence and asking for permission to enter,

• explaining my intention in sitting within the client’s reading proximity of my notes and asking about the client’s comfort,

• inquiring about the client’s preferred name and pronouns. 

       Furthermore, the responses elicited the client’s described/articulated needs, thereby, a means to improving the client’s comfort and engaging them in the act of reflection. 

In this context, collaboration is a means of ‘doing’ with the client rather than ‘doing’ for the client. Therefore, collaboration is an important skill I utilized to facilitate power-sharing. While the client outlined her daily activities, collaboration ensued via my active listening. The most helpful means to collaborate was actively listening with a present-time consciousness that encouraged the client’s ongoing efforts in the participatory process. My aligned empathy, altruism, trust, and respect collaboratively supported the process. Therefore, to collaborate, I genuinely listened to the client, and to reflect on this listening, I enlisted positive/open body language. This body language paralleled the clients and included a physical orientation to the client with both feet flat on the ground, a chair placement that is side-by-side to the client (rather than across), an inclined head or head nod to empathize but not interrupt, and maintained eye contact. To further collaborate, I repeated/echoed the client’s statements to encourage us both, if needed, to clarify and reflect. “If I heard and understood you correctly, you mentioned that sitting during work is stressful….”  Deepening this collaborative relationship was thanking and thus acknowledging the client’s efforts. Then, respond with a call to shared action. “Thank you for sharing. What do you think about including sitting here (pointing toward the productivity tab).” 

      Also, the shared experience of collaborating to determine which activities of daily living to write-down, and where to write-down the activities of daily living, was a collaborative, power-shared experience that improved the delivery of the assessment.  Considering the time requirements, I genuinely needed Daphne’s collaboration and efforts. Therefore, the client’s participation in the process enhanced our experience. 

In this context, education, congruent to consulting, is a means to spark transformative learning and is interwoven into the entire assessment. In turn, the client educated me on how her occupation had been disrupted. And I, after consulting the client to deduce the need for information, explained the arc of occupational therapy, and the roadmap/outline for the assessment.  

      The skill of coaching provided insight into the potentiality of building goals. The utilization of coaching encouraged Daphne to not only recall essential aspects of her occupational patterns but to determine further if these patterns are important, satisfying, and are (by the client’s standards) being performed accordingly. To coach the client into a mindset by which she could better contemplate her conscious awareness of her surrounding framework, I stated the following: “The intention of this assessment is to create and hold space for your session. This is your time. If you need to pause for any reason, albeit a question, bathroom break, water break, or to adjust your seating, you are welcome to do so.” Next, by consulting the client and following up accordingly, my intention is to guide Daphne further into the participatory process. “I heard you say your back hurts, and I see you are modifying your sitting position. Would you like to move to a different chair (orienting toward the table and my chair)?”. My objective in cueing the client to consider possibilities was to begin navigating the potentialities of what is and what could be. Thus, to prepare the client for the upcoming reflection activity and consideration of what may be supporting or inhibiting her from living life to the fullest. 

      Looking forward – in agreement with the client’s feedback, I need to work on an efficient delivery and cadence of speech. Meaning a faster delivery of my elevator speech that describes OT. I believe that the repeated process of the following: practice, reflection, and contemplation will finesse my assessment skills. Moving forward, I am contemplating the following questions: How do I consult to educate and thus efficiently draw my attention to language, culture, and diversity? How do I ease the educational process for the client and myself? And how, especially when working within the reductionist medical model, does one do this as quickly as possible without neglecting the client? I believe that through this repetitive process, I will not only improve my delivery but also attain insight to ‘sharpen’ my enablement skills. 

Reference

Townsend, E., & Helene, P. (2013). Townsend, E., & Polatajko, H. (2007). Enabling occupation II: Advancing an occupational therapy vision for health, well-being, & justice through occupation. Ottawa: CAOT Publishers. (2nd ed.). Canadian Association of Occupational Therapists.