122 – You Are Not Client Centred

Are you client-centered? Are you sure? Does your initial reaction to a situation indicate that you are too? After coming across a little video of a man learning to use his new prosthesis with no supports outside on the grass. He falls multiples times but gets back up and keeps trying. Unfortunately, the original video has been removed so I can’t show you all but I still wanted to share with you my reflections on the reaction to this video.

Look after yourself, look after others, and always keep Occupied


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Brock Cook 0:00
Good day and welcome to another episode. Before we get started, I just want to say a massive thanks to all of the the patrons that are supporting occupied on occupied plus over@patreon.com, forward slash occupied. Plus, you guys are amazing. I’ve had a couple of supervision slash mentorship sessions that I’ve jumped into in the last couple of days. And I’m just overwhelmed by the quality of clinician that is out there at the moment, this profession I can safely say is in very safe hands, going forward so warms my heart and makes me so happy to get to know you guys, and even happier that you are open and willing to support this podcast this projects, get the extra resources not always stoked when I get your reflections on those extra resources be that episodes or assessments or reflections that I put out. Yeah, it’s overwhelming. If you are interested in joining those amazing people pop on over to patreon.com forward slash occupied plus there is a tier for your budget for your wants for your needs. There is something there for you. pop on over and have a look and just see what you might be able to get out of it. That always amazes me when you come across things that make you reflect on your own practice, no matter how small the things usually are. This episode is about one of those things so I’m very keen to hear your opinions, whether or not you have reflected and can relate, etc. So hit me up in the comments send me a DM send me an email, let me know. Get a My name is Brock Cook and welcome to occupied. In this podcast we’re aiming to put the occupation in occupational therapy. We explore the people topics, theories and underpinnings that make this profession so incredible. If you’re new here, you can find all of our previous episodes and resources at occupied podcast.com. But for now, let’s roll the episode. So, picture this if you will. You rock up to Starbucks and order your favorite pumpkin spice macchiato. Chai whatever drink and the person behind the counter guys. Oh, that’s a lot of sugar. I’m gonna give you an Americano instead. Because it’s better for you. Would you be super stoked about that? Either they right? Does that matter? Let’s level look at it. So technically, is an Americano, better than one of your super sugary pumpkin spice whatever’s they’re not wrong? Does that make it better for you? Well, objectively on paper with nothing else taking into account. It is a healthier drink than the other one. Taking into account the context of your diet being eaten around that how you exercise your current physical status. Yeah, it gets a little bit more complex. But for the most part, on average, most people would probably agree much lower in galleries like 10 calories versus 2000. Probably a relatively easy decision as to which drink was healthy physically. Now, mentally, on that day, you are just really fighting to get your teeth around some pumpkin spice. Because apparently at this time of year, that’s the thing to do. That person has made the decision for you that no, this is going to be better for you. You’re not having that you’re having this instead. How does that make you feel? You’re thinking about this drink all day, hanging for it. You’ve planned out a time where you can go and get it you’re going to sit down you’re going to enjoy it. How does it make you feel having someone else tell you not gonna do it this way. I want you to

have a reflect on that. Positive if you need I’ll get to the point behind in a second, but I really want you to work out how you would feel in that situation. For me, I am quite consciously aware that I am not the best one being told what to do. I’ve always been that way. I don’t know whether it was growing up listening to punk rock, or captaining sports teams or, you know, just always wanting to be in some kind of leadership position as a kid. I don’t know what it is. But I’ve never been particularly fond of just being told flat what to do. Now if I’m told what to do and I get a good explanation and then I kind of agree with it. Or for it, no worries at all too easy let’s go ahead let’s do that plan. But just being told not I know what’s better that for you than you know what’s better for you. The that doesn’t fly. I suspect that there’s probably quite a few of you listening to this that may lean towards that maybe not to that extreme. But being able to make your own decisions and not have the made by someone else for you, is probably something that a lot of you find quite important. I would imagine I would love to hear from you if you disagree, or if you agree with this. But here’s the point that I want to get to. I was scrolling through Facebook as you do one of my not so favorite pastimes but something I definitely still do. And I came across this video this video was posted in a Facebook group. It was a video of a sort of, from what look like a middle aged man who had lost part of his leg and seem to be learning again, there was no context to this video. It was just the video seems to be learning how to walk again with a prosthesis. He was walking on like a grassy area there seemed to be some kind of therapist or doctor or someone with him someone in scrubs in the sort of background, but he was trying to independently mobilize using this prosthesis. He was for the first few clips anyway like making it one or two steps and then falling over on the grass. And the video was in continually like it was short clips of him continually trying to walk independently without any aids other than the prosthesis obviously without any support from other people without any walking rails treadmills, any of that stuff. To me initially the video was kind of nonchalant it wasn’t anything that I was like oh wow, look at that. That’s amazing. I’m like okay, that’s cool. I’ve seen similar videos in the past. I’ve seen videos of pulled together people may or may not know of him if you haven’t definitely look him up. He is an ex Navy Diver clearance diver from Australia who was attacked by a shark in Sydney Harbour lost one leg and one arm and yeah, and I’ve read his books and followed his story for a long time but I’ve seen him do a very similar video about himself when he got a new prosthesis I think it was a running processes as opposed to just his everyday walking what he calls his walking leg and him trying to get used to that and doing a very similar thing trying failing trying failing trying failing trying failing trying failing until eventually he got it the thing so like I said that video to me when I first watched it I’m like cool. Yep, that’s pretty cool. But it wasn’t anything dramatic. And then I found the comments. Again, this is in an OT group so I am presuming majority of these comments are coming from either OTS or ot students the comments for the vast majority of them were trashing the the health service whatever service that may have been that that person was involved in for not implementing all of these supports walking rails Why was there no one hanging on to him? You know, why are we letting him fall over what if he gets hurts all of these

kinds of things which on face value, again, objectively without any other context. Potentially valid arguments. But there was one thing missing from all of these replies. So I being me, couldn’t help myself but point out this one thing that was missing. And that was the fact that what if that was that person’s preferred way of learning? What if that was how they wanted to do it? What if they didn’t want to be that person who relied on grading things right down to walking hanging onto two rails which don’t know about you, but I’ve never done that in my life. in everyday life, I’ve never gone all of two rails and grabbed onto them and walked hanging onto two rails. Understand completely, I’m not saying that they don’t have their place. But I need people to be a little bit more open minded when they’re looking at these things. Here’s the reply that I put into the group. So I write honestly, if you’re thinking of the operational issues before thinking of the client, you’re doing it wrong. If I was in the situation, and the therapist wanted to put all of those restrictions on how I learned how to use my prosthetics, I’d probably tell them to get effort as well. I don’t think therapists recognize how disenfranchising it is having your choices and wishes ignored, because a process of processing quotes. Now, this is assuming that it is his choice, and he wants to learn on the grass with minimal supports. I’m not saying it’s the safest or most efficient method, but it’s his method. Don’t shut down every idea just because your initial reaction is in quotes. That’s not how I do it. Because you’re not right, there is no absolute truth. Now, I want to unpack that a little bit. And I did a little Episode A while ago, I had a hospital stay of my own towards the start of this year. And I had one simple interaction that made me feel completely useless. And that was I was in there for a saliva stone in my throat, like essentially, in my saliva gland, which is an underside of my mouth. They would not let me walk between wards, due to the process due to the risk, apparently, of falls, etc. I had completed their fourth assessment, I am obviously qualified and well aware of what goes into a false assessment. And I was extremely low on that scale. I wasn’t on any medication, I hadn’t had previous falls, I was stable and steady on my feet. I wasn’t dizzy, I was fine. being forced to sit in a wheelchair against your will to be pushed by a small nurse, probably half to a third of my size around the ward was so embarrassing and disenfranchising. And I just absolutely hated it. Why? Why did I hate that so much. Because being in a wheelchair, when I have the capacity and the capability to walk has never been part of my identity. You’re taking away something that I’ve taken for granted in my own life. You’re taking away something I didn’t even realize was something that I had to choose. I choose to walk around, I choose to get up Yeah, I could technically go and buy a wheelchair if I wanted to and, and wheel myself around. But I’m choosing to use the gifts that I have the skill set that I have the capacities that I have. I’m choosing to exercise them. Having that taken away, even though it’s something I didn’t even know was something that I was choosing just effected me more than I could ever have predicted. And it was a probably a 15 minute period and it tainted like my day and had me thinking about it for hours. Because why did I feel like that? Why did this simple thing arc me up so bad that I argued with the nurse?

Why does anything where we take away someone’s right to choose affect them so much? Because we are essentially attacking their identity when we are taking away things that they believe or they want to try and see if they are correct As of now, there are a whole other side to this argument that I am by far not an expert in that is the legal side of it. There are obviously in the states anyway, I Hi. Culture of you know, you need to do like people potentially could sue you if you do the wrong thing essentially. Yes, that is definitely something that you may need to take into account 100%. But is there a least restrictive way. Now, having a look at that video alone, people were worried about or what if we break something else if he falls if he hurts himself, etc, having a look at that video, and no other contextual information, his upper body strength, you see him lifting himself up, you see him bracing himself, he’s not falling far he’s not running at speed, he’s just trying to walk. He’s a relatively fit looking individual. He doesn’t appear to have any upper body limitations See, his strength and everything seems to be there, his range of motion seems to be there. His balance seems to be there you can see his arms moving to try and balance himself while getting used to this new limb. Everything except the fact that he’s not using his leg he’s using a prosthesis seems to be working as intended. So is taking him all the way back when he validly wants to, let’s assume that he actually is requesting to and wants to learn how to walk try to walk on a soft surface, like the grass outside, it does look very lush, in the video, very lush, really grass is taking him all the way back inside. And having two people maybe three people hang on to him while he’s hanging on this walk rails. Is that going to do anything for him physically? Well, the argument could be made everyone know what everyone in that field will be able to go. Yeah, best practices this that and that. Okay, fair. Physically, there might be a more effective way of learning or a more efficient way not necessarily effective, but a more efficient way of learning. People were talking about all you need to scale it back and do this and that and this and I’m like, yep, okay, cool. That’s all well and good, you may be able to do that, mentally, is that gonna be the best way for him. And if he is wanting to go outside, just the fact that he’s outside after being in hospital, potentially, you know, no one goes in for day surgery for an amputation. So potentially, he’s probably spent a fair bit of time in a hospital. Just the fact that he’s being outside might be a big thing. The fact that he’s actually in nature was nature’s you can be on a hospital campus, while he’s doing his rehab might be a massive thing for this guy. The fact that he is enacting his own locus of control over the way his therapy is going. Now, again, we’re assuming that it’s his choice to want to learn how this how to use this prosthesis outside in his own way, is there anything wrong with what he’s doing? Well, yeah, that’s the risk of injury etc. I would argue that the risk of injury from falling around all of that equipment and other people and being pulled in different directions due to falling with a walk belt, potentially, there’s risk there too. And there’s probably risk of things going much worse, if all the stars align in a bad way.

There is risk in those risking getting out of bed, there’s risk in staying in bed, there’s risk in sleeping too little there’s risk and sleeping too long. There is a huge risk in driving to work. There’s also a huge risk in not driving to work. We need to understand that there is risk in absolutely everything we do. Every single thing we do is a risk vulnerability compromise. And we make that decision with absolutely every choice we make. Me choosing whether to have chicken or ham on my sandwich for lunch is a risk. How old’s the chicken? How’s the hand? Where did it come from? Has it been stored correctly, blah, blah, blah, blah, blah, there is risk in every single decision. No one overcomes anything without balancing or taking on some of that risk. Whether that’s in a walk, belt and With rails, or whether that’s learning to use your nuber thesis, outside, in the sun on the grass. That person to me looking at that video looking at his upper body strength is coordination is balanced, everything is mitigating so many of those risks that there’s probably not a lot else that you could do on your own. Like there’s nonetheless he could do to improve his individual risk management. There was staff on hand in case something did happen. And if something did happen, that is also a choice he made, he made that choice, acknowledging the risk that may happen. People that play sports, any sports, you are putting your body at risk of injury. And you know that people that dance people that sing, people that I don’t know, play jigsaw puzzles, you are putting your body at risk, but you are acknowledging that the benefits of completing that activity outweigh the risks for you know, I played rugby for a number of number of years now anyone who knows rugby, YouTube, but if you don’t know, it can be a pretty rough sport. It’s heavy contact tackling, it’s kind of like NFL without the pads. There is risk of injury. And yeah, I did get some injuries, minor ones, nothing major, luckily. But there is a risk of injury. But to me, that risk was far outweighed by the benefits I got from participating in that particular occupation. I guarantee you will be able to find something in your life right now that you can observably see that the risks are being outweighed by the benefits. What am I getting at? It’s the same situation with this person trying to learn how to walk with their prosthesis and someone else coming in and saying, Nope, that’s not the way we’re gonna do it. Because this is safer. It is the same thing as my little Starbucks question to you at the very start. You are taking away someone’s choice. Now, again, context is everything. Had this person being physically compromised in other ways his body strength is balanced cognitive abilities, etc, then that changes things. But I don’t think people should be automatically writing off the fact that this might be the best way for this person, purely based on the diagnosis, which is exactly what was happening. In the comments of that video. People were assuming that this person needs support, they need all of these assistive texts, they need this best practice of best practice in quotes rehab process because they’re an amputee. And that was it. That was the only information they had. And that was the only information I had. Get. My reaction was slightly different to everyone else’s, because I was like, no good on him. The dude’s trying to do what the dude wants to do. And until told, otherwise, I can’t see how you could be a therapist. It’s kind of like innocent until proven guilty. The person you shouldn’t be trying to wait for the burden of proof to be on the person to prove to you that they’re capable of walking outside on the grass. You’re not the gatekeeper.

You’re there to support people, not to gate keep their progress. And I think that’s a really powerful message for all therapists. Well, no matter what area that you’re working in, we are not the gatekeepers of progress. Doing that isn’t going to keep us in a job. Doing that isn’t going to make us more effective therapists. It’s not going to make us even feel good compared to supporting a person to do something the way they want to do it. That’s gold standard right there. If you’re thinking about the legalities, am I gonna get sued Am I allowed to do this before you think about the person their wishes, their choices and their locus of control There’s something there that you need to look at in your therapy process. Again, I’m not saying that they’re things that you need to ignore. But I’m saying that if you’re thinking about that stuff first, you’re not thinking about the client as the center of your therapy that is not quite centered practice. That is systemic process centered practice, because everything then is going to be based around the limitations put by that system. And you’re only allowing that person to operate within the limitations of our system that somebody else wrote. You’re not allowing them to operate to their potential. And yes, if there are some barriers that the system creates that maybe you can’t go, it can’t overcome. hate to tell you, but maybe it’s time to put your advocacy hat on. Maybe it’s time to do some research and see, well, is this actually best practice? Is this actually getting the best outcomes? Because until that is the default mindset for our therapists, we’re not paying client centered. We’re doing this for the job, or for some people, possibly the prestige of being a health professional, although many people nowadays would probably question how much prestige there is in being a health professional, but you’re doing it for reasons other than the client. And that doesn’t sit well with me. And I know many, many other therapists that I’ve spoken to about this doesn’t sit well with me either. So I challenge you have a think, have a reflects, reflect on my little Starbucks example, reflect on any instances when you’ve been working with clients where maybe you did or didn’t think of them before you thought of processes and rules and guidelines and all that sort of stuff. Again, I don’t want to get a Hebrew reply. So are you telling us to ignore that because I’m definitely not definitely not telling you to ignore your processes and your best practices. But if you want to be truly client centered, it needs to be centered around the client. So have a think about that.

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