This month I had my first big wobble day, where I really started to think the system I am part of is not working and can I stick this out? 

Every week I attend ward round, when the MDT and I see 6 patients, one by one, for a fortnightly review/catch up. On this particular day it was hard not to feel the frustration of each man as they sat with us. Like a scene out of “Groundhog day” the same ongoing issues holding them back was discussed about what they need to do to progress. My experience is often OT is seen as boredom relief or a discharge checkbox, by both patients and the team. Witnessing this at “Willow House” makes me believe a major change is needed. Could implementing the VdTMoCA be that change?

I came home feeling sad, deflated and exhausted. Meditating with these feelings, I was able to recognise being able to sit in this space of powerlessness was not a space I felt able to breathe in, let alone have energy to enjoy my free time. I just need to recover.

In contrast, on the days when I am able to use my OT skills to enable patients to envision their future after discharge and to start to take steps in that direction, I am reminded why I love my job. There it is possible to experience a sense that in some way I do have agency, I am able to fulfil my role as part of an MDT in supporting the men under our care towards discharge. Over the last month I have had to keep reminding myself that an important part of my role, particularly in forensic mental health, is to attempt not to have attachment to whether a patient chooses to engage or follow the plan we developed together. But to keep trying and believing in their potential. To do this day in, day out can be exhausting. Add to the mix limited resources and complicated working relationships, it has been increasingly difficult. 

This is where having a VdTMoCA lens helps. It enables me to zoom out and see the bigger picture. 

Thanks to having this space as a catalyst to reflect on how to do this, I was prompted to read again the thought provoking post Wendy Sherwood published at the beginning of the year. In it, she encourages the reader to consider their level of creative ability is (a key construct of the model), in relation to their ability to learn and know the VdTMoCA. 

Being able to apply the theory to my personal learning journey really helped my neurodiverse brain consolidate this key element of the model:

Self-Differentiation

VdTMoCA training challenged my thinking. Inner resistance called it a waste of effort, so “destructive” best describes that voice.

Self-Presentation

After training, I actively deepened my understanding by reflecting on core concepts. I did this with help of the model’s key textbook. This demonstrates a “constructive exploration” to learning the model.

Passive Participation

With a mentor’s help over 6 months, I learned VdTMoCA and saw success with clients. Initially hesitant, I relied heavily on guidance, like a toddler learning to walk. This stage involved building “norm awareness” and being “experimental” with the model.

Imitative Participation ?

Reading the section on the discussion and indicators of the “Imitative Participation” level of creative ability in chapter 4 in the VdTMoCA key text book, in terms of my learning and knowing the VdTMoCA, I am in two minds whether I am at this level or not.

I have a strong need to know precisely what it is I must do and how to apply the treatment principles. But as much I try to figure it out for myself, I have come to the conclusion that I need external support to be able to progress. 

Is it possible to get that external support I need through this space?