Early in my career, I worked as an occupational therapist in a busy office with seven other colleagues. Looking back, I realise my neurodiversity made me more sensitive to that environment than perhaps a neurotypical person would have been. Working from home in the community team was a positive change but it did have its challenges. When the opportunity arose to return to an inpatient setting, my biggest fear was sharing an office again. I just wasn’t sure how I would handle the sensory overload. However, my understanding of my neurodiversity and having coping strategies helped me manage. Another advantage I learnt is having face to face access to other MDT colleagues who work with the same patients.
One strategy was personalising my work space by sticking above my work station a card with these words on it:
“Growth and recovery of creative ability occurs as a result of exertion of effort in meeting challenges resulting in tangible or intangible products.”
It was one of the first nuggets of VdTMoCA theory that gave me a bit of an “AHA moment”. Due to my neurodiversity I had a tendency to over think what I was doing with a patient, and often devise over-elaborate intervention plans. This often meant I spent more time planning than with being with the patient. These 23 words of gold nugget theory stuck up on my wall act as a compass and a constant reminder: this is what I need to focus on.
The question is how can I create opportunities for the patients under my care to experience this?
The men at Willow House have access to a kitchens in their different flats but rarely use them. I saw this as an opportunity to promote patient growth and recovery through a cooking group. The group would rotate through the flats, with residents being invited to contribute to a shared meal in each flat. This approach offered a chance to build social connections, a key component for growth in the VdtMoCA.
The groups of men living in each flat together had all sorts of cooking skills – some were confident, while others were nervous beginners. In one of the flats, I approached “Jim”, who was notorious for bending the rules, unexpectedly suggested making a complex African dish. Although I was aware of his history of causing difficulties, his genuine enthusiasm and detailed explanation about the recipe, including each step and the necessary ingredients, persuaded me to support him in his plan. The experience itself became a revelation. Not only did it showcase Jim’s talent in the kitchen, but it also unveiled a surprising leadership quality within him. Throughout the cooking process, Jim unofficially assumed the role of a mentor, patiently guiding “Jess”, his peer also in the same flat, who was eager to learn new recipes. By the end, we had not only enjoyed a delicious dish, but I had also gained a newfound appreciation for Jim’s capabilities and potential.
In these first proper OT group sessions I had the opportunity to deliver at Willow House, I realised I’d been using the VdTMoCA framework without even thinking about it! Rather than just see the mundane details of a cooking session, I observed how each man was different in how motivated they were and how well they handled the unexpected challenges that came up (which is what the VdTMoCA calls the “creative response”).
Please share a positive experience of seeing the world through a VdTMoCA lens in the comments section.
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Your observations of the cooking session are interesting, considering the different levels of motivation. The creative response indeed reflects the preparedness of both participants to exert effort. It would be interesting to know the levels of the two individuals and how you go on and structure and present sessions applying the treatment principles to your practice. If you are now in a position, that you feel confident in using the VdTMoCA, our readers may need some more guidance on how this session would be executed.
Thank you so much for your question. Without clinical supervision from a VdTMoCA practitioner, having questions like this from the VdTMoCA community is the one of the primary reasons for creating this blog.
This is particularly useful as I have now completed the first cycle of sessions in all flats. This week in supervision, my supervisor and I are going to evaluate what I learnt and decide what next.
Giving this some thought what I think is important next is:
Jim is not my patient. My supervisor is his occupational therapist. She is supportive of me using VdTMoCA but has her own practice. To be able to add to my observations of Jim, I could request to discuss him with my supervsior using the CPA grid to determine his level of creative ability. It could also be an opportunity to better understand what her treatment aims are for him, and to agree how this second session could contribute to his recovery.
Into to the mix I am hopeful another patient in their flat would join the next cooking session ( who was not able to join the last one). He this a patient I know well and he is an accomplished, confident chef who loves food.
With this information I would then approach the patients to discuss what is important to them and how they would like to build on the previous session.
Any thoughts?
There are many ways to approach your work, so this is just something thrown into the mix to stimulate your thinking. You might have thought of all this already, of course, but other readers may be interested.
First bullet point above – just because it’s an unfamiliar activity, doesn’t mean it should be pitched at Self-presentation (SP). If he is in the transitional phase, it might better be pitched at Passive Participation (PP). It’s the phase that will determine what level to design and grade activity to. I just want to state that, particularly for newcomers to the model who may be misunderstanding how one clinically reasons the level. This is the difficulty of publicly discussing a case – it’s complex, and there’s no easily explained clinical reasoning. If people are looking for ‘the answer’ or a recipe for what to do, they shouldn’t find it in forums like this, only some learning.
To gauge the level of Jim (and Jess who has some components in SP and some in PP), may I suggest that you step away from the Creative Participation Assessment form (CPA). It’s great that you’re using it, and you should do -well done. But it’s also important that you can start sensing someone’s level just from being around them and seeing their action. SP and PP are very different, especially when they’re doing activity with end-products. Ask yourself, “what is this person after? Trying to gain?” from their doing of activities and in their relations with others?
Making products in a social situation/for a social situation, e.g. cooking a meal for others…..
A person on SP, particularly in the therapist-directed and patient-directed phase, tend to have a lot of energy and enthusiasm for the doing of it, without thinking a great deal about whether it is good or right FOR OTHERS. PP are more likely to have performance anxiety, and are carefully following the recipe, measuring everything carefully, checking on everything. SP, not so much. PP are more likely to be considering others – will it be too spicey for some? Should I have some options for people to choose from? Will it be ready in time? Have I made enough? Does it look good? This consideration and degree of anxiety is not evident in SP in early phases. End products are an extension of oneself – they are the products of your efforts. SP ‘deliver’ or show end products in order to gain positive feedback, which makes them feel good – it is affirmation that they are liked. Remember that SP is SELF-presentation – it’s predominantly all about finding out whether you like ME. Ultimately, making this meal is all about ME.
If the person is on PP, it will be quite a different presentation. It is about whether what I have done is good enough FOR YOU. Positive feedback on SP absolutely delights them – they can’t hide it. On PP, it’s less comfortable to receive (although important), because there’s probably still some doubt about whether they did it well enough, and small errors will be on their mind.
So, all of this is evident because it’s how a person behave, how they present. It’s their action, which is expressing their VOLITION. So, always when working with a client, ask yourself, what is this person after? What is driving how they are, what they’re doing and WHY they’re doing it? The volition aspect will show in most of what they do. You use the CPS form to find out what’s happening in the components to result in the overall picture, but when you’re with clients, focus on answering this question – WHY is this person doing, behaving, interacting in this way? If you’re only seeing other people rarely, you won’t have enough assessment information to accurately complete the CPA form – but you can get a sense of the level. You must of course, recognise that the sense of the level is only in that one situation.
You and I have had detailed correspondence via email before, so you know that I can’t commit this much time to discussing clients regularly – this is not clinical supervision. But I will drop by and see if there’s anything I can offer to be helpful from time to time.
Your discussion has reminded me of a couple of clients I observed and provided supervision for, and also of an approach to group cooking. That’s all too detailed to post here, and it is after all a forum for you to share your journey, so I’ll share that info on my own site when I have time https://www.patreon.com/icancreativity
Thank you Wendy for taking the time to give me so much to consider and chew on.