Debora A. Davidson, PhD, OTR/L, Clinical Occupational Therapy Editor

Debora A. Davidson, PhD, OTR/L, Clinical Occupational Therapy Editor

I live in St. Louis, a community that, unfortunately, recently has made international news because of violent events. Just so you know, most of us live here in the river city in peace. However, that does not mean that we go untouched by anger, or even aggression. In fact, all of us working in healthcare spend our days doing one of the more dangerous jobs out there. Even if you generally avoid physical assault, chances are you will experience clients’ frustration or even rage as they come up against the realities of loss.

I work with young adults with disabilities who need help to reach their goals for careers, independent lives and a sense of belonging. I strive to engage my empathy, to keep the balance of power weighted on my client’s side and to avoid saying or doing things that could be coercive. When things are going well, this is easy. It’s not unusual, though, for our trajectory of progress to be unexpectedly thrown off by events, moods or changes of heart.

This occurred when a young guy I work with went from acting enthusiastic about his chosen career path one week, to unexpectedly refusing to discuss his plans or much of anything else the next. His face was wooden and his legs jiggled under the table as I attempted to engage him in conversation about next steps for education, training or volunteer work in video game development, his career of choice. He reacted by saying, “You don’t know anything about video games or software development, and my mom is just wasting her money on these dumb sessions.”

My face grew immediately hot as my mind began to race. Wasting their money? I had already brought this guy further in his career exploration and planning in one month than others had done in a year! Dumb sessions? He had been so happy just last week when we found a local game developers group near his home. He had no reason to reject all that we had accomplished to date, and I immediately wanted to correct his thinking and salvage my ego.

My initial impulse was to formulate arguments, but I knew that arguing was not going to be helpful. This guy loved to debate, and he could just decide to fire me today. Instead, I stepped away from the fray in my mind, and tried to imagine what my client might be feeling at that moment. I sat quietly and observed. He looked closed off, kind of pained. His face was flushed, and his eyes averted. His jiggling legs gave a sense of agitation or anxiety. Although his words and behavior invited anger, I called forth my compassion for his discomfort, and began to feel sad for his loss of the optimism of last week.

“I am sad that you seem to feel so discouraged today,” I said, and then waited. (His face grew more relaxed.) “I wonder what has caused this change. Last week you seemed so excited about exploring your career.” I waited for a bit. (He sighed, then said he had looked at the curriculum for computer software development and it seemed too hard and too long.) “I can understand that the idea of a four-year program just seems overwhelming right now. Maybe we need to back up and consider smaller steps.” (His legs stopped jiggling.) Now we could get some work done.

These small, yet pivotal, interactions play out every day, in all kinds of OT care settings, all over the world. They are the fulcrums upon which critical changes in a patient’s whole trajectory can occur, and the foundations of therapeutic alliances. I don’t always get it right, but when I do it absolutely makes my day. Given a choice, compassion and empathy almost always prove the best answer, and always are worth trying.

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