Hi John

Thanks for your reply. You put forward some interesting ideas which i will
certainly give some thought.

Jane



-----Original Message-----
From: Jdchacksfield@... [mailto:Jdchacksfield@...]
Sent: Fri 14/05/2004 19:37
To: forensic_occupational_therapy@...
Cc:
Subject: Re: [forensic_occupational_therapy] Occupational Therapy practice with
people...



Dear Jane

This is an interesting question. While I personally do not agree with
Occupational Science as a valid concept (I would recommend covering the argument
for and against this idea in your dissertation), I have observed that occupation
can have considerable effect on people with a personality disorder and promote
positive change.

During my time in a high secure forensic setting, where patients are detained
for an average of 8 years (1999 internal reports), I observed benefits in
patients engaged in vocational activity, in particular.

A good example was the bricklayers department. Here patients learned
bricklaying skills and were also part of a team. The team included the role of
foreman that a patient could act in.
Workers had to interact with each other and with the foreman to share equipment
and cooperate in the designated tasks. This brought the usual tensions and
expressions of personality that are associated with any work setting. People
with personality disorders, however, use different coping strategies and
interactional styles from non-personality disordered individuals. In many
settings this can cause interpersonal difficulties and lead to violent
behaviour. In a forensic setting clearly negative interactions can have negative
consequences for clients. Frthermore, the task of bricklaying can either work or
not. It is not possible to interpersonally manipulate an activity (occupation).
Any attempts to sabotage or avoid work or avoid instructions from the foreman
lead to clear consequences - either the activity is unsuccessful or group
pressure from other workers (who might also be psychopaths) counteracts the
behaviour.
These clear behaviour-consequence patterns lead to change and more adaptive
styles of coping and interaction and greater self-awareness. This is even more
powerful where adaptive strategies are modelled by staff and even further where
patients learn coping skills in a separate group (e.e. social skills or
assertiveness or anger management) and are helped to apply these in the real
activity setting.

Over a long period (sometimes 8 years or more), positive change can occur in a
person's personality. I observed these kinds of changes in several of the
clients I worked with. It is possible that this could be attributed to maturity
- however it is also possible that a group like the bricklayers session can
increase the rate of maturation through targeted appraoches.

A useful theoretical base for this is from Psychology - Carl Jung's theory of
Individuation. Jung says that individuation occurs through the events in our
lives. My theory is that perhaps, through the events that occupational
therapists create, individuation can be facilitated.

Another theoretical base is that of developmental theory (also from
psychology). Here, as applied in OT, a model such as Mosey's activities therapy
model is very useful in planning activities to develop group interaction skills
within the service user.

Rather than occupational science, we can turn to psychology for help and apply
this to help us analyse and understand occupational therapy and its effects on
people with personality disorders.

Hope this helps

John

John Chacksfield
(Former Forensic OT)


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