Connectedness is an essential part of recovery that is effectual in restoring mental health and survival in the community (Slade, 2013). It allows for a sense of purpose and meaning, positively impacting mental health (Saeri, Cruwys, Barlow, Stronge, & Sibley, 2018). Social connections will provide Trish a platform where she can deal with her challenges and this will be achieved by strengthening her current relationships, especially with her daughter and grandson, positively impacting on her roles as a mother and grandmother (Slade, 2013). With her family engaging in activities together, Trish would be more likely to participate in social activities (Krupa, Woodside & Pocock, 2010). Building new relationships in communities, will generate a sense of belonging and connectedness (Brown, Stoffel & Munoz, 2010). As an occupational therapist (OT), I will support Trish in building relationships by facilitating therapy groups and community events where she can engage with others who have had similar experiences, forging peer support network that is vital to recovery (Cruwys et al., 2014; Slade, 2013). Decreased connectedness and social reclusiveness is commonly linked with depression (Wade & Kendler, 2000). People who had a sense of connectedness established during therapy groups and in the community, have exhibited lower levels of anxiety and depression (Saeri et al., 2018). I will a encourage Trish to continue her role as a lived experience educator (LEE), adopting it as a therapeutic approach, sharing her experiences, spreading awareness and educating others about mental health care (Happell et al., 2014). As she did not mention the meaningful occupations in her life, I would find out more by utilising the (CPPF) Canadian Practice process Framework (Fazio et al., 2008). I would suggest picking a hobby that is meaningful to her (Scott, 2014). I would then get her to engage in the hobby within a group setting, allowing her to cultivate a sense of connectedness in a positive, non-judgemental environment (Slade, 2009). Working alongside Trish in a client centred way that would make her feel listened to and valued, will also give her a sense of connectedness (Brown, Stoffel & Munoz, 2010).
Hope is being motivated for a better future and cultivating an eagerness for change to improve one’s wellbeing (Heller, 2014). Post trauma, individuals acquire a pessimistic outlook of themselves and life (Scott, 2014). Trish mentioned feeling discouraged from all the times she believes she failed her loved ones and contemplated suicide a few times, this indicates a sense of hopelessness (Cleary, Sayers, Lopez, Shattell ; Cleary, 2016). Trish mentions that she believes that “trying doesn’t protect children…trying is failure…my best wasn’t good enough”. Multiple expressions she said, such as, “How do I live with myself? What do I do? why didn’t I? how does one accept the damage?” projected a lack of hope and uncertainty (Cleary et al., 2016). A noteworthy determinant for suicidal individuals is hopelessness (Heller, 2014). To counter this, Trish needs to be exposed to hopeful environments where she can envision herself perform well in roles that are meaningful to her (Pitt, Kilbride, Nothard, Welford ; Morrison, 2007). My approach towards Trish will affect her recovery; conveying concern and believing in her abilities and strengths, would be first steps of creating a hopeful environment, encouraging productive participation in society (Brown et al., 2010). As an OT I will consult with Trish on what her dreams and goals are and decide upon a plan together with her to reach them (Cleary et al., 2016). I would get Trish to focus on all the good experiences and accomplishments she has attained thus far (Slade, 2013). Recovery is an relies on connections and relationships (Mancini, 2007). Introducing her to others with similar lived experiences, who have had recovery, through counselling or peer support groups will be beneficial for her in becoming self-efficient, as she will gain hope observing others performing in occupations well (Mancini, 2007).
Establishing one’s identity apart from being labelled as a person with mental ill health is the greatest component of recovery (Brijnath, 2015). Identity is aspiring, having dreams and desires unique to one’s self (Slade, 2009). Negative identity with views such as low self-esteem and low confidence impacts performance of meaningful occupations and overcoming stigma (Anthony, 1993; Iwasaki, Coyle ; Shank, 2010). Trish shares, because of her tumultuous childhood, she indentifies as a protector stemmed from endurance and sacrifice. However, she identifies more as a weak individual who was and is incapable of guarding her loved ones from harm. She also identifies as someone unworthy of being part of her children’s lives due to her mental ill health. Identity is impacted greatly with individuals who have gone through sexual trauma during childhood, and to reverse the impact, a sense of self needs to be instilled in Trish (Brown et al., 2010). I will help Trish with positive identity development by introducing interventions that will contribute to her well-being and achieving her goals (Brijnath, 2015; Slade, 2013). I will encourage her to volunteer frequently as a LEE, where she is able to share about the challenges she has encountered, in turn allowing those listening to value her story (Slade, 2009). In the process, she will meet others with alike experiences, giving a sense of “shared experience and identity” (Slade, 2009). Trish mentioned that she felt hurt when her daughter was affected by her actions of shutting her out and cannot comprehend how her daughter could still be supportive. This indicated that Trish was self-stigmatising (Anthony, 1993). I would work together with her daughter to make Trish feel valued and loved, arranging activities that they could do together as a family, such as dining out and holidays (Scott, 2014). I will introduce Trish to art projects such as painting or sculpting, where she can utilise it as therapeutic activities to express her feelings; developing a positive identity (Brown et al., 2010). Trish mentioned she deals with her challenges through self-management and self-indulgence (Brown et al., 2010; Anthony, 1993). As her OT I will create an environment of respect and guide her with strategies to handle her breakdowns, allowing her to be engaged in her own recovery process (Sterling et al., 2009). I will encourage Trish to confide in a friend/s whenever she faces any difficulties, doing so endorses good emotional health (Sterling et al., 2009). Self-indulgence such as leisure and relaxation allow for a renewed sense of self through purposeful participation, aiding with management of post traumatic challenges (Iwasaki et al., 2010). I will encourage Trish to take up occupations such as exercising, meditating, reading and writing (Iwasaki et al., 2010).
Meaning is self-characterizing, not restricted by mental ill health or stigmas surrounding the disadvantages about it (Slade, 2009). It comprises of what matters to an individual, their goals and life purpose (Pilgrim, Rogers & Pescosolido, 2010). Recovery is shifting from estrangement to a sense of worth and determination (Ridgway, 2001). Significant adverse life experiences such as Trauma, generates negative meaning, affecting one’s occupational performance in their meaningful role/s (Pilgrim et al., 2010; Slade, 2009). My goal as Trish’s OT is to guide and support her towards constructing meaning and motivation in her valued roles and occupations (Brijnath, 2015). I will seek to find out about the occupations she values and has interest in and delve into the meaning she associates with them (Brown et al., 2010). I will conduct an initial interview based on the Person Environment Occupation (PEO) model, as it would allow me to acknowledge Trish, her valued occupations and her environment as well as detecting any impediments affecting her performance (Fazio et al., 2008). Circumstances in one’s life, such as divorce affects meaning (Pilgrim et al., 2010). Trish mentioned having split with her ex-husband, thereafter not trusting to be in a relationship. She was also a hard-working single mother. Studies show the idea of being desired and cherished that comes with motherhood provides meaning and purpose to one’s existence (Pilgrim et al., 2010; Slade, 2009). However, she mentions that she used to be her daughter’s everything, this indicated Trish had a loss of meaning in her valued role as a mother later (Pilgrim et al., 2010). Trish expressed self-reproach, regret and dispiritedness. I would get Trish to voice out her emotions either through writing or sharing with others, this narrative approach aims at her strengths, assisting with social participation allowing for recovery (Brown et al., 2010). Engaging in occupations like daily walks, provide routine and meaning (Iwasaki et al., 2010). Mental distress can be viewed as a spiritual occurrence; Spirituality impacts meaning in life, as an individual will be able to accept their future’s unsureness (Ridgway, 2001). Religion involvement is a critical part in establishing meaning, therefore I will locate religious associations that support individuals with mental ill health and respect Trish’s decision on the matter (Pilgrim et al., 2010). Through her continued role as a LEE, she will foster concern for others generating meaning in her (Ridgway, 2001).
Empowerment is a recovery aligned attitude that presumes an individual’s ability to be liable on their own through their strengths and behaviours regarding life choices, treatments and being part of society (Brijnath, 2015; Slade, 2009). Studies evince that empowerment is paramount in the recovery of individuals with mental ill health, positively impacting (Pitt et al., 2007). As her OT I will make sure she is supported and validated, I will enlighten Trish about her symptoms and coach her with self-help skills (Sterling et al., 2009). I will help her in identifying her strengths and weaknesses (Sterling et al., 2009). “peer to peer” courses will help her observe others with similar challenges empower themselves (Happell et al., 2014). Involving herself with music and travelling will steer Trish to lead an empowered life (Iwasaki et al., 2010). I will introduce various options of treatments that is available to her, having the autonomy to pick whichever option will reinforce self-competence and empowerment (Mancini, 2007). I will help Trish’s role as a LEE to be utilized to convey her recovery goals (Lloyd, Waghorn ; Williams, 2008). I will aid in nurturing Trish’s self-esteem and outlook through self-help books and activities, this will cultivate optimism, beneficial for recovery (Lloyd et al., 2009; Scott, 2014).
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Scott, M. J. (2014). Moving On After Trauma: a guide for survivors, family and friends. Hoboken: Taylor and Francis.
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