Occupational therapy interviews

Definition

The occupational therapy interview is the initial fact-finding session between an occupational therapy practitioner and a patient to determine the patient's problem(s) and to discuss possible intervention and treatment.

Purpose

The interview is the first opportunity for the occupational therapy practitioner to get a complete picture of the problems, concerns, and limitations of the patient. All of the information gathered is used toward defining a treatment plan. During the interview, the therapist should learn about how the patient perceives himself or herself in various roles at home, school, work, and during leisure time. The patient also should express goals he or she would like to achieve and what needs should be met.

However, the initial interview should not only be an information-gathering experience for the therapist, but also for the patient. The interviewer should explain his or her role as an occupational therapist and how he or she will facilitate an independent and functional life for the patient. It is the initial interview that helps to set the stage for treatment and becomes the foundation on which the practitioner-patient relationship is based.

Precautions

The therapist should be prepared to gather information about the patient, such as the patient's needs or lifestyles, that the therapist may not agree with. Occupational therapy practitioners need to remain open-minded in any evaluation process and recognize that patients may have differing moral and philosophical views.

KEY TERMS

Assessment —A specific test developed to measure a particular function or role of a patient. In occupational therapy, the words assessment and evaluation are not used interchangeably.

Evaluation —Determination of a person's ability or function using an assessment.

Narrative —A detailed account of an event or experience.

Description

Interviews between the occupational therapy practitioner and patient may begin by the therapist explaining the meaning of the occupational therapy profession and what the therapist hopes to achieve through the rehabilitation process. It is important for the patient to understand what is expected of him or her, and understand that the mission of occupational therapy is to facilitate independence and function within the client's life. The therapist also should cover areas of rehabilitation that pertain directly to the patient's needs, such as physical or mental disability, arthritis, sexual dysfunction , or a learning disability.

An effective form of interviewing is the narrative interview where the patient is permitted to speak at length and in depth about his or her life, problems, concerns, or any other topic. This allows the patient to speak freely about whatever topic that troubles or interests him or her most. In any type of interview and throughout the rehabilitation process, the occupational therapy practitioner should employ good listening skills and answer questions with great thought. Therapists should not ignore the use of metaphors during the interviewing process. Studies have shown that it is not uncommon for patients to use symbolic images that represent a feeling in their lives, such as entrapment or fear.

In occupational therapy, several assessments exist in which the patient's occupational performance is measured. They include, but are not limited to, the Canadian Occupational Performance Measure (COPM), the Assessment of Occupational Functioning (AOF), the Occupational Performance History Interview (OPHI), and the Activity Configuration. Each of these assessments yield information on education, work, leisure, activities of daily living, and a patient's satisfaction in his or her performance in daily activities. Several specific areas of the interview should include:

• • Education: type of school the patient attended, highest level achieved, grades, social clubs involved in, and career aspirations.
• Work history: past and present jobs, likes and dislikes about job, desirable type of job, preferences of working alone or with others, and plans for future jobs.
• Leisure activities: involvement or interest in sports and hobbies, and whether the patient has a desire to get involved in sports and/or hobbies.
• Culture: what cultural group does the patient identify with, and what customs does the patient engage in, if any.
• Daily schedule: roles and the balance between all roles.

Preparation

In order to sufficiently prepare for the initial interview, the occupational therapy practitioner should plan ahead. The practitioner should arrange for an environment that is conducive to a private interview. Because the therapist's goal is to facilitate openness, the patient should be made to feel comfortable and assured that the information relayed will be kept confidential. The therapist should plan at least several questions in advance that are open-ended and allow for sharing. The practitioner also should plan on taking notes and/or recording the interview. However, they should keep in mind that notetaking and recording can make some clients uncomfortable, so the therapist should explain why it is important to thoroughly document all information shared during the interview so that a comprehensive treatment plan can be formed.

Aftercare

It may be beneficial for the practitioner to seek out the client's family members, friends, or co-workers to gather more information following the initial evaluation with the client.

Results

The occupational therapy practitioner assumes many roles when beginning treatment with a patient: counselor, caregiver, evaluator, researcher, and advocate. The practitioner's comprehensive approach to treatment is imperative to a patient's success.

Health care team roles

A patient seeking occupational therapy services almost always will have contact with other health care professionals who should factor in to the patient's treatment program. Physicians should be kept abreast of ongoing progress. It is always possible that the occupational therapy practitioner will refer a patient for further treatment; for example, mental health counseling that is more specialized. Occupational therapy practitioners must work collaboratively with physical therapists, speech pathologists, and any other health professional the patient has consulted.

Resources

BOOKS

Neistadt, Maureen E., and Elizabeth Blesedell Crepeau. Willard and Spackman's Occupational Therapy. Philadelphia: Lippincott-Raven Publishers, 1998.

Reed, Kathlyn L., and Sharon Nelson Sanderson. Concepts of Occupational Therapy. Baltimore: Lippincott Williams & Wilkins, 1999.

Williams Pedretti, Lorraine, and Mary Beth Early. Occupational Therapy, Practice Skills for Physical Dysfunction. 5th ed. St. Louis: Mosby, 2001.

PERIODICALS

Mallinson, Trudy, Gary Kielhofner, and Cheryl Mattingly. "Metaphor and Meaning in a Clinical Interview." American Journal of Occupational Therapy 50 (May 1996): 338–46.

ORGANIZATIONS

The American Occupational Therapy Association. 4720 Montgomery Lane, Bethesda, MD 20824-1220. (301) 652-2682. <http://www.aota.org>.

Meghan M. Gourley