The stories we tell ourselves about the past
The concept of narrative captured my interest sometime around 1984 - ironically - because it may have been the Orwell novel with that year ' s title that prompted my thinking on the topic.I was interested in written narrative and how Winston Smith established his rebellion and then his freedom through a written form (even if it all eventually led to a horrible end). I was also fascinated by his attraction to the paperweight that he purchased - something that was old - and seemingly of unknowable utility.What was the purpose of knowledge, or of the past - except that it all did represent a freedom from the drudgery of the p...
Source: ABC Therapeutics Occupational Therapy Weblog - June 16, 2022 Category: Occupational Health Tags: ABC Therapeutics OT practice OT stories parenting Source Type: blogs

The demise of practical pain management
Cast your mind back to the last time you decided to create a new habit. It might have been to eat more healthy food, to do daily mindfulness, to go for a walk each day. Something you chose, something you decided when, where and how you did it, something that you thought would be a great addition to your routine. How did it go? How long did it take to become a habit you didn’t need to deliberately think about? How did you organise the rest of your life to create room for this new habit? What did other people say about you doing this? While we all know a reasonable amount about motivation for change – impo...
Source: HealthSkills Weblog - May 29, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Coping strategies Health Motivation Occupational therapy Physiotherapy Professional topics Psychology Resilience/Health biopsychosocial pain management Therapeutic approaches Source Type: blogs

The New Fascism in Occupational Therapy
I am sometimes hesitant to extend my commentary to the academic editorializing that happens in the occupational therapy literature of other countries, but I am unable to remain silent.  Too often the ideas expressed elsewhere slither their way into the thinking of academics in the United States.And, of course, any objection to these ideas immediately causes one to be branded xenophobic, and usually worse, so I will simply gird myself for that criticism; I know it is coming. Over time I have raised the issue of international ' goodness of fit ' of philosophical constructs - initially in OT24VX presentations. ...
Source: ABC Therapeutics Occupational Therapy Weblog - April 26, 2022 Category: Occupational Health Tags: OT Education OT practice philosophy Source Type: blogs

Rehab Fails: What goes wrong in pain rehabilitation 3
I’m beginning to think this series could grow into a monster – so many #rehabfails to pick from! Today’s post is about rehabilitation that doesn’t fit into the person’s life. Or that the person hasn’t been supported to fit the rehabilitation into their life. THEIR life, not ours! You know what I mean: for six to twelve weeks, this person has been coming along to their treatment sessions, doing the things the therapist suggests. They make progress and it’s time to end the programme. “Good bye patient” the therapist says. And the patient skips off into the sunset, f...
Source: HealthSkills Weblog - April 3, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Clinical reasoning Coping Skills Coping strategies Interdisciplinary teams Occupational therapy Pain conditions Physiotherapy Professional topics Psychology Research Resilience/Health Science in practice Uncategorized Source Type: blogs

Rehab fails: What goes wrong in pain rehabilitation (1)
Well obviously I’m not going to cover everything that goes wrong – and certainly not in one post! But inspired by some conversations I’ve had recently, I thought I’d discuss some of the common #fails we do in rehabilitation. Things that might explain why people with pain are thought to be “unmotivated” or “noncompliant” – because if the rehab doesn’t ‘work’ of course it’s the person with pain who’s at fault, right? So for today, here goes. Starting at the wrong intensity One of the main things that happens when someone’s in pain...
Source: HealthSkills Weblog - March 20, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Chronic pain Clinical reasoning Cognitive behavioral therapy Cognitive skills Motivation Occupational therapy Pain conditions Physiotherapy Psychology Resilience/Health Science in practice biop Source Type: blogs

The problems with polarity frames in occupational therapy theory
There is nothing quite like starting off a Monday morning with a good theory article.  I opened up my Twitter feed to find a link to Taff& Putnam ' s contribution entitled " Northern philosophies and professional neocolonialism in occupational therapy: A historical review and critique. "The authors " suggest with confidence that the current American philosophical landscape in 2021 is a mix of mostly analytic philosophy accompanied by a smaller measure of neopragmatism predisposed to a Continental mindset. " (Taff& Putnam, 2022).  I am uncertain if this is a view shared by all, and to any degree that it is...
Source: ABC Therapeutics Occupational Therapy Weblog - February 28, 2022 Category: Occupational Health Source Type: blogs

Reflective practice
In occupational therapy and some other health professions, reflective practice is a vital part of professional clinical activity. In others – not so much. And the term reflective practice has a heap of assumptions attached to it, so it may mean different things to different people. I thought I’d unpack a bit about reflective practice today because I think it needs to be part of working with people experiencing pain. It helps us get out of our own mindset (when it’s done well), and opens a space for questioning what we do and why we do it – and as you probably all know, questioning is part of who...
Source: HealthSkills Weblog - February 13, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Clinical reasoning Pain Professional topics Research Science in practice Therapeutic approaches critical thinking Health healthcare reflective practice supervision Source Type: blogs

Your patient has psychosocial risk factors: what now?
Congratulations! You’re an insightful clinician who’s offered your patient a screening assessment to find out if she or he has psychosocial risk factors – and yes! they do! Well done. Now what? Do you… send your patient to the nearest psychologist?spend at least one treatment session offering pain neurobiology education?scramble to find a “psychologically informed physio” to send them to, because it takes really highly trained and special clinicians to work with these peoplegive your patient the same exercise prescription you were going to anyway because, after all, they still have...
Source: HealthSkills Weblog - January 16, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Back pain Chronic pain Clinical reasoning Occupational therapy Pain conditions Physiotherapy Professional topics Psychology Research Science in practice biopsychosocial healthcare pain management Therapeutic approaches Source Type: blogs

Making first contact: What to do with all that information! Part 5
People come to see us because they have a problem. So the formulation approach I’m taking today begins from “the problem” and works back and forward. It’s called a “network” model, and is something many of us do without knowing that’s what we’re doing. The network model can also be called a functional analysis where we’re looking at what happens, and what a person does, and the ongoing consequences or loops that occur over time. Angelina comes to see you because her neck is very sore. She’s not sure why it’s sore, or what happened to start it off, but sh...
Source: HealthSkills Weblog - January 9, 2022 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Assessment Clinical reasoning Cognitive behavioral therapy Interdisciplinary teams Occupational therapy Pain conditions Physiotherapy Professional topics Psychology Resilience/Health Therapeutic Source Type: blogs

Making first contact: What to do with all that information! Part 4
In the previous few posts on what to do with all that assessment information I’ve talked about generating a formulation to guide treatment, and a little about how teams might work together to generate one. This post is a little different because I want to situation the discussion around the ultimate aim of therapy. I usually work with people who have long-standing pain that hasn’t changed much and doesn’t seem to be disappearing. I’m not a nihilist, but I do wonder if clinicians are trying too hard to “change pain” when the body doesn’t seem to respond all that much to whatever...
Source: HealthSkills Weblog - December 12, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Assessment Clinical reasoning Coping strategies Interdisciplinary teams Occupational therapy Pain conditions Physiotherapy Psychology Science in practice Uncategorized Source Type: blogs

Making first contact: What to do with all that information! part 2
Last week I described some of the reasons for using a case formulation approach when working through initial assessment information, and today I’m going to describe one approach for organising a formulation. This is the “4 P” formulation, and it’s one that’s often used in mental health (Bolton, 2014). In the 4 P model, there are four questions to ask yourself: Preconditions – Why is this person vulnerable to this problem?Precipitating factors – Why now? This can mean “why is this person having symptoms now?” or “why is this person presenting to this person ...
Source: HealthSkills Weblog - November 28, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Assessment Chronic pain Clinical reasoning Pain conditions Professional topics Research Science in practice biopsychosocial case formulation Occupational therapy pain management Therapeutic approaches Source Type: blogs

Making first contact: what to do with all that information! part 1
Last post I wrote I said I’d continue with a process for structuring and synthesising the information we gather from the initial contact we make with the person. This process is integral to clinical reasoning, and somewhat surprisingly, there’s not a great deal of research to give us guidance on the best way to do this – and it’s even more challenging for those of us working in an interprofessional team setting, where different professions, personalities and assumptions are part of it. If we work backwards from the end point, we might get some clues about what to do. Our end point is to help this...
Source: HealthSkills Weblog - November 21, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Assessment Clinical reasoning Interdisciplinary teams Occupational therapy Pain Pain conditions Physiotherapy Professional topics Psychology Science in practice Uncategorized Source Type: blogs

When occupational therapy and public health collide
 Presented at NYSOTA ' s Annual Conference. 11/13/21Thanks for stopping by to look at my slides!Click here for slides! (Source: ABC Therapeutics Occupational Therapy Weblog)
Source: ABC Therapeutics Occupational Therapy Weblog - November 13, 2021 Category: Occupational Health Tags: OT Education OT practice Source Type: blogs

Making the first contact
How do we begin working with someone who is asking for help with their persistent pain? In this post I’ll describe some of the considerations I have when I begin, because as Benedetti points out, the “meet the therapist moment” is one of the most potent times in the therapeutic ritual (Benedetti, 2011). It’s the time when the person’s expectations and the clinician’s empathy and competence meet, and the “meaning response” blooms. My two clinical questions are: Why is this person presenting in this way at this time, and what’s maintaining their predicament? And wh...
Source: HealthSkills Weblog - October 17, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Assessment Chronic pain Clinical reasoning Science in practice biopsychosocial initial assessment Occupational therapy pain management subjective Therapeutic approaches Source Type: blogs

Pain – or pain-related disability?
I’m struck at how often clinicians focus on pain intensity when how much pain intrudes on life matters more. I wonder whether new therapists might not have read some of the old studies looking at the relationship between pain intensity and disability – because while there is a relationship there, it’s not nearly as strong as we might think. Let’s define a couple of terms first: pain is, I think most of us can agree, “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”. (click for full definition and not...
Source: HealthSkills Weblog - October 3, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Uncategorized Source Type: blogs