Working from the Inside Out

I was thinking about my FW last week and just can't seem to get Mr. Z out of my head. Mr. Z made such an impression on me, but not in the usual way. It wasn't his pleasant personality, the expressions of his face, or the way he expressed himself. In fact, it was the absence of all the above that has left me still thinking about Mr. Z. Have you ever thought about how difficult it is to work with someone who has severe flat affect? Think about how frustrating it must be to have flat affect but be feeling so much inside and not able to express it. In class we all learn about strategies for therapeutic use of self. I watched my CI, with years of experience and an excellent therapeutic use of self therapist, struggle with Mr. Z. I thought about myself and how I thrive off of others energy. Therapeutic use of self is a concept that usually comes easy for me, but in Mr. Z's case there is not a lot to work with. He doesn't give any indication that he is happy, sad, tired, frustrated, or even in pain. We can see "physically" his improvements or deficits, but his emotions and feeling are hidden from us. As OTA's we are looking at the whole client, the inside and out. Some of Mr. Z's psychosocial issues we might have missed. Was he feeling confused, anxious, or even self-conscious? Did he remember his past or have any inner delusions? I can't answer those questions and I think that is why Mr. Z is stuck in my head! I have been working on understanding schizophrenia this semester. This topic of flat affect and psychosocial issues got me to thinking about the schizophrenic client as well. Flat affect can be present in many schizophrenia clients. I came across this web page that really helps the reader see inside this situation. If you start with schizophrenia and the negative affects headline, the author expresses how flat affect actually keeps him from forming relationships. The idea is that people don't want to be around the person because they don't get anything from him. Eventually the person becomes isolated and alone and the schizophrenic symptoms only become more exasperated. The web site is very insightful, I hope you get a chance to explore it. One of the reasons I love OT is because we actually look at the client as a whole. The inside is just as important as the outside. Many physical dysfunctions are medically complicated and people need our help in understanding the illness or help taking care of the body part that was affected. The inside work, gaining insight into the problem, dealing with the emotions the injury brings, and even sorting out different feeling and emotions of family members, are all part of our job as an OTA!!