Running head: OCCUPATIONAL PROFILE AND ANALYSIS

Occupational Profile and Analysis Yara Bezgina Touro University Nevada

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Occupational Profile and Analysis Introduction The client is 52 years old Caucasian male attending sober living community program five times a week for educational and mental health purposes. Client has been sober for nine months and is currently residing in the sober home. Clients history of alcohol abuse is over 30 years. For ten years before admittance to the sobriety program client lived on the streets. Client has a previous history of relapse, just right after three months of sobriety program. Clients current psychosocial diagnoses are substance abuse, Attention Deficit Disorder, anxiety and depression. In addition, client suffers from a number of physiological conditions such as, diabetes mellitus, chronic pancreatitis, and peripheral neuropathy in lower extremities related to diabetes and history of alcohol abuse. Clients task analysis is based on clients participation in group therapy session. This task is considered as social participation area of occupation. Client Factors: Person and Family Client reports that his biggest value in life is keeping sober, and being trustworthy. Client has been able to re-establish his contacts with his family and is currently working on regaining their trust for the first time in 30 years. Client has been able to re-establish his faith in God, and trusts that he was given one more chance to find his purpose in life, and make everything right. Client believes that his motivation and faith in God will help him to achieve his goals, and keep him on the right track. Client reports that living in the sober house is beneficial, and he has been able to see positive change from interacting with others going through the same situation. Client stated that he has become more spiritual, which helps him to deal with stigma of being an addict, and with his low self-esteem. Client is maintaining contact with his family, and stated that his mother is his rock and biggest support. Client also has siblings, a younger brother and sister, and just recently became

OCCUPATIONAL PROFILE AND ANALYSIS an uncle. Becoming an uncle was the biggest event in clients life and he is looking forward to being a part of the family again. Current Concerns According to client, his main concern is his ability to establish healthy friendships and participate in social interactions. Client reports social anxiety and low self-esteem when it comes to any social exchange. Client is unable to initiate a conversation, is shy when engaged by others, and is emotionally dependable and vulnerable on his current friends and family. Client has been unable to find or maintain any employment due to poor social and interaction skills, and reports feeling down and useless because of that. Client has reported feeling bored and inadequate on a number of occasions, and stated that finding structure, meaningful activities (besides staying sober), leisure or work would help him to feel like a normal person again. Areas of Occupation Client stated that he does not feel like he has been successful in any areas of his life for the past 30 years. However, client has been able to stay sober, maintain his health and follow his medication regimen, as well as, establish a few friendships at his sobriety home. Client is successful in managing his Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADL), routines, sobriety community chores, and has been able to work on his education by taking online writing class. Furthermore, client has been able to find new interests such as reading and cooking. Client mentioned that he is responsible for managing and cooking potluck meals every Friday for his housemates. Areas of occupation causing risk are lack of opportunities for leisure, social participation and employment. Participant lacks necessary skills needed for participation in theses occupations, which cause him feelings of sadness, worthlessness, and depression. According to client he has frequent thoughts of relapse, and they occur when he is bored. Client reports that there is lack of

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activities to engage in during the day or on the weekends. This is a potential risk factor that may lead to relapse and loss of established occupations, hence inability to enjoy life and boredom are correlated to more thoughts about using. In addition, client also expresses concerns about being a good uncle, as he has limited social skills, and does not know anything about children or how to interact with them. Context and Environment Contexts inhibiting clients engagement is his current community living setup. Client lives in sobriety home with seven housemates and shares room with three roommates. Client reports privacy concerns, and finds room being too overcrowded for his taste. He gets bothered that his every action is on display and sometimes he cannot participate in activities he likes because he feels shy or judged. Client stated that his community home is equipped with a gym and swimming pool, but he never uses it because he is socially anxious and shy. Furthermore, client reports that inability to use internet is a big disadvantage, because it is so much easier for him to keep in touch with his family through email. Client was able to access internet at the lobby for couple hours a week, when he was taking online class, and wishes that he had an opportunity to self-educate and have more access to virtual resources. Context that supports client engagement in occupations is the social setup of community sober living. Client reported that even though he gets bothered by absence of privacy in his sobriety home, the opportunity to engage in conversations with his roommates and housemates on the daily basis is helpful. Client reported that when he was admitted to the sober living home he had no friends, and over the course of six months he has been able to develop one meaningful friendship, and is able to communicate with his housemates without feeling anxious. Client finds that values of his sobriety community such as, staying sober, finding meaning in life, sharing, and supporting each other are helping him to stay sober and concentrate on his goals.

OCCUPATIONAL PROFILE AND ANALYSIS Another context that supports clients engagement in occupation is Community Counseling Center where he is able to speak about his feelings without being judged. Client reports that educational and social environment of the group setting made him a better person. He was able to establish trust in people, learn a few useful coping mechanisms, and connect to his group members. Client also reports that is social environment is another supporting mechanism, because he relies on the help of his family, friends, and sponsor to help him to get to his goals. Client states that he cannot let down people who invested time and trust in him. Occupational History According to client, he used to have a career as a fine dining cook that he really enjoyed. However, due to his substance abuse problem that started in his mid-twenties he lost his job, and was unable to develop any positive occupations since then. Client reported that he has been unemployed for 30 years, and lead chaotic and hectic lifestyle. Being homeless for 10 years meant that he had no structure to his life, and no responsibilities. His main occupation were drinking, begging, and stealing. Client reports that his main value was alcohol, and he does not want to be that person again. Client has been able to re-establish his life through a number of healthy routines and habits which he learned in recovery program. Clients daily routines consist of praying, staying sober, managing his medications, and attending counseling group. One of his habits is to read inspirational literature before bed, or composing new recipes. Client reports that one of his rituals is to have Sunday for meditation; he says he needs this day to clear his mind, analyze his achievements, and prepare goals for upcoming week. Priorities and Desired Outcomes According to client his most important priorities are: 1) sobriety, 2) maintaining and working on his social relationships, 3) finding employment after he graduates from the program. Client stated that working on his social skills would be his main priority after saying sober, followed by

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learning work skills and finding employment.

Client is also interested in pursuing more

education courses, and is interested in writing as a potential hobby or career. Client stated that in six months he would like to see himself employed, hopefully as a cooks assistant, and back with his family in Florida. Moreover, client also mentioned that he wants to see himself surrounded with friends, engaged in some type of social club, and potentially in a romantic relationship. Body Functions Specific mental functions Client displays problems with sustained attention, and requires frequent cues during group discussions, as he cognitively wonders off or forgets the questions easily. Client has difficulty following logical train of thought, gets confused and is repetitive more than 50 percent of the time. Client presents with mild difficulty with concept formation and requires in depth explanation and reminders. In addition client shows inhibited behavior regulation, and requires verbal encouragement for participation. Client struggles with self esteem and disturbed body image of himself, which affects clients participation in a negative way, as evidenced by social withdrawal and difficulty to engage in group interactions. Client is oriented and aware, however presents with unstable levels of arousal, ranging from lethargic to extremely talkative and excited. Sensory functions and pain Client reports problems with reduced sensory input and occasional abnormal tingling sensations in his lower extremities related to diabetic neuropathy. Client reports reduced pain sensation, occasional numbness, and sensitivity to light touch. Client also reported a few incidents of random twisting pain in his toes.

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Neuromuscular and movement related functions Client reports occasional weakness in his lower extremities, and complains of inability to walk as long as he used to due to muscle fatigue secondary to peripheral neuropathy. Digestive, metabolic, and endocrine system functions Client has history of chronic pancreatitis, but mentioned that his condition is controlled and he is not experiencing any symptoms. Client is insulin dependent and, reports no fluctuations in blood sugar, and is managing his diet and medications. Other body functions Client states that he has no history or complaints related to cardiovascular, respiratory or immunological systems. No speech and voice functions disruptions have been observed and reported by the client. No wounds or skin abrasions have been observed or reported by the client. Activity Demands Space demands For participation in group therapy session a large and ventilated room is required. The room should be dim enough to promote relaxing atmosphere, but spacious enough to position 12 chairs far from each other, so that everyone is within comfortable personal space. Social demands Participants are expected to understand the rules of the group therapy: 1) respecting others and their opinions, 2) taking turns when speaking, 3) avoiding interrupting and speaking over others, 4) keeping all the information discussed in the group confidential and 5) discussing relevant topics. Participants should be able to share personal information, engage actively, and control their emotions in case the discussion gets too personal or unbearable. Participants are expected to maintain attention throughout a three hour group session, and are expected to be able to share supplies or handouts provided by the facility.

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Sequence and timing Participants should be able to arrive on time, introduce themselves, and describe their current emotional status in the beginning of the discussion session. Participants should be able to time their responses and arrange enough time for everyone to discuss relevant issues. Every participant should establish a goal or topic before each meeting that they would like to discuss or come back to. Required actions and performance skills Participants should be able to hear, and answer questions with appropriate tone of voice, and use proper words. Participants should be able to dress appropriately, and maintain alertness throughout the group session. Participants should be able to make independent judgments on when to use the restroom, and excuse themselves properly. Required body functions Participants should be able to sit in the chair for three hours without feeling tired, sleepy or in pain. Participants should be able to stay conscious, alert, and oriented during the group sessions. Participants should be able to speak coherently and should be able to maintain their concentration and attention levels to stay on task. Participants should be able maintain bladder and bowel continence throughout the session. Required body structures Participants are required to have intact auditory (at least on function ear), speech (larynx box), and intact structures of the nervous system to be able to participate in the group. Structures of the cardiovascular, immunological, respiratory, and genitourinary systems do not apply to this scenario, but should be functional in order to partake in community based therapy session.

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Performance Skills Due to psychosocial nature of the setting and clients psychosocial impairment the performance skills such as, motor and praxis, and sensory perceptual skills are not considered in the analysis, since they do not affect the clients level of performance. Emotional regulation skills Client shows difficulty expressing his own feelings, and requires prompting from the group facilitator. Client is emotionally withdrawn, yet if engaged shows inability to control emotions as evidenced by, crying, talking in high tone voice and occasionally lashing out at others. Client is unable to utilize relaxation techniques when presented with something that upsets him, and requires time to calm down and gather himself together. Client shows emotional vulnerability and dependency on social approval from other group members. Cognitive skills Client is able to keep track of conversation during group, but shows mild difficulty concentrating, and remembering details of certain topics. Client is unable to prioritize or choose relevant topic to discuss, and sometimes talks about irrelevant issues during the group. Client forgets the goals or issues he discussed with peers earlier, and sounds repetitive and out of sync with the rest of the group. In addition, client displays difficulty shifting and sustaining attention for longer than 10 minutes, and needs cueing, or facilitation to remain on the subject. Client shows distractibility 50 percent of the time when in group. Communication and social skills Client displays difficulty with initiating conversation, and with maintaining appropriate eye contact during dialogue; client often looks into the ground or sideways when talking to another person. Client is able to maintain acceptable physical space, and acknowledges opinions of others, however client takes critique and advice from others too personally, and either

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completely withdraws from conversation or displays increased emotional reaction. During the group client is shy and unconfident and prefers to stay silent, until engaged. Performance Patterns Habits Client always starts the check in session with stating three things he is grateful for in life. Client also reported reciting in his mind the material he is going to discuss in the group. One of the clients habits is to arrive first, and pick the chair the farthest and in the dimmest corner of the room, or the chair that is right next to the door. Over one month observation the client never picked a different seat. Routines Clients daily routine begins with a prayer and with a phone call to his sponsor or family member. During the group session routine client usually begins with his reflection on previous day, and finishes up with his current feelings. Client follows group rules and complies to sober community routines such as, cleaning, cooking and different chores. Client also writes his daily journal in the evening, and discusses it with his social worker on the weekly basis. Rituals One of the clients rituals is to recite an inspiring quote from the bible before a group or during group discussion; client states it helps him to stay concentrated and on task. Roles Clients main role is a recovering addict, and he states that he does not mind the negative connotation associated with that term, because it reminds him of who he was before and who he is now. Other important roles in his life are being an uncle, and being a good friend and support to others going through the same recovery process. Client is also a group member in

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various support groups like Alcoholic Anonymous. In addition client has a role as a resident of sober living community and is expected to successfully fulfill social expectations placed on him. Functions and Body Structures Primarily Influenced Body functions primarily influenced by participation in therapy groups are mental and cognitive functions that relate to emotional control, sustained attention, concentration and emotional regulation. Mental functions are needed for judgment, concept formation, attention and awareness during group discussions. Execution of movement of oral praxis is required to produce speech and articulate ideas, and global mental functions are responsible for alertness, level of arousal, and level of consciousness. Mental functions are also responsible for temperament and emotional stability, and are a necessary component for participation in therapeutic group activities. Voice and speech functions are involved as the client is required to actively participate during group. Contexts That Relate to Performance Community counseling environment is important for clients performance, as it is set to provide the client with relaxing and non-judgmental atmosphere. This setting is designed to improve clients performance in social situations, and is structured around personal growth and self-awareness. Group rules and facility rules are built in to keep participants motivated, engaged, and respectful. Small group size and family-like interactive environment promote culture of friendship and support that further facilitate clients engagement in occupation. Clients personal contexts such as, recovering addict and homelessness correlate to overall group population, as many of the members have been in the same situation. Clients sociocultural contexts related to sober living community affect his performance in a number of ways: 1) client has limited opportunity for leisure, education or work, 2) conflicts and lack of privacy affect clients social performance and moods, 3) client has no income or financial support and is unable

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to participate in social outings or leisure, 4) client has lack of opportunities to develop friendships outside sober living program. Problem Statements 1) Client requires encouragement and prompting (50 percent of the time or more) to participate in social interactions due to low self-esteem and social anxiety. Clients lack of social skills relate to other barriers that affect his occupational performance and quality of life. It is important to address social participation/interaction problem first; as it will help the client to build a foundation that will be required for engaging in other occupations like work, leisure, and education. In addition, by improving clients self-esteem and social skills we are also working on increasing clients quality of life and family relationships. 2) Client is unable to engage in work related activities due to lack of social skills and poor emotional regulation. Client displays problems with emotional regulation, and shows intense emotional responses to critique or friendly advice. Acquiring an employment and attending interviews will require a client to have good control over his emotions and behaviors. In addition good social skills and understanding of social etiquette are necessary for successful engagement in work. This problem needs to be addressed in order to help the client to learn how to interact with potential employer, co-workers, friends or significant others. 3) Client requires reminders and cueing 50 percent of the time during social interactions due to short attention span and inability to concentrate. Attention span and concentration are necessary components of everyday functioning. Lack of sustained attention may present potential safety risks or loss of employment. For example, if the client found a job as a cook, he will be required to attend to a lot of tasks at the same time; if unable to do so, the safety risks such as fire or burns or injury may occur.

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Addressing concentration and attention will help the client to stay more focused during group therapy, and will help the client to manage life and different occupations in a more efficient and safe way. 4) Client is unable to participate in leisure due to inability to engage in social setting, and lack of skills to adapt to new social situations Client shows lack of skill to adapt to social situations, and is unable to adjust to changing environment or conversation. Client shows no knowledge of how to find leisure opportunities at this time, and will benefit from interventions that will focus on education about available resources. Interventions that will focus on eliciting adaptive response through participation in sports of choice, social events or spontaneous games will be beneficial for the client. 5) Client is unable to maintain emotional stability during social interaction due to lack of coping skills, and increased sensitivity related to low self- esteem. Client shows increased emotional responses during social interactions, and will benefit from learning relaxation methods or coping skills to control self. It is important to address this problem because it causes the client a great deal of stress, and potentially contributes to his withdrawn behavior during group therapy sessions.

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References American Occupational Therapy Association. (2008). Occupational therapy practice framework: Domain and Process (2nd ed). The American Journal of Occupational Therapy, 62 (6), 650-651