You are on page 1of 12


Case Study: Mr. Mackintosh

Gretchen Kempf
The University of Scranton

This paper critically examines the structure and techniques used in an interview,
conducted in November of 2013, with Mr. Daniel Mackintosh, a 57-year-old C5-C6
quadriplegic, through the use of the Microsoft program Skype. It also discusses the use of the
Canadian Occupational Performance Measure (COPM), which was utilized in the interview, and
examines how the COPM enhances the client-centered approach to therapy. This paper also
provides some background information on Mr. Mackintosh and his disability and suggests
several hypothetical treatment goals that could be used to guide treatment if Mr. Mackintosh was
an actual occupational therapy client of the interviewer.

On November 8, 2013, I interviewed Mr. Daniel Mackintosh from his home in Chalfont,
Pennsylvania, utilizing the voice and video features of Microsofts Skype software. This was
my first experience in using this type of software application for an interview and proved to be a
very different undertaking than interviewing someone face-to-face. Conducting an interview
through the use of technology was much more difficult than I had anticipated. Although I
generally was able to see Mr. Mackintosh for the entire duration of the interview, the picture
image sometimes briefly would freeze or cut out completely and the microphone feature also cut
out several times. This made it hard to catch everything that Mr. Mackintosh was saying and I
had to interrupt him numerous times to ask him to repeat responses to questions. This was
problematic during this interview in particular because Mr. Mackintosh was talking about his
disability, which is a deeply personal topic that can be difficult to discuss openly with others.
Asking Mr. Mackintosh to repeat emotionally-charged information had the potential to create a
true rift in the interview process and I worried that this would overly upset him; thankfully, he
did not seem to mind my requests to repeat himself. I also found that when the microphone
and/or video would cut out, Mr. Mackintosh and I would talk over one another, or start talking at
the same time, due to the loss of visual and/or audio clues as to when the other person was
talking. The use of technology made the interview process awkward at times and added
unnecessary stressors to a situation that was, by its nature, already stressful enough. Given the
chance to re-interview, Mr. Macintosh, I certainly would opt for a face-to-face interview.
Mr. Mackintosh is a 57 year-old C5-C6 quadriplegic. He is the father of my best friend
from high school, Danielle, her older brother Corey, and her younger sister Maggie. He lives
with his wife, Judy, and his children in a single-family home in a suburban neighborhood about
25 miles northeast of Philadelphia. In 1991, when Mrs. Mackintosh was pregnant with their
youngest child, Mr. Mackintosh was swimming laps in an in-ground pool at a company party
when he misjudged the distance to the end of the pool and hit his head on the concrete wall of the
pool. Trying to play it off, he got out of the pool, walked to the side of the pool, and jumped
back in the water. As soon as he hit the water, Mr. Mackintoshs body went numb and he was
unable to move any of his limbs. The next thing he remembers is waking up four days later in
the trauma center of the local hospital. He learned that someone had seen him on the bottom of
the pool, pulled him out of the water and revived him using CPR. Doctors speculated that if Mr.
Mackintosh had been under the water for a mere three to five seconds longer, his chances of
being revived would have been slim.
Mr. Macintosh eventually was transferred to Thomas Jefferson University Hospital in
Philadelphia where doctors told him that he most likely had broken his neck when he hit his head
on the wall of the pool and his subsequent jump into the pool caused the broken ends of his
cervical bones to severe his spinal cord. While in Jefferson Hospital, Mr. Mackintosh was in a
state of extreme confusion; he could not make sense of the tubes and wires surrounding his bed
and of the metal halo that had been surgically affixed to his skull to support his neck. He had no
functional movement at all at that time. Upon his discharge from the hospital, Mr. Mackintosh
was transferred to Magee Rehabilitation Hospital in Philadelphia for intensive occupational
therapy and physical therapy and his stay there lasted for two and one-half months.
After leaving Magee, Mr. Mackintosh returned home where he continued to receive
occupational therapy for several months. The occupational therapists treating him at home
provided him with skilled instruction regarding the utilization of adaptive equipment designed to
increase his independence in performing tasks such as handwriting, self-feeding, working on a
computer, and picking up items, all of which were difficult tasks for Mr. Mackintosh due to his
severely compromised ability to grip objects or otherwise use his fingers. Mr. Mackintosh was
able to recover some movement in his upper extremities and a limited range of motion in his
legs. He continues to receive physical therapy to this day to strengthen his upper body.
Mr. Mackintosh owns a variety of adaptive equipment, which affords him a greater
degree of independence. He has an electric wheelchair that gives him functional mobility and
that reclines to allow him to relieve some of the pressure on his bottom to prevent the
development of pressure sores. He also has a van that has been adapted and customized to allow
him to drive. He is only able to drive short distances, however, because of painful neck and back
cramps that are triggered by his position behind the wheel. He also has adaptive wristbands that
allow him to write and to pick up small objects.
I chose to interview Mr. Mackintosh because, although I have known him and been
around him for years, I never knew much about his disability. As the father of my best friend in
high school, Mr. Mackintosh used to pick us from soccer practice in his adaptive van, which I
always found very fascinating. I did not want to ask too many questions at that time out of fear of
making my friend or her father uncomfortable. In addition to my natural curiosity about Mr.
Macintosh, my choice of him as an interview subject also was spurred by my dream to one day
work at Magee Rehabilitation, or a similar rehabilitation institution, on a spinal cord injury unit.
I also thought that Mr. Mackintosh would be a good candidate for this interview because he has a
wicked sense of humor and does not seem to take himself too seriously. I knew his humor would
go a long way in making us both feel comfortable during the interview experience.
I chose to interview Mr. Mackintosh using the Canadian Occupational Performance
Measure (COPM). This assessment helps to formulate a true picture of the quality and
functionality of the life a person with a disability is experiencing currently and takes into
consideration the patients personal assessment of how well they are performing the tasks they
want to do, expect to do, and/or need to do. It also takes into consideration the clients
satisfaction level with their progress and performance. This assessment allows occupational
therapists to use the information generated directly by the client with regard to the areas of their
lives they would like to improve or change. If Mr. Mackintosh was my client, I would be able to
use the information gleaned from this interview to make his treatment sessions as client-centered
as possible since the problem areas to be addressed in therapy would have been identified by Mr.
Mackintosh himself. I actually enjoyed this assessment because I think Mr. Mackintosh
benefited from our discussion of possible problem areas; the interview seemed to help him
articulate why some activities in his life were more important to him than others.
The COPM seemed to be a more appropriate tool to use than other assessment tools
because it gave me detailed insights into Mr. Mackintoshs life as it is today. I was hesitant to
use other assessments that required me to examine in depth his life before his accident because I
thought that would stir up too many bittersweet memories for him. I certainly did not want this
interview to be emotionally draining or painful for my subject. Also, since Mr. Mackintosh
sustained his C5-C6 injury well over twenty years ago, it would not be beneficial for a therapist
to spend an inordinate amount of time comparing the function he had before and after the
accident. The function that Mr. Mackintosh has today, twenty-two years after his accident, most
likely is at a stable level and his current chances for improved functionality are quite slim. If he
were my client, it would be my job to work with the function he has now and to adapt his
lifestyle so that he could maximize his functionality in his everyday life routines. I would be less
focused on helping him to regain lost functionthat would have been a more appropriate focus
during the acute phase of his recovery. The COPM was the most appropriate assessment because
it did not remind Mr. Mackintosh of what he has lost due to his accident and it allowed him to
view his life clearly as it is now and to identify areas in which he would like to see improvement.
Before launching into the COPM, I asked Mr. Mackintosh some background questions
regarding his disability. This gave me a better understanding of possible problem areas that he
might later identify in the COPM and gave me a generalized understanding of his current
functional capabilities in advance of my actual implementation of the COPM. This introductory
phase also served to build rapport and to set the tone for the balance of the interview. Mr.
Mackintoshs very emotionally-charged story, and his willingness to open up to me about it,
made me feel closer to him. I was both elated and grateful that he felt comfortable enough to tell
me his story in such great detail. Developing relationships is the most essential skill that a
therapist brings to any treatment session. If Mr. Mackintosh was my client, our relationship
would create the foundation for building trust, understanding his needs, and ensuring that
treatment was individualized and customized for him (Drench, Noonan, Sharby & Ventura,
As mentioned above, the COPM is a tool that allows the therapist to take a client-
centered approach to guide treatment since the client personally identifies all problem areas. The
client-centered interview goes a long way toward demolishing any power struggles during an
interview (Drench, Noonan, Sharby & Ventura, 2013). If I were going to treat Mr. Mackintosh, I
would use the COPM to identify those areas in his life in which he was least satisfied with his
performance and I, in turn, would focus treatment on activities designed to bring about
improvement in these areas. I also would take into account the relative importance that Mr.
Mackintosh assigned to each such area, which data would be compiled and recorded as an
integral part of the COPM.
After assessing Mr. Mackintosh using the COPM, he was able to identify five important
problem areas in his everyday life in which he was not 100% satisfied with his performance.
These areas include the use of his hands, his inability to obtain a paid job, issues with shopping
independently, issues with driving, and issues with dressing himself. From these five concerns, I
was able to develop the following three treatment goals that would be implemented into my
theoretical treatment of Mr. Mackintosh: 1) Patient will complete a simple meal preparation task
while utilizing adaptive equipment to increase use of hands with moderate assistance by week
three; 2) Patient will perform community outing at a local grocery store to increase independence
with shopping requiring moderate assistance by week two; and 3) Patient will perform lower
body dressing utilizing adaptive equipment requiring maximum assistance by week two.
Throughout treatment, as Mr. Mackintosh and I continued to focus on these goals, the
expectation is that the level of assistance he requires would decrease as time went on.
Mr. Mackintosh, due to the severity of his injury, must rely on a caregiver and his family
to help him participate in many daily activities. He has a caregiver that comes in every morning
to help him brush his teeth, shower, shave, dress, and transfer from his bed into his wheelchair.
This same caregiver comes again in the evening to help him with his bedtime routine and to help
him transfer from his wheelchair into bed. When his caregiver is not present to help him, Mr.
Mackintosh depends heavily on his family members to assist him. Mr. Mackintosh talked at
great length about how important and helpful his family has been throughout his entire journey.
The support they have given him over the years has truly made life easier for him. Since Mr.
Mackintosh has a lot of difficulty using his hands, his family takes sole responsibility for such
tasks as making his meals, emptying his urine bag, andlastly, but not least!-- entertaining him.
After learning about the roles of caregivers and family in my advanced interpersonal dynamics
class, I think that it is safe to say that if Mr. Mackintosh was my client, I definitely would
incorporate his family and caregiver into treatment as much as possible since they play such
critical roles in his life. This incorporation would help his family learn more about the things he
can and cannot do for himself and it also would help motivate Mr. Mackintosh in therapy since
he would have his support system at hand.
During the interview, Mr. Mackintosh did share that, although his family members have
taken on extra burdens in the household due to his condition, he has taken on the role of
managing the finances of the household. Our discussion of his role as the financial manager of
the household helped us to segue into the topic of his work experience. This was an area of his
life with which he was quite displeased. After his accident, his attempts to find employment all
proved fruitless since, to his way of thinking, he is unable to use his hands to his satisfaction. He
has held many volunteer positions since his accident, such as being a member of the township
parks and recreation committee and working at a local elementary school; however, it bothers
him to no end that he has not been able to be a financial provider for his family.
I am confident that I was able to use therapeutic use-of-self with rapport, insight,
patience, humor, energy, honesty, and my voice and body language during the interview. I did
my best to show Mr. Mackintosh that I wanted to be there and that the interview was my number
one priority. We chatted between questions which allowed him to elaborate on some of his
thoughts and we both were very honest with one another. If he did not understand one of the
questions or if I was unable to follow one of his responses, we were both comfortable in asking
for clarification. I was able to joke around with him, which helped to lighten the mood of this
interview about a difficult subject. As I did in my interview with Mrs. McCarthy, which I
conducted a few weeks prior to this interview, it was important for me to keep in mind that Mr.
Mackintosh was my elder to and treat him with appropriate decorum, respect and deference.
As a result of conducting this interview, I realize that the therapeutic process is made
much easier when you let the client take center stage. During the interview, Mr. Mackintosh
discussed which of his therapists he did or did not like. I was saddened to learn that very few of
his occupational therapists had taken the time to focus on the issues that Mr. Mackintosh felt
were most important. They seemed more concerned with directing therapy toward areas they
thought he should want to focus on. Permitting and recognizing the client to be the expert on
their condition and allowing them the time to discuss areas in their lives with which they are
dissatisfied is extremely important. To increase the quality of life for any client, a good therapist
must take time to sit back and listen carefully. This action serves to increase the motivation a
patient has to participate in the treatment and to enable the therapist to build a better rapport with
the client since it demonstrates that the therapist cares about the patients wishes and needs.
This course, in particular, has alerted me to the aspects of a disability that may be
somewhat hidden during an initial assessment of a client. It is critical that I keep in mind that the
emotional and mental aspects of a disability can be even more disabling than the physical
aspects. I also now am cognizant of the fact that a successful therapist must focus attention on
the client while taking into consideration the other individuals who may be important
contributors to the big picture. It also is important to recognize that even though incorporating
family members and caregivers may be an important factor for consideration, it may not be
appropriate for certain clients. No two clients are ever the same even if they are living with the
same disability. Family dynamics and support systems vary greatly and it is crucial to
understand the clients perspective of family members and/or caregivers before including them
into the treatment plan. This course has allowed me to see both the positives and negatives that
exist in the field of occupational therapy and has strengthened me in my resolve to become a
therapist who is client- centered, who utilizes occupation-based treatments, and who is viewed
by my clients as one their biggest fans and supporters.
In summary, I really enjoyed having to do this interview since it afforded me the
opportunity to get to know someone, with whom I have been acquainted for years, on a much
more personal level. I now have new respect for all that Mr. Mackintosh has accomplished (and
continues to accomplish) and for the manner in which his entire family teams up to support him
and one another. I also am glad I had the opportunity to conduct another interview prior to this
one, because that experience boosted my confidence level going into an interview that I knew
had the potential to be emotionally-fraught and extremely personal. The prior interview
experience enabled me to step out of my role as Mr. Macintoshs daughters friend and, instead,
present myself to Mr. Macintosh in a professional manner. Since the two interviewing
experiences were very different in many aspects, I was able to draw unique valuable lessons
from each. My initial interview experience with Mrs. McCarthy served as a wake-up call to the
fact that the interview process can be quite stressful and challenging and a successful interview
requires thoughtful advance preparation and careful use of technique. My interview with Mr.
Mackintosh underscored those lessons and additionally drove home the lesson that the utilization
of client-centered therapy session is of crucial, vital importance to the effectiveness of therapy.
The emotional impact of Mr. Mackintoshs interview, and his insights into what makes for a
successful therapy session, surely will stay with me forever. I am so grateful for this experience
that has enriched both my professional and personal life.

Drench, M., Noonan, A., Sharby, N., & Ventura, S. (2013). Communication. In
Psychosocial Aspects of Health Care (3
ed.). Boston: Pearson Education.