Lack of Insight

This week in group supervision…

We were talking about those clients who get referred to OT just because the funding body requests an FCA, or because the Support Coordinator isn’t really sure what else to do. You know the ones - we rock up to their house and get:

“I don’t know.”

“I just want to go to the community more.”

“Cool — what are your barriers?”

“...Nah, nothing.”

And suddenly we’re just the report writers again (yes, a huge part of the role but what about actual meaningful change?).

Here’s the tricky bit: to facilitate change, people need to want to change. But what happens when you’re working with someone who doesn’t have insight? Lack of insight is not just into their abilities, but also into what OT is for, how they could use their funding, or what they’re actually struggling with day to day?

Often these clients are “told” they need OT. They rely on that external messaging and prompts that they should engage with us. But when we come to the party, the above conversation happens… So, do we just discharge..?

This is where we have to be big, brave therapists.

We have to call out the barriers and restrictions, and show them what they can’t yet see.

Because insight doesn’t magically appear. Someone has to be the link. Someone has to hold up the mirror.

Developing insight often looks like doing the occupational (hello task analysis!!):

• Driving unsafe on scooters - lets video, rewatch, talk through mistakes

• Home visit with dirty dishes every where - no notes of needing to clean these? photos, side-by-side comparisons, highlight what they’re missing.

• Don’t want Occupational therapy, but engages well with support worker - se that connection! Educate the worker, empower them to call things out too.

Insight is tricky. Sometimes it sticks, sometimes it doesn’t. But what matters is that you try. Even if your client doesn’t develop insight, they deserve a brave OT who’s willing to name what’s in front of them and kickstart the process of change.

Until next week,
Imogen