Academic journal article British Journal of Occupational Therapy

The Role of Occupational Therapists in Supporting Psychological Wellbeing after Stroke Using a Solution-Focused Psychological Approach to Mood Assessment

Academic journal article British Journal of Occupational Therapy

The Role of Occupational Therapists in Supporting Psychological Wellbeing after Stroke Using a Solution-Focused Psychological Approach to Mood Assessment

Article excerpt

This practice analysis describes a solution-focused approach to mood assessment and care with stroke survivors. A brief introduction to a solution-focused approach is detailed, together with the rationale for its use in stroke rehabilitation settings. The mood assessment procedure is described, with reflections from occupational therapists using the approach. Implications for how this can enhance patient-centred care in line with current United Kingdom Department of Health principles are outlined.

Statement of context

The author works as a clinical psychologist within a multidisciplinary stroke rehabilitation service in a National Health Service (NHS) setting. The need for good psychological care after stroke is currently a priority area as part of the overall NHS Improvement Strategy for Stroke (NHS Improvement 2011). The example described in this practice analysis is from an inpatient setting.

Critical reflection on practice

A solution-focused approach in stroke

A solution-focused approach has its roots in solution-focused brief therapy (SFBT) and is interested in first establishing what a person's 'best hopes' are, then amplifying their existing expertise and noticing what the smallest sign of 'even better' might look like for them (de Shazer 1985). A solution-focused approach shares many of the guiding principles of occupational therapy, not least in regarding the client as a unique individual who is expert in their life, and in focusing on strengths and resources rather than problems and disabilities (Duncan et al 2007). A range of literature from the field of positive psychology supports the use of positive psychological models in physical health settings. For example, researchers have found that having a positive sense of self is consistently associated with lower autonomic and cortisol stress responses (for example, Seeman and Lewis 1995). Optimism (that is, positive expectations about the future) has been found to predict better psychological adjustment over time (Carver et al 1993, Taylor et al 1992); optimists are more likely to disengage from unsolvable problems (Scheier et al 1986). Helping patients to think in this way is arguably particularly important in terms of 'adjustment' post stroke. Furthermore, Sherman et al (2000) found that bringing to mind positive attributes in one domain can help people manage negative information in another, suggesting that reminding people of their strengths can enhance their ability to cope with a present difficulty.

Solution-focused approaches can enhance emotional wellbeing and reduce depression and anxiety, supporting patients who are navigating complex issues such as psychological adjustment to a long-term condition or disability (Gingerich and Peterson 2013); they can also help health professionals to tap into the 'expert patient' agenda (Department of Health 2001) in that they are brief and enhance communication skills. A solution-focused approach helps staff to become truly patient centred and ensures that care is tailored to the individual, thus helping organizations to comply with Care Quality Commission Outcomes 1 and 4 (Care Quality Commission 2013). In addition, the approach maximizes patient motivation, resilience, and self-efficacy, as recommended in various national stroke guidance documents, including the National Clinical Guideline for Stroke (Intercollegiate Stroke Working Party 2012). Southport and Ormskirk NHS Hospital Trust uses a solution-focused approach to enhance psychological wellbeing for patients, both in stroke and, more widely, with patients with long-term health conditions (including chronic pain) and cancer. The approach was recommended in the National Institute for Health and Clinical Excellence (NICE) guidance for supportive and palliative care for people with cancer (NICE 2004) and success has been reported in training a wide range of staff in the approach (Bowles et al 2001, Simm et al 2011). …

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