My experience of Prac Prep and first week at King Dinizulu Hospital:

A war zone at varsity became the norm during the week of prac prep. It’s strange that I became accustomed to a group of AK47 men, with extremely large guns and bullet proof vests who greeted me as I took my usual route into campus. A gas bomb exploding when I walked towards the cafeteria did not even frighten me. I was picking up the rubber bullets scattered along the corridor leading to the bathroom. An environment can change so suddenly for students and we adapt very easily to the conditions, despite the consequences on our study efforts. There’s no other option.

I will be honest. I am accustomed to these conditions, but that does not make me brave. I was tense the whole of prac prep, observing and listening to every sound and watching the door be opened hesitantly each time a student came back in. The fact that striking students could come banging on the door, shouting with possible weapons during prac prep was far from a crazy thought. Shutting the windows so that tear gas did not cause the already nervous students to cry… hysterically, was a necessity at one stage. Is this a conducive learning environment for preparing to treat our psych patients, I ask myself? No, but it is only our REALITY.

I felt sufficiently prepared after prac prep – Feeling a bit uncertain of how to decide on a psych theoretical framework. However, I am feeling more equipped for that after going through our assigned case studies at King Dinizulu. After printing the necessities and creating multiple files, I finally began organizing the piles of dusty notes lying in the corner of my room from the previous semester. Fresh start.

This week has consisted of two psychology group sessions. I’ve seen the anxiety levels and the stress build up in the students’ emotions, as they account for things they have experienced. An overall feeling of helplessness and vulnerability is the atmosphere in these hour sessions. With minimal solutions made and an environment filled with tense, drained students, the sessions have been exhausting.

Emotions were also shed during the role play sessions and team building warm ups with Debbie. Not only did this make our class closer, but I also realised the therapeutic value of these tasks for the first time.

Psych prac has been extremely interesting and slightly overwhelming. I definitely need to regain the theory behind the assessments a lot quicker than I currently am. I have forgotten many of the descriptive psychotic words, after a year of focussing on Physical. Going through the MSE definitions is a task I have made for myself this weekend.

I have been given a client with a Schizophrenia diagnosis. I researched more into how an OT should treat this diagnosis. According to Hayes, R. (2008), a review of Occupational Therapy literature on the treatment of schizophrenia identified four loosely defined treatment categories: (1) sensory integration, (2) activity groups, (3) social skills training, and (4) living skills training. From their available data it proved that sensory integration therapy has been able to improve the motivation and affect of schizophrenic patients and structured activity programs can contribute to a reduction in positive symptomatology. Social and living skills training can be used as treatment methods to promote the community functioning of this population.

I’m also feeling anxious by the time bound reality. Will my client be discharged soon? I felt helplessly frustrated when I was unable to do my treatment session on Friday, after arriving with packets of ingredients and setting it all up. I have decided that between 9-10am is the best time to do my treatment sessions in the future. This factor puts me behind by a week in treatment, as I cannot focus on a new treatment session on Tuesday.

A different client who is more low functioning than my current client loves to join in my sessions. I have become creative in my ways of coping with him. For instance, when I needed to personally interview my client, I gave the low-functioning client some paper on Friday and asked him if he would like to draw at another table. He was content with this task, enjoying it for the next 40 minutes without disturbing me and allowing us privacy. His artistic drawings were impressive when he showed me his final product.

I gained insight into my client’s delusions on Friday. I was trying to comprehend the words that came out of his mouth, whilst keeping a therapeutic face. He sounded so convincing and to be honest I could not tell what may be true and what couldn’t be. I will need to dive into the meaning behind certain characters or images he plays out a bit further.

I will conclude with this quote by Stuart Sorenson: “Always keep in mind that the psychotic experience is real to the patient. As a rule they will be as convinced of their perception of reality as you are of yours”. I need to be mindful of my reactions, facial expressions and response when discussing the client’s thoughts in their mind. According to (Sorenson, S. 2019), it’s extremely important never to ‘enter the delusion’. This means never agreeing with the delusion or behaving in ways which imply agreement. This will be a challenge working with these patients. Schizophrenia is an interesting diagnosis which I am excited to learn more about and understand how to treat holistically.

References:

1.      Sorenson, S. (2019) MH Today. Talking with Psychotic Patients. http://mental-health-today.com/clinicians/psychotic.htm

2.       Hayes, R. (2008). Occupational Therapy in the Treatment of Schizophrenia. https://www.tandfonline.com/doi/abs/10.1300/J004v09n03_05

3.       Vivaelpato. (2019). Pinterest. Schizophrenia. https://www.deviantart.com/vivaelpato/art/Schizophrenia-553692583