“Choosing Cool Shoes”

“Occupational therapists use their knowledge, skills and personalities to enable the client to experience his possibilities. He must be given the chance to choose on the basis of reality, not fantasy. He is not adequately informed to make choices until he can anticipate the results of those choices.”

Elizabeth June Yerxa, OTR, 1966 Eleanor Clarke Slagle Lecture 

“Choice”

Choice. Ahhh…one very important element that makes occupational therapy unique. As human beings we all love the freedom in choosing. For us it is the smallest choices in our own lives that make us feel alive. Choices like what to wear each day, what to pack for lunch, and thank goodness, how much cream to put in our coffee!  All of these things, though seemingly simple and routine, allow us to express who we are and give us a bump of serotonin that helps us forge through the day.  

So what does “choice” have to do with occupational therapy? Well here, the answer, friends, is “everything”. Choices do not impose, they give voice, personal freedom, and empowerment that elicits commitment on the part of the individual to their outcome in the occupational therapy process.  As occupational therapists honoring choice, we must invest in a client-therapist partnership, instead of taking on an authoritarian role of “you must do this because this is good for you.” (Yerxa,1966). When thinking of the use of choice and the many people we’ve worked with through the years, this simple story is the one that stands out for Jennica. Meet Dwayne… and his “cool shoes”.

Jennica and Dwayne’s Story: “The Cool Shoes”

Dwayne was a former student of mine who was extremely independent in the school setting by 4th grade. He was born with a left hand deformity with only 2 functioning fingers.  This physical difference was almost unnoticeable to others, as Dwayne had adapted to performing every academic and functional task in school independently. So much in fact, he had not been on my direct caseload for over 2 years. So, I was taken a bit by surprise when I received a phone call from Dwayne’s mom, asking for my help. She explained that Dwayne was adamant he no longer wanted velcro fastener shoes, and needed the latest “cool” sport, laced shoes, exactly like his 4th grade peers. She shared a bit about his resistance to her opinions and suggestions. I could decipher her fear that this was something that needed guidance. She intuitively knew the potential for failure with laces could have a lasting impact on Dwayne’s identity.  I could also relate as a mom of 3 boys to the anxiety of purchasing these “cool” and “expensive” shoes. It was a monetary investment that needed some level of guaranteed success. Especially since they were only going to fit for a short time on 4th grade feet that grow incredibly fast!

Therapeutic Use of Self:

Using My OT Knowledge

I immediately began the mental dig into my “toolbox” and “OT knowledge”, as I listened and reassured Dwayne’s mom that I could be of help. I quickly began tabulating all the methods and adaptations I knew for tying shoes. 

• One-handed methods for those I worked with affected by stroke.
• Elastic shoelaces for my former arthritis and hip and knee replacement clients.
• The new trend of stretchy “no tie” sport laces professional athletes were beginning to market. And yes, I just happened to have a pair in my desk drawer, because I too, thought they were “cool”, and wanted to try them out. I mean, what OT can resist a BOGO offer, when you know the “get one” might just come in handy at work too?

In looking at these options, it also came to mind that almost all my former clients eventually decided the elastic laces were so much easier than learning any new one-handed or adaptive tying method we practiced. So, my initial hunch was that adaptive laces would likely be the final decision and best option for Dwayne too. 

Little did I know…

Using My Skills and Personality 

With these strategies in mind, I met with Dwayne. It was great to sit down with him again after so much time had passed, to see first hand the confident 4th grader he had become. We talked about what is new in his life. With a sparkle in his eye he was happy to share his new love for everything technology.  Video gaming and the YOUtube App were top of the list, along with recess games of football, tag and basketball with his friends at school. 

Digging a little deeper into personal choices with Dwayne, I asked him to tell me about those “cool shoes” that he wanted. He shared a quick mention of what they looked like. In one sentence he explained,  “Oh yeah, they are super cool, Nike, red and black hightops.” One sentence…That’s it!!! I was waiting for so much more! He then went on in great detail about his network of friends, and those shoes being just like theirs, and most importantly, revealing his worry about not missing any recess time trying to get them tied. He no longer wanted velcro shoes, he “Wanted to learn to tie the regular laces!”.  It was confirmed that the shoes were about looking similar to and performing this function just like his peers. Dwayne’s choice was not only about the “cool shoes”. Rather, his choice was also about the formation of his identity, peer influence and the feeling of  “belonging” to a school community.

Some other things I knew about Dwayne’s identity and history were that he was one of only a few black students in a predominantly white school. Dwayne was proud, happy, kind, and well liked by his peers. His confidence was a thing of admiration. His basic needs were met with a supportive family and school.  He had grit and determination, and believed that with a little hard work, he had the capability to overcome challenges. 

Self-Initiated Purposeful Activity:

Honoring Dwayne’s Choices

So after our conversation, I quickly took my list of adaptive strategies, including the elastic and  “cool sport laces”  and put them in the back of my mind. Those were techniques I was comfortable with and had been “tried and true” solutions for my past clients, but those did not honor Dwayne’s choices and interests. 

This is when I took a moment to remind myself that no matter how excited I was to share my amazing “tool box” of methods and techniques, I first needed to consider Dwayne’s activity preferences. In doing so, it naturally allowed him the opportunity for self-initiation in the therapeutic process.  “Self-initiated refers not only to the psychological choice but to elicit sensory-motor participation” (Yerxa, 1966). In addition, I needed to honor Dwayne’s history of perseverance and his “I-can-do” attitude. These were strong personal assets that fueled his self- initiation and desire to learn how to tie his “cool shoes”.  

Next, in reflecting on the fact that Dwayne identified technology as a favored purposeful activity, I suggested we start there.  As a partner in the therapeutic process, together we looked at multiple videos for one-handed shoe tying methods.  With my guidance, Dwayne began trying different techniques for efficiency and success. We worked together for several sessions to determine the best methods for Dwayne to continue practicing at home.  His school-issued i-Pad and his access to technology at home was a true gift, allowing him to self-initiate, and engage in working towards his goal whenever he was motivated to do so.  Within 3 weeks, Dwayne was able to tie his shoes! In another week, he had mastered his favorite method in under 30 seconds! Dwayne accomplished his goal, he could do the same things as his peers. He had the cool shoes and could make it out to recess on time. 

 

Reality Orienting and Perception:

Mirroring Capabilities and Limitations

As Dwayne’s partner in the therapy process, I was with him, guiding his journey of trials and errors, challenges, triumphs and self-discovery.  Obviously, in our work there are some desired outcomes that are outside the realm of possibilities of our client’s initial decisions. If Dwayne had not been successful with tying his shoes we would have continued on. He likely would have experienced moments of difficulty and frustration, and the emphasis of my intervention shifting to reality orientation.

In this process of reality orientation, like a mirror, I would help reveal to Dwayne his capacity and limitations in a safe environment, taking time to allow him to re-adjust his value system and self-perception to continue on. Ultimately, I imagine we would have tried different methods, and eventually I might have re-introduced those adaptive sport laces.  I like to think that because we began the therapeutic process authentically, honoring the elements of Dwayne’s choices, and integrating his identified self initiated purposeful activities, that we established a relationship that allowed for me to “hold up a mirror” to guide his perception of self-worth when his initial plan failed.  In this way, I would have continued to support him emotionally and physically, guiding him with choices and ideas on his journey of identity and “cool shoes.”  

Choosing Authentic OT Practice  

Leanne and I have to laugh, because occupational therapy is really never about the sentences we are required to document on paper to get a paycheck. Most of the time documentation for billing feels like a complete disconnect with authentic practice. The ingredient of choice makes occupational therapy unique, authentic, and is truly what makes for successful outcomes for each individual.  It is in the time spent figuring out what each person we meet cares about (what makes them “tick”) and creatively developing a plan with them to honor their choices and preferences during our time together. Our role is an active partnership, one that begins with listening to and using client choices, and expands to evaluating the effectiveness of those choices and providing alternative choices when needed throughout the therapeutic process.  In doing so, we have come to find that choice is the catalyst or “spark”, that creates the dynamic process of authentic occupational therapy.  

Choosing Authentic Living

We want to remind you that as you honor the choices of others, it is also important to nurture yourself and your own personal authenticity! That being said, we want to encourage you to go and honor your own choices, and show self love! It’s not just about OT practice, it is a theory we can apply to our own everyday living.  Therefore this blog’s “Recipe for Living” is to incorporate the key ingredient of choice, to actualize who you are and who you are to become. 

On that note, remember it can be rather simple. Go and enjoy that favorite beverage, treat and activity of your choice.  Then, be sure to join us back here for our next blog when we “unpack” the meaning of our Homestyle OT logo!

Warm Regards,

Jennica & Leanne

Sharing our stories…

To print the recipe card, download the image by right clicking > save image to downloads. Then print the recipe card from your downloads!

 

 

References:

Yerxa, E. J. (1966).  1966 Eleanor Clarke Slagle Lecture Authentic Occupational Therapy In Padilla, R., & Griffiths, Y. (2017).  A Professional Legacy, The Eleanor Clarke Slagle Lectures in Occupational Therapy 1955-2016 (Centennial ed, pp. 105-115). Bethesda: American Occupational Therapy Association, Inc.

Acknowledgements

A special thank you to the parents and children who inspire our stories and remind us that choice is essential in everyday practice and living.