Role-playing is training tool for staff, patients
OT instructor offers examples of instructive play
Rehab facility staff and managers can brush up their instruction skills by adding a little role-playing or scenario acting to the lesson plans. These methods give rehab therapists an opportunity to experience some of the limitations of being a rehab patient, and they help teach staff how to cope with different types of client behavior.
"In order to be an effective therapist, you need to be a good communicator, not just to talk with peers, but to communicate with clients," says Cynthia Ballentine, OTR/L, CEAC, certified environmental access consultant, community practice therapist, and instructor at Washington University’s program in occupational therapy in St. Louis. Play acting is a good way to learn better communication skills, she adds.
Ballentine recommends rehab managers try several different types of acting scenarios to improve staff communication and understanding and to improve patient therapy. Here are some examples:
1.
Improving client self-esteem. A psychologist or therapist leads a group of staff who are learning how to improve client self esteem and handle the occasional disruptive patient. The group leader assigns one staff member to be the disruptive patient, who will talk out of turn, ignore instructions, and attempt other disruptive or rude behaviors.
The other members of the group work on finding ways to prevent the disruptions or teach the actor/patient how to behave more appropriately. For example, they might choose to ignore the person whenever there’s a disruption or interruption. Or the group leader might tell the person that there will be consequences to his/her behavior, saying, "If you do not wait your turn you cannot participate in this group and will have to go back to your room."
Or the therapist leader could address the disruptive person, using an approach that aligns the therapist with the patient, saying, "Normally, you’re doing a good job, but today it looks like you’re not paying attention. Could you tell me what’s going on with you today?"
Participants in the group try to figure out which approach will work best. The participant who is the chosen disrupter is not told when to become compliant. Instead, the person is told to behave in response to the different techniques, according to what feels comfortable. So if another group member is not employing a skill correctly, the actor/patient wouldn’t calm down and pay attention.
2.
Accepting criticism from clients. Another role-playing scenario involves the experience of
a new therapist who is taking over a group of clients left unexpectedly by the previous therapist. The previous therapist had left for medical reasons and didn’t have a chance to say good-bye, and the patients are angry about the change.
In this scenario, one staff member plays a client who is openly angry and aggressive. This person might complain that the new therapist is too stupid or too young and doesn’t know what he/she is doing. The actor/patient also might directly ask the new therapist what she/he is doing there when the other therapist was better.
The group’s task is to come up with strategies to help clients accept the change. For example, the new therapist could ask, "If I did things the way the previous therapist did, would you feel better working with me?" This type of question is not stating that the new therapist is giving in to the criticism, but is simply acknowledging it and is trying to figure out what the problem is.
The key is for therapists to listen to what the client is saying and ask for clarification throughout the process, Ballentine explains.
"At the end, when they’ve de-escalated the situation and showed they were listening, they can find a solution that lets both sides have dignity, without one person as a winner and one as a loser," she adds.
3.
Learning good communication skills. Another role-playing group could work on active listening and improving communication skills. Again, one person in the group would act as a rehab patient, while another member would attempt to engage the patient in a conversation, using skills that enhance communication.
For example, the therapist can actively listen to the actor/patient, repeating strings of the actor/ patient’s words and thoughts and asking questions that facilitate more detail. The therapist also could work on building rapport and finding out what the actor/patient’s issues are, instead of attempting to jump in and fix all problems immediately.
The actor/patient would be instructed to react positively to good communication strategies, such as open, attentive body language, good eye contact, and facing the person directly. Attentive body language includes sitting up straight instead of slouching, for instance. Active listening skills include offering empathy and paraphrasing something the actor/patient says in an attempt to make sure the therapist has understood.
"If someone is telling you something negative, you could say, I can see how that would make you angry,’" Ballentine says. "I understand that didn’t make you feel very good.’"
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