psychodynamic perspective and time use in mental health

time use and occupation

- Time use refers to the allocation of time to different activities and is represented in terms of "clock time"
- A way to represent what people do in daily life in terms of the amount and variation in their activities over a particular time period (e.g., a day, week)
- Describes the frequency, duration, sequence and repetition of these activities, whether measured at an individual or population level

time use patterns

- Lifestyle characteristics, such as activity levels, the extent of participation in particular types of activity (e.g., social activity, leisure, physical exercise) are related to longevity, health status, risks for various chronic health conditions, and measures of well-being
- Higher levels of activity, in particular in socially valued, productive roles and activities that support social connections, appear to be associated with higher levels of satisfaction and community engagement
- Activity patterns, such as those associated with high allocation of time to passive activities, or limited engagement in activity are linked to poorer health and well-being outcomes
- Allocation of time can reflect experiences of poor health in that health experiences will influence activity participation

occupational patterns

- Enfolded activity
- Routines
- Temporality

occupational balance

- Occupational patterns that contribute to health and positive experiences related to well-being, such as satisfaction, meaning, and fulfilment.
- Conversely, occupational imbalance characterizes occupational patterns seen as undermining or detrimental to health and well-being.

conceptualizations of occupational balance

- Balance between self-care, productivity, leisure, rest
- A balance of occupations with different characteristics
- Time spent in varied occupations,
- Pattern of occupations that includes varied, obligatory, and discretionary occupations, which are personally meaningful and satisfying
- Chronobiological perspective
- Lifestyle balance

understanding of individuals' time use patterns and occupational balance

o can serve to address issues and challenges related to:
- Very limited occupation or disengagement from occupations in daily life
- Patterns of participation that lack variety, challenge, satisfaction, fulfilment
- Patterns of participation that are missing benefits in one or more areas of physical, social, emotional, or intellectual health and well-being
- Time use patterns impacted by disrupted sleep/wake cycles or fluctuating experiences of a phenomena such as stiffness, pain, fatigue, low mood
- Difficulties organizing time use efficiently, or in a satisfying way.

time use diaries

- record what a person does within blocks of time over the course of one or more days
- Reflection on time use experiences,
- Calculation time spent in different categories,
- Information about elements of participation (e.g., location, social connections, experience of health and well-being)
- Comparisons to general populations where time-use data are collected on a population-level

principles for addressing time use and occupational balance

- Identifying with each person his/her repertoire of occupations (lost, present, new)
- What extent s/he wishes to engage in them (daily, weekly, or monthly)
- Identifying each person's level of engagement
- He or she experiences being under- or over-occupied, or a sense of balance in his/her occupations, including his/her perceived balance/imbalance between restful, playful and productive occupations
- Framing optimal time use as a long-term goal, (taking into account valued, obligatory and discretionary occupations)
- Identifying short-term goals for working towards personally defined optimal use of time
- Supporting each participant to structure daily occupations identified in the short-term goals, into a participation pattern that has a rhythm in synchrony with the light-dark and activity-rest cycles
- Offering education about time use and health, as well as information about what is known about the relationship between mental illness and engagement in daily occupations

key features of psychodynamic approach

- Collective Unconscious (Carl Jung)
- Psychosexual Development (Freud)
- Unconscious Mind (Freud)
- Psyche (Freud)
- Defense Mechanisms (Freud)
- Psychosocial Development (Erikson)

key concepts and components of psychodynamic approach

- Both conscious and unconscious processes influence human behavior.
- Inner conflicts (conscious or not) may be experienced as psychological symptoms
- Human emotional and interpersonal experiences are influenced by past experiences
- Psychological symptoms serve a purpose that is meaningful, even if complex and multi-layered

criticisms of psychodynamic approach

- Unscientific in its analysis of human behavior.
- Many of the concepts central to Freud's theories are subjective and impossible to scientifically test.
- Evidence for psychodynamic theories is taken from Freud's case studies
- Psychodynamic perspective is too deterministic - Leaves little room for the idea of personal agency such as free will

psychodynamic FOR in OT

- provides an explanation for how mental processes, influence one's selection of, participation in, and satisfaction with occupation
- perceptions, thoughts, feelings, conscious as well as unconscious
- activities are used to enhance interpersonal communication, facilitate healthy emotional experiences, enhance self-awareness and self-acceptance, enable the identification and pursuit of one's skills and interests

psychodynamic perspectives as relational in nature

- Assumes humans are motivated by desire for human contact and relatedness
- Facilitating environments in childhood are foundational to development of the self
- Attachment to primary caregiver serves as a secure base for exploration and self-development
- Play with inanimate objects serves transition function between primary caregivers and exploration and self-enhancement in external world
- Therapist-client relationship provides conditions for growth and change

contemporary influence of Psychodynamic Theory in OT

- Occupational therapy is essentially relational in nature (Transference, projection, containment)
- Beliefs, thoughts and feelings emerge in work together and shape the interpersonal interactions(therapeutic use of self, clinical supervision

psychodynamic or psychoanalytic Occupational Therapy

- Materials used in occupational therapy can serve as "transitional objects,".
- Gathering information about client's object relations
- Creative activities serve as a means to engage in self-exploration and development, and reveal potentially difficult inner emotions

psychodynamic approach methods

- Case Studies
- Dream Analysis
- Free Association
- Projective Tests
- Slips of the Tongue (parapraxes)
- Hypnosis

types of psychodynamic assessments

- Early occupational therapy projective assessments
- Azima Battery
- Shoemyen Battery
- Goodman Battery
- Lerner Picture collage
- Barbar Hempphill Battery
- Human figure drawing
- Build a city
- Bay area Functional Performance Evaluation

relational model of OT

- Tree Theme Method (Gunnarson,2008)
- "Modello Vivaio" (MOVI), is a relational model of occupational therapy practice (Piergrossi & Gibertoni, 2013).
- Creative Therapies (Atkinson & Wells, 2000)