Katherine is 32 years old and has struggled with issues around eating since the age of 13. She left home at 20 to go to University and has worked as a teacher for the last 8 years. Unfortunately an episode of depression, triggered by the breakdown of a relationship the previous year, had led Katherine to feeling unable to work and she had not worked for the last nine months resulting in her having to move back in to her old family home with her parents.
Reason For Referral
Katherine was referred to Occupational Therapy by her Consultant Psychiatrist due to the deterioration in both her mood and her eating over the last three months. Katherine was steadily losing weight and had a BMI of 15 at the time of her referral (her weight was being monitored fortnightly by her GP). She had been referred for specialist therapy with the Eating Disorder Service and was on a six month waiting list. At the time of the referral Katherine had very little structure to her day and her parents were her main point of contact.
Occupational Therapy Assessment
An initial person-centred Occupational Therapy assessment was conducted and drew on a number of occupational therapy models and treatment strategies including the Model of Human Occupation and a more informal one to one interview. The assessment identified that:-
- Katherine had been a dedicated teacher and her work had taken up much of her time both at school and at home. She had therefore not had many other interests over the last eight years and since she has stopped working she had been engaging in very few activities and was spending much of the day asleep;
- Katherine’s parents appeared to strongly identify with the role of being her carer and felt that they needed to look after and care for Katherine – they were therefore doing the majority of the cooking, cleaning and shopping and spending much of the day with her;
- Katherine had not lived in the local area since leaving to go to university 12 years earlier and was anxious about going out alone in case she met people she used to know and have to explain why she had moved back home;
- Due to her current financial difficulties Katherine was unable to contribute much to the household running costs and was therefore allowing her parents to make most of the decisions leaving her feeling helpless and worthless.
Occupational Therapy Treatment Plan
Katherine was offered an Occupational Therapy programme consisting of 12 weekly sessions focussing on:-
- Helping her establish meaningful ways to structure her time by identifying a range of activities she could participate in;
- Identifying how she could take the lead in her recovery and become less dependent on her parents;
- Enabling her to explore alternative coping strategies to help her manage her emotions as an alternative to restricting her eating;
- Identifying how she could feel more in control of her environment;
- Liaison with the local Eating Disorder Service.
On completion of her occupational therapy programme Katherine was able to:-
- Establish some boundaries and ground rules at home giving her protected time alone each day and able to attend to her own shopping/cooking;
- Identify ways to spend time with her parents where they did not feel the need to assume a carer role such as cooking them a meal each week and engaging in activities they used to do together before she was unwell such as going to the cinema together, watching films and gardening;
- Increase the number of activities she was participating in during the day and revisit previous activities she enjoyed such as reading, knitting and writing;
- Create a graded exposure plan to increase her confidence in going out independently (this included making contact with old friends living locally);
- Identify how important it was to work towards her goal of returning to work – she began to help out at a local Brownie group to increase her confidence in working with children and started applying for teaching posts in the local area;
- Start her therapy at the local Eating Disorders Service based on the recommendation of her Occupational Therapist regarding readiness for therapy.