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Analysis of Therapeutic Self

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    I was born and raised in Ethiopia, which is in East Africa. My cultural background has played a major role in whom I have become today. I would consider myself as a low-key person with a reserved emotional character. In my culture, adjusting and conforming to people is considered desirable than influencing them. For this purpose, a serious tone with low emotional demeanor is preferable when compared to being energetic and/or enthusiastic. Having a reserved or quiet personality tends to be valued more than being expressive, open or outgoing. My professors and classmates have suggested that I speak louder so that clients are able to listen to me, especially if I plan to work in Geriatrics in the future. Not Long Ago I had to take an occupational profile from a client who was wearing a hearing aid and the client was not able to hear me even though I was trying to speak loudly. I ended up writing down my questions on a piece of paper for her to read. She might not have been able to hear me even if I shouted because of her hearing problem but it made me realize this will be an everyday occurrence depending on the setting I ended up working in.

    One thing all my friends including myself will agree upon is the fact that I am a good listener. I also give good feedback and try not to judge and push my own principles on people. I learned that sometimes when we reflect and give advice, we tend to push our own agendas and beliefs on to the other person and that will have its own consequences. Most of the time People feel free and open towards me to share their troubles and worries. A lot of people I have come across on a personal or professional level also find me to be genuine and respectful. As much as I can, I try to be helpful and understanding of their point of view without passing judgment and being phony. Even though being a good listener is a good quality, sometimes I have to remind myself to be careful in the professional world not to cross some boundaries. Six years ago, I used to work as an interpreter, even though it wasn’t allowed to bond with the clients outside of working hours or environment, one client kept on sharing his worries about his son’s condition with me. I did not know how to say, “No Sir, you and I cannot have this conversation outside of work environment”.

    So, it kept happening and after a month or so the client called me and asked if he can move in with me because he had a fight with his wife. I was dumbfounded and did not know how to answer him. That was a big lesson for me; I learned that even though it is great that people trust and open up to me, I also need to set some boundaries when it comes to the professional world. I am an abstract thinker. I try to look at and understand things from various perspectives. I feel like I became more understanding of people’s different outlooks and ideas as I grow older. The fact that I have lived in two different continents has helped me be an analytical person who is understanding of different beliefs and ideals that are different from mine. Being able to see things from different perspectives has also helped me develop smooth and conflict-free professional and personal relationships. I am not a confident person and even when I pretend to be one, people can usually tell I am not a confident person. I have been questioned in many instances in the past, by people who are close to me, “why are you not confident in your abilities even though you have; the smarts? what it takes? and etc.….”. One of the things I am not confident about is my accent when I speak in English. I did my fieldwork during my junior year at Booker T Washington Center.

    The children there would snicker and laugh at my accent openly and I remember one day one of the Kids asked me where I am from and when I told him I am from Africa, he then started to speak with a different accent and wrong grammar, while beating his chest like a gorilla. That day, I said to myself, these children barely listen to what I say because of my different accent, and now this kid is talking to me like I do not know how to speak the English language. I already have doubts about my abilities to communicate well with clients and this incident confirmed my fear that my communication skills are not good enough. When I started to believe my own fear, I began to stutter and lose my words after that incident, especially when I am stressed. Confidence is something that I must work on because I know it starts from within. I tend to avoid confrontation if I can help it. When I am thinking about confronting someone; my heart rate increase, my hands shake, my whole-body shivers and I cannot focus on my occupation or whatever it is I am supposed to be doing at that moment. If I must confront anyone, I prefer it to be with someone, whom I believe can handle differences well and not take things personally. I understand that sometimes I should be able to confront someone, to ensure the safety of a client, even if they might not be able to take it well or positively. I used to work for a nongovernmental organization (NGO) back in Ethiopia which distributed antiretroviral medication to patients and followed their progress. Some days I would find myself crying with the patients because they do not have the money or resources to buy enough food to withstand the side effects of the medication.

    That emotion of pain and sadness would linger with me for days. One incident that stuck with me is when I had to do a house visit to a patient’s house who was enrolled for care in the NGO. The patient invited us to her house because she was grateful for what the NGO has done for her so far. My colleague and I went to her house which was a one-room house built from mud and there were cooking items and a mattress in the room. The patient’s husband left her by herself to raise three children when she told him she tested positive for HIV. The week before our visit her eldest child lost her one eye because a kid from the neighborhood accidentally injured her eye when he threw a rock at her while playing. Her youngest child has contracted HIV during delivery because the mother wasn’t receiving antenatal care during her pregnancy. Here was this lady going through all these misfortunes and still found a place in her heart to see hope and be grateful. I cried like a baby that day the whole day and I still tear up when I think about it to this day. I did not know how to feel, I was so moved by the anguish in her eyes. At the same time, I was amazed by her resolve and strength which was apparent in a way she was taking care of her children and herself. As I gained experience as a professional, I realized that I cannot be crying and reacting to patients’ hardships or emotions because it wouldn’t help them in any way. I understood I am there as a professional to lend an ear or find an answer whenever possible. As I grow older, I learned to contain my emotion and started focusing on finding a solution when possible to help tackle the cause of the negative emotion. I am not usually a funny or amusing person, but I use humor with my family and friends from time to time. I also use humor sometimes to help defuse a tense situation. If I see two people having a heated discourse and if it seems the argument is escalating, I would interfere and try to use humor to make light of the situation.

    Qualities such as; confidence, knowing how to confront people in a positive manner and having a high arousal level energy come in handy when assuming the role of a leader. I struggle with being confident and confrontational: that is why it is difficult for me to take the role of a leader. I usually take the role of a follower. I work well under the guidance of a leader with a facilitative leadership style. I had to take the role of a leader when I was working in Ethiopia and was successful at it even though it took a while for me to get comfortable with the position. There were times that I had to confront colleagues who worked under me and ended up firing them because they weren’t performing as expected and weren’t improving despite verbal and written warnings. Even to this day, I find myself wondering if my decision was right in firing them from their job and if there was anything, I could have done for them to help them keep their job. I rely heavily on nonverbal communication to know what people are thinking. I find nonverbal communication usually reliable than verbal communication because most people, including me, cannot usually control our body language when we are feeling a certain type of way. Sometimes when I tell jokes in English my friends at Gannon University think it is sarcasm or an insult because I use the same tone that I use when I tell jokes in Amharic, my native language.

    I must remind myself to watch my tone and be aware of peoples’ culture when I communicate. I like it when things go according to plan but I do not have the need to control every little detail and how it should be done. I do not work well in a chaotic environment, but I have learned how to adjust and work around it. During group projects, I like to prepare ahead of time and have a plan on how the project should be done. But other people have their own way of doing things and schedules so sometimes nothing will be done till the last minute and the group project will still end up being the best. After going through these kinds of group projects and assignments for more than a year now I have learned to let go and work in a chaotic environment. I still prefer to know when things can be done and how ahead of time, but I have also learned that is not the reality, things cannot and will not always go as planned. I do not feel comfortable asking strangers and my friends’ personal questions, but I am comfortable probing into the personal lives of my family and close friends. I do not believe it is either professional or ethical to probe into things that do not concern me except in situations where probing might benefit the other person. Sometimes people will not openly tell you things verbally, but you can read their body language and assume things are not what they appear to be on the surface. In those situations, I usually probe unless they tell me to back off. Most of the time my assumption will be right, and they end up feeling better after they talk about it.

    In my culture it is normal; to hug and touch people even those you are not close to when you are talking to them, and to hold hands with your same-sex friend when you are walking down the street. I am the same way, I used to unconsciously hug my friends here at Gannon University. I have gotten better at not doing that because I know it makes them uncomfortable. I know I invade people’s space sometimes when I talk standing close to them, and that is how we naturally communicate in Ethiopia. I have realized that is not the norm here and I must take precautions not to do that especially in a professional environment. Living in the USA for almost nine years has changed me a lot too, I went for a visit to Ethiopia in 2018, and I felt uneasy when people spoke to me while standing or sitting at close range. I use short sentences and simple words to communicate in English. When I try to use long sentences, I think it is hard for people here to understand me. Using short sentences is not ideal sometimes because it is difficult to get the point across just using few words. I found out my vocabulary is limited in English when I joined Gannon to study Occupational Therapy (OT). I was taught in English starting from high school and during my undergraduate study. I have worked in Ethiopia and in the USA and the working language was English. From my experience so far, the field of OT uses more vocabulary than any other field I have worked in before. During my 40 hours of volunteering, I did not realize culture and societal norm played a huge role in OT. When professors mention a name of a game or puzzle as a form of intervention in class, or when my classmates mention games from their childhood as an activity to do in a group project: most of the time I find myself asking or googling to find out what it is and how the game is played. I did not know most of the childhood games or puzzles my classmates were mentioning because I did not grow up playing those games.

    I realize if I want to become a good OT I need to assimilate into the American culture. Lack of confidence, being passive, having a limited vocabulary, my accent and low emotional arousal level are my weakest qualities. If I am not confident and assertive and look like I don’t know what I am talking about, how can I expect a client to trust me and perform what I tell them to do? If I am talking in such a low voice in a dull manner how can I expect to motivate a bedridden client to perform activities or occupations which are physically and mentally tasking to them? It would be hard to build a therapeutic relationship if clients cannot understand what I am saying due to my accent or for not using the proper vocabulary or grammar when communicating with them. The first thing I would like to improve is my English fluency and accent. My lack of confidence mostly comes from my inability to communicate well with my professors and classmates and I have this gnawing feeling I will have the same difficulty during my fieldwork. I have already told my Ethiopian friends not to talk to me in Amharic for a while in order to improve my English flow and accent. The problem with going back and forth between two languages is that you tend to think with the language you commonly use. When I speak English, in my mind I am thinking in Amharic, and then I translate it into English which kind of takes a while. Sometimes when I speak faster and continuously, it might not come out the way I wanted it to because you think differently in the two languages. I plan on speaking slowly so that people can understand me better. I also plan on recording myself and reading out loud when I am studying to improve my accent. I will also like to work on my confidence which I think should start with recognizing my self-worth and realizing I have what it takes to help clients and earn their trust. I asked a psychiatrist who is also a friend of mine how I can work on developing self-worth and confidence.

    He told me it begins with faking it and then working hard till you make it. What he suggested made sense to me; if I study hard, improve my accent and develop good clinical reasoning skills, then I will be able to build my self-confidence up and be able to establish a good therapeutic relationship with the client. I would say having empathy, being a good listener, my cognitive style and ability to read and understand people’s body language are my strong qualities. All these are important to build a good therapeutic relationship with a client. My ability to interpret body language will help me analyze the kind of mood my client is in before and during therapy, and that will aid me in adjusting my approach towards the client accordingly. If a client feels like a therapist identifies with her or his situation, motives, and feelings then it would be easy to establish a good personal connection with the client and lay a foundation for a therapeutic relationship. I have a long way to go before I become a competent OT. The environment at Gannon provides me with the right challenge to face my fears and insecurities at the same time build my positive traits so that I become one amazing OT.

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