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Riitta Keponen, OTR, Master of Health Science
Lecturer, Finland

I am going to share an experience of working with a 26-year old man named Jorma, who has degenerative changes in his lumbar spine. He lives with chronic pain and attended a pain rehabilitation program where I worked at the time. By administering the Occupational Performance History Interview (OPHI-II I) I gained invaluable insights into his situation that influenced my therapy.

In the interview Jorma talked about how his life had changed so much due to his symptoms and difficulties performing. When he was younger he had been able to control his body so well that he had won a junior championship in wrestling. His back pain, he reported, took away that control. “It's like a big man who tells you to lie down and you have to obey.” In the interview he also noted of his everyday life, “I am stuck to this tight routine, it's like a tight jacket, that holds me together.” Both of these expressions are metaphors for how he felt imprisoned by the pain that, according to him, now had control over his body and forced him to an unsatisfactory daily routine and life style.

However, the interview also revealed a small but important bit of information. Every day he would engage in a meaningful occupation of woodworking that allowed him to escape the prison of pain and go on with his life. When immersing in this creative and productive occupation he would momentarily forget his pain. He had a worry; “If that is taken away I don't know how I would survive it.”

When I planned therapy with him, I built on the interview suggesting that he could teach me and few others how to decorate wood surface with a wood-burning tool. He not only enthusiastically agreed but brought his own equipment. Bringing tools he had self-adapted gave him a role of an expert. This began a process of therapy in which Jorma shared this “survival” occupation with me and other clients (e.g., bringing in photos of wooden sculptures he had carved in the past). While engaging in various woodworking activities, he talked about his occupation of woodworking and its place in his life. The process led him to be able to reconstruct an occupational narrative in which he would vision other ways of normalising his daily routine. As he restructured his narrative he was able engage in problem-solving to make changes in his routine that allowed him to participate in the things that mattered to him even though he continued to have chronic pain. In the end, he felt more in charge of the pain, and on the way towards a more satisfactory life style.