The value of reflections

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The value of reflecting – learning from experience

When you think of the word ‘reflection’ what does this conjure up? For some, it will be an image reflected in a window or a mirror, but for others, it will mean a pause for thought on things that have occurred and how they could be bettered had one had the opportunity to go back and change events.

Questions will arise when reflective thinking is applied: what could have been done differently; how could the outcome be changed to a more positive one; how can this situation make me learn and grow; how can I be better prepared for next time?

Day to day reflective thinking

Reflection is a continuing process that allows a person to consider, possibly alongside previous experience, both the potential or actual positive and negative outcomes relating to events, activities, or interactions. It allows for improvement in self-awareness and emotional intelligence, can deepen understanding of others around them, and helps to develop new or hone existing skills to learn new ways of approaching any given situation.

As individuals reflective thinking, allows us to step back from the critical inner voice, pause and reconsider, thus allowing for more logical, clearer thinking with an unbiased, pragmatic view or a change in behaviour.

Within the context of human function our thoughts, feelings and doing of activities is fed by our internal reflections and experience which in turn influences our occupational choices.

Jo Throp - Clinical Director

Reflective practice in occupational therapy

Within neurological occupational therapy, clinical reflection is a key component of clinical reasoning and evidence-based practice. There is an untold number of benefits to be gained by the clinician and ultimately the receiver of occupational therapy services. Standing back and reflecting on the ways we can engage clients within the occupational therapy process, taking time to consider our role and the unique viewpoint of the individual and their hopes for the future, including values, interests, lifestyles, vocational aspirations, goals and objectives.

As Occupational Therapists, with our clients, we will inherently look at environmental factors, personal perceptions, the aim of the intervention and how outcomes can be achieved, all of which are based on a clinical reflection of each individual, their needs, desires and functional capabilities. Occupational therapists have proved themselves to be the masters of clinical reflection. It could be argued that the complexity of our role, and the professions complete focus on the individual, means that without clinical reflection the overall effectiveness of occupational therapy intervention could be compromised.

So how can we reflect in a manner which offers effective, sensible, and realistic outcomes?

In each scenario, one could consider a variety of questions to help understand a situation or problem that has arisen. Each of these questions allows a clinician to reflect on an experience.

Questions such as:

what did I learn?
what did or did not go well?
what behaviours were displayed?
what would happen if…?

Using reflection as a tool within neurological occupational therapy, allows a clinician to look back on a situation, think critically about it and learn from it.

Reflective tools in occupational therapy practice

Let us consider some of the reflective tools that are available to use as occupational therapists to enhance skills within occupational therapy practice. Some of these strategies can be applied to clinical intervention to assist individuals who have sustained a brain injury to promote awareness and insight regarding return to an enriched life, both personally and vocationally.

Many reflective models exist; some are more common than others, but each offers unique ways to consider a variety of situations. Some of the more common models are Gibbs, which is used for examining completed issues; Johns, which is based on 5 key questions to breakdown an experience to determine processes and outcomes; and, Borton, which is used for examining ongoing issues.

Gibbs’ reflective model, for example, allows Occupational Therapists to learn from experiences that either did or did not go well. It covers 6 key areas: the narrative of experience; the thoughts and feelings towards that experience; assessment of the experience, whether negative or positive; analysis, allowing the opportunity to make sense of things; the conclusion, i.e. what has been learned and what can be done differently; and, finally, a plan of action to deal with a future, a similar situation that may arise. Whilst this model was primarily advocated for use in repeated situations, it is often applied to single stand-alone situations; thus, showing that reflective models can be adapted and are not rigid.

Neurological occupational therapy and brain injury

For clients living with brain injury, or indeed any accident or injury that has disrupted their life in any capacity, reflection is an integral part of the learning process for recovery and offers the basis from which positive steps can be taken towards regaining independence. Reflection allows for a person to understand what works well for them and what does not.

Reflective practice models offer a structure that can be followed to help embed changes to behaviour. Indeed, if someone is not provided with the tools to reflect upon the experience, then it will be harder for that person to learn, progress and grow.

Jo Throp - Clinical Director

Reflective models offer the potential for clinicians to continually assess the progression of their client’s goals from their client’s perspective and adjust steps that are needed to form new and positive experiences, thus enabling, and encouraging clients to continue onwards. It allows for more logical and clearer thinking about how a situation has made them, or their clients feel and identify what area have worked and what areas have not.

Of course, reflection is not just a tool that is used to support a client’s needs, nor is it about thinking a situation through alone and coming up with solutions. Sometimes, it is about recognising the need to consult reading materials or colleagues, whose own experiences and reflections can offer additional guidance and opinion on how things could be bettered – as the saying goes, two heads are [sometimes] better than one! For many years occupational therapists have recognised the value of formal clinical supervision and have experienced the benefit of this in their clinical practice.

Reflective practice and continuing professional development (CPD)

According to the British Association of Occupational Therapists (BAOT), reflective practise is vital to ongoing Continuing Professional Development (CPD). CPD is important to keep skills and knowledge up to date to be able to practice safely, legally, and effectively (College of Occupational Therapists [COT], 2010; Health and Care Professions Council [HCPC], 2012a).

Using any reflective tool will always require ongoing practice to determine what works best for you as a practitioner and within differing circumstances. It is a valuable skill that, when used daily, will become a natural part of clinical assessments. As Dr Stephanie Tempest, Royal College of Occupational Therapists (RCOT) Professional Development Manager explains:

"The ability to analyse your practice and reflect on what went well and what could be improved is a crucial element of being an occupational therapist and is essential for CPD. This affirmation from the nine healthcare regulators shows the pivotal role that reflection has for us as occupational therapists and together in the multi-disciplinary teams in which many of us work.

"Becoming and being a reflective practitioner is a central tenet within our profession. It’s incorporated into our pre-registration standards, code of ethics and professional conduct, professional standards and career development framework. Our CPD resources encourage reflection to aid learning within teams and as individuals."

Using models of reflective thinking makes our reflections meaningful to our CPD (Armitage et al., 2012). Reflecting, recognising, and acknowledging ones owns limitations and seeking guidance and support is fundamental in being able to practice occupational therapy safely and to the benefit of each of our clients. Indeed, reflection can quite often be more productive when carried out in the presence of a clinical supervisor, another appropriate peer or group of peers.

As clinicians, we must use reflection as a tool to increase our self-confidence, skills, and knowledge. Regular professional mentoring, such as that which is offered at Krysalis, allows for one to stand back and seek guidance and support.