The Power of Emplotment

The word "therapy" brings forth the stereotypical idea of psychoanalysis. A narrative of a therapist listening to one's deepest and darkest secrets to perceive what one cannot see in themselves. Without a doubt, cognitive-behavioral therapy remains a very important tool in the treatment of many afflictions like depression and compulsive disorders. However, the important role of the occupational therapist tends to be shadowed by the umbrella term of therapy. An occupational therapist helps people with extreme disabilities - like spinal cord injury- regain their sense of purpose and be reintegrated into societies. Many of these patients lose the ability to talk, walk or navigate their world without the help of another.

How can the therapist give hope to someone that will not be cured? In contrast to therapy for mental health, occupational therapists cannot promise that the patient will walk or talk again. Often, patients will never regain the use of that which they lost. Moreover, an occupational therapist must be willing to both acknowledge that the patient will never be normal; while also providing the patient with the tools to look forward to small victories. To achieve this feat, therapists employ the method of emplotment. Best described by Cheryl Mattingly, emplotment is the process whereby a therapist uses times spent in a clinical setting to create a story. Through emplotment, the therapist creates a gestalt rendering of different events in the clinic. This larger temporal whole allows the patient to focus on the small victories.

To understand emplotment it's important to understand the idea of linguistic determinism. In linguistics, the Sapir-Whorf hypothesis proposed the idea that language determines the way in which we perceive the world. Although this theory has been proven to not be fully correct, an important takeaway is the way in which our conceptualization of time affect the way we perceive it. In other words, the way we perceive time differs based on how we think about the future and the past. The therapist used this idea, to break down the time spent in a clinical atmosphere into smaller stories that can be woven into a part of a bigger story. Therapists use words like "you did better than yesterday", or "tomorrow we will work on this". The future of each patient is only based on "tomorrow". Emplotment creates an idea there's no end goal but rather a multiplex of smaller quotidian goals that build into a narrative of emotional and physical growth.

A patient undergoing this type of therapy loses the potential of leaving a "normal life" and must accept the idea that life will never be the same. At first, this existential reality tends to be hard to accept. Which is why the re-conceptualization of time is so important. Both the therapist and the patient must agree upon the idea that the goal is not to be cured, but rather to find ways around the disability. This is done through the weaving of time from both the patient and the therapist. Furthermore, it requires the willingness of the patient and the patience of the therapist.

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