Dan Mackintosh Interview

Running head: CASE STUDY INTERVIEW 1

Case Study: Mr. Mackintosh

Gretchen Kempf

The University of Scranton

CASE STUDY INTERVIEW 2

Abstract

This paper critically examines the structure and techniques used in an interview,

conducted in November of 2013, with Mr. Daniel Mackintosh, a 57-year-old C5-C6

quadriplegic, through the use of the Microsoft program Skype™. It also discusses the use of the

Canadian Occupational Performance Measure (COPM), which was utilized in the interview, and

examines how the COPM enhances the client-centered approach to therapy. This paper also

provides some background information on Mr. Mackintosh and his disability and suggests

several hypothetical treatment goals that could be used to guide treatment if Mr. Mackintosh was

an actual occupational therapy client of the interviewer.


On November 8, 2013, I interviewed Mr. Daniel Mackintosh from his home in Chalfont,

Pennsylvania, utilizing the voice and video features of Microsoft’s Skype ™ software. This was

my first experience in using this type of software application for an interview and proved to be a

very different undertaking than interviewing someone face-to-face. Conducting an interview

through the use of technology was much more difficult than I had anticipated. Although I

generally was able to see Mr. Mackintosh for the entire duration of the interview, the picture

image sometimes briefly would freeze or cut out completely and the microphone feature also cut

out several times. This made it hard to catch everything that Mr. Mackintosh was saying and I

had to interrupt him numerous times to ask him to repeat responses to questions. This was

problematic during this interview in particular because Mr. Mackintosh was talking about his

disability, which is a deeply personal topic that can be difficult to discuss openly with others.

Asking Mr. Mackintosh to repeat emotionally-charged information had the potential to create a

true rift in the interview process and I worried that this would overly upset him; thankfully, he

did not seem to mind my requests to repeat himself. I also found that when the microphone

and/or video would cut out, Mr. Mackintosh and I would talk over one another, or start talking at

the same time, due to the loss of visual and/or audio clues as to when the other person was

talking. The use of technology made the interview process awkward at times and added

unnecessary stressors to a situation that was, by its nature, already stressful enough. Given the

chance to re-interview, Mr. Macintosh, I certainly would opt for a face-to-face interview.

Mr. Mackintosh is a 57 year-old C5-C6 quadriplegic. He is the father of my best friend

from high school, Danielle, her older brother Corey, and her younger sister Maggie. He lives

with his wife, Judy, and his children in a single-family home in a suburban neighborhood about

25 miles northeast of Philadelphia. In 1991, when Mrs. Mackintosh was pregnant with their


youngest child, Mr. Mackintosh was swimming laps in an in-ground pool at a company party

when he misjudged the distance to the end of the pool and hit his head on the concrete wall of the

pool. Trying to play it off, he got out of the pool, walked to the side of the pool, and jumped

back in the water. As soon as he hit the water, Mr. Mackintosh’s body went numb and he was

unable to move any of his limbs. The next thing he remembers is waking up four days later in

the trauma center of the local hospital. He learned that someone had seen him on the bottom of

the pool, pulled him out of the water and revived him using CPR. Doctors speculated that if Mr.

Mackintosh had been under the water for a mere three to five seconds longer, his chances of

being revived would have been slim.

Mr. Macintosh eventually was transferred to Thomas Jefferson University Hospital in

Philadelphia where doctors told him that he most likely had broken his neck when he hit his head

on the wall of the pool and his subsequent jump into the pool caused the broken ends of his

cervical bones to severe his spinal cord. While in Jefferson Hospital, Mr. Mackintosh was in a

state of extreme confusion; he could not make sense of the tubes and wires surrounding his bed

and of the metal halo that had been surgically affixed to his skull to support his neck. He had no

functional movement at all at that time. Upon his discharge from the hospital, Mr. Mackintosh

was transferred to Magee Rehabilitation Hospital in Philadelphia for intensive occupational

therapy and physical therapy and his stay there lasted for two and one-half months.

After leaving Magee, Mr. Mackintosh returned home where he continued to receive

occupational therapy for several months. The occupational therapists treating him at home

provided him with skilled instruction regarding the utilization of adaptive equipment designed to

increase his independence in performing tasks such as handwriting, self-feeding, working on a

computer, and picking up items, all of which were difficult tasks for Mr. Mackintosh due to his


severely compromised ability to grip objects or otherwise use his fingers. Mr. Mackintosh was

able to recover some movement in his upper extremities and a limited range of motion in his

legs. He continues to receive physical therapy to this day to strengthen his upper body.

Mr. Mackintosh owns a variety of adaptive equipment, which affords him a greater

degree of independence. He has an electric wheelchair that gives him functional mobility and

that reclines to allow him to relieve some of the pressure on his bottom to prevent the

development of pressure sores. He also has a van that has been adapted and customized to allow

him to drive. He is only able to drive short distances, however, because of painful neck and back

cramps that are triggered by his position behind the wheel. He also has adaptive wristbands that

allow him to write and to pick up small objects.

I chose to interview Mr. Mackintosh because, although I have known him and been

around him for years, I never knew much about his disability. As the father of my best friend in

high school, Mr. Mackintosh used to pick us from soccer practice in his adaptive van, which I

always found very fascinating. I did not want to ask too many questions at that time out of fear of

making my friend or her father uncomfortable. In addition to my natural curiosity about Mr.

Macintosh, my choice of him as an interview subject also was spurred by my dream to one day

work at Magee Rehabilitation, or a similar rehabilitation institution, on a spinal cord injury unit.

I also thought that Mr. Mackintosh would be a good candidate for this interview because he has a

wicked sense of humor and does not seem to take himself too seriously. I knew his humor would

go a long way in making us both feel comfortable during the interview experience.

I chose to interview Mr. Mackintosh using the Canadian Occupational Performance

Measure (COPM). This assessment helps to formulate a true picture of the quality and

functionality of the life a person with a disability is experiencing currently and takes into


consideration the patient’s personal assessment of how well they are performing the tasks they

want to do, expect to do, and/or need to do. It also takes into consideration the client’s

satisfaction level with their progress and performance. This assessment allows occupational

therapists to use the information generated directly by the client with regard to the areas of their

lives they would like to improve or change. If Mr. Mackintosh was my client, I would be able to

use the information gleaned from this interview to make his treatment sessions as client-centered

as possible since the problem areas to be addressed in therapy would have been identified by Mr.

Mackintosh himself. I actually enjoyed this assessment because I think Mr. Mackintosh

benefited from our discussion of possible problem areas; the interview seemed to help him

articulate why some activities in his life were more important to him than others.

The COPM seemed to be a more appropriate tool to use than other assessment tools

because it gave me detailed insights into Mr. Mackintosh’s life as it is today. I was hesitant to

use other assessments that required me to examine in depth his life before his accident because I

thought that would stir up too many bittersweet memories for him. I certainly did not want this

interview to be emotionally draining or painful for my subject. Also, since Mr. Mackintosh

sustained his C5-C6 injury well over twenty years ago, it would not be beneficial for a therapist

to spend an inordinate amount of time comparing the function he had before and after the

accident. The function that Mr. Mackintosh has today, twenty-two years after his accident, most

likely is at a stable level and his current chances for improved functionality are quite slim. If he

were my client, it would be my job to work with the function he has now and to adapt his

lifestyle so that he could maximize his functionality in his everyday life routines. I would be less

focused on helping him to regain lost function—that would have been a more appropriate focus

during the acute phase of his recovery. The COPM was the most appropriate assessment because


it did not remind Mr. Mackintosh of what he has lost due to his accident and it allowed him to

view his life clearly as it is now and to identify areas in which he would like to see improvement.

Before launching into the COPM, I asked Mr. Mackintosh some background questions

regarding his disability. This gave me a better understanding of possible problem areas that he

might later identify in the COPM and gave me a generalized understanding of his current

functional capabilities in advance of my actual implementation of the COPM. This introductory

phase also served to build rapport and to set the tone for the balance of the interview. Mr.

Mackintosh’s very emotionally-charged story, and his willingness to open up to me about it,

made me feel closer to him. I was both elated and grateful that he felt comfortable enough to tell

me his story in such great detail. Developing relationships is the most essential skill that a

therapist brings to any treatment session. If Mr. Mackintosh was my client, our relationship

would create the foundation for building trust, understanding his needs, and ensuring that

treatment was individualized and customized for him (Drench, Noonan, Sharby & Ventura,

2013).

As mentioned above, the COPM is a tool that allows the therapist to take a client-

centered approach to guide treatment since the client personally identifies all problem areas. The

client-centered interview goes a long way toward demolishing any power struggles during an

interview (Drench, Noonan, Sharby & Ventura, 2013). If I were going to treat Mr. Mackintosh, I

would use the COPM to identify those areas in his life in which he was least satisfied with his

performance and I, in turn, would focus treatment on activities designed to bring about

improvement in these areas. I also would take into account the relative importance that Mr.

Mackintosh assigned to each such area, which data would be compiled and recorded as an

integral part of the COPM.


After assessing Mr. Mackintosh using the COPM, he was able to identify five important

problem areas in his everyday life in which he was not 100% satisfied with his performance.

These areas include the use of his hands, his inability to obtain a paid job, issues with shopping

independently, issues with driving, and issues with dressing himself. From these five concerns, I

was able to develop the following three treatment goals that would be implemented into my

theoretical treatment of Mr. Mackintosh: 1) Patient will complete a simple meal preparation task

while utilizing adaptive equipment to increase use of hands with moderate assistance by week

three; 2) Patient will perform community outing at a local grocery store to increase independence

with shopping requiring moderate assistance by week two; and 3) Patient will perform lower

body dressing utilizing adaptive equipment requiring maximum assistance by week two.

Throughout treatment, as Mr. Mackintosh and I continued to focus on these goals, the

expectation is that the level of assistance he requires would decrease as time went on.

Mr. Mackintosh, due to the severity of his injury, must rely on a caregiver and his family

to help him participate in many daily activities. He has a caregiver that comes in every morning

to help him brush his teeth, shower, shave, dress, and transfer from his bed into his wheelchair.

This same caregiver comes again in the evening to help him with his bedtime routine and to help

him transfer from his wheelchair into bed. When his caregiver is not present to help him, Mr.

Mackintosh depends heavily on his family members to assist him. Mr. Mackintosh talked at

great length about how important and helpful his family has been throughout his entire journey.

The support they have given him over the years has truly made life easier for him. Since Mr.

Mackintosh has a lot of difficulty using his hands, his family takes sole responsibility for such

tasks as making his meals, emptying his urine bag, and—lastly, but not least!-- entertaining him.

After learning about the roles of caregivers and family in my advanced interpersonal dynamics


class, I think that it is safe to say that if Mr. Mackintosh was my client, I definitely would

incorporate his family and caregiver into treatment as much as possible since they play such

critical roles in his life. This incorporation would help his family learn more about the things he

can and cannot do for himself and it also would help motivate Mr. Mackintosh in therapy since

he would have his support system at hand.

During the interview, Mr. Mackintosh did share that, although his family members have

taken on extra burdens in the household due to his condition, he has taken on the role of

managing the finances of the household. Our discussion of his role as the financial manager of

the household helped us to segue into the topic of his work experience. This was an area of his

life with which he was quite displeased. After his accident, his attempts to find employment all

proved fruitless since, to his way of thinking, he is unable to use his hands to his satisfaction. He

has held many volunteer positions since his accident, such as being a member of the township

parks and recreation committee and working at a local elementary school; however, it bothers

him to no end that he has not been able to be a financial provider for his family.

I am confident that I was able to use therapeutic use-of-self with rapport, insight,

patience, humor, energy, honesty, and my voice and body language during the interview. I did

my best to show Mr. Mackintosh that I wanted to be there and that the interview was my number

one priority. We chatted between questions which allowed him to elaborate on some of his

thoughts and we both were very honest with one another. If he did not understand one of the

questions or if I was unable to follow one of his responses, we were both comfortable in asking

for clarification. I was able to joke around with him, which helped to lighten the mood of this

interview about a difficult subject. As I did in my interview with Mrs. McCarthy, which I


conducted a few weeks prior to this interview, it was important for me to keep in mind that Mr.

Mackintosh was my elder to and treat him with appropriate decorum, respect and deference.

As a result of conducting this interview, I realize that the therapeutic process is made

much easier when you let the client take center stage. During the interview, Mr. Mackintosh

discussed which of his therapists he did or did not like. I was saddened to learn that very few of

his occupational therapists had taken the time to focus on the issues that Mr. Mackintosh felt

were most important. They seemed more concerned with directing therapy toward areas they

thought he should want to focus on. Permitting and recognizing the client to be the expert on

their condition and allowing them the time to discuss areas in their lives with which they are

dissatisfied is extremely important. To increase the quality of life for any client, a good therapist

must take time to sit back and listen carefully. This action serves to increase the motivation a

patient has to participate in the treatment and to enable the therapist to build a better rapport with

the client since it demonstrates that the therapist cares about the patient’s wishes and needs.

This course, in particular, has alerted me to the aspects of a disability that may be

somewhat hidden during an initial assessment of a client. It is critical that I keep in mind that the

emotional and mental aspects of a disability can be even more disabling than the physical

aspects. I also now am cognizant of the fact that a successful therapist must focus attention on

the client while taking into consideration the other individuals who may be important

contributors to the “big picture.” It also is important to recognize that even though incorporating

family members and caregivers may be an important factor for consideration, it may not be

appropriate for certain clients. No two clients are ever the same even if they are living with the

same disability. Family dynamics and support systems vary greatly and it is crucial to

understand the client’s perspective of family members and/or caregivers before including them


into the treatment plan. This course has allowed me to see both the positives and negatives that

exist in the field of occupational therapy and has strengthened me in my resolve to become a

therapist who is client- centered, who utilizes occupation-based treatments, and who is viewed

by my clients as one their biggest fans and supporters.

In summary, I really enjoyed having to do this interview since it afforded me the

opportunity to get to know someone, with whom I have been acquainted for years, on a much

more personal level. I now have new respect for all that Mr. Mackintosh has accomplished (and

continues to accomplish) and for the manner in which his entire family teams up to support him

and one another. I also am glad I had the opportunity to conduct another interview prior to this

one, because that experience boosted my confidence level going into an interview that I knew

had the potential to be emotionally-fraught and extremely personal. The prior interview

experience enabled me to step out of my role as Mr. Macintosh’s daughter’s friend and, instead,

present myself to Mr. Macintosh in a professional manner. Since the two interviewing

experiences were very different in many aspects, I was able to draw unique valuable lessons

from each. My initial interview experience with Mrs. McCarthy served as a wake-up call to the

fact that the interview process can be quite stressful and challenging and a successful interview

requires thoughtful advance preparation and careful use of technique. My interview with Mr.

Mackintosh underscored those lessons and additionally drove home the lesson that the utilization

of client-centered therapy session is of crucial, vital importance to the effectiveness of therapy.

The emotional impact of Mr. Mackintosh’s interview, and his insights into what makes for a

successful therapy session, surely will stay with me forever. I am so grateful for this experience

that has enriched both my professional and personal life.


References

Drench, M., Noonan, A., Sharby, N., & Ventura, S. (2013). Communication. In

Psychosocial Aspects of Health Care (3rd ed.). Boston: Pearson Education.

Dan Mackintosh Interview

Documents

Transcript of Dan Mackintosh Interview