The Sorting Task: A useful tool to tackle challenging communication
I’m a paediatric physiotherapist working in mental health with children and young people. This job has its challenges. A key aspect of my role is to facilitate and support children and young people to do their own physiotherapy to help them get better. This treatment is often difficult, uncomfortable, painful and progress can be relentlessly slow. Motivation, rewards and support are key to successful outcomes and it is important that the young person is on board with the treatment process. Good communication is crucial in achieving this. Young people benefit from being provided with choices, having a say in their treatment and being involved in decision making. This is tricky when they just don’t want to talk about it.
This year I decided to try something new. I looked into activities based on communication for a session away from typical movement-based physiotherapy. The sorting task seemed like a good choice to start with because I could use it to discuss daily routines, a key aspect of rehabilitation for someone with a debilitating, long-term condition. I hoped this activity would help me understand more about what’s important for an individual and how to motivate and engage them more in their own treatment.
I got more than I had bargained for.
What is a sorting task?
The sorting task is an activity that helps someone think about and communicate their preferences around a specific topic. I have used it to help young people with somatising disorders to sort activities of daily living into these three sections:
-activities that they can already do
-activities that they aren’t interested in
-activities that they can’t do and want to do or want to do better
I marked out these three sections on a board. I then gave the young person a pack of cards that I had made with basic daily activities on such as eating, brushing teeth and getting dressed as well as sports or hobbies particular to them. I then asked them to sort each card into one of these sections and used Velcro or blutac to stick the cards down.
Before trying this activity I had hoped that it would provide a helpful way to discuss activities the young people want to work on. I had not expected the wealth of insightful conversation generated just by the process of sorting the cards. One young person talked about activities they hadn’t yet felt able to discuss with staff. They explained that they had previously avoided this in conversation for fear that staff would make them do the activities even though they didn’t feel up to it. This led to a conversation about the difficulties around talking to staff and how to deal with this. It also provided valuable information about the young person’s anxieties, enabling us to talk about how they felt and how to overcome difficulties around this.
Another young person was very indecisive about placing the cards into the different categories. This sparked useful conversation about decision making and goal setting and the young person talked more than I’d heard before, despite working with them for months.
With each sorting task completed it felt like the process helped me to build a better rapport and therapeutic alliance with the young person involved. It also appeared to help the young people focus more on their goals and how to achieve them, encouraging them to engage more in their treatment as a result. I hope that these conversations have helped the young people to feel heard, feel more involved in their healthcare plans and to have more control over what they’re going through.
Creating the cards and the board used for the sorting task took longer than expected as I decided it was important to have decent colour pictures and to be thorough in the choices I provided. A rougher version would likely still be effective. I also thought laminating the cards would allow repeat use for other young people, saving me time in the long run. After the first attempt, the activity was significantly quicker to organise and complete.
The duration of the activity depended on the individual involved. The indecisive young person took over an hour to complete the activity but fortunately I had the luxury of time on my side on that occasion. The next young person completed the task in about half an hour. In the future I could start with only a few cards to test how long the activity might take. In my experience the conversations started early in the activity so it would be worth trying a shortened version in a tighter time frame.
In previous roles I would have found it hard to justify spending this amount of talking time with a patient without more hands on, practical physiotherapy activities. Busy working environments and a lack of time can often conflict with aspirations of taking time with patients to listen to them beyond basic conversation or questions. Allowing patients more time to indulge in information that is important to them can sometimes feel like it’s distracting away from work based priorities. However I am becoming increasingly aware of how powerful and productive communication activities can be, and specifically when separated from traditional physio sessions. I believe they have the potential to improve compliance, save time and improve treatment outcomes.
These experiences have shown me that communication activities can help to stimulate conversation when things get stuck. They have been extremely rewarding, have provided valuable learning for me and I feel they have had a positive impact on young people.
I’d love to share thoughts and ideas about communication activities to help facilitate and encourage child centred communication. More information about the sorting task is available
Feel free to get in touch: emailing Rachel at [email protected] or via twitter @RENphysio
Specialist Paediatric Physiotherapist
& Me first Project facilitator