What is Occupational Therapy? An OT Spiel

“What’s your OT spiel?” Is an ongoing discussion for OTs. The occupational therapy (OT) spiel is similar to what’s commonly known as an elevator speech, but for OTs. My purpose in writing this article is as a personal assignment to organize my favorite OT spiels into one place.

Introduction

Defining OT was one of the first assignments I remember in my introduction to OT class. “Develop your OT spiel” was one of the first pieces of advice I remember from doing clinical work. The OT spiel continues to be an important discussion among OT circles.  I do not believe there is a one-size-fits-all OT spiel.

During my second American Occupational Therapy Association conference in 2017, I went to a presentation titled “PromOTe.” There, audience members were invited to come onto the stage and give their best “elevator speech.” Surprisingly, though the room was packed, nearly no one volunteered. Wearing the extrovert shoes I do in social situations such as that, I volunteered. 

My goal was to make people laugh and act personal. I said something along the lines of “most people think occupational therapy is all arts and crafts, but I like to inform them it can be fun and games too.” 

Maybe one or two people chuckled, mostly the joke fell flat on the audience. I continued with about one minute more of talking. As soon as I finished, the presenter asked the audience if they had any feedback.  Apparently they had been listening, because I swear, the entire audience, raised their hand. 

“it was too long.” 

“it wasn’t professional enough.” 

“it made OT sound like all arts and crafts.”  

Thankfully, the presenter boasted my self-esteem when commenting she was proud that I was one of the few who had the courage to attempt an OT spiel. Well, ignorance is bliss, because I realized after the session why I was one of the few. 

The presenter was Karen Jacobs, a recent president of the American Occupational Therapist Association (AOTA). I was only glad to have figured that out after I left the room and not on the stage. 

Since that moment, I have thought deeply about what occupational therapy is, to the point of diving into the Archives of Occupational Therapy, edited by Wm. R. Dunton, Jr., MD, Volumes I-III, 1922-1924. These documents are found at the Wilma L. West library which can be located online at the American Occupational Therapy Foundation (AOTF) website. 

An OT Spiel From the 1920’s

One of my favorite definitions of OT comes from one of the original founders of occupational therapy Adolph Meyer (1922): 

“There are many other rhythms which we must be attuned to: the larger rhythms of night and day, of sleep and waking hours, of hunger and its gratification, and finally the big four – work and play and rest and sleep, which our organism must be able to balance even under difficulty. The only way to attain balance in all this is actual doing, actual practice, a program of wholesome living as the basis of wholesome feeling and thinking and fancy interests. 

Thus, with our patients, we naturally begin with a natural simple regime of pleasurable ease…Our role consists of giving opportunities rather than prescriptions. There must be opportunities to work, opportunities to do and to plan and create, and to learn to use material.” 

While words change, definitions change, culture and rhythms change, there was an understanding that Adolph Meyer had about humans. While argument and debates about what is what, may always be. For a moment in time, Adolph Meyer understood something about us that I argue, can not be understood better. All further definitions are simply new interpretations, culturally relevant applications, and translations into modern words.  

My Personal OT Spiel 

If I were to say what occupational therapy is to me, it would be this: 

Occupational therapy is more of a philosophy than a skill set. It’s an idea, that people must be actively engaged with the world in doing things as opposed to not doing. It’s by this ‘doing’ that meaning, purpose, and value is brought to life. ‘Doing’ is anything from mundane daily routines to the pursuit of our passions, from washing dishes, dressing, brushing our teeth, to photography. So, what matters to you?” 

 

My Mental Health OT Spiel

In the workplace however, I typically start any discussion on what OT is with: 

“Have you ever worked with OT before? If so, what’s your experience of its purpose?” 

When I begin explaining occupational therapy in the mental health setting it goes something like this:  

“Occupational Therapy is dealing with how people ‘occupy’ time. Think ‘routine’. Wake up, shower, get dressed, eat, work, talk with friends, journal. That’s healthy living. When I’ll-health stops that, we focus on strategies to get back to a healthy routine. If in a wheelchair, being able to get into the shower is important. If dealing with depression, having a coping strategy is needed (…or insert your own examples). Being able to engage in day-to-day activities is the occupation, practicing is the therapy.” 

My Physical Health OT Spiel

I do not believe mental health is separate from our physical health, but the reality is, the public does. I believe it’s important to meet others where they are at and gain an understanding through listening first.

My typical OT spiel for the inpatient rehabilitation setting where those with physical injuries like stroke, cardiac & spinal injuries, amputations, and other disabilities go for “intensive therapy” prior to going home, goes more like this: 

“Occupational therapy may look different depending on the setting, but it’s goal is the same, to help people be as independent as possible with their day-to-day activities, with stroke that might look like dressing or using the bathroom, or simply getting around your room.”  

Depending on upon the day or conversation, I may further elaborate. 

Conclusion

What occupies our time may change, but the need for the human to be occupied will not.  The word occupation itself may even carry different images and opinion, yet the understanding of the human need to be engaged remains as critically important forever.

In an international discussion on “what’s your OT spiel?” Several occupational therapists reported a negative stigma associated with the word occupation and occupy more as a “meaningless” or “blasé” use of therapy. This stigma may exist in different forms in the US or around the world as well.  

I don’t believe there will ever be a final definition of what occupational therapy is. I believe occupational therapy is an idea that can only live in the minds of those who see it. Words are used to translate that idea and phenomenon, but the problem is; occupation fundamentally relates to people, and people change. However, people’s need to be engaged does not change.  

The realist OT will always stand adaptable, ready to modify and adapt that idea into the frameworks and understanding of the audience to whom they wish to share the idea.  

References

Meyer, A. (1922). The philosophy of occupational therapy. Archives of Occupational Therapy, 1,1–10. Retrieved from http://www.aotf.org/resourceswlwlibrary/archivesofoccupationaltherapy 

How Being A Parent Has Helped Me As A Therapist

You missed it - sorry

My work as an Occupational Therapist has it’s benefits. I work specifically in mental health with young adults ages 18-24. However, many often associate occupational therapy with pediatric work. In which case, I often hear people describe the idea that my profession gives me the skills to provide my daughter with above and beyond challenges that will give her an advantage in life.  

In some ways it does, but not how most would expect.  

Her Exceptional Fine Motor Skills

It was this Halloween a friend noted how well developed my daughters fine motor skills were for her age. My daughter can open jars, lids, and more things than I’d prefer. In fact, her well developed fine motor skills are slightly bothersome because we have to be so careful with what she can access. Halloween was not the first time others have made note of my daughters healthy development and made comments such as “I bet it’s great to have an occupational therapist as a dad.” However, being an occupational therapist has only helped me recognize the value of “day-to-day” activities. 

I mean, being an effective parent has as much to do with what I don’t do as what I do. 

A cute picture here
“The Itsy-Bitsy-Spider…”

The Gold Standard of Occupational Therapy

The gold standard of occupational therapy is “occupation.” That is to engage in the everyday tasks people do. This could include but is not limited to; showering, dressing, eating, playing, taking pets out for walks, going to the grocery store, and playing cards with friends. The mistake people often make about therapy when they imagine colorful cones, bins of odd shaped toys, and fancy gym equipment when doing those “therapy” like tasks, is that they are better than doing the everyday tasks I just listed. In truth, it is far better to be practicing showering, dressing, eating, playing, and so forth, than moving cones.  

In my opinion, the two things fancy therapy techniques and tools are used for is: 

  1. To support eventually practicing the occupation (showering, dressing, eating, playing etc.) 
  2. To avoid the miserable boredom of repeating the attempt at occupation if it’s not working. 

What I mean by number two is, if therapy is working on self-feeding, a patient can’t just practice eating for an hour or they would vomit. The use of therapy tools by occupational therapist is always only to support the eventual and hopefully current engagement in occupation or day-to-day tasks. That last sentence is not my opinion. 

Engaging in Everyday Tasks is the Best Therapy

It is not likely I could make my daughter a super human with therapy techniques. My daughter has well developed fine motor skills because I allowed her to help me hammer nails, wash dishes, prepare food, play with my special Star Wars Legos, and put many book shelves together. I was never providing therapy, but I was also not pushing her away from participating in every-day tasks. Kids are natural at engaging in occupation, the danger is when we stop them.  

Lots of Legos Here
Sharing the Lego Tradition

Even kids with developmental disabilities, the thing that is most beneficial, is for them to simply to be allowed to engage in day-to-day tasks even if specialized tools are needed.  

What parenting has taught me about my job as an occupational therapist, is the most effective therapy I can provide is often NOT me teaching and educating, but rather simply doing pumpkin carving. That is, simply to support and experience occupation with others. 

The day before Halloween I facilitated one of the best mental health groups yet. I measure this by my personal objective observation of joy and laughter. Group members said “I can’t believe I’m pumpkin carving in a locked inpatient unit” and “my girlfriend is going to be so surprised when I tell her what we did for group while I was here.” I even had one patient discharge and take her pumpkin home with her to show her kids. 

Pumpkin
Happy Halloween! I hope you enjoyed it and remained safe!

I don’t have lots of research for the post, just sharing a little something I’ve learned that I hope can be of value to you.

For more info on what Occupational Therapy is, click here.

For more about what I do, read: What I Teach for Mental Health

The Best Job Ever: Occupational Therapy in Mental Health

Picture of Coffee cups

Mental Health Occupational Therapy

Following Your Passion

First, I want you to think about a few mental health questions.

Who has ever dreamed of being an Olympic athlete?

How about a sports coach?

Personal trainer?

Or, if your like me, who of you would have been happy just being the towel or water boy?

What does this have to do with mental health? Well, the goal of this article is to share a brief picture of what occupational therapy looks like in mental health and what I do on an inpatient mental health unit. This is difficult to address without first addressing the “follow your passion” mantra. “Follow your passion” is a cultural belief common today; whether that is good or bad is another story, but the reality is, this belief exists.

It could be argued that most kids dream of being athletes and coaches because they imagine waking up for work doing what they love, which is generally sports. Similarly, it might be more common today that kids want to be video game designers and testers than athletes. Again, to wake up, go to work, and do what you love all day long.

Do you suppose if your job was to be an Olympic athlete, you would be in good shape and physically fit? Of course! If your job was to test video games, you would be great at video games too.

I played Junior Varsity basketball my Sophomore year of High School and was the only player who never scored. Sure, I was a bench warmer, but the other bench warmers still scored once in a while.

Olympic dreams crushed.

It didn’t help I never made it to 6-foot-tall, like the doctors always said I would on that little curvy graph they showed me every childhood checkup. They lied.

So maybe that’s why I gave up my Olympic athlete dreams. But was that really so bad?

A Mental Health Athlete

Now let me ask you another question: How’s your mental health doing?

When was the last time you dreamed of being a mental health athlete?

Or as that might translate better, do you find yourself wishing you were happy?

How many of you would simply like to have the energy to wake up, show up at work, or simply make it to work without hating yourself?

Well, imagine your job was to practice mental health techniques with people like an Olympic coach teaches exercise. That is just what I do and I believe all of us should value mental health like physical fitness. Coaches are not always in perfect shape, and neither am I. But I do practice what I teach. I “take my own medicine” if you will. In the same way, practicing mental health is not only for therapists like exercise is not just for Olympians.

You see, I’m an occupational therapist (OT) working in a locked, inpatient, mental health unit. This unit is focused specifically on helping young adults, which are ages 18-24ish. The primary cause for arriving to my unit is being a danger to self or others, generally from attempted suicide, suicidal ideation, self-harm, manic episodes of bipolar disorder, and active or new onset episodes of schizophrenia. Nearly everyone is a mix of these challenges and more to top it off.

Crazy right? Not so much, it turns out, one thing you would learn quickly if you spent time on an inpatient mental health unit, is the people that end up there are like you and I; students, workers, daughters, fathers, dreamers, and world travelers all the same. It’s quiet unlike One Flew Over the Cuckoo’s Nest or Shutter Island.

What’s My Role as an Occupational Therapist?

I asked you a question earlier about how your mental health was doing?

If your mental health is not doing well, then like I mentioned, you might think of the difficulty getting out of bed in the morning or getting to work, feeling fatigue and despair which makes it harder to do the things you love. Or, what you might be thinking of is more basic, the things you do on a day-to-day basis like showering or going to the store to shop for groceries.

All those “day-to-day” activities is what my profession calls “occupations” hence, occupational therapy.

By the time people end up on my unit, their “day-to-day” activities are severally disrupted by mental health that is not doing well.

If you were on the inpatient mental health unit, the most stereotypical step of the day is that staff do their best to wake you up and get you to come take your medications. Which is given with incredible effort by staff to be respectful of patients’ personal wishes and boundaries.

Then comes breakfast.

After that, comes the first of two “community meetings” in which everyone is encouraged to attend. Here staff share the schedule for the day and expectations of respect for others. I do my best to attend the majority of these morning community meetings to share what I call, my “OT schpeel.”

Which goes similar to this…

“Hi everyone, my name is Grant, I’m an occupational therapist and I lead a variety of groups here. Occupational therapy is dealing with how we ‘occupy’ time with our ‘routine’. Wake up, shower, get dressed, eat, work, talk with friends, journal or read; that’s healthy living. When mental health stops that routine, I focus on strategies to practice that routine for healthy living. If dealing with depression, coping strategies might be needed, or groups with physical activity. It might be focusing on an craft project, or simply manage the anxiety of being around others. These day-to-day activities is occupation and practicing is the therapy.”

…End of Mental Health focused OT schpeel.

Now, you may or may not have seen OT in multiple settings. Understanding the value of healthy routines to OT may make more sense when looking at OT in different settings. A school OT is addressing the school aspect of a child’s routine, the nursing home OT is helping your Grandma continuing to “do” the routine gardening she always loved while in a wheelchair.

While occupation is commonly synonymous with “vocation”, work can be apart of your routine and therefore can be something an OT would address if you had an injury or mental health challenge. However, patients on the inpatient mental health unit where I provide OT, are far more focused on getting through the day than work or school. That is why we are not addressing purely job skills. Yet, at the same time it’s important to recognize that coping skills is very much need in the work place too.

Conclusion

If you had asked me where I wanted to work, I would have never thought it was going to be mental health. Mental health was not my passion. Yet, since I’ve begun practicing all the mental health strategies and exercises I help facilitate on the unit I work, I have begun to value both OT and mental health in a new way.

In this way, I bring my positive mental health from home to work, and my skills and practice from work to home. That is why I want to share this with you.

I hope you enjoyed learning a little bit about OT in mental health. More so, I hope you are encouraged to value your mental health and not feel pressure to ignore mental health as only for the ill.

Are you interested in WHAT kinds of things we practice in OT group treatment sessions? Read my next post found at the link below:

What I Teach for Mental Health

 

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