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 

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