Occupational Therapy: What Is It?

Despite the fact that the profession of occupational therapy (OT) has been around for 100 years, it remains mysterious to many. Unless you or someone you know has benefited from OT services, chances are good that you are among those who think occupational therapy practitioners help people get jobs. Through this blog post, I hope to demystify the profession and bring clarity about what it is that occupational therapy practitioners actually do.

 OCCUPATIONAL THERAPY DEFINED

 The Occupational Therapy Practice Framework: Domain & Process, 3rd ed. defines occupational therapy as “...the therapeutic use of everyday life activities (occupations) with individuals or groups for the purpose of enhancing or enabling participation in roles, habits, and routines in home, school, workplace, community, and other settings.”

 What does all of that mean? Very simply put, occupational therapy practitioners focus on helping people do what they want and need to do every day. The signature of occupational therapy is that we use these everyday activities as a therapeutic means as well as an end. Mary Reilly, one of the most influential people in the field of occupational therapy, described it best in her famous quote, “Man, through the use of his hands, as they are energized by mind and will, can influence the state of his own health.” If you have a moment, allow these words to marinate in your mind. Have you ever found yourself lost in a task not noticing that hours passed by? This can have a very healing effect, even for those who are healthy. Imagine finding that something for someone who is experiencing a challenge in life...imagine helping someone find some peace, comfort or joy and the healing effect that can have.

While ultimately it is the patient or client who must engage in the therapeutic process for well-being to occur, there are times when people need direction. Occupational therapy practitioners can help.

OCCUPATIONS – NO, WE AREN’T GOING TO HELP YOU GET A JOB

I can’t tell you the number of times someone has told me they can’t work or they’re beyond the days of employment so they won’t need to see me. I agree that the terms “occupational therapy” and “occupation” can be deceptive, so let’s begin here. The word occupation, chosen many years ago, is used to describe the tasks we do everyday. Occupations are broken down into categories:

1. Activities of Daily Living (ADL’s) – ADL’s are tasks we engage in daily such as bathing, dressing and feeding.

2. Instrumental Activities of Daily Living (I-ADL’s) – more complex than basic ADL’s, I-ADL’s are tasks that support us in daily life. Some examples are taking care of others, driving and community mobility, and financial management

3. Rest and Sleep – proper rest is essential for healthy participation in other occupations.

4. Education – activities for learning and participating in formal and informal educational settings

5. Work – regular engagement in activities for financial or other reward

6. Play – activities people engage in for fun

7. Leisure – activities we do just because we want to

8. Social Participation – activities done with others

 Life can be difficult for someone experiencing a struggle in any of these areas. An occupational therapy practitioner, like a detective, is specially trained in how to decipher where a breakdown may be occurring; then, works with a client or patient to find solutions to help ease or eliminate the problem.

CLIENT FACTORS – THE WHOLE PERSON

As an occupational therapy practitioner, I’ve often been able to garner information about a person that others were surprised to learn. I think this is in part because our training includes “Therapeutic Use of Self,” but also because we understand the importance of the aspects of the person themselves and how they influence participation. These Client Factors include values, beliefs and spirituality, body functions, and body structures. Knowing what drives a person and understanding how to use those aspects of a person is important for connecting interventions with meaning and, thus, optimizing the chances of client engagement, carryover, and goal achievement – all part of successful and positive outcomes. Body functions and structures are just as they sound – essentially the physiological and anatomical aspects of a person.

PERFORMANCE SKILLS – TAKING ACTION

Performance skills are divided into three categories – Motor Skills, which consist of movements a person makes as she or he interacts with objects and the environment; Process Skills, which necessitate cognitive abilities for successful execution of daily tasks; and Social Interaction Skills that are seen when interacting with others. “Performance skills are observable elements of action that have an implicit functional purpose; skills are considered a classification of actions, encompassing multiple capacities (body functions and body structures) and, when combined, underlie the ability to participate in desired occupations and activities.” (AOTA, 2014).  Sound understanding of Client Factors and Performance skills along with knowledge of the level of function within each patient plays a key role in how occupational therapy practitioners design needed interventions.

THE POWER OF PATTERN – KEEP IT SUPER SIMPLE

Habits, routines, rituals and roles drive human behavior, allowing us to easily move about our lives. Taking time to think about completing each task we engage in would leave us mentally exhausted AND cause our lives to slow waaaay down. There is a level of power in using these behaviors, but there is also a line to consider between supportive and destructive patterns. The habit of engaging in a routine of starting the day with a delicious cup of coffee or a favorite workout can keep someone on track for a smooth day. Routines are multiple and vary depending on the role one is carrying out at the time. A woman in her late twenties may have the role of employee, wife, mother, daughter, sister, etc. Her morning routine as an employee and mother may include several habits – drinking a bottle of water upon awakening, kissing her children when dropping them off at day care and then going through the Starbuck’s drive through for coffee.  Drinking her coffee in silence while driving may be a ritual she enjoys on her commute to work. Occupational therapy practitioners understand the importance of these Performance Patterns and how they can support or hinder an individual’s ability to independently engage in occupations.

KEEPING IT ALL IN CONTEXT - MR. SMITH, IN THE BEDROOM, WITH A PAIR OF PANTS

Similar to a game of Clue, the context and environment where one engages in daily activities are key factors to consider. Everything we do is done somewhere within some situation. In order to help an individual achieve maximum independence, it is essential to understand this information. For example, a person who gets dressed in the bedroom (environment), in the morning (temporal/time), after showering (temporal/time) while getting ready for work (context) is very different from someone who stays in their night clothes most of the day.

PUTTING THE PIECES TOGETHER – IT ISN’T AS PUZZLING AS IT SOUNDS

If you like puzzles, you know how satisfying it is to put in the last piece...The final piece of this “OT puzzle” is something that occupational therapy practitioners are highly skilled at – activity analysis. It is essential to consider the intricate aspects of the task a person needs to perform along with all of the other pieces involved in order to determine how to help someone achieve optimal function. It’s like putting a puzzle together. OT practitioners consider the whole picture of a person’s life. We know what to tweak if something doesn’t match up quite right.

To sum it up, we aren’t going to help you get a job but now you know how we can work with you to:

• Determine what is getting in the way of a person’s ability to live life to the fullest

                            and

• Develop a plan to help overcome any limitations.

NOTE: The Occupational Therapy Practice Framework: Domain & Process, 3rd edition is a great resource that can enhance your understanding of occupational therapy. It is written in easy to understand language, appropriate for healthcare professionals and all others.

Reference:

American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1-S48. http://dx.doi.org/10.5014/ajot.2014.682006