In https://pd2ot.wordpress.com/2012/05/21/ot-is-for-thick-people/ I explored my first encounters with Occupational Therapists and why I felt their intervention was, at best, pointless. I think it’s only fair to explore the process of moving from being the client who got themselves banned from OT to the passionate student engaging in their first placement. I expect the reflection to highlight that when the issues that limited the success of earlier interventions were resolved I benefited from therapeutic occupation, but I anticipate there may be other influences, too.
I remember I was slightly less resistant to OT sessions at periods when I was detained on a psychiatric intensive care unit (PICU). I was feeling somewhat less depressed than the period before, when OT just felt like too much effort and totally overwhelming, but the slight elevation in mood had increased my self-destruction, hence the transfer to PICU. I think, at that point, I only engaged because it was an opportunity to get off the ward (albeit to the adjacent PICU OT room, with everything locked away). However, I do feel it was a useful experience because it reduced my agitation that resulted from the containment (and tedium of 24:7 coverage of the Beijing Olympics, which was the only other realistic occupation).
But on the whole, my experience of OT in psychiatric hospital was not a good one. In fact, when I finally agreed that I would transfer to a Therapeutic Community (TC) my Consultant thought it was some kind of ironic karma that the TC allocated the OT as my keyworker. I have to admit I was convinced it would never be a happy, or useful relationship, but how wrong I was!
So, how did it all turn around?
Unsurprisingly, the fact that the OT at the TC was a highly intelligent (both emotionally and intellectually) woman that was passionate about the role of occupation was a big factor in my change in attitude. Her belief in OT was infectious, even to a sceptic like myself. She also worked at my level. She explained enough theory to me, found that my inner geek loved playing with pie charts/statistics and so encouraged me to chart my time use in graphs that I could compare month on month. But, importantly, she listened when I said ‘this is all bull****, I appear to have ‘occupational balance’ but my sleep is distressed and filled with flashbacks, I hate every aspect of my leisure – it’s all fuelled by a compulsion to exercise, and this ‘self-care’ is just me complying with the expectations of the programme to eat/cook/wash, I don’t actually want to do that for myself’. This was vital. One of my biggest resistances to OT was based on the misguided belief that OT was only about just doing the correct (correct in terms of what society believed was right, not what I wanted) occupations, and fear that I could do them and be left with the emotional torture of how it felt to be ‘doing the right thing’. Over time we worked through the aspects and found ways for me to achieve occupational balance that actually felt ‘ok’. It was a slow process and it also required input from the TC, psychotherapy and dialectical behavioural therapy (DBT).
I could go through all of the steps, but it would take forever! So, I’ll just mention the part I attribute to my recovery being transferable and sustainable to, and in, life in the community. I was incredibly fortunate to secure funding for an additional 4 months in the TC as a day patient. This gave me the opportunity to practice the new skills in the real world, to experience the likely problems I would encounter and discuss them with the community and to build up occupations that I could continue on discharge. It was an incredibly testing and emotional period and things only seemed to fall into place in the last month. The OT talked through the options I had with me, but in such an empowering way. She simply nudged me in the right direction while providing a safe space to thoroughly explore worries I had and the emotions and thoughts evoked by engaging in the new occupations. While I had done considerable work on meal preparation in the OT Kitchen at the TC, I found that when I tried to do it at my flat I was either enveloped by distress or avoided the task entirely. One of the most crucial points of the therapy was a supported cooking session in my own kitchen. At this point I truly understood the influence of context on occupations; I was a capable (albeit unsure, due to eating disordered thoughts) cook, had a well equipped kitchen and no physical limitations, but I failed to appreciate the barrier imposed by the difference in emotional experience in my own space, compared to an OT Kitchen that I could convince myself I was just performing and complying, rather than choosing to engage for myself. In terms of finding leisure activities that I wanted to participate in we discussed the issue with the eating-disordered fuelled ones and tried to discover what might provide more healthy, yet meaningful, experience. Once I, tentatively, said I wanted to dance again we explored the issues around it for me in terms of links to a difficult childhood. Once those had been problem-solved I was left to investigate and decide on the exact class and location. My hand was not held and I had autonomy. The process was not straightforward, but issues were discussed rather than the idea being abandoned as ‘too risky’ and the outcome was a more positive body image, some incredible opportunities and a group of fantastic, supportive friends.
When I left the TC I felt fairly confident that OT was the pivotal influence in me having a life I wanted to engage in and I knew meaningful occupation was essential to ensure my continued recovery. I felt I was ready for more of a challenge and knew study was the next step for me. I decided on an Access course to provide some structure without being too demanding academically. I was also preoccupied by the thought that I wanted to become an OT. I was concerned I was feeling that way to either try and find an identity in copying the career of the person who facilitated my recovery or too ‘fragile’ to so soon be considering the transition from service-user to professional. I spent a lot of time reflecting on this and also spoke to, and visited, a lot of OTs in other settings to find out if the profession interested and inspired me outside of the area I had experience of. Encouragingly, it did. In fact, the more I read and saw, the more I wanted to be part of it. The experience of the degree course has been mainly positive, at times I’ve been frustrated with feeling patronised or hand-held by lecturers, but I’ve also had equal experience of fantastic lectures and workshops and am currently on placement in a setting I had fairly low expectations of, and I’m loving every minute.
So yes, OT does delight me. I strongly feel that for me, when it was applied in a person-centred way (so, for me, including the theoretical aspects), as well as being empowering then it can enable sustainable recovery from a condition that is often felt to be a bit of a life sentence.