Now, before you post angry responses, let me explain.
I do not believe this to be true but it is a direct quote from myself, when I was a service-user. I also believe I have, in the past, said the same in relation to dialectical behavioural therapy (DBT). So, now that I’m training to become an OT I started musing on how the person who had such disdain for the profession came to want to be part of it. I also have been wondering, in retrospect, what my statement really meant.
I consider myself to be a fairly intelligent person, by no means a genius, but I have always enjoyed using my brain and I am naturally quite reflective. When I was ill I found this to be a bit of a nemesis; I challenged a lot of what the professionals told me (in my head, I was always outwardly fairly compliant), always thought I knew better and didn’t believe any of their interventions could help me. So, when it came to OT I failed to believe that attending sessions on baking, relaxation, computer skills and woodwork could possibly make my chaotic and hellish world ‘all better’. Especially as someone who was very good at putting a front on and ‘performing’ and ‘engaging’ in structured activities, only to suffer the emotional fall-out once back on the ward.
There were several issues with my first experiences of OT (on an acute ward and psychiatric intensive care unit). As a student the emphasis on the need for occupation to be meaningful in order for participation to be therapeutic is frequently stated, yet as a service user this wasn’t evident. Generally, my OT timetable was selected based on the sessions that had spaces and the times that I wasn’t in psychotherapy or ward round. I realise that the NHS is always going to be limited in what it can provide and know that the OTs were working with the resources they had. However, I do feel the service failed those with fairly high functional levels. I remember attending a computer workshop where I was taught how to make a basic poster in Word. As a recent university drop out (due to my mental health problems) this provided evidence that I was indeed worthless and incapable of anything more challenging. I also think that if an OT had explained to me some of the theory around occupational therapy, such as setting goals and finding a way to grade my return to the things I wanted to engage in, then I might have been better able to see the value in what I was doing. I don’t know if the OTs had any ‘grand plan’, it certainly felt that they were, at best, attempting to stave off boredom.
I’m also now using my experience to reflect on the role of the OT to challenge the choices I made. It is part of the profession that OTs have to sit with uncomfortable feelings when a client selects a goal that is not in their best interests. Park (2009) explains that if a client is competent to understand the risk involved in the choices they make, then it can be a helpful to engage in a level of risk. However, in my situation, choices to attend a woodwork session (to gain access to materials to self-harm with) or to attend cookery sessions (despite being underweight and obsessed with food, delighting in taking a plate of cakes back to the ward to ‘feed’ the staff with, never daring to eat one myself) were never challenged. These examples are of occupations that did actually hold meaning for me, perhaps just not such positive meaning as one might like. Were the OTs being incredibly client-centred in letting me choose to engage in destructive activities because they held meaning, or were they just not thinking about me and my likely volition at all. I suspect the latter. So what would I do if the roles were reversed? I think my subsequent experience of being part of a therapeutic community (TC) has taught me the value of questioning the rationale behind every behaviour. As an OT I’d try and discover why they were selecting the activities they were, and explore how it enabled goals they wished to achieve.
I often wonder why I had such disdain for OT. I do believe that the absence of understanding the rationale of the therapy was a major barrier. When you are endlessly handed sheets of colouring in to do, with felt tip pens that have nearly dried up because you can’t be trusted with a pencil sharpener, it’s understandable that you feel somewhat infantilised. Especially as art was a pretty traumatic experience at school. If someone had said, ‘what areas do you feel you can’t do the things you want and need to do in?’ and ‘Ok, let’s look at the steps we might take to get you back to that level of functioning’ I might have been more co-operative. I also would have been more convinced that I wasn’t trying to be distracted from being a nuisance on the ward if I’d been given age-appropriate (and perhaps intellect-appropriate) things to do.
This reflection has also got me back to thinking about the common topic of why occupational therapy isn’t clearly understood by non-OTs. I know when I was a service user that the staff in the multi-disciplinary team didn’t explain OT as anything other than activities to pass the time. Is it because the profession is so based on utilising activities that are essentially ‘normal’, that non-OTs don’t endeavour to understand the approach? It’s not like medicine where there are medications or procedures, or even physiotherapy where there are exercises and ‘hands-on’ treatments. For OT there is substantial theory (and increasingly, evidence) behind what we do, the methods require extensive training before the professional is ‘let loose’ and yet, because the therapy is based on things we are all familiar with and so heavily focus on enabling the client to do things for themselves, I believe the complexity of the process is often overlooked. I think it’s important that as an OT I remember this, not every client will be interested in the theory but I hope that by ensuring that, at the very least, I work collaboratively and explain the process we won’t always be seen as ‘activities co-ordinators’. I know that once I worked with an OT that explained the rationale for the intervention I was certainly more willing to engage and less resistant to being able to be helped by carefully chosen goals using occupational engagement.
Finally, on a personal level, I want to consider why I was so adamant that OT was for ‘thick people’. Mostly the answer is in the above reflection, I didn’t understand OT and felt insulted by what the staff were suggesting I do. As a person who had had an eating disorder for years I had long since mastered the art of distracting myself from a ravening hunger (or more precisely, using the eating disorder to distract myself from emotions and thoughts that felt like they had the power to annihilate me), so I felt I didn’t need people to give me further tips. I was also scared. On so many levels. I was scared that OT might help me. What if I started to be able to cook nutritious balanced meals again? I was convinced I’d be left with all the feelings and a tool-kit of functional skills that would make the disparity between my internal and external worlds even greater. I was also scared that someone would realise that I was dissociating through all of the ‘relaxation’ workshops when any of the male patients got agitated, and work out why that might be so. I got so scared that I used an OT session to seriously (and unusually for me, publicly) hurt myself so that I was banned from future sessions. So essentially, for someone who is bright, being deprived of information ensured that any OT intervention was set to fail.
I’m aware that I haven’t covered how I managed to move from this view to one of advocating occupational therapy as a profession I believe in, and want to be part of. That’s a topic for another day!
Park, S (2009) Goal Setting in Occupational Therapy: a Client-Centred Perspective. In Duncan, E. Skills for Practice in Occupational Therapy. Edinburgh: Churchill Livingstone Elsevier.