Pd2ot Becomes an Occupational Therapist.

IMG_20150323_223948I miss blogging. I could make excuses about my lack of posts being due to being busy at work, but that wouldn’t fully explain it. When I first started writing I had so many ideas to explore and I made time for the blog. Now it’s dropped into that rather full  category of “things I’ll do when I have some free time/am not so tired/am bored”, which has a very low probability of being the chosen occupation if/when any of those situations arose. Why am I not blogging any more? I suspect it’s a combination of feeling a little like I’ve moved on a lot from ‘needing’ to explore pd2ot-type topics and a less conscious disconnection from pd2ot. However, in recent weeks I’ve had a little more time for all things pd2ot, which has reminded me how much I enjoyed writing.  So, this is going to be a pretty basic ‘catch up post’ to get me writing.

This week actually marks the beginning of my PhD. I’ve spent the last six months working full-time in my clinical role to have time to embed my skills as a newly-qualified occupational therapist and develop a better understanding of the client-group and service my research will be focused on. It’s been great. Tough, challenging, I’ve learned a lot, AND I’m really ready to start work on the research. I’ve always struggled a lot with routine and getting bored, and although my clinical work is so varied and without time to breathe,never mind get bored, I do find that I’m grateful for a new dimension to my weekly routine. I’m really excited to have 3 days every week to just focus on research.

It’s probably good timing that I’ve just returned from the College of Occupational Therapists – Specialist Section: Mental Health’s (COTSSMH) Conference at the University of Liverpool. I’m feeling motivated and ready to start my study. As I first discovered at Emerging2OT, live-tweeting added a valuable dimension to my participation in the event. I always enjoy reading other delegate’s perspectives and thoughts on the session they are attending. The only downside is when you’re following the hashtag you may read tweets from a different session that sounds unmissable. At least with tweeting you still get the opportunity to read the tweets even if it can feel like you missed out!

The live-tweeting may not have been a new experience for me. However, presenting at the Conference certainly was. I was fortunate enough to have an abstract accepted for a 45 minute seminar on self-defeating occupation, a concept I developed from this blog post. I’ve always been a little ‘last-minute.com’ with my preparation for assignments/presentations, however I was probably pushing it to the extreme with this paper as I was frantically trying to decide what to say and scribble some notes in the break immediately before the session. Fortunately it all seemed to come together in the minutes before and I actually really enjoyed presenting my work. Who knows, maybe I won’t avoid thinking about it so keenly before the next one…

Public-speaking and presenting is not something I get too worried about normally, however I suspect the content of this presentation meant I was more concerned about its reception than a piece of assigned academic work. It was my original thoughts and ideas, rather than an answer to a question set by others. I’d debated whether to include my Twitter name on my title slide and to explain where the concept originated from during my preparation. In the end I didn’t include it, but actually felt quite sad that I didn’t ‘join things up’ so fully in the end. The paper was received well and the live-tweeting that accompanied it allowed for pd2ot to be joined up with Sarah, the presenter, which felt really positive and congruent.

My experience at the COTTSMH Conference prompted me to reflect on how I feel about the ‘pd2ot’ side of me. At times I almost forget that that side ever existed. I think in my current line of work it’s quite easy to forget. So how have the first six months of being qualified occupational therapist been given my history of mental health problems? To answer that I’ll explain a bit more about what’s been happening in that time. I work in a service that is in the early stages of becoming an integrated care team, but at present the physical health side of the job dominates. I work with a great team of people, including a large team of district/community nurses. However there’s minimal formal mental health experience within the team. I think this leaves me wondering ‘how much do my colleagues understand about mental health’.

Unlike when I was a student I haven’t needed to disclose much about my mental health history as I am well and don’t need significant adjustment to my work pattern. I do, however, where a uniform that exposes my arms which are very scarred from previous self-harm. As I student I was absolutely terrified of this, and generally agreed with educators that I would wear long sleeves other than when it was necessary for infection control reasons. So in general I’d have a cardigan on when I was in the office. In fact, my university supported me to have a first placement that didn’t require me to be bare below the elbows at all, and allowed me to gradually develop the confidence to expose my arms. On my first day in this job I decided I’d just make sure I was in my short sleeves even when in the office so that I stopped needing to be self-conscious about it (fortunately my office is very warm, so that became a promise I was very relieved to keep!). In terms of reactions from colleagues it has been minimal. One person said “that looks sore” and another asked “Sarah, what happened to your arms?”. Out of the two approaches I prefer the latter. It allowed for a brief, yet honest, discussion about it. Most people, however, have not commented. Partly it feels like it’s a difficult thing for people to talk about and I’m left wondering if people actually know the cause of the scarring – I find it difficult to appreciate how much awareness of self-harm people have if they don’t work in mental health or have personal experience of self-harm. Mostly, though, it feels that my colleagues simply accept me as I am. I’ve always wondered how I’d feel if a patient commented on them. I suspect it will happen at some time but my experience to date would suggest that most people I visit have far bigger things to worry about or even notice, than some old scars on my arms.

As many people with be very conscious of, mental health problems are often invisible. Given that my mental health is pretty good at the minute, the only indicator of previous problem is the scarring. I think this probably explains why the ‘pd2ot-side’ can feel very distant at times.  As ever, I feel grateful for my experience as a service-user. There are numerous skills/experiences I wouldn’t have without it. I’m also really glad that it is not a defining feature of my experience as a clinician. I feel like I’m a BETTER occupational therapist due to my experience as a service user, but that it is not the only thing I offer the profession.



VC Medal

*brushes dust off neglected blog*

That’s better. I’ve definitely not had much blogging-mojo in recent months. Perhaps this blog has served its purpose to some extent, although my hope is that I will still write the occasional post.  And here is one today! The title is, ‘Graduation’ although I suspect it may be a bit of a general reflective ramble.

When I started this blog it was the result of a conversation with my academic tutor about preparing myself for a career in research by having a space to regularly write and play about with ideas. It also was suggested that it could be a valuable place to explore the experience of being an occupational therapy student who had extensive experience of engagement with mental health services as a service-user. The idea was that the blog would be relatively anonymous and I could test the water of being a bit more open about my background, with the understanding that if it all went horribly wrong I would have a better understanding about the level of openness I could afford with colleagues. Fortunately it’s been a very positive experience and I’ve gained many connections, and even some wonderful friends, who knew me initially as ‘pd2ot’ before getting to know the ‘in real life’ me, with whom there has been an amazing level of acceptance. This has definitely translated into other situations as I tend to be much more open about my own history of mental health problems as I feel comfortable now about its value in my career as an occupational therapist/researcher, I also don’t worry about the anonymity any more (but I still like the ‘pd2ot’ name so hold onto it for that reason alone!).

This week I attended my graduation ceremony, following completion of my undergraduate degree in occupational therapy. The day was an amazing mix of nerves, excitement, happiness, sadness and pride. It prompted me to think about my starting point and the ‘journey’ I have been on (sorry, I hope this doesn’t come across as too ‘look at how far I have come, aren’t I amazing?’ as I hate that stuff, and equally I’m feeling reflective and want to validate the amount of effort I, and a huge number of supportive people, have put into me getting to this point). The other wonderful thing about the day was seeing so many of my cohort again, and beginning to understand just how much graduating meant to us all. It was a challenging three years and I don’t think anyone sailed through it untested, indeed many had massive hurdles to overcome along the way. I’d really love it if lots of people wrote down their ‘this is how I was at the start, and this is what I faced all the way through, and here I am now having learned x, y and z about myself’, but maybe I’m just nosey!

So yes, graduation! Well the picture above is the ‘Vice-Chancellor’s Medal for the Faculty of Health and Life Sciences’, which I won for my degree results. I was shocked when I found out, in fact I emailed a member of staff to check they’d got the right person… I guess I still lack a bit of self-belief! On a practical level I was a bit oblivious to the potential for there being prizes as the focus of my degree had never been about chasing marks. Due to previous experiences of university my only aim was to complete the degree in a good state of well-being. Of course, I always tried to produce work I was proud to hand in, but I actually has quite low expectations of the marks I needed to achieve. It was all about ‘just getting through’ and there were several points in the course where I questioned if it were possible. So yes, winning prizes wasn’t on the agenda! The other more tricky part to this is my past experience of being known for academic achievement. I have never had a good experience of getting good results in things. For this reason I decided that I would never discuss my marks with other people during this degree, and other than with very close, mostly non-uni, friends I kept that vow. So when I was told about the prizes I’d be receiving I realised that made it all a little more public! I can’t say being in the limelight for academic achievement felt at all comfortable, but it was manageable and nothing awful happened.

The part of the day that I’m probably most proud of though was being asked to give the ‘Student Vote of Thanks’. This involved reading a speech to a capacity-filled York Minster full of students, family, friends and academics. No pressure! I suspect anyone would have been a bit nervous, and I definitely was. However as I returned to my seat at the side of the stage after, I think, making a reasonable job of it I had one of those ‘Wow, I’m not sure anyone 5 years ago would have predicted that happening’. When I was part of a therapeutic community and beginning to engage in The Real World I had a real problem with being seen. When I left the therapeutic community I immediately commenced an Access to Higher Education Diploma and I remember that when faced with giving a presentation to one tutor with a video camera I really struggled. It took several weeks of my therapy time to discuss the issues around it and devise a plan of how to face it. I was incredibly uncertain of how I could continue into higher education and repeated experiences like that. So yes, four years later and there I was making a speech to, and definitely being seen by, over one thousand people. And in that moment, it felt OK to be me.

There are far too many changes to list here, but I think I feel content in the knowledge that completing my undergraduate occupational therapy degree has completely changed me. I feel so fortunate to have done it at a university that was the perfect mix of challenging and nurturing and I know that there were a lot of lecturers, tutors, friends, family and therapists who played their part in making sure I arrived at this point in one piece. (I have this image of lots of people around me ready with sticky tape to hold me together at the tough points and then some good quality furniture polish to give me a good clean up at the end… but hey, my brain is a little worn out at the minute!)

So to everyone who’s been there along the way (including all those on Twitter and here), thank you!

Pro-Eating Disorder Websites – a Personal, Occupational Perspective.

1-1259162961jHiYI have a number of issues with Channel 4’s ‘Supersize vs. Superskinny’ programme, which returned for a new series last night. However, I often find myself watching to ‘keep an eye’ on the messages they are promoting. There are so many areas I could discuss but the purpose of this post is the reflections it prompted for me on the topic of pro-eating disorder (pro-ED) websites (often referred to as pro-ana or pro-mia sites, using the abbreviated versions of the illness names to promote a familiarity  with, or even personification of , the condition), which they included as a feature in the first episode. I wanted to consider my view on the ‘should they be banned’ debate, as well as analyse my own experience of engaging with them from an occupational perspective.

What was my experience?

When I had an eating disorder (ED) I initially drifted towards some excellent recovery forums and websites designed to provide peer-support to people who had EDs. They provided me with some understanding and insight into my experience and I could tell I wasn’t alone, but they didn’t quite ‘fit’. The problem was that I wasn’t in recovery. I wasn’t ready to consider it and so any support given wasn’t congruent with the situation I was in. I soon discovered the world of pro-ED sites. While I did come across the type often cited in the media – those promoting anorexia as a normal lifestyle choice, or those involving high levels of competitiveness between members – the majority were simply spaces for people living with a very challenging illness to find a shared understanding and support.

The site I mostly used allowed sections for posting ‘thinspo’ (images designed to motivate people to meet their goals), and also posted things like the foods we’d eaten or binged on that day, however tip-sharing was strictly prohibited by a moderating team. Along side the ‘encouraging’ posts there were serious posts about emotions, challenges, recovery as well as a forum full of games and distractions to help cope with the isolation often experienced when eating disordered. I’ve already acknowledged in Self-Defeating Meaningful Occupation that these sites provided me with a level of companionship. I made real friends there – some of whom I am still in contact with now that we’ve made our individual steps into a life after an eating disorder. I never felt that the sites prevented recovery – when someone was ready to recover they were supported to do so genuinely and sensitively. The nature of social media use meant that supportive friendships could be maintained through sites like Facebook or via MSN Messenger (it was a little while ago…) for those who wanted to step away from the site. For me, the pro-ED site definitely maintained my eating disorder – it provided a space where I was accepted and some level of comfort. However, I feel things could have been much worse without it.

Should pro-ED sites be banned?

I was never under any illusion that my eating disorder was healthy, ‘normal’ or ‘OK’ but I felt I needed it and was unable to stop. It provided me with a means to cope with high levels of distress and really was a lifeline at a very difficult point in my life, as well as nearly killing me. That’s the thing with eating disorders, they are full of conflict; allowing survival whilst simultaneously contributing to demise. Perhaps that’s the reason why it’s hard to have a clear view on pro-ED sites – they sustained my life AND my eating disorder.

I don’t feel proud of my engagement in the site – I hate to think I could have encouraged someone else to develop or maintain an eating disorder by discussing what I’d eaten that day, however, I was very unwell and have compassion for myself. I also worry about those people for whom a pro-ED site makes their eating disorder worse (mine was very serious long before I found the websites). I don’t believe, however, that a website like that can create an eating disorder that doesn’t already exist. Perhaps the question should be, ‘Do pro-ED sites encourage eating disorders to be sustained and potentially cause harm?’. I suspect they do. I also suspect that their existence saves an equal number of lives by providing a level of understanding that pro-recovery sites cannot, for those not ready to consider recovery. I feel very sad that there are still thousands of people out there who will tonight be posting on a pro-ED site, I wish there was a way to take away all of their problems this instant. Sadly that’s not realistic. I don’t know how I feel about banning the pro-ED sites. I don’t want to glorify them or say they’re OK, they really aren’t, BUT they do provide something very valuable and I really feel that without them I would not still be alive. Perhaps a greater understanding of the function they serve would be more useful that debating whether they should exist?

What did the occupation of being involved in a Pro ED site involve?

The occupation of posting on a pro-ED site involved so much! It was something I felt was a classic ‘self-defeating meaningful occupation’ meeting many of the occupational needs highlighted in the linked blog post. The forum provided a frame for my day – allowing conversation about emotional issues, current affairs or ‘fun’ topics as well as a space to report the food-based occupations I’d participated in. I developed habits relating to times of day I would post in the various sub-types of forum (evenings were about food, day time about distraction). Also, due to the international nature of participants, there would always be someone online to chat with when chronic insomnia meant you were wide awake at 4am. I also established roles; from ‘newbie’, to established member, to friend. At a time in my life when relationships were very challenging this was significant and valued. I understand my engagement with this occupation as being one that synthesised experiences of productivity, pleasure and restoration (Pierce, 2003) in such a way that made it very fulfilling and important to me. The pro-ED site was a perfect record of all the energy I was putting into my eating disorder – there were significant elements of productivity involved and this almost felt like the ‘office-end’ of the job – the public (but anonymous) record of my work. The pleasure came from elements of satisfaction at this productivity as well as the connections with others and the light-hearted conversations that were had (which, when in a dark, all-consuming abyss of an eating disorder, was quite remarkable). The restoration was experienced as it was a place of acceptance of, and occasionally peace with, the chaotic world I was living in. I did not have to hide the life I was living (I use the term loosely), I could be me – someone in the grips of a very serious eating disorder.

I hope this post provides a little more insight into what the experience of engaging in pro-ED sites was really like, for me at least. I think the image portrayed in the media is very short-sighted and the problem is much more complex than described.I honestly don’t know what the answer is, but I think it might need to be the ‘question’ that is reconsidered first.


Pierce, D (2003). Occupation by Design, Building Therapeutic Power. Philadelphia: F.A. Davis Company.

When Occupational Therapy Goes Wrong.

tick-or-x-button‘When Occupational Therapy Goes Wrong’ is the title of the #OTalk Twitter chat I’m hosting on Tuesday 17th September at 20.00 BST.  If you’re new to Twitter chats and want some help to get started please feel free to contact me (@pd2ot) or the OTalk/occhat team ( @OTalk_Occhat on Twitter, or browse the main blog). Due to the nature of the discussion it is important that all participants are mindful of professionalism, especially confidentiality. The full Health and Care Professions Council Guidance for Social Media can be accessed here.

The idea for the talk originated on Twitter through a somewhat playful discussion about unhelpful experiences of occupational therapy. My own initial experiences of receiving occupational therapy as a service user were far from positive (I explored the issues I faced in ‘OT is for Thick People’ ), but I then went on to experience some great treatment.  Rather than the chat being a space simply to vent frustrations, my hope is that service users and professionals can unite to explore times when occupational therapy has ‘gone wrong’, gain understanding as to why  the quality of the service delivered/received was less than ideal and work out how  things could have been different.

We really welcome contributions from service-users, carers, students and professionals (and any combination of the four) for this chat. Here are some questions to prompt some reflection before the chat.

Service-users and Carers

What has been your experience of occupational therapy?
Have you ever felt your occupational therapy ‘went wrong’, or observed it happening to the person you care for?
What sort of things have been unhelpful?
What would you have preferred to happen?
Have you ever had a better experience? What made it more positive?


Are there any specific challenges for students, not common to qualified staff, that have meant occupational therapy ‘went wrong’ in the practice environment?
How did you overcome these challenges? Or how would you approach things differently in a similar situation?


What type of things do you think are included in ‘occupational therapy going wrong’?
What type of things do you think service users and carers include in ‘occupational therapy going wrong’?
Have staff shortages, service policies, limits on resources or intervention duration, politics or any other external factors ever meant that you were unhappy with the type of occupational therapy intervention provided?
Have you felt you lacked the experience, support or knowledge to prevent ‘OT going wrong’?
Have you managed to overcome these challenges? How did you do it?
Have you had to be creative in your approach to manage the challenges?
How are you checking you’re ‘getting it right’? Outcome measures? Service-user feedback?
What have you learned from times when things have gone wrong?

We’re looking forward to hearing your views during the chat using the #OTalk hashtag. If you’re unable to join in during the live hour please tweet anyway as all tweets will be collated into a grabchat 24 hours after the chat. Comments are also very welcome on the blog post.

Remember, from every ‘what went wrong’ we hope to use the experience to improve the quality of occupational therapy provided or received.

‘Emerging 2 OT’ Conference


On Friday the 31st May I had the pleasure of attending the ‘Emerging 2 OT’ conference organised by Michelle Perryman (@Symbolic_Life) and her fantastic team at the University of Cumbria. I arrived the night before and enjoyed a meal with some of the speakers, organising team and delegates. It was a lovely opportunity to meet some real-life ‘tweeps’ and discuss all things occupational therapy.

On the morning of the conference I chauffeured my lovely host, @clissa89, and myself to the conference and was rewarded with a tour of the campus. I then registered, picked my workshops (having a hard time excluding one of the four enticing workshops scheduled) and the day began.  Robert Berry, outgoing chair of the British Association of Occupational Therapists Northern and Yorkshire Region gave the opening plenary, reflecting on his own experience of his transition from student to qualified practitioner. This was followed by Professor Matthew Molineux joining us via video-link to discuss ‘occupation for occupational therapists’, with a key message that we are in a fortunate position to promote the role of occupational therapy by use of our unique skills and being occupational occupational therapists. I attended 3 great workshops discussing aspects of the transition to newly-qualified occupational therapist from working in private practice, being a Band 5 within the NHS and working in academia within the first 5 years of qualifying. The messages from all seemed to be that there will be challenges AND rewards, that supervision and support are key and that we must be creative in our approach to both finding work and within the role we have. The day concluded with Lesley Crichton (Professional Head of OT at Cumbria Partnership NHS Foundation Trust) sharing her wisdom regarding her ’50 top tips for Applications’. There were lots of giggles at some of the ‘don’t do’ tips and also lots of great advice that I’ve noted for the applications I’ll be completing in less than a year.

So, that’s the ‘practical’ and very brief account of the day. Now for the ‘personal’ stuff. My over-arching feeling of the day is about how excited I am to be entering the occupational therapy profession. Having met so many motivated and interesting students I feel confident that the profession is heading for even greater things. The day was also significant in the joining up process of my personal, ex-service-user and author of this blog, online experience with that of being a ‘real-life’ OT student. It was lovely to meet people I’ve communicated with online, but I wasn’t too anxious about that as they’ve accepted the ‘pd2ot’ version of me. What was possibly more notable was joining up the pd2ot identity with the OT student identity with some students from my own university. It’s not the first time I’ve done it, but it’s anxiety-provoking AND nice, every time.

The conference was also my first experience of ‘live-tweeting’. I have to admit I was sceptical before I started that it could be done mindfully and without missing out on the content of the presentation. Well, I was totally wrong! I think it allowed me to be more focused during the talks, it required me to quickly process and succinctly convey the key messages (and be confident that I’d understood the meaning as it was going to be a public record) and allowed me to connect with other people and consider their understanding of the same event. I took my trusty ‘conference notebook’ with me (with pages of notes, never revisited from previous events) and barely wrote anything. Instead, I have an easily accessible record on my Twitter timeline, complete with retweets of the key points ‘borrowed’ from other people. Live-tweeting is definitely something I’ll be doing again!

Oh, I nearly forgot… I had a lovely #OTgeek moment of ‘OT Tourism’ and visiting the University of Cumbria’s library, with particular focus on the OT section – fantastic times!

So, overall a fantastic day on many levels. I’ve taken so much away from it. Although I think many delegates were final year students I feel very lucky to have received all that input on the transition before I complete my first application. I have to say the organisation of the conference was excellent, and all of the team were friendly and helpful. The only minor glitch of the day was the video-link cutting out at the very end, but in true OT style, this was instantly problem-solved with the offer of submitted questions to Matthew Molineux online or via the team. I really can’t fault the day at all (apart from wishing it had been a two-day conference!).

Checking in – pd2ot and the brain.

brainIt’s been quite some time since I blogged. The dissociation post remains a 70% complete draft and my list of blog topics I want to write about is growing, yet I have been pretty silent on here and Twitter (except for much needed #teamduvet chats at the weekends). So I thought this post could be a brief update and pave the way for more regular blogging.

At the moment I’m getting to grips with unstructured time again. I’ve just finished an 8 week placement in neurosciences and now have some assignments to do before I break up for the summer. A big part of me is terrified of the thought of several months with no placement or assignments, so I’m noticing I’m having problems engaging with my work for fear of finishing it. Mindfulness is helping and I know I’ll get there in the end.

Placement itself… Possibly my most challenging placement to date, and also probably the first one that I could see myself working in as a qualified occupational therapist. I think the variety appealed to me. My youngest service user was in their teens and my oldest in their eighties. I worked with people with a wide variety of conditions (in fact most of my preparatory reading about Parkinson’s Disease and Multiple Sclerosis was in vain as we experienced a series of referrals for people with much more uncommon neurological conditions). The interventions used ranged from work on personal activities of daily living and equipment assessment to work on leisure occupations and vocational rehabilitation. The settings included inpatient wards, outpatient appointments and community work. Needless to say this variety prompted me to feel a little(!) overwhelmed at the start, AND I loved it – because I wasn’t going to be bored or unchallenged.

Before starting the placement I was worried about a number of things. Firstly, this was going to be a ‘properly physical’ placement. My comfort zone is mental health and while I enjoyed my first placement in a physical setting (social services) I was still afraid that I wouldn’t be any good at the ‘bread and butter’ occupational therapy required in this setting. Fortunately my fears were unjustified and the combination of university work, previous experience and transferable skills from other settings made this nothing other than a manageable learning opportunity.

My other worry had been about the requirement to be ‘bare below the elbows’ when working with patients. My arms are scarred from past self-harm and it is only within the last year that I have done any, literal, ‘exposure work’ of having them uncovered when exercising, I also have not yet had a placement that required me to be bare below the elbows. I was worried it might cause judgment from others or prompt me to feel insecure and exposed. Mostly, I feared it would be a barrier to my usual ‘apparent competence‘. The reality? I didn’t experience any overt negative attitudes from others and mindfulness prevented me attempting to mind-read their thoughts. However, the internal fallout, initially, was huge. I spent the first two weeks cycling home from placement at high speed, as an attempt to escape the discomfort of being there. I drafted many an email to my tutor and the placement co-ordinator saying that I couldn’t cope and wanted to quit. But, like in other placements where there were challenges I also knew that I didn’t want to give up, and this particular placement experience was not an opportunity I wanted to lose. I think I knew the emails would never be sent and were simply a way of validating the experience to myself. I’m also grateful that I tend to be incredibly stubborn and it takes a lot for me to stop doing something. Gradually, as I became more confident in my work being bare below the elbows was easier to manage. I don’t think I ever became less aware of it but I did become much more secure in my role as a competent occupational therapy student.

While the personal and professional challenges of this placement were probably the biggest I’ve encountered to date I know I benefited from the time of year of the placement. Like many, I really struggle with the winter. Although we had several weeks of bitterly cold weather at the start I found my energy levels were helped by the increasing daylight. I also found being able to cycle to placement so helpful, not just in the reduced journey time compared to previous placements but also starting and finishing the day with physical activity. I also found myself able to get to the gym several nights during the week, which I find so helpful for my mental health but just hasn’t been possible during my placement experience up until now. Fortunately my final placement falls at the same time of year next year, so I feel confident that I can manage it with similar success.

Does ‘being pd2ot’ make me less competent?

296-1248099726Ti7pThis post is being written at the expense of the ‘Dissociation’ blog post, which still remains a half written draft. There are two reasons for this; 1. the dissociation post is proving very hard to attend to and 2. the topic of this post is one that more urgently warrants personal reflection. I will reflect on the question with consideration of my experience of being the student that is pd2ot, at this, the halfway point in my course.

So, am I less competent as a student that has recovered from Borderline Personality Disorder?

It is possible that you are wondering why I’m even considering this. Especially as I have been fortunate enough to receive quite public feedback about the contribution my experience could make to the Occupational Therapy profession through this blog/Twitter. Well, the reason for this is my own internalised stigma. I am soon to face a practice placement where I will be ‘bare below the elbows’. When I discovered this I was terrified as it will mean that my scarred arms are visible to staff and clients alike. My panicked concerns ranged from ‘What if my educator judges me as incompetent?’ and ‘What if my clients don’t want to work with me as they don’t trust me with their care’ to the slightly more probable ‘What if my performance isn’t as good because I feel self-conscious and can’t hide behind apparent competence?’ I had a very useful meeting with my academic tutor, in which we explored the issue and action-planned how I would manage various scenarios. I know that the reality is likely to be that it will be a complete non-issue and most likely something that is very good for me getting experience of being accepted ‘warts and all’, but it feels good to be prepared. During this meeting my tutor asked me if I feel less competent due to being a person who has experience of self-harm. My short answer was ‘No’, but I am aware that if I 100% believed that we probably wouldn’t have been sitting in a room having the conversation. Like many things I think ‘being pd2ot’ has advantages and disadvantages.

The Challenges

Rest. I still have a pretty horrendous sleep pattern, this means that I find functioning and getting myself to placement/university in the morning to be hard work. Judging by feedback from my previous educator this wasn’t at all evident in my performance on placement. It simply makes placement a pretty big challenge for me. While I am very glad that it doesn’t effect my performance, it can make it all the more challenging to speak up and say ‘I can’t keep doing this’, because to all concerned all they observe is a student managing really well. This is probably the most significant area for making me doubt my competencies, because sometimes just managing is hard work. 

The skills you can’t explain. Fortunately my CV has a lot of experience that would go some way to explaining some of the skills I exhibit. However, I do feel a little sad that the Therapeutic Community (TC) that was so crucial to my recovery never gets any of the credit. It often makes me giggle inside when ‘working in a busy shop at Christmas’ gets the credit for my ability to manage ‘customers’ with high stress levels. The reality is that once you have lived in a TC for a year, with infinite unrelenting crises occurring, there’s really not much left to phase you. Similarly, the Samaritan’s training for volunteers is getting an awful lot of credit for my abilities to listen and relate to people. Now, these things are probably ‘positives’ really, the challenge is simply feeling like it’s best to hide your experience. There’s also the ‘skill’ of having an extensive working knowledge of psychotropic medications that significantly exceeds that expected of an OT student. Unfortunately there’s nothing on my CV to explain why I know that likely side-effects of intra-muscular haloperidol injection, or even have such good understanding of the sections of the Mental Health Act, but I suppose it’s all valuable information to have.

Them and Us. At both university and placement I have experienced a degree of ‘them and us’ type thinking (the university experience was explored here). I do hope that one day I can help challenge some of that thinking by being more open about my experiences. For now, my work is in getting through my training in one piece. As a student it feels difficult to challenge overtly, but I do hope that my discussions and way of working with people who have been ‘written off’ due to being ‘personality disordered’ might prompt other practitioners to reflect.

Am I completely better? I am still in therapy, and have significant work left to do. This can make me wonder if I am ready for a professional career. However, I would not meet the criteria for BPD or any other mental health condition and probably have a much more balanced approach to life the the majority of people. I think there can be a disparity between the way I manage life and the amount of effort it takes to manage in such a way. Compared to some (some, but most definitely not all) people I suspect I have to work harder at the little things. Does that make me a less competent OT? No. I don’t think so. It gives me awareness of how hard life can be.

The Advantages

Skills. As alluded to above, my year in a TC has given me a range of skills: From the teamwork required to live in a TC, to being a co-facilitator of a range of therapeutic groups, from learning to tolerate hearing difficult things and providing support to those in great distress to gaining the ability to reflect and realise when you are absorbing ‘someone else’s stuff’ or projecting ‘your stuff’. These skills are not taught on an OT degree, they may in part be developed on a practice placement but the reality is the experience gained is probably equivalent to that  gained in the first few years of employment. The value is significant, I have only worked with one or two people diagnosed with Personality Disorder so far in my training, yet the skills have been transferable to the people I’ve worked with in both placement settings (older adult mental health and social services).

Interest. I am perhaps not the best student at studying ‘what I am meant to’. Like many people, once reading for an essay, I lose interest. I also struggle a little with the delivery of our lectures, I find it hard to remain engaged when we are not challenged to think. So, having this blog based on my own experience has been a lifeline. I know I have developed my skills in applying occupational theory to my own experience, which has given me the confidence to do the same when out on placement.

Perspective. It sounds a little ‘corny’ to say this, but I will anyway. My life experience puts university into perspective. That does not mean I don’t treat my studies with respect but it does give me an attitude of ‘I’ve come a long way to get to this point, I can certainly manage the stress of a degree’. That doesn’t mean I find it all easy, but it does give me the self-belief to get through it.

Opportunity. I have recently written a service-user commentary for a chapter in a forthcoming edition of an occupational therapy text. This was a privilege as I got to read new material before it was published and it feels quite special to know that I will have my name in a text book before I even graduate. I suppose the next goal is to have my name in print as a student/practitioner/researcher rather than service-user.

The role of this blog. It’s been difficult to write as many posts as I would like. The ‘sleep’ issue above means I often have to prioritise energy levels for university work. However, writing the blog only came about from suggestion of my tutor and what a brilliant suggestion it was. Having this perspective opened up a world of opportunity for my engagement in occupational therapy in the social media domain. I’ve read countless other blogs, had enlightening discussions on twitter, joined in #OTalks and #occhats, met up with some brilliant people, made some valued friends and ‘outed’ my inner OT Geek, all of which wouldn’t have happened if I didn’t have the pd2ot story to tell. The feedback received has also helped me integrate my experience. The support given about my perspective has let me experiment with letting more people in. There are several ‘real life’ friends who have read the blog, and I am much less afraid about sharing (in a boundaried way) parts on my experience with the right people, more confident in the knowledge that I’ll be accepted. So, thank you readers/tweeters/commentators. I also was humbled to receive nominations in two recent social media awards. The thing that struck me was that I was not nominated as a service-user, but rather in categories for ‘academic’ or ‘occupational therapy’ content. This felt quite powerful, and hopefully means I’m getting the balance right. I am primarily an OT student, who is influenced by her experience of having BPD.

So, no, I do not believe being pd2ot makes me less competent. It does mean there are challenges for me that some other students might not face (but I suspect they have their own, unique, challenges) but overall the range of ‘positives’ outweighs the challenges. There is also a significant point to remember, while I am reasonably confident that being a student who has had BPD helps me be a better OT student, I am more certain that without having had BPD I would never have embarked on this career.