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.

Alien’s Occupational Journey

alien_frail_friendlyOccupational Alienation

Occupational alienation is a term that I closely relate to, in terms of my own mental health problems, health care treatment and recovery. So when I read that Dr. Wendy Bryant was hosting next week’s #OTalk Tweetchat on this very topic I decided I needed to avoid writing a blog about it and process my thoughts on here. I really recommend you read Wendy’s post about the Tweetchat.

Wilcock (1998) discusses occupational alienation as a negative consequence of engagement in occupations that do not align with a person’s needs and results in ‘estrangement from society or self’ (p. 257). I can think of many times that my engagement in occupation didn’t ‘fit’ with my needs, and most notably it would be the time I was engaging in a degree at a university that felt ‘too good’ for me. I perceived the subject matter and the level of study to be way beyond my abilities, and so I felt very estranged from the rest of my cohort. Perhaps unsurprisingly I became depressed, and my, already fragile, sense of self became more fragmented. The short version is that I didn’t overcome that occupational alienation and dropped out of university.

Self-Defeating Occupation as an Alienating Occupation

I’ve proposed before the concept that occupations that are ‘self-defeating’ in nature can serve purpose and meet internal needs. If you’d like to read the original post it can be found here: Self-defeating Occupation. For me, when I engaged in many self-defeating occupations their ‘fit’ with the person I experienced the world as was perfect. I was chaotic and distressed and those occupations were the only ones that provided any meaning or value at the time. So in that respect I wouldn’t support the idea that non health promoting occupations contribute to occupational alienation, however the alienation was experienced via the relationship between those occupations that were ‘right’ for me at the time and those which would be ‘socially acceptable’. My world felt very disparate to the one I was residing on, and perhaps explains why I valued online communities in which I could be honest about my occupational engagement. As part of this post on pro-eating disorder websites I discussed the unique support I found through such websites.

Symptomatic Causes of Occupational Alienation for people with Borderline Personality Disorder

I’m also conscious as I write this how much the nature of Borderline Personality Disorder (BPD) is quite a significant risk factor for occupational alienation. I’m sure there are more examples, but two of the common features of BPD seem to predispose a person to occupational alienation. As I alluded to in the opening paragraphs I experienced a very distorted sense of self. I found it incredibly challenging to know who I was, what I liked and what values I had. Consequently it was almost impossible for me to engage in occupations that weren’t going to feel alienating, because that understanding of myself was entirely absent. Linked to that is the experience of dissociation. One element of dissociation can be to experience the world as if you are watching yourself from the outside, you are removed and isolated from the world. If this occurs regularly it is unlikely that someone is going to have a sense of belonging or control in their engagement in occupation, thus exacerbating any occupational alienation experienced.
The potential for Occupational Alienation within Occupational Therapy

As I mentioned above I experienced my first university education to be a source of occupational alienation. When I dropped out I ended up needing a lot of hospital care over the next few years and this was my first experience of occupational therapy. I’ve written before about how unhelpful I found this due to receiving therapy that didn’t support my own needs and experience of the world. As someone who had become very alienated when studying at degree level being offered very low demand occupations, such as colouring in, reinforced this feeling that I was somehow destined to drift away from the world and get lost. My hope is that if the occupational therapy occurs in its ‘true sense’, that is, it really addresses the occupational needs of the person in a creative and individualised manner, it shouldn’t heighten occupational alienation but there is always the potential there. The virtue of the therapy occurring in clinical settings is often an immediate source of occupational alienation and I know I’ve had to work hard in clinical settings to minimise this risk.

Alienation versus Occupational Alienation

Wendy’s comments about the challenge of separating occupational alienation as an occupational and social construct are something I’ve wondered about. My experience of occupational alienation sometimes resulted from society having different views to myself. Those occupations were not alienating in how they aligned with my needs, but they were opposed to the values, and perhaps collective needs of society. At other times the alienation occurred because the occupation in question did not support my needs, but was entirely acceptable to society. So I suppose in my experience it can occur due to internal or external conflict between occupation and need.

Becoming an Occupational (non-Alien) Being


When I was a service-user in a therapeutic community I engaged in art therapy. Each week I drew a picture of Alien. Alien was lost and desperately unhappy at the start and I used his image to represent my struggles. By the end of my therapy he had managed to make a rather shaky journey to Earth, he landed and wasn’t quite sure what the next step would be but he was going to give it a try. As I reflect back on the time I can see parallels between someone who was ‘just’ feeling alienated from the world as a whole and the level of occupational alienation I was experiencing. As Alien floated around outer space I struggled to get through daily life in hospital. Alien would make tentative steps towards Earth as I attempted to find occupations  that supported my recovery and helped me begin find a space in the world. When Alien made it to Earth he was here, and pleased to be so, while also being incredibly different to the rest of the people he met, at this time I was attempting to meet people and find occupations that truly fit with who I was, rather than just being things I did to distract myself from distress or that created a contrived structure. Sadly I didn’t continue Alien’s journey! I suspect now he’d be someone who really enjoyed life on Earth and mostly forgot he had green skin and four antennae!

This is a really interesting topic and I hope to give more time to consider my thoughts and those of others more fully soon. The Tweetchat is being hosted by Dr. Wendy Bryant on Tuesday 18th November at 8pm GMT, more details here. I’m planning to be there – I hope you can join in!

Wilcock, A. (1998). An Occupational Perspective of Health. Thorofare: Slack,