One of the most helpful parts of Occupational Therapy, for me, was time-use analysis. Initially we used a diary sheet to note down what we had been doing in each thirty minute section of one twenty-four hour period, and used it to reflect on whether we felt we had ‘occupational balance’.
After attending a Learning Network for Personality Disorder and Occupation I, and occasionally other clients, would transpose the results into a pie chart. I’d attended a talk from another PD service that advocated the use of pie charts to document change and progress, with respect to occupational balance. My ‘inner geek’ (this quality I now understand and share with many #OTGeeks on social media sites) embraced the idea and enjoyed producing the chart and trying to devise an Excel spread sheet that automatically produced the graphs. This was easy for the pie charts that showed the split of occupational domains, but less straightforward for the charts I liked that displayed time-use, by domain, on a donut that illustrated where in the day I was engaging in the occupation types. I never did create a formula to automatically create those ones!
As a service-user it was quickly apparent that dividing occupations into 4 ‘simple’ domains was a challenge. Could an hour spent cycling to quieten the eating disordered thoughts really be called ‘leisure’? What about time spent planning for suicide, was it a productive occupation as it provided issues that kept professionals employed, self-care by finding a way to reduce mental suffering, or something I was engaging in to provide some renewal from real-life stresses, akin to a leisure activity? Often, making plans was sufficient to stop me trying to act on the impulses, so while suicide planning would be unlikely to be considered by many people as a positive occupation it did improve my mental well-being (on a relative level), it also kept my mind occupied and provided relief from reality. So, not only did I struggle to assign ‘negative occupations’ to the OT domains I was presented with, I also struggled to just assign them to one category. When I started my OT degree I was interested to read Karen Whalley Hammell’s Paper, ‘Self-care, productivity, and leisure, or dimensions of occupational experience? Rethinking occupational “categories”’ (2009b) as I found myself in agreement with many of the key messages of the paper. Despite being white and middle-class, which Whalley Hammell argues is the background the traditional occupational domains is exclusively suited to (2009a), I found I was aware of the function of my occupations on a much broader level. Had I read the papers when I was in therapy I may have decided to try implementing some of the categories suggested by Whalley Hammell. However I would suspect that at the start of my therapy, when I was still very distressed and hopeless, I would have struggled with applying the suggestions of ways people experience occupation;
as ways to contribute and achieve a sense of connectedness;
as ways of fulfilling duties, responsibilities, and interests;
and as ways to connect the past and present to a hopeful future”
(Whalley Hammell, 2009b, p112),
However, I did gain significant benefit with persevering with the common domains of productivity, leisure and self-care, with an additional category for rest, but perhaps not in the way people might expect.
When I presented the first pie chart to my OT, showing fairly equal divisions in time-use, I remember feeling almost judged by the statistics. I felt like it was proving, ‘look, there’s no issue, lots of leisure, lots of everything, perfectly balanced’, whereas my own experience was ‘everything I do is torture, I get no pleasure from anything’. And that was the point. Almost a quarter of my day was ‘leisure’, experienced as compulsive exercise I had to do to punish and protect myself, and the same figure of ‘rest’ involved no sleep, but instead anxiety and dissociation. Feeling so misunderstood by these categories prompted me to speak honestly about my engagement in occupations.
Several months later my pie chart looked very different. It was recorded over the 24hr period that had the same structure, and therefore similar productivity, as the first pie. While leisure only made up 13% of my day the difference was significant, it was leisure that I enjoyed and wanted to participate in. My self-care had increased, as I was taking more pride in my appearance and exploring the challenges in living independently as a day-patient and cooking for myself. In those early days cooking an evening meal took several hours and a lot of support and encouragement(both internal and external). I divided ‘rest’ into sleep and ‘activities designed to promote rest’ when I couldn’t sleep. This helped me feel that people could understand how little sleep I got and how hard I was trying to rest and let my body cope.
So, time-use was very important for me. For making me reflect and think about the function of my occupations and for the value of its limitations in providing me with the opportunity to have an emotional reaction to what I felt the theory implied. I still analyse my time-use today and find it a really useful reflective tool, as well as a marker of my progression as I realise how my daily occupations are now largely meaningful and incredibly positive.
Whalley Hammell, K (2009a) Sacred texts: A sceptical exploration of the assumptions underpinnings theories of occupation Canadian Journal of Occupational Therapy 76 (1) 6-13
Whalley Hammell, K (2009b) Self-care, productivity, and leisure, or dimensions of occupational experience? Rethinking occupational “categories” Canadian Journal of Occupational Therapy 76 (2) 107-114