What the Heck is Occupational Therapy?

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"We are an all-purpose tool to bring each body function, life pattern, and skill into the context and environment of everyday life."

How many times have you heard, "We're trying to help you do the things you have to, want to, or need to do?" Or how about, "We're here to get you back to your daily routines, so you can be safe?" These are the usual suspects, and honestly, I'm just as guilty as the next person in explaining occupational therapy in these exact terms. When you are short on time, and the subject is as big and as unknown as OT, these are typically the most applicable answers, but isn't OT so much bigger?

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"Aren't we professional problem solvers and life therapists?"

Occupation is life. It is literally everything you do as a human. When you add therapy to life, you end up with life therapy. I had a professor once who would occasionally tell clients that he was a professional problem solver. While that explanation certainly isn't the most in-depth, it is true, isn't it? Aren't we professional problem solvers and life therapists?

A huge barrier facing the occupational therapy profession is the lack of understanding surrounding our field. Many physicians and even other therapists of different disciplines cannot explain what we do beyond a narrow description of "rehabilitation professionals who work on functional skills such as ADLs." People are often shocked when they learn that we treat those with metal illness, individuals with feeding difficulties, as well as hospice clients facing end of life care. They are even more shocked when they learn that sexuality and spirituality are within our domain.

I like to think of OT as the Swiss Army knife of the therapy professions. We are an all-purpose tool to bring each body function, life pattern, and skill into the context and environment of everyday life. Basically, we pull together everything that a physical therapist, psychotherapist, speech therapist, vision therapist, and-I'm-sure-there's-more-therapists into the real world and fine tune these skills.

So how is pocket knife different than a machete or a saw or a...? you get the picture. A pocket knife can do anything in a pinch but is most effective in tweaking what other tools have accomplished and bringing it all together as needed. Of course, occasionally, no other tools are needed... and a handy dandy all-purpose tool is king (as long as it's not on an airplane--please, don't bring a knife on an airplane!). Occupational therapists bring everything together and facilitate clients in generalizing their abilities to different situations.

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This brings me to learning theory, or "ARG!" I always picture a pirate with a parrot on his shoulder when I think of the phases of learning. The pirate's "ARG!" stands for acquisition, retention, and generalization. Sometimes, the phases of learning are parroted with "CAA!" like the sound a parrot might make. The parrot's "CAA!" stands for cognitive, associative, and autonomous. Whether written as CAA or ARG, the phases of learning are the same. In order to learn, first we must begin to acquire new skills. As we practice these new skills, we begin to retain them with effort. Eventually, we can apply what we have learned to not just one setting but many without an ounce of focus, and thus our new skill is generalized.

OT comes in to bring skills from anywhere along the phases of learning continuum to generalization. This can sound simple, but just think of the areas of life and meaningful activities that are disrupted when there is an acquired injury, disability, or the end of life looms. As OTs, we are tasked with bringing as much wholeness as we can to a client under any circumstance and at any phase of life.

Seeking out wholeness for our clients entails a level of training, knowledge, and compassion that is overwhelming but amazingly rewarding. Knowledge of anatomy, kinesiology, psychology, as well as the myriad of bodily functions and the vast array of activities humans participate in is, well... enormous. But what keeps me going is that I have a lifetime in a career to learn all of these things and deepen my skillset. The thing that really matters, is the commitment and desire. In that way, entering OT is a bit like entering a marriage. So, what does a potential partner need more than any other trait?

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I would argue that the first and most vital step in becoming an OT is compassion. To buy into what we do, we must have an inherent sense of a time when we fell short and were deprived of participation in a meaningful activity. Maybe it is a painful memory of being cut from your high school basketball team, being denied entry to a social circle because you didn't have the right clothes, job loss, pregnancy loss, traumatic injury, being excluded from a religion due to your sexual orientation. The denial of meaningful activities (aka occupations) is central in understanding how important occupational participation is.

Sure. there are studies outlining the decimation that occupational deprivation brings, but isn't it instinctual? When you are left out, it stings. When you are constantly left out, and never able to participate across many areas, life is agonizing.

When as an OT, we can bring back or create meaningful participation for clients, we truly are giving them back life. So, Swiss Army knife, life therapists, professional problem solvers... each is correct. I don't think there is a one-size-fits-all canned answer for explaining what an OT is or does, but what truly does matter is that we understand the enormity of our contributiuon and share it with others. Proclaim from the mountain top what an OT can do, and when others learn, they'll keep us in their back pocket (or surgical tray as it were) ready to provide the just right function.

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