Welcome to Occupied 3.0. Some of you may have noticed a lack of episodes recently, and for that unannounced break I apologised. But I’m back and I’m inspired to continue bringing you more regular eps and interviews again!
A hot topic every April during OT month. Why does no-one know what we do? I want to look deeper into how this became a problem and what can we do to fix it.
Occupational Therapy Practice Framework: Domain and Process (3rd Edition)”. American Journal of Occupational Therapy. 68 (Suppl. 1): S1–S48. March–April 2014. doi:10.5014/ajot.2014.682006
Look after yourself, look after others, and always keep Occupied
So many moons ago, I did an episode on occupied about how to talk about occupational therapy. And it remains, to this day, one of the most popular episodes that are out there. There’s been a lot of talk recently, around a similar topic. And it tends to be something that comes up pretty much every April every 18 months, surprisingly, in the States. So I thought I’d revisit this topic and try and delve into a little bit more detail so that we have a better understanding of why it’s important that we do gain a good professional identity, we do gain confidence in what we do, and we are speaking about the profession in a more consistent manner. Why? Or how do we know this is an issue, I only have to look into a number of ot Facebook groups or Instagram accounts, or particularly my favorite meme pages to see that the complaint of no one knows what we do is still prevalent within the profession. There’s been some talk recently about blaming the individual or blaming the profession. And I do want to assure you, I’m not here to blame anyone. But I am here to hopefully get you to see that although it’s not an individual’s fault, or it’s not the professions fault, it is also our responsibility to fix it because no one else is going to fix it for us. So I think it’s important that we have a look back at sort of how we got here. And to do that, because we’re such a young profession, we have to go right back to the very start. So it’s important to know if you don’t already that ot was birthed from a group of people from a number of different professions, there were psychologists, or psychiatrists, nurses, and a lot of other professions, I can’t read all of them off the top of my head, but other professions are weren’t even health related, who all saw this sort of gap in the medical model at the time, there were people slipping through the cracks, and there was things not being done because it didn’t fit within that medical model.
The overall sort of consensus was that occupational therapy could be a profession that looked more at the complex interrelation of social, economic, and biological reasons for a person’s dysfunction, rather than just the medical reason. So it was looking outside the medical model to improve health and well being, even if they weren’t exactly the terms used back in the early 1900s. There was early on, and I believe he was one of the founding people of IoT, I can’t remember his name off the top of my head. But they came up with four sort of core points for what would become occupational therapy. And those points were that occupation has a positive effect on health and well being. That occupation creates structure and organizers. I’m that occupation brings meaning to life, culturally, and personally. occupations or individual people value different occupations. The weird thing about that thing, the thing that I actually really like about that, as even though that was written many moons ago, and the profession has through a number of different phases, the phase that we’re coming back to for the last 1520 years. This fits perfectly. I can’t think of a really good sort of occupation based practice or that that doesn’t fit within these four points. But since that was written before or like after that was written, we went through a phase around World War Two, were based on the huge number of injured vets and some criticism From the medical model professions, the medical model health system, OTS adopted more of a reductionist philosophy, we kind of merged, we assimilated more with that medical model. And I think it was more to do with just needing more hands to do what they were doing. OSI at that point in time, very small, a very small percentage. And we’re thinking sort of David and Goliath type sort of odds. But we were essentially it was mob mentality, in a way we, the dominant culture was the medical model culture. And after looking for validation and looking to, I guess, kind of cement our identity, even though we’re still kind of forming our own identity, and didn’t really know what that was, we still are to a degree, we tended to, or the profession itself tended to move into that reductionist philosophy, where a lot of practical skills were adopted, and grown, especially around the areas of physical rehab, and assistive technology, etc. But we tended to drift away from our core philosophy, which was the use of occupation as a therapy. This way, there’s a number in in in different clinical settings, there is still a number of different phases, but the main sort of ones we’re we’re that were started off being very occupation based, we moved into a more reductionist role, a more reductionist framework around the sort of late 40s 50s. And it really wasn’t any really wasn’t until occupational science was coined, and was was formally formed in 1989, and then rolled out through the early 90s, that the profession had a good hard look at itself and started to move back towards its roots. Now, I can’t imagine how big a shift that would have been, and the the time and effort that it would have taken to shift our whole profession, even that, yes, in the 90s, to get the profession would have been much smaller population wise than it was than it is right now.
But you’re really trying to steer a huge ship with what essentially was a handful of therapists that we’re driving that movement. So whether you are in care, occupational science or not our ridiculously impressive feat. Either way, the underlying philosophy of at evolve from being more of a diversion from illness, which it kind of had evolved into during that reductionist period, it became more of a diversion or thing as opposed to looking at enablement through the use of occupation. So that’s how we kind of got here, we’re still in that transition phase, we’ve still got therapists that qualified and worked. We’ve still got, like during that reductionists period, yes, there. They may be in the academic roles. They may be retired, they’re still the one thing I’ve learned about OTS is even in retirement, they still seem to they love the professional enough that they still are usually quite involved, which I think is says amazing things about the profession itself, which is, which is wicked. But there’s still that influence. A lot of the theories and the textbooks that we don’t even think twice about using were develops during that reductionist time period. And yes, some of the newer ones may have been developed through the sort of transition period of the 90s. But there’s still that flavor. I’ve talked a lot on occupied about cultural transitions. And I’m thinking and again, completely unrelated to the topic, but the idea of ongoing cultural influence in my episode, interpret and God around the colonization of Australian healthcare system. And yes, in that example, yes, like, I’m not trying to colonize the work that I’m doing. But I’m working in a system that has been influenced for many, many years, quite often without me really putting any thought into the fact that hey, wait a minute, maybe this isn’t working for everyone involved, that the the profession is the same, we are enculturated into the workplace that we go into. And if that workplace is heavily influenced by a well now very old reductionist paradigm, then you’re going to be as a new grad enculturated into that. One of the reasons that I believe that we need to talk about ot more or better is, in order to change this. Now we need to try and complete this transition over to our very occupation based back to our roots, our core assumptions. Back to those four points that I spoke about earlier, that occupation has a positive effect on health and well being it creates structure and organizes time brings meaning to life, culturally and personally. And it’s individual people value different occupations. The reason we need to get back to that we need to complete the transition back to that is at the present, if we pictured on I don’t have the exact numbers, but if we picture that there’s 50% of the profession, and that’s probably a bit overkill, but 50% of the profession working in a very sort of reductionist paradigm still and 50% working from the more widely promoted occupation based paradigm. How are those two kind of diametrically opposing philosophies going to form one single, cohesive, professional identity?
You think about the recent US elections, like there was so much turmoil, because there was two parties that had such an opposing view on opposing philosophy on one what it was to be an American, and to the what the system does, pretty much everything wasn’t really on, it was pretty much everything. And that kind of you saw the turmoil, that that created of not being able to form this cohesive identity of Hey, this is America, this is our system, this is etc, etc. Same thing, any any opposing views, people struggle to be able to negotiate that middle ground for an identity. I can’t remember who said it, but the one of my favorite quotes, I think there might have been Einstein actually talked about the true measure of intelligence being able to hold two opposing views without reacting. That’s a side note. But anyway, so why do we want to talk about it? So, I come from a very socially social constructionist lens, in that. I believe that words, form meaning. Words, create relationship, words, creates. our beliefs and shapes are lenses that we look through. One of the issues with not having a cohesive, a strong professional identity is that we’re kind of all doing our own thing. And when someone goes, Oh, what’s it everyone’s got their own idea? everyone’s working from their own little silo, everyone’s looking at their profession through their own little lens. And we’re looking when we when we get asked that question, it’s us as professionals as OTS looking in inward at the professional going, Hey, well, what exactly are you and through my lens, you’re this and through Joe blows lens, you might look slightly different and they’re gonna explain it differently. There’s no there’s no way to really change that from the inside so that when everyone looks in, we’re all reading off the same page, what we need to do is sort of get a groundswell of people who are confident and understand what the profession is. And the only way that we’re going to know that people understand what the profession is, is if they’re talking about it. So we can go, Hey, that person there is describing the professional exactly the same as I do. One interesting thing that I did find today, actually, while I was doing a little prep work for this episode was for many moons. I’ve used an elevator talk. For the for describing the professional when someone asked me what is OT, I start by setting the expectation of what occupation is, is one of the biggest complaints I see from therapists is was no point because people don’t understand occupation, or people think occupation means something else. And my argument has always been well, it means what we think it means, or has meant that for a lot longer than it’s meant to be, like our job or employment. So and people understand. When we describe it, the way we look at it pretty easily, I’ve never had anyone get it, that doesn’t make any sense. So the definition that I’ve used quite often is, when as OTS, when we’re looking at what we call occupation, we’re looking at anything, any activity that you do anything that you’re engaged in, that occupies your time. And for different age groups, that’s going to be different things for kids, it’s going to be playing for elderly people that might be reminiscing and family time for middle aged people. It could be work holidays, growing a family, whatever it is. And then we would then look at anything that then stops you from engaging in those things. We work with you to come up with creative and sustainable ways to get back to occupying your time with the things that you want to do,
and need to do. So my focus when I when I talk about occupation has always been very much on the time. And it always shocked me when I put out that that first episode mail probably two years ago now that a lot of people were like, Oh, that’s really novel that’s new. And I was just like, I don’t really know if it is. This thing that I found today is that the American ot Association has the occupational therapy practice framework, which I know, I’ve heard many American therapists or Mac students mainly talk about having to study the OT pf in the textbook associated with that, which according to this references, the OT pf, or occupational therapy framework, domain and process a third edition from 2014, I believe. There’s a sentence in there that struck me, and it was talking about occupations. And it says an occupation is defined as defined as any type of meaningful activity in which one engages in order to occupy in quotes, one’s time. So I don’t fully understand why the time aspect of my definition was sort of novel. But it also supports that, that the eo ta is trying to change that consistent message from the inside using our metaphor from before. So that if we, if if you are using the occupational therapy practice framework, that’s your consistent, that’s what you should be looking at, for your whole process. But right from the point of defining what occupation is, now, if we’re all defining occupation the same way doesn’t matter what practice area in if you think about your practice area, and you read over that definition, an occupation is defined as any type of meaningful activity in which one engages in order to occupy one’s time. Any practice area, think of your practice area, that definition fits. If that definition doesn’t fit to your practice area or one that you’re thinking of slightly different issue and we may need to have a look at that. But that’s that’s what the profession is. That’s the the core assumption is that that anything that fits under that definition has a positive effect on health and well being creates structure and organizers Time brings meaning to life culturally and personally, and is individual. So people value different, different things, different ones, to any type of meaningful activity for an individual. Again, this sets us up just this definition sets us up perfectly and how we should be looking at ourselves within a clinical practice. We’re looking at the individuals, what they find what occupies their time, for starters. And the meaningful activity. The occupation is what brings that meaning to their life culturally and personally. So it sets us up as very much the E almost in a consultative role, we’re not in the center of this, it puts the person right at the center of our practice, just by definition, how it’s worded. It’s perfect. I mean, it’s obviously not perfect, perfect, but it’s a really, really good starting point for us to start considering where we fit how we define occupation, if everyone starts talking about occupation, and defining it in a fairly simple, I’m not saying you have to use this, you can use that exact definition if you like, or any variation of it, or you can use your own as long as it’s sort of highlighting the same points. If everyone is relatively consistent, that language then starts forming, or it starts shaping your lens, your view, looking back at the profession, it starts shaping your lens, when everyone is shaping their lens, and those lenses start to be semi consistent, we start reshaping the culture of the profession, because that’s what culture is. Culture is those shared values and beliefs. So if we are using our own language, and that language is spreading, people are resonating with it, people are using it.
Clients start defining occupational therapy to other people, in the same way that we have that almost I guess you describe it nowadays as going viral. That word of mouth, that spread of information that helps shape our culture. And once that sort of groundswell happens, it’s kind of like a snowball effect in that the more people doing it sort of exponentially means that even more people are going to start doing it, we do will, we will get that mob mentality. effect, so to speak. But that’s how we can groundswell from the from the grassroots from you guys, the people on the ground working directly with clients. That’s how you can help change the profession. When everyone’s thinking the same, that’d be a culture and that becomes a consistent professional identity. With that professional identity comes confidence in being able to stand up for what we are, who we are, what we do, and where we work. Now, yes, there are systems in place that do not align with all of that those things that I just listed. But we as individuals don’t have a lot of control over the external factors of the system. We have been described as a very transactional model. But we are actually a part of this profession. We are a part of the culture, you are part of the system of occupational therapy that makes up occupational therapy. You and your influence over the therapists and the surround you have the power to start that snowball. We have that power to start changing minds, changing opinions. And bringing the profession closer and tighter than it has been in 100 years. Bringing ot back to its roots bringing ot back to being a very tight knit consistent, but still very broad in where we work. I think that’s the other thing is that by doing this, we’re not losing anything. We’re not losing any opportunities for places that we work, we are simply taking back our power and our identity as therapists. And I think that’s really important. The other aspect of language is obviously that there are a lot of occupational therapy specific terminologies and words, you know, we look at occupational deprivation, occupational apartheid, occupational justice, etc. I would see little branching out into some of those as almost secondary to being able to define the profession itself. A lot of those terminologies help bolster confidence in the profession from within the profession. But there’s not a lot of times that I’ve seen that those terminologies are used outside of the profession, which is an interesting point in itself, and probably the topic for a whole nother podcast about whether or not we should be using those terms when there are equivalent terms outside of the profession that we might be able to tap into and use anyway. But we’ll leave that for another time. For now, I challenge you to come up with your elevator speech. Let me know you can message me through Patreon. You can tag me on Instagram. I know ot for life is running a little campaign throughout ot month this year in 2021. asking people what the elevator speech is, and I’m gonna send her mine. I’m gonna put mine up on Instagram, I will
tag it, feel free to have a look at it. I encourage you to tag yours tag me and tag OT4lyfe and let’s start trying to build a more cohesive culture within occupational therapy. So yes, it’s no one individual or no profession to blame, but it 100% is still our responsibility to fix it, because if we don’t no-one else is gonna do it for us.