April is Occupational Therapy Month! In celebration of Occupational Therapy, we present the following tribute to the profession, written by our Occupational Therapist, Andrew Klein, M.S., OTR/L.
“The real cycle you are working on is a cycle called yourself. The machine that appears to be ‘out there’ and the person that appears to be ‘in here’ are not two separate things. They grow toward Quality or fall away from Quality together.”
-Robert M. Persig, Zen and the Art of Motorcycle Maintenance
“What is Occupational Therapy?”
This is the question every occupational therapist has had to answer regarding his or her career. This question is invariably asked somewhat reluctantly and awkwardly, because no one wants to seem ignorant about the meaning of an entire profession. In truth, most occupational therapists answer this question less often than they should due to such reluctance. Even those that have worked alongside occupational therapists may have some misapprehensions about the meaning of occupational therapy, as a result of what one might call anecdotal exposure: “They help with fine motor skills.” “They do sensory integration.” “They work on the arms, whereas physical therapists work on the legs.” “They teach activities of daily living (ADLs).” These answers have elements of truth, but are insufficient.
Part of the reason that it is so hard to define occupational therapy is because the very meaning of the word “occupation” has changed in the last 100 years. Today, the word “occupation” is almost synonymous with “job.” But in 1917, when the profession was first established, the word “occupation” dove to greater depths. To engage in an occupation was to participate in any activity that holds meaning and purpose. Indeed, this very concept is a strange one to grasp in today’s world. How much do individuals think about all the activities performed through the day, and how they help give our lives meaning?
Occupations, and perspectives upon occupation, can change when taking into account culture, geography, economy, and a myriad of other factors. But one universal fact about occupation is that it becomes the subject of much greater focus when it is impaired or absent.
This is, in fact, where occupational therapists come into the picture. The people that we work with find their lives changed on the deepest level when a life event, trauma, illness, disorder, or developmental delay leaves them unable to participate in the core activities that make up their daily lives. There are a great many different ways that occupation can be impaired. A hip injury or replacement may leave an old man unable to climb in and out of the shower, or on and off the toilet. A stroke may leave a young woman without the motor control to bring a fork or spoon to her mouth for feeding. A hand injury may leave someone without the ability to manipulate the tools needed for work. A young man with cerebral palsy may have difficulty dressing in the mornings. An acute incidence of mental illness may leave someone without the capacity to perform basic hygiene or go about daily activities safely. A child with autism may lack the developmental skills needed to engage in forms of play and academics.
In all of the examples above, and they are but a few examples of many, the occupations are such basic components of daily lives that they are most often taken for granted. However, when absent, these occupational deficits will have a debilitating effect. They can destroy a person’s very sense of self, and often isolate the individual from their community of peers.
To help a person gain or regain their occupations is no simple task. There are a variety of different medical and scientific prerequisites to treatment, such as knowledge of anatomy, neuroscience, psychology, and development. But an occupational therapist’s skills must go beyond their academic knowledge. To treat effectively, an occupational therapist must, metaphorically speaking, paint a rich portrait of the lives of the individuals we work with, encompassing the person’s environment, personality, culture, family, roles, and skills. These things are important, because they tap into an individual’s volition, their driving force, and allow for a therapeutic connection between therapist and client. The reason for this is simple, but often overlooked: Occupation is not a mere cognitive or physical task. It is very much a part of a person’s identity. In a very real sense, the things we do make us the people that we are, and this powerful connection imparts the need for an equally powerful connection between therapist and client.
We have, as a result, an interesting dichotomy within the professional responsibilities of an occupational therapist. On one side, we are bound by what one might call a classical framework of scientific rigor. Our practices must be research-driven. Our assessments must be standardized. Our treatment must have quantifiable outcome measures, and goals must be clear and measurable. However, the driving force in much of the work we do falls into what might be called a romantic framework: Our clients can only succeed if we, as therapists, can empathize with their needs and passions. It requires a knowledge of the person, not the diagnosis or deficit. It also requires what we call “therapeutic use of self”: The therapist must know their own driving forces and use these forces as a tool to connect to each client.
It seems practical to describe this endeavor as both a technical skill and an art. One might argue that the description of occupational therapy as an art form dilutes its validity as a science, but I would argue for the opposite. This art complements the science of occupational therapy, or, to go further, the art and science are two parts of the same thing. Research based practice provides a system, a framework, for occupational therapy, but this therapy becomes a reality only through the connection between therapists and the people we work with.
So what is occupational therapy? Let us take the wise words of Robert Persig, with a bit of modification: The occupation that you are working on is yourself. The task that appears to be “out there” and the person that appears to be “in here” are not two separate things. With the powerful connection between yourself and an occupational therapist, you grow toward improved quality of life together.