Any time I’m asked what I do for work, the follow-up response is almost always “Oh, I didn’t know occupational therapy had anything to do with mental health, what does that look like?”. This question is understandable, considering that in the US roughly 3% of occupational therapists (OTs) work in mental health settings (1), and the mental health component of our work in other settings can often go unnoticed. Since this is the first question I’m typically asked, I thought it should inform my first blog post!
There have been multiple books and textbook chapters and articles and blog posts written on this subject, so this is certainly not meant to serve as the be-all-end-all of answers to the question of how occupational therapy (OT) and mental health fit together. This is a bird’s eye view based on what I have learned from studying OT theory, talking with other OTs, and integrating information from clinical practice and personal experience. Some of those OTs - from all over the world - have contributed their voices, and their quotes are highlighted between the paragraphs of this post. (Selected quotes were edited for length, but not content).
Here is the heart of the matter: occupational therapy is rooted in a holistic, integrative approach to therapy that incorporates experiential modalities – acts of doing or being in a particular way – to help clients find healing, meaning, connection, purpose, and satisfaction in their life. The experiential (or “occupation-based” in OT language) methods are used in conjunction with talk-based methods, and are designed based on each client’s values, interests, needs, and goals.
“It’s firstly about identifying a person’s strengths and resources, goals, challenges/barriers. Sometimes the engagement is in coaching and teaching new skills...sometimes it’s about fostering hope and self-efficacy through meaningful activity and occupation.” - Emma Jackson
Each practice setting looks a little different in the day-to-day components of the work, but whether an OT is working in a rehab unit, a school, a prison, an eating disorder treatment center, a hand therapy clinic, or somewhere else, the core skills and treatment approach remain the same. I won’t bore you with all of the different theories behind the work that OTs do, but the short story is this - humans don’t exist in isolation; there is a constant interplay between and within:
the person and their thoughts, feelings, beliefs, values, experiences, and abilities,
the environments they exist in; physical, social, temporal, virtual, cultural, etc., and
the activities they engage in; work, play, rest, education, etc. (2)
Occupational therapists are trained to assess the relationships between all of these factors in order to develop a treatment framework that honors each client’s whole self, rather than an isolated piece or symptom. Within the “person”, the relationship between the mind and body is a particularly important aspect of our training and approach to therapy. Too often there is a line drawn that labels issues as physical vs. psychological, when in reality there is such a strong relationship between the two that rarely - if ever - are there situations in which one is affected but not the other. A few examples of this relationship include:
Mental stress (e.g. anxiety about taking an exam) can weaken the immune system (3)
Imbalances in gut bacteria can contribute to anxiety and depression (4)
Anxiety can impair a person’s ability to recover from surgery (5)
Chronic pain after an injury can result in increased anxiety and depression (6)
Fear can change basic processes such as heart rate, breathing rate, digestion, and
temperature regulation (7)
....and so much more. These examples aren’t even the tip of the metaphorical iceberg of ways in which the mind and body communicate and influence each other.
“What we do affects our state of mind, and our state of mind affects what we do.” - Debbie Bub
Occupational therapists incorporate both talking and doing in our assessment and treatment in order to honor this mind-body-environment relationship. This approach allows both client and therapist to learn about and interact with the client’s experiences from a unique perspective. For example, if a client and OT are painting pottery as part of the session, emotional experiences of the client may be translated in the way that they engage in the activity. The OT can bring attention to these body-based expressions and help the client put words to them, bringing insight to something that may have previously existed outside of the client’s awareness. This is just one of the many different ways in which OT theory is put into practice.
Within this practice framework, occupational therapists specialize in the design of modifications, adaptations, and strategies to support success. Whether a client is experiencing chronic symptoms that cannot be healed or recovered from, or they are facing a difficult recovery process, or they are feeling disengaged from life and don’t know why, OTs are skilled in finding ways to support the client in participating in the parts of life that they want and/or need to participate in. This skill – along with the others – can be applied in any treatment setting. For a child born with one leg who wants to play soccer, adaptations may involve body mechanics training and adaptive equipment. For someone with an eating disorder who wants to host a dinner party, adaptations may involve pre-planned grocery shopping routes and anxiety management strategies.
“It is helping people realize all that they are capable of...increasing their confidence in being able to engage in the activities that make their life worthwhile.” – Ally Ferren
The ultimate goal of occupational therapy is to support our clients’ wellbeing and engagement in life in the way they desire to. The same way that psychologists practice with different theoretical orientations, occupational therapists have unique ways of approaching that goal. We each draw on some theories more than others, and we use different methods to apply those theories in practice. There is no “absolute” value to one approach vs. another, it is simply a matter of the goodness of fit between the therapist, their specific treatment approach, and the needs and preferences of the client.
I want to leave you with this quote from Abi Grek that especially resonates with me; it sets aside theory and academics and speaks from the heart.
“Aħna noffru support u tama' waqt it-tempesta tal-oħrajn.”
“We offer support and hope during the storm of others.”
*For more information about how I implement this approach in my practice, see the “About” section of my website. Thank you for reading!
1. (n.d.). Retrieved October 27, 2018, from https://www.aota.org/Education-Careers/Advance-Career/Salary-Workforce-Survey/work-setting-trends-how-to-pick-choose.aspx
2. Kielhofner, G., & Burke, J. P. (1980). A Model of Human Occupation, Part 1. Conceptual Framework and Content. American Journal of Occupational Therapy,34(9), 572-581. doi:10.5014/ajot.34.9.572
3. Segerstrom, S. C., & Miller, G. E. (2004). Psychological Stress and the Human Immune System: A Meta-Analytic Study of 30 Years of Inquiry. Psychological Bulletin,130(4), 601-630. doi:10.1037/0033-2909.130.4.601
4. Evrensel, A., & Ceylan, M. E. (2015). The Gut-Brain Axis: The Missing Link in Depression. Clinical Psychopharmacology and Neuroscience,13(3), 239-244. doi:10.9758/cpn.2015.13.3.239
5. Ali, A., Altun, D., Oguz, B. H., Ilhan, M., Demircan, F., & Koltka, K. (2013). The effect of preoperative anxiety on postoperative analgesia and anesthesia recovery in patients undergoing laparascopic cholecystectomy. Journal of Anesthesia,28(2), 222-227. doi:10.1007/s00540-013-1712-7
6. Stalnacke, B. (2008). Post-traumatic stress, depression, and anxiety in patients with injury-related chronic pain: A pilot study. Neuropsychiatric Disease and Treatment,1245. doi:10.2147/ndt.s4104
7. Overview. (n.d.). Retrieved October 27, 2018, from https://www.nhs.uk/conditions/phobias/symptoms/