By now, you should be familiar with what occupations are. But the question is why? What’s the big deal with it and why should we help clients to get back to doing their occupations? If you have seen my video on occupation as means versus ends video, you learned how occupation can be used both as a process and as an end goal. So similarly, the reason why we as occupational therapists use occupations is that they can be useful tools for therapy. For example, having a client do their ADLs such as brushing their teeth at the sink is not only functional, but this therapy itself is a tool to reach the end goal of being independent with brushing one’s teeth.
So the first reason why we do occupation for OT is for clients to feel a result, or end goal or outcome or something that terminates. This could be for our clients to do an ADL like feeding themselves an entire meal, donning clothes, using the toilet, or even sexual activity. Same goes for IADLs – washing their car, doing their dirty dishes, their load of laundry, paying their bills. Or sleep and rest – being able to get a result of a good night’s sleep. Or school-related like completing a school assignment. Or for employment, being able to complete a specific work-responsiblity like packing a shipping box on the assembly line. We as humans all work towards end goals, or a result. Allowing clients to achieve and feel their results is useful because they can then transfer it to other client goals, like wrapping a gift for Christmas. In a way, we as occupational therapists are trying to make our clients better at the set of skills that are part of their goals and to make ourselves obsolete and not needed. So in an ideal world, that’s when we have done our job and can successfully discharge them from our OT services.
A second concept is that of mastery. Have you ever learned something or practiced something that made you “master” something? Maybe it’s learning to play an instrument, or a sport, a favorite recipe, maybe you’re really good at doing your make-up or whatever. You go from being a beginner to a novice to a pro through mastery. How did you feel when you were a beginner and sucked at doing that thing? Did you feel like quitting? After you have mastered this skill, did you feel better about yourself? Proud? Confident? Successful? Most likely right? The same concept of mastery applies to occupations. Imagine not being able to feed yourself. We probably take this skill of feeding ourselves for granted, but it is something that we have all mastered. Now imagine having a family member or friend, or even more realistic for most of our patients, a stranger regularly feed you like a CNA or staff or a machine like a feeding tube. How would that make you feel? Now imagine being able to practice and re-master this skill say, after a stroke. You regain your mastery and you feel more empowered and no longer feel dependent on someone for help.
The last concept of why we do occupation with our clients is getting immediate feedback. Have you ever had a coach or a mentor or a tutor or a teacher give you immediate feedback with something? Playing an instrument, a sport, a homework assignment, art, a specific skill, whatever – it’s very helpful right? Imagine how much harder it is to practice yourself in isolation right? You don’t know if you are doing things correctly and on the right track because you don’t have that feedback. When we do occupational therapy with clients, we as occupational therapists have the ability to provide immediate feedback ourselves externally.
Now think about this. Do you think the client also gets feedback too, without us? In a way, yes right? Using the example of playing an instrument, even if you were to practice playing the piano by yourself – you would get immediate feedback by how well or how poorly you played. Or if you recorded yourself, such as how we can sometimes do videotaped feedback in therapy. The same goes for occupations – ADLs when you miss and bring the toothbrush to your face instead of your mouth. IADLs when you mistake with sequencing some steps for meal preparation, and other occupations.
So in way, occupation as therapy is kind of cool because it provides two kinds of immediate feedback. Intrinsic or internal feedback from yourself and your own awareness of how you are doing or how not well you are doing with an activity, as well as externally or extrinsically via the therapist providing feedback to the client’s performance. Note that this can be verbal or nonverbal. The idea of the OT providing feedback becomes especially important in cases of cognitive impairment, such as TBI. Why? Because these types of clients often have poor awareness of their deficits. They may even be in denial. So without an OT, they can engage in an occupation all they want, but if they are overestimating their performance, then that does not do them any good. This is why OT is important and our job as occupational therapists is so important – not only do we provide and ensure the client’s safety, but we provide holistic client-centered care to maximize the client’s performance in their meaningful occupations by allowing clients to learn faster through this feedback through us, the therapist.
In summary, three important reasons why occupation is used in therapy are to 1) help clients achieve a sense of mastery, 2) help them feel a result or end goal – the light at the end of the tunnel so that they can generalize their skills to other goals, and 3, to provide instant feedback on their performance.
Now for a critical thinking exercise – how else do you think occupation can be useful for our clients? Think about 1:1 interventions, group interventions, and even virtual interventions. What are the advantages and disadvantages of each type?