A great OT week activity!

I just discovered an activity done in Occupational Therapy Awareness week in 2014 to celebrating and promote our profession alongside occupational therapists across the globe. For me a meaningful occupation is going for walks! A great question to ask the people around you and learn more about each other. 

So what have we covered?

I have really enjoyed researching and developing my blog about meaningful occupation and mental health. I have gained a good understanding how meaningful occupation can facilitate to improve the mental health well being of an individual and how this enhances their recovery.

The main points we have learnt in this blog are:

- Occupation is defined as self cares, leisure and productivity.
- Meaningful occupations fulfil a goal or a purpose that is personally meaningful and culturally important.
- All individuals benefit from participating in meaningful occupation in regards to their mental and physical well being.
- People can have difficulty participating in their meaningful occupations in regards to lack of self worth, motivation, and impact of their illness.
- Meaningful occupation provides the motivation for people to participate in activities therefore enhancing their mental and physical well being and enhancing their recovery.
- There is evidence is the literature to show that meaningful occupation benefits people with mental health illness in regards to their quality of life.

So it can be seen that perhaps the best way the profession of Occupational Therapy can serve society in the future is by providing interventions and and research geared towards meeting peoples' need for meaningful existence through occupational performance. In this blog I have explored how one of the most important needs of our time is for people to engage in occupations that help them individually and collectively create meaning in their lives. 

How can we use it in Occupational Therapy?

When something interrupts or prevents us carrying out meaningful occupations the loss of this activity can lead to dependency, lack of confidence and depression. Meaningful occupations affect our sense of wellbeing, self-worth and inclusion in our communities and enhance our mental and physical health as well as giving meaning to life.Most of us know intuitively that we experience the deepest satisfaction when we engage in meaningful activities and we feel fully alive, when we passionately pursue a worthy life goal.

Meaning is all we have, because we are a meaning-seeking, meaning-making species, shaped by a culture of socially constructed symbols and moral norms. Thus, our ability to understand clients’ meaning systems, from their self-concept to their cultural context is the key to helping them and therefore uncover the therapeutic gains that occupation may bring (Persson, 2011).

Since meaning is a holistic construct, including spiritual, cognitive, and behavioural dimensions it is important to makes use of both CBT skills and phenomenological methods, as demanded by the unfolding of the therapeutic process.


Here are some useful assessments that have been used:

• Life Orientation Scale (Wong, 2012) was designed to determine the extent to which individuals hold a meaning mindset or global belief that life has intrinsic meaning.
• Cultivation of intrinsic self-worth.  To help clients become aware of the intrinsic value of every life is a base of what we work on. 
• Mindfulness  is the intentional, accepting and non-judgmental focus of one's attention on the emotions, thoughts and sensations occurring in the present moment. By using this technique it provides strategies to to manage health and began to engage more in meaningful occupations (Greeson, 2009).  
• Occupational Self Assessment (OSA) is a self report and planning form used to assist the client in establishing priorities for change and identifying goals for occupational therapy. I used this on my recent placement and saw how it provides a client with the opportunity to identify and address their participation in important and meaningful occupations.
• Occupation Mapping looks at the historical meaning or significance of carrying out the occupation for the individual. By using Occupational Mapping the Therapist is able to determine the demands of the occupational performance by means of the level of skill required, its complexity and its social or cultural value to the individual. The occupation is broken down into component parts focusing on the sequence of how the task is performed, the tools and equipment required. Paying attention to issues of safety and risk factors involved (Kielhofner and Forsyth 2009).

References: 

Greeson, J. M. (2009). Mindfulness research update: 2008. Complementary Health Practice Review, 14, 10-18. 

Kielhofner, G. and Forsyth, K., 2009. Activity Analysis. In: Duncan, E.A.S. Skills for Practice in Occupational Therapy. Edinburgh: Elsevier, 91 – 103.

Wong, P. T. P. (2012c). What is the Meaning Mindset? International Journal of Existential Psychology and Psychotherapy, 4(1), 1-3.

Finding the means to make meaning

While it may take less thought and effort just to reach for the weights or coping skills worksheets, choosing therapeutic activities that are meaningful and relevant to clients' daily life roles is a best-practice method to maximize functional outcomes. 

As a student therapist, I find my most rewarding sessions come when I get to know my clients' roles and values, so I can tailor my interventions to their individual occupational needs. Plus, clients easily see how what they are doing in therapy affects their daily activities, so they are more motivated to participate! 

Here are some examples I've seen for using meaningful and occupation-based activities: A grandmother and former motorcycle rider can paint a model car that she can share with her grandson -- while standing to address endurance. An adult with schizophrenia can use the microwave to cook popcorn for a "movie night" with peers to enhance social interaction and independent meal preparation. A older gentleman who has a lifelong hobby of woodworking can build a birdhouse or sort nuts and bolts rather than using the ever-present pegboard to address fine motor and cognitive/ perceptual skills. 

When we define ourselves as occupational therapists, then our clients need to see that we are actually addressing the "occupations" we hold so important to our practice. 

For me Anne Wilcock was the author that made me see that in an occupationally just environment, individuals have access to adequate supports and resources to participate in occupations that are necessary and meaningful to them (Townsend & Wilcock, 2004).

References


Townsend, A. & Wilcock, A.A. (2004). Occupational justice and client-centred practice: A dialogue. Canadian Journal of Occupational Therapy 71, 2, 75-87

The clients perspective

From informal discussions with peers and fieldwork supervisors these are the words that were drawn on most commonly. These are what Steger, Wilcock and other theorists have eluded to in their articles. These words are also key to the people we work with, our clients. Client-centered practice is emerging as an important approach to intervention in all areas of occupational therapy (Sumsion, 1999).

Viktor Frankl, was an Austrian neurologist and psychiatrist who survived the Holcaust, provided great advice for increasing meaningfulness in his book “Man’s Search for Meaning.” He noted that “striving to find a meaning in one’s life is the primary motivational force” (1963). In other words, meaning comes from having a purpose in our lives.

For Occupational Therapists we see a lot of people who have had an experience that has caused them to have to change their view of what means something to them. This transitional period can be a challenge. Takes patience and adaption. 


Reference:

Frankl, V. E. (1963). Mans search for meaning. New York: Washington Square Press

Sumsion, T. (1999). Client-centred practice in occupational therapy: A guide to implementation, London, United Kingdom: Harcourt Brace and Company ltd.

Giving meaning

The bioethicist and philosopher Engelhardt (1983) has stated that Occupational Therapists are meaning-givers. He believed that "it is only with a context of meaning that treatment can take place" (p, 142).

By creating the a context of meaning we are seeking to elicit and discover the meanings of the situation and we offer occupation as a way to respond to those meanings and to help create new meaning. From this reading I have found that occupation is a vehicle for creating meaning in the Occupational Therapy context of care.

The profession of occupational therapy supports the assumptions about the relationship between occupation and health as follows;

-          People are occupational beings

-          Engagement in occupation is healthy

-          People need a healthy balance of occupation

-          There are links with purpose and meaning

-          Occupation is a tool for healthy participation in life

(Creek and Lougher, 2008, p.26)

So in order to action meaning, it is in the action of "doing" that meaning is realised in our lives. So ultimately it is occupational performance that leads to unfolding layers of meanings.



Reference:
Engelhardt, T (1983). Occupational therapists as technologists and custodians of meaning. In G. Kielhofner (Ed.), Health through occupation (pp. 139-144). Philidelphia, PA: F.A. Davis.

Making meaning

"If you have taken this rubble for my past
raking through it for fragments you could sell
know that I long ago moved on 
deeper into the heart of the matter

If you think you can grasp me, think again;
my story flows in more than one direction 
a delta springing from the riverbed 
with its five fingers spread" 

~Delta, by Adrienne Rich 1989 

Rich uses the metaphor of a river Delta to give voice to the meanings of her life. Meaning and everyday occupation in our own lives are like the river delta in Rich's poem. What we do in our day to day lives and the meanings created from those doings are inextricably bound together in the flow of life. 

I imagine daily occupation as the essential current that propels each of us along on life's journey. Hasselkus (2011) describes "... the occupations of our lives and the meanings of these occupations are essential contributors to the pace and direction of the life flow" (p. 21). Occupation is such a powerful source of meaning in our lives; meaning arises from occupation and occupation arises from meaning. 

Cabtree (1998) stated that "it is the nature of humans to make meaning through occupation". Yet I see it that it is also possible to say that it is the nature of humans to create occupation from meanings. Either way, occupation and meaning are inextricably intertwined in our lives, each contributing to the other throughout our life spans. 

References: 

Cabtree, J. L. (1998). The end of occupational therapy. American Journal of Occupational Therapy, 52, 205-214. 

 Hasselkus, B. (2011). Meaning: An Essential for Life. In The meaning of everyday occupation (Second ed.). NJ: SLACK Incorporated. 

Rich, Adrienne (2001). Adrienne Rich, ed. Arts of the Possible: Essays and Conversations. Why I Refused the National Medal for the Arts. pp. 95–105 New York: W.W. Norton & Company