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 

What makes your life meaningful?

This is a TED talk by Michael Steger titled 'What makes life meaningful'. Michael F. Steger is an Associate Professor of Psychology at Colorado State University. He has spent more than a decade researching people's ability to find meaning in their lives and the benefits of living a meaningful life. In his talk, he asks the question "What Makes Life Meaningful?" and he shares an insight to his research findings.

I found this talk and his research to be informative and relevant to grasping the concept of 'What is meaningful occupation'? He states how when talking about ‘meaning’, it’s important to think in terms of purpose and significance. “Purpose is the need to do,” (Tedx Talks, 2013). As Anne Wilcock states "we are occupational beings" and doing is often used as a synonym for occupation within Occupational Therapy so  profession and is so important that it is impossible to envisage the world of humans without it (2002). 

Here is Michael Stegers direct website for more information and a great insight to "meaningful living" : http://www.michaelfsteger.com/?page_id=113


References:
Tedx Talks, (2013, March, 14). What Makes Life Meaningful: Michael Steger at TEDxCSU [Video file]. Retrieved from https://www.youtube.com/watch?v=RLFVoEF2RI0

Wilcock, A. (2002). A theory of the human need for occupation. Journal of Occupational Science, 17-24.

Meaningful Occupation?

“People who are engaged in occupation tend to be exhibit a general rhythm to their daily routine, a balance to work, rest, play and sleep activities and display more organised thoughts and actions” (Rebeiro,1998, p.15).

Since we have learnt what occupation is, we can now understand the true meaning of meaningful occupation. As this is the fundamental component in occupational therapy.

Meaningful occupation is the primary tool in which we, as occupational therapists, help people to establish purposeful goal orientated living. 

So what is this powerful tool?!

How we differ from the sister health disciplines is that our primary tool is meaningful occupation. Regardless of the condition, disorder or dysfunction someone experiences we use the everyday activities in peoples lives to help them to overcome challenges. We are one of the most poorly understood professions. People do understand meaningful occupation. What is the point of it? A talk therapist uses talk, a physical therapist uses exercises, meaningful occupation is not something you can point to. 

From an article that I found whilst researching this topic it's clear that what makes it meaningful is that it isn't defined by us as the therapist. We are not the expert, we are simply the guides. What's meaningful is defined by our clients and people we serve. I think that is the beauty and healing power of meaningful occupation. And reminds us how valuable it is to find out what is important to our clients. 

People have said to me - "Well, that's a stretch teaching people to go to the bathroom, how to dress themselves, what's the meaning in that? 
If at any stage of your life, even temporarily, you have ever experienced a loss in one of those fundamental areas, you know how meaningful it is to be able to do that task. Especially something that you have done since you were 2 or 3 years old. 

Meaningful occupation is a very powerful tool and can be used on any life stage/span to overcome anything, every day, individuals perform meaningful occupations that provide them with both a sense of autonomy and purpose throughout their everyday lives. Mee and Sumsion (2001) states that meaningful occupation can “improve the quality of an individual’s life through doing, not just through thinking” (p.122). Doing as such is an important aspect of being human. With meaning, occupation has the impact of enhancing an individual’s quality of life. 

As occupational therapists and occupational therapy students, we need to understand that everyone will have different reasons as to why their occupations are meaningful to them. 

For example; travel is meaningful to me because it provides me with enjoyment, social interaction and a challenge, however to another person, they may believe travel is meaningful to them because it enables them to get to a destination, a way of releasing stress  or an opportunity for movement. 

So what are the benefits? There are many benefits people endure through the use of participating in occupations that are meaningful and purposeful to them. Some examples include an increased perceived self efficacy of one’s self such as the sense of mastery and self worth, quality of life and satisfaction, competence in our ability to perform and complete the activity, social interaction, sense of belonging and a way of relating to others.

Participation in meaningful occupation “provides opportunities to discover new information, to use capacity, and to create promoting a sense of mastery and self worth” (Goldberg, Brintell and Goldberg, 2008, p.18).

ACTIVITY: Have a think and discuss with a friend: What occupations would you miss if you were told you were never able to do them again? Why would you miss them? What impacts do these occupations have on your life?

References:

Goldberg, B., Brintnell, S., & Goldberg, J. (2008). The relationship between engagement in meaningful activities and quality of life in persons disabled by mental illness. Occupational Therapy in Mental Health, 18(2), 17-44.

Mee, J., & Sumsion, T. (2001). Mental health clients confirm the motivating power of occupation. British Journal of Occupational Therapy, 64(3), 121-128. 

Rebeiro, K. L. (1998). Occupation as means to mental health: A review of the literature, and a call for research. Canadian Journal of Occupational Therapy, 65(1), 12-18.

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

We are living with meaning and purpose

This short clip is a brief introduction to how each of us are unique within our desires to do what it is we love. Making meaning from our own lived experience.

IBS Experience, (2014, January 14). We are living with meaning and purpose [Video file]. Retrieved form https://www.youtube.com/watch?v=wpdqbGqTF5Q

What is occupation?

In order to understand 'meaningful occupation' we should first clarify what the term occupation means. 

Occupations are all the things that you do – for these activities help express who you are, how you feel about yourself and how you connect with others. As Wilcock (1998) has identified, we are occupational beings. All of those everyday activities that we do as individuals, in our families and with communities to occupy time and bring meaning and purpose to our lives. Occupations include things people need to, want to and are expected to do.

It's such a mind opening statement to first hear as you settle into early lectures ready to start training to become a health professional, an occupational therapist. It's in the name so shouldn't it be obvious? 

Occupation – (official definition)

“…occupation is everything people do to occupy themselves, including looking after themselves (self-care), enjoying life (leisure), and contributing to the social and economic fabric of their community (productivity)” (Kielhofner, 2009, p. 44).

'

For most of you this isn't news, it's your daily work that Occupational Therapists use the term in the widest sense of the word. So, if occupation is everything you do, such as – driving a car, cooking, caring for yourself or others, a hobby, a sport, a paid job, or something you do for relaxation – then everyone will have a number of occupations that make up what they do and who they are. 

Have a think about the occupations you do? 

Kielhofner, G. (2009). Conceptual foundations of occupational therapy practice (4th ed.). Philadelphia: F.A. Davis.

Wilcock, A. (1998). Reflections on doing, being and becoming. Canadian Journal of Occupational Therapy, 65(5), 248-256.

Welcome!

Welcome to my blog!
My name is Veronica Waddy and I am currently a passionate third year student, studying Occupational Therapy at Otago Polytechnic in Dunedin. I tend to question why we do things and 'meaningful occupation' is a concept I wish to delve into further. 

In this blog I will explore:

• What meaningful occupation is
• Some ways to identify meaningful occupations with clients
• How meaningful occupations change and develop with illness and disability
• How we use meaningful occupation when working with clients

I don't claim to be an expert in this area and I plan on developing my knowledge throughout this blog. Feel free add any of your own opinions and perspectives or any advice that you may have. 

Thank you and enjoy reading!