Kimberly Breeden, MS, OTR/L Founding Partner

Things I Wish I Could Tell Myself as a New Grad OT Practitioner: Part 2

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If you read my last blog, you know that I recently turned 50 years old and so far am loving it but also reflecting on a lot of things.  I decided to share some of the things that I have learned in my OT practice and what I wish I could go back in time and tell New Grad Me. Last week I shared by first 4 thoughts, in this blog I am sharing my last 4 thoughts.  I hope it helps you find meaning in your practice. 

5. "Question the status quo"

I often ask myself why didn't I question things as a new practitioner.  I see how what I learned to do as a student later became habits for my own practice.  I realize that as a student on my fieldwork placements, I didn’t question the interventions or treatments that were different from what I learned in school for many reasons.  First, I wanted to pass.  Second, how was I supposed to know which was actually the right way to practice?  It was easy to assume that my professors may just have been out of touch with actual practice. Third, who was I to question anything? I had less experience than everyone else that I was working with.  Obviously the clients were going home and improving, so the treatment interventions must have been appropriate.  In looking back those interventions were appropriate for my clients, but physical therapy could have provided a lot of them.  

I understand now that I could have been more client centered and work on more occupations that the client wanted to do instead of utilizing so many non-purposeful activity interventions.  I now realize that the questions that I should have been asking were "why aren't we using occupation-based treatments?"; "How is what we are doing different from physical therapy or speech therapy?"; "Is this treatment really best addressing the client's individual goals?"; "Is there an intervention that would be more meaningful to the client?'  Most importantly, I should have been asking my clients more questions.  

If I could go back in time I would ask the same questions that I do now.  "What would you like to work on the most? "; "So how are you coping with everything?"; "Do you have questions that I can help you find answers to?"; "What are your thoughts about our treatment session today?" ; "Do you feel that this treatment session was beneficial to you?"; "What would you like to work on next time?"  

I ask these questions now in my current practice and I work to identify what occupations my clients wants to engage in.  I then identify how they can begin to engage in that activity and how can we use that activity as a therapeutic intervention to support recovery and meet other goals as well. Now I give my clients the opportunity to choose from several different intervention options.  I also explain to my clients the evidence that supports the use of purposeful vs non-purposeful interventions.  This helps them better understand why I have suggested the interventions, but also helps me with my clinical reasoning.  

6. "The client is the expert, NOT YOU!"

In my early years of practice I tried to be the expert during treatment sessions.  If I did not have something new to teach my client, than I thought that meant they did not need occupational therapy.  I also thought there was a "right way" to do things and it was up to me to figure out what would be the "right way" for my client to carry it out.   Quite frankly, I told my clients what they should be doing and I told them what they should stop doing.  The best way I can describe the role I used to play was that of a "prescriber", by this I mean that I told my clients what they needed to do in order to be healthy.  At that time, I thought that it was my job to ensure that my clients followed all of the recommendations and precautions that were given to them.  In other words, they just had to do what we the healthcare team told them to do the way we told them to do it.   

Boy was I wrong!  Practicing in home health made this crystal clear to me.  There are many different ways to do things safely and effectively, even if it is not THE safest way to do it.  As I have gotten older, I realize that I do not respond well to people telling me what to do. It is actually probably a pet peeve of mine.  If I don't like being told what to do; I am confident that many of my clients do not either.  My current approach to treatment is much more open minded; I come with a "show me" attitude with the expectation that I may be the one who learns something.   I also realize that people have the right to make their own choices for their own lives. I have seen so many orthotics and adaptive equipment just sitting in closets and never used because they were prescribed instead of asking the client if they wanted it.  I see a lot of therabands and home exercise programs collecting dust, because no one asked the person if they wanted an exercise program or of if they would prefer to learn about occupations that they could do to obtain the same benefits.  I now realize that it is not my job to change people.  My job is actually to support my clients and help them live the life that they WANT to live or choose to live.  They are the experts in their own lives; they are the experts in their own experience.  My job is to listen more and talk less, so I can identify what brings meaning and purpose to them and help them get to it!   

I have to be honest, when I witness other healthcare providers using that "I am the expert" approach, it makes me cringe.  I see some of my clients cringe too.  I am often told "no one asked me what I wanted to do before";  "Thank you for asking me what I wanted work on". 

7.  "People are not broken which means they do not need to be fixed" 

During my early practice I thought the goal was to help people be or return to "normal" which would be the same as achieving health and wellness.  This approach I am sure lead to my clients feeling like they were broken and needed to be fixed.  I want you to pause for a second and really take this in.  

Just because someone has an injury this does not change their value as a human being, it just means they might need to do things differently to promote recovery and engage in occupations during that process.  Because someone no longer has certain functions in their body that they had before, this does not change their value as a human being.  It means engaging in meaningful occupations will require a change in previous habits, routines as well as the environment.  If someone's body is differently abled,  their value as a human being is no less than anyone else who has different abilities.  Their ability to engage in meaningful occupations might mean that the demands of the activity or the environment may need to change, not the person.  I think we often unintentionally suggest to our clients that they are broken and we are there to fix them.  Even if someone could be fixed (or even wanted to be), only they would have the true ability to do so, we are just the support system.  

I suggest that we rethink our mindset that "occupational therapy helps people with illness, injuries or disabilities."  That is actually not correct.  Occupational therapy can help anyone…… ANY O…N….E…. who is not doing what they want to do or need to do.  Many people want to live a healthier lifestyle, lose weight, be more productive, be less productive and more leisurely, do more social activities, write a novel, declutter, or be more organized.  Occupational therapy can support any of these individuals to engage in those meaningful occupations and achieve their goals.  OT practitioners are currently working with college students to support them in engaging in the occupations associated with college life.  OT practitioners are working with college athletes to help them successfully transition to the demands associated with their new roles. Unlike other disciplines, someone does not have to have a medical or psychosocial condition to benefit from OT services.

I would tell new grad me to rethink just what OT is all about.  I now feel that one of the most important things I can do as an OT practitioner is identify someone's strengths, help them identify their own value and help them overcome the barriers to doing what they want and need to do to, in order to live their life to the fullest. You would not believe how many clients tell me "no one in healthcare has ever told me what my strengths are".  I often see their eyes light up when we start focusing on what they are good at, what they are currently doing that is successful and what things they are most proud of about themselves.  

8. "Age does not define a person's capabilities"

When I was 21, I really thought that at the age of 50 life was a slow downward spiral.  I based this assumption on my knowledge about the aging process of the human body and society's value for youth and physical appearance.  I also had a perception that adults became less productive, after age 50.   I am sure that this attitude affected my treatment interventions and my interactions with my clients.   

Part of the issue too was my own lack of life experience.  I had barely lived 20 years and I could not relate to being 70 years old.  I tried to imagine what it was like, but I could not relate to something I had not experienced.   My attitude is very different now.  As I have experienced 5 decades of life, I have so much more experience to draw from.  My tragedies and my successes have shaped me into who I am now.  I am a different person than I was when I first became an OT practitioner.  I can only imagine what I will learn and how I will grow over the next 30 years.  Now, I can't get enough of my older clients stories and their advice.  I pinch myself sometimes, because I can't believe that I have the opportunity to learn from so many different people with such rich life experiences.  I have worked with artists, tradespersons, performers, business owners, politicians, over-comers, athletes, recovered addicts, and those who have nurtured thriving families.  All of them had so much to teach me, so much experience to share and so much to give the world to anyone who would listen.

We now know that there is some research that indicates that there is no difference in the productivity of older vs younger workers.  My personal and professional experiences support this as I have seen most individuals reach their greatest professional accomplishments in the later years of their careers.   Most of all, I realize that the physiology and appearance of someone's body does not determine their value.  I would tell new grad me that I could not hold a candle to my older clients knowledge and accomplishments, so proceed with respect and admiration.  

I will conclude on that last point.  At the age of 50 I have never loved practicing OT more than I do now.  I have never been so excited about my professional future than I am at this moment.  I have no plans to retire … I am not kidding.  I truly feel that being an OT practitioner is one of my purpose's in life and I plan to do it as long as I am able. I hope to continually learn from my experiences and improve the services that I provide.  I hope to help more individuals achieve meaningful engagement in occupations. To be more specific, I  plan to help individuals find meaning in what they do, this is really what it is all about.   Just as importantly, I hope to support other OTs and OTAs in their journeys and find their meaning in what they do.  My body may some day prevent me from practicing and supporting OT practitioners as I do now,  but I will work to find new ways to do the things that I love.  

Here's to 50 more!    
Written by: Kimberly Breeden, MS, OTR/L
Founding Partner of Aspire OT

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