Here is an abbreviated version of my speech that was delivered to this year's state conference. I am tickled pink that it was accepted for publication in an AOTA's upcoming book, Living Fully: Stories of Occupational Therapy.
This year’s theme for the Maryland Occupational Therapy Association’s Conference is to Make OT Shine in 2009. I see already that in the audience we have some glimmers and even a few glowing patches. Light is so attractive; be it a sunrise or sunset, the lamp in the window at home, the flickering candle on the restaurant table..... people are drawn to a light. The year 2010 is around the corner with challenges old and new; I want you to be ready and to shine. Our profession needs to draw people in and for people to be drawn to us. So the subject for my talk today is, “How to Get Your Light On.”
I’m not sure when it was that I had to define “occupational therapy,” but most certainly it had to have occurred when I was an occupational therapy student. Without a doubt, I know that on some quiz or test, I had to write the definition of occupational therapy, and it was likely quoted word for word from that year’s trusted Willard and Spackman’s textbook. After those many weeks, months, and years of learning, I anticipated that I would be thoroughly educated and knowledgeable about every aspect of this concept of occupational therapy.
Despite all that wonderful instruction, in looking back at my first years of employment, my “green behind the ears” years, I really had no clue. Oh, I knew the concept of occupational therapy, and I could perform the job that I was hired for, but as time went on it became all too obvious that it was one thing to do it (to “provide” occupational therapy) and altogether another thing to actually embody it. That state of being, where you have processed the idea and spirit of occupational therapy so that it comes naturally and easily for you to communicate and share it with another human being - that’s "getting your light on."
I had humbling beginnings. My first job was in a spanking new rehabilitation hospital smack-dab in the middle of Texas. I would tell my patients that I was the one who would help them get back into doing their daily activities like dressing or cooking. I should have guessed that this was not always an effective way of promoting occupational therapy because my patients’ retorts sometimes read like the options listed in a multiple choice question:
“What do I need that for? I have a wife for that.”
“I just need my rest. When I get home, I’ll be able to do all of that.”
“There’s nothing wrong with me.” (The answer of choice for the people with left-sided hemiplegia) or
“I don’t need occupational therapy. I just need to walk. Take me to physical therapy.”
When I couldn’t sell my explanation of occupational therapy, I would usually put on my poker face, lay my cards on the table, and speak directly as if I had the upper-hand: “Your doctor ordered it, so you will be coming to occupational therapy and working with me.”
The process of “getting my light on” truly began one day at that rehabilitation hospital, when I entered a patient’s room to introduce myself. I vividly recall enthusiastically telling my new client, an elderly man who was gazing at the ceiling and lying supine on his hospital bed, that I was his occupational therapist. To this, his head turned slowly to me, and he rolled his eyes. Then his lips parted and with a long, southern drawl (or more appropriately, a “Texas twang”) he said, “Honey, I doh-n’t need no job. Can’t you tell I’m re-tyr-ed?”
That man left me for once, at a loss for words. I have never forgotten his very clever comeback. That moment was the beginning of a whole new outlook for me; it began a journey of defining and redefining my ideas and explanation of this concept of occupational therapy.
My mantra for our state association has been "Stand Up for Your Profession." It was that incident thirty years ago which made me realize how important it was to be able to explain to others what I stood for.
Over the span of many subsequent jobs, several evolutions of explaining occupational therapy occurred. Men particularly appreciated my “fewest word answer” which seemed to elicit more cooperation than any other explanation that I could give. I simply stated, “the word ‘occupational’ refers to ‘how you are occupied,’ so I’m the one who’s going to help you get back to doing what you normally do.” Function became the emphasis of choice, rather than any particular activity. However, periodically my patients would still equate function with the singular task of walking and wanted to steadfastly focus only on that.
In those days, I wish I had been as quick-witted as my colleague, Rae Ann, who when faced with the same situation asked her patients just one question: “So you're going to walk naked?”
Clients haven’t always been bold enough to ask me “What is the difference between occupational and physical therapy?” which I had felt was essential to explain - else you’ll never get the full credit for what you do and your work might be referred to as the “other physical therapy.” People define things based on what they see, so I had to speak up when a patient flatly told me that in occupational therapy one works from the waist up.
“In occupational therapy, we are concerned with how you are occupied. People occupy themselves with activities. An occupational therapy practitioner will use activities in a therapeutic way. And generally, in order to do an activity you need the use of your arms and hands. This is why we are particularly knowledgeable and skilled in rehabilitation of the arms and hands, but that’s only one aspect of OT. We address a person’s entire functioning.”
That was my embodiment of occupational therapy several years ago. I felt I was good at telling others about what OT represented, but it was flawed because often I explained it through the context of me, and oftentimes what I did as opposed to another professional.
Working in various skilled nursing facilities brought to light on how I needed to stop focusing on what "I", was all about. When I first performed my evaluations, I wanted the answers to questions such as these: “How well does this person understand me?” “Can this person roll over?” “Where are the joint limitations and contractures?” “How strong are this person’s arms?” “How much help does this individual need in putting on her blouse?” At least I can say that I was a better assessor than some other professionals, who would march into the room straight up to the reclining patient, and then demand that the person pull this, lift that, straighten up, sit up, and stop being so scared to transfer over to the wheelchair.
Many of those same patients later in the week would be sitting in the rehabilitation department, parked at the worktable, chatting idly with whoever would be nearby, and using sophisticated vocabulary in their conversation. And if you listened, truly listened, you were struck that this wasn’t a “patient,” but someone with a wealth of knowledge. Someone with a story.
I was getting my light was on. The first thing of importance wasn’t to get this measurement or that test done. What was important was listening to that person’s story. How could I be an effective OT without understanding what was it that this person wanted and desired, even if it were to be left alone? What had their life been like, yesterday, last week, last year, 20 years ago? What were this person’s resources? But more than that, this never was about what I could provide, but rather, it was about, “How could I be a vehicle, a catalyst, for this individual and infuse occupational therapy concepts into her being, so that she could re-engage in function and be effective in her own right? That she could return to and perform activities that were meaningful and important to her?
I had come face-to-face with what others have called, "the therapeutic use of self."
In recent years, I’ve had to readjust my thinking once again. It’s been quite the journey these past two decades working as a school system therapist. Where we once focused on addressing the child’s disability at school, we now focus on the barriers and supports that permit the child to access, participate, and progress in his or her educational program. The school-based therapists who have their lights on know that merely possessing a disability does not matter at school. What is important is this - by virtue of a disability, one can’t obtain an education. And I use that word in the broadest sense, for school systems are slowly recognizing that obtaining an education doesn’t mean the curriculum only spells-out academics, such as the three R’s of reading, writing, and arithmetic; it also includes functionality with peers to complete a group project in class or applying organizational skills so that the work content can be delivered on time and intact to be graded. School system practitioners who know what they stand for, that is, fathom the role of occupational therapy in this arena, never have to ask the question, “Does this student need occupational therapy to implement their IEP?” The “writing on the wall” is clear. The only decision that needs to be made is which avenue is best: "Direct or indirect?
I had quite an education myself this year during Maryland’s Legislative Assembly. The Athletic Trainer’s licensure bill went before the State’s House of Representatives and Senate. Our lobbyist and I visited various Delegates and Senators prior to this bill being heard in the respective committees. The very first legislator we visited was cosponsoring the Athletic Trainer’s bill in the House; that meant of course, this politician had a vested interest in this bill passing.
I wanted to have my light on, but the “glow” I felt wasn’t coming from within. What initially started as a pleasant meeting, turned out to be a grilling, with me as the main course over the hot coals. The legislator made it clearly understood that he would not tolerate “turf wars” over services; athletic trainers were recognized as health professionals, and they were qualified to treat injuries. He pointedly told me that the consumer should be able to get treatment from his provider of choice.
At the testimony in the Senate, however, all those years of defining and redefining occupational therapy as I knew it; my long road engaging and practicing the art and science of occupational therapy, all of it, came to a crowning point.
I discussed the need to define in the bill who qualified as an athlete, which was a point of contention surrounding the topic of scope of practice with the professional groups. I sat at the microphone and told the Senate committee that I felt it was important for Athletic Trainers to only address “athletic injuries.” I mentioned a previous conversation I had had with the President of the Maryland’s Athletic Trainer’s Association. I had disagreed with the President who adamantly informed me that the Athletic Trainer’s services should not be limited to just athletics: “An Athletic Trainer is qualified to treat an ankle injury whether it’s on the field or off. An ankle injury is an ankle injury, you follow the same protocol.”
Then I sat upright and looked at the panel. I laid to rest what I stood for. “The Athletic Trainers, they think all injuries are the same. This is exactly why their practice must be limited to athletic injuries. Let me tell you the importance between Athletic Trainers and Occupational Therapists. I don’t treat injuries. I treat people ... and they are NOT all the same.”
The room suddenly hushed, and I felt a bit warm. With that, I knew I had got my light on.