Coming to our senses

Last week I spent hours going through the various occupational therapy journals. It made me very despondent. There seems to be scarcely a single article published that would inform my actual practice as an occupational therapist. This doesn’t mean that they are not well written, and I would be happy to have conversations with any of the authors. But it seems that the emperor has no clothes. As academics we are all lost in some kind of netherworld of metrics, and it’s time to come to our senses.

Occupational therapists are known for our common sense. When we help people, it’s because we manage to fit them back into a world that is common to all of us. We don’t do voodoo, we don’t have evidence-based remedies to offer. What we do is to work with individuals and help them to get on with their lives – or with their dying. We witness a story midstream, and we imagine and believe that there is a next step to take. This is never going to be proven with RCTs

There are also a number of things that we need to clear out of the way right now. About twenty years ago, occupational therapists started to congratulate themselves that they had found their way back to occupation, after nearly ‘throwing the baby out with the bobath water’. I somehow doubt that this was ever true – I know some of the occupational therapists who practiced through the 1970s and 1980s and they had the same amount of excellence, integrity and credibility among them as every other generation of people who ever have chosen to care for others.

However, right now, I don’t have any time to waste. My mission is to understand who I am as an occupational therapist, and it seems that there are some things that need to be cleared out of my way before I can get started. These are the rabbit holes that I have enjoyed going down and I could be very tempted to go down them again. However, one of the biggest services that an academic mentor does for students is pointing out when something is a rabbit hole and pulling them back when they threaten to go too far down. I can now report from the stance of over 30 years experience that the following are all dead ends.

1) Social justice is the business of all citizens, not the core issue for occupational therapists .
2) Occupational Science does not add anything to occupational therapy practice.
3) Neuroscience is very cool, but it does not explain occupational therapy.
4) Systematic reviews get us nowhere.

I repeat that I speak with some authority about these rabbit holes, because I have spent long years going down every one of them. In a time when I am determined to be an occupational therapist, I have found few genuinely helpful tools – but here are some of them.

1) Occupational therapists are ergotherapists.
2) This means that we help to fit people to the world that they live. We understand the environment and assistive equipment.
3) Our core skills involve analysing activity and environments
4) People understand sensory processing better than occupational therapy. It tells them that we prioritise bodies, activity and environments over language and it’s quite a relief.
6) We use a variety of types of clinical reasoning and they are all important.

There is obviously a lot more to add to this, but this is a bit of a clearing house. However, prioritising what is helpful to practitioners, who are helping clients, seems like the way to go. Here are some suggestions that come from this prioritising:

1)We need ethics that informs our clinical reasoning.
2) We need research translation, practice based evidence and implementation science
3) We need research methods that really speak to our practice, including activity as a method.

4) We need health economics to argue our case.

5) We need our history to help us know what comes next.