How was I an OT today? 2

30/4/22

My final day at Develop Therapy. This has been the most wonderful opportunity to fall back in love with occupational therapy – and I have done so. It’s not always been easy. I have the self-doubting monster on my back. On my second last day, as I prepared handover notes, I wondered what I had really achieved. The job was about mentoring, developing an adolescent service and providing clinical input. I was there for 8 weeks, three days a week. I felt that I had been given so much – but what did I really contribute?

As a mentor, I had conversations with relatively experienced occupational therapists. They had all graduated at least four years ago and they had a degree of confidence in their clinical reasoning. They all were able to choose me, and one said it was a ‘no brainer’. I am someone different in clinical practice – after 30 years in academia. For me the greatest success was the person that I learned most from. She came prepared to every single session with particular questions. Her last session with me was about how she could deepen her conversations with clients. She knows that she is good when she is dealing with assistive technology, but her PD goals were about extending that.

There are approaches that you might take to doing that. In particular, there are some questions that I frequently use when I am working with people, whether clients or research participants. One of them is simply – is there anything I should know about you to do this work? Another way someone in palliative care frames is this – what do I need to know about you to care for and with you? Another thing I ask, which can seem random is: what have I forgotten to ask that seems obvious to you? I will always ask: what is this like for you? And sometimes I’ll ask: how has this affected your spirituality.

However, I didn’t suggest any of those to her. Instead I told her about David Whyte and his book “The Three Marriages: reimagining work, self and relationship”. David wanted to provide a counterbalance to the usual rhetoric about the work life balance. He (and I) thinks that this is rubbish. We don’t balance anything. Instead we have relationships. These relationships are with the self, with our partner and with our life work. Sometimes when we deepen the relationship with one of these, then we deepen it also with the others. Sometimes it seems like we need to focus on one of these to the exclusion of all else. However David Whyte says that to separate these marriages is to destroy the fabric of happiness itself. He says that we make commitments to each of these relationships and they are all connected. We need to understand this connection, to know what stage each of these journeys is at and this helps us to bring them together into one connected life.

Telling her about Whyte, I then asked about her journaling – and she admitted that she journals about her ‘life’ – but work is not included in this. So I asked her instead to do this thing of unifying the areas of her life. I suggested that she ask the question: how am I an OT in all the different areas of my life? This is somewhat different to what Whyte suggests – but it is also completely connected. Because, there is something so deeply spiritual about the philosophy and practice of occupational therapy. I know that it is more than what I do at work. It is what I do when I love the people in my life and care for them effectively; it is what I do when I manage to listen closely to my inner self and help this to manifest into the outer world.

And of course, in saying this to her, I was also saying it to myself. I started to journal this answer and one thing led to another till I thought that it was time to blog these thoughts. It feels like a thread that is worth following in this stage of my life. I have made the deepest commitment to my love of occupational therapy at this stage in my life. If I was to configure it as a person my relationship with OT at different times has been inspired, tentative, full of misunderstanding, angry, hurt, fulfilling, energising.

About two years ago, I made the enormous decision to refuse to work in toxic environments. I did not realise at that time just how enormous a space that refusal would open up in my life. I started to set my dreams and to follow where they led. It meant that I left my home and my family and crossed the water. And it was not a happy ever after story. I ended up in a toxic institution, in a bullying context that was more like a woman’s prison than an educational institution. But what happened was that my love of OT was growing every single day. It was like the initial commitment started something ticking in me. I was no longer alone in this journey, instead people and events started to meet me along the way.

David Whyte expresses this sense very beautifully in his poem “Everything is waiting for you”. He wrote it at a time when people seemed to recognise that he was a poet, but he was not actually writing. So he talked about how the world starts to call to you – and to engage you in a conversation. This is exactly what happened to me. Once I made the commitment to be brave and to take the first step, everything else has followed.

Everything is waiting for you

Your great mistake is to act the drama
as if you were alone. As if life
were a progressive and cunning crime
with no witness to the tiny hidden
transgressions. To feel abandoned is to deny
the intimacy of your surroundings. Surely,
even you, at times, have felt the grand array;
the swelling presence, and the chorus, crowding
out your solo voice. You must note
the way the soap dish enables you,
or the window latch grants you freedom.
Alertness is the hidden discipline of familiarity.
The stairs are your mentor of things
to come, the doors have always been there
to frighten you and invite you,
and the tiny speaker in the phone
is your dream-ladder to divinity.

Put down the weight of your aloneness and ease into
the conversation. The kettle is singing
even as it pours you a drink, the cooking pots
have left their arrogant aloofness and
seen the good in you at last. All the birds
and creatures of the world are unutterably
themselves. Everything is waiting for you.

(printed without permission – but with great respect and love – from David Whyte, River Flow: New and Selected Poems 1984-2007)

So much for mentoring. My goal was to set up an adolescent service. I did intend to write some kind of report – -with lots of references. However, none of what I read about makes the slightest sense in terms of what I felt was needed with the teenagers I was meeting. The best practice that I would want to model on came from the work of another therapist I was mentoring. She runs groups for young people, some of whom have turned into teenagers along the way. Her groups model the injunction to have a ‘high level of preparation and a low level of structure’. The groups name themselves. Sometimes this means that they get called ‘the lego club’, even when there is not a piece of lego in sight for years; another groups calls itself ‘the edible science girls and other non binary people’, which is the loveliest nod to the necessary LGBTQ space that so many girls create these days.

The way that she runs these groups is deeply respectful and engaged. The young people get to hang out together and to practice what it would be like to have friends. It doesn’t mean that they have to be friends, but they need to hang out respectfully; if they behave badly they don’t get away with it; they are not to storm out of the session because they have to come back to it the following week; Sometimes they might do something, but this always emerges from the context of the relationships in the group. They might build a hut together, or go on a rampage against a much maligned soft toy; or they may decide to make playdough because this occurs to them. There are always things that can be done at Develop, and the therapists job is to hang out with the young people and to keep the environment safe. She might remind them of their history – missing the people who have move on; or she might insist that cleaning up is done, because glitter in the playdough really was a crap idea.

So, all I know is that any adolescent groups would have to be run in this kind of way. It might be handy if there was a Dungeons and Dragons group, or if there was an LGBTQ group. But actually, what is really needed is for a group of young people to come together and to work out themselves what they want in a safe environment. That means not being threatened by the need to ‘do’ things. It means that sometimes the group might not get past the waiting area, where they all hang out together.

Of course, I did also mention in my handover that I thought YouthInc was a fabulous place that would definitely suit some of the young people that are with Develop. So, in my last act with one of my 17 year old clients – I phoned up his mum and suggested that this is the place for him. This suggestion came after 8 visits and phone calls; after doing a COPM with him; after listening to his mum have a few meltdowns about her health and domestic situation; after bringing in a social worker to do some of that stuff; after starting the process of learning how to catch a bus. So, this suggestion of doing a recon at YouthInc definitely did not come out of the blue. It came from that place of deep knowing, where I ‘get’ his sense of humor and his mum’s desperate desire to help him transition into adulthood. So when mum said “you’re like a fairy at the end of the garden’, I was able to take it as an accolade worth having. She resonates with my Irishness, connects me with her own GB Shaw connection. I hope that this works out for them. My job has been to set the wheels in motion by being part of their process for awhile.

This is how practice reminds me of Hannah Arendt. Because in “action” we insert ourselves into the human story; we are welcomed in and we set things in motion. We are never able to predict the outcomes. This is the exact opposite to what happens when we set goals and predict outcomes. This is the process that she describes as ‘work’, where something is fabricated. It makes the world and it is expected that there is a beginning and an end point. Action is not like this. This is prepolitical, where we make the human story and it unfolds in ways that we have no control of. However, as occupational therapists we become part of someone’s story for a period of time. We are ‘as if’ friends and family for a little while. We make believe and pretend even to ourselves that this is the case.

Part of me knows that I engage with someone as a therapist and there is a boundary that won’t be crossed. I know this because I have had decades of practice. Even with people who are now part of my life and my heart, there is always something that tells me I am there for them in a particular way – for them. It the way that Richard Flanagan describes the leadership of Dorry in the “The Narrow Road to the Deep North”. As they work as japanese POW, the men put Dorry into a leadership position. They want him to be this person. He knows that he is not that person, but he acts as though he is – and therefore this is what comes to pass. He is their leader, and when he is out of that role he will no longer be that person. In same way, as therapists we enact this journey with our clients. I totally believed that this family was my friend. I was genuinely fascinated by the mum’s brilliance and artistic neurodivergence; by the dad’s kindness and patience, which was bound to snap at times; by the son’s gentle affectionate nature, and the lovely spaces in his brain that had not been colonised by any school system.

So, when someone tells me I am like a ‘fairy at the end of the garden’, then I believe that this is exactly what I have been. Like the fairy stories where they come and do the work during the night for the family. And then they eventually leave once they have been seen. There is no staying as a therapist once the person has seen through you – which is exactly what should happen when you have done your job.

I can honestly say that I feel like I was an occupational therapist after all. The context created by Develop was so affirming, so non-blaming. It is a long time since I have been such a genuinely non-toxic culture. I feel very lucky to have had this experience – and I am looking forward to bringing what I learned into my new role starting next week. So, in all naivity I add the collage that I made for the art show curated by the nine year old client at Develop a few weeks ago. It was something that brought the whole practice together, which made things happen in lots of ways – for example an old client came back to sell the painted flower pots that she is now making as a business. This was after two years work with one of the fabulous therapists. And I put together this collage as a way of expressing what the place meant to me. The words around the ‘fairy’ are the occupational therapy values that Drolet collected in 2016. I would definitely add a few more. But it seems that I already was the fairy before my client said that I was. This satisfies the deepest folkloric part of my soul. If I can be a fairy in this land, then I am truly listening to the soul of the soil.

References

Drolet, M. J., & Sauvageau, A. (2016). Developing professional values: perceptions of francophone occupational therapists in Quebec, Canada. Scandinavian Journal of Occupational Therapy, 23(4), 286–296. https://doi.org/10.3109/11038128.2015.1130168

Richard Flanagan, 2013, The Narrow Road to the Deep North, Vintage Books Australia

David Whyte, 2009, The three marriages: reimagining work, self and relationship. Riverhead Books