About Debora Davidson, PhD, OTR/L

Debora Davidson, PhD, OTR/L, has practiced OT since 1979. Her clinical career initially centered on children and adolescents with behavioral and emotional problems. For 20 years she served as an OT faculty member at several nationally ranked universities. In 2011 Debora left academia to initiate Bright Futures in Focus, a private practice serving young adults with disabilities who want to achieve a satisfying transition to adulthood. From 2011-2015 she was the OT Clinical Editor for OnCourse Learning. She is a clinical occupational therapy blogger for TodayinOT.com. Debora initiated Authentic Occupational Therapy to inspire OTs who want to regain their clinical mojo. Join the conversation at www.facebook.com/AuthenticOT.

Altruism benefits us all

Since starting my private practice, I have had many opportunities to explain what I do to business people who work outside of healthcare. Many times their reactions run something like this, “It takes a special person to do that kind of work,” or “That is so wonderful!” While it’s fun to be considered special or wonderful, I am not really generous or self-sacrificing. I am actually taking excellent care of myself when I work with my clients.

While healthcare providers are not giving strictly for its own sake (we are paid for our work), my experience tells me most of us have selected and pursued our careers as much for emotional satisfaction as for the salary earned. Research indicates that when we do things for others we are healthier, less likely to suffer depression, more socially connected and even live longer.  Great fringe benefits for OTs! Read more about the benefits at http://greatergood.berkeley.edu/topic/altruism/definition.

We can apply these findings to our therapy. Providing opportunities for our clients to give to others transforms them from the recipients of care to being empowered to provide care — a dynamic shift that can plant seeds of self-determination and pro-social behavior.

When I worked in child and adolescent psychiatry, we arranged a secret Christmas gift exchange among patients.  They each drew the name of a patient not located on their unit, and made a small gift for that person in OT.  The therapists provided ideas about the gift recipient’s interests and preferences, so the gifts could be personalized. Although the items were simple, the excitement of the gift givers and recipients was a joy to watch. Children who had previously shown little attention to detail or quality were newly invested in doing […]

By |December 12th, 2013|Categories: From the Editor||0 Comments

Timing is everything

Regardless of each client’s unique needs and goals, there are some universal truths to doing effective therapy. For example, there is the notion of the “just right challenge,” which requires the OT to have solid skills for activity analysis and matching tasks with clients’ abilities and level of motivation. Another principle is client-centeredness, which requires a sense of the client’s interests, preferences and values. These are critical to effective intervention, and I’ll probably write about them at some later time. Right now I want to explore the issue of timing as an essential ingredient of therapy.

OTs typically enter peoples’ lives at difficult times: an injury, illness, disability or other setback has disrupted someone’s life. They do not want to need help with their everyday activities but may be preoccupied with pain, fatigue, worry or self-consciousness. We step in during rough times and ask them to learn, take risks and push themselves beyond their comfort zones.

Therapists use a variety of approaches in interacting with patients. Sometimes we present a challenge and wait for the client to figure out a solution. At other times we may actively instruct. The therapist knows when to offer words of encouragement, remain in the background or point out errors to show the client how to correct the problem.

An OT continuously makes skilled, considered decisions, choosing among many options, observing results and making adjustments based on the client’s responses. Timing these interactions to match the client’s changing condition amounts to an elegant improvisational dance. I would say this is one of the key reasons that, in the hands of an expert OT, even the most ordinary activity can be a powerful medium for therapeutic progress.

Good therapists know what to do and […]

By |November 11th, 2013|Categories: From the Editor||0 Comments

Courage to care

You might end up wishing you hadn’t read this column, but doing so will prepare you for some of the most important work that you can do as a client-centered occupational therapist.

It’s about a topic that all too often gets swept under the rug. It’s a preventable public health issue, one that polite people do not like to discuss, and that even seasoned healthcare professionals find too disturbing to contemplate, sometimes blinding us to that which is before our very eyes. What is it?

Here’s a hint: The Report of the 2012 National Survey on Abuse of People with Disabilities was released in early September. The online survey, conducted by a team led by Nora Balderain, PhD; Jim Stream, and Thomas F. Coleman was completed by more than 7,200 people who identified as members or close associates of members of the disabled community.

While you may be prepared to hear that the news is bad, you will almost surely be alarmed to read just how bad. Here are a few key findings:

• More than 70% of all respondents with disabilities reported having been victims of abuse, including verbal-emotional abuse, physical harm, sexual violation or financial exploitation.

• Groups reporting abuse included those who identified themselves as having: mental health conditions (75%), speech impairment (67%), autism (66.5%), intellectual or developmental disability (62.5%) and mobility impairment (55%).

• The vast majority of those who had experienced abuse had been victimized multiple times.

• Most often, incidents of abuse went unreported to state agencies and unaddressed.

• Most of the people who were abused received no counseling.

• On a brighter note: 83% of those who did receive such counseling found it to be helpful.

Why does this problem exist? The formula for increased risk […]

Metaphorically speaking

Anyone who has spent much time with me knows that I love to use metaphors and similes to explain things. My usual preference is food-related: “We need to layer up the topics in the first part of this paper like a parfait, then blend them into a creamy mousse at the finish.” Clarifying, and fun to think about at the same time, right?

Recently, I learned about a book on the topic of metaphor, “I Is an Other: The Secret Life of Metaphor and How It Shapes the Way We See the World” by James Geary. Geary writes that metaphors are found in many aspects of daily life, beginning with a toddler’s early play, when a paint stirring stick can be used as a comb. (This is something I sadly learned when my little daughter arose from her nap before I could clean up my home improvement project.)

Geary wrote: “Metaphorical thinking, our instinct not just for describing but for comprehending one thing in terms of another, for equating I with an other, shapes our view of the world and is essential to how we communicate, learn, discover and invent. … Metaphor is a way of thought long before it is a way with words.”

A while back, I was struggling to conceptualize and explain what I wanted to develop in a private practice. Everyone from my friends to my accountant kept asking me what I would actually be doing. At the same time, I was teaching Introduction to OT classes and trying to explain our complex profession to eager occupational therapy students. As we all appreciate, explaining occupational therapy in a succinct-yet-complete way can cause one to break a sweat. After more than 35 years of […]

By |September 5th, 2013|Categories: From the Editor||0 Comments

Expand your reach

Some years ago, I was talking with a faculty colleague who taught in the nursing program, discussing the clinical education components of our professional programs. As she described the challenges nursing students faced, she said, “Well, you know we eat our young.” My eyebrows shot up, and I pressed my lips together as I considered this rather shocking remark. I had heard it before, but I did not expect a nursing educator to say it.

This exchange led me to think about occupational therapy’s culture and attitudes toward preparing our young practitioners. Perhaps I wear rose-colored glasses, but I view our professional culture as collaborative and nurturing, and dedicated to challenging learners at a “just right” level whenever possible. We work with our clients to achieve mutually agreed-upon outcomes, and I think this focus should extend to how we prepare our future colleagues, too.

This is not to say that serving as a clinical instructor for fieldwork students is about serving cookies and milk. Students enter fieldwork 2 having achieved the academic requirements of an accredited program, but that leaves a lot of room for variability in terms of their readiness for clinical training. Some come intrinsically prepared to interact professionally and personably with clients and co-workers, and others still are learning these skills. Most have exemplary work habits, but some need improvement. Some have the confidence and courage to get busy and apply what they have only read and talked about to actual practice, and others need a lot of support. The variables are many, and each student, clinical instructor and setting present a unique combination of traits that combine with more or less ease.

In truth, taking occupational therapy students for fieldwork presents risks to […]

Let’s get this done

Occupational therapists are core team members in a wide array of contexts, including rehabilitation, schools, acute care and long-term care. We provide unique services that complement those of our colleagues, and we are valued for our creativity, practicality and successful results. Our knowledge and skills are considered to be a great fit for clients with physical, developmental and educational needs, but we rarely serve those whose primary concerns involve mental illness. The reasons for this are beyond the scope of this column; I am going to focus on why and how to fix the problem.

According to the National Institute of Mental Health, about 6% of Americans have a serious and persistent mental illness. Services typically consist of medication and crisis management, sometimes with additional counseling or vocational support. ADLs and IADLs may be discussed, but are rarely taught or practiced. Many clients and families express great disappointment with the poor results of this limited treatment.

I have been a “mental health OT” since 1979, and I know we can provide services that will significantly improve these clients’ outcomes. In my work, I regularly get to witness how participation in carefully selected activities produces healing, recovery, joy and life satisfaction for clients with chronic mental health problems. By doing everyday things effectively, my clients show themselves and others that they can be competent, safe and valued members of the larger community. Sometimes the therapy sessions offer the first such experiences in a long time — or ever.

Yes, I am proud to be one of the fewer than 3% of us who identify with mental health practice. I work with my clients through a small private practice, serving people whose families can afford to pay out of […]

Careerlong learning

Last month, I had the good fortune to attend the National American Occupational Therapy Association Conference in San Diego. What a lovely city and a terrific conference. As I mingled with more than 5,000 of my colleagues, I was struck by the breadth of what occupational therapists are interested in learning about, and the depth of practitioners’ knowledge and skill. The combined knowledge of the OTs attending that kind of an event is awesome, and I could sense the excitement as people talked, laughed and shared with one another.

Novice, intermediate and experienced therapists all seek new ideas, knowledge and skills to help improve their practices — and because we are just plain curious. As we participate in a class or reading, each of us receives and interprets the information uniquely with reference to our own backgrounds and methods of learning. A green practitioner often is eager to learn how to do things and will pull very practical hands-on information from a learning experience. A more experienced therapist attending the same continuing education session will compare the information with past experiences and knowledge, which can be affirming, additive or challenging. An expert in the field considers how the material is being organized and presented, and considers new ways to educate others or research the topics at hand. While the information may not be all that new to each learner, the way it is presented can ignite new associations and ideas for future clinical application and development of scholarship.

The (perhaps) sad news is that, the more we gain expertise in an areas of practice, the harder it is to find continuing education that surprises us and provides novelty. The good news is that occupational therapy is […]

Pitching OT

You are at a social gathering and a new acquaintance asks: “What do you do?” The follow-up to your response is: “What is OT?” How do you feel when you hear this question? Are you eager to talk about your exciting career? Or do you feel a wave of anxiety? As a startup entrepreneur, I have been learning about the importance of developing an effective, 1-minute-or-less “elevator pitch” to explain what I do. This is harder than it sounds, especially for an occupational therapist.

When I was a young practitioner faced with the casual query, “What is OT?” I used to launch into my “History of OT” talk, slowly working my way forward from the reconstruction aides of World War I. I would watch the poor listeners’ increasing regret as I approached the biomedical era of the 1960s, and then complete glazing over of their eyes as I hurriedly described how occupational therapy was experiencing a renaissance, which allowed us to really address the individual needs of clients in a person-centered … . Well, you know where this is going.

I love to be asked, “What exactly is OT?” or even, “How is OT different from PT?” I have developed a few guidelines to craft my responses:

Consider the questioner, and what really interests him or her. What is their context and reason for asking? Do they want to know how you can help them or a loved one? If so, respond in that vein: “I often help my patients with relearning their self-care, such as getting dressed and bathing.” Or, “I help kids to learn and practice the skills they need to go to school in a regular classroom and to make friends.”

Do they want to […]