Debora A. Davidson, PhD, OTR/L, Clinical Occupational Therapy Editor

Debora A. Davidson, PhD, OTR/L, Clinical Occupational Therapy Editor

I recently served as a CI for a Level II OT student, and it was an eye opening experience for both of us.  She split her week between Bright Futures, my private practice that serves adults who need help with transitional goals, and a local inpatient rehabilitation center serving older adults. Our OTS spent two days per week with Bright Futures and the other three days at the rehab center.

Just before midterm I noticed that our OTS was looking a bit stressed and was perhaps not having as much fun as I was.  When I asked her how things were going overall with her fieldwork, she surprised me. I was worried that the sometimes slow, uneven pace of our clinical days at Bright Futures was not as stimulating as she had hoped or that perhaps the sessions were not as technically oriented as she had expected. (Perhaps making a casserole with our client with Down syndrome was not doing it for her? Or spending time culling through job ads with one of our fellows with Aspergers syndrome was kind of tedious?)  I was prepared to hear this and to try and find ways to amp things up a bit more, somehow.

To my surprise, our student’s universe did not revolve around Bright Futures! Yes, she was in some distress, but it was more related to realizing that her other placement was disappointing in some key ways. This OTS loves working and being with older adults. She went into the rehab center ready to fall in love with the job and to serve the patients with her whole heart. What she experienced was the corporate-driven, factory-style therapy that has become too common. She was scolded and pressed to be productive at an extreme level that prevented the provision of client-centered, occupationally relevant, personalized care.  In fact, it even prevented her from taking care of her own basic needs during the workday and gave her the false impression that real OT is quick, rote and dollar-focused

The extreme contrast between the two placements was, I am sure, part of her stress. Kind of like going from a marathon one minute to yoga class the next! While our OTS loved her older adult patients, it was hugely apparent that the therapists at the rehab facility were not able to really practice the kind of OT that the student had been taught in school. Having been an educator in her program, I know that occupational science, PEO and MOHO were emphasized, along with biomechanical, motor learning and other applied frames of reference. I do not know of an OT theory of “rush the session, make every second billable and document-as-you-treat.”

Once again I must ask: What will we do to take control of our professional practice in the face of the business-driven medical model that so many of us now work within? We OTs are more educated, more capable and more evidence-supported than at any other time. How is it that we let non-OT administrators tell us how to practice?

We know what helps our patients best, and we must advocate for them to have it.  It’s right there in our OT Practice Framework1 and Code of Ethics2; we have promised to look out for our clients’ best interest, and to provide real occupational therapy.

I am not saying this because I feel superior, nor do I have neat answers. I ask it in all honesty and humility. I beg you to respond. If we all put our heads and hearts into this, I truly believe that we can win this.


  1. American Occupational Therapy Association. (2015).  Occupational therapy code of ethics (2015). American Journal of Occupational  Therapy, 69 (Suppl. 3).
  2. AOTA. The occupational therapy practice framework: Domain and process (3rd edition). American Journal of Occupational Therapy, March/April 2014, Vol. 68, S1-S48. doi:10.5014/ajot.2014.682006

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