“Be the change you want to see in the world” – Mahatma Gandhi

Some years ago my mother, sisters and I traveled to London together. It was my first transcontinental flight, and I was excited and a bit nervous. As I sat next to my older sister, I saw her remove her shoes and put on some little sock slippers. I took off my shoes and put on slippers, too. Soon after, she reclined her seat; I did the same. When asked if she wanted a beverage, she ordered green tea. I also ordered green tea, but soon regretted my decision. You see, I truly hated green tea!

Why on earth did I, a grown and very independent woman, imitate my sister even to the point of ordering (and yes, choking down) a beverage that tasted like grass? I had to laugh at myself, even as I sipped the nasty stuff. Once a kid sister, always a kid sister, I guess.

If you recall your psychology courses (social learning theory), you know that it was more than just family dynamics; it was behavioral modeling. The hard-wired tendency to unconsciously copy one another is arguably the foundation for all human bonding, grouping and the evolution of cultures.

The things we do and the choices we make every day are influenced by many unconscious perceptions. Going with the flow is great for keeping harmony and ease. However, it becomes a problem when we sacrifice things we value such as integrity, originality, improved performance — or a good beverage, for example. Unless we deliberately elect to stay attentive and course-correct as needed, we probably end up navigating our days on imitative auto-pilot.

I sense that behavioral modeling is one of the reasons that the practice of occupational therapy has become reduced in too many places. Our academic programs have been teaching occupationally focused, holistic and clients-centered practice models and techniques at least since the early 1990s. The ACOTE Standards require this, as does the OT Practice Framework. Our leaders and scholars have exhorted a “return to meaningful occupation” for decades.

Despite these efforts, each year, invariably, a sizeable proportion of students returns from Level I fieldwork having observed little beyond hand-bike level occupational therapy. They think that this is real world OT. They go on to Level II and are further acculturated to what I call “Faux T”.

If this makes you squirm, then maybe it’s time to turn a page. Behavioral modeling is not the only game in town — self-determination is a real thing, too, and it’s not just for our clients.

I won’t sugarcoat it. Breaking away from practices that everyone else around you is doing and being rewarded (or at least not punished) for is hard. Trying new approaches to therapy is scary and initially awkward. The clients may resist, although if it’s a break from the usual rote-and-routine nonactivities, I think it’s safe to bet that they will mostly love it, and you.

Pretend your clients are case studies, and you’re making a plan that your favorite professor will love. Go on, be a hero. Help your client to stand at the counter and make a cup of tea, make a group collage to celebrate the changing season or a favorite sport, or knead dough for homemade pretzels. Let them practice getting into and out of an actual car. Get wild and ask them what they like to do and tailor sessions accordingly.

Dealing with the quizzical looks, questions and frowns of your colleagues who get disturbed that you dare to be different can be unsettling. Getting challenged by non-OT team members or administrators can be alarming. But I promise that if you prepare yourself with a well-planned response and stay the course, it gets easier as you go — especially when your clients are excited about your sessions and you see their joy and accomplishment.

Rest assured, just as there is a huge gravitational pull toward imitating the group, some people in that group will feel a gravitational pull toward trying your way of doing, as well. You’ll know it’s starting to work when they get a little upset. It’ll start out small, but your deviance may be the saving grace needed to influence your peers, and to bring your clients the great value that real OT provides. And it will be the saving grace that brings you into your full potential and integrity as the former OT student who once sat and glowed with excitement in the classroom.

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