“Habit is necessary; it is the habit of having habits, of turning a trail into a rut, that must be incessantly fought against if one is to remain alive.” — Edith Wharton

In my practice I work with young adults who have “failed to launch” because of some combination of developmental, mental health and social factors. Each of my clients is unique, but many share key features. Here is a (fictionalized) example:

Rob is a young man who is very bright, though often socially awkward. At age 18 he went to college, but stopped after two semesters because of low class attendance and failing grades. His parents brought him home and took him to numerous psychiatrists and therapists. Rob was diagnosed with Asperger’s syndrome, depression and anxiety. He disagreed with all of these diagnoses, and refused to take medication. Rob felt he just needed to rest up and that he would return to college next year. That was six years ago.

When I initially met with Rob, I saw an overweight, poorly groomed young man who rarely looked at me, rubbed his hands together continuously and perspired a lot. His mother said they had to bribe Rob with dinner at a favorite restaurant in order to convince him to meet with me. During our first session, I asked Rob about his daily routine of activities, which he described as:

  • Wake up and start the day: Sometime between 10 a.m. and 2 p.m.
  • Eat breakfast
  • Play video games
  • Watch TV
  • Dinner w/ parents: 6:30-7 p.m.
  • Video games
  • Sleep: Sometime between 11 p.m. and 4 a.m.

Weekdays and weekends are undifferentiated. When I asked how Rob felt about his activities, he stated, “I’m bored and embarrassed.”

“Well, thank goodness!” I think. Signs of health and readiness for change.

I’ve seen Rob’s situation in many of my clients: the thin, repetitive routines of activity that are so ingrained the person and his family (and sometimes even his psychiatrist) no longer fully appreciate how bizarre and reduced the person’s life has become. With prolonged patterning come ever-diminishing expectations and avoidance of challenges. The person actually loses his appetite for enjoyment or adventure. Tragedy! Occupational emergency!

Can this guy be saved? Absolutely. Even after 35 years of practice, I continuously am amazed at the power of meaningful occupation to completely change the trajectory of someone like Rob’s life. I have seen clients who were completely homebound for years progress to taking college courses, volunteering, starting careers, going out with friends and traveling the world. How do we do it? By spending a little time learning about the person’s hopes, likes, dislikes and skills, then coaching and supporting them in different activities and settings until we create the just-right fit.

In Rob’s case, therapy was desperately needed to help him join the world of the living and enjoy life, instead of living in self-imposed seclusion. Being “in a rut” might not affect your life so drastically, but it could make your professional pursuits and fulfilling your responsibilities to your patients to the best of your abilities more difficult.

Getting into a deep groove of limited, small activity can happen before we even realize it.

So, here’s my challenging question for you, dear colleague: How are you doing, rut-wise? Time to assess where you are as a practitioner. Are you appropriately excited to go to work? Or are you into a rote pattern that reduces your sense of adventure and joy in your practice? Do your sessions reflect your full capacity for clinical reasoning and your clients’ unique preferences and needs, or are they sadly predictable? No need to feel guilt or despair, just take time to make a solid appraisal, and fix the problem.

We’ll talk more about that next month. Or, if you’ll be at the AOTA Conference, join me from 2-5 p.m. April 8 for Advanced Workshop No. 209, Rejuvenating Your OT Practice … Falling in Love Again.