#OTalk 25th November 2014 – Authentic Occupations

I came across an abstract of Mandy Graham’s (@OTLeeds) thesis – ‘Keeping it real: an explorative study into the use of authentic occupations within forensic occupational therapy’ – in the August issue of the British Journal of Occupational Therapy. She’s kindly agreed to host an #OTalk to help us reflect on/explore this topic. We’ve already had questions from our community about what makes an occupation ‘authentic’, so read on to find out!

As usual, the chat will take place on Twitter using the #OTalk hashtag at 8pm GMT (click the link to find out your local time). If you’re new to tweetchats, check out this guide from our #anzOTalk colleagues, and contact me (@geekyOT) if you need any extra help getting to grips with #OTalk.

– Clarissa

Authentic Occupations

“Authentic” occupations have been described as the things that people would do within their own “normal” cultural and environmental contexts, rather than artificially constructed occupations for “therapy” (Christiansen and Townsend 2004).

Research investigating the impact of the environment on occupational choice and experiences (Farnworth et al 2004; Stewart and Craik 2007) has highlighted the potential barriers to providing authentic and realistic occupations to individuals within secure care. A research study undertaken in 2010 investigated the experiences of three occupational therapists working within an NHS low secure forensic unit within Yorkshire, England (Graham 2014). Interpretative Phenomenological Analysis (IPA) was utilised in order to explore the nature and meaning of occupational therapists’ experiences, via semi-structured interviews, following approval from the South Yorkshire Research Ethics Committee (REC).

Following analysis of the data, four significant central themes were found – “It’s What it Says on the Box”; “The Locked Box”; “Thinking Outside the Box” and “Ticking the Right Boxes”. The study explored several different elements with participants including their understanding of the term authentic occupation; how they determined what is authentic for their service users; the usage of authentic occupations within treatment; and the barriers and supporting factors in the provision of authentic occupations within a secure setting. The use of authentic occupations has been described by some as an ethical obligation (Luebben 2003) and furthermore to be denied the opportunities to engage in occupations as cruel and unjust (Whiteford 2004). It is hoped that this #OTalk session will stimulate broader debate and discussion in order to support authentic occupational therapy practice of the future (Reed, Hocking, and Smythe 2013).


  • What does the term “authentic” mean to you?
  • How do OT’s utilise “authentic” occupations with their patients/clients/service users?
  • Do traditional OT settings facilitate or inhibit the use of “authentic” occupations?
  • What can we do to ensure that we understand what is truly “authentic” for our service users?


Christiansen, C. and Townsend, E. (2004) An Introduction to Occupation. In: Christiansen, C. and Townsend, E. (Eds.) Introduction to Occupation: The Art and Science of Living. Prentice Hall.

Farnworth, L. Nikitin, L. and Fossey, E. (2004) Being in a Secure Forensic Psychiatric Unit: Every Day is the Same, Killing Time or Making the Most of It. British Journal of Occupational Therapy, 67 (10), pp.430-438.

Graham, A. (2014) Keeping it real: an explorative study into the use of authentic occupations within forensic occupational therapy. British Journal of Occupational Therapy, 77 (8), pp.421.

Luebben, A. (2003) Ethical Concerns: Human Occupation. In: Kramer, P., Hinojosa, J., and Royeen, C. Perspectives in Human Occupation – Participation in Life. Lippincott Williams & Wilkins.

Reed, K. Hocking, C. Smythe, L. (2013) Exploring the meaning of occupation: The case for phenomenology. Canadian Journal of Occupational Therapy , 78 (5), pp.303-310.

Stewart, P. and Craik, C. (2007) Occupation, Mental Illness and Medium Security: Exploring Time-Use in Forensic Regional Secure Units. British Journal of Occupational Therapy, 70 (10), pp.416-425.

Whiteford, G. (2004) When People Cannot Participate: Occupational Deprivation. In: Christiansen, C. and Townsend, E. (Eds.), An Introduction to Occupation: The Art and Science of Living. Prentice Hall.

The Numbers

880,173 Impressions
580 Tweets
63 Participants

#OTalk Participants

The chat transcript is available at this link, or you can download the PDF.


#OTalk 18th November 2014 – Occupational Alienation

During my second year of university, I developed an interest in occupational risk factors – namely occupational disruption, occupational deprivation, occupational imbalance and occupational alienation (see the COT website for definitions). While I instinctively understood the meaning of the first three, it took me a while longer to ‘get’ the fourth. Two years post-qualifying, I am only now beginning to fully grasp the complexity of the concept of ‘occupational alienation’ and how valuable it can be in practice. Reading Wendy Bryant’s chapter in McKay et al. (2008) was a real ‘aha’ moment for me, and so I’m very pleased that she’s agreed to host this #OTalk. Here is an excerpt from Wendy’s pre-chat blog post:

So many people might be feeling alienated, occupationally or otherwise. Can naming the experience as an occupational one add anything helpful in health and social care practice? I would argue that it’s worth thinking about. For people who are bored, frustrated and demotivated, it suggests a way forward that focuses not on what they might want to do, but the way they might want to do it.

I’d highly recommend checking out the full text on her blog. Also, if you haven’t read the aforementioned chapter, I’d recommend that too!

As usual, the chat will take place on Twitter using the #OTalk hashtag at 8pm GMT. If you’re new to tweetchats, check out this guide from our #anzOTalk colleagues, and contact me (Clarissa; @geekyOT) if you need any extra help getting to grips with #OTalk.

Wendy’s twitter username is @DrWMB.


EDIT (13/12/14): Following on from the chat, Wendy has posted a revised definition of occupational alienation on her blog. Check it out! Here’s an excerpt:

Occupational alienation is indicated when a person is doing something they are not engaging with. This is indicated in lay terms such as going through the motions or her heart wasn’t in it. Repeatedly experiencing occupational alienation has adverse consequences for health, associated with prolonged exposure to the physiological and psychological stress response.



Bryant, W. (2008) in McKay, E., Craik, C., Lim, K.H. and Richards, G. (eds) Advancing Occupational Therapy in Mental Health Practice. Oxford: Blackwell Publishing. pp. (to be completed when I’m reunited with my book 😉 )

Thank you to everyone who joined in the chat.

The Numbers

934,472 Impressions
584 Tweets
50 Participants

You can catch up with the transcript at this link, or download the PDF.

#OTalk 11th November 2014 – Meeting the physical health needs of individuals with mental health problems

Earlier this year, I met Alison Clements (@AHP_SWYPFTat the College of Occupational Therapists annual conference in Brighton. I was interested to hear about the work she’d been doing in supporting occupational therapists working in mental health to enhance their skills/confidence in equipment provision. I’m glad she’s agreed to host this #OTalk, so we can think about how mental health OTs meet the physical health needs of their service users (whether with equipment, or other interventions).

– Clarissa

Alison has kindly agreed to share her conference poster with us.

Aim of the discussion

To reflection on the subject; meeting the physical health needs of individuals with mental health problems.

Equipment training for mental health OT’s

The OT Professional Leads working for a mental health Trust were involved in supporting OT’s to refresh their knowledge and skills to be able to safely provide equipment for mental health service users with physical health difficulties. The need to address the physical and mental health needs of service users has been emphasised by documents such ‘No health without mental health’ (DOH 2011). Service user experience should be at the heart of care, offering timely access to treatment. COT states that ‘a holistic, client centred occupational philosophy should inform our practise’ (COT 2010), therefore, when an OT is working with an individual to address their mental health needs, physical health needs should also be considered. This also prevents unnecessary referral on to other services and delays in treatment. This project was initiated following concerns that inconsistencies existed amongst OT staff in the Trust whether they were undertaking the assessment and provision of equipment in cases where there was an identified need and whether they have the skills to safely assess and issue equipment. A survey was conducted to establish the percentage of staff who were involved in the assessment and provision equipment, frequency of provision and to gauge staffs confidence when doing this. The Leads sought to achieve a minimum standard of competence for all 80 OT’s across Trust through delivering equipment training. A list of the key pieces of equipment that OT’s in the Trust should be competent to issue was developed; bathing, toileting, seating, bed and access. The training was delivered in 2 phases. Some of the OTs completed a 2 day training course and became ‘champions’. The training was then cascaded to the remaining OT’s using buddying system. During the training the OT Leads came across issues around willingness to engage, however, the training evaluations showed that most staff who completed the training felt more confident in their skills.


Why do we need to consider physical health needs when working with people with mental health problems?

What is people’s experience of addressing the physical health needs of individuals with mental health problems?

Is there a potential problem with becoming too specialised? Could this lead to staff feeling de-skilled?

How can we ensure that we do consider the physical health needs of individuals with mental health problems? What are the top tips?


Department of Health (2011) No health without mental health: A call to Action. Available from: www.dh.gov.uk (Accessed 19/9/13)

College of Occupational Therapy (2010) Code of Ethics and Professional Conduct. London. COT.

Discussion facilitator:

Alison Clements. OT Professional Lead. South West Yorkshire Partnerships NHS foundation Trust.

Other people involved: Mandy Graham. Senior Lecturer. Leeds Beckett University. Former OT Professional Lead. South West Yorkshire Partnerships NHS foundation Trust

Thank you to everyone who joined in the chat.

#OTalk Participants

The Numbers

939,832 Impressions
577 Tweets
60 Participants

You can view the transcript of the chat at this link  (opens in new window) or download the PDF.

4th November 2014 – #ot24vx14 (no #OTalk Journal Club)

There is no scheduled #OTalk chat this week. The OT 24 Hour Virtual Exchange (#ot24vx14) will be running from 8pm GMT on Monday 3rd November until 8pm on Tuesday.

The Virtual Exchange is a free online occupational therapy conference, and this year it’s running in collaboration with the World Federation of Occupational Therapists. This year’s theme is ‘A World of Health and Wellbeing’.

Things you can do to get ready for the OT24Vx 2014

1. Follow link for orientation to Webinar system Blackboard Collaborate. http://tinyurl.com/3m8n9zz

This link to the Blackboard Collaborate support portal is especially useful for first-time users. http://tinyurl.com/3gotox5

2. Visit the Participants Practice Room” to check that your computer system is working and maybe even meet an international colleague! When you go to this link – follow the prompts to download and launch Blackboard Collaborate. http://tinyurl.com/OT24Vxparticipantroom

You may like to check out some previous #OTalk transcripts that link to themes in some of this year’s presentations:

  • The dark side of occupation‘ #occhat (13/03/12) in preparation for Rebecca Twinley’s presentation at 8pm GMT ‘Everyone is a moon: the dark side of occupation’ (session 3)
  • Occupational therapy and the fire service‘ (19/08/14) #OTalk in preparation for David Marsden’s presentation at 8am GMT ‘Using MOHO to improve fire safety’ (session 14)
  • End of life care‘ #OTalk (24/09/14) in preparation for Joanna Beveridge’s presentation at 4pm GMT ‘Occupational therapy and health promoting palliative care’ (session 21)
  • Sleep as an occupation‘ #occhat (27/03/12) and ‘Restorative occupations‘ #occhat (31/07/12) in preparation for Sophie Faulker’s presentation at 5pm GMT ‘Sleep and occupational therapy’ (session 22)

See you next week, when we’ll be chatting about equipment training for mental health occupational therapists.