This weeks chat will be hosted by Abigail Matthews @Abi21643842
I have recently started to learn about the role of Acceptance and Commitment Therapy (ACT) in supporting individuals with severe and enduring mental health needs, through an occupational lens. This therapy teaches that people should focus on what they can control and make actions towards values which create a meaningful life. ACT is a mindfulness-based behavioural therapy that encourages clients to expand their lives alongside the existence of inevitable pain and suffering (Harris, 2011). His renowned self-help book the happiness trap (2011, b) prioritises acceptance and personal development over symptom reduction. If one is focused on improving the present moment, there is recognition of the world of opportunities outside our own self-critical thoughts and current difficulties. We are more than the sum of our past experiences, thoughts and feelings (Harris, 2011). The 21st century is full of complexity and life stressors (eg. work, politics and healthcare) which can ultimately negatively impact mental health and well-being, if we do not embrace contentment and meaning in everyday life (Harris, 2011). If we solely focus on solving problems we will never achieve happiness. In a similar way, Behavioural activation helps alleviate depression through planning pleasurable activities based on what we are motivated to change (Ekers et al, 2014). It teaches us that we are able to control our mood through our behaviour. This approach is often used by Occupational therapists to create change based on the occupations that we both want and need to do in order to live a fulfilling life. To maintain health and well-being, Occupational Therapy helps people to develop a sense of being, becoming and belonging through engagement in everyday life (Wilcock, 1998). In a similar way to ACT, solution focused brief therapy also focuses on achieving happiness by exploring solutions rather than trying to resolve indicators of poor health (Nicholas and Schwartz, 1998). These psychological approaches appear to hold a common focus in identifying action aligned with personal values. It could be argued that as Occupational Therapist we are already following a values based approach, given that client centred prioritises what’s important to the client (Townsend et al, 1990). It is through expanding our occupations of interest (self-care, leisure and productivity) that we can maintain our mental health and well-being (CAOT, 2002). This OTalk will explore these psychological approaches further and consider their place in OT practice.
What do you feel is the role of ACT in your setting and working with specific population needs?
What OT tools and strategies could you use to embed an ACT perspective in your practice?
How well do you as occupational therapist embrace a values based approach in your practice?
What have you taken from today that will support you in your OT role?
Canadian Association of Occupational Therapists (CAOT, 2002). Enabling occupation: an occupational therapy perspective. Ottawa, ON: Canadian Association of Occupational Therapists.
Welcome to this week’s #OTalk Research. I am Jeni Woods (@Jeni_Woods_OT) and I work as a Specialist Haematology Oncology Occupational Therapist at the Christie NHS Foundation Trust in Manchester and Chair of the RCOT Specialist Section for Major Health Conditions.
Research is a core component of occupational therapy’s practice and is outlined within the Health and Care Profession’s Council (2013) standards of proficiency for occupational therapists and the Royal College of Occupational Therapists (2019) Career development framework.
This summer I completed a MSc in Advanced Occupational Therapy at the University of Salford. I have grown so much from a leadership and research perspective over the course of the three years it took to complete the course. As I progressed throughout this course and undertook various local and national projects relating to improving patient care in oncology and palliative care – the need for occupational therapists to undertake and publish research has resonated deeply with me. Without the evidence to demonstrate the impact that occupational therapists can have on a person’s health, well-being and overall quality of life – how can we be expected to be included in national guidance, which often draws upon the evidence base available?
However, as I handed in my dissertation I thought that was enough studying for me. It had been a tough 18 months balancing the demands of raising a young family, my role at the Christie and my voluntary work with the specialist section. Furthermore, I’d experienced a number of deaths of family members, which had impacted my studies. But after six weeks of no studying, no reading and critically appraising journal articles, no musings over how to structure an argument with an essay and no going round in circles with seemingly never ending literature searches – I had some persistent thoughts. I missed studying and the way it challenged my thinking and enabled me to generate new ideas, which influenced my clinical practice. Moreover, undertaking the MSc had enabled me to develop my research skills and I wanted to be able to build upon these.
Various options are available which could facilitate achieving this goal, but for me, the decision has been made to pursue a PhD or Professional Doctorate option.
So here I am reaching out to the #OTalk research community for advice on how myself and others in a similar position can shape their early research career.
What opportunities are you aware of, or have you experienced, which support occupational therapists to develop on their research career journey?
What advice would you offer to anyone considering formal study, such as a PhD or professional doctorate, to further their research career?
What are the challenges and rewards of undertaking a formal research qualification to develop your research career?
What activities helped you to strengthen your CV as an early researcher?
What did you find helpful when preparing a research proposal?
Can you share any tips or advice to support others with their application to study at doctoral level?
This weeks chat will be hosted by Nina Bedding & Cath Turner @OT_ninabedding. @CathTurner7.
During September we, alongside other universities across the country, have welcomed back returning and new students in a very different way to previous years. The use of technology and virtual learning is at an all-time high as we are forced to stay safe throughout this global pandemic. It is lovely to have such passionate and enthusiastic students who are flexible and willing to adapt to the various learning and teaching methods. Students will be wondering about if and how practice placements will be incorporated in to their courses, as well as having the usual anticipatory feelings about the new experience coming their way.
Every Occupational Therapist began as a student. We expect every one of us in the occupational therapy community had apprehensions about placement at the same time as being super excited. Some of our students have had placements cancelled and therefore desperate to get out into the ‘real world’ others are more cautious as they are now in second year and have still not had that valuable placement experience. So what better way than for us to use this reflective #OTtalk opportunity to share our experiences and advice around practice placements. This hour will also offer students the opportunity to share advice and ask questions about the journey they have embarked upon. As you will be sharing examples, please remember to maintain the confidentiality of the people that you worked with and the places where you were on placement.
For any new students please jump in and ask questions as the hour goes by.
For our students out there, what are you most looking forward to and least looking forward to?
What preparation would you advise a student to do in the lead up to a placement?
What was the highlight of your placement experience, were there any light bulb moments?
If you could give one bit of advice to a student about to commence a placement what would it be?
Trigger Warning: This #OTalk may not be suitable to attend for anyone currently struggling with disordered eating. If you need help and support with this at this time do check out BEAT – https://www.beateatingdisorders.org.uk/.
Watch this video about Ytisebo
In some respects I see this as an expansion to the diversity in OT series but also fatphobia as an issue impacts so much on people in society and within healthcare in particular. In this chat, Sarah, Alice and I hope to expand your awareness on one of the last great “socially acceptable” forms of discrimination.
Alice Hortop is an OT lecturer at UWE who has keen interests in the therapeutic use of humour, hygge and occupation and infertility. @laughingot Sarah Merton is a Social Sciences student at LSBU exploring the body positive movement on instagram. @sociology_sarah Kirsty Stanley is an Independent OT who is passionate about ALL OF THE THINGS – but sadly not her own body. She once lost 5 stone with Slimming World but because – funnily enough – losing weight didn’t fix all her life problems has put it all back on and more! She has recently been diagnosed with ADHD and is just learning more about the food = dopamine connection. @occ4lifeltd
Consider this discussion between friends:
“It’s because I’m fat.” “Oh no you aren’t, you are beautiful. I don’t like to hear you so down, where’s your cheerful self?”
And this within a healthcare situation:
Person: “I dropped my laptop on my toe and I think it’s broken.” Dr: “There’s not much we can do about that but have you thought about losing weight?’ “Oh I have lost a stone over the last couple of weeks” “I thought you looked thinner. Well done.”
Or this scenario:
Walks by a colleague and is eating a biscuit that was brought to a team meeting.
“Be careful, I don’t want to have to buy you a bigger uniform again.”
In the first scenario: Fat identity is not legitimised. Thinness is equated with beauty. Looks are associated with ‘being worthy’. The ‘cheerful’ fat friend narrative is continued.
In the second there is a danger of alienating people we work with. If all they ever hear is about their weight they they may disengage with services. This may also lead to them actually putting on more weight. It also risks health issues being missed, e.g. rapid weight loss and cancer. Or recognising that bodies change over time. Alice and I have both written about fertility, to access support with fertility issues women are often made to lose weight in order to ‘try and conceive naturally’ and investigations into other medical issues are delayed – creating a vicious cycle with subsequent mood disorders and unhealthy eating patterns. Also BMI has been criticised no end but it is still being used widely within healthcare.
Fat is not a moral failing. Fat is a feminist issue.
It will have taken that person A LOT to ask for a bigger uniform, to belittle that is traumatic. You never truly know the struggles people have around food.
A summary of Sarah Merton’s research on Body Positivity
My name is Sarah Merton and I am a second year PhD student from the Social Sciences department at London South Bank University. During spring 2020, my online survey went live as part of postgraduate study into the body positive movement on Instagram. It was a tense time. The study was unveiled following 18 months of preparation just as large proportions of the global population entered into state induced lockdown. However, the research experience was one of community and camaraderie. Not words always readily applied in conversations about ‘toxic’ social media spaces. I received over 500 survey responses submitted by Instagrammers who had used a #BodyPositive hashtag, or as they are more colloquially known, ‘BoPo Warriors.’ Originally, the study aimed to understand whether the Instagram platform could be conceptualised as a ‘protest site.’ Yet it soon became apparent that, although to some the app signalled an arena for hashtag activism and/or feminism, an overwhelming majority regarded Instagram as a therapy space. 71.2% (n=351) of Instagrammers described the platform as a site of solidarity with other women. ￼ The summer was spent reviewing the hundreds of emotive first-hand testimonies generously shared by BoPo Warriors and it made for a heart-breaking experience: ‘After suffering with Bulimia and hating my body for years and dieting over and over again I wanted to find a better way.’ ‘I struggled with eating disorders my whole life. I was on instagram telling my weightloss story for 3 years or so before I ran across the hashtag Body Positive and read some of the posts.’ Though the body positive movement is borderless and networked in constitution, the impact of fatphobia, sizeism and weight stigma united dispersed but substantial populations. Diet culture permeated a diversity of cultures. When looking at the most common precursors to joining the body positive movement, eating disorder recovery presented the highest ranked reason for women seeking out connectivity. ￼
In fact, 85.8% (n=429) of body positive Instagrammers said they used social media to share stories of struggle against narrow beauty standards. Beyond the filters, the jiggle and the wiggle, there was another underbelly of brutal biographies. There was shame, blame and weighing scales. The fatphobia that put the fire in those bellies. The fat female body is endlessly prodded and policed by external agencies from media to medicine. This often prompts an alienation from your own sense of bodily autonomy because it feels like everybody else’s property rather than your own. The summer I spent reading the stories behind the Instagram Stories, belonging to body positive hashtivists, alerted me to the shared struggle beneath the selfies. I had thought that I understood BoPo Warriors, but I only knew the half of it, up until then I never fully comprehended the body battles preceding the Insta-ready performances. The real-life reasons underlying the rallying cries of, ‘Riots not Diets!’
A physical barrier, consciously and uncomfortably worn.
Visible grief, heavy on my bones,
Heavy with judgement,
And the irony?
The unwanted padding of grief,
Traps you into the childlessness that caused it,
Fat people aren’t allowed to be mothers.
Sea Swimming and Body Positivity – Alice Hortop
A miracle happened after years of fat shaming and desperately trying to shed pounds but actually making myself very ill. I gained weight through the grief of involuntary childlessness. I was refused IVF for being a size 16 at 5’11, I tried for 2 years to lose the weight, only managing to gain a few stone in desperate fad diets and developing IBS. I went on to be fat shamed by social workers when I tried to adopt for increasing to a size 18. I am curvy, voluptuous with a big bust, bum and hips. I was conflicted and outraged that my whole humanity, my human right to have a family, to be a mother recognised by international laws, was reduced to the numbers on the weighing scale. My body abandoned me in my greatest desire to have a family but further left me open to endless cruel and humiliating judgments from strangers in health and social care. It is hard to love yourself, love your body, when you are treated as if you are lazy, weak willed, greedy and undeserving of a family as a result. Everyone should be told they are attractive, it’s really not hard to compliment the warmth in a smile, a sparkle in a pair of eyes, the colour of an item of clothing that flatters or an engaging body language. I found except from my partner and a handful of friends that compliments were rare, especially as I gained weight. Family praised weight loss but in my yoyo weight loss and gain cycle those were few and far between especially when they finished with the deflating encouragement to lose more. I had been a triathlete and surfer in my twenties but stopped due to back and hip issues. I have lived by the sea for most of my life, including now. I have always loved the sea and swimming but never felt body confident, whether a size 10 or 18. A friend up north was raving about wild swimming for about a year, she is inspirational and brave to my mind, but I could not imagine doing it. The previous summer I had been in the sea with my dog as it was boiling, I wore a dress to avoid exposure. I have dozens of bathing suits, always bought in the sale in bigger and bigger sizes but always looked awful. This summer was boiling and I failed to fit into any of my swimsuits. I had a sudden thought, I wondered if they did tall swimsuits. They did! I bought a tall polka dot swimsuit and it actually fit, smaller than the bigger ones that did not! The first day I went to the sea I had an argument with my partner, one of those ones where you disguise the row by arguing through a grimace of closed teeth. In summary I wanted to get as close to the sea as humanly possible before revealing my swimsuit body. In the water I had a wonderful time, laughing out loud and splashing in the waves. The next few times I became less self-conscious and dare I say it brave! Now, I am a fully-fledged mermaid! I recorded my World OT Day 30 sec film on the life affirming occupation of wild swimming, with no makeup and in my polka dot bathing suit in the sea! It’s November and I still go in most days, happily strutting around in my bathing suits… I have many tall ones now! I do not care who sees me having an epic time, often enjoying boisterous camaraderie with the rest of my sea-swimming pals. It is interesting that many of us were body shy but not anymore. Who knew that wearing far less would give us the armour of body confidence we needed. My body feels so gorgeous in the water, how could I continue to hate it? I honestly feel I could teach a lecture in my bathing suit now, my body didn’t let me down, society did.
Recommendations/Key Discussion Points for OT
Activity related rather than weight related (or BMI) goals. A target weight is often never enough – there is always that extra couple of pounds to go. Support people with access to food, time, routine and skills for food preparation, help them balance alternatives, e.g. is it better to eat 3 moderately nutritious meals, than to eat a ‘perfectly balanced’ salad and binge late at night. Do not shame or bully people into weight loss – it doesn’t work! Please don’t buy into the lockdown or post Christmas weight loss narrative – or the shame associated with it. Consider this for people of ALL genders. No Body (Type) can be wrong – this is an ableist narrative. Health does not have a look or aesthetic. It can’t be beat into submission, it is not a machine. No food is naughty. Be aware of the societal focus on individualistic responsibility. What about the mantra ‘wealth over health’. What whole society changes could we support, e.g. governmental responsibility vs Marcus Rashford – MacDonald’s offering free meals. Deprivation and Gluttony dichotomy. Conflicting messages. Don’t assume that people are using instagram passively – when they are actively engaging in social justice issues around Body Positivity. The joy of movement – joyful movement. Exercise for the fun of it and not to burn off calories. Dance like nobody is watching. If you do exercise that you don’t enjoy it stresses the body. (https://www.theactivetimes.com/fitness/why-hate-working-out-science). Recognise people’s lived experience. Consider all of this when working with “bariatric” clients. Obesity related conditions often related to the stigma rather than the weight itself (https://onlinelibrary.wiley.com/doi/abs/10.1111/spc3.12172?fbclid=IwAR1sc3zgtdwojzg64n04KyMUMEqF3tUzwQR3-2cF0qd8kLRkOxu-A6J4_AA)
Questions for the chat
Share an image of the “perfect” body type? Why? How does that make you feel about your own body?
Fatphobia and Body Positive Occupational Therapy #BoPoOT – what do they mean to you?
After the Prime Minister’s ‘War on fat’ what steps will you take to be ‘fair on fat’?
How can we support people to live their lives in a body positive way, love their bodies, and step back from the need to strive for the stereotype, whilst also promoting health and wellbeing?
Can instagram/social media be reclaimed as a protest space and a therapy/recovery space?
We would love to start a #BoPoOT Movement. Share your thoughts and reflections (and images if comfortable to) using the hashtag.
Finding your Professional Development/CPD mentor- By: Bill Wong, OTD/OTR/L (@BillWongOT)
Behind many successful OT practitioners, they either have their own CPD mentors or mentoring teams. For example, I once overheard that Charles Christensen supported Michael Iwama’s OT journey. I also overheard that Barbara Kornblau (former AOTA president) supported Shawn Phipps’ OT journey. (Shawn is one of the members of my CPD mentoring team.) I am sure there are countless stories of others in OT land as well.
In my own OT journey so far, I had experience with a singular CPD mentor and a CPD mentoring team. My first CPD mentor was the late Terry Olivas De La O. (Those of you who participated in #otalk in its earlier days may remember who she was. But for those of you who didn’t participate in #otalk in its early days, I will fill you in a bit about her. Terry was a certified occupational therapy assistant in the USA. She was highlighted in the 2012 Slagle Lecture by Karen Jacobs. She was also amongst the 1% of certified occupational therapy assistants who received the Roster of Honor designation in the USA, which is equivalent to a fellow for that position in the UK for occupational therapists. She was known for her passion in anti-bullying, as well as getting the word about #valueofOT out to the general public. Unfortunately, she passed away in early 2014 due to a host of health issues.) After Terry passed away, I spent two months looking for her replacement. I ended up with Michael Iwama, Barbara Kornblau, and Shawn Phipps as my CPD mentoring team.
What led me to a team approach vs. a singular mentor? I actually borrowed the concept from Major League Baseball (MLB), as I am a baseball fan. Since the early 2010’s, many successful MLB teams started to implement a team approach with its hitting and pitching departments. (For those of you who don’t follow baseball, hitting and pitching are two of the most important elements of baseball.) Therefore, I thought, “If successful MLB teams can make a team approach work, why can’t I do that for my CPD?” 6 years into having this approach, I would say it has worked out pretty well for me. The primary benefit for me- sometimes I need to hear certain things explained to me in another way so that I can maximize my professional potential.
I will switch to a Q & A format for the rest of the blog.
Q: When is it a good time to find a CPD mentor or mentoring team?
A: It depends on you. My own suggestion is ASAP. My reasoning is- If your mentor(s) already have rapport with you, they will be more likely to give you direct constructive advice.
Q: Why do you want a CPD mentor/mentoring team?
A: Early on in my OT journey, I realized that I have a lot of potential to make a difference in the OT world. However, I need people to provide clarity on the steps to help me reach my potential. Fast forward to today, I want my mentors to be my accountability partners for my CPD goals.
Q: What qualities do you want from your mentors?
A: For me personally, I look for compatibility and competence. Compatibility is important because I want to hear advice by people I want to hear from. Competence is important because I don’t want to waste time and effort on doing things that are not constructive or relevant to me. In addition, there are times I also want to know if things I want at the time are really to my best interests.
Q: How do you go about finding your mentors?
A: For my first couple years in my OT journey, I did a lot of window shopping. After all, I am an introvert. I needed time to figure out a list of people who would fit my criteria, as I started my OT journey without really knowing anyone in OT well. Then, when I found Terry, I popped the question when I met her in person for the first time about a year after connecting on Facebook. At that time, because I was fairly new to the profession, being local was also an important criteria. After all, we met several times during our two years of mentor-mentee relationship together. As for Barbara, Michael, and Shawn, I settled on them because I tried to replicate what I had with Terry. However, geography wise, I no longer needed a mentor that is geographically close to me (although Shawn is actually so) because Terry did such a good job with me.
Of course, there can also be some quick and easy ways, too. Sometimes there are formal mentorship programs. For example, earlier this decade, AOTA has the Emerging Leaders Development Program. Since then, some state associations in the USA copied the same blueprint. Recently, COTAD has launched its minority mentorship program. (I am not in tune of what’s available in countries outside of USA, however.)
Q: What else have you really learned?
A: A mentor-mentee relationship should be a collaborative process. The mentor should not be forcing on his/her agenda to the mentee. Instead, the mentor can suggest things for the mentee to do while keeping in mind of his/her interests. Meanwhile, the mentee should be an active participant in the relationship. This includes taking charge of his/her development, making appointments to chat with his/her mentor, and doing as much homework as he/she can before asking mentor for advice. Another thing- if you have no preferences geography wise, you will have a bigger pool of potential mentors to choose from.
Q: Can I change mentors over the course of my career?
A: Of course. In some formal mentoring programs, you will have to be with your assigned mentor for a certain period of time. After that time is over, it is up to you to decide whether you want to continue the relationship or not off the program. Meanwhile, some of my mentees stopped asking me for advice when they felt like they no longer needed me.
Do you have a CPD mentor or mentoring team? If you have one, what qualities are you looking for?
Do you have CPD mentees? If so, what qualities are you looking for?
If you have a choice, do you prefer a formal or informal mentorship arrangement? Why?
If you have a choice of anyone in OT to be your mentor/part of your mentoring team, who are they? Why?