Expert Interview: All you wanted to know about Occupational Therapy

Hello Jessica, can you briefly explain to us what occupational therapy is all about?

Occupational therapy is a health-care occupation founded on the link between human activity and health. Our goal is to maintain or help patients get back the ability to perform activities in a safe, autonomous and efficient way. We accompany the patient in her environment giving her the ability to reduce or even eliminate handicap situations she or he comes across in her or his daily life activities (personal care such as bathing, dressing, mobility, communicating, leisure activities, eating…). Occupational therapy takes the patient's needs, life habits and environmental factors into account as well as any handicaps, and proposes a customized solution. The occupational therapist develops a program that includes re-education and/or re-adaptation that favor patient autonomy.

What qualifications do you need to practise as an occupational therapist (OT)?

To become an occupational therapist, you need to complete an HCPC-approved pre-registration occupational therapy program at either an undergraduate or postgraduate level. All programs are accredited by the Royal College of Occupational Therapists (RCOT) and WFOT.

A full-time BSc in occupational therapy takes approximately three years in England and Wales and four years in Scotland to complete. There are part-time programs available at some institutions as well. They last around four years and require attendance of two days a week at the university.

[Editors Note: For the United States, prior to 2007, to become an occupational therapist, an individual had to complete a bachelor's, master's, or doctoral level occupational therapy program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE®). However, after 2007, to become an occupational therapist, individuals must complete an ACOTE-accredited occupational therapy program at the master's or doctoral level. In recent years, there has been movement to make all occupational therapy programs in the USA doctoral. Graduates of an accredited program at the respective level are then eligible to sit for the national certification exam administered by the National Board for Certification in Occupational Therapy (NBCOT®). Upon passing of NBCOT exam, the graduate is qualified for practice and may do so upon application and approval for state licensure by the respective state. 

To note, all graduates of an ACOTE-accredited occupational therapist program, regardless of the year of graduation or the level of degree, are occupational therapists. Upon passing of the NBCOT exam, these graduates are licensed occupational therapists.]

Which patients can benefit from occupational therapy? What goals can patients achieve?

There are many patients and forms of chronic conditions that can benefit from occupational therapy. The reasons that people come in to see us can vary (physical re-education, advice on choosing a wheelchair, making their environment more accessible, retrofitting their home, installing mobility aids, etc.), but we try to help anyone who comes to see us obtain the greatest degree of independence possible in their particular circumstances.

What does an occupational therapist with a psychology degree do?

Occupational therapy (an occupational therapist) will help the patient take care of herself or himself and perform activities that are important to the patient, as well as other people in the patient's environment. The programs we propose often focus on everyday life and developing a patient’s abilities in order to make her or him more self-reliant. For example, we might suggest a kitchen re-arrangement workshop with different end-goals depending on the patient’s needs. One example I can think of: making a grocery list (organization/planning), getting out of the house to do the shopping (managing one’s emotions/behavioral issues and factors), and even the physical act of carrying out the task (practicing physical movements or decision making). Emotional and social skills are usually handled by OTs with a psychology degree.

What are the benefits of occupational therapy for those suffering from memory loss, notably from Alzheimer’s?

An occupational therapist can intervene at different points in the progression of the illness. At the onset, an OT may propose cognitive stimulation workshops to retain abilities. Stimulation will depend on the interest of the patient or it might be in a group setting to favor social exchanges. Further, the OT may propose measures to compensate for memory loss in the patient’s daily activities, for example putting up a memory calendar or clock that tells Mrs. X not to forget to go to the market on Thursdays. The OT can also make a person’s daily activities easier to do with technical aides. For example, we could create a cookbook with all of Mr. Y’s favorite recipes to allow him to continue to cook the things he likes to eat without forgetting any important steps. Accompanying the caregivers of the patient is also a very important part of occupational therapy.

Can occupation therapy assist in the re-education of someone who has suffered a stroke?

Following a stroke, the OT will come to hospital to make sure the patient has everything she or he needs to maintain independent (mechanical bed, proper mattress, a wheelchair or walker if necessary, technical aides for eating, dressing, going to the toilet, etc.) The OT will then draw up a therapy program (physical and/or cognitive) that is adapted to the specific needs and abilities of the patient to allow her or him to retain maximum autonomy. Over time, the OT will adapt the program. When the patient leaves the hospital, the OT may visit him at his residence to do an evaluation of the home and propose changes that will help the patient ease back into home life.

How can patients make an appointment with an occupational therapist?

Generally by referral.

You can get occupational therapy through the NHS or social services, depending on your situation. If you can’t pay for the therapy by yourself, talk to your GP about getting a referral or make a request.

If you have the funds, you can pay for therapy directly. The Royal College of Occupational Therapists has a list of qualified and registered occupational therapists that you can call to see if you can make an appointment. This is the quickest way to be seen, but it’s more expensive, of course.

[Editor's Note: For the USA, in order to see an occupational therapist, if you wish to use insurance, Medicare, or Medicaid, you will first need to obtain a referral from a GP or another qualified medical practitioner. However, there are a growing number of cash-based practices, offering cash-based prices, but not accepting insurance.

The best method is to first speak with your doctor to discuss your concerns and to evaluate the need for occupational therapy.]

Does a patient need to see an OT over a long period of time or are a few sessions usually enough?

Everything depends on the person and her or his needs. Sometimes just one appointment is enough to help the patient master daily tasks. Sometimes a few appointments are necessary. In general, we see a patient over a longer time period since, as I mentioned earlier, we tend to intervene at different points in an illness’ evolution.

How do you determine how many sessions are necessary?

We perform assessments and an evaluation before each session, for whatever the condition is. Depending on the patient’s goals, the OT will propose an action plan and determine the number of sessions needed to reach those goals. The patient’s physician will also help in determining how many sessions (Editors Note: In the USA, sessions are commonly referred to as visits) are authorized.

Do you go directly to the hospital or do you visit patients in their homes? Do you bring anything with you?

OT’s can propose either option, depending on the patient’s needs and goals.

We can certainly come directly to the patient’s home, notably to conduct an evaluation of the residence after a change in circumstances, or when the house needs to be retrofitted to provide the patient more independence within her or his environment. An OT may visit a patient’s home as part of a larger medical and caregiver team or independently.

The materials we bring with us varies a lot and depends on our specialization. Every session changes depending on the patient and there’s never really a “typical day”.

What are your patients’ biggest apprehensions? How do you put them at ease?

I’d say the biggest apprehension is just not knowing what an OT does. Sometimes patients are referred to us without knowing what we can do for them or only knowing a little bit about our field. Often, a patient will contact us to get help in just one area of their daily life and after we do an evaluation we realize that their handicap is affecting many other aspects of their life. People are often quite surprised by how we can improve their quality of life in such a wide variety of areas and grateful for the advice we give them on how we can help make their daily lives easier and better.

I generally ask patients to trust me and try it out first.