“Let’s Get Real”

Man through the use of his hands as they are energized by mind and will, can influence the state of his own health. (Mary Reilly, 1962

I doubt that there is an OT or OTA program in the United States that doesn’t feature this wonderful quote. In fact, it’s so commonly referenced that I wonder how often we actually stop to consider its full meaning.

This year I’ve been reading books and articles about what it means for human beings to make and repair objects by hand. These are first-person reflections by craftsmen and mechanics. They have moved me to think deeply about the differences between doing things that directly affect and are affected by our physical world, vs. doing things that are digitalized or merely cognitive. Doing things that produce a tangible product that the doer and others can see, hold, use and appreciate.

As we are often reminded, occupational therapy was invented to help heal patients who were psychiatrically ill due to the traumas of war. Occupational therapy originally involved making, tending and growing things. To become an occupational therapist required proficiency in teaching patients to engage in activities such as woodworking, weaving, sewing, crocheting, leatherwork, metal tooling, ceramics, and painting. Cooking, gardening, and caring for farm animals were also considered to be therapeutic media when guided by a trained occupational therapy practitioner.

When those early patients came to their OT sessions, they expected to use their hands to create a tangible product that made sense to them and others. Something of common value that they could use or give to another. By doing so, the patients would re-engage with the world they had by necessity left behind, in order to participate in fighting the war. This would help them to once more feel safe, competent and whole. It would bring them home in an emotional sense.

In my own practice, I have facilitated “making things” with many clients across the life span and with an array of diagnoses. I can say with conviction that the very act of creating a product had a uniquely powerful therapeutic effect on the vast majority who tried it.

Quick story: Jim was a 17-year-old student at Giant Steps, a school for children with severe behavioral and autism spectrum disorders. Jim had been a GS student for many years when I started there, and he had utilized their wonderful sensory integration spaces during those years. During our time together he came willingly to OT, but was difficult to engage. He wandered the room quite a bit, stayed with activities very briefly, and sometimes stepped out the door without permission.

So I started trying different things. Like assembling and cooking grilled cheese sandwiches in a electric skillet. And using a powered screwdriver to put screws into a board (which we later used for string art). But the therapeutic masterpiece was his sanding, painting and decorating a rusty metal plant stand that I had rescued from my neighbor’s trash.

Jim worked diligently on this project, and accepted guidance and teaching well. There was no wandering the room or ducking out the door. While Jim’s face remained passive throughout our sessions, his purposeful manner of coming into the OT room, locating his materials, and focusing his attention and actions for the entire hour spoke volumes. Jim was engaged in a way that was new and compelling.

Here’s the cherry on top: once the project was completed, I asked Jim if he’d like to donate the plant stand for the upcoming fundraiser for our school. (I’d mentioned this idea when we started the project, too.) He shook his head, picked up the plant stand and left the room. He walked down the corridor, carrying it around the school to hold out to others, receiving many compliments. He took it home that afternoon.

I like to imagine that colorful plant stand gracing Jim’s family home, and that every time he or his mom sees it, they enjoy knowing that he has the ability to make things that are beautiful and useful.

Based on the OT literature from the U.S. and conversations with many colleagues, I am concerned that making things in OT seems to have been largely abandoned. Although our OT leaders speak and write eloquently about the need to get back to an occupational focus if we are to demonstrate our distinct value, such seems to be missing from many practice settings.

One way is to inch our way back to the kind of “occupations as ends and means” (Julie McGlaughlin Gray, AJOT,1998) that we say we want is to routinely add in at least one therapeutic activity that results in a tangible product to your repertoire, and see what happens. Facilitate your clients’ making a snack, useful device, or small gift. Learn if they already have a “making” hobby and facilitate their opportunity to do it while in care.

My passion for this idea is so strong that I am going to write more posts on the topic. I’ll share some of what I’ve learned from my readings, as well as ideas for how “getting real” can translate into your sessions.