Intentional Space.

Intentional Space.

"I play the notes no better than many, but the pauses...ah, that makes all the difference."
-Arthur Rubinstein, pianist, when asked what makes his music sound incredible.

When was the last time you sat (or stood) with a patient, in silence, even if for a few seconds? When was the last time you took to your computer to document, and paused to bring full attention to recall the session?  When was the last time you felt refreshed for the next patient? When was the last time you reduced the noise, and heard yourself think?

As therapists we are all used to treating our patients without much space.  In school-based therapy, we see kids in hallways, small corner offices, alongside fellow special educators, or in the gyms when not in use.  In rehab settings, we find ourselves sharing the gym space, the bathrooms, and the hallways.  In skilled nursing facilities, we see patients in group settings, or in the shared space of our patient's room with the roommate present.  We see our patients alongside our colleagues, and we write our documentation on shared computers or in shared office spaces, with limited time and space.  We are surrounded by distracting conversations, noises, and sights.

I'm exhausted by enumerating the above. What I want to know, in this busy time, is how can we enter our days, our work environments, and our therapeutic relationships with some space? 

We can set an intention to allow the space to find us.   We can take a purposeful pause (as Janice Marturano writes in her book, Finding the Space to Lead).  Pausing can happen in silence, a breath, listening without interruption, and reflecting.

Occupational therapy is about empowering engagement, promoting participation, and providing presence.  Take time today to ponder the space which allows you to practice.  Honor the mental and physical spaces which bring you clarity toward a refreshed version of you, and a renewed relationship with your patients.  The pauses will make all the difference.

Tune In.

Tune In.

“Why does everything have to be scientific with you?” my nine-year-old patient Owen* asks.  In the middle of an occupational therapy session, Owen, who always challenges me at the end of my 10-hour Wednesdays with his unending energy, poses this question. I had just given him the scientifically-supported data as to why core-strengthening exercises were going to help him.  “We are strengthening your core so that your erector spinae muscles, your abdominal wall, and your postural endurance all work together to sit upright for longer periods of time, so that you may attend more easily in school/  This will help you navigate your day without as much fatigue and provide you with the stability for challenges to balance.”

I can tell you right now, though I am a mid-30s-year-old woman with 8 years of practice in pediatrics, I answered the question defensively and with some statement like, “It’s the only way I can prove to you they are important, because otherwise you won’t do them.”  Mind you, Owen’s verbal wit is lightning speed, and my processing speed alone is that of a dial-up internet connection from the 1990s.  That was all I could come up with in my fumbling to satisfy him.  I would take to writing this blog post to provide him (really myself) with a better answer.

Why does everything have to be scientific, Miss Emily?

I’m a doctoral candidate at Tufts University in the Department of Occupational Therapy.  I study the research literature all the time. I thrive on finding practices that are supported by the evidence.  It excites me to see trends in the research which support the modalities of therapy I find useful, attractive and effective.  I speak with colleagues about the new advances in scientific thinking in our profession.  My training in my doctoral work challenges me to “go to the literature” to provide justification for my research process, especially if I am hoping to fill a gap in my field. 

As I stewed on Owen’s comment while running a few days later, it hit me. Our greatest teachers are our patients.  We are reminded by our patients, continually, that as much as we can read a text book, search the empirical literature, or apply the science, the art of therapy is just as important.  In the present moments, being attuned to the flow and transformative process of the therapeutic relationship, coupled with what is felt, is all the evidence we need.  Jon Kabat-Zinn instructs us in his foreward in The Art and Science of Mindfulness: Integrating Mindfulness into Psychology and the Helping Professions (Shapiro & Carlson, 2009) to always remember that our patients know much more about what is going on with them, even if they can’t put it into clarified thoughts or they ask us to explain why.  Our patients and clients are answering a call to provide the energy to put forth intention, awareness and focus toward their goals and health outcomes.

It isn’t always science Owen, it, too, is art. 

If I am mostly certain of the science that supports my therapeutic modalities, how can I put it aside in the moment, and provide a fully-engaged heart and mind within my therapeutic relationships?  As I practice mindful occupational therapy, I can embrace myself with loving kindness and presence within my therapeutic relationships.  In turn, I may embody compassion, unconditional positive regard, and help precipitate my patients’ motivation toward goal achievement. 

Perhaps Owen was asking me, though willing to follow my instruction, because he wasn’t interested in the exercises.  Perhaps Owen was asking me because he was curious about my reasons for any of our activities. Or perhaps, Owen asked because he was on to something.  His question served as the reminder therapy is also an art.  We are all students, attached to our own learning experiences, adjusting our self-attunement.  I am learning how to be a therapist- in practice, in theory, and in the supporting science.  As I reflected on Owen’s comment, I had the opportunity to think- maybe I’m a humble student in the art?

Therapy is also the spontaneous, felt experiences.  My years of practice allow me to tune in, and respond with humor, openness, curiosity, compassion, and attunement to my patients.  Wherever Owen finds himself in the therapy process, I meet him there.  It is my call to sponsor his growth, fully present to his distinct client factors, occupational goals and possibilities for growth.  Whatever therapeutic modalities used, it is no matter.  Owen’s experience in the moment, and my joining him in a therapeutic alliance, allow us together to flow.  We create, through a dance of trust, imagination, and skill, the art of our therapeutic relationship.   

*Names changed.

Take a Breath

Take a Breath

When you are embarking on a journey, to set your intention and sustain your focus, take a deep breath.

Over two years ago, I started the path of post-graduate education at Tufts.  At that time, I was working two jobs as an occupational therapist, training for road races, going to night class, attending networking events, seeing friends and traveling to visit family.  I was essentially living out of my car, barely spending time at my home to rest, recover and reflect.  I was emotionally drained by my clinical work as a practitioner, physically exhausted by my exercise, and spiritually depleted by my multiple, time-consuming commitments.  My class was an exploration of pursuing the non-profit sector as an entrepreneurially-minded occupational therapist (OT).  It was informative, a lot of new learning, and yet I felt my direction was lacking focus.

With the help of my career mentor, I decided to apply at Tufts to the doctoral program in the Department of Occupational Therapy.  I was accepted and entered head-on, determined to concentrate my project on burnout and compassion fatigue in OTs.  I was supervising students at work, taking classes, still running road races and training for marathons, seeing friends and family, trying to stay "cultured" in the arts, and meeting life's daily demands.  Though I now felt direction, something was nagging at me in the back of my mind.  

It was that little voice that tells you to slow down when you are suddenly aware you are rushing, but don't know why, or driving too fast, but you know you have plenty of time. The little voice that I tell my pediatric patients all the time said, slow down and take a deep breath.

 

If I am training to refine my expertise as a leader in the field of occupational therapy, how do I embrace its values if I am running right past the scenery on the trail?  If I want to lead my patients, peers and the greater good to employ the practice of present participation in life's meaningful moments, aren't I supposed to embody the leadership skills and know-how?  Why do we often intend to set an intention, meeting objectives and obligations, without stopping to take it all in, to take a deep breath?

I inhaled a big breath, feeling my body expand.  My mind opened up to space.  I exhaled.  I took 10 more minutes of slow, deliberate breaths. I allowed my body, mind, and spirit to let go.  I felt myself reconnecting with my intention, the air supplying my alive-ness.    

My hope is to remain connected to my intention, and to practice the present with my work and education.  To do so, and make life meaningful in return, I will forever remain a "humble student of our own experience.", as Jon Kabat-Zinn writes in his foreward in the The Art and Science of Mindfulness: Integrating Mindfulness into Psychology and the Helping Professions by Shauna L. Shapiro and Linda E. Carlson.  

I am awakened to the mindfulness stream alongside my educational trail.  I am in the middle of my journey toward finishing my doctoral education.  I will always be on the path toward embodying and cultivating the art of being present, as a mindful OT, as a way of being.   

Breathe.