Occupational therapy helps the disabled, the elderly and the sick not only physically but also mentally. But work-based healing practices can also be applied to everyday life to reduce anxiety and relax the brain.
Many perceive work as a routine duty – without it, you can’t catch a fish from the store, and you can’t put it on the table. And there is the idea of using labor for therapeutic purposes, which is successfully used not only for those who need inpatient treatment, but can also be adapted in order to put themselves in order, relieve anxiety, and “relax the brain”.
This method of treatment and maintenance of quality of life is called occupational therapy. From the name it is easy to guess that this is the use of labor forms of employment for therapeutic purposes. With its help, it is possible to develop, restore or maintain physical and mental activity and productive activity both in individuals and in groups and communities of people.
Occupational therapy is also a profession in the healthcare industry. If autotherapy with the help of some forms of labor to reduce the level of stress or depression can be used by a person even intuitively (someone begins to wash dishes, iron shirts, knit or chop wood), then in the case of rehabilitation after injuries, high professional requirements are imposed on the therapist. Therapists in this field often work with people who have mental health problems or developmental disabilities, people with congenital or acquired disabilities, or various injuries, both physical and psychological.
Occupational therapy may include helping children with disabilities adjust to school and social situations. For adults and children, occupational therapy can be helpful in rehabilitating from injuries. It can provide support to older adults experiencing physical and cognitive changes.
Occupational therapists often work closely with professionals in physical therapy, speech and language pathology, audiology, nursing, social work, psychology, medicine, and assistive technology.
Angelica Jolly, psychologist: “Occupational therapy is the use of activities adapted for patients in the rehabilitation process. Occupational therapy has a wide range of applications, it can be used both for teaching self-care, assistance in socialization, and in order to develop real work skills with the prospect of subsequent employment.
In the process of occupational therapy, the patient is selected a load that is suitable specifically for his situation, so that the activity is proportionate and can bring not only development, but also satisfaction from the process. Occupational therapy works only on a voluntary basis, any pressure or coercion can backfire and worsen the condition, as well as cause additional symptoms to the existing ones. The most important thing is the motivation of the patient himself.
How did the idea come about
Examples of the use of employment for therapeutic purposes can be found in late Hellenism. Greek physician Asklepiades at the turn of the XNUMXnd and XNUMXst centuries BC. e. used therapeutic baths, massage, music and exercises to treat mentally ill patients. Similar methods were used by the Greek physician of the XNUMXnd century Celsus. But with the decline of ancient civilization, the relatively humane treatment of the mentally ill has sunk into oblivion and was limited, at best, to their cruel isolation.
The reform of psychiatry in 18th century Europe laid the foundation for the further development of occupational therapy – Philippe Pinel and Johann Christian Reil stopped using chains and other severe restrictions in their medical institutions. Instead, in the late 18th century, they began to enforce strict work and rest schedules. This was the era of “moral treatment”, corresponding to the spirit of the European Enlightenment. These reforms of psychiatry laid the foundation for occupational therapy. The movement flourished in Europe, but interest in the United States fluctuated throughout the 19th century. In our country, supporters of the widespread introduction of occupational therapy were the life physician under Empress Maria Feodorovna (mother of Alexander I and Nicholas I) Ivan Ryul, psychiatrist, neuropathologist and reformer of the system of keeping psychiatric patients in Moscow hospitals Vasily Sabler, psychiatrist, organizer of the psychiatric patronage system Nikolai Bazhenov and psychiatrist Petr Kashchenko.
The development of occupational therapy was influenced by the Arts and Crafts movement of 1880-1910. Its participants followed the ideas of the art theorist and artist John Ruskin and the English writer, artist and designer, the founder of the movement William Morris about the superiority of manual labor over machine. In the United States, which was then in a stage of rapid industrialization, similar societies opposed the monotony of factory labor and the loss of autonomy due to its mechanization and standardization. In applying these ideas to therapy, followers of the movement believed that learning the craft and arts through action avoided the boredom of long hospital stays and provided a creative outlet.
Eleanor Clark Slagle (1870–1942) is considered the founder of occupational therapy. Her ideas were based on the belief that participation in meaningful routine activities creates a person’s well-being. An attentive reader of the literature of that time can see how such ideas shape the moral and ethical image of the older generation in such classic works of North American literature as “The Adventures of Tom Sawyer” and “The Adventures of Huckleberry Finn” by Mark Twain and Lucy Maud Montgomery’s series of novels about Anne Shirley – “Anne from Green Gables. Slagle has proposed work skills training as the main model for occupational therapy. The training was aimed at creating structure and order in time and achieving the best balance between work, rest and leisure. Her model of occupational therapy was focused on the treatment of people with mental disorders, but the potential of the core principles seemed to expand its application to a wider audience.
The first occupational therapy training program was started by Eleanor Slagle in 1915 in Chicago. In the United States, the E. K. Slagle Lecture Award is presented annually. It is awarded to that member of the Association of Occupational Therapists “who has made a creative contribution to the development of the body of professional knowledge through research, education or clinical practice.”
In the Soviet Union, where occupational therapy corresponded to the basic idea of Marxism-Leninism, therapeutic labor workshops were opened in psychiatric hospitals. Their goal was precisely treatment through the process of occupational therapy. However, researchers note that in Soviet psychiatry there were a number of shortcomings associated with the use of occupational therapy in practice. In particular, in the medical and labor workshops there was a very limited set of activities, all of them were monotonous and routine (for example, in the Oryol Special Psychiatric Hospital of the USSR Ministry of Internal Affairs, occupational therapy consisted of weaving nets-avosek or potato sacks). This ruled out the possibility of the progressive development of the patient’s skills and the implementation of a phased rehabilitation through employment.
Victims of Soviet punitive psychiatry left memoirs in which far from the most flattering characterization of occupational therapy in medical and labor workshops is given: there was a violation of sanitary standards, the violent nature of therapy, exceeding the permissible load standards to obtain economic benefits from the work of patients and the inadmissibility of refusing such “therapy” .
With the development of the dispensary system, it became possible to slightly reduce the dependence of psychiatric care on hospitals and transfer some patients to outpatient treatment, which could use a wider range of work for rehabilitation. However, it was not possible to significantly expand the list of activities and thus individualize the approach to the treatment of each patient.
With the collapse of the USSR and the accompanying systemic crisis, almost all such workshops were closed and the point existence of medical and labor workshops was supported solely by the enthusiasm of doctors and social workers.
How it works
There are many variations of the occupational therapy process, which vary by school, country, and tradition. However, in general, they all contain in one form or another three basic components: an assessment by a specialist of the current state of affairs to determine the strategy and tactics of future therapy, the actual process of intervention (therapy) and evaluation of results. Such a relatively unified approach allows for the continuity and consistency of therapy among different specialists.
The structure of occupational therapy practice consists of two parts: domain and process. The domain is the environment, factors of the patient himself, such as motivation, state of health, status of performing professional tasks. This is the context that helps to understand how to diagnose and treat a patient. The process is the actions taken by the therapist, his strategy and tactics.
One of the most important elements is to identify the strengths and resources of both the patient and the therapist to develop a treatment plan.
Angelica Jolie: “Occupational therapy is used in a variety of situations. For example, with addictive behavior, it helps to switch attention from the object of dependence. It is also used in working with children with developmental disabilities, for whom it is important to learn to independently perform feasible daily activities.
The mechanism of work of occupational therapy is to gain greater independence, independence and additional support in life, which makes it possible to feel control over one’s life and take responsibility, which has a beneficial effect on all mental processes in general.
Unlike the usual work activity, where the goal can be a financial component, occupational therapy can only be considered the load that benefits the mental state of a person and contributes to its development. Activities must be carefully planned in such a way as to avoid overstrain, stress and burnout.
Why this is necessary
Occupational therapy helps maintain independence and activity in the elderly. Regular employment provides an opportunity to continue to participate in society and lead an active lifestyle. For example, occupational therapist assessments are used to determine the degree of safety when driving a car. In the event that the patient has already begun to undergo some age-related changes, the professional can choose what measures will help preserve driving skills, reactions, motor skills and, therefore, protect both the elderly driver and pedestrians.
In addition to maintaining life skills in good shape, people with low vision turn to occupational therapy, it can help with senile dementia and Alzheimer’s disease.
Occupational therapists can also help assess the safety of older adults by their ability to do household chores and get around. Their purview includes recommendations for specific modifications to the home to suit the patient’s condition. The use of employment for therapeutic purposes can combat depression in older people.
In rehabilitation, occupational therapy can be useful for people with low vision – and this already applies not only to the elderly, but also to those who have lost their sight as a result of an injury or in connection with professional activities. In addition, rehabilitation through therapeutic employment is applied to people with various physical and mental disorders and injuries. This may include working with children and adults with autism spectrum disorders to increase their socialization and independence. Occupational therapy has been successfully used for people with cancer in order to reduce anxiety and stress levels and avoid depressive states. In addition, cancer survivors are more likely to develop comorbid chronic diseases, so occupational therapy helps them improve their quality of life while maintaining and rehabilitating skills that are useful in everyday life.
An important role is played by training in the use of one hand due to amputation or loss of a limb, or training in the use of a prosthesis or myoelectrically controlled limb.
Angelica Jolie: “Occupational therapy ideas are often incorporated into psychotherapeutic techniques for working with depressed people. Since depressive states are characterized by a decrease in volitional activity, and difficult cases seem overwhelming, the treatment includes the principle that one complex and difficult task is divided into several simple and easy ones so that they can be completed. This helps a person to distribute the load evenly and more often to bring the matter to the end, which has a good effect on self-esteem.
Also, given the tendency of people who are depressed to think negatively and lose interest in any activity, the therapeutic process includes the search for activities that bring pleasure. As a homework assignment, a depressed client might be asked to make a list of 10 easy, pleasant things to do each day of the week that the client thinks they should enjoy. After completion, you can discuss the results and feelings with the patient and evaluate in points the degree of satisfaction received. This task helps to shift the focus of attention from a negative perception of the world to a positive one, find a resource and maintain or even gradually increase vital activity.
You can independently use light monotonous tasks to relieve anxiety, for example, various types of needlework, housework, and gardening in the summer. Such activities help to switch from obsessive thoughts to a positive way and emotionally relax from experiences.