Psychotherapeutic occupational therapy

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I was recently invited to take on the role of Psychotherapy Lead for RCOT’s Mental Health Network. This is a new role, but one that is desperately needed to raise the profile of the valuable and unique contribution that occupational therapists can make within the field of Psychotherapy.

Not a new or ‘emerging’ role

OTs have practiced psychotherapy within their scope of practice for over one hundred years – this is not a new or ‘emerging’ role.

Despite this, many people, including other professionals, and some of the main Professional Standards Authority (PSA) regulated counselling and psychotherapy bodies have little or no understanding of what occupational therapists do or how their holistic work can significantly improve overall psychotherapy standards for people. One regulating body even confused occupational therapy with occupational health!

Occupational therapists undertake rigorous university pre-registration training across both mental and physical health domains – including a minimum of one thousand supervised practice-based hours.

Entry-level professional OTs can work across many different spheres of mental health – ranging from acute hospital settings to community-based roles, prisons and so on. This opens the door to the huge potential of specialisation.

Psychotherapy is one such specialisation where OTs can embed their unique holistic skill set to improve the lives of others. However, it is not an entry-level specialisation.

Common psychotherapy modalities used by occupational therapists

There are multiple modalities within psychotherapy which complement an occupational-focused holistic approach.

On top of core training in occupational therapy, many OTs work within psychotherapy, utilising modalities such as: 

• dialectical behaviour therapy (DBT)
• cognitive behavioural therapy (CBT)
• acceptance and commitment therapy (ACT)
• solution focused therapy (SFT)
• eye movement desensitization and reprocessing (EMDR)
• flash technique
• somatic therapy
• transpersonal counselling
• humanistic counselling
• mindfulness
• compassion focussed therapy
• motivational interviewing

and more … This list is not exhaustive by any means!

The solid and holistic nature of occupational therapy allows for a perfect foundation for a later career specialising in psychotherapy with additional training in the modality (or modalities) which complement the OT’s experience, expertise or personal interest.

Unlike OT, most psychotherapists in the United Kingdom work within independent practice. However, more OTs are increasingly moving into the independent sector, especially those who combine counselling and psychotherapy skills; there is huge potential for growth in this area.

However, a well-qualified occupational therapist who is also trained in psychotherapy modalities can really benefit and enhance the lives of patients, service users and clients within statutory practice fields too.

OT can add a truly unique perspective

Mental health rarely affects just one area of someone’s life. People who seek therapy are often in crisis, and it is this crisis which impacts every area of life, including:

• daily routines
• self-care
• self-nurture
• the ability to enjoy the smallest things
• relationships
• work
• previous interests

… and their core identity as a unique and special person, with talents and ability.

Trauma and mental health challenges affect every aspect of a person’s being. No two people are the same, and indeed, no two people respond to traumatic life events in the same way either. Therefore, for therapy to be truly effective and impactful, there should not be a ‘one size fits all’ approach.

This is where occupational therapy can add a truly unique perspective, especially when combined with other psychotherapy modalities, in enabling a person to ‘live a life worth living’.

Regulation

Although occupational therapists hold protected and regulated titles and are deemed both safe and capable to work in mental health settings, psychotherapists in the UK do not hold protected status.

It is unlawful for anyone to use ‘Occupational Therapist’ as a job title or say they practice ‘occupational therapy’ unless they are registered by the Health and Care Professions Council (HCPC). However, as the UK law presently stands, anyone with little or no training can call themselves either a counsellor or a psychotherapist. There is nothing to stop a person with no qualifications from setting up their own training school, or even a governing body.

There is currently much debate about regulating psychotherapy in the UK so that there is wider public protection and transparency.

Interestingly, in some countries where psychotherapy has been regulated and is classed as a controlled act (for example, in several states across Canada), occupational therapists are recognised as one of five core professions with sufficient mental health training who are permitted to practice it. There are also ongoing debates and emerging standards of practice across psychotherapy modalities in terms of additional training, embedding skills into practice and appropriate supervision.

In the UK, occupational therapists are similarly recognised by the British Association for Behavioural and Cognitive Psychotherapies (BABCP) as being one of a select few professionals who hold adequate competency in mental health. With further specified training hours in CBT, OTs are eligible for accreditation as cognitive behavioural psychotherapists. Yet despite this, some of the other UK PSA regulated psychotherapy bodies are unaware of what OT is.

The Psychotherapeutic Occupational Therapist 

However, professional identity matters, and that includes how occupational therapists use their title to reflect their practice within psychotherapy and to promote their service – especially if they work within the independent sector.

It is vital to show the public that OTs hold a protected title, but unless someone has had direct treatment from an OT, or has worked with them, they may not know how their practice relates to psychotherapy.

Taking a lead from countries like Canada, it is important to be transparent in terms of professional titles which accurately reflect practice. For example, Occupational Therapist Practicing Psychotherapy is one of the advised titles to reflect occupational therapists who use the controlled act of psychotherapy – this can be perceived as somewhat lengthy though.

A title which I personally prefer, and indeed use myself as both a qualified Occupational Therapist and Psychotherapist, is Psychotherapeutic Occupational Therapist.

This is a term I derived from an emerging trend of counsellors who have undertaken further psychotherapy modality training using the title of Psychotherapeutic Counsellor. A Psychotherapeutic Occupational Therapist is clearly conveying that they are specialising in psychotherapy and embed it within a more holistic framework, using the protected underpinning skills of Occupational Therapy.

There is still much progress and discussion to be had amongst the wider professional counselling and psychotherapy communities here in the UK. However, occupational therapists need to be part of that dialogue.

Psychotherapeutic Occupational Therapists offer genuine hope

OTs need to promote their unique skill set and be prepared should psychotherapy become a protected act, as in some other countries. Psychotherapeutic Occupational Therapists offer genuine hope to the person when they are at their most vulnerable. It is this hope that can be truly transformative, empowering and life-changing – that in itself is the true nature of occupational therapy.