Ugh.. So well.. like so many things in my life, I have incredible intentions and I start out well and then… I run out of puff… Which is entirely what has happened with this blog and why it’s taken me so long to write again. And not because I haven’t had thoughts- I have a notebook full of half written posts and a myriad of thoughts but I haven’t sat down to write them out “officially” and post them on here. It would be a lie to say that I haven’t had time… I have been busy but I really believe that “not having time” is frankly a rubbish excuse; we make time for things that are important. And it’s not that this isn’t important- it is- and it’s not that I don’t want to- I do. The reasons are… well… always complicated. Some of it is a predictable pattern that regularly shows up in my life around starting things- and having extreme difficulty with finishing them! This comes from elements of perfectionism; it’s never perfect, so finishing is hard because it means accepting that. Whereas if I’m still working on it, then it’s unfinished; and that’s why it’s not perfect. And that is much more easy for me to tolerate. Discomfort over unfinished things; than finishing something with flaws and errors. Or I guess finishing something and accepting that it is as good as I can do at the time and putting it out there bravely for critique… Because I have a somewhat deep seated need for external validation; that I’m only worthy if someone likes what I have to say or what I’ve done. So you know… it’s scary to be truly authentic and transparent and vulnerable because what if all 5 people that read this don’t like what I have to say?!
Anyway, there are a myriad of things I can share and explore about myself and not finishing things that I start but that wasn’t really what I wanted to share today. I have had a lovely couple of weeks re-connecting with a former OT colleague and also doing a supervision session with a wonderful OT. I always find that I learn from my supervisees as much as I might share my experiences with them. And one of the things I’ve found myself reflecting on from these conversations has been about Occupational Therapy and our scope of practice. Both of these clinicians are incredibly self aware individuals who know their own strengths and areas for development and they’re both very driven in their own growth and personal and professional development. However, we all struggle in different ways with expectations from clients, referrers and others about what we as OT’s can and will do. Now this is a long standing OT issue; a running joke in a way about no one really knowing what OT does or no one being able to deliver a good definition of OT. I will leave that for another day because I have many thoughts on that!
What I think is challenging is that sometimes our OT scope of practice is really broad and really overwhelming because unlike other health professionals we don’t focus on one particular body area or function or domain (crudely speaking for example, physiotherapy focussing on the physical body, psychology focusing on the mind and emotions, speech therapy focussing on the mouth and speaking/swallowing). As OT’s we focus on occupation (things that someone does) and one of my mantra’s is that when we move our focus from occupation, then we lose our way (again another post for another day!). But the challenge with this focus is that it is broad. Everyone does something and frequently, that something is impacted if you have any kind of health condition or disability. So for an OT, that means that you’re in our scope of practice because we’re the health professional to help you do that something. Except that we don’t define ourselves by that something that we’re good at helping people with. You don’t go an see a “showering OT” for help with showering; we all (in theory) do that! Driver Trained OTs like myself, I guess are one occupation based type of therapists but we cannot, per our registration, say that we specialise in driving. There’s other informal differentiations by areas of practice e.g. paediatric OTs, mental health OTs, hand therapy (which I find a unique distinction by body part). I have a post graduate degree in Clinical Rehabilitation (Neurological Occupational Therapy) but I cannot call myself a Neuro OT. I think the challenge is then that many of us sort of do end up specialising in an area or working in a preferred area of practice; only we do it secretly, almost ashamedly.
In the business world, having a “niche market” is considered a positive business strategy. It means you are specialized and focussed on a particular market with an unmet need and focus your business on meeting that need. It serves to differentiate you from others in the market and prevent falling in to the “jack of all trades, master of none” space where you spread yourself thin helping everyone and anyone and not really being particularly good at it all.
I think the challenge for us as OT’s, particularly when we’re in private practice, is that we can see and feel the reasons for the niche but feel uncertain about pursuing that as we’re not “allowed” to specialise. We can feel like we’re letting clients down when they ask us to do something we have less experience in delivering but we can also feel pressure to deliver services when we have a good relationship with a client. I know when I’m asked to do hand therapy or make a splint (something I can do and indeed I have even worked in hand therapy), but I always joke and say, “Why would you get the Driver OT to do something like that?”. Because whilst I can do this, I would take longer, it would be harder for me to do and it would not be as high quality as something a hand therapist could deliver. But indeed, I did (with help!) whip up a splint for a client this week.
I know I’ve also felt pressured by other therapists that are perhaps more comfortable with extending their scope further to do the same; sometimes because those therapists have believed in me more than I have. I think we can sometimes feel like we shouldn’t restrict our scope of practice; that we want to reserve the right to pursue other areas of practice. I might never have worked in paediatrics but I might still one day; and if I call myself an “adult neurological and driver OT” then would I be cutting myself out of that opportunity? I think we can have pressures within a business perspective to say yes to referrals that aren’t a great fit because we need to financially and we worry our perfect client might never come along. I know we might also find ourself unexpectedly out of scope, when initially we were confident we could meet a clients needs. And then we feel the pressure to see the service through.
So what do we do about this? I cant say I have all the answers but I think some of it comes down to networks and connections to discuss these challenges and feeling OK to move referrals on to someone who is a better fit. I think having supervision and support to have these conversations is also vital; in case we do want to expand, stretch or explore our personal scope of practice further. Or mentoring and support to maintain our boundaries and refine and hone our expertise in a particular area.
And I think… or wonder really… maybe we can have a niche in a business sense, that we’re open and honest about in terms of our experience and preferences, without saying that we specialise in a particular area? I wonder if this is this something we should do?
Or should we stay generalist and try and help everyone? Is there a way to straddle that line carefully whilst remaining true to our profession and true to ourselves?
Anyway, this ended up much much longer than I was intending (also likely to be a trend you’ll notice if you stick around for any more blog posts!) and so I’ll leave it there for now.
Feel free to comment on my Instagram @encourageoccupationaltherapy if you want to share your thoughts!
[Also picture of a mug from Far Kew Emporium who sell these awesome OT definition mugs https://farkewemporium.com/products/occupational-therapist-dictionary-mug]
