Today’s blog is written by Stefanie Kruger, private practitioner at Simply Senseable, and SAISI board member, who decided to conduct some of her own research into the loss of “OT-ness” in this year of the pandemic.
Vanilla essence is a delectable scent. It infuses anything it is mixed with, whether it is a milkshake, cookie dough, tea or soap, with that unique vanilla flavour. However, a spoonful on its own is rather bitter. For any young baker, that is often a surprising discovery: the secret of balance on a very concrete level. By adding “just the right amount” (not too much, and not too little) to the other ingredients, one would get the desired flavour. On a more abstract level, the term ‘‘essence” can be defined as the intrinsic nature or indispensable quality of something, especially something abstract, which determines its character. This may be the reason why it is so hard to describe the exact character or essence of hands-on occupational therapy, especially when we have a passion for the Ayres Sensory Integration (ASI®) approach. What is that indispensable, often intangible, quality or abstract “thing” (or probably mixture of things) that we miss when we cannot see our clients in person? It is that special something-ness that is so hard to compensate for over a screen e.g. for those who provide therapeutic support via a telehealth platform as well as those who did not see clients at all during lockdown earlier this year.
Perhaps we can also ask similar questions when it comes to presenting or attending training sessions or webinars over a virtual platform. However, for the purpose of this blog we will focus on hands-on OT intervention with a special interest in ASI®. That could be another topic for another blog 😊
As OT’s with a special interest in ASI®, we are all familiar with concepts such as the art and science of intervention, as well as the requirements according to the Fidelity Measure (Ayres 1972, 2005; Parham et al 2011). It is interesting that about half of the process criteria of the Fidelity Measure pertain to therapy as play and the therapist as a skilled playmate, the promoter of play as well the person responsible for being able to create the just-right challenge and developing a therapeutic alliance (Bundy and Lane 2020). By using this playful approach in intervention, the therapist often infuses imaginative play and creative themes so that the child loses track of time and effort. It allows the child to become engaged in challenging activities that might not otherwise be possible (Schaaf and Smith Roley 2006).
It is evident that play is the essence of childhood, and of ASI® intervention. Play is intrinsically motivating, it relies in on the child’s inner drive, and allows the child to be and feel in control. Play, in the context of intervention, involves a careful balance of freedom of rules and the constraints of reality, with some subtle and unobtrusive structuring and framing by the therapist. Being playful with children and watching them flourish through play with us, is what makes our work so enjoyable, satisfying and effective. Providing structure and support for adaptive responses is one of the key issues for collaboration in activity choice and for the therapist to create that just-right challenge (Bundy and Lane 2020).
What gives an OT-session that unique character, or OT-ness which makes activities in a “real-life” session different than over a screen?
When we think about the idea or concept of an OT-session, and how to use different pieces of equipment, one of the terms that comes to mind is affordances. This implies knowledge of objects, actions, and appropriate object-action interactions. Dr Teresa May Benson mentioned that praxis has to do with our library of motor possibilities: when we make an adaptive response, we put a new book into our library to interact with the rest of the library. She further added that action-semantic fields link with the total experience of a sensory-motor input, and that we encode these books in our library as pictures (generic images) and not just with words. Arnheim (1966) stated that his mind in its “ordinary operations, is a fairly complex picture gallery, not of finished paintings, but of impressionistic notes”. When we think about the characteristics of a cat, we can describe its body parts, diet and perhaps its habits. But what are the action-semantic fields and encoded images, which give a cat, its total experience of cat-ness? We could probably add that our perception is based on our interactions and previous experiences with a cat. (Based on workshops notes presented by Dr Teresa May-Benson 2015: Assessment and intervention for ideation and praxis).
Survey feedback
Thank you to everyone who completed the online questionnaire for this blog. We received 56 responses of which 78.6% presented telehealth sessions this year. It truly was amazing to tap into the wisdom of this crowd in an attempt to capture what the “essence of OT-ness” is from our personal experience. It was even more exciting to find the supporting evidence to support our perceptions with up-to-date literature.
- From your perspective, what did you miss the most by not being able to see your clients face-to-face? (irrespective if you did telehealth sessions or not):
Human connection, personal interaction, touch, being hands-on, sharing in the small joys and successes, subtle support and adaptations within activities, gauging the child’s non-verbal cues, therapeutic relationship, tangibility of working in real-time and space, spontaneity, natural flow of a session (being more flexible e.g. in terms of planning and preparation), being able to control / manage the environment and equipment within.
- In your opinion, the “essence of OT-ness” is a:
Feeling (67.9%)
Physical therapeutic space (50%)
Having a variety of equipment available (44.6%)
Other (28.6%)
Click on the link to open the chart: Chart 1
“Other” included:
Being together in the moment, combination of who we are and what we know, adaptability, balance between art and science, facilitating problem solving as it happens
- Which statements describe the “essence of OT-ness” the best?
The following options were given and the results are indicated in the bar graph below (click on link to open):
- Sharing space (e.g. not necessarily in conversation, but just “being” together or doing something meaningful together)
- In-tune with the client’s needs in the here-and-now (e.g. able to subtly adjust grading quickly in the moment or as needed)
- Intuition (e.g. able to read non-verbal cues and support client’s needs such as emotional and sensory regulation)
- The joy of having fun together
- Dynamic exchange of ideas and trying out different things
- The satisfaction of seeing the client succeed (ability to scaffold, tweak and adjust challenges)
- Empathy for the client (e.g. when something goes wrong or not according to plan)
- The freedom of being creative within a session while still keeping goal-setting in mind
- Spontaneity (e.g. the flow of a conversation, or within activities)
- Types of activities and grading that can be presented by the therapist (e.g. not limited by what parents have at home)
It is indeed fascinating to see that the following items were the top five (5) descriptions of the essence of OT-ness from the 56 responses that were received:
- Intuition (98.2%)
- In-tune with clients’ needs (85.7%)
- Satisfaction of seeing the client succeed (80.4%)
- The freedom of being creative within a session (75%)
- Spontaneity and the flow within the session (62.5%)
- Describe the “essence of OT-ness” in one word, phrase or sentence:
Fun, play, adaptable, collaborative, flow, small moments of joy, engage, connect, synchrony, empowering, meaningful, creative, available to child, intuition with skill, the feeling of sharing space and time, therapeutic use of self.
Finding balance between the art and science of OT – creating a sensational palette
The most effective intervention reflects a partnership between art and science, where the relationship is fluid. Science is explicitly concerned with knowledge and theory, and crucial for clinical reasoning, effective goal-setting and targeted intervention. Science allows us to situate a session in the proper constructs of ASI® theory. Art on the other hand is more intuitive, almost ethereal. Art is fluid, and allows for that “ever-adapting activity required to meet the moment-to-moment needs of a child”. “The artist’s mission may not ever by reduced to words or rationally understood, but its invisible magnetizing presence will infuse an artist’s work completely” (Alex Grey 1998 in Bundy and Lane 2020).
Peloquin (1989) indicated that art is the soul of occupational therapy practice. (Bundy and Lane 2020). Peloquin (2005) further stated that effective practice is artistry and science together “Grains of sand and waves of sea together make seaside. Seaside would not be if one were gone” (Bundy and Lane 2020).
Let us go forth in the ever-evolving future and strive to balance the science and art of OT intervention, so we as therapists, as well as the people we work with, may experience the soul of OT in its totality.
References
Ayres AJ. Sensory integration and learning disorders: Western Psychological Services; 1972.
Ayres AJ, Robbins J. Sensory integration and the child: Understanding hidden sensory challenges: Western Psychological Services; 2005
Bundy, A., and Lane, S.: Sensory integration theory and practice 3rd edition (FA Davis 2020)
May-Benson TA, Blanche E, Schaaf R. A theoretical model of ideation. Understanding the nature of sensory integration with diverse populations. 2001:163-81
Parham, L. Diane, Roley, S. S., May-Benson, T. A., Koomar, J., Brett-Green, B., Burke, J. P., Cohn, E. S., Mailloux, Z., Miller, L. J. and Schaaf, R. C. (2011) Development of a Fidelity Measure for Research on the Effectiveness of the Ayres Sensory Integration Intervention American Journal of Occupational Therapy, 65, 134 – 142
Roley SS, Blanche EI, Schaaf RC. Understanding the nature of sensory integration with diverse populations: Pro-Ed; 2001.
Schaaf RC, Mailloux Z. Clinician’s guide for implementing ayres sensory integration: Promoting participation for children with autism. Bethesda, md.: American occupational therapy association. linda. linneanet. fi/F. 2015.
Schaaf RC, Roley SS. Sensory integration: Applying clinical reasoning to practice with diverse populations: PRO-ED, Incorporated; 2006.