Sensory Diets: Explained

We pediatric OTs sure love big words and jargon. Hey, you can’t blame us. We need to sound fancy every once and awhile, especially since we are typically covered in shaving cream and glitter for the majority of our work day. One of our favorite phrases has to be “sensory diet,” a term created by Patricia Wilbarger, an OT who has made significant contributions to the field of sensory integration.

What is a sensory diet?

My husband has been married into the peds OT life for the better part of a decade. At this point, he pretty much gets it. But when I asked him what came to mind when I said “sensory diet,” he shrugged and said, “An apple wearing headphones?” Sigh… (But also, thanks to him for the title image for this post.)

A sensory diet is a set of activities tailored to meet the specific sensory processing needs of your child throughout their day. Or, even more simply – it’s a home exercise program for children with sensory processing difficulties.

Using the term “diet” in the phrase makes it sound a little more complicated than it actually is, but I think it allows for a good analogy to a food diet. I mean, you can’t avoid eating food; you need it to live. However, some foods are better for your well-being than others. Maybe you avoid dairy for the sake of your gut, or eat sugar in moderation so you won’t crash a few hours later.

Using that same frame of reference, if you live in the world with the rest of us, you likely can’t avoid sensory input (touch, smell, taste, etc…). However, some types of input might be better for your well-being than others. For example, unexpected touch might cause you to become over-stimulated or jumpy, while repetitive movement or sound may cause you to become under-stimulated or zoned out.

Therefore, just like a nutritionist might assist someone in choosing the right foods for their body, an occupational therapist can assist a parent in choosing the right sensory activities for their child.

How exactly does a sensory diet help? 

It is important to note that a lot of children with sensory processing difficulties have huge peaks and valleys in their arousal levels on any given day. Over-excited and over-tired are not favorable places for their nervous systems to hang out. By engaging in regulating sensory activities throughout their day, or avoiding activities which send them into a dysregulated state, the child is better able to adapt to challenges and be more successful in their daily occupations.

Think about your own life – do you sit completely still in a meeting that has gone way too long? Or do you swing back in forth in your chair, bounce your leg up and down, or click your pen incessantly? Whatever you choose to keep yourself from dozing off in that super important meeting is your attempt at regulating your arousal level. Children simply don’t have as many choices or control in their little worlds as we adults do.

So instead of pen clicking, little Johnny might be climbing to the top of his bunk bed and free falling into a laundry pile. He needs a sensory diet of activities that provide the type of input his nervous system is seeking to become regulated, but in a much safer and structured way. That way, you might not have to discover a daredevil show staged in your child’s bedroom on a regular basis.

So what does it look like?

The interesting thing is that a sensory diet looks different to every therapist. It’s the beautiful and sometimes frustrating part of sensory integration theory in practice – everyone seems to have a slightly different interpretation.

I’ve seen detailed, hour by hour directions that look something like this:

8AM – 3 somersaults, 10 jumping jacks, 10 wall push-ups
9AM – Spin 10 times, crab walk, etc…

I’ve also seen general themes to guide the day, which may be as simple as a conversation with your therapist:

“He seems to do much better if you can do heavy work activities before you leave the house, and maybe incorporate messy play whenever you can…”

I dare say that one isn’t necessarily better than the other; more than anything, it has to do with what works for the family and parenting style. Some people are intimidated by long laundry lists of “things to do,” while others thrive on the structure. OTs should always be tailoring our treatment to the family we are working with.

There are programs such as The Alert Program: How Does Your Engine Run and Zones of Regulation which are designed to develop sensory diets and promote self-regulation in a progressive, structured way. My favorite part of programs like these is the fact that they give children and parents mutual vocabulary to talk about how a child is feeling in a given situation. Having a line of communication with your child about their sensory processing can be life changing.

Some therapists will also use specific protocols to develop sensory diet programs for children, using things like (get ready for some serious jargon right here…): Astronaut Training, Therapeutic Listening, Wilbarger brushing protocols, reflex integration, Bal-A-Vis-X, Brain Gym activities, I could go on… It depends on their training, their experiences, and their assessment of your child.

If you feel like you aren’t getting enough direction in your sensory diet, just straight up ask your therapist what you should be doing at home. Even if no one uses the term “sensory diet,” you can be collaborating on home program ideas which will assist your child in maintaining their optimal state of arousal.

What’s the end result?

Having a sensory diet allows you to better understand what your child needs in order to stay regulated throughout their day. It might even change your entire perspective on why your child is acting the way they are in certain difficult moments- Do they need more movement? Less auditory input? When you are able to become their sensory “detective,” life becomes much easier for everyone.

A rewarding scenario can be when a parent comes to a session and says something like, “I noticed he was getting restless in the grocery checkout line, and I did some joint compressions/offered him a fidget/let him push the cart, and he calmed right down.” This is such a better outcome than missing the signs, having the child become overstimulated, and going into total meltdown mode. That’s no fun for anyone.

Also, as your child engages in appropriate activities through their sensory diets, their bodies learn what “regulated” feels like, and hopefully they can gain a little more control over how they feel, and ultimately more independence in self-regulation.

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In Appreciation of Home Health Therapists

Clinics. Hospitals. Schools. People’s homes.

One of these things is most definitely not like the others. As therapists, many of us have treated in one or maybe even all of these locations. But the special ones, the ones that I admire wholeheartedly, they treat in people’s homes every single day. I can say this in complete admiration because I’ve done it on two separate occasions. After the first time, I told my husband he had to remind me never to do it again.

And then I waved off his concerns and signed up again anyway.

But for real this time; never again. Because I am not a home health therapist.

At this point in my career, I am comfortable figuring this out about myself. There is a particular type of therapist suited for this job. When I was out there wandering the back roads, driving in areas my GPS swore had no real roads whatsoever, I ran into these amazing people. (And of course the handful of new graduates who didn’t know what they were getting into…and expected it to be way different…and were kind of freaking out…and wow, there really isn’t any supervision or anything, is there?)

Besides, home health isn’t just a job, it’s an entire lifestyle. In your honor, home health therapists, here are a few things you can handle, that I clearly can’t.

-Oh, you wanted to grab groceries while you were out and about? Too bad, your trunk is full of toys. And equipment. And a dried up pack of baby wipes…

-Yes, you have the ultimate schedule flexibility, in theory. But traffic and distance exist, and both of those totally get in the way. I’m sure you’ve spent plenty of time on Google maps plotting the most efficient routes between houses, all while attempting to avoid nap times and other therapists’ visits. It’s a complicated algorithm.

-You usually get paid per visit, and your hustle can yield positive results. But weirdly, going into people’s homes doesn’t always equal high productivity. People can hide in the shadows when you come knocking (no, just me?), they can fall asleep at weird times, get evicted without notice, or just aren’t there.

-Speaking of schedules, you are able to run on some weird alternate time schedule that would make a clinic therapist’s head spin. Appointments around 8:20, 11:47, and 1:52? Sure, why not!

-You assess fast food restaurants by saying, “Oh, they have nice bathrooms.”

-You tolerate crazy temperature changes that impact your tools of the trade. There’s nothing more disappointing than a melted wad of crayons, or bubbles that refuse to work when partially frozen.

-You know how to kill time in a Target if a patient cancels while far away from your own home. (If you are lucky enough to have an actual Target nearby.) Although don’t you think people are starting to assume you are stealing things based on the amount of times you enter a store and don’t buy anything?

-You venture into places you might never have gone before, under the guise that you are invincible wearing scrubs or carrying a bag of toys.

-You are somehow able to do therapy with a dog, a cat, or a sibling on your lap. All of which are attempting to sneak off with whatever you decided to bring with you that day.

-You are literally the coolest, most popular person in any daycare. (To the kids, of course, the workers are sometimes another story.)

-You’ve seen things that truly open your eyes to the way people live. From infestations of bugs and filth to impeccably clean spaces. Either way, you try not to touch too much. Besides, your blanket that you carry with you is a safe space, a clean space, and the only space you’d like to stay.

-You’re up to date on daytime television, or have been given the stink eye upon offering the suggestion to turn the TV off.

-You’ve been ushered into a back room quickly upon entering a home, or quarantined to the front room. There seems to be no in between.

-You are comfortable providing therapy on someone else’s turf. It’s like playing against a team that has home field advantage. So that moment when the child runs out of your designated play space – how far do you venture after them?

-The smells. Oh the smells. While the gesture is very sweet, I’m impressed if you have tried whatever is offered from the kitchen. And I’ve been floored by the number of people that still smoke heavily in their homes.

-You manage to carry a scooter board, 3 bean bags, a therapy ball, and a bolster under one arm, no problem.

-If you leave a home with the same amount of items you came in with, you are a miracle worker.

Going into someone else’s space is not an easy task, especially when you are there to teach families and give advice on how to change their ways for the better. But this job is so important, especially in early intervention, as you have one of the greatest opportunities to make a difference in a child’s life. Also, the fact that you go into someone’s home offers the opportunity for beautiful and strong relationships with the families you work with.

So cheers to you, home health therapists. May your gas tanks always be full, your bathrooms clean, and your drinks the appropriate temperature in your Yeti mug.

 

Posted in Lessons Learned, Occupational Therapy | Tagged , , , , , | 5 Comments

Frozen Water Beads

Oh Pinterest, what did we do before you? Inspiration. Treatment Ideas. Pretty pictures of delicious meals I’ll never, ever make… Ok, ok, back to business. If you want to take a look at past Pinterest pins I’ve tested in therapy, click here.

This week I stumbled upon a new sensory idea over at the Busy Toddler Blog: Frozen Water Beads.

Let’s face it, I’ve made every slime, putty, and dough mixture out there. In search of something new and exciting, this seemed like an easy way to add a different spin to the proven popularity of water beads.

The idea is beyond simple. In fact, here’s the directions:

1. Freeze water beads.

Yep. That’s it. How could you mess that up? Oh, funny you should ask. Remember, I’m here to make the mistakes so you don’t have to. Learn from my tragedies, everyone!

For example: Don’t freeze the water beads inside a water bottle. Bad idea. Oh, and don’t leave it to freeze overnight. Super bad idea.

I managed to create a solid brick of water beads trapped by the unforgiving and ridiculously small opening of a water bottle. When they finally emerged, I was greeted by what I can safely describe as water bead sludge. (It sort of resembled the blue goo that comes in a reusable ice pack.)

But hey, I’m an OT, I would never scoff at the opportunity to play with sludge. Talk about mixed, inconsistent texture experiences! Oh, and it’s cold!

Here are the results of the first round of poor water bead torture:

For the second round, I was able to freeze the water beads in a wider jar, and only for an hour or so. They came out in a much more usable/recognizable state:

So how did it go in therapy? It was a big hit! I’m a fan of incorporating temperature changes in order to impact the type of input the child is receiving. I also say it’s a more challenging tactile experience overall due to the fact that the beads don’t hold their shape as well and crumple a bit more than when they aren’t frozen. This causes a more unpredictable mixed consistency when the children are playing.

The water beads also seemed to be even more fun to squish when frozen, which allowed the children to work on pinch and finger isolation. Their little hands were eager to work hard to excavate the beads from the ice chunks, which was a great way to work on dexterity and strength. We also used the beads to hide pegs or pony beads for the children to fish out, and practiced scooping and using utensils to fill smaller containers.

Plus, BONUS, the water beads don’t seem to bounce around the entire room quite as uncontrollably when in this state! (I’ve experienced my fair share of water bead explosion regret…) Overall, a fun activity that can incorporate many different therapy goals.

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Development of Visual Perceptual Skills: Visual Closure

Visual closure is a sub-test on the Test of Visual Perceptual Skills (TVPS) that children tend have a lot of trouble with. As described in my previous post about Visual Perceptual Skills: Real Life Applications, visual closure is a skill that allows a child to see part of a word, shape, or picture, and fill the rest in their head.

First of all, think of how important this skill is for spelling, writing, reading, etc. Actually no, strike that. First think about how difficult this skill is. In fact, if you look at work by Warren (1993), she sees the whole concept of visual processing as a hierarchy, and way up at the top of her model is where you’ll find visual cognition – the skills that we are typically assessing in our evaluations.

So what does that mean? Well, to me, it means hold up for just a moment. If you are scouring the internet for activities related to a specific area of visual perception that a child has a deficit in (i.e. figure ground, visual spatial, visual memory, etc.), don’t just assume that you can throw these activities at them and see all of their functional skills improve. That’s a recipe for splinter skills. (When you can do a very specific task, but it doesn’t generalize beyond that specific task.)

You first need to look deeper into the foundation skills that sit underneath visual perception. Things like acuity, oculomotor control, postural control, attention… and so on. You can’t expect a child to improve their visual perceptual skills when they can’t even sit upright to look at the paper, or can’t dissociate their eye movements from their head, or can’t attend to a visual stimulus for more than a few seconds. You can’t run before you can walk, you shouldn’t put your cart before the horse, and, you know, all of those other helpful sayings that might apply here. This is really true with anything we do in therapy, building the foundation first, but more and more often I see this getting lost when dealing with visual perception.

Ok then, allow me to get off of my foundation skill soap box. Let’s assume you’ve done all of that ground work, maybe made a referral to an optometrist, covered all of your bases, and are truly ready to challenge certain aspects of visual perception. Here are a few ways I’ve seen and used to work on visual closure:

Grid designs: This is a very simplistic way to get started with visual closure skills. Using two grids, the child copies a design from one grid to another. Grade the challenge up or down by changing the number of dots you use, how close the grids are to one another, or maybe even incorporate vestibular/oculomotor work input by placing the model behind or to the side of the child so they have to turn their head or move their eyes in order to complete the task.

As you continue to increase the challenge, you can slowly fade away grid points so the child has to do more work to accurately complete the shape.

This can also be done with more functional designs such as letters or pre-writing shapes.

While on the note of visual closure and forming letters, I want to bring your attention to a commonly used prompt for children. How many letter worksheets do you see with the dots like the picture below? Think of what you are asking the child to do – it falls into the realm of visual closure in order to accurately trace the dot letter. For children that have trouble with this skill, it might not be an effective way to practice and remember letters. If the child isn’t having success remembering letter formations using the dot technique, I’d start with a highlighter for tracing as a way to grade the activity down for more initial success.

Dot to dots: Along the same lines as grid designs, but way less official or potentially intimidating, you can find dot to dot activities in many commercial children’s activity or coloring books.

Stencils: Stencil sets allow you to create an outline of something, and then add on details. The child could trace an animal or a shape, and then add details in order to complete the image.

What number/shape/word is this?: Only showing a portion of a picture or a word. You can do this by writing a word on the marker board, then wiping away a portion of it, or you can cut out a card stock grid that only shows a portion at a time. The best part about doing this on a dry erase marker board is that you can grade how much of the shape or image you choose to wipe away depending on the success of the child.

Finish the picture: Giving the child half of a picture; “pic-art” style would be easiest, as shown below, and a full detailed magazine picture would be the most challenging. Another idea I’ve enjoyed is to start a picture that looks like one thing, but then the child has to change it into something else.

 

For even more simplicity, you could cover up part of an illustration in an book you are reading together, and see if the child can guess what the whole image is.

A lot of these activities are fairly easy to incorporate into home practice after they are introduced in a session. As with any home program, your therapist should be able to help you find an appropriate starting point for the child, and then grade the activities up as needed.

P.S. Yes, I know there are many apps out there that promote these kinds of skills as well, but I’m going to be that crotchety old therapist that wants to avoid adding any more screen time for a child than they are already getting.

Warren, M (1993), A Hierarchical Model for Evaluation and Treatment of Visual Perceptual Dysfunction in Adult Acquired Brain Injury, Part 1. The American Journal of Occupational Therapy, 47 (1), 42-54.
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Therapy Students in the Clinic: A Realistic Look

As students are finishing up their final rotations of graduate school and preparing to take their national board exams (AKA a scary, intimidating test that determines if they can actually do what they went to school for…), I thought it would be a good moment to talk about what it means to have a therapy student in your facility.

If you are a therapist, that means you’ve been a student. There’s no getting around it. As a student in an OT master’s degree program, you must complete Level II Fieldwork in order to graduate, which typically consists of two 12-week placements during which you practice hands-on clinical applications of everything you learned in school.

But what exactly does that look like?

For a student:

-You are super enthusiastic, excited to make a difference, and you haven’t been jaded by the real world just yet. Enjoy it. I’m serious. Enjoy the opportunity to practice your skills as you are on the verge of completing something you have worked very hard for.

-This is your chance to decide if a certain field is where you want to practice. So if you get a pediatric rotation, I sincerely hope you have an interest in pediatrics. The information is specific, nuanced, and difficult to do half way. So please, don’t tell your Fieldwork Educator, “I’m never going to work in pediatrics,” before the rotation even starts. It’s a real bummer for us.

-It can get boring in the beginning as you meet an overwhelming caseload and do more observing than interacting, but for the love of all that’s decent in the world, DO NOT FALL ASLEEP! Take notes, practice your skills of observation, and get acquainted with parents and families. On the flip side, as you get in the groove of treatment, expect to be exhausted. You’re constantly thinking on your toes, planning, moving equipment around, and it’s tiring.

-Please ask for help. I’ve had quite a few students give off an air of confidence that was borderline annoying. I’d be blown off by a quick nod or shrug while trying to explain a concept, which made me assume they knew what I was talking about. So when I let them “sink or swim,” I finally got an admission that they were just nervous to look like they didn’t know something. It’s kind of the whole point to be learning new things.

-It’s fair to ask for a concrete set of expectations. How many patients should you expect to see each week? At what point are you expected to take on a full caseload, if at all? Having a clear set of expectations allows you to be better prepared for what’s coming. I mean, I was forced to lead a small group session on my first day of a rotation. (Don’t worry, I only blacked out a little bit from the fear.)

-Supervision: You want it? You don’t want it? According to the AOTA practice advisory for Level II students, the initial level of supervision is line of sight, but that can decrease depending on a number of factors. I know I was treating people alone on numerous occasions when I was a student. This can be a delicate balance depending on the setting, and I hope you aren’t being treated as a means to increase staff productivity; you are there to learn. Ultimately, your supervising OTR or COTA is responsible for the services you provide.

-This is essentially a 12 week job interview. Don’t take the opportunity lightly, because as the field becomes more saturated, those connections you make can be all the difference. So be on time, do what is asked, and even if you know you don’t want to do the job, you never know how your fieldwork experience might impact what’s ahead in your career.

For a Child/Parent/Patient: 

-Have an open mind. A student comes in with a lot of textbook knowledge, but the execution might be super awkward as they begin. However, I can guarantee that student has likely put a ton of time and thought into the activities they are attempting with your child, and I have discussed and/or approved these ideas.

-Adjusting the children to a new person can be difficult, and then preparing them for their departure can be even more of a challenge. It is a strange concept to invite a new person into a close-knit therapeutic relationship for a limited amount of time, but we have to all work together to make it as seamless as possible. And no, I’m not quitting or training my replacement, as like 75% of parents assume when I introduce a student.

-So you are private paying $150 a session to work with a student? Yes, you totally have the right to tell me you don’t want a student working with your child. I will try my best to explain the process and how much supervision and planning goes into their training, but sometimes a parent is adamant that they just don’t want anyone else working with their child. Please speak up if you are uncomfortable, it’s a learning experience for everyone.

-Ultimately, I’m going to want the student to run an entire session on their own. This doesn’t mean I’m being lazy, or want to take a break (ok, maybe a little…), it means they have gained the confidence and the skills to plan and implement a therapeutic session from start to finish. I might just be watching, making comments or notes, or busying myself with something else so that I can actually let them try and work things out on their own.

For a Therapist/Fieldwork Educator:

-Ah yes, the opportunity to impart wisdom, experience, and life lessons along to the next generation of colleagues. Sure. But ALSO, doing your regular job while simultaneously explaining every aspect of said job to an affixed shadow in the hopes they can absorb, synthesize, and execute it in a skilled way.

I feel like there are two reactions to this particular challenge:
1) Therapists who revel in the opportunity to show their skill set. Some of these therapists are able to foster an amazing learning environment, while some just make the students cry in the bathroom at least once a week.
2) Therapists who reluctantly take on a student because they know they should, and try their best to find time in their schedule to teach as much as they can, crossing their fingers that they get a “good one.”

-There is a payout for that investment of time and energy up front, because as the student becomes more competent and confident, they are able to assist you in a big way. Plus, to have an additional set of hands is a beauty and a luxury one must not take lightly. (Bathroom breaks for everyone!)

-You might have to check your ego a bit. I’ll admit, this is hard to do. There have been times when I’ve noticed I get a bit protective of my treatment plans and have to open up to a student’s new ideas. And if something new works, you have to let go of the “why didn’t I think of that?” guilt.

-Free continuing education! Ok, so just a skimpy 0.5 hours of CE for every week you have a student. Which again, it’s free, but it’s definitely way more work than going to a conference and possibly much less inspiring. Yes, you might gain some new insight or fresh technique ideas from a student, but it’s not going to be all you need.

-Through the student’s university, you typically gain access to journals, academic connections, and all that other good stuff that will turn you into a super-therapist (and I swear I’ll look at it all when I find that spare time…).

-You have to mesh with a new person all up in your space. Even when most of them seem so young. (Does this date me? I think it dates me.) But if I get another email from a student that starts “Hey!” rather than a real greeting, I might just cry. Plus, you must be prepared to adapt to someone’s learning style, therapeutic style, and ability (or lack thereof) to demonstrate clinical reasoning and flexibility when that treatment plan they worked so hard on gets thrown out the window.

-Most importantly, as much work as it is for the therapist, it is an opportunity to give back to your field. Without facilities willing to take on students, or therapists willing to be Fieldwork Educators, we wouldn’t have new therapists. So while it can be a lot of work, it can be very rewarding as well. Think of it as an opportunity to be introspective about your caseload, have a fresh set of eyes, and keep your interventions current and evidence based.

So to all the new OTs out there about to graduate, congrats and good luck!

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Beware the Putty Stains

I sat in therapy putty three times in the last month.

THREE TIMES.

Did I notice right away, when an emergency extraction could have been completed? Or much later, while folding a pile of supposedly clean clothes on a Sunday night, suspiciously scraping at a mystery stain while crying out, “What is that!?”

I’ll let you decide.

(For those that don’t know, once therapy putty has settled into the fibers of anything, it officially lives there. Forever.)
Regardless, I’m going to call the experience a neon-colored siren song back to a land known as internet blogging.

As you may have noticed, I took a little break from the site in the last few years. At the time I stepped away, I realized it is possible to become burnt out on the thing you started to keep yourself from burning out. Deep stuff, right? But I’ve finally asked for some help to manage the spinning plates of work and life, and I hope you’ll have me.

A big thank you to all that have participated in the conversations up to now, I appreciate you reading, commenting, and sharing with others. While I am loaded with a few years worth of fresh observations, I would love to hear from YOU. What’s going on where you are? What things are driving you crazy? Have you run into any techniques that just seem bonkers? What can we do better in treatment or maybe just in support of each other?

I am excited to hear from you. But for now, I’m going to go spray WD-40 on my pants in an attempt to remove the putty stains, because I guess that’s a thing.

Posted in Lessons Learned, Occupational Therapy | Tagged | 7 Comments

To the Therapist That Comes After Me

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Most of us pediatric therapists work with children that have profound, life-long challenges. Sure, we have those patients that come in for a few months, make great progress, and get discharged – never to be seen again. But those are few and far between. (And seem to be fewer and father between now a days.) We build relationships, we get attached, and we work hard to enrich every aspect of a child’s life. There’s really no avoiding it. (Unless you are made of stone, you monster!)

But that also means things get messy. Lines blur and melt together, which is why it’s so much more than a job. It’s why we burn out, why we cry, and why we find ourselves searching for something else on those really tough days. We might end up moving, changing jobs, or just starting a family. And for those reasons, we might be “replaced” by another therapist.

Having been on both sides of that situation I can tell you, I’m not sure it’s fun either way. So here’s what I’d like to say to the therapist that follows me, and what I’d like to hear as the therapist that follows behind.

-I hope you get to make a connection just as strong as mine was.

Ok, well sort of. This is one of those things that I’d like to hear someone say to me, and is harder for me to say to someone else. Who doesn’t want to hear that they were the “best”? But on the flip side, when you are the therapist following someone else, you just want your chance to shine. With that being said, I hope that you get to chat comfortably, learn about a child’s life, and be welcomed as an important part of a child’s family.

-I hope you hear about me every once and a while, but not too much.

Miss “So-and-so” would always do ____. But, Miss “So-and-so” really wanted her to work on _____. Is that what Miss “So-and-so” would have done?

Yes, it’s annoying to hear what another therapist did while you are trying to do your thing. And it’s hard to try to be someone else when you just have to be true to the way you treat. I would want a family to appreciate and understand what I had done for their child, but also allow another therapist to show who they are and what they can do.

Plus, on the flip side, I hope the family doesn’t speak about their old therapist in a negative tone, either. It’s super awkward when you are the following therapist that hears everything the parent didn’t like about their old OT. It’s a pretty big red flag that they’ll be looking for things to criticize in you, or at the very least, make you feel like you have to avoid any potential similarities you may have with the old therapist.

-I hope you don’t try to prove me wrong, or criticize what I’ve done.

Haven’t you ever found yourself in one of those OT pissing contests with another therapist? Oh, you aren’t certified in Therapeutic Listening? Wait, you don’t precisely adhere to Jean Ayres’ methodology? Haven’t you extensively studied reflex integration yet? It’s exhausting. Why do we do this to each other?

I think/hope it comes from a place of wanting to help a child and family, but it mostly comes off as this crazy OT ego battle. We are probably all guilty of looking at someone else’s paperwork and saying, “Why in the world did they do THAT?” With that being said, you can carve out your own treatment plan in a way that doesn’t minimize or belittle someone else’s work.

-I hope you are given a chance to try your own way.

Come on, OT is a journey with about a million different pathways. My way and your way might not match, but it doesn’t mean one is better than the other. Another therapist is a whole new set of eyes, and a completely different perspective. Sometimes, when you’ve been seeing a child for YEARS, it’s nice to have a fresh set of eyes.

Besides, we all spend our time studying different aspects of our profession, and we bring unique skill sets to the table. When you get a new child on your caseload, you might see something that someone else didn’t, or at least try a new way that might bring even the smallest amount of change. I hope you never feel like you are stuck in someone else’s plan, because no one wins in that scenario.

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