Occupational therapists work on the front lines of incredible human suffering. An occupational therapist who has his or her own personal mindfulness practice will be more able to remain present to his or her own internal mental and emotional dialogue and physical wellbeing from one moment to the next thereby reducing potential for burnout anad enhancing self-efficacy.
Occupational therapy promotes health by enabling people to perform meaningful and purposeful occupations.  However it is often the case that we are not present or "conscious" during these meaningful occupations. Not only are we not present but we are often lost in thought. These thoughts can often be dysfunctional or destructive to our emotional, mental, and physical health. MBOT requires that we ask, "What is the quality of participation in meaningful acitivies?" As the OT integrates mindfulness into their own daily personal and professional life they begin to become aware of their quality of participation in meaningful activities. This awareness is then infused into all clinical interventions as well as personal and professional interactions.
Let's say for example the OT is working with an individual with a spinal cord injury. Before the OT enters the patient's room she will become aware of her own breath and remain present with what is unfolding before her. She will remain present as she meets her new patient who has experienced and is experiencing an intense life occurrence. She will be present to the needs of her own body as she cares for the individual by being less likely to put herself in compromising situations. She will be more in touch with the needs of her patient's body and their emotional wellbeing which can put the patient at ease and reduce anxiety and stress. As one can imagine this Way of Being in relationship to OT practice and in relationship to our patients can significantly improve our therapeutic use of self thereby improving rapport building and potentially significantly improving clinical outcomes.
Mindfulness-based occupational therapy (MBOT) is occupational therapy that incorporates features of mindfulness into OT practice interventions. MBOT is unique to other interventions traditional to OT practice in that it requires that the OT have their own personal mindfulness practice in order to implement the mindfulness features. The "mindfulness-based" components of MBOT are based on a program developed by Jon Kabat-Zinn called mindfulness-based stress reduction (MBSR). Mindfulness practices draw upon universal wisdoms that examine what makes all humans suffer and offer awareness-based relationship to moment-to-moment experience.
“In mindfulness, the meditator methodically faces the bare facts of his experience, seeing each event as though occurring for the first time” (Goleman, 1988) Mindfulness is cultivating curiosity and discernment vs. judgement.
MBOT is appropriate for any population an occupational therapist would work with: pediatric to geriatric populations, stroke survivors to individuals on the autistic spectrum. MBOT is a valuable practice to help improve clinical outcomes and reduce stress and anxiety on the part of the clinician and the patient. A 2011 study demonstrated that mindfulness practice alters the structure of the brain in 8 weeks. The article can be viewed here: http://www.eurekalert.org/pub_releases/2011-01/mgh-mmt012111.php
Mindfulness Based Occupational Therapy draws from awareness-based practices, including mindfulness-based “3rd wave therapies” and somatic approaches to healing. MBOT incorporates features of mindfulness into interventions: awareness, acceptance, motivation, embodiment, and learning how to be in relationship to intensity for vastly varying expressions of physical and mental suffering.
Mindfulness-based therapies are currently used by OTs at Stanford, Alta Bates, El Camino, O'Connor Hospital, Sequoia, Mills Peninsula, Good Samaritan Hospital....
- Presence, Curiosity & Receptivity are necessary. Consider what threatens these?
- MBOT facilitates connection
- Therapist must have personal mindfulness practice and experiential knowing of it; willingness to cultivate and increase awareness; turn towards what makes us uncomfortable
- We all need to be seen, heard, witnessed
Ways for any healthcare professional to incorporate mindfulness:
- In approach, verbal cues & body language.
- If any concepts / exercises do not ring true for you, don’t use them. Share what you "know". They must be embodied/modeled/authentic.
- Use evidence-based knowledge to back up your recommendations...it's easy as there is so much research available now!
Here is a link to an amazing resource of Mindfulness Research: http://www.mindfulexperience.org/
Languaging & Mindful Communication:
- Words matter - the language you use must reflect the population you are working with
- Silence is Golden
- Appropriate Eye contact
- Body language
- Cadence & pacing
- Silent Presence as mindful communication
- Cultivate active listening Utilize poetry & literature appropriately
Resources for mindfulness training for OTs:
Consider this: How does "presence" and "quality" merge when we are talking about meaningful activity? How might these qualities affect our quality of participation in meaningful occuaptions?
“The patient-practitioner relationship demands close attention...It is an embodiment, a direct expression of interconnectedness and interdependence. Beyond a doubt we work on ourselves as a means of helping others and, simultaneously, working with others is a way of working on ourselves. The simple truth of this is hard to open up to because it changes the entire nature of the healing relationship from one of fixing and rescuing, or authority and domination, to one of service, collaborative creativity, and inquiry. This alone is a cracking open of our imagined sense of self and position. For our work and our privilege is to assist and accompany others into the discovery of their own intrinsic wholeness existing behind illness, even when death is close at hand or when one faces living with a chronic illness . . . . What is called for, right alongside of our medical procedures and clinical strategies, is a slowing down . . .an intimate embracing of our own tattered hearts.”
From Heal Thyself - Lessons on Mindfulness in Medicine, by Saki Santorelli, Ed.D., Director of Stress Reduction Clinic at UMass Memorial Medical Center; Director of Clinical and Educational Services in the Center for Mindfulness in Medicine, Health Care, and Society Assistant Professor in the Division of Preventive and Behavioral Medicine at UMass Med School
The Guesthouse by Jalāl ad-Dīn Muhammad Rūmī
This being human is a guest house. Every morning a new arrival.
A joy, a depression, a meanness, some momentary awareness comes as an unexpected visitor.
Welcome and entertain them all! Even if they're a crowd of sorrows, who violently sweep your house empty of its furniture,
still, treat each guest honorably. He may be clearing you out
for some new delight.
The dark thought, the shame, the malice, meet them at the door laughing,
and invite them in.
Be grateful for whoever comes, because each has been sent
as a guide from beyond.
1. Willard & Spackman (2008). Occupational Therapy is art and science (11th ed), p. 16; Lippincott Qilliams & Wilkins.