10 Life Lessons I Learned As An Occupational Therapist: Part 3
"Life lesson: Success is not final, failure is not fatal,
it's the courage to continue that counts."
—Winston Churchill
Following Part 1 and Part 2, this is the third installment of the teachings of my job.
Listen to the podcast version of this article.
Occupational Therapy Life Lessons
The struggle is an investment
Letting someone struggle is an essential part of the growth process. It’s never easy but the return on investment is worth it. By being forced to comfort our limitations and weaknesses, struggle improves independence, resilience, and character.
Letting a patient battle to open a heavy door as you stand there making sure they don’t fall was as hard a decade ago as it is but now I have a more personal angle: my kids. There’s no better way to learn how to walk, get dressed, learn about friendship, and, well, develop, than with hardship.
Stepping in to help has its place but excessive help leads to helplessness, weakness, and fragility. It doesn’t get easier but they get better. Struggle creates growth.
2. What gets measured gets managed
Blood sugar, movement, blood pressure, HRV, flexibility, goals, and the amount of help needed for every ADL. These are all things we can measure and this measurement leads to management which leads to improvement.
Biometric data with watches and phones make it easier than ever to both past and real-time data and have conversations about wayward trends. This knowledge allows us to transition the abstract to the objective and suddenly we’re able to link cause (eating that piece of cake) and effect (blood sugar spike then drop, low mood, fatigue) as measured by a CGM.
The therapist’s goal is to transfer this knowledge and the onus of these measurable data to the patient to allow them to develop autonomy for these management skills. If there’s no checking then there’s no incentive to change. If there’s too much checking or too much data then the mind gets quickly overburdened and there’s no incentive to change.
Measure something, but not too much. Be consistent. Note the underlying reasons for changes. Improve.
3. The most important part of the lesson is often the pause after the lesson
Conversational pauses have many uses. Often times they are used as an exclamation point used for emphasis and dramatization but the power of the pause can extend further. This gap can be strategically used as a tool to allow information to be reflected on and encoded, that is, stored for recall later.
Without these pauses, information just gets pushed along with the tide, never having an opportunity to be digested. Words are wasted with haste. Use silence to your advantage.
4. You won’t make someone healthier by telling them what they need to do
My younger, overly-rational brain used to think that throwing stats and studies in front of people would give them the “a-ha” moments it tends to give me. After too many attempts at trying to go through the mountain, I switched techniques and climbed over.
Change starts with purpose but you can’t tell someone what their purpose is or how to live their purpose. You have to let them find it. Motivational interviewing is a catch phrased overused by life coaches and the like but, in truth, it’s a very effective strategy. Telling someone how to lose 20 pounds and showing them all the evidence-based data on how to do would work for a robot, but not a person.
Use motivational interviewing (find more about this here) to go deep on why they want to change--to play with their grandkids, live independently, work longer–and allow them to fuel their own fire.
Save the how for later.
Focus on finding the why.
5. The soft crowbar: “Tell me more”
I may use the phrase, “Tell me more about that” more in a treatment session than any other combination of words. Conversations with strangers are a constant back-and-forth of our minds measuring a degree of trust among one another. It’s rare that someone will divulge all of their issues in a session (red flag if they do). Instead, they will subconsciously lay breadcrumbs, or maybe something will just slip.
After a pause, and while maintaining eye contact, I say “Tell me more about that.” Sometimes this is a dead end but more often than not it’s an emotional Pandora’s box. “Tell me more” is like a soft crowbar, a therapeutic tool that lowers the walls of resistance.
If you’re interested in more therapeutic communication tools, see these takeaways from the book, Never Split The Difference.
6. Attention is the key to memory, learning, and happiness
Attention is one of the most obvious symptoms of an injury to the brain. That spaced-out look or a seemingly total lack of interest is often seen in those with severe brain injuries but even subtle deficits in attention play a large role in our lives.
The inability to attune the mind to a topic or situation means that neurons can’t encode and, therefore, can’t remember information. The necessary and natural process of building concepts on top of one another for physical and cognitive development just ceases. (Ever miss a day of school and feel like you’re months behind because you can’t apply that skill you didn’t learn?)
Furthermore, having difficulty concentrating also limits our ability to be mindful. Being mindful requires a focus on the present moment and this focus has a direct correlation to joy.
Strengthen your skill of attention through meditation, breathwork, and mindfulness.
Related:
See the article, The Secret of Happy People, for more on this.
Learn how attention significantly impacts productivity (and what to do about it).
7. Consistency is critical
A colleague of mine once said, “Rome wasn’t built in a day but they were laying bricks every day.” Change and progress often happen slowly. Be consistent with your life roles, your work toward goals, and your principles.
“Mastery doesn’t come from an infographic. What you know doesn’t mean shit. What do you do consistently?”
—Tony Robbins
Become a master of monotony.
8. Pessimism begets pessimistic results
One’s personality has a strong impact on where they end up after turbulent times. Every once in a while I’ll work with a downright cynical patient where every psychological technique I use to evoke hope, motivation, and purpose just blows up in my face.
This combination of pessimism and a fixed mindset typically develops early in life, often in conjunction with trauma. This personality type leads to a vicious cycle of noting things “going wrong” and things “going wrong” as a result.
Changing a mindset is no easy feat, especially when it’s paired with a history of trauma. Change, however, begins with a desire to change. Start small, seek help from a psychologist if needed, and become better.
Related
This topic is a common theme in many of the books I read such as The Coddling of the American Mind, The Subtle Art of Not Giving a F*ck, The Obstacle Is The Way, and Do Hard Things. See the full list here.
9. Cognitive dissonance: distortion for protection
Cognitive dissonance–mental discomfort with contradictory beliefs and information–.is one of those cognitive heuristics every human brain has.
It works like this: negative beliefs and behaviors lead to negative emotions (anxiety, guilt, shame) which leads to cognitive dissonance. It can present in the form of avoidance, hiding behaviors, or through rationalization and “explaining things away.”
I see this in various ways when working with patients. For example, about 80% of the time I show a patient their high blood pressure they will immediately explain it away by saying things like, I just worked hard in PT, I took my Meds too late, I drank coffee, or I ate a donut 3 weeks ago. If that blood pressure immediately plummets then more rationalizations fly. On a deeper level, I see cognitive dissonance about fears, addictions, body image, unhealthy habits, and anything society deems taboo.
It’s a great immediate coping strategy but it has terrible long-term effects. Become aware of your cognitive dissonance tendencies.
Related:
To learn about the interesting origins of the term, cognitive dissonance, see this Atlas of the Heart article.
10. You can teach an old dog new tricks, thanks to neuroplasticity
Neuroplasticity is the ability of the brain to adapt and change in response to new experiences and learning. This means that old dogs can indeed learn new tricks, contrary to the popular belief that their brains become rigid and unchangeable with age.
Through hormesis, growth occurs when we challenge our bodies in the right doses. Yes, our glory days might permanently live in high school but that doesn’t mean you can’t get better.
A 70-year-old can run 100 meters in under 14 seconds, an 86-year-old nun can crush an Ironman, 91-year-old Warren Buffet is still dominating in his role as CEO, and 95-year-olds can graduate from college.
The only thing stopping you from getting better is thinking you can’t.
