Degree escalation and doctoral education are sinking the occupational therapy profession

Occupational therapy started on a simple premise - that man, through the use of his hands as they are energized by mind and will, can influence the state of his own health.  That statement was provided to the profession by Mary Reilly, our greatest theoretician.

It is a simple concept, borne out of a core philosophy of pragmatism and infused with a dose of all the good intentions of the moral treatment movement.  If you carefully read that core philosophy of occupational therapy you will hear the Emersonian reverberations of self-reliance: 'Trust thyself: every heart vibrates to that iron string.'  That is what occupational therapy seeks to nurture in the spirit of people: Independence, harmony with the self, harmony with nature, and a satisfaction in authentic work and effort and purpose and meaning.

Occupational therapy is a concept that was designed to create solutions for the problems of living - and was field tested in the settlement house projects of Chicago and Boston, in the gardens of Consolation House, in the pottery and rug making and other craftwork shops along the Eastern seaboard from Massachusetts to Newfoundland to Labrador, and then in the base hospitals in Europe during the Great War.  Do things with your own hands, be productive, find meaning - and you can heal your own life.

In the last twenty years it has been determined in the United States that the occupational therapy idea is so complex that it requires graduate degree training and now even a doctoral degree in order to be qualified to do the work. There has been very little justification offered for why this determination has been made, but more significantly, there has been very little conversation on the matter.  What is it that has philosophically changed that should up-end the traditions of occupational therapy training?

Reilly also told us, "The wide and gaping chasm which exists between the complexity of illness and the commonplaceness of our treatment tools is, and always will be, both the pride and anguish of our profession."  I like to consider the medical complexity of one of the first 'official' occupational therapy patients - George Barton - who describes his own condition that led to his need for treatment: "Four attacks of tuberculosis, four surgical operations, including an exploratory laparotomy and an amputation, morphinism, hysteria, gangrene, and paralysis."  His treatment consisted of gardening, working a drill press for carpentry projects like building pigeon coops, and mechanical drawing/drafting.  Are patients today situated with any more complexity with their disabilities?  Ironically, many treatment techniques commonly used by occupational therapists have gotten more simple: how many people routinely see patients in a long term care facility working on arm bikes and with stacking cones.

You need a doctoral degree for that?

How is it that for so many years occupational therapists managed to bridge the divide that Reilly was concerned about by using the simple philosophy of engagement - but now in order to mindlessly place clothespins on a dowel or swing a foam pool noodle at a balloon you need a doctoral education?

The answer to the problem of therapists abandoning their philosophical beliefs is not to escalate the degree level.  The correct answer lies in a re-examination of core values and a re-commitment to curriculum development that properly orients and educates new therapists to the 'magnificent purpose' that Reilly extolled.

The abandonment of philosophy is not restricted to long term care facilities.  You can find the same lack of direction and lost purpose with OTs across many practice settings.  This is in part facilitated by academia and the endless fascination with the philosophical drift that has OT students imagining roles for themselves in all kinds of 'emerging areas' that don't even reflect occupational therapy practice.  Now the ultimate betrayal of curricular and pedagogical logic is manifest in the fact that for the capstone experiences for doctoral education of occupational therapists, the student does not even need to be supervised by an occupational therapist.

The good ship Occupational Therapy is not only un-moored from its dock.  It has sunk to the bottom of the ocean.

Correction starts with a halt to the escalation of degree requirements for entry into the profession.  From there it proceeds with building an awareness that educators need to revise their curricula and re-locate and re-embrace their philosophical roots.  Practicing clinicians can help by pointing to high quality and occupation-based treatment as a standard to be expected.

Without these steps, the occupational therapy profession will be an anachronism in twenty years - a profession that destroyed itself by abandoning its original simple purpose.


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