Other OT-Related Information Do occupational therapists do psychotherapy in mental health?

[InfoNerd101]

I know most of what occupational therapists do in mental health is engaging in meaningful activities but they also do CBT and DBT to some extent, so is that considered psychotherapy?

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[Kidamnesiac]

Psychotherapy usually refers to psychodynamic therapy, and we definitely don't do that. Think function...if you're doing CBT or DBT, it's en route to helping people be more functional.

 

[InfoNerd101]

Psychotherapy usually refers to psychodynamic therapy, and we definitely don't do that. Think function...if you're doing CBT or DBT, it's en route to helping people be more functional.

What is psychodynamic therapy? And also is CBT a form of talk therapy as well?

 

[Therapist4Chnge]

CBT / DBT / Psychodynamic Therapy are all types of talk therapy that have their own theories, frameworks, and interventions.

I'm not sure if traditional talk therapy is something in the modern OT's wheelhouse, though I've seen reference on here to it being something from 'back in the day'. I've worked in a range of hospital/in-pt/out-pt settings and other professionals tend to do the traditional talk therapy work, but utilizing specific interventions to facilitate OT/PT/SLP needs seems pretty common. I work with my OTs/PTs/SLPs on how to deal with problematic behaviors and utilize different (mostly behavioral, but some cognitive) interventions to help them get/keep their patient engaged in treatment.

 

[InfoNerd101]

CBT / DBT / Psychodynamic Therapy are all types of talk therapy that have their own theories, frameworks, and interventions.

I'm not sure if traditional talk therapy is something in the modern OT's wheelhouse, though I've seen reference on here to it being something from 'back in the day'. I've worked in a range of hospital/in-pt/out-pt settings and other professionals tend to do the traditional talk therapy work, but utilizing specific interventions to facilitate OT/PT/SLP needs seems pretty common. I work with my OTs/PTs/SLPs on how to deal with problematic behaviors and utilize different (mostly behavioral, but some cognitive) interventions to help them get/keep their patient engaged in treatment.

You're right it must be from back in the day because in the mental health floor where I work we have a mental health occupational therapist who got he degree back in the 80's and she does mostly "talk therapy" (ie, CBT and DBT) along with her skill and activity engaging groups.

 

[Therapist4Chnge]

I'm not sure how that'd be billed in today's healthcare market. I am most familiar with acute in-pt, step-down/sub-acute care settings, and out-pt...and they tend to bundle their services, meaning the facility gets one $-amount for services provided. Insurance carriers tend to have very stringent requirements for # of hours required to get paid, where I'm at it is, 'the three hour rule' meaning therapies need to be at least 3 hours per day to get paid. There are other requirements, but that's the gist. In an out-pt setting the billing can be done separately, though again I'm not sure what codes would qualify bc services tend to be very much based on functional (physical) gains; It's all about FIM scores….for better or worse.

 

[Kidamnesiac]

What is psychodynamic therapy? And also is CBT a form of talk therapy as well?

Psychodynamic therapy is rooted in Sigmund and Anna Freud's work of talk therapy, focusing on past relationships and the relationship between the therapist and analysand (transference). CBT and DBT are more about recognizing and intervening to the client's thoughts and beliefs (CBT would be more about thinking rationally about thoughts, like when people think "ugh, my friends always criticize my work" the therapist would ask if it REALLY always happens; DBT is more about recognizing triggers/thought patterns, acknowledging that they're there, and knowing how to live with them).

CBT and DBT can be used to bolster interventions, but really shouldn't be interventions in and of themselves. It happens though.

 

[smalltownpsych]

CBT and especially DBT also involve learning of skills and implementing those in real world situations. These can definitely be implemented by a variety of people on a treatment team including OT. Keep in mind that the skill instruction and implementation is just part of psychotherapy and to develop expertise in psychotherapy requires extensive training. It involves at least as much training and expertise as it takes to become a good OT.

 

[Kidamnesiac]

CBT and especially DBT also involve learning of skills and implementing those in real world situations. These can definitely be implemented by a variety of people on a treatment team including OT. Keep in mind that the skill instruction and implementation is just part of psychotherapy and to develop expertise in psychotherapy requires extensive training. It involves at least as much training and expertise as it takes to become a good OT.

I meant to say that CBT and DBT shouldn't be implemented in and of themselves by OT's (even though we can get certification in them). Psychologists are obviously more qualified and appropriate to implement these options! (Although, I believe that Deleuze/Guattari have thrown some serious shade at the assumptions of psychodynamic theory).

 

[smalltownpsych]

I meant to say that CBT and DBT shouldn't be implemented in and of themselves by OT's (even though we can get certification in them). Psychologists are obviously more qualified and appropriate to implement these options! (Although, I believe that Deleuze/Guattari have thrown some serious shade at the assumptions of psychodynamic theory).

I haven't seen these particular criticisms but just want caution that it easy to criticize aspects of any of the major theories and psychologists seems to be love the straw man approach. Recent example was on our forum where poster criticized DBT mindfulness. None of the theoretical perspectives has all the answers for all of the patients. I imagine OT people probably get that better than many of the psychologists since you are more focused on whatever strategies will work for each patient and less comcerned about theory. That's just from my own observations and inferences.

 

[Kidamnesiac]

I've actually heard many positive experiences with DBT...much more than CBT even! D & G aren't necessarily attacking all of psychology...just psychodynamic/Freudian assumptions that have permeated popular culture. AFAIK, the psych community doesn't even look all that kindly on psychodynamic anymore.

 

[smalltownpsych]

I've actually heard many positive experiences with DBT...much more than CBT even! D & G aren't necessarily attacking all of psychology...just psychodynamic/Freudian assumptions that have permeated popular culture. AFAIK, the psych community doesn't even look all that kindly on psychodynamic anymore.

There is plenty of modern psychodynamic theories that are pretty far removed from Freud. In fact, the term psychodynamic tends to refer to the more modern perspectives. The old Freudian stuff we usually call classical psychoanalysis.

 

[Kidamnesiac]

There is plenty of modern psychodynamic theories that are pretty far removed from Freud. In fact, the term psychodynamic tends to refer to the more modern perspectives. The old Freudian stuff we usually call classical psychoanalysis.

I'm sure that you know about it than I do, but I feel that the object relations model that Anna Freud proposed carried along the tradition to some extent. And then there's Lacan. Even the more pointed critiques of classic Freudian thought like Reich still don't think too far outside of categories that were introduced by Freud. D&G's critique isn't necessarily that Freud was wrong...I think that everyone can agree with that point. They actually show how Freud himself admitted fault with his own theories, and try to show where he would have gone had he not put Oedipal (and categorical/relational structures) as primary, rather than seeing how social structures are actually more primary than those psychological categories. Cultural psychology is currently moving in this direction.

 

[smalltownpsych]

I'm sure that you know about it than I do, but I feel that the object relations model that Anna Freud proposed carried along the tradition to some extent. And then there's Lacan. Even the more pointed critiques of classic Freudian thought like Reich still don't think too far outside of categories that were introduced by Freud. D&G's critique isn't necessarily that Freud was wrong...I think that everyone can agree with that point. They actually show how Freud himself admitted fault with his own theories, and try to show where he would have gone had he not put Oedipal (and categorical/relational structures) as primary, rather than seeing how social structures are actually more primary than those psychological categories. Cultural psychology is currently moving in this direction.

Freud was wrong to change his theory that hysteria was caused by sexual fantasies as opposed to sexual abuse. I also disagree that the social is more important than the relational, if that is what you are saying. Also, you are again citing very old psychodynamic thinkers. Modern theory is looking more at the neurobiology of attachment and how that is involved in emotional regulation. Just because Freud didn't know the actual structural mechanisms of the brain that were involved and made up names for them such as id and ego doesn't mean that they don't exist and that much of what he described isn't accurate. Freud knew that the term psychosexual was going to be misunderstood but he chose to continue to use it to increase interest in his theory. It is easy to stand on the shoulders of Frued and criticize him, many have, but he was also very right about a lot of things and his views changed the world. I work with a lot of pre-Freudian thinkers and you would be amazed at the level of somaticizing and other primitive defenses that are in this population. Reminds me of how the world must have been in the Victorian era with the swooning and hysterical women.

 

[Kidamnesiac]

I will just say that the Internet/tech boom, impact of taxation on job availability, expansion of the legal definition of families, objectification of women, and resources available for community support of mental health are all examples of the way that social structure can drastically change psychological structures, and also present examples of influences that are more primary than relational structures. Not that they are the only influences on the psyche, but they also shape the way that academics are even able to form definitions of psychological structures.

 

[smalltownpsych]

I will just say that the Internet/tech boom, impact of taxation on job availability, expansion of the legal definition of families, objectification of women, and resources available for community support of mental health are all examples of the way that social structure can drastically change psychological structures, and also present examples of influences that are more primary than relational structures. Not that they are the only influences on the psyche, but they also shape the way that academics are even able to form definitions of psychological structures.

Of course they affect this, but at the level of psychological functioning, the most important predictors are the developing brain. How the societal factors affect the developing brain is most important from my perespective. That is the reason that I so strongly support feeding kids at schools. I think they should also have more play time. These are both very strongly supported interventions. Also, kids shouldn't spend too much time in the electronics world. Like my parents told us when we were kids, "tv will rot your brain". I tell parents the same thing today about their kids regarding the internet. In some ways, the more things change, the more they stay the same. 🙂