PhD advising for OT - should I pursue a Psych PhD or something else?

[Chanandler Bong]

Hi, it's been FOREVER since I posted on this message board... missed y'all. 🥰

I completed my master's in occupational therapy, have been in practice for a few years, and now I am seriously thinking about PhD studies. I enjoy research and the university environment, and I can envision myself as a professor in a health sciences program. Alternatively, I'd be interested in a leadership role at a hospital or non-profit, perhaps coordinating research or being involved in clinical education -- but as you can tell, I'm not 100% sure what that role would look like, and I'm not as versed on what PhD opportunities exist outside academia.

Anyway, I am not sure exactly what program to apply to! There are very few "occupational therapy" PhD programs. My program was not heavy on mathematics or biomechanics, so my research was more qualitative in nature (think: surveys, interviews, personal narratives/ethnography) vs. quantitative/typical biomechanics research (I was not in a lab placing sensors on people's skin or doing stuff with computer programming or imaging, which is what a lot of programs seem to be looking for).

I am wondering if I should pursue a degree in public health, psychology, education or... something else? I am not entirely sure how to best sell my skill set. I feel I can definitely contribute to my profession as a researcher, but I'm a little disadvantaged from not following a more quantitative path. ☹️ So anyway, please help!

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[WisNeuro]

Look at the leadership roles that you can see yourself in within those hospital settings? What degrees do those people have? Around here it's usually midlevels with business degrees at the mid level leadership level, and MDs and MBAs at upper level leadership. Different systems and regions may vary, but make sure you see what the current market is before setting off on a long path that may not even get you there.

As for PhD outside of academia, the clear majority of clinical psych PhD grads are primarily clinicians.

 

[summerbabe]

I don’t read anything that screamed ‘Yes, pursue a PhD in psychology asap!’ in your post and you’d also need both additional experience as well as specificity (e.g., research focus) to be competitive for a PhD in psychology.

Realistically, you are looking at 1-2+ years of prep + 4/5+ years in grad school + 1 year predoctoral internship + possible 1-2 year postdoc to compete for a shrinking pool of tenure track assistant psych prof gigs that may represent a significant paycut to your current OT salary (newly hired profs at my old PhD program which is a commuter state school in the South make like $40k starting out).

What is driving this urge to switch? Is OT a bad fit? Are you burned out by clinical work? Feeling unchallenged or bored? Prefer university life compared to your current work setting?

Also how versed are you with research and what it would mean to be a full-time academic? Unless you’re going to continue education in OT, the costs/benefits of respecializing into another field could be daunting.

 

[futureapppsy2]

OT faculty/researchers can do very psych-related research. A colleague of a colleague is an OT faculty member with a PhD in OT and her research focuses on suicide in autistic people. After all, OT has its roots in psychiatric rehab!

 

[PsyDr]

Go watch how OTs “treat” autism spectrum disorders. Think about the scientific rigor of a profession that thinks that walking on a balance beam fixes autism.

 

[WisNeuro]

Go watch how OTs “treat” autism spectrum disorders. Think about the scientific rigor of a profession that thinks that walking on a balance beam fixes autism.

What about 70% on RBANS picture naming being "good"for a 40 year old?

 

[PsyDr]

What about 70% on RBANS picture naming being "good"for a 40 year old?

You’d better put him/her through some activity off of a Japanese game show! Maybe spin them around for vestibular stuff? Paddywack machine for sensory issues, even though that’s based on a single article? Shoot them with some tennis balls for sensory gating?

Or is it not funny to put vulnerable people through American Gladiators activities for profit?

 

[futureapppsy2]

Go watch how OTs “treat” autism spectrum disorders. Think about the scientific rigor of a profession that thinks that walking on a balance beam fixes autism.

To be fair, there’s plenty of psychologists who practice absolute pseudoscience—doesn’t mean the whole field is bunk.

 

[WisNeuro]

To be fair, there’s plenty of psychologists who practice absolute pseudoscience—doesn’t mean the whole field is bunk.

There definitely are, but I would say that after getting into IMEs and reviewing thousands upon thousands of pages of records, OT is by far the biggest source of iatrogenic harm in the mTBI world. Followed closely by chiros.

Edit, I may actually put SLP slightly above the chiros in terms of harm done.

 

[Chanandler Bong]

@PsyDr @WisNeuro whoa, didn't know enough people knew what OT was for it to gain this kind of vitriol. 👀 Can you share more of your perspective re: OT doing harm? (I'm well aware of the rampant pseudoscience within the field, which is part of why I'm interested in research at all.)

What I'm gathering, though, is you think a PhD that's NOT specifically in OT would be better respected than one that is. Because apparently psychologists think we're quacks and that OT is synonymous with sensory integration, pediatrics, and autism.

 

[PsyDr]

@PsyDr @WisNeuro whoa, didn't know enough people knew what OT was for it to gain this kind of vitriol. 👀 Can you share more of your perspective re: OT doing harm? (I'm well aware of the rampant pseudoscience within the field, which is part of why I'm interested in research at all.)

What I'm gathering, though, is you think a PhD that's NOT specifically in O.T. would be better respected than one that is. Because apparently psychologists think we're quacks.

1) OT is great at some rehab things. I have no issues with that stuff. It is a little funny that one of your most efficacious treatments was invented by a psychologist.
2) Go look at how "sensory integration disorders" was created. Then look up the number of tests to confirm that diagnosis. Then look up the efficacy of OT specific interventions for ASD.
3) "Dry needling" is based upon something that the WHO said was impossible to reconcile with science. An OT didn't seem to understand science and put a needle in my friend's lung. Which was a fun trip to the ER. I'll let you know about the lawsuit.

 

[Chanandler Bong]

I don’t read anything that screamed ‘Yes, pursue a PhD in psychology asap!’ in your post and you’d also need both additional experience as well as specificity (e.g., research focus) to be competitive for a PhD in psychology.

Realistically, you are looking at 1-2+ years of prep + 4/5+ years in grad school + 1 year predoctoral internship + possible 1-2 year postdoc to compete for a shrinking pool of tenure track assistant psych prof gigs that may represent a significant paycut to your current OT salary (newly hired profs at my old PhD program which is a commuter state school in the South make like $40k starting out).

Not sure how the math works out in your scenario... what "additional experience" or "1-2+ years of prep" are you referring to? I'd be applying to a psych program (not necessarily clinical psychology, mind you) with a MS in a related field and clinical experience. My intent would be to teach in a rehabilitation sciences or allied health program (i.e., probably teach OT or OTA students). I'm in California and have looked into what kind of pay to expect here.

What is driving this urge to switch? Is OT a bad fit? Are you burned out by clinical work? Feeling unchallenged or bored? Prefer university life compared to your current work setting?

PhD has always been the long-term plan. But sure, maybe a little burned out and missing the university.

Also how versed are you with research and what it would mean to be a full-time academic? Unless you’re going to continue education in OT, the costs/benefits of respecializing into another field could be daunting.

I do qualitative research. I have two peer-reviewed publications (which is probably not a lot for someone out of a psych program, but in my field it's significant because most OTs do not do research). I'm currently preparing a manuscript with my alma mater, and I volunteer as a data collector on a local project. So, I'm staying involved in research as much as I can as a practicing clinician in my current location can.

No, I don't know what it's like to work as a full-time academic -- are you suggesting I pursue a faculty role before considering a PhD?

 

[Chanandler Bong]

1) OT is great at some rehab things. I have no issues with that stuff. It is a little funny that one of your most efficacious treatments was invented by a psychologist.
2) Go look at how "sensory integration disorders" was created. Then look up the number of tests to confirm that diagnosis. Then look up the efficacy of OT specific interventions for ASD.
3) "Dry needling" is based upon something that the WHO said was impossible to reconcile with science. An OT didn't seem to understand science and put a needle in my friend's lung. Which was a fun trip to the ER. I'll let you know about the lawsuit.

1) Most of the stuff we do was invented by other fields.
2) Like I said, we're not all into that.
3) Yikes. Hope your friend is okay.

 

[summerbabe]

what "additional experience" or "1-2+ years of prep" are you referring to? I'd be applying to a psych program (not necessarily clinical psychology, mind you) with a MS in a related field and clinical experience.

Most people who successfully get into a clinical or counseling psychology PhD program have at a minimum presented a poster at a conference and potentially been a secondary author on an accepted peer-reviewed journal article. Other PhDs in psychology (experimental, cognitive, social, etc) likely have similar requirements plus possibly greater emphasis on previous lab experience.

It's great that you have OT research - the question will be how much that experience is seen as relevant to doctoral study in psychology. If it's not seen as relevant or only tangentially relevant, you probably won't be very successful when applying without putting in some additional time to build up a psychology-oriented CV, which would very well take 1-2+ years. Additionally, most PhD admissions in psychology don't place a ton of emphasis on previous clinical experience, including people who are licensed master's level therapists.

Now if you're applying to things like online/hybrid general psychology PhDs offered by places like Grand Canyon or Acapella, the bar for entry is much lower (e.g., I can pay tuition). But I'm not sure if the modal outcome for these programs will provide the career advancement that you're looking for.

 

[borne_before]

Process comment: This turned into an OT bashing thread. I currently work with some awesome OTs and have had some wonderful OTs in the schools I've worked with. They can really help with handwriting and adaptive tech for people with CP, SB, etc.

Like many fields, there are quacks. But many hospital and school based OTs do great work. Not a huge fan of sensory processing disorder, but I view that as us being ill equipped and still in the stone ages on how to best help people with asd.

Re: OTs and ASD, that is a symptom of lack of other supports for people with autism.

Third, I think if you said, I got a degree in OT. I dont like some the pseudoscience stuff, that's why I'm leaving. It would be very impactful.

 

[Chanandler Bong]

Third, I think if you said, I got a degree in OT. I dont like some the pseudoscience stuff, that's why I'm leaving. It would be very impactful.

Wow, this is quite the perspective. I see what you're saying, and maybe that would sound good to another profession... but getting a PhD in another discipline is not viewed as "leaving" by the OT profession. It's normal because there are so few OT PhD programs. Most profs in an OT department will have master's degrees or professional doctorates. The ones with PhDs often have them in psychology, counseling, engineering, rehab science, education, gerontology, or leadership.

We're a field that has lagged behind when it comes to research. When I was applying to OT school, one brand new program nearly rejected me because of my interest in research, according to the admissions staff -- I called to check on the status of my application and was asked what happened in the interview and why I talked about research, because they felt I "didn't understand the profession." 👀 This attitude is a problem to me. I believe it has cost us in terms of reputation and legal scope of practice -- ex: I certainly don't see people arguing about whether PT is legitimate or defined by its pseudoscience, and although our roots are in mental health most states don't actually name us as qualified mental health providers.

Sorry, you didn't ask for that big long explanation. 😅 It's something that's bothered me for a long time -- this pervasive idea that understanding science and being a clinical OT have to be two completely separate things.

 

[Sanman]

Wow, this is quite the perspective. I see what you're saying, and maybe that would sound good to another profession... but getting a PhD in another discipline is not viewed as "leaving" by the OT profession. It's normal because there are so few OT PhD programs. Most profs in an OT department will have master's degrees or professional doctorates. The ones with PhDs often have them in psychology, counseling, engineering, rehab science, education, gerontology, or leadership.

We're a field that has lagged behind when it comes to research. When I was applying to OT school, one brand new program nearly rejected me because of my interest in research, according to the admissions staff -- I called to check on the status of my application and was asked what happened in the interview and why I talked about research, because they felt I "didn't understand the profession." 👀 This attitude is a problem to me. I believe it has cost us in terms of reputation and legal scope of practice -- ex: I certainly don't see people arguing about whether PT is legitimate or defined by its pseudoscience, and although our roots are in mental health most states don't actually name us as qualified mental health providers.

Sorry, you didn't ask for that big long explanation. 😅 It's something that's bothered me for a long time -- this pervasive idea that understanding science and being a clinical OT have to be two completely separate things.

There is plenty of pseudoscience and crappy care to go around. Seen it all during my sub-acute rehab/ltc days. More power to you if you don't want to be a part of it. That said, I really am not that familiar with the background of academic OTs. All I can say is good luck and consider whether you want to take the next step. It does not sound like there is a straight forward path here and there may be considerable risk in jumping into a PhD vs getting a job in research or the AMC environment.

 

[cara susanna]

Hi, it's been FOREVER since I posted on this message board... missed y'all. 🥰

I completed my master's in occupational therapy, have been in practice for a few years, and now I am seriously thinking about PhD studies. I enjoy research and the university environment, and I can envision myself as a professor in a health sciences program. Alternatively, I'd be interested in a leadership role at a hospital or non-profit, perhaps coordinating research or being involved in clinical education -- but as you can tell, I'm not 100% sure what that role would look like, and I'm not as versed on what PhD opportunities exist outside academia.

Anyway, I am not sure exactly what program to apply to! There are very few "occupational therapy" PhD programs. My program was not heavy on mathematics or biomechanics, so my research was more qualitative in nature (think: surveys, interviews, personal narratives/ethnography) vs. quantitative/typical biomechanics research (I was not in a lab placing sensors on people's skin or doing stuff with computer programming or imaging, which is what a lot of programs seem to be looking for).

I am wondering if I should pursue a degree in public health, psychology, education or... something else? I am not entirely sure how to best sell my skill set. I feel I can definitely contribute to my profession as a researcher, but I'm a little disadvantaged from not following a more quantitative path. ☹️ So anyway, please help!

I just wanted to say hi because I remember you and especially your username.

 

[futureapppsy2]

Re: sensory issues. I agree that there's not good empirical evidence for SPD as typically defined or the related, non-evidence-based therapies that are often used, but I do think there's a real need for research on addressing sensory issues that goes beyond the psychological standard of "just make them habituate to it". I have sensory issues when it comes to loud, high-pitched sounds--fire alarms are literally physically painful for me--probably due to some combination of pre-natal/neonatal brain injury and being born at 26 weeks (there's some compelling evidence that earlier preemies tend to have sensory issues because their nervous systems are exposed to stimuli outside the womb before the nervous system has developed adequately). People always assumed I was "just scared" of the sound, and to this day, people don't seem to get that I was scared of it because it was/is incredibly painful for me. It's why I cringe when I see ABA colleagues treat sensory sensitivities as a matter of "just expose them to it, and they're be forced to tolerate and eventually habituate to it."

 

[borne_before]

Re: sensory issues. I agree that there's not good empirical evidence for SPD as typical defined or the related, non-evidence-based therapies that are often used, but I do think there's a real need for research on addressing sensory issues that goes beyond the psychological standard of "just make them habituate to it". I have sensory issues when it comes to loud, high-pitched sounds--fire alarms are literally physically painful for me--probably due to some combination of pre-natal/neonatal brain injury and being born at 26 weeks (there's some compelling evidence that earlier preemies tend to have sensory issues because their nervous systems are exposed to stimuli outside the womb before the nervous system has developed adequately). People always assumed I was "just scared" of the sound, and to this day, people don't seem to get that I was scared of it because it was/is incredibly painful for me. It's why I cringe when I see ABA colleagues treat sensory sensitivities as a matter of "just expose them to it, and they're be forced to tolerate and eventually habituate to it."

Whoa! Given your age (I guess around 30), that was the edge of survivability... I have about a million q's for you.

 

[borne_before]

I have sensory issues when it comes to loud, high-pitched sounds--fire alarms are literally physically painful for me--probably due to some combination of pre-natal/neonatal brain injury and being born at 26 weeks (there's some compelling evidence that earlier preemies tend to have sensory issues because their nervous systems are exposed to stimuli outside the womb before the nervous system has developed adequately).

Premies often have low frequency hearing loss from the hum of medical equipment!

 

[Chanandler Bong]

It's why I cringe when I see ABA colleagues treat sensory sensitivities as a matter of "just expose them to it, and they're be forced to tolerate and eventually habituate to it."

Yeah, ABA is so hated by autistic people that have experienced it that I wouldn't dream of recommending it.

FWIW a typical OT response is going to be more common sense. Ex: Person hates a workplace noise (the fire alarm)? Make a plan for what to do if/when they encounter it (employee can access ear muffs/ear plugs for fire drills/fire emergencies), and otherwise avoid the noise (person is notified of fire drills ahead of time and can go outside before the drill/person can demonstrate exiting the building along the proper route while the alarms are not going off). Making someone experience the alarm over and over would be kind of mean and stupid.

 

[futureapppsy2]

Whoa! Given your age (I guess around 30), that was the edge of survivability... I have about a million q's for you.

33, but sure! Happy to answer whatever.