Two OT students share their experiences with holistic OT fieldwork.
By Mandy Lubas, OTR/L, RYT, AWC
Editor’s note: This Holistic OT column was written by Kristen LeBlanc, COTA/L, and Amanda Couture, OTA/S.
“Here, you guys are going to be working together!”
This was the first statement we heard while meeting each other for the first time at Ananda Shanti Yoga and Wellness Center in Manchester-by-the-Sea, Mass. With both of our personalities being shy at first, it wasn’t long after that we connected. Quickly, we realized we were like-minded people sharing similar interests, visions with our careers, and of course, Mandy Lubas, OTR/L, RTY, AWC, who gave us the opportunity to be a part of this whole experience. Together, we learned how to work independently and as a team to accomplish the wide array of tasks and challenges requested of us.
As in all fields in which internships are a part of the curriculum, occupational therapy students have the opportunity to practice what’s learned in classes. This experience reinforces the fundamental foundations of the field. Information can be learned through textbooks, but it’s not until we work with clients that the information becomes real.
Up until this point, we’d both learned a great deal about the field in traditional practice areas. Now, working with Mandy, we were offered a chance to learn about holistic occupational therapy, which is an emerging practice area, where we could gain new tools to fill our occupational therapy toolboxes.
What is Holistic OT?
Before getting into our experiences, let’s first define occupational therapy. Occupational therapy is a profession that’s difficult to define because it is such a broad area of practice.
Generally speaking, OT uses a client-centered approach to balance a person’s well-being of function with physical, mental, emotional, and spiritual proficiencies of activities of daily living and instrumental activities of daily living. ADLs include functional mobility, swallowing and eating, self-care, and hygiene, to name a few.
IADLs include job performance, caring for others, shopping, medication and financial management, and being in the community. The objective is to promote the highest level of functional living with adaptations and/or modifications to the environment to achieve a level of independence based upon a client or patient’s goals.
Now, let’s define holistic occupational therapy. This type of OT focuses on “‘traditional” occupational therapy practice but with the emphasis on the mind-body connection. It still remains a client-centered approach striving to reach a person’s functional goals including ADLs and IADLs. It utilizes therapeutic modalities such as yoga therapy to increase a person’s function and independence in daily life, whether it’s treating cognitive disabilities, physical disabilities, and/or mental health.
Holistic OT essentially uses the body’s natural ability to heal itself by using various modalities, such as reflexology, meditation, reiki, bodywork, acupuncture, and chiropractic adjustments. Both holistic OT and “traditional” occupational therapy share common characteristics emphasizing the balance of everyday activities such as work, leisure, play, ADL, IADL, education, exercise, and social participation.
It’s clear to see how these practices go hand-in-hand, addressing the overall well-being of an individual through client-centered practices. Furthermore, it continues to show how these modalities and approaches truly do help attain a client’s specific goals to improve the quality of life in a healthy, meaningful way using measurable outcomes.
Individual Backgrounds
Amanda: Originally, what brought me to the field of occupational therapy was the possibility of working with children in a new capacity beyond my previous work as a teacher/nanny. Quickly, I realized how broad the field is, and started getting interested in other areas as well. Non-traditional settings and emerging areas of practice were of particular interest once I began looking at what other options the field offered. So, when the prospect of doing a level II internship in holistic OT came about, I was all in.
It began back in March 2015 when I decided to attend the Salem State University Occupational Therapy Conference with some classmates from the OTA program at North Shore Community College (NSCC). One of my classmates had met Mandy Lubas and told me that I should go and talk with her. Mandy was there promoting holistic occupational therapy and a program she was putting together for OTs to educate on holistic occupational therapy.
The work Mandy was doing sparked my interest because of my own practice in yoga. I had been doing yoga for a couple years and really saw the benefits of a consistent practice on my overall well-being. Briefly, between sessions at the conference, I was able to talk with Mandy about holistic OT and what she was offering through her training program.
Now, we’ll fast-forward a little to when I was deciding which practice areas to choose for my level II internship. I originally came into this field wanting to work with children. My first preference chosen for level II was pediatrics, followed by developmental disabilities, not knowing that working with Mandy was even an option. When I went for my meeting to discuss my level II options with my internship coordinator, I mentioned my other interests besides OT, one of which was yoga.
I proceeded to tell my coordinator how I met an OT who uses yoga therapy as a way to treat her clients and how I found it fascinating. To which her response was, “Oh, you mean Mandy.” I was shocked my coordinator knew whom I was talking about, and that Mandy currently had a student from NSCC working with her. I changed my mind instantly, and put the internship with Mandy as the primary option and bumped pediatrics to second.
That decision opened up a new door to the world of holistic modalities, with which I fell in love. The reason holistic OT resonates so well with me is because it fits in the category of non-traditional, is an emerging field, and draws upon my passion for yoga.
My internship with Mandy was at the wellness center and also at Well Life Medical in Peabody, Mass. Kristen and I worked together at the wellness center doing marketing and attending yoga classes. At the wellness center I treated clients from Well Life using yoga therapy where we billed insurance as “community.”
In the first couple weeks of my internship, I assisted Mandy with treatment sessions, and then was able to take on my own caseload. The way I ran my treatment sessions was similar at both the wellness center and at the medical practice, but the two locations differed greatly.
Well Life is an internal and integrative medical practice incorporated in the same facility. It is a fast-paced environment with clients coming in for traditional medical purposes working in partnership with holistic services such as occupational therapy, acupuncture, and massage therapy. The wellness center is a quieter environment with clients coming in for Ayurvedic treatments, psychotherapy sessions, and yoga classes. Both locations provided me with a well-rounded learning experience.
Kristen: A couple years ago, I attended a yoga class with Mandy. Unlike the classes I had taken in the past, which were mainly power yoga classes, a faster-paced type of yoga, this class was therapeutic-based. It was a class I wasn’t used to because it worked on mindfulness and body awareness, which was foreign to me.
During one class, Mandy made it slightly more challenging, which the other students were having a difficult time with. She stated, “I’m an occupational therapist, it’s therapeutic, and I won’t let you get hurt.”
When she stated her occupation I was instantly intrigued with her work and how she integrated yoga and occupational therapy as one. I also was shocked to meet an OT in the community, because you don’t come across OTs very often.
At the time, I was just beginning my career as a COTA so it made it more exciting to meet another OT since it’s such a small and unfamiliar occupation. In one class I finally got the confidence to initiate a conversation and introduce myself, saying I was a COTA.
Ever since then, I kept in touch with her. In August, I was seeking a volunteer opportunity relevant to the field in which I already practice. When I asked if Mandy had volunteer work that I could participate in, she said, “Absolutely! I have so many opportunities for you to do and help out with!”
I couldn’t have been more thrilled, because I knew I’d be able to gain knowledge on a whole new perspective of occupational therapy and be a part of building upon this new and emerging specialty.
I graduated from the OTA program at North Shore Community College in 2011 and will soon be starting my bachelor’s/master’s degree at Salem State University in summer 2016. Similar to Amanda, I’ve been taking yoga for a number of years, have seen it in all areas of practice, and have observed the incredible benefits it has for people.
I too, went into the OTA program with the intention to only work with pediatrics, but that changed when I did one of my internships in a skilled nursing facility (SNF) on the short-term rehab unit — the complete opposite, but I loved it. I always wanted to find a new way to provide more for patients through other types of integrated therapy.
Since I was a competitive dancer almost my entire life, as well as a teacher, it led to a passion for movement, or even dance therapy. I’m still very interested in movement and dance therapy to work with the Alzheimer’s and Parkinson’s disease population. Furthermore, accepting this opportunity allowed me to see how I can integrate these treatments and some of the modalities into everyday practice.
Range of Therapies Explored
Within the past two months, we’ve had the opportunity to learn about a number of holistic therapies and modalities at both the Wellness Center and Well Life.
Before working with Mandy, we did not know what Ayurveda was or how to utilize it in OT treatments for clients with a range of diagnoses. We now know that Ayurveda means the “science of life,” and the way we use it in treatments is through lifestyle modifications. We use the Ayurvedic questionnaire to determine the client’s body constitution (dosha), look at their nutrition, and determine whether the client would benefit from Ayurvedic body work.
Abhyanga is one type of body work meaning “rub limbs” in Sanskrit. It is a full-body warm oil massage used to remove toxins from the body. Kristen had the opportunity to experience Abhyanga. It was great to experience the modality in person to gain a greater understanding and be able to explain to others from first-hand experience what it was like.
Abhyanga is beneficial to nourish the mind and body by releasing toxins and bring the body to relieve stress caused by an imbalance. Amanda was introduced to Shirodhara, which translates to “head flow.” Warm oil flows in a steady stream on the forehead to induce a relaxed state. Although the experience was in a teaching setting and wasn’t completely silent, it still was a very calming experience that brought the body into deep relaxation. It is a “vata” balancing treatment with many benefits, including improved sleep patterns, decreased stress and anxiety, and rejuvenation of hair.
At Ananda Shanti, we participated in a Satsang session. In Sanskrit, it means “gathering together for the truth.” It is a gathering of like-minded people who come together for discussions. In other words, it’s similar to a support group where everyone is able to express their feelings and emotions with support and feedback from the group.
Another therapy introduced was Kirtan. Kirtan is structured in a call-and-response format with the leader as the mantra. Its method uses ancient chants and music that quiet the mind if listened to with purpose. Chants are sung in both English and Sanskrit, together as one with the leader, as well as the call-and-response — leader then group.
Yoga therapy and yoga classes involve and have benefits of body awareness, body alignment, flexibility and stretching, strengthening, and relaxation.
Relaxation is also a part of meditation where you quiet the mind and are in the present moment without the focus of the past or future, since our lives are generally always on the go. The majority of yoga therapy and classes we have experienced have utilized “singing bowls.” Singing bowls are also called tuning bowls, which use vibration with various tones and pitches to enhance and deepen relaxation. In turn, they are used for sound healing and balancing chakras within one’s body.
We have also had the opportunity to observe, experience, and use tuning forks. A tuning fork is an acoustic resonator in the form of a two-pronged fork with the prongs (tines) formed from a U-shaped bar of elastic metal. Tuning forks are a form of sound therapy that uses vibrations on certain points to provide a deeper state of relaxation, mental clarity, and brain function, grounding or centering the body. It is also used for balancing the self to relieve stress and integrates the left and right hemispheres of the brain. We experienced the tuning forks in yoga classes, observed use during treatments, and Amanda used a tuning fork on students in a prenatal yoga class.
Craniosacral therapy is another modality we were introduced to, which is a gentle hands-on approach. It is used to release tension deep in the body to relieve pain and dysfunction, strengthen health and performance, and improve the body as a whole.
Success Stories
By using holistic modalities, there have been noticeable changes in clients. The progress is evident and more prominent when the client is willing to make changes and put in the work.
Some clients expect an “instant gratification” fix; however, this type of therapy is not a quick fix and after one session you won’t be going home completely pain free. This is a progressive therapy that takes time and effort, in collaboration with the therapist. Home programs and recommendations are given and it’s up to the patient-client to carry them out and adhere to lifestyle modifications in order to see progress with their own goals.
We have been able to see progress in clients, but they have been small changes since we’ve only been working with clients for two months at the most. One client, whom we’ve been seeing since September, has demonstrated a decrease in pain. There was a report of pain at a level of 7-8 out of 10 and now, in November, reporting 3-4 out of 10 for pain in his back. In one session, the client stated that there weren’t any setbacks in this therapy like there was with other types of therapy, and he feels that it is really working.
Another client who came in for shoulder pain participated in three sessions and decided this therapy wasn’t necessary anymore, due to reporting no pain. Another client, who is in high school, reported feeling more relaxed after a session with Amanda and almost a week later, this client’s mother stated how beneficial the session was in terms of increased relaxation of her son. These are just a few examples of progress seen in clients during the past two months of treatment sessions.
During OT sessions, Amanda has implemented yoga therapy in treating clients with a number of diagnoses including shoulder injuries, neck pain, spondylitis, and executive functioning deficits. She researches the diagnoses of the clients and determines what yoga poses would be beneficial to relieve pain and stretch and strengthen areas of the body affected by the diagnosis.
For insurance purposes, billing codes are required for coverage of modalities in a medical setting. When billing for yoga therapy, Amanda uses the codes for therapeutic exercise, therapeutic activity, and BADLs for insurance to cover the sessions. When documenting treatments, she breaks down yoga poses into simple terms to describe their purpose for functional outcomes and progress.
Our notes are structured in a SOAP note format, customized to specific areas of the holistic therapies and also meeting the criteria for insurance companies. Documentation in this area of practice is not all that different from other practice areas because we are still looking for measureable outcomes related to goals, assessing clients during treatment sessions, and making recommendations and plans for the next session.
Exceeding Expectations
Going into this internship, we didn’t necessarily have expectations because we didn’t exactly know what to expect. For us to fully engage in a new scope of practice, we realized we needed to have an open mind with minimal expectations.
Learning new skills and building an expansive amount of informational/knowledge base to apply to the framework of occupational therapy has been impressive and opened our eyes to a whole new frame of reference. In turn, this experience has surpassed any expectations we could have ever imagined in this profession.
Considering the nature of working with an occupational therapist who is building her business, our experience culminated in a whole lot more than just learning and practicing occupational and holistic therapy modalities. One of the biggest components of our work has been doing administrative tasks such as creating templates for note writing and evaluations, flyers for events held at the studio, and a brochure to promote the yoga and wellness center.
Creating these marketing tools gave us the opportunity to take on a leadership role in promoting occupational therapy and holistic practices in the community. We developed marketing tools for a major event where a world-renowned motivational speaker, medical astrologer, and Vedic Counselor presented a talk on the topic of “Health and Happiness.”
We were honored to welcome Dr. Suhas Kshirsagar at Ananda Shanti. He is an Ayurvedic physician who traveled extensively around the world, teaching Ayurvedic medicine. Dr. Suhas owns an Ayurvedic clinic in California offering Panchakarma, diet and lifestyle consults, to name a few. He has worked closely with Dr. Oz and Deepak Chopra throughout his career. We had a really great turnout at the studio and the presentation was incredible.
Work In Progress
Through participation with modalities, researching, and learning about holistic occupational therapy, this internship had a tremendous impact on our lives due to the diverse types of work we have done. Our views have changed on where we see ourselves as occupational therapists.
Even though we may have slightly different visions of where to practice, we want to continue to demonstrate competence and insight in the holistic therapies using these newly acquired skills and modalities in our future practice. Occupational therapy is such a broad profession and we have the ability to apply holistic therapy treatments in not only one practice area, but in all practice areas. This affords us the chance to integrate what we have learned thus far and to continue learning.
After completing this internship, we would recommend it to students in a heartbeat. The kind of student that we would recommend would be a highly motivated person that has the willingness to learn about occupational therapy in a non-traditional way.
In school, there isn’t a section that brings awareness to the holistic OT area of practice, which makes it less known. We would recommend a student that is willing to take on responsibilities such as researching independently, participating in classes offered at the studio, including meditation, yoga practice, and workshops, as well as working behind the scenes to market and promote this field and specialty. We would also recommend a student who is looking to utilize holistic therapies such as Ayurveda, craniosacral therapy, reiki, and massage therapy, not just the interest in yoga.
This particular internship is a work in progress. Mandy is building her business, and we got to be a part of something developing from the ground up. We were able to see the trials and tribulations of creating something from nothing. It’s an honor to be a part of this process and to be able to build upon the role that we’ve taken on within this experience.
Going into the world as an OT, whether it’s a COTA and/or eventual OTR, our perspective has shifted from “traditional” OT and opened up a whole new door to the “non-traditional” holistic approach of this profession.