Understanding the Role of a Mental Health Occupational Therapist
- Juanita Gnanapragasam
- Jul 23
- 6 min read
Welcome to our newest monthly blog ‘Ask an Occupational Therapist’ which attempts to answer all of your🔥 burning🔥occupational therapy-related questions.
In our first blog post, we wanted to start with some introductions! Let's start with me: my name is Juanita Gnanapragasam and I’ve been an Occupational Therapist (OT) for just over three years. If someone typed my name into a search engine, it was probably because they were looking for something like… “Creative therapy ideas for adults with mental health challenges;” “OT who gets neurodivergence and real life;” “help making sense of my values, goals, and messy feelings;” “group therapy that’s actually useful and not awkward;” or “what to do with my life or time?”
I work with individuals (8 years old and above) and especially love helping first and second-generation Canadians, young adults, and neurodivergent folks. I also use Accelerated Resolution Therapy (a trauma therapy that started under the auspices of Eye Movement Desensitization and Reprocessing, or EMDR) to help clients overcome specific sensory and trauma-related events that are getting in the way of their overall wellbeing and engagement in the community. In my practice I blend deep emotional insight with flexible, tangible strategies to help clients spend time on things that matter. Basically, I’m an OT that LOVES helping people figure out how to occupy themselves well.
What does it mean when I say I'm a Mental Health Occupational Therapist?
Depending on your lived experience, you might have worked with an occupational therapist before. Based on the setting or clinic, an OT works in (especially in physical medicine), their practice can look very different. Some OTs support the utilization of mobility aids, and others provide healthcare interventions like splinting and wound care. Situated in mental health therapy practice, as I am, means that I'm focused on a client's psychological and emotional needs first and foremost, with their physical wellness taking more of a backseat. Regardless of the setting, all OT's share the common thread of getting individuals back to doing the things they love.
While "what occupies you?" is a question that most of us don't think about all that much, that's what OT is all about! What gives a person meaning? What sensory experiences affect their day-to-day life? What gets in the way of them doing the things they care about the most? These questions are important to mental health Occupational Therapists in particular because they offer therapeutic services that enhance how a person “occupies” or spends their time in order to promote health and wellbeing on a more holistic level. As a mental health OT, I want to know: "what does a healthy, happy, thriving life look like for my client?" Especially important in my role is understanding what the client would be doing in that ideal life. That means delving into activities that give the client meaning and purpose--like social relationships, leisure pursuits, employment, schooling, self-care--and bringing them closer to their vision of psychological and emotional wellbeing.
During sessions I don’t just listen for content, I listen for patterns, emotional subtext, and unmet needs to understand what’s getting in the way of living the life the client wants to live. Then we work together to treat the barriers and learn new skills to accomplish the goals the client sets out for themselves. I like to think I bring a designer’s mindset to therapy. I’m constantly creating, adapting, and testing new tools to meet people where they’re at. Recently I completely nerded out over building a vegetable-themed version of the game 'Werewolf' to help teach neurodivergent folks social skills. I spent an evening rewriting the rules so no one "died," the missing vegetables became part of a soup, and every card had a role tied to the kitchen ecosystem.
What does a Mental Health Occupational Therapist actually do?
At YEG Family Counselling, Occupational Therapy is practiced as a goal-based therapy. Some clients will work on multiple goals at the same time, and some like to focus on a single goal. We've broken the process down into steps, the duration of each varying for every individual. The process is also highly collaborative, with the therapist working closely with the client to honour their journey, and ensuring a personalized approach.
Step 1: The first step is to understand what the client's goals for “occupying” their time are. Things like trauma and changes in one's environment or life circumstances--like medical or psychological diagnoses--can throw a curve ball at a client's ability to to do the things that matter to them. So, in our first session I do an informational interview that helps me to get to know the client, their journey, and their goals, all while the client also gets to know me.
Step 2: Next, the client and I work together to identify the block to accomplishing their goals. We do this through psychological assessments and therapeutic approaches. Common blocks include previous traumas, experiences of neurodivergence, or even the environment the client currently finds themselves in.
Step 3: Once the block has been identified, we treat it with therapeutic modalities like Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT), Acceptance Commitment Therapy (ACT), Accelerated Resolution Therapy (ART), environmental modifications, and/or psychoeducation.
Step 4: Lastly, I work with the client to teach them skills and give them a road map to accomplishing their occupational goal. This might look like working together to write a resume and providing the client with psychological support as they navigate the job application process. Or it might involve supportively facilitating a client's participation in social situations by attending a Dungeons and Dragons night with other neurodivergent folks. I would then check in with he client throughout the process until they feel comfortable continuing on their own.
Why might someone choose to see an OT over a Psychologist or Counsellor?
As you notice above, unlike with a Psychologist or Counsellor, psychoeducation and psychotherapy are only part of the work I do with clients. That's because, central to OT, is doing. So whether a client's goal is career exploration, finding balance, fostering relationships, household management, or something else, they can expect homework and some of their therapy sessions to engage in evidence-based activities that help solidify the skills and strategies we're working on.
Here's an example that demonstrates this further. Let's say a client's therapy goal is to be more confident and cultivate self-esteem. A Psychologist might treat the underlying causes of low self-esteem (e.g. attachment issues, previous trauma, etc.) to promote healing and recovery. The OT however, will explore activities with the client that they struggle to engage with because of their low self-confidence (e.g. socializing with new people). Then, the OT would teach strategies to improve self-confidence (e.g. practicing positive self-talk) or modify the activity to promote self-confidence and self-esteem (e.g. supportively attending a social event with the client). Other types of OT approaches might include role-playing, learning a new skill, changing the activity, or modifying the environment to encourage success. Through this process, we might address the underlying causes of low self-esteem and self-confidence, or discover that more work with a psychologist to treat those causes would be helpful.
Because of this difference in scope, folks looking for help in these areas often choose to work with an OT instead of (or alongside) a psychologist:
Deciding whether to pursue further post-secondary education and if so in what field;
Career advising;
Advocating for academic supports in school;
Developing emotional regulation skills;
Understanding how one's brain processes sensory experiences and how that impacts mood and energy;
Support in managing household tasks.
Of course, the above is not an exhaustive list. Lots of individuals seek occupational therapy for a range of concerns that would benefit from some practical, tangible, direct interventions.
Additionally, OT's are often able to conduct assessments that can help individuals understand their struggles and, sometimes, support them in advocating for the necessary workplace or educational accommodations they require to succeed. The assessments I provide include:
Frustration tolerance and how people learn best (e.g. ACLS);
Recovery and hope (e.g. CPROM, QPR, PHQ-9);
Initial screening for cognitive challenges (e.g. MOCA, SLUMS);
Sensory Processing Assessments (e.g. Adult Sensory Profile); and
Goal-oriented assessments (e.g. GAS, COPM)
As with the previous list, we’ve just listed the most common ones and this should not be considered exhaustive. If a client is ever interested in having another type of assessment done, they can always connect with YEG Family Counselling administrative staff to see if I'm able to provide it. As with any assessment, I would discuss the nature of what the client would like to have assessed and how it’ll support their therapeutic goals. Once the assessment has been conducted, I will complete a write-up that the client can share with their other healthcare providers to inform future treatment plans or advocate for necessary supports.
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