Preparing for a Fieldwork Rotation in Mental Health

Lindsey Hoffman

My first level II fieldwork rotation was in a psychiatric day treatment program, a challenging and exciting place to learn about the value of occupational therapy in mental health. I went into the rotation with knowledge of common psychiatric diagnoses, medications and their side effects, psychosocial frames of reference, group dynamics, and safety considerations. These are all important things to know; however, there was so much more to this experience than could be learned from a class or textbook. Here are some tips to keep in mind during a mental health fieldwork rotation:

Look Beyond the Label

Clients may arrive in both inpatient and outpatient mental health settings with psychiatric diagnoses such as depression, bipolar disorder, PTSD, or schizophrenia. While these diagnoses can provide some information about the challenges the client may be facing, it’s best to leave preconceived notions about these labels at the door. For example, prior to fieldwork, I had heard the common misconception that people with Borderline Personality Disorder (BPD) are “manipulative.” Upon getting to know people with this diagnosis, I found that what could be perceived as manipulation may just be a way for the person to meet their own needs or cope with emotional distress. As OTs, it is our job to provide holistic care - to get to know the person for who they are, what they want to accomplish, and what environmental and contextual barriers may be preventing meaningful engagement. A person is so much more than their diagnosis and it’s important that we focus on every client’s strengths and interests in order to provide client-centered care.

Trauma-Informed Care is Essential

The majority, if not all, of the clients I interacted with during my rotation had experienced some form of trauma or intense emotional distress in their lives. Some dealt with heartbreaking loss, some experienced homelessness, others had experienced abuse. It was important to maintain a trauma-informed lens in all my group therapy sessions, which meant providing a safe environment for clients to be vulnerable, empowering clients to make their own choices about their treatment, being aware of potentially triggering situations, and providing strategies for managing triggers. Sensory strategies are especially important techniques that occupational therapists can teach clients to manage distress. For example, it was important to have a sensory bin available in every group therapy room and to explain the benefits of using tools such as weighted blankets or stress balls in distressing situations. By providing deep pressure stimulation, these tools calm the nervous system and reduce anxiety. 

Keep Treatment Occupation-Based 

As soon-to-be occupational therapists, you bring a unique perspective to the mental health team. You understand the health benefits derived from engagement in meaningful activities. Don’t be afraid to incorporate this concept into all your group therapy sessions. Many of the groups offered at the day treatment program, which were run primarily by licensed mental health counselors, were discussion-based. While this provides a great space for clients to talk through their thoughts, feelings, and challenges, it’s also important to incorporate other activities throughout the day. Groups focused on occupations such as meal preparation, leisure exploration, or employment readiness are essential for helping clients transition back into independent, fulfilling community living. You can also play a role in helping clients explore new coping strategies and wellness activities. For example, I often incorporated dance sessions, mindfulness, yoga, and social activities into my Coping with Depression group, and witnessed how much it increased mood and engagement in therapy. 

Familiarize Yourself with Common Psychotherapy Interventions

“How can we reframe this thought?” “Is it possible you’re catastrophizing?” “How would the wise mind respond to this situation?” These were common phrases I heard daily at the day treatment program. All of them stem from psychotherapy, a type of mental health treatment that emphasizes the development of effective coping skills and habits. One of the most common forms of psychotherapy is Cognitive Behavioral Therapy (CBT), which is focused on changing patterns of thinking or behavior. CBT language was used throughout the day, both in and outside of groups, at the day treatment program, so I found it especially important to research CBT techniques and to apply them in groups. During my fieldwork experience, I utilized the website Therapist Aid, which has great worksheets to breakdown psychotherapy concepts and provide a great jumping off point for conversation among group members.

Prioritize Your Own Mental Health

As the saying goes, you cannot pour from an empty cup. In order to take care of others, it is important to take care of yourself first. I found it absolutely essential to find ways to process my fieldwork experience and to dedicate time to self-care. Journaling is one useful strategy to process the feelings that came up during my rotation, especially in a setting so focused on emotional health. It’s important to utilize your own self-care strategies, not only to maintain your own mental health, but also to model these skills for your clients. For example, spending time in nature, meditation, yoga, and drawing are all self-care skills that I use regularly and that I practiced with my clients during group therapy sessions.

Keep an Open Mind

Adaptability is important in every OT setting, and mental health is no exception. Every day will be different, some days will be challenging, but the experience will be extremely rewarding if you keep an open mind and heart. If you’re on the fence about taking a rotation in mental health, I highly recommend it. Mental health is a part of every single person’s human experience, so it will come up in every setting you work in. The skills you learn in this setting will serve you well wherever you end up on your OT journey.

Lindsey Hoffman, MSOT, OTR is an Associate Editor of AOTA’s OT Student Pulse. She is a recent graduate of the entry-level master’s program at Tufts University in Boston, MA and is currently working in skilled nursing in Portland, OR. Her interests are in community-based practice, geriatrics, and mental health.