From “power over” to “power with”: Alternatives to the occupational therapy white coat ceremony

Occupational therapy is all about connecting with people to empower engagement in daily activities that bring purpose and fulfillment to their lives. It’s a unique profession that prides itself on being holistic, client-centered, and collaborative. As OT students, we’re taught to focus on building strong therapeutic relationships with our clients. This dynamic, often described as a “power with” approach, contrasts sharply with the traditional “power over” hierarchy existing in many health care professions, where the practitioner dictates the patient’s treatment.

So, where do white coats fit into this picture? The answer became clear when reflecting on our fieldwork experiences.

Why the White Coat Feels Out of Place in OT

The white coat has a long history rooted in the medical model. Initially black, it became white in the 19th century to symbolize cleanliness during a time of poor hygiene. Today, it’s a powerful symbol of authority in health care (Marques Caetano Carreira et al., 2021). While this might work well in hierarchical fields like medicine, OT thrives on collaboration.

Many students have seen the tension a white coat can create. For example, Brooke shadowed in an inpatient hospital wearing scrubs, similar to a majority of other health care workers. A nurse commented on how approachable she seemed to patients, saying, “You don’t look intimidating, and that helps people open up to you.” It made us question: Would that interaction have felt different if she’d been wearing a white coat?

The Problem With “White Coat Syndrome”

For some patients, white coats symbolize more than authority—they represent anxiety and even fear. White coat syndrome refers to the spike in blood pressure some people experience around health care providers in white coats (Hochberg, 2007). Many of us have likely felt that nervousness during physician visits.

When we consider the core values of occupational therapy—empowerment, inclusion, and creativity—it becomes evident that shifting away from the traditional medical model toward a more holistic approach allows us to build stronger relationships with our clients and better align with our profession's principles. A ceremony that reflects these values can further emphasize our commitment to client-centered care and collaborative practice. Emily was completing fieldwork at a skilled nursing facility and recalled a client hesitating to share concerns with her physician about her hip replacement recovery, saying, “Well, no, they don’t want to know all that.” It made us wonder: If we also wore white coats, would clients feel as comfortable sharing their needs with us? We are a holistic, diverse profession, not only guided by the medical model.

What Makes OT Unique

Occupational therapy stands out because it thrives on human connection. Whether leading group activities with older adults or collaborating with pediatric clients on crafts, we’ve seen how occupational therapy fosters trust and rapport. The white coat, with its rigid formality, feels at odds with the warm and collaborative nature of our field.

This was evident during Cole’s outpatient clinic experience, where therapists wore casual business attire or scrubs. Their clothing reflected professionalism without sacrificing personality or functionality. Dressing for comfort and flexibility is essential when transferring clients or working on the floor in a pediatric setting. What we wear should support—not detract from—the relationships we build with our clients. Our diverse uniforms, which adapt to various settings and needs, highlight the flexibility and versatility of the occupational therapy profession while demonstrating our commitment to individuality, adaptability, and approachability.

Reimagining the White Coat Ceremony

Ceremonies have historically been used to mark significant milestones, celebrate achievements, and bring communities together (Isaacs, 2017). For occupational therapy, the ceremony celebrates students' academic achievements, marking their transition to clinical practice. Recently, this has sometimes been marked by the white coat ceremony. The question is, do white coats really represent us as occupational therapy practitioners (OTPs)? What if we reimagined this tradition in a way that better aligns with our values and reflects our diverse profession?

Here are a few ideas:

• Athletic Jacket Ceremony: Celebrate adaptability and movement with sleek, branded jackets.
• Blue Coat Ceremony: Honor OT history with blue, a nod to World War I’s “Bluebirds,” some of the first occupational therapists (Pettigrew, et. al., 2016).
• Scrub Top or Jacket Ceremony: Highlight the practicality of what we wear in practice.
• Stole Ceremony: Stoles, historically used to recognize honor or achievement, can be used in OT to symbolize students' dedication to academic excellence, leadership, and the profession's core values
• Professional Pinning Ceremony: Pins symbolize our journey in a subtle, meaningful way.

A Personal Challenge to Fellow Students

As future OTPs, we have the opportunity—and responsibility—to shape the identity of our profession. That means questioning traditions like the white coat ceremony and advocating for alternatives that may better align with our principles.

For us, choosing to move away from the white coat is about more than attire. It’s about embracing what makes occupational therapy special: our focus on connection, collaboration, and empowerment. So, let’s celebrate who we are in a way that truly represents us.

Whether you’re just starting occupational therapy school or preparing for fieldwork, we challenge you to think critically about what symbols represent your identity as a future OTP. Together, let’s build traditions that reflect the values we bring to this incredible profession.

Brooke McKeon is a third-year Occupational Therapy Doctorate student at Western New England University in Springfield, MA. She is passionate about advancing mental health, primary care, research, and academia within the field of occupational therapy.

Sarah Brokus is a graduate from the Drake University Occupational Therapy Doctoral Program and currently an Occupational Therapist at MercyOne in Dubuque, Iowa. Sarah is passionate about pediatrics and mental health as well as advocacy for both her patients and the field of occupational therapy.

Emily Labrie is a third-year Doctor of Occupational Therapy student at Western New England University in Springfield, MA. Her professional and educational interests lie in the areas of adult rehabilitation, oncology, first responder mental health, and academia.

Cole Brockman is a second-year Occupational Therapy Doctoral student at Drake University in Des Moines, IA. His areas of interests include industrial rehabilitation, ergonomics,  hand therapy, and academia.