Occupational therapy: Holistic approach

In the UK, neither psychotherapy nor counselling are regulated professions or protected titles. In fact, as the law stands, anyone can call themselves a “counsellor” or “psychotherapist” without holding a qualification. There is no legal requirement to be a member of a professional body, either. There is also no restriction on a person setting up their own psychotherapy training school, or even creating their own professional membership body.

Despite the efforts of several counselling and psychotherapy membership organisations to change this, the unfortunate reality remains.

Occupational therapy, however, is different. It is protected by UK law. It is illegal to use the title unless a practitioner holds a Health and Care Professions Council (HCPC) recognised, regulated university qualification, and is registered with the HCPC (HCPC, 2025).

Interestingly, in several states across Canada, psychotherapy is classed as a controlled act, where it is illegal to practice it without belonging to a protected title profession. In Canada, occupational therapists are among the five regulated professions who are permitted to deliver psychotherapy within their scope of practice (Marshall et al, 2022). Increasingly in the UK, more and more occupational therapists (OTs) are working independently in roles using psychotherapy, counselling and coaching.

This article intends to explain what mental health occupational therapy is and how a holistic psychotherapeutic approach is used within it.

What is occupational therapy?

There continues to be a lack of awareness of just what an occupational therapist does, not merely by the general public, but also within the wider counselling and psychotherapy community. Unless you have either worked directly with mental health occupational therapists or you have been a patient/client, then you may not know the value of what they do or how they practice.

Ask several people what they think occupational therapy is, and they may answer that it has something to "do with work" (admittedly, the title 'occupation' can be slightly misleading), or it is "something like physiotherapy", etc. In fact, I witnessed this lack of awareness recently, when one of the leading UK counselling and psychotherapy professional bodies (regulated by the Professional Standards Authority) informed me that they do not accept “occupational health” qualifications as part of their membership criteria. This open lack of knowledge, between two completely different and distinct professions, by a PSA regulated professional membership organisation, is profoundly concerning, yet may reflect a wider lack of awareness. It highlights that there is still much work to be done in terms of information around the role of the occupational therapist within mental health. In addition to how psychotherapy and counselling are embedded within its practice.

At the heart of occupational therapy is the use of individual, purposeful, and meaningful activity and this is used within sessions to scaffold and integrate psychotherapy. So, for example, activities can range from expressive art, cooking, self-care, exercise, social skills, gardening, music, etc. The list and potential are endless.

At the core is the use of Kielhofner’s Model of Human Occupation (MOHO) (Taylor, 2017), which acknowledges that, as people, we all need to be engaged in activities (occupations) which hold importance to us. For example, there would be no point in using football as an activity during therapy if someone has no interest in it. Activities used therapeutically have to hold a personal meaning, relevance, or be of value to the individual.

If we don’t (or can’t) participate in meaningful occupations for any reason (including mental or physical illness), then this will directly impact our ability to engage in a life worth living, which in turn makes any condition or struggle worse. Occupational therapists play a crucial role in preventing relapses and hospital re-admissions, ensuring that people are supported both physically and emotionally in all they do.

Training and regulation

It is also important to understand how occupational therapists are educated. Training is a minimum of three years full-time undergraduate study at an approved university (i.e. Monday to Friday, 9am-5pm). Part-time courses can last up to six years, and there is also an option to complete a two-year full-time post-graduate MSc, for those who hold a degree in a relevant field (i.e. Psychology, Sociology, Biological Sciences, etc) (Royal College of Occupational Therapists, 2025).

Education is designed to treat the whole person in terms of mental, physical and spiritual health. In addition to university attendance, students are required to complete a minimum of 1,000 hours’ practice placements with direct supervision of patients/clients across a range of different mental and physical health settings. Only students who are deemed safe and ethical to practice can graduate. Therefore, an occupational therapist’s starting point training is robust, holistic, and adheres to the highest professional standards.

Who can benefit from occupational therapy?

Occupational therapists are highly educated, regulated professionals who work across both physical and mental health settings, including hospitals, clinics, GP surgeries, hospices, schools, the community, social care, charities, prisons, private practice, etc.

They work with all ages right across the lifespan, from children to the elderly. In mental health settings, occupational therapists are trained to help people experiencing difficulty arising from challenges at any stage (i.e. ranging from acute care needs to more enduring life-long conditions) to overcome personal challenges and live meaningful and purposeful lives, in the present moment, underpinned by hope.

The origins of psychotherapy and counselling in occupational therapy

Occupational therapists have always practised psychotherapy. There is much published evidence of this dating back to over 100 years when the profession first emerged (Marshall et al, 2022; Mandzuk and Wener, 2025). In fact, occupational therapy has its origins within mental health. It is firmly underpinned by the person-centred, humanistic and existentialist traditions, both of which are rooted within many wider-scale current counselling and psychotherapy modalities (Fried, 2023).

Common psychotherapy modalities used by occupational therapists

Alongside the Model of Human Occupation and the humanistic tradition, many mental health occupational therapists will have further post-qualifying training in a range of psychotherapeutic approaches, which are embedded into their practice. These commonly include modalities such as:

• cognitive behavioural therapy (CBT)
• dialectical behaviour therapy (DBT)
• acceptance and commitment therapy (ACT)
• motivational interviewing (MI)
• compassion-focused therapy (CFT)
• solution-focused therapy (SFT)
• transpersonal approaches, including mindfulness

Many will integrate these with a holistic humanistic approach, which is client-centred, aimed at achieving the self-actualisation they need (i.e. fulfilling their potential in life in the present time, whilst addressing past traumas and difficulties). Goal setting (i.e. the use of SMART goals) is therefore important, as a sense of accomplishment feeds into our own self-worth and self-efficacy (i.e. knowing what we can do well).

Mental health occupational therapists also work within a trauma-informed perspective and may have undertaken further specific training. For example, evidence-based approaches like EMDR and Flash Technique are frequently employed as an adjunct which complements a holistic, trauma-focused occupational approach.

Examples of how mental occupational therapists may work using psychotherapy

Within mental health, trauma, PTSD, and complex PTSD always impact on a person’s ability to perform meaningful activities. An occupational therapist will assess the person to see which activities of daily living or occupations are being impacted by their traumatic experience.

For example, sleep may be the occupational focus to start with, within sessions. It is commonly disrupted when a person is traumatised (including nightmares, getting to sleep, staying asleep, or early morning waking). Sleep is a basic physiological need. Abraham Maslow, who is central to the humanistic tradition, which underpins occupational therapy (Fried 2023), addressed this in his hierarchy of needs. It is at the root of all we do whilst awake and can seriously impact a person’s psychological and physical recovery. Therefore, a patient/client may seek therapy to help alleviate and/or reprocess their trauma symptoms, but the occupation they also need to work on at the beginning is how to achieve restful sleep, so they can start to feel better and start to engage in other areas of their life.

Alongside working on the trauma, an occupational therapist may visit the person at home, assess the physical sleep setting, advise on sleep hygiene, aids, and help the person to establish a healthy sleep routine via psychoeducation. They may employ CBT techniques (i.e. the sleep restriction method) or via a structured process, which I discuss in my book, the 4 Step Morning Routine (Foulder-Hughes, 2023). Once a more beneficial sleep routine has been established, an occupational therapist will then work with the person to address other aspects of their lives that the trauma is impacting upon, and help them to set goals within an occupation-focused framework. The overall goal is not only to help the person overcome their trauma, but to become more autonomous and empowered in all they do in life.

Achieving post-traumatic growth (PTG) is an important part of an occupational therapist’s work, enabling a person to find out what really matters to them and how to move beyond their trauma using occupation. People who have experienced significant trauma, depression or anxiety frequently have low self-worth and lack the belief in life that they can achieve the things they want to, or need to. Post-traumatic growth is about exploring the potential a person holds, turning their traumatic or impactful experience into a powerful positive agent for change, so that they can achieve the things they need (Foulder-Hughes, 2023). For example, a survivor of sexual abuse or violence may decide to write about their experience to help others, or want to set up a support group, or even a charity following their recovery. An occupational therapist can help them set the goals they need to achieve their aim of post-traumatic growth and how they move into a more positive future, where they can fulfil their potential in life.

Occupational therapists also work with children within mental health and psychotherapy settings. For example, a neurodivergent child may seek occupational therapy following a negative school experience, or bullying, which has resulted in them feeling anxious, depressed, “different” or isolated from others. Firstly, an occupational therapist will build a trusting relationship with the child and their family; this is crucial, especially if there is school-based trauma and a learned experience of not being protected, seen, heard, or supported by adults (i.e. teachers). They will then really listen to the child and what matters to them to help them process and make sense of their experience in a meaningful way.

An occupational therapist will work with the child to build healthy self-esteem; address any sensory or motor difficulties they may have which impact on mood regulation, perception, or tasks (i.e. using sensory integration techniques); explore the use of different activities and play that are both enjoyable and meaningful to the child, whilst also introducing new and unfamiliar activities in a safe way; work on emotion and self-soothing regulation (i.e. DBT and sensory integration strategies); help them to reframe their own negative self-perception (i.e. CBT strategies, and the use of graded task accomplishment); teach mindfulness and relaxation techniques to help control anxiety.

The most important goal is to find out what children can do rather than what they cannot, and what they enjoy doing. Being able to enjoy things in life and to have positive experiences helps to set more meaningful and hopeful ways of being, and they are lifelong strategies. In fact, a common strategy in DBT is to build pleasurable experiences every day into a routine, which occupational therapists can support them with.

Crucially, an occupational therapist can help the child to discover what their passion is in life, which in turn instils a sense of purpose, meaning, and hope; whilst helping them to develop self-efficacy and build social and emotional resilience skills (Foulder-Hughes, 2023). Within this framework, the occupational therapist will also work with both the school and the family, so a more holistic and integrative approach is taken across all settings. This, in turn, supports the child’s wider social, emotional, behavioural, and cognitive needs.

The above are brief examples of how occupational therapy may be beneficial and used within psychotherapy roles.

Why we need more talk about occupational therapy

As more occupational therapists are now working in independent practitioner roles within psychotherapeutic settings, it is important that the public have knowledge about how they may benefit from their services if they are seeking counselling or psychotherapy.

Occupational therapists are highly skilled, regulated mental health practitioners who are competent in the delivery of psychotherapy within their scope of practice. They play a vital role in helping people to participate in purposeful and meaningful activities which directly impact mental well-being. Their holistic role within psychological health settings is often poorly understood. Greater awareness is needed about their positive contribution and impact within mental health, by both professionals and the public alike.

So, the next time you encounter an occupational therapist helping a child make a clay model, a person with depression baking a cake, a teenager walking in nature, or an elderly person being taught how to knit, remember there is much more purpose and meaning occurring right across mental, physical and spiritual domains. All of which are underpinned by core psychotherapeutic approaches, often rooted in complex evidence-based approaches.

So, if you are seeking counselling or psychotherapy, an occupational therapist may be just the professional you are looking for to enable you to address past trauma, process difficulties, set goals, bring hope, achieve post-traumatic growth, and ultimately lead a life worth living.

References:

Foulder-Hughes, L. (2023). REMIND The Prescription of Happiness, Success, and Fulfilment in Life. Austin Macauley Publishers. London. Available at: https://www.amazon.co.uk/Remind-Prescription-Happiness-Success-Fulfilment-ebook/dp/B0BZSN4W89

Fried A (2023). The Humanistic Approach to Occupational Therapy. Cambridge Scholars Publishing. Available at: https://www.amazon.co.uk/Humanistic-Approach-Occupational-Therapy/dp/1527593193#:~:text=The%20core%20of%20the%20book,cornerstones%20of%20the%20therapeutic%20process.

Health and Care Professions Council (HCPC) (2025). Available at: https://www.hcpc-uk.org/

Mandzuk A, Wener P (2025) Occupational Therapists' Psychotherapy Competence: A Scoping Review of Secondary Data. Canadian Journal of Occupational Therapy. Available at: https://doi.org/10.1177/00084174251319768

Marshall CA, Murphy M, Marchior K, Aryobi S, Wener P, White C, Lariviore N, Isard R, Chohan A, Forhan M, Kiepek N, Barbic S, Sarunsky V, Moll S. (2022) Psychotherapy Within Occupational Therapy Literature: A Scoping Review. Canadian Journal of Occupational Therap. 26;89 (4): 376-394. Available at: https://doi.org/10.1177/00084174221102732

Royal College of Occupational Therapists (2025) Start planning your path. Available at: https://www.rcot.co.uk/learn-about-occupational-therapy/become-an-ot/routes 

Taylor R (2017) Kielhofner’s Model of Human Occupation: Therapy and Application. Lippincott, Williams and Wilkins. Available at: https://www.amazon.co.uk/Kielhofners-Model-Human-Occupation-Application/dp/1451190344