Transcending Addictive Systems Through Relationship Building with Kary Gillenwaters, OTR/L

Free Occupational Science 101 Guidebook
https://beacon.by/evolved-living/occupational-science-101-guide-podcast
OS Empowered OT Facebook Group
https://www.facebook.com/groups/1569824073462362/

Kary Gillenwaters, OTR/L:
Blog: https://solidagovc.com/blog
Facebook: https://www.facebook.com/search/top/?q=life%20well%20occupied

Books Referenced on Addictive Patterning/Systems:
The Addictive Organization
Daily Reminders for Living a New Paradigm
The Mindful Family Guidebook: Reconnect with Spirit, Nature, and the People You Love
See Me as a Person

Video/Podcast Transcript in English

Episode Corrections:

• OT for the Advancement of Minnesota Mental Health Services (OTAMMHS) was co-developed between clinician Beth Kessler, OTR/L, and academic/clinician Kristine Haertl, PhD, ACE, OTR/L, FAOTA with the Minnesota Community as a joint effort to expand access and impact of Mental Health focused OT.

• Upon greater reflection, we regret framing the conversation on encouraging OT autonomy and exploration through the metaphor of "offering greater leash" as this framing still upholds an imbalanced power dynamic and we both wish to encourage the development and encouragement of OT practice that is empowering for all outside of hierarchical power dynamics where ever we live, work, play, and grow.  

Key Insights:

• Occupational Science is at the core of OT practice and is used by many other disciplines

• It is important to be aware of the power imbalance that can exist in the relationship between OTs and OTA's and to ensure that all voices are heard in policy decision-making

• Occupational Science can be a powerful tool to help with creative understanding and problem-solving

• OTs in Minnesota have a longer and more focused history on mental health

• OT clinicians need to build relationships with OS researchers in order to better understand how to bring their clinical insights into the academic world

• OTA's and OTR's should be seen as having equal value in the OT community and it is important to crea

Evolved Living Network Instragram @EvolvedLivingNetwork
Free Occupational Science 101 Guidebook
https://swiy.co/OS101GuidePodcast
OS Empowered OT Facebook Group
https://www.facebook.com/groups/1569824073462362/
Link to Full Podcast Disclaimer
https://docs.google.com/document/d/13DI0RVawzWrsY-Gmj7qOLk5A6tH-V9150xETzAdd6MQ/edit

Transcript

Kary Gillenwaters Interview 

[00:00:00] Josie Jarvis: Welcome everyone. It's the latest episode release of the Engaging Occupational Science Podcast. Thank you for your patience in the month of February. It has been a huge occupational disruption completing my degree at the end of January in returning to clinical practice. Full-time. I am on my journey back to occupational balance with this interview being one of the first to sort of Kristen, the new beginnings of the starting stages of transitioning into Spring.

[00:00:31] Josie Jarvis: I'm so excited to share Kary Gillenwaters work with you. So just so you can get some context about Kary. Kary is an occupational therapist, an entrepreneur. Spent most of her life collecting insights from lived experiences and her roles as an addiction counselor, friend, consultant, mother, daughter, wife, educator, and student.

[00:00:53] Josie Jarvis: All of these roles really, in retrospect, were retrospect, began with some variation of, it [00:01:00] was not what I had planned. However, it's the culmination of these roles along with the influence of her current focus transitioning from what seemed. Secondary to a primary partner in her children's education has led to lots of practice with getting comfortable with the uncomfortable and unknown.

[00:01:19] Josie Jarvis: This makes Kary a great representative for what it means to engage with occupational science and her work as an occupational being and as an occupational therapy clinician and educator, as she also works as a field work coordinator.

[00:01:33] Josie Jarvis: It's also been it also has guided her focus in occupational therapy, perfection profession. The learnings from these experiences have led her to her greatest endeavors that are focused more on collective occupational needs. Than individuals alone. Recognizing the interconnection of these occupations requires community level collaboration and attention.

[00:01:55] Josie Jarvis: This combined with her experience in mental health addiction and [00:02:00] relationship-based care has led her to recognize the role of addictive systems, that addictive systems play in how individuals, groups, and communities functions. It is this awareness that fuels Kary's commitment to convening and participating in spaces where being in process as opposed to reaching solid conclusion is expected, welcomed, and celebrated.

[00:02:25] Josie Jarvis: She is such a great role model of what it looks like to embody and include some of the insights of occupational science in the ongoing development of our ot. In the United States and beyond, she is currently enjoying restructuring her time and expectations to make room for more collaborations, projects, and opportunities to foster community connections and honor that full depth and breadth of occupational therapy.

[00:02:51] Josie Jarvis: It has to offer at a collective level. In particular, she looks forward to following the invitation opportunities as they peer. She is [00:03:00] truly an allied stakeholder. We have so many shared goals in building community conversations and finding and exploring new opportunities for occupational therapy and occupational science to grow in the community-based world.

[00:03:14] Josie Jarvis: And I'm so excited to introduce you to some of her passions and insight and work, especially around addictive systems patterning. We did, in reflecting on our conversation, wanted to add that we engaged in this notion of what it means to give OTs. OTAs and our clients a sense of a leash giving some room to play and have that flexibility.

[00:03:37] Josie Jarvis: We wanted to role model again, some reflective practice as well in terms of conceiving finding our Agency and our autonomy as a profession and an active partnership in the liberation and solidarity with the clients that we work with. In, in second ga in second review we just wanted to qualify that, leash might not be the best and most empowering metaphor because if [00:04:00] there's a leash man, there's somebody holding it and.

[00:04:02] Josie Jarvis: Not really the true spirit of building collaborative community equity valuing human rights, where everyone has an equitable equitable seat at the table and is part of our collective problem solving process. We really are invested in creating a ecosystem of liberation that can be enjoyed by everyone, which means actually cutting the leashes, , releasing.

[00:04:25] Josie Jarvis: Leashes. We do not want there to be space for disempowered power dynamics. We want to create consensual and equitable relational healthy systems where everyone feels empowered included to have their own autonomy and rights as part of the world that we collaboratively and messily build together.

[00:04:44] Josie Jarvis: So we just wanted to reflect in framing that the spirit of wanting to create more flexibility and autonomy for OT practice in the systems we work in doesn't mean that long term we want there to be any leashes involved necessarily. So we hope that you understand that and just wanted to qualify that before we [00:05:00] jump in today's conversation.

[00:05:02] Josie Jarvis: I am so excited to leap you in into the society, exciting body of work and what value we can gain when we start thinking relationally. And we start really investing in what it means to adapt to transcend some of the addictive patterning that's fundamental in many of the social systems that we're navigating as OTPs in the current climate.

[00:05:21] Josie Jarvis: Thank you guys so much for joining. Let's jump right in.

[00:05:25] Josie Jarvis: Welcome everyone to March. I appreciate everyone's patience in the month of February. I'm so excited to be rejoining with you guys to introduce some conversation related to infusing occupational science into everyday OT practice, and even looking at how we can start utilizing occupational science, inspiration and terminology and everyday discourse.

[00:05:51] Josie Jarvis: One of the things I'm really excited to discuss with our guest today, Kary Gillenwaters, did I say your name right? You did, yes. [00:06:00] Fantastic. Good. I'm excited to introduce you. One of the things that will be a topic of discussion today is how occupational science is actually a science that's literally for everyone, including other disciplines.

[00:06:12] Josie Jarvis: And it's this amazing invitation that we get to share with every human being and possibly non-human across the globe to help with creative understanding and problem solving and looking at. We can use shared language of some of the struggles that we have in adapting to the modern world to build partnerships and connections across difference.

[00:06:37] Josie Jarvis: And one of the things that we're excited to talk about today too is how challenging it is despite its existence for everyone to get connected to occupational science, to feel empowered by its language, and that we're gonna need to be, oh, almost a little creatively disruptive in figuring out how to create more awareness of the opportunities the occupational science has [00:07:00] to offer.

[00:07:00] Josie Jarvis: But I've certainly been able to join with care and through a shared appreciation and proc occupational science language to start a start building informal partner. That are connected to our roles as OTs , but wanting to build broader community in general to problem solve some of the challenges that we have in the systems that we work in.

[00:07:22] Josie Jarvis: And looking at some of these core human cycles in particular, Kary specializes and looking at the compulsive addictive patterning that can be really encouraged, especially in the United States culture. And that can be a tendency. So bring some awareness to that is something else that we would love to touch on in this conversation.

[00:07:43] Josie Jarvis: So today I'm gonna welcome Kary to introduce her relationship to OT practice and we hope inspire a really fruitful conversation about the value that can be gained from gaining some start, starting to engage with some of these occupational science concepts [00:08:00] in your own life and contemplating what they mean for you in your own practice is being a really important place to start and building occupational science literacy.

[00:08:10] Josie Jarvis: So Kary, welcome. Thank you so much for joining us today. And I thought maybe I can just ask you a little bit about your background as an OT and how you came acquainted with occupational 

[00:08:23] Kary Gillenwaters: science. Sure. First thank you Josie for inviting me. It's always good to have a conversation about this topic with you.

[00:08:29] Kary Gillenwaters: So now we get to have it with a broader community that is extra fun. So yeah, to understand how I came to OT in one way I would describe it as I thought I was heading towards a degree in clinical psychology. When I was in working as an addiction counselor I started that really thinking it would give me the clinical experience of being in counseling cuz you couldn't get a, any kind of real experience with just a bachelor's.

[00:08:53] Kary Gillenwaters: And that I would then go on for my doctorate. While I was there, I learned, wait a minute, what I was really seeing with people [00:09:00] was, what do I do now that X, Y, Z? And it was that awareness and that interest in people no matter what kind of disruption was occurring to their lives. This happened to be addiction and people who loved them or, and codependency and things like that.

[00:09:15] Kary Gillenwaters: That people were needing to figure out how do I reorganize my routines, my habits, what matters to me? So that led me to ot. And then I went went to school for OT and. Loved it. I think like many OTs , but there's so many different things that we could go into, that it's, Ooh. Hard to pick.

[00:09:33] Kary Gillenwaters: But my work has primarily been in pediatrics and or more so geriatrics at all levels. And therapeutic relationships and mental health have always been, I think, at the core of what I do because of where I started in my career as well. And so long story short is I went through some more relationship focused consulting work in my lifetime and then ended up at a point in the pandemic where all these things were [00:10:00] culminating where I needed a big shift in what I was going to do.

[00:10:03] Kary Gillenwaters: And so now I am an accidental homeschooling unschooling mom or life schooler. And I am an entrepreneur who writes a blog about what it means to live a life well 

[00:10:15] Josie Jarvis: occupied. Oh, that's amazing. Okay. I actually wasn't aware of your blog. That's so great. So we'll have to really plug that in the show notes here.

[00:10:24] Josie Jarvis: Sure. Cause I really encourage everyone to connect with Kary's work not just from the, just the pure interest of looking at I don't know how much you talk about the addictive systems and how that kind of patterns in, in your blog. Oh, good. I think that is such a, an important lens to look at, especially here in the United States.

[00:10:42] Josie Jarvis: I imagine it's in other cultural contexts in particular. But I think that having. That lens in the United States can help give us some insight into where some of those disruptions came in and how challenging it is to make transformative change when you're in an addictive cycle, right?

[00:10:59] Josie Jarvis: It's so [00:11:00] compulsive, it's hard to shift and connecting to your work and that you also do really intentional community building. Where your study. So do you mind speaking to you a little bit about your cultural context? Cuz every time I hear about your work, it's so inspiring and exciting in that here in Washington state where I'm at, there isn't really a strong presence or conversation for occupational therapy in the mental health sector.

[00:11:26] Josie Jarvis: There are certainly seeds of that starting. We have an exciting bill before our state legislature right now that would open up Medicaid reimbursement for behavioral health diagnosis, occupational therapy. So if you're from Washington State or supporter, please follow up conversation. Encourage our lawmakers to open up access to this important therapeutic discipline that can be so transformative for the lives of folks with behavioral health and mental illness.

[00:11:52] Josie Jarvis: But you mentioned that in the Midwest, that you guys have been transforming your practice to look a lot more at mental [00:12:00] health from the foundation and more of a justice lens, which I think might be something that's unusual in some of the other states that OTs are practicing. 

[00:12:09] Kary Gillenwaters: Yes. That's one of the things that's got me so excited about the OT Compact is what we're going to learn from each other about what's present and what's missing all around the United States.

[00:12:18] Kary Gillenwaters: But I would say, so I live in Minnesota, which I didn't realize just how lucky I am until I started learning about other states that isn't as much an emphasis. So I had the privilege to study at St. Kate's with several faculty who are very much mental health focused. They also happen to be deeply involved with occupational science.

[00:12:41] Kary Gillenwaters: So that's part of the context for me. Here in Minnesota, we have things like, there's an organization called Autumns OTs for Advancing Minnesota Mental Health Services, where about a hundred OTs who are focused on mental health gather. I think every other month now and talk. So part of that is in Minnesota we [00:13:00] happen to have this longer and more focused history on mental health.

[00:13:04] Kary Gillenwaters: And as a result, our practitioners in this state have more access and just a little bit more comfort level, I think with mental health as a focus. Yeah. So that's part of what's happening here in Minnesota. 

[00:13:15] Josie Jarvis: That's wonderful. Part of my hypothesis is , what I've noticed in these cultural contexts where occupational science has been adopted early on by an occupational therapy culture be that United Kingdom, Australia, Canada, south America, Japan many different cultural contexts that were enthusiastic early participants in the conversations around os.

[00:13:41] Josie Jarvis: My informal gaze appear to be in a good position to take advantage of some opportunities that are just coming to the surface now in terms of having policy interest in funding services to address occupational justice issues, occupational disruption and alienation issues. , [00:14:00] it's like maybe they've had some time to really stew in those concepts and consider, what they might mean in the context that they live in.

[00:14:08] Josie Jarvis: And from that they've been able to take advantage of this concept that I learned in undergrad called critical junctures that sometimes with making big, long-term systemic change, once in a blue moon there will be this opening that happens where there's an open conversation to address an issue.

[00:14:25] Josie Jarvis: For example, we've had gun violence be something that re currently just in this last two years had those critical junctures open up where we can actually create policy and legislative change to fund services to address mental health on a different level. And One of the things that I, one of my goals with this podcast and any of making OS language more accessible is so that OTs , and that includes OTAs. So I'm a proponent of . The OTP terminology is if we can [00:15:00] all get some ownership over some of these concepts and looking on and adopting this lens and building that awareness, it can help us not just understand some of the barriers in the system that we're working with, but also some of the opportunities and we can support each other to create solutions.

[00:15:14] Josie Jarvis: So it should be hopefully inspiring to everyone to see that having some OS faculty and some leadership and community building in the Midwest has enabled building actual infrastructure to address mental health and occupational justice issues here in the United States. So I hope that will register it as an exciting opportunity and win.

[00:15:35] Josie Jarvis: Better to start than now. Having that too, you mentioned that there were some folks that sort of helped introduce you to occupational science more explicitly. And if you can speak a little bit about your in-person experiences with some of these OS disseminators that have been a champion for the development of the science.

[00:15:56] Josie Jarvis: I think it's so important to humanize some of these figures [00:16:00] in that sometimes academia, it feels so distant. Some people I think still. Look at Professors as folks that you're not really supposed to disturb or you're not supposed to talk to. And really occupational science, I think challenges us to equalize the value that every human brings to the table.

[00:16:19] Josie Jarvis: And it's really important to be in partnership with occupational science scientists and also need help disseminating their work. So I just, can you speak to how you got introduced and maybe a little bit about some of these figures and help you to see too, while you're listening to this in the audience, to know that, Kary started in this conversation as a clinician, just like you and as a student.

[00:16:42] Josie Jarvis: So it's not that you have to get a PhD in OS Right to start learning about these words or connecting with OS researchers. They really tend to be very open and welcoming people to talk to as human 

[00:16:57] Kary Gillenwaters: beings. Yes, absolutely. So [00:17:00] I I happened to be part of St. Kate's program right around the time that they started rolling out a dual degree ibel, I believe it was right when they were rolling it out.

[00:17:10] Kary Gillenwaters: A dual degree in OS and ot. So occupational science was a bachelor's degree for a lot of my cohort. And while they were simultaneously earning their master's in occupational therapy, I entered as an entry level person. But because of that and the structure of the classes, we were trying to remember this last night, why is it so familiar to me?

[00:17:28] Kary Gillenwaters: I think part of that was because it was embedded into all of our classes and there were extra assignments for those who were in occupational science. They went deeper in maybe some other areas, but we still got exposure and we, we still were, I think, deeply intertwined together in how we learned.

[00:17:45] Kary Gillenwaters: And so that terminology, Is really at the core of how I see things. And it also made sense for why I entered the profession. If you listen to my why, I was really talking about occupational disruption, occupational alienation, occupational loss. I'm [00:18:00] talking about all these things that I was like, who's dealing with that?

[00:18:02] Kary Gillenwaters: Because medical care is not going to psychology. Alone's not going to, I was trying to figure out who does all the things OT can do all the things. So part of it was this opportunity in being there at a university that had OS and OT as part of their program. Some of the faculty that were there, Dr.

[00:18:20] Kary Gillenwaters: Kristine Haertl, PhD, ACE, OTR/L, FAOTA Linda Buxell Professor Buxell, both of them were heavily involved in the OS stuff and still are to this day, I believe. And and so having the chance to be around them, and I'm still in touch with both of them to this day. In fact, I would say that now there's more of a sense of colleagueship where you notice opportunities for one person.

[00:18:44] Kary Gillenwaters: They notice opportunities for you. Like where are the conversations that you need to bring to one another's attention? That's part of what kind of happens now. 

[00:18:52] Josie Jarvis: I think that's so important. We need to have that dual relationship where it's so important, I think, for us as [00:19:00] clinicians to start challenging ourselves to build relationship with these academics, right?

[00:19:04] Josie Jarvis: It's often structurally very difficult, if not impossible to maintain a. Kind of an embodied appreciation for the reality of the daily clinician once you transition into being a full-time scholar. And you I think that it's a huge advantage that I think it might even be a majority of occupational scientists that are currently in academia got their start as an occupational therapy clinician in some capacity.

[00:19:32] Josie Jarvis: . And that's rare to have a human service discipline where you are really infusing the science with folks that have clinical experience prior a lot of other human services you'll progress through to that PhD level maybe without having an applied field part of it. That's, I always love the metaphor of field biology when it comes to ot, that we have that opportunity to develop in the [00:20:00] context of the field and be responsive to the lived realities of the folks that we wanna support when we give ourselves permission to have that approach.

[00:20:07] Josie Jarvis: But what I wanna connect to and what I think hopefully you and I can be great role models to those that are listening to the podcast. It's very important that we build relationships with OTs cholars from a variety of different standpoints, including OS because they need us as much as we, we need them

[00:20:25] Josie Jarvis: If we're doing our job on the field, I'm hearing your homeschooling mom and a. Fieldwork educator. You're balancing a lot of roles. When we are in our best peak as a clinician and in our own everyday life, , we also don't have the capacity to do a lot of the academic work that's needed to advance our profession.

[00:20:45] Josie Jarvis: Yes. And so figuring out how we can find those points of mutual need and support where we're more successful together than we are separate and working through the tension. I love what you said, that you're in a position not just [00:21:00] to get wisdom and scientific insights from somebody like Dr. Kristine Haertl.

[00:21:04] Josie Jarvis: Remind me of how to say her last name. Okay, perfect. Kristine Haertl, PhD, ACE, OTR/L, FAOTA, you're also finding opportunities for her work to get translated and embedded in the field in some ways. So that's a great example of how we can start building empowering partnerships across the board that really should be like, I think that's part of my role as an OT in so many ways now, is looking for those opportunities and trying to empower everybody around me to express their gifts in a way that can help counter their burnout.

[00:21:36] Josie Jarvis: I've been saying like, OTs are gate openers. We're not gatekeepers. We gotta open up and. Make it feel like more constructive change is possible in a broken system. Because as systems start to transition and change, that's actually what creates those critical ju junctures , with big shifts. Not only is there some sort of destruction or disruption, there's also an [00:22:00] opportunity to respond and to evolve with that challenge.

[00:22:04] Josie Jarvis: And that's actually something that OS has helped me see because it's it's the study of how we evolve to challenges in the environment and how we navigate around. And I'm curious too, because it sounded like you were saying that by starting your education with an OS foundation, it almost let you build what we call an occupational science lens.

[00:22:24] Josie Jarvis: , definitely. How do you relate to that concept of having an occupational science lens and how, is that something that you've noticed evolve 

[00:22:31] Kary Gillenwaters: over time? I think it's core to everything I do. Ultimately it's what guides me to what's the next best thing. If I'm lost and I'm thinking, what is this, what am I feeling right now?

[00:22:42] Kary Gillenwaters: Going back to that terminology is very helpful. It's, I see it as yeah, core and central and and I think it also then helps guide where do those partnerships, where do those opportunities, where do you draw things in? So for example, when I was working. [00:23:00] I was embedded in a team with nurses.

[00:23:02] Kary Gillenwaters: I was the only OT on the team. I learned so much, and I hope they would say the same about occupational therapy and I know that they would is that there was this awareness of how are we such a profession that's so similar and we have many, these points of intersectionality, but we don't really know how we compliment each other very well and what to do.

[00:23:24] Kary Gillenwaters: And so while I was there, I would see opportunities of, okay, I was big in therapeutic relationships. And so I would then reach back out to the faculty and say, what do you think about, should we see if there's an opportunity to study some of the therapeutic relationships and how that impacts things.

[00:23:41] Kary Gillenwaters: You just start building those, inroads or those partnerships or those connections of, Hey here's two professions who benefit from knowing each other. You have a need. They have a need. Let's, put it together. So I would say that's part of what it's done. And then it also I would say too, because.

[00:23:58] Kary Gillenwaters: Different people then know [00:24:00] you, then it leads in even more people of who else do you need? Who else is missing from this conversation? Who would understand things? Dr. Kristine Haertl, PhD, ACE, OTR/L, FAOTA and Dr. Charles Christensen worked together on lots of different things. And so that's how I learned about more about Dr charles Christensen. To me, he was just before, not just, but he was this name on a book that I was like, I see him everywhere. He's in so many of the, these things. I'm lucky enough to have him in Minnesota. And so now I get to have conversations about these things and I get to have just even more inroads into how do we figure out what to do next and how do we build those relationships so we can do 

[00:24:39] Josie Jarvis: yeah. That kind of highlights something that we were just talking to prior to getting into this recording here. Of that I think hopefully up until going into this era, it seems that the mechanism that occupational science has become known is through this six degrees of separation from [00:25:00] Kevin Bacon to OS that you really have to know someone that knows someone, and it was.

[00:25:06] Josie Jarvis: Strategically Trojan Horse in I love, that's a concept from the Dr. Th OTs podcast with Dr. Dr. Khalilah Johnson and Dr. Ryan Lavalley, where they talk about OT Trojan Horsing, where we get brought into a system under, one pretense, which is maybe to address sensory needs or fine motor needs or ADL needs.

[00:25:28] Josie Jarvis: But meanwhile, you've let an occupational therapist into your organization, possibly an occupational scientist. So meanwhile, that OT brain is yes, especially if you have an empowered relationship to occupational science perspective and diverse perspectives. One of the ways that I love to do in engage in occupational science is just to have that l give my.

[00:25:49] Josie Jarvis: Conscious brain, some leash to contemplate the organization that I'm in as an ot. Okay, where are we located geographically? What's the history of this [00:26:00] area? How are these occupational beings connecting? It's the nurses and the social work and what's the role of the janitor? Okay, the activities person has a little bit of a limp today that might be a barrier to them getting to this place on time.

[00:26:13] Josie Jarvis: If you give yourself permission as an OT clinic clinician to inhabit these environments that you're in and looking at 'em like a, like an occupational science, because that's the environment that your clients are in at this moment. You need to understand the context just as much as the client.

[00:26:29] Josie Jarvis: Cause the client is an open system. Exactly. It's taking in that, so what I'm referencing right now is this principle called transactional, which is like a fancy word for the fact that systems have an impact on each other. The fact that I'm breathing in oxygen right now means that my body is impacted by a chemical plant a couple miles away.

[00:26:52] Josie Jarvis: If I'm taking in those chemicals, it's impacting my health. If one of my, if parts of the staff are being like [00:27:00] exploited by horrible payment and labor practices, that impacts me as an OT because clients' rooms aren't clean and they're not getting. Up for meals, so our clients aren't regressing. It's good to start you.

[00:27:14] Josie Jarvis: I think sometimes OTs we start to think about things this way, but then we almost cut ourselves off cause we think, oh, I'm not allowed to do that. Oh, I'm breaking the rules. I'm not allowed to think about this thing. But would you say, Kary, that in some ways having a foundation occupational science allows you to give yourself permission to consider a lot more of the client context than maybe if you imagine if you hadn't gotten introduced to occupational science in some way.

[00:27:42] Josie Jarvis: Like Yeah, I think it would've been harder to give yourself permission to try to understand these 

[00:27:47] Kary Gillenwaters: systems. Yes. I think I didn't realize that was affecting me honestly until yesterday. It was really, as I thought more about being ready to have this conversation with you and doing a little double checking on fact [00:28:00] checking myself and thinking wait a minute, was this not the thing that everybody had?

[00:28:04] Kary Gillenwaters: Those kinds of things that I realized, oh, that is part of the context. And I would say, when I'm listening to you talk about the leash, ugh, I just think the number one thing that you could give any OT to be beneficial in any setting, whether it's paid work, just any team where, wherever you're at, give us leash.

[00:28:24] Kary Gillenwaters: Actually give yourself permission. You, don't wait for somebody else to give it to you. And maybe that's part of what I'm grappling with here is because of who I am and how I'm. I think I've always given myself that because it's what, that's what, how I can view, I can't be effective if I don't have that space because it's, oh, it's really that pausing and noticing and reflecting and now what do I do?

[00:28:47] Kary Gillenwaters: And pause, take it in, notice, try something new. All of that, the whole OT process that is allowing us to be effective and the context, as you said is so huge that I can't not, we can't [00:29:00] not see it. And to not do something about it, I think is painful to our 

[00:29:04] Josie Jarvis: spirit. It's a mind shift in a way that I feel like often in ot, especially in social media, but also in person, lot of things just devolve into these semantic battles.

[00:29:17] Josie Jarvis: Yeah. Which, this might be a tangent. It was one of the things I wanted to talk about with you, because I think that you've been a big champion about trying to help enhance the relationship. The OTs can have OTRs. Can have with OTAs in the us Yes. And I noticed, and I think in the past week there was something from, speaking of Chuck Christensen, I think he's very involved in the occupational therapy journal of Research.

[00:29:44] Josie Jarvis: I think it's what it's called. I'm bad about this. Okay. But very welcome. OT JR is one of the rtr. You're right there journals that you can get a discounted access to. By the way, if you happen to be an AOTA member and you wanna catch up on OT [00:30:00] literature and because I think there's been involvement of some OS figures within the O T J R, I'm guessing that might be a journal that we can find more occupational science research.

[00:30:12] Josie Jarvis: Sure. I am personally critical. So many OT journals are not accessible to clinicians and it's very frustrating. , but it's frustrating. Yeah. Anyway, in that regard, I wanted to cycle into we end up getting into kind of semantic battles all the time. This post that talked about, sorry, transitioning have adding into our acronyms.

[00:30:35] Josie Jarvis: The moniker of OTP, which stands for OT practitioner or I think that's mostly what it means. It might mean OT personnel, but it it equalize. The status when you're sharing information to say, Hey, this information is both for OTs and OTAs. Cause I've noticed in trying to put some initial content that I put out there, unless I [00:31:00] specifically state that it's for OTAs as well, I've had many OTAs that are in, my social media ecosystem.

[00:31:08] Josie Jarvis: Reach out to me and ask if they have permission to engage with the information. Oh, wow. So I personally like having something like OTP wherein one statement. I can be clear that this is for OT as OTRs retired OTs OT academics. It's just nice to have an inclusive language where it's like clear everyone's at the table, everyone's invited.

[00:31:35] Josie Jarvis: We need everyone to be an empowered part of the conversation anyway. I noticed at least in one OTs ocial media group, there was a lot of backlash to introducing the term of OTP. Which I think is a sign that a lot how, OTP has been something in academic literature for I think well over a decade at this point, but it maybe is just getting, awareness in the general clinician [00:32:00] community like ne.

[00:32:01] Josie Jarvis: Many people are like, I'm today years old and I've learned about what an OTP is. Sure. But part of me just had this sense of some of the backlash to the term might be rooted with not wanting to acknowledge the equitable value that OTAs and OTRs have to offer and a vested interest and a power dynamic

[00:32:21] Josie Jarvis: And I think that one of the things that o s, especially with looking at occupational justice concerns is it challenges us to get real about human rights and to say, you know what? All humans have equitable value in our social systems. They deserve to be included in democratic decision making. If we're gonna be very grounded about these values and principles that we claim, we need to put actions behind human rights being a real thing that organizations have to implement, commit to and adapt for the humans that can't fit in those systems so that they have access to rights and opportunities.

[00:32:58] Josie Jarvis: . I thought I would just bring that in [00:33:00] too, to highlight some of the work that you've been doing to help repair some of the relationships that have been damaged with OTAs in our community. Sure. That often feel that they don't have permission to access these spaces or have these conversations. One of my big goals is for OTAs to also feel a sense of ownership and empowerment in learning about occupational science.

[00:33:19] Josie Jarvis: So I, I wanna give you a clap for, to speak Sure. For that in any direction you'd like to go. 

[00:33:24] Kary Gillenwaters: Sure. So one thing when I think about OTPs we've had a lot of d conversation about this with fieldwork students, about just, I think I used to use the word OTR/L and OTA to differentiate, and then somebody brought up, not everybody is an R, they might be only licensed.

[00:33:39] Kary Gillenwaters: I'm like, oh, that doesn't quite work, so we're trying to figure out what is the best, acronyms to do things, and we're talking about ot. When we're talking about ot, we're often talking about OT process. So I've struggled to use OT and OTA even though it's probably more accurate.

[00:33:55] Kary Gillenwaters: But so OTP helps us see the umbrella almost. It's an [00:34:00] OTF that if you struggle with the word, the letter P for some reason, like it's the OT family and that, how do we. How do we acknowledge the whole OT family? And none of us are better than any other, like you said, it's an equitable thing.

[00:34:12] Kary Gillenwaters: And the thing that I've really realized since I've taken OTR/L and O or OTD and OTA students is I think because of my understand, there was a lack of clarity about the role of an OT who's a, r and l versus an OT who is an assistant or an OT assistant. And so I think my understanding of it before, and what I'm finding is if we did, if we actually sent out a survey to say, what do you think the role is for OTA ?

[00:34:42] Kary Gillenwaters: What's the role for OTR/L? I would bet you would find at least 90% of occupational therapy or professionals have an unclear or inaccurate understanding of what our roles are in reality. You put us together, we are a whole new [00:35:00] superpower that I did not even realize because my construct around what it, what each person did was more like an OTA needs OTR/L supervision in order to practice.

[00:35:11] Kary Gillenwaters: They can't treat without that. Then you enter academic people such as Dr. Traci Kruse and Professor 

[00:35:19] Julie Grivna. Who helped me understand. No, Kary, it's actually you're supervising the OT process. Each person has their own license. We all have our own license to practice under it's process. So just that shift in language helped, I think, clarify things.

[00:35:36] And when you see the different focus of each profession or of each role, it's OT is so broad. We almost need And the 

[00:35:45] Josie Jarvis: capacity. Yeah. And the potential. And what I love too, just in this, it was a mere image of that con conversation about, hey, academics need US clinicians just as much as we need them as academics.

[00:35:58] Josie Jarvis: And we, oh man. [00:36:00] It's so clear. As an o, otr, personally. , how much, oh man. COTAs saved my life. Yes. OTAs saved my life on a daily basis. I'm so grateful for them and I have felt this inner drive. I'm not sure how connected this is with occupational science, but I'm certain that there's some sort of anchor point in it.

[00:36:20] Josie Jarvis: But I'm driven to be what I didn't receive. Like my challenge in having a constructive aging process is learning for these systems that. Have been hurtful, that have been painful. Or practices like as a neuro divergent student, for example, when I went into school-based practice, there was this drive, I think that's in most of us as humans.

[00:36:46] Josie Jarvis: , that is I wanna be what I needed in some ways and that in a bad way that can be projection and that can be something to balance out when we're trying to work through our own issues. But that's, I guess that is a good side note of what I like [00:37:00] about working with occupational science and getting back to the theory and core of occupational therapy, is it can be an appropriate way for you to contemplate some of your own challenges and your own occupational balance issues.

[00:37:12] Josie Jarvis: And most of us in OT in the United States, and I'm sure it's beyond the United States, Working and providing services in the context of late stage capitalism that has gone increasingly predatorily, predatory and is kinda actively in the process of deconstructing our health, social service, net educational infrastructure, which is, can be very bleak and depressing.

[00:37:39] Josie Jarvis: However, if you can wire yourself to look for those critical junctures and opportunities that come when systems start to evolve and break down, like with complexity theory and chaos theory that are really explored in occupational science it helps me a approach these challenges with some optimism in some [00:38:00] ways.

[00:38:00] Josie Jarvis: Yeah. Oh gosh, let me try to get back to this original thought. The main thing is we talked about giving OTs leashes, right? . . Okay. If you can do one thing in an organization, try to give your OT more leash, which reminds me too of that there's some data out there, I can't cite it right now, that show that when you invest in women in a community, the investment that you can get back is like amazing in terms of any time you invest in women, there tends to spread beyond that immediate thing in this magical way.

[00:38:34] Josie Jarvis: So I think. More so I want to, with the OTAs I work with, also give them some leash. No one likes to feel mi micromanaged. We can have this tendency to recreate systems that have harmed us when we don't process them, when we don't process the damage from the system. It's so easy to become that system and to reproduce those cycles of harm.

[00:38:59] Josie Jarvis: Which [00:39:00] actually, as I'm saying this, Kary, does that connect to addictive patterning? Absolutely. That's what it's saying. Maybe this is a great segue into building awareness of addictive systems and how they play out. Cuz I think what I'm heard from your work in a way is there's a way of understanding that on the individual level.

[00:39:21] Josie Jarvis: , but then it also works out and plays out in that there's patterns you can see in systems around Absolutely. The individual micro meone and macro level, which by the way, this is very meta in the group. Us, including these's conversation. You guys are being involved in occupational science conversation right now.

[00:39:39] Josie Jarvis: This is what it means to go from the individual microme overlap macro and have the OP permission from OS to start seeing things in systems. So yeah, let's talk 

[00:39:48] Kary Gillenwaters: about addictive patterning. . Yeah so you heard me say, when I became an addiction counselor, I thought I saw it as a means to become a clinical psychologist.

[00:39:56] Kary Gillenwaters: I didn't enter it thinking this is what I wanna be for the rest of [00:40:00] my life. Joke was on me because I, even though I don't practice as an addiction, licensed addiction counselor anymore, it has informed my understanding of everything, and particularly at the community level of what is going on in, various sized teams.

[00:40:17] Kary Gillenwaters: Whether it's one team, an organization, it's healthcare, it's business, it's schools, it's law enforcement, everything. And so what I started noticing was, geez, this feels familiar. It was more of a intuitive like this. Why does this remind me of something? It reminds me of running groups in, in addiction therapy, except some people don't know that they need to be there and they're really ticked that you're trying to say there's an issue.

[00:40:45] Kary Gillenwaters: And so what I started noticing is this was so prevalent in all of these systems and that the structure was really informing the function. It wasn't that you. All of these people who were problem children, it was that the structure was [00:41:00] informing how it functioned. And so then I was thinking why aren't we talking about this?

[00:41:04] Kary Gillenwaters: I don't understand. We especially as an ot, that's our job is to pay attention to context. But when we're so zoomed in to just individuals and if we're only having these conversations at the individual level, we miss these opportunities to talk about the things that are really, the things is the best way I could put it.

[00:41:21] Kary Gillenwaters: And so if you're 

[00:41:22] Josie Jarvis: overly if you're overly restrictive in your lens Yes. If you're like only seeing formalized fine motor skill function or you're only looking at ADL performance, we're missing the forest from the trees in terms of what could be the most consistently disruptive force.

[00:41:38] Josie Jarvis: I have a side, an slight anecdote that I wonder if, like plays into some of your work around this concept. One of my favorite client experiences in my first travel contract is I got to work with somebody who was in their younger life, a commercial fisherman, and he got to travel all over the world.

[00:41:58] Josie Jarvis: And it [00:42:00] helped me contemplate later on, he ended up. Being very fixated on casinos and that was his primary occupation to the point of it being out of balance. Sure. Where it would maybe constitute as an addiction. And I, that was one of the first times that I really put from an occupational lens, could see how wow, there's not really a better occupation to have an addictive disposition than the commercial fishering because it was so boom and bust.

[00:42:32] Josie Jarvis: Like you, which 

[00:42:34] Kary Gillenwaters: show up every reality a 

[00:42:35] Josie Jarvis: routine. , you would never know like what you were gonna get and you would get these random big payouts. It was a ticket to see the world. You have connection to everyone around you and to all of a sudden get to a point where you no longer can execute those life roles in those routines.

[00:42:54] Josie Jarvis: It just made sense to me that the casino would be the replacement occupation [00:43:00] and that you would be primed in that position. And so that's like going from an occupational lens of what was this occupation, what was their identity and how does that interate with maintaining and courting and addiction.

[00:43:14] Josie Jarvis: Which by the way, a big development in occupational science over the last two decades in particular has been opening the door to understanding the dark side of occupation. Yeah. Because doc occupations don't always enhance physical, emotional, social health and justice outcomes. Sometimes our occupations perpetuate inequalities, they compromise our health.

[00:43:37] Josie Jarvis: They support imbalance and disjunct in so social relationships. And that's like the pathology of occupation that we're as clinicians trying to innovate towards positive occupations. Okay. I stole the platform for too long. You're good. You're good Harry. That, so you in pursuing to understand addiction better found [00:44:00] that occupation was a really helpful lens and that occupational science enhanced that and that it's probably important to see that addiction isn't just an individual thing, it's as a social thing that we engage with together in these systems.

[00:44:15] Josie Jarvis: Is that kinda what Yeah. 

[00:44:16] Kary Gillenwaters: Yeah, absolutely. Cuz what I would see happening and what's, cuz it, this ties back to your fisherman story too. So this will help, is that the, these individuals, like people would label people as, oh, they're, they made a poor choice. They did this, they did that. Often you would see multiple generations.

[00:44:35] Kary Gillenwaters: Sometimes when I would work in rural communities, I, I might be the only person there. It wouldn't be uncommon for me to see three generations of the same family going through these things. And so sometimes we like to say, oh, addiction is it's hereditary, it's a disease. And I do believe that there's hereditary stuff.

[00:44:52] Kary Gillenwaters: I don't know that we understand it as fully as we'd like to think. I suspect it's more connected to, the broader [00:45:00] system of environments that produce addictive environments. And yes, it might be this hereditary, multiple generations, but are we zooming out far enough to consider that becomes a preferred coping mechanism?

[00:45:11] Kary Gillenwaters: Because that's what the environment requires if you don't have this capacity or skills. I think it's, Tara Burke talks about it's not about having a lack of desire. It's lack of capacity. And what I see as an OT is so many people are in chronologically, adult bodies behaving in ways that are much more like children.

[00:45:32] Kary Gillenwaters: And no matter how evolved you think you are, we all do that in different spaces. I don't think any of us are immune to that. And I think that's part of why we would so easily transfer. Like you're talking about this fisherman who's doing this? The one thing you go on to do it in another, if you don't have other.

[00:45:48] Kary Gillenwaters: Of course you're gonna do the thing 

[00:45:49] Josie Jarvis: that's, we're also, I think, I think it's so important to consider these questions and to contemplate, obviously it's helpful to think about where [00:46:00] these concepts can play out in your own life. , because I personally have a hypothesis that capitalism is a social system that's very well served by addictive patterning.

[00:46:10] Josie Jarvis: Yes. And that it requires it's a good way to start a business, right? We know that's success of Starbucks here in Seattle. If you can find something that people can become compulsively dependent on as part of their daily, weekly, monthly routine, you have a sustainable, profitable business.

[00:46:28] Josie Jarvis: Especially if you can get the the like thing that you're, the addictive thing that you offer as a lower price point as possible. That's part of where we had to really respond to the public health crisis of cigarettes, in the 1950s that took a whole. Micro meso, macro level social intervention to curb some of the health impacts from long-term addictive use of cigarettes and marketing to children and things like that.

[00:46:56] Josie Jarvis: It, it probably behooves all of us as OTPs to get some [00:47:00] awareness around addictive systems, addictive patterning. Obviously I think both Kary and I would be enthusiastic supporters too, of learning more about how our economic system impacts our behavior, impacts our psychology. But the truth is, if you're an OT working in the United States and everywhere, , you're working with addiction, whether you know it or not.

[00:47:21] Josie Jarvis: Yes, 

[00:47:22] Kary Gillenwaters: exactly. 

[00:47:22] Josie Jarvis: Like healthcare professions. Right now I'm a post-acute A care ot. Nurses, healthcare professionals are higher statistical probability of developing substance use addictions over their time, cope with things like burnout. Parents of kids with disabilities adolescents, adults with significant disabilities, trauma, depression.

[00:47:41] Josie Jarvis: We work in addictive systems and addictive patternings. And if we're not aware of it, We could play an active role in enabling and neglecting some of the most destructive sides just by not being conscious of the potential. And I wanted to add too, from what you're saying, I think that occupational [00:48:00] science is so important in asking questions about addiction, in that I think we'll get unique insights from having the doors that occupational science opens.

[00:48:10] Josie Jarvis: One of the common critiques of the mental health system is that they can also just be very individualized in just focusing on parts of the brain. , and that a lot of the other social sciences are not communicating respectfully with each other and understanding these phenomena. Other fields are also missing the contextual and systemic factors that actually need to be modified and adjusted to probably effectively treat addictive traits like toxic addictive traits long term.

[00:48:39] Josie Jarvis: I'm curious, how have you approached relating to addiction from an OT and OS lens? What insights have you found from 

[00:48:47] Kary Gillenwaters: that? Part of it is, I would say my whole career, it's affected where I choose to stay and when I choose to move on. If there's not space to, to address what I'm seeing within a [00:49:00] system like.

[00:49:01] Kary Gillenwaters: Sometimes you can only take it so far. It's like when somebody's not willing to get sober, you can only do so much to where somebody's just still choosing, they, they just wanna remain active in their addiction and you can't force somebody out of that or force somebody out of being co-dependent, enabling.

[00:49:16] Kary Gillenwaters: And that perfectionism stuff that seeps in part of what I see now is because we don't talk about these things, it's become part of our structures, our systems, our policies, our procedures, and we've normalized it as that's just what you have to do to be a grownup. That's what you have to do to be a hard worker.

[00:49:36] Kary Gillenwaters: And I would really encourage us all to pause and back up and say, is that true? Is any of this stuff that we thought, is it doing what we thought? And so I put myself in spaces now more where that is an expected and necessary part of the process. Because if any of us think we've got it all figured out, I think we're in trouble.

[00:49:59] Kary Gillenwaters: And I don't [00:50:00] know that I can, I don't know that I can be as effective in those spaces. And so for me it's noticing readiness to create the space that's necessary for things to grow, to create the space that's necessary for reflection. To notice is this a space where people are allowed to. Pay attention to and act on their interceptive awareness?

[00:50:22] Kary Gillenwaters: Or are we trying to keep it all in our head? If this is all functioning from thought thought without bearing any kind of respect for we sense way, there's, we use all of our senses and sometime, and I will tell you hands down, my internal or my introception and my internal sense of this is funky, has been, I would say a hundred percent accurate.

[00:50:49] Kary Gillenwaters: Yeah. I have issues when I'm trying to follow what I think on a spreadsheet it looks like it should be this. That's when I struggle. And and that's part of honoring different ways of knowing is that if we [00:51:00] don't have different ways of knowing, then we're probably gonna miss a lot of things.

[00:51:04] Kary Gillenwaters: I also 

[00:51:05] Josie Jarvis: think that's what, when what we bring to the table as OTPs can be confidently claimed as a skilled service. Absolutely. Sometimes I think there's a confusion and I don't know where it roots from. And I think it's something in relation to the medical model. And I am, I feel confident enough to call it misinformation about the scientific process that.

[00:51:33] Josie Jarvis: There's this sense that if an intervention is standardized or an assessment is standardized in how it's implemented and interpreted, that's what makes the service skilled. And from my perspective and in my experience, it's actually the opposite. Yeah. So the skill part of implementing, say, a standardized assessment tool to standardize a tool [00:52:00] is to make it consistently administered by anyone,

[00:52:06] Josie Jarvis: By anyone in this is where I think academic literacy is very important to see where these things come from. And sometimes we're playing a telephone game and the words don't end up in the field. It's not , there's been a lost connection. So when we're saying an assessment tool, we're trying to be pretty clear in what we're measuring.

[00:52:25] Josie Jarvis: And so you start to standardize a protocol for how you're administering the assessment so that you're measuring the same thing consistently over time and you're accurately measuring change in that thing. So the implementation of that tool is standardized, so it doesn't require a skilled provider to implement it.

[00:52:44] Josie Jarvis: You are often partnering with nursing field clinicians, patients, when you're designing research, you're trying to get the tool trained in a way that anybody that administers it, we're measuring something reliable. And we do that so we can cheaply delegate. Science, just [00:53:00] like every other sector is trying to cost cut penny, pinch our way.

[00:53:05] Josie Jarvis: Into getting things. So for clinicians, whether you are an OTR/L or an OTA , it's important to know that the tools that you use to measure isn't the skilled part of your service. The skilled part of your service is the interpretation of that tool in the context of an OT process, which is outlined in the United States through the occupational therapy practice framework, domain and process.

[00:53:33] Josie Jarvis: Fourth edition, it's updated every four years. But as OTs , in order to be scientific, in order to be in alignment with how our policies are set out, and I'm not saying they're perfect, they're just communicating that this is the way it's laid out. We're meant to, as OTRs follow that domain across a sequence with every client we have, whether it's an individual, a group, a population.

[00:53:56] Josie Jarvis: We need to follow a sequence of steps. Building occupational [00:54:00] history and occupational profile understanding what that client's goals are. So if it's a community, you're taking data to find out what the occupational disruptions are in their community, the injustices in their life, the challenges that are getting in the way of occupations that they need to perform in, participate in experience, wellbeing, justice, and belonging through we then use a variety of different tools and measures to accurately understand what those disruptions are, where they can come into play, and then we can collaborate with our clients and with our OTAs that we work with to collaboratively problem solving solutions to address those disruptions in the process through the implementation of occupational therapy treatment.

[00:54:44] Josie Jarvis: So what's skilled about that is how you're developing that cla plan of care collaboratively with your client, with your team, with the system that you're working in, how you're interpreting those tools in relation to goals and problems. That's the skilled part of your service. When we [00:55:00] are using standardized tools and delivering protocols in a one size fits all fashion, that's actually something that is supposed to be funded through other sectors than Medicare or policy like most of in the us most of our only reimburse our skilled services when it's standardized.

[00:55:21] Josie Jarvis: And can be delegated and implemented by somebody without OT training. , which is what standardized protocols do. That's not the skilled side of your servant . I'm sorry, I'm just taking some time to break this down because I think it's a huge problem and where we're getting lost in how to apply the insights of our science base, both from OS and from more conventional clinical questions in our domain and process.

[00:55:45] Josie Jarvis: You are supposed to give your client a leash, the OTA a leash, and you a leash to creatively problem solve collaboratively with your client in the context that they're in these tools and these protocols are supposed to be [00:56:00] guidelines and things to accurately measure what you're changing, the process of how you're changing and instituting constructive change in the system.

[00:56:08] Josie Jarvis: That's not supposed to be rigid, and it's supposed to be customized and individualized. And if you do a really earnest read of the Domain and process, fourth edition and the developments, our science space, not just in fringe OS communities, but mainstream OTs takeholders, this is the current state of our science.

[00:56:27] Josie Jarvis: We have to be collaborating with our clients to come up with their own solutions and understanding of their occupational barriers and descriptions. And we're supposed to be focusing on outcomes that are meaningful to the client and are connected directly to their occupational performance, participation, justice outcomes, inclusion, being in belonging and becoming.

[00:56:48] Josie Jarvis: All of those things are now embedded in our process. And you should know and have some empowerment and that's what makes our service skilled. We're not supposed to be machine workers that come in every day and [00:57:00] just do the same exact thing every day. That is not what skilled occupational therapy is meant to look like and how our leaders and our visioners are actively shaping our practice right now.

[00:57:12] Josie Jarvis: Thank you for giving me space to outline that. But 

[00:57:15] Kary Gillenwaters: I think it's an important distinction, Josie. I really do. And I think that part of that is, what you're identifying is that need for a rhythm, a pattern We need to build in rest as a means to integration. If we don't have those rests built in, there's no time and space allowed to actually take in and sit with for a little bit.

[00:57:35] Kary Gillenwaters: What are we actually noticing here? And so we're gonna come, we're gonna do conclusions cuz we're trying to hurry up and keep a temple that isn't even conducive to affecting those things. Also, our relationships with each other is part of the environment. I always would tell students, the way I would describe that is if you are not considering yourself and your team and the broader organizations and communities of which you are a part, as part [00:58:00] of the context as well as historical context, then you are not truly paying attention to the environmental factors that are affecting somebody's occupational performance.

[00:58:09] Kary Gillenwaters: So we must know ourselves as occupational beings. We need to build space so we can notice, like today I am not gonna do my personal best. It's not possible and that's okay, it's being human. And how do I then work with the team? Cuz we always still have to be, have these therapeutic relationships.

[00:58:28] Kary Gillenwaters: How do I then work with my team so that somebody can do that? And in my work with Creative Healthcare Management, at they, they have a book called See Me as a Person. And they have a program that they offer about that too about see me as a person. And part of what we would talk about is healing happens.

[00:58:45] Kary Gillenwaters: At the intersection of your technical skills and your relational skills. It's I remember someone had once described it as a little bit like when you score, if you have a field goal, you don't score a point. If you hit on the left or the right, it has to go between the posts.[00:59:00] 

[00:59:00] Kary Gillenwaters: That's where the healing happens. And so often we're so busy trying to do the technical piece that the relational piece gets missing, and I don't know that we structure it in a way to prioritize those relationships, and so then we suffer as a result. And if we don't, so what do we do about that? Now you might say, no one's gonna change their productivity.

[00:59:19] Kary Gillenwaters: I can't change that. Part of what this goes back to when you asked What are you doing, Kary, about, is that I started realizing you're gonna have to have these as informal conversations. And not only that, they actually work better. I think outside as informal conversations beyond our workplaces and us coming together from a variety of places and just having Socratic cafe style conversations where it's just what's on your mind about being an ot?

[00:59:45] Kary Gillenwaters: What's on your mind about rest as a healthcare professional? What's on your mind about OT and ota a collaboration? These are some of the conversations I've been hosting in the last couple years and really for over six years to say what's [01:00:00] on your mind about that? Because I think we take all that mental and emotional load back home with.

[01:00:06] Kary Gillenwaters: and we don't really stop to let it go. Recycle, integrate process. And if we don't build those structures in, we're gonna 

[01:00:16] Josie Jarvis: start to see issues. That's right. Yeah. Cause if you're not empowered in that system to do anything about it I think what you're, what I was hearing too from you is that like importance of what we're losing by maybe not intentionally cultivating a reflective practice as part of our work that we have to in invest in having this capacity.

[01:00:37] Josie Jarvis: And that sometimes there's a short term loss to taking that time. And like for me, I'm so grateful that, I guess I took out debt to have this gift to have some reflective time about Yeah. Who I am as an occupational being, what is my identity as an occupational therapist because I went [01:01:00] back to school in 2019.

[01:01:03] Josie Jarvis: Prior to the pandemic, I was already feeling like OT for me was just a series of dead ends. And it didn't matter unless I was committed and willing and able to provide subpar practices to the point that I couldn't sleep at night, like , for example, I think I'm passionate about the misinterpretation of what standardized measures mean and really maybe getting more awareness of the OT practice framework and the invitation that offers to clinicians to provide empower practices and to leverage our legal frameworks to provide like powerful transformative practices for our clients. I really want that vision for myself. Like for, I wanna, I feel like I need to cope with the risk of burnout and cynicism. I need to have a meaningful outlet for my own work. Yeah. And that's connected to my own health and [01:02:00] satisfaction and wellbeing.

[01:02:01] Josie Jarvis: And I want that for all of us and what we have together because I think it's truly needed. It's not available. So the empowering spin I can put on all the systemic barriers OTs offer is, it also means that there's a lot of opportunity, there's a lot of space where OT hasn't really been developed or fully expressed.

[01:02:20] Josie Jarvis: When we're underutilized, there's an opportunity to demonstrate, to show that, to be a trailblazer. All of us can be now founders of a new era of OT by starting to give ourself permission to leverage our science and what our evidence-based makes available to transform the lives of our clients. I think we then have to get to a point of reflecting how and where are we not doing that and where are there systemic barriers getting in the way of producing these results and having that leash for yourself, for your ota, for your clients to creatively problem solve.

[01:02:57] Josie Jarvis: In order to creatively problem solve. You gotta disrupt the [01:03:00] system because the system isn't working. It's not producing results where that person can dress themselves every day. Where they can hold and maintain housing, where they can care for others, where they can access community. It's not working.

[01:03:13] Josie Jarvis: It's our role as therapists to partner with our clients to disrupt that systemic logic and to imagine, I think this is where Kawa can be so powerful. . Cuz kawa, if from a river perspective, it doesn't respond to the barriers in the land as oh Can't go there, . We're just done. Yeah.

[01:03:35] Josie Jarvis: It's gonna be being persistent in that terrain and learning from the terrain and adapting and working with the truth of our systems is they're not fixed. Entropy to my understanding, is likely a real force in the universe. All of our systems are going to become more com complex over time, and there's gonna be more degradation.

[01:03:57] Josie Jarvis: There's not gonna be more order. So we have to learn a [01:04:00] relationship to chaos. We have to have a constructive relationship to chaos. You can't just ignore it and pretend it's not gonna do anything. I think in many ways that can be your role as an OTP is working with the unknown and working in partnership with your clients to disrupt some of these systems, to find new solutions that better serve not only your client, but possibly everyone in the system as well.

[01:04:24] Josie Jarvis: We're not gonna, we're not gonna advance inclusion, we're not gonna advance accessibility. We're not gonna advance in these goals without intentionally disrupting these systems. I think with a core intention of producing a solution that helps everyone and not just being in I think when we're in anger , we like just wanna we wanna break everything down.

[01:04:43] Josie Jarvis: I hear that a lot about AOTA , there's a lot of anger at AOTA and I'm sure it's totally valid. , and I'm not sure if walking away from these challenges in these systems is gonna be a long-term solution. Sure. So like, how do we leverage our anger? How do we [01:05:00] understand these injustices to also use that as an opening to build relationships, like you're saying, to reflect and have insight of what are the factors that are reproducing these challenges that are frustrating for us.

[01:05:12] Josie Jarvis: I think what I am connecting with what you're saying is it's worth it if you can carve out time in your own life, and you might find some value in using something like occupational science to consider these questions and to reflect on these questions. We sometimes need to do this work outside the systems.

[01:05:29] Josie Jarvis: , but use that resourcing, that capacity building to go back to the systems that us and our clients are trapped in as occupational things. Why can't we try to make things more fun and interesting for everyone? You have to start by understanding, reflecting and then giving yourself permission with your clients.

[01:05:44] Kary Gillenwaters: And I really question, what makes me excited is this idea that so many of us are entrenched in systems that we don't even realize is a structure informing our function. And imagine if we knew we were to being in, in process, [01:06:00] we now we recognize we're in process and we're, we keep asking ourselves again and again, what is possible now.

[01:06:07] Kary Gillenwaters: Like I almost view it as OTs in some ways. If you're driving down the road, it's snowed here today, so I've got a snow metaphor in mind. You're driving down the road and you see somebody who's stuck or you notice what you're doing that's creating the conditions that somebody's likely to get stuck.

[01:06:21] Kary Gillenwaters: You don't just say too bad we notice, okay, what can I do that would make it less likely for you to get stuck again? We anticipate that there's gonna be these points of disruption. We know we're at a time of rapid evolution, so we've gotta build so that there's more space for that to happen. Those structures we've done so far, some of that has been so carefully.

[01:06:43] Kary Gillenwaters: our attempts to control and feel like, okay, we get tighter and tighter on this stuff. Thinking like then that's addictive. Ho that's a hallmark of an addictive system. 

[01:06:52] Josie Jarvis: Addictive patterning. Yeah. That's playing out. I think we've talked about that. Like part of my sense of feeling like OT for me was just a dead [01:07:00] end.

[01:07:00] Josie Jarvis: Was in part, I was trying to make school-based practice work and I happened to work in a state that is very wedded to a fine motor only qualifying area for OT practice. And that's where I felt squeamish. You talked about those internal like intuitive. Ugh. It was untenable. It was clear we were incompatible as a relational system while I was there because I couldn't, I didn't feel ethical about pretending that fine motor issues were the barrier for the students that I was working with.

[01:07:35] Josie Jarvis: , to truly transform their school role performance to support a free and vape for getting the acronym free and appropriate. Anyway, when you read the laws of sped and like the interpretation of OT as a related service in the United States, we're meant to support access to the general educational environment and to support [01:08:00] teachers to adapting curriculum to be accessible for folks with disabilities in a variety of different things.

[01:08:06] Josie Jarvis: If you read the actual laws, there's a lot of latitude in our best practice in our development. There's some really exciting potential of what OTs can offer a school district and an ecosystem at a school. But you can't do that when the system is wedded to only analyzing one client factor at a time.

[01:08:27] Josie Jarvis: It's not addressing the context, right? It's not addressing the disabling aspects of the disability. It's not seeing the client as a human being, and it's having your assessment tool determine whether or not that student's gonna access services or not, which has a huge slew of justice issues because often when you're going based on one factor, whether it's a diagnostic or assessment tool, , you're intentionally biasing the data pool.

[01:08:54] Josie Jarvis: It's not making those services equitably accessible to everyone that the law is outlining is supposed to have [01:09:00] access to a service. And if, especially if you're using a tool that's not connected to an occupation based outcome or an occupational performance , you're not targeting the outcome-based intervention.

[01:09:11] Josie Jarvis: So anyway, I was systemically trapped in having to pretend. To either address the occupational issues through a random fine motor score, not being able to pick up kids that were having clear occupational disruptions related to executive functions, sensory issues poverty and addiction type factors. I was systemically required to lie and paid out by the district for ignoring the disabling factors of the students that we're working with that needed systemic support.

[01:09:45] Josie Jarvis: So I just ethically could no longer provide services in that system. And when we've talked about this in the past, you said like that has components to addictive patterning, like , we can't walk away from this addiction to fine motor OT or something [01:10:00] like. I'm curious if you have any thoughts on where OTs might be experiencing some addictive patterning within the systems where traditional services are happening?

[01:10:09] Kary Gillenwaters: Sure. So part of it I would say is, so in an addictive system, you'll see things like, there's the scapegoat, there's the hero, there's the enabler. And so somebody's gotta pretend nothing's going on. There's always that role. And if somebody else leaves that role or tries to get out of it, the system.

[01:10:27] Kary Gillenwaters: Kind of needs that player in order to survive. So it's gonna try to find some other way to draw you in. These are not like intentional thoughts necessarily, but that's what the system requires to function. So we could all think about who's the cast of players who, who's an enabler in any system.

[01:10:42] Kary Gillenwaters: Like person who's oh, it's not a big deal if I have to clock in or if I have to just work off the clock in the morning, or I work at night. These are part of the things that we do in those systems people do to take on, like, how do I manage the fact that I can't get my work done within the time allotted to me, and [01:11:00] that if I don't get my work done, and I'm not this much per, productive, I'm gonna be written up on a performance plan and they're gonna say, I'm at threat of losing my job.

[01:11:09] Kary Gillenwaters: So what do people do? They put up and they shut up, or they found, they find the most palatable way, palpable or palatable way that they can to manage that system. So that's one of the things that people do. Or or it's somebody else becomes a scapegoat where it's other organizations are doing this.

[01:11:26] Kary Gillenwaters: Why aren't you, why can't you figure it out? These people over here they're managing what's wrong with you? That's another way that it looks like, or it looks like writing these really overly prescriptive, detailed policies and procedures about what you will do, how you'll. That don't leave any space for life as it is.

[01:11:48] Kary Gillenwaters: And really there's no feasible way you could do that cuz too many e, too many environmental factors shift within a period of time. And then holding you accountable for something that, how could you [01:12:00] possibly know if you could meet that within a year's time or something like. I think of our employee reviews, a lot of employee reviews that people do, they don't make a lot of sense.

[01:12:09] Kary Gillenwaters: Would we do a treatment plan for somebody for a whole year and expect that you're going to be able to make sure you meet those things. There's a lot that happens, especially in a covid or post covid area that, or era that there's nothing that you could do to change that. So those are some of the things that I think our signs for us that an addictive system is at place.

[01:12:29] Kary Gillenwaters: And I think 

[01:12:30] Josie Jarvis: some of what you're speaking to that often doesn't go acknowledged is just how often health and human service employment environments can fester in toxic workplace patterns. And that I think you were referencing, I forget the author of it, but it's idea of the drama triangle.

[01:12:48] Josie Jarvis: Which is like a very has been very well utilized I think in the clinical psychology literature of trying to explain these systems on that more meso level. I find [01:13:00] a good example of where you can find it a lot is on social media discourse and we can kinda see those roles play out. Cause there's often.

[01:13:09] Josie Jarvis: A victim, somebody that's totally innocent, that just got targeted by a random perpetrator that was an intentional agonist that went out of their way to ruin something for the victim. And then we need the whole other part of the internet to come in as a rescuer and teach the perpetrator, you did a bad lesson.

[01:13:30] Josie Jarvis: Go sit in your corner. And meanwhile the issue that was brought to light, maybe by the presence of the victim, was something that needed all of us to contribute. And we all had a role in that pattern continuing to happening. But the fact that we had a convenient scapegoat to blame and take off that energy means that we can excuse ourselves from taking any reflection or constructive action about how we could be perpetuating this [01:14:00] problem.

[01:14:00] Josie Jarvis: I saw that kind of play out with AOTA as really convenient scapegoat for a lot of the challenges that we're having systemically. There was a lot of backlash to that OTP post because there was a sense of oh, this is what AOTA is doing with their time and just coming up with new words.

[01:14:17] Josie Jarvis: And meanwhile, we're struggling with productivity limits, PT taking over our practice encroachment in every direction. Meanwhile as clinicians, and I'm speaking as a representative clinician and somebody that has had pretty unhinged anger at these systems, so I fully respect having anger. And at the same time, we also need to reflect and look at, oh, a o t elections had a 3% turnout in the last year.

[01:14:48] Josie Jarvis: Oh, a OTA is composed of less than 10% of members. How can we functionally expect this organization to know about and be responsive to our [01:15:00] clinicians if we've made maybe functionally no effort to convey it to them? They can't jump into our shoes and really understand, and we can't be angry about them not doing research into certain challenges if we're not funding their capacity to be respondent.

[01:15:18] Josie Jarvis: I'm not saying that this is all on clinicians and that AOTA and these representatives and academics don't have a role, but the truth is in an equitable democratic society that values and centers the human rights of all, including non-humans , you have a responsibility to show up to the table.

[01:15:37] Josie Jarvis: You don't get out of problem solving, you can't expect some other outside entity to come in and be the hero. You are part of the solution. And that takes tangible investment and an earnestness and bravery and credibility, creativity to build a new system. Those are the actions like I'll have to share this article with [01:16:00] you.

[01:16:00] Josie Jarvis: Kary, maybe you saw, I posted on my timeline that was talking about the empowerment triangle as opposed to the Dr the drama triangle . Yeah. 

[01:16:09] Kary Gillenwaters: Nice. 

[01:16:09] Josie Jarvis: I'll have to share that with you because I think that is now becoming the core of my practice. In some ways, and maybe this is just a symbiotic thing and probably you're dec discredit for a big part of these insights is just realizing that drama triangle is a trap.

[01:16:23] Josie Jarvis: It's like addicting. It feels good. It feels like you're doing something while preserving the system and the exact state that it was when you left it . 

[01:16:32] Kary Gillenwaters: Absolutely. Absolutely. And that's probably too, that kinda language is very familiar to me because of the nurses that I worked with that they.

[01:16:42] Kary Gillenwaters: They would tell us as OTs that we were ki we're in this different position in terms of, we haven't been around as long. But that, so when you think of the doctor nurse dyad and the codependency and who, like that to me is wow, look at this. Look at how they have been conditioned to respond to [01:17:00] one another.

[01:17:00] Kary Gillenwaters: And so you've got that going on. And then the OTs , we, we're almost like a more of a baby in the family of the healthcare family. And so they've gone through some of the things that we have a little bit earlier than, like they're almost have entered the re the realization for a need for recovery maybe before some OTs .

[01:17:19] Kary Gillenwaters: IVUS says we're in a recovery process as OTs 

[01:17:22] Josie Jarvis: gained from it in a way. Like I, who doesn't know that nurses are holding the power right now in the developments in the critical junctures of the US healthcare system right now. Taking the time to reflect and how these questions and thinking about how you can empower.

[01:17:40] Josie Jarvis: From the top of your organization to the very foundation of your system. I think we have a lot to learn from nursing. Yes. In so many other fields too. Like one of the places that I see that scapegoating pattern play out a lot is with the applied behavioral analysis field. And a lot of our discourse around that, which I know I'm gonna have some [01:18:00] probably controversial podcasts on in the future because my relationship to a cloud behavioral analysis changed drastically once I entered the field.

[01:18:08] Josie Jarvis: In looking at more systemic change I'm a big advocate for collaborating with every interprofessional practice almost, especially if we disagree with them because there's so much potential for. Growth and creativity through that tension in some ways, and an opportunity to advance OTs role, for example.

[01:18:25] Josie Jarvis: However, what I find interesting about dialogues around schools with high behavioral analysis is that nearly every human service profession utilizes behaviorism as the foundation. It's part of our economic system. It's part of how we reward, and I'm sure that's full of addictive patterning, when we look at it like how you're, what you're paid for, what you're not prepaid for.

[01:18:48] Josie Jarvis: When we use punishment, when we don't. So what I, what irritates me sometimes about the discourse around ABA is how much we can project some of our own skeletons onto a new coming [01:19:00] field and avoid some of the accountability that we have of perpetuating systems, of ableism, of behaviorism, of punitive practice, and Failing to be holistic.

[01:19:11] Josie Jarvis: Sometimes it's so easy to see those challenges in others. And that suggests the absence of a reflective practice because if we're actively projecting, we're not resolving. And often those things that bug us and systems and other people are the things that we need to invest in and look at. And when you give yourself that time and that permission to reflect and see where the systems are playing at around you, yeah, it is a painful process.

[01:19:40] Josie Jarvis: It is not fun to get feedback. However, it also creates this like fertile soil that we can grow from and enjoy like the fruits of our labor. And what you're saying is that like nursing maybe started this when you were talking to them decades before OT having, and maybe we can help [01:20:00] catalyze some of these conversations in the OT world where, couple of decades out from that, the fact that they had these conversations where they created an empowered role for everyone on the team to understand where their position in the healthcare system.

[01:20:13] Josie Jarvis: now they carry mo a lot of the leverage, they took the time to have those conversations, that community building . . If we're not even at a step that we can acknowledge that we have a problem and then we might as well be centuries away from solving it. 

[01:20:26] Kary Gillenwaters: . And that's where I think I get so passionate about these relationships that we have with ourselves, with our team, with OT and OTAs with other disciplines.

[01:20:36] Kary Gillenwaters: And I think that's one thing that OS like I, we were talking earlier, I had not realized how much other professions utilize occupational science as reason to justify their services. Maybe even more so than a lot of occupational therapy professionals. And so therein lies okay, there's some [01:21:00] people who already know this language.

[01:21:01] Kary Gillenwaters: So this whole issue we have about not being seen or nobody understands what we do. We often laugh at nobody knows what we do. I say part of why nobody knows what we do is because if we don't live it ourselves and it doesn't become an embodied thing, then our words are the misalignment between our words and actions is gonna make it harder to show what we do in some degree.

[01:21:24] Kary Gillenwaters: I really, no, I think you're 

[01:21:26] Josie Jarvis: right. I feel that there's some projection sometimes when we have this conversation. That was one of the. That came up in that thread. There was another thread in reaction to the OTP one that was also talking about how OT just needs to change its name to functional therapy.

[01:21:41] Josie Jarvis: , that would make everything easier if we're understood. And that to me was one of those things that was a red flag about how the loss of an opportunity that in the US are not having some conversation of OS in all the different areas of OT education, that [01:22:00] exposure if you don't have exposure to occupational science, it's easy to see where occupation is this clunky, frivolous term that's more of a barrier.

[01:22:09] Josie Jarvis: Than a supporter of your practice. Because it's really occupational science. Okay. I think I wanna outline a little bit of the historic context that helps me, cuz I think it will help for those who are hopefully listening to this conversation. At the birth of occupational therapy as a technical term and as a fully legally codified profession in the US in the 1917, the turn of the century.

[01:22:34] Josie Jarvis: The areas in the west where OT was developing as a professional thing between the uk, Canada, and the United States was specifically at a time where women were not systemically encouraged to have a role outside the home. And it was in the first like couple decades where it was somewhat okay for women to have professions and you could have a profession as long [01:23:00] as it was related to your domestic role, and it hopefully didn't take up too much of your time, and particularly if it didn't disrupt a man's power over you.

[01:23:11] Josie Jarvis: So there were certain sectors of privileged women that were able to get a formal education and they were systemically allowed to have a profession as long as it didn't detract from their domestic duties. And they weren't allowed to progress in their academic training beyond that profession. That was OTs history.

[01:23:32] Josie Jarvis: And by the way, I believe it's Jennifer Creek that has done a lot of the academic work to outline a lot of this in some OT and OS textbooks. So anyway, OTs ystemically wasn't allowed to have her own scientist, wasn't allowed to have her own academics as largely a group of women. This is different than I guess the nurses had in their connection to doctors.

[01:23:54] Josie Jarvis: A little bit more access to the educational system over time. But even they had to fight really hard, like you've [01:24:00] discovered in working with them. Anyway, we haven't had an OT any autonomy over how we shape our science, how we shape our our curriculum until really the 1990s here in the United States.

[01:24:16] Josie Jarvis: We didn't end ties with the AMA structuring every aspect, so systemic sys sexism and paternalism, which is this idea that women cannot make decisions for themselves. They're inherently untrustable. That isn't to say that particularly white women don't have many systemic privileges and advantages and opportunities that are even more regressive for other marginalized status.

[01:24:41] Josie Jarvis: But part of the problems that I've noticed in OT is systemic sexism over centuries at this point, limiting our ability to progress as a science, but you don't have a true understanding of what occupation is and what it means until you [01:25:00] have occupational science. That is the, that is now the arm that we have PO developed with now over the past 34 years, that you don't know really what occupation is until you engage with occupational science and some of the discourse around these things.

[01:25:17] Josie Jarvis: So it cycles back. We're projecting OT isn't understood because a lot of us haven't had systemically the opportunity to understand and develop what occupation is until the 1990s. So let's now we'll get together and make up for lost time. It is now possible to understand what occupation is, and I believe firmly that a lot of you, if you learn and engage in these conversations, you'll start to clinging to it and be like, no, we can't lose occupation.

[01:25:45] Josie Jarvis: It is the magic dust that makes transformative practice happen. And that's very much the mission of this and I think part of the mission of your work to carry, like it seems like you're helping with this relationship building and going outside, creating [01:26:00] space outside of where if you're in a space where it says, no, you can't do anything, shut down.

[01:26:06] Josie Jarvis: Do. Kary, do you think that that is then an invitation from the university? Go find another space, ? 

[01:26:12] Kary Gillenwaters: Absolutely. It's the, if you think of a Kawa model, it's guiding your flow, like it's guiding you to say what helps you still flow? And so rather than view it as these people, and get really frustrated, I think there's always gonna be a time where you're gonna feel that way.

[01:26:26] Kary Gillenwaters: I've definitely felt that. But to view it more as in the long run, if I look at, if I look back at my life in the whole flow of it, any of those things that felt like, ah, I don't have time for this is a big disruption. It actually guided me to the next. Thing. And it was, in some ways I see those huge disruptions as, Ooh, what's about to come next?

[01:26:52] Kary Gillenwaters: Because it usually is a preci. Yeah, it's a precipitory, yeah. Aci. 

[01:26:57] Josie Jarvis: Yeah. Yeah. It guides you to find out. [01:27:00] It's like a character building thing. , I use that lately with my practice is with geriatrics. And it's nice that you've worked with geriatrics too. , that I try to have this messaging around falls to try to remove some of the stigma around it.

[01:27:15] Josie Jarvis: And just look, we're in a lifelong war with gravity. Sometimes it wins. Everybody falls. You're keeping us in business. And I say it's it's not if you're gonna fall, it's when you're gonna fall. And the question is, what are we gonna learn from this? This could really be pivotal life learning event to set yourself up for quality of life.

[01:27:35] Josie Jarvis: Like this can really be the, which I guess is more of that addictive patterning, right? Because it's yeah, you literally hit rock bottom. Yep. Yeah. There's nowhere to go but up from here. What are we gonna do with this new lease on life and what you've learned from this occurrence? 

[01:27:50] Kary Gillenwaters: No, absolutely.

[01:27:51] Kary Gillenwaters: And I think that's where, and I started blogging. I did it as a therapeutic release, much like what you were saying, I don't even know where to go with this. I was trying to pull all [01:28:00] together what I was seeing and observing and having a lifelong role of being really a listener and a guardian, for what's going on.

[01:28:09] Kary Gillenwaters: Cuz a lot of times I think it's about just people so rooted in being right. They're not necessarily focused on being understood to or understanding one another. And so there's, yeah, there's this need for a huge amount of curiosity and a pockets full of ampersands is the best way I could describe it.

[01:28:30] Kary Gillenwaters: Let's have lots of ams. It's not about this it's that black and white thinking is another hallmark of addiction. And so paying attention to, if there's a lot of black and white stuff there, chances are there's an addictive system at play. And so that to me, if I'm getting stuck in that helps me recognize, oh, what's the, what's the structure here or what, what is it about this that might be problematic?

[01:28:54] Kary Gillenwaters: And so like you said, there's all these opportunities. There's chances to notice [01:29:00] whose voices in this s addictive system are we trying to not listen to pretend don't exist, that we're forced to just be quiet in order for this process to continue. How do we that's 

[01:29:11] Josie Jarvis: interesting. I didn't, so that it is shutting down.

[01:29:15] Josie Jarvis: Dialogue and intentionally ignoring things. That's a hallmark of an addictive system, 

[01:29:20] Kary Gillenwaters: right? Okay. Because we're gonna discover that the addiction occurs. And so we gotta pretend like somebody's the hero. It's just a way of distracting us. Look over here. Don't look at this real issue. And and so we can see that even with OT about who's, who's prevalent, who's not what and our commitment to making sure that there is a large variability in who we are as a profession and who are we actively seeking to build relationships with one another and to show it, I believe every human, if we actually spent the time to focus on who are you and what do you bring, and then safeguard our [01:30:00] ti, our time and energy balance, so we could actually do those things and respect that.

[01:30:04] Kary Gillenwaters: It's not, one person might be able to do 20 times more in a day than somebody else. And that doesn't mean they're better or worse than anyone else. Exactly. But how do we take everyone's brilliance and put it together in a way. Is so much more impactful. 

[01:30:20] Josie Jarvis: I don't, and supports it and creates an ecosystem Yeah.

[01:30:23] Josie Jarvis: Of flourishing, which I think like nursing in its peak and best state, and I'm not saying nurses are perfect we're all in this growth process. We're all learning, collaborate. But I do think that there are elements where you can see, oh wow, you really want the CNAs to be the peak of what they can be.

[01:30:41] Josie Jarvis: . And you want everybody in that system is in some ways empowered to hold their role and they know their role in that system. And I'm not the biggest fan of a pure medical model and not why like OTs are there, but there is this sense of you want everyone to be strongest in their expression.[01:31:00] 

[01:31:00] Josie Jarvis: Yeah. Whereas I think OT in being more of a feminine field, we have some of those historic western stereotypes of women always being in competition with each other and it being threatening or systemically punished. Like part of our role maybe has been, I'm speaking as a white woman from a more patriarchal culture lineage that I come from where sometimes if you see a woman getting too powerful, too big for her britches, that tall buttercup or whatever it can be rewarded in our, in those cultures to shut that down and say, Hey, look, that's not your role. Just like the history of ot. Those uppity women that maybe wanted to build the science of our profession, they say, Nope. You get in line, the doctor tells you what to do, you sit down, you be quiet, Missy or like little girls.

[01:31:48] Josie Jarvis: I think to me, when you say unspoken, like I was thinking like earlier, we were talking about the unspoken labor in homes and the domestic labor and how occupations are often imbalanced between the [01:32:00] masculine and feminine. And that, the masculine doesn't get as empowered to have a strong domestic role and they get isolated and they'll get access to that information.

[01:32:08] Josie Jarvis: In the same way a lot of OTs have been told to like, shut down. Shut up, be quiet. Just do this small piece. Okay. We just need you to address handwriting. We just need you to do ADLs. Sit down, be quiet as you're told. And when people act like that too, like that impacts you. Especially if you're not processed.

[01:32:27] Josie Jarvis: It's easy to take that out on somebody of oh, my boss just told me what to do, and I'm in a very disempowered position and so in order to feel better or like I have some value and esteem in the system, I'm not gonna like tell my, I'm gonna micromanage my coda kind of I'm gonna reproduce the same system that I don't like. Versus reflecting and thinking about how. What can we learn about what doesn't feel good to explore and play around with what could feel good and what can act differently? And I feel that, like in social media discourse, there's a [01:33:00] lot of skepticism about like entry level doctorates and having mixed roles for different OTPs out there.

[01:33:07] Josie Jarvis: Where it's threatening maybe to have masters in doctorate level trains like, oh, I'm gonna get replaced. I have a bachelor's, I need this isn't I must out somehow lower. Which is also the sense of this virus of social superiority and hierarchy that's endemic to western systems that tends not to serve everyone instead of looking at it and saying, Oh, this is cool.

[01:33:31] Josie Jarvis: Now we have folks that have one foot in practice and one foot in academia. We need leader leadership to start building more literature and to help with policy discussions. I'm just a clinician. I don't wanna have, there's a lot of OTs that just wanna be clinicians. Sure. And so you can look at and be like, oh, cool.

[01:33:50] Josie Jarvis: I can partner with clinical doctorates. New grads have something that I don't, they have connect technical skills, but I have this everybody has something amazing to [01:34:00] offer and , we can choose to see as everyone being equally valuable just as human beings. Full stop. Including our clients, including our coworkers and our staff members.

[01:34:10] Josie Jarvis: They have insight into how we can evolve our systems just as much as we do as a quote unquote expert. Yes. Gotta start by listening and feeling confident with everybody on our team, including our clients, including everyone being in their peak most awesome, empowered Express state. True confidence is where your value as a human being irrespective of how, who's in your system, who's there.

[01:34:34] Josie Jarvis: If you're a bachelor's level ot, if you're associates level ot, if you're this, you have an important and empowered role, and we need to find ways to give each other leash to , like really be who we say we are in an empowered way. I truly believe it's possible once we get to a place of giving ourselves permission and actively reflecting on these problems.

[01:34:53] Josie Jarvis: I think there's so much potential capacity in the OT world to be a really dynamic, transformative force, and you can [01:35:00] see evidence of it all over the globe and how OT has evolved in different ways. But it's like you said, to start out, we've gotta come to peace. There isn't just one way to do ot. There isn't one way to be ot.

[01:35:11] Josie Jarvis: There's space for a lot of diversity in our field, and that's actually a positive thing. It's not bad that we're not one size fits all. The only thing I think we should be one size fits all about maybe in the US is following the OTP F domain. In process, you should have a process that continues to evolve over time.

[01:35:30] Josie Jarvis: The new insights, it's okay to cohesively follow a process, but it's not okay to just absentmindedly implement some sort of pro proclamation. That's like dogma. It's not scientific at all. , you shouldn't be in a automaton just doing something that some random authority figure told you to do. You need an understanding, you are the role of implementing this process that is like a really cool responsibility that you can take on.

[01:35:57] Josie Jarvis: We don't have to be, you can choose not [01:36:00] to participate in these systems. Have you found any resources that are helpful in understanding about these addition systems and making choices to do things differently? 

[01:36:09] Kary Gillenwaters: Yeah one, one book that this is this much poor book has been like really used a lot, but it's called Daily Reminders for Living in a New Paradigm by Anne Wilson Shae.

[01:36:20] Kary Gillenwaters: And she's in the, she actually recently passed in the last few years, but she's in the addiction arena is where her work has been. But she's talking about participation as requirement for living in a new paradigm and that we're gonna have to go through some of these trial and error of things.

[01:36:36] Kary Gillenwaters: But she, so that's just a daily reader that I like as a reminder of still show up Kary. Like it doesn't have to look exactly the same every day, but continue to show up. So that's one. She also wrote a book in the eighties, I think called The Addictive Organization and When Society Becomes An Addict.

[01:36:55] Kary Gillenwaters: And so those are things like she was predicting back in the eighties that there was such an issue [01:37:00] with addictive systems and organizations that. By, I think she was saying 20 years from then, it's now been 40, that like 80 to 90% of people would be functioning in 80 would be functioning in addictive systems and not even know it.

[01:37:15] Kary Gillenwaters: Like it'd be so baked into the policies in our work. Or she was talking about really rigid, like an example, being a really rigid professor who's got such a stringent grading ru rubric that you can't even possibly achieve it. Those are like examples of addictive, like codependent, perfectionist type of behavior.

[01:37:36] Kary Gillenwaters: There's never an, we're always trying to achieve this higher and higher thing. So you almost 

[01:37:42] Josie Jarvis: have to give permission to yourself to be messy. Yeah. 

[01:37:45] Kary Gillenwaters: In a way. Yeah, absolutely. So her work I think is one the Mindful Family Guidebook by Brenda. I always forget Brenda's, she's got two names, so I never wanna say it's just the last name because in case I, if she goes by both, but the Mindful [01:38:00] Family Guidebook is helpful for that.

[01:38:01] Kary Gillenwaters: And really, when I talk about nursing and creative healthcare management has a whole variety of resources, following anything. They have a journal called Creative Nursing or Creative. Yeah, creative Nursing Journal. And so 

[01:38:12] Josie Jarvis: also some of our founders for OT were nurses and Right social workers and mental health.

[01:38:19] Josie Jarvis: So it's important to know. I'm trying to decolonize and actively deconstruct, like how much sometimes when we like put the history over the contemporary and equalize that , but even by those more formal technical terms we get to claim this lineage of having, being informed really because ot, I mean because OTs were systemically blocked from developing in academia for so long.

[01:38:44] Josie Jarvis: Tho those that did progress had to pursue degrees in other disciplines that did enable and support that. . So like Katie, Katherine Reid, Dr. Katherine Reid she got her degree in library science. A lot of us, it's, I think that's a beautiful gift now in a way because [01:39:00] it allows us to be interdisciplinary thinkers.

[01:39:02] Josie Jarvis: Yeah. And to think across these like divisions of thought and being more holistic and more transactional. Totally. A different way of thought. Providing, but. Even an OS thing. It's not like we wanna be mindful of things like appropriation and stuff like that, but you're allowed to be inspired and to notice and get insights from like the nursing literature, for example.

[01:39:23] Josie Jarvis: And thinking about what's worked for other groups. That is such a positive thing and it's a good thing to look at what is, how is OT developing in other states and in other countries around the us? If we can adopt instead of like a comparison mindset of more of a collaboration, one that is when we're in a competitive thing of looking at what other professions are doing and feeling threatened and insecure, that somehow that makes it worse.

[01:39:47] Josie Jarvis: How can we spin for an opportunity that it actually creates a situation where a rising tide lifts all boats, and having a different thought relationship to it. I think that there's so much I like that you brought [01:40:00] that up. And I think there is a way to mindfully consume others' literature and to be inspired by other communities if you're giving proper credit and you're actively making empowered relationships, like you're saying you've built with the nursing community.

[01:40:15] Josie Jarvis: Man. It just brings insight and healing to the whole system. I really wish this is the way that science worked in every capacity. I think that's a sign of some of the toxic addictive patterning probably in academia where you keep everything so strictly separate. And you're. Literally competitive about another, who's gonna be the first one to publish on this insight rather than let's collectively celebrate that we accurately were all identifying a shared concept.

[01:40:39] Josie Jarvis: It must be a real thing that we identified. We could be happy for each other and get to a different it is just so helpful to understand these things that they actually play out systemically. And to 

[01:40:50] Kary Gillenwaters: understand the why of why would we, why would these issues happen that it's not so much, because people, I always joke, you're not a jerk.

[01:40:57] Kary Gillenwaters: It's your nervous system. Like when you feel like [01:41:00] you need to go and fight and flight or freeze or shut down chances, our nervous system is telling us, like our body's giving us cues as to what's happening there. Or to get curious about historical context that maybe has nothing to do with present day, but what's, what happened back there.

[01:41:15] Kary Gillenwaters: And that's where I think it's so important now to look at like Dr. Britney Connor work, bringing in more community stuff into the intro to OT te or Intro to OT text. I'm so excited about her partnering with 

[01:41:27] Josie Jarvis: a little bit about that. Is that the textbook that just recently 

[01:41:30] Kary Gillenwaters: got launch launched?

[01:41:31] Kary Gillenwaters: Yeah. That's most recently launched. Yeah. Yep. So I'm hoping that becomes a common thing because, Dr. Connors is not from. Academia and she's bringing the community. So you see that bridging between academic lens and the community clinician lens. And her work is, I view her work as very community focused and looking at the broader whole, and always calling us as OTs to come back into wanting [01:42:00] better for us as a profession.

[01:42:01] Kary Gillenwaters: And, some of 

[01:42:02] Josie Jarvis: these, so this is an introduction to occupational therapy text, and it was like the original text. Like they probably might read it in that first introductory section or a pre OT program? Probably. Yep. And so you're saying the author, the original offer from that actively opened up an opportunity to partner with a clinician, somebody that wasn't traditionally, 

[01:42:26] Kary Gillenwaters: I believe, I don't know how that partnership launched.

[01:42:28] Kary Gillenwaters: Oh, okay. I, but I do know that it is the two different, two different experiences coming together. Dr. Dan O'Brien, I think is the other author that's 

[01:42:36] Josie Jarvis: incredibly inspiring. So that's 

[01:42:38] Kary Gillenwaters: something that, again, follow right. Pay attention to where those things are happening. 

[01:42:43] Josie Jarvis: And you can do that too.

[01:42:44] Josie Jarvis: I feel as a clinician, like I think that's now a, an ethic. I've internalized and learning about occupational science. I always look at the example of Louis Leaky. So Louis Leaky was a physi, biological anthropologist [01:43:00] that had a really high position in academia in the UK in the late sixties.

[01:43:05] Josie Jarvis: And he broke from protocol on terms of who was supposed to be given opportunities to help develop that science. And he took a risk on two people that end up being important to OTs history and legacy. Diane Fosse and Jane Goodall as part of the Tri Mates. I'm just highlighting them because Diane Fosse was an occupational therapist and Jane Goodall went on to contribute to the development of occupational science.

[01:43:31] Josie Jarvis: But both Diane Fosse and Jane Goodall. Or Jane, good old didn't even have a bachelor's degree, I believe, or she only had a bachelor's degree. And I don't mean to use those disparaging terms. But these were systemically, quote unquote undereducated women that would maybe have no business being on the ground for facilitating a study around human origins.

[01:43:55] Josie Jarvis: But Louis Leaky took a chance, disrupted the system, and as [01:44:00] a result, changed the entire scientific paradigm for how even in the West, they understood the value of non-humans and the connection that humans naturally have to the outside ecological world. And imagining that animals can also have subjective experiences as they develop and navigate their, their ecosystem.

[01:44:24] Josie Jarvis: I feel like that action right there is core to. What I wish for occupational therapy and occupational scientists and seeing your potential as an OTP, as a gate opener. . And this is not just insight for academics to continually broaden the table for who gets to develop our science and our evidence base, but you as an OTA can open up those opportunities for your clients on a daily basis.

[01:44:49] Josie Jarvis: We're there to help our clients have a voice at the table and to enable connection, belonging, an empowered voice in how their treatment is happening in the healthcare system, where [01:45:00] they're not an empowered seat at the table. This book, that's just something that is important. You get to give yourself permission.

[01:45:07] Josie Jarvis: And the legacy of OT is that you can be a gate opener, and we will see our practice positively evolve as a result and as a clinician, please show up to these tables. Oh, AOTA has a clinician representation deficit . Let's challenge that. Let's show up and find ways where there are openings. If you're in a position of power, create openings so that can be.

[01:45:31] Josie Jarvis: I'm sorry for stealing the mic again. 

[01:45:33] Kary Gillenwaters: No, not at all. It's a very passionate subject. I absolutely get 

[01:45:37] Josie Jarvis: it. Yeah. And that's one of the other things that we wanted to talk about is looking at preventing, like tokenization of voices too in these addictive systems discourse that we often have is around performative activism.

[01:45:50] Josie Jarvis: One of the things that came up is there was a sense of creating the term of OTP was maybe a sense of virtual signaling or performative activism where they're putting lip [01:46:00] service to inclusion, but not really supporting it in some way. And I know that's been a concern of yours and is also something that I guess in general, we were having a conversation about what does it mean to include diverse voices when we're making decisions and how do we make that substantive?

[01:46:17] Josie Jarvis: I think your salons are a really great way of where this isn't performative activism. This is an act we can show up at this table and actually talk about these issues in an empowered way in hosting things like that. And I'm curious what you also wanted to have in this topic of how do we include diverse voices?

[01:46:34] Kary Gillenwaters: Yeah. I would say, again, everywhere we're at, there's a chance to be curious and notice who's missing from these conversations. Sometimes we don't even notice they're missing because it, it feel like sometimes we can have such. Like we've almost accidentally thought one way is the human way, and that is so not true.

[01:46:56] Kary Gillenwaters: Or depending on how many different ways of being a person is [01:47:00] exposed to, you just think oh, this is just something everybody's experienced. No they haven't. And so I think part of that is intentionally being around a lot more people first observing from afar, and, going on reading, going on YouTube, like whatever, all the different ways that you can observe without go and like almost stairstep like you would being 

[01:47:21] Josie Jarvis: outside the echo chambers.

[01:47:23] Josie Jarvis: Yeah. 

[01:47:24] Kary Gillenwaters: And then build towards, having more relationships that are intentional and understanding. And because I in reality in the United States, there's so many different cultures here. Theoretically it should be like this great big conference of the meeting of people from all over the world where there's so many opportunities born.

[01:47:42] Kary Gillenwaters: Instead, structures are informing the functions where if the structure has it all look one way, then it's a good cue. Hey, wait a minute, this structure that 

[01:47:52] Josie Jarvis: might not be accurate. I definitely think that's not good science. That's, I think that drives me crazy about the over [01:48:00] standardization of trying to assume.

[01:48:03] Josie Jarvis: Assume there's some magical standard in a way that a body is supposed to look how it's supposed to. It's just like when I was studying biology in my undergrad prior to going into ot, one of the things that we would study a lot in critique was some developments in agriculture. So if you have what's called a mono crop where you genetically engineer a strain of a seed to have certain properties that are very useful in industry the problem is that strain that you created, because it has it's the same operating system inside the plant, it's really easy for viruses and patho pathogens to engineer ways to take advantage of the vulnerabilities in that system.

[01:48:45] Josie Jarvis: And that's part of why ecology tends to be pretty diverse and non-linear over evolutionary time because there's genetic long-term advantages. for the lineage to have [01:49:00] diverse representation in different forms. That's part of why we have different biological sexes and genders. , is that you actually, the genome itself is more robust over time if you have a diversity of reproductive and environmental adaptation strategies.

[01:49:15] Josie Jarvis: Cuz time and space in over evolutionary time is incredibly volatile on earth. You get ice ages and the landlines. There isn't a lot of stability in science actually. It's really you have to be open, reflective in asking curious questions and observations in lifetime in order to get accurate, meaningful information that helps you adapt to the next stage if you're going off of a data set that was standardized in 1978.

[01:49:41] Josie Jarvis: Guess what? We live in a different world now. I personally like will be so bold as to say, I think that the cle, the pre covid 19 normative data set, I think we've actually cleared the slate. I think humans are development developing. My hypothesis is that humans are developing differently post [01:50:00] covid.

[01:50:00] Josie Jarvis: And that we can assume that they're a confounding data set from all of our normative statistical data. Pre 2020. , I don't know if it's safe to assume that fine motor skills will unfold in the same continuum. And this is like I That's true. Can have this perspective in some ways because I invested early on in.

[01:50:17] Josie Jarvis: Scientific literacy and you got that early opportunity to develop OS literacy and it almost seeps in, in unexpected ways. I think most of us go okay, I just finished my col community college degree, never using that again, just finished my bachelor's degree, never using that again. Meanwhile, where am I gonna actually make my money?

[01:50:36] Josie Jarvis: But it's now now that I'm going into my thirties, I'm actually saying oh crap. That is the value that I got from investing five years and learning about field biology for some reason. , I now can see things that maybe are different. It's a different perspective. How great is it that now OT gets the insight of a formal field biologist and an addictive patterning specialist and Right.

[01:50:59] Josie Jarvis: Clinical [01:51:00] psychologist, we're actually a more robust, likely more scientific field because we have such a diverse cohort. We're so used to seeing that as a disadvantage, but I really think if you take a little bit of a perspective shift and you're willing to bravely take advantage of the invitation that offers, it could help us be one of the more for example, real quick in one of the things I learned from field biology is in a landscape where there's a high degree of volatility over, space and time, like it's a seasonal environment like in the northern hemisphere generalists are favored, generalist species are favored.

[01:51:37] Josie Jarvis: So you'll see things like raccoons in North America thrive , above the equatorial line. And that's because they can pivot and take advantage of different dietary sources and they can respond to ecological changes in cold and heat and migrate and whatnot. But in places where there's a stable climate and stable ecology, specialists are gonna be [01:52:00] selected.

[01:52:01] Josie Jarvis: So if you take that metaphor and look at human systems , if you have a stable healthcare system, probably the specialists are gonna be more valuable. If you have an unstable human and health system, it could be that the generalists become more valuable. So then that prompts to me, why are OTs still trying to specialize when the outside environment is actually starting to favor generalists. 

[01:52:26] Kary Gillenwaters: And I would say too that as OTs , when I think about our opportunities as more generalists, I think of, I see the future of OT moving towards more community based that I see us, we're still in medical model, but I'm. Intrigued by the community and wellness preventative stuff is what we understand about occupation loss deprivation, all those kinds of things and how it affects us.

[01:52:47] Kary Gillenwaters: I if we were almost like you think of general practitioners, the general medicine doctors that if, as if we are listening for the community needs of, as the general practitioners and then spoken to the different [01:53:00] specialists or specialists, wouldn't society benefit far more from us being the listeners and guardians and helping help us figure out, okay, how do we reorder it in today's fast moving world if we are serving in more consultative roles?

[01:53:15] Kary Gillenwaters: I suspect y that's the, that's the space, that's the leash you refer to. Give us that space. Wow. 

[01:53:23] Josie Jarvis: And we give ourselves permission for that leash because yes, I know that some of this sounds oh, that sounds too good to be true, or, That can't be real, that generalists would ever be more valuable in a system.

[01:53:35] Josie Jarvis: I think if you're giving yourself permission to look and are open for some of those insights. In the post-acute setting that I've worked in, there's been points in time where CNAs were pulling higher wages than OTRs and OTs and other, like more senior nursing staff because that's where the scarcity is in the system.

[01:53:54] Josie Jarvis: Sure. At some point, whoever shows up and creates that meaningful change, which by the way [01:54:00] is why I think ABA is so powerful and so threatening, is I think that they as a discipline went in a direction that I wish OT had considered about 40 years ago. Wish I was born 40 years ago or longer than that. But they used single subject research designs to test their hypotheses about the impacts of their interventions.

[01:54:23] Josie Jarvis: So what they did is they took pre-data on the client that they were working with, then they introduced ecological interventions. One of the more like cool things about ABA really is they actually take on a social model of disability from the start. It's ironic. They don't consider anything about the internal reality of the person.

[01:54:42] Josie Jarvis: It's just fully the external reality. So they mostly mediate through creating changes in the environment and where the reinforcement in the system about what's motivating for that. So they introduced their more environmental changes and then they pulled those supports away and they showed that the client regressed without those supports.

[01:54:59] Josie Jarvis: They then [01:55:00] built the foundation of their therapy delivery model to be mostly community-based, like you're saying. They designed their intervention to empower the frontline technician. So the frontline technician in the AVA business model is the most important piece of the puzzle. It's not the one that needs to they don't really want them changing the plan necessarily off the guidelines.

[01:55:23] Josie Jarvis: And I personally, part of why I'm a proponent of a ABA being a licensed, registered accountable profession, because I think that ABA is incredibly dangerous when it's unregulated and there's no oversight. And if you get rid of ABA a, you also get rid of the legal oversight protections and you'll get people utilizing behaviorism without mechanisms of community accountability.

[01:55:46] Josie Jarvis: So that's why I'll never advocate personally for getting rid of baby A. But at the same time they have built the, what was I trying to make? . It reinforces having a community-based model and it, there's [01:56:00] an advantage to delegating and empowering and giving that leash to everyone in the system because humans are amazing and we're incredibly adaptive problem solvers.

[01:56:09] Josie Jarvis: . But if we require humans not to be humans and to resist some of those things, we're not getting the benefits of those transformative outcomes. And yeah, I might have to pass off to you cause I totally lost my train of thought. No and what 

[01:56:22] Kary Gillenwaters: I would say is you're really talking to us about whether you're a practitioner or a human or not, it doesn't matter.

[01:56:28] Kary Gillenwaters: Any living being presume, competence Pro presume the fact that everybody has something to offer and is designed to do that. And when I think about that, and I think of, some OTs in the field that help speak to that is anything Dr. LaVonne does too. She's now currently doing some work on developing a program, I believe.

[01:56:48] Kary Gillenwaters: I think it's the Turtle Mountain Community College in North Dakota. But she's talking about decolonizing education and reinserting indigenous ways. Just recognizing to me the [01:57:00] colonization is equivalent with addiction. It's all part of the same system. , it's so understanding.

[01:57:06] Kary Gillenwaters: That is impacting us as huge. So I'd follow anything that she's doing. And also when I think of which again ties back into indigenous ways of knowing is that Alice Hortop work, and she's talking about belonging in the uk and she's talking about some of the things that we've come to believe like Maslow's Hierarchy of Needs and recognizing that actually that work was based on Blackfoot Nation.

[01:57:29] Kary Gillenwaters: And if you go back further, actually, you'll find out there's a woman who talks about this, who actually has a direct tie to that, found out that the reason that Maslow's hierarchy is listed as it is because some business professionals got a hold of him and said, we don't want you to, they didn't want it portrayed the way that Blackfoot Nation exactly had done it.

[01:57:49] Kary Gillenwaters: So they basically, they paid him off to have it be this levels of like you're trying to reach self-actualization. When in reality what he had witnessed was that indigenous, the [01:58:00] way they were raising them in black people or their families in Blackfoot Nation was, you are born self-actualized. Who you are already complete.

[01:58:08] Kary Gillenwaters: Your job is to notice who, how someone is part of a community. So that the community can go on perpetually. That's how it was actually designed to work. But when we put profit out as the number one thing, we don't want people to think that, cuz that's not gonna drive business 

[01:58:24] Josie Jarvis: disrupts the whole kind of systemic 

[01:58:27] Kary Gillenwaters: logic.

[01:58:28] Kary Gillenwaters: So it, I guess my, what I'm saying in all of that is it's okay to question all the things. It's probably necessary for us to question all of the things. I don't have all the answers, but I feel ver I, and I think that also speaks to res men's work about talking about there's gonna be pain, it's clean pain or dirty pain.

[01:58:47] Kary Gillenwaters: And so I don't fear having these conversations, maybe because I've been doing them since I was 21 and became an addiction counselor, I'm more concerned about not having them Yeah. And not having them in ways that [01:59:00] hold the space to honor all of our unique ways of being. And that yeah. That to me is frightening.

[01:59:07] Kary Gillenwaters: So I'm wherever there are spaces where people are willing to go there and to always recognize, we are all part of these systems in some capacity, so none of us are going. Enter these conversations and have it all together and perfect. We're gonna, it's gonna be 

[01:59:22] Josie Jarvis: messy. It's gonna be messy and preparing our nervous systems to be yes.

[01:59:26] Josie Jarvis: In a state of grace. And I imagine even though I talk a big game on this podcast, for example, and I'm a huge, enthusiastic person for holistic full scope OT practice in the US and beyond. And I'm a big enthusiastic contributor for that. I'll admit, I'm mostly trained as a pretty typical traditional OT clinician in the us.

[01:59:49] Josie Jarvis: I'm still evolving my practice on a day-to-day basis and finding those opportunities to play with the edge and be rough and like you're saying, giving myself permission to play [02:00:00] in enhancing my practice and finding opportunities to be more holistic. But that being said, I can speak, and I know some of the background of being a more traditional biomedical OT and with what you're saying, I feel like even traditional biomedical OTs that we're focusing, just on individual client factors and things in the system.

[02:00:21] Josie Jarvis: But what you're saying is very similar to what we do in post-acute on a daily basis, where if somebody is limited by knee pain after having a total hip replacement, we are used to. Understanding their perspective, their denial of what their needs are, and how, like sometimes you have to listen to your pain, right?

[02:00:42] Josie Jarvis: And we need to find the right times to implement solutions and when not. Some of these conversations are new and some of them are ancient, but as an OTP, You likely already have well-developed skillsets around these questions in your, in the work you're already doing with your clients, that this is, that [02:01:00] first step is acknowledging the context that we're in, noticing that we've had a disruption, something we thought and what we expected to have happen didn't go as expected.

[02:01:11] Josie Jarvis: I'm thinking social thinking's terminology, right? Is this a big problem? Is it a little problem? What are our emotions, what is our zones of regulation around it? We can utilize these tools we've already cultivated with acknowledging these bigger questions that are Yeah. Painful to consider.

[02:01:27] Josie Jarvis: They're difficult to take on and face, but that's just the first step. Once we face that and then we get the right community, the right specialists that might come in unexpected forms might not be in a hierarchy. I think I remember the train of thought was about how c n a is at certain times during the staffing shortage are polling bigger wages because you are, I think the future of healthcare is, it is gonna go to those that show up, do that, move the needle.

[02:01:55] Josie Jarvis: And that really should be where the money is going and something I'll be an advocate for if [02:02:00] we're not contributing in some meaningful concrete, almost material way to transform the lives of our clients in the systems we're working in. And we can't show on a measurable spreadsheet in connection to the subjective and qualitative factors of what we do.

[02:02:15] Josie Jarvis: OS gives us a mechanism for that by the way. They allow for mixed method inquiry and data implementation sciences, moving in a direction where we can take outcomes data along with those qualitative subjective experiences that need to shift. Showing up on the front lines is really where this conversation is going, not just in theory, but in actual healthcare funding.

[02:02:37] Josie Jarvis: right? This is a chaos theory in the nursing landscape. I complexity theory, that is what is dictating a lot of staffing policy in hospitals right now cuz they're responding to the biggest needs rather than pretending that they can pre-plan a hierarchical system. System. Like that goes back to that like stable terrain of a health stable healthcare system where you're imagining that you can prepare [02:03:00] and budget for something in the year ahead.

[02:03:02] Josie Jarvis: That's obviously. Not gonna succeed during a international pandemic. Instead they were, they're using a more responsive model where you staff according to the highest need and you get better outcomes. The more leash you give to the frontline clinicians to make decisions that's the he future of healthcare happening right now.

[02:03:24] Josie Jarvis: And the slower that OT adapts to this new, more non-hierarchical model, this more decolonized model, I think the farther we'll be left behind personally. 

[02:03:33] Kary Gillenwaters: No. So it would behoove us to put our time and energy in that direction. And to to figure out, yeah, what does that look like? How do we know each other so that each of us can show up with our best abilities?

[02:03:45] Kary Gillenwaters: Cuz like the other pieces we're everyone juggles multiple roles. How do you reconfigure how we spend our time and energy? Is a 40 hour work week necessarily going to be the thing that gets us there? I don't know about that. Is it better? [02:04:00] There's, are there better other ways that are waiting to emerge during this time?

[02:04:04] Kary Gillenwaters: Yeah. Colo sees a book about that too. There's a whole book about. Custom design. Different ways to think. Yep. 

[02:04:11] Josie Jarvis: Why don't, what do I'm thinking, Kary, is I would love, I'll follow up with you to capture some of the references that you have, but I think we should have you on for another episode too.

[02:04:22] Josie Jarvis: Sure. And applying some of these, cuz you have developed a tool of reflecting on your roles and that might be a good transition. That's right, . So I think just in reflecting on this conversation so far, we've been able to hit on a few really key areas, which is that Addictive patterning is something that isn't just on the individual level.

[02:04:42] Josie Jarvis: It also plays out in the micro meso macro level in different systems. And that if you build some literacy in how addictive systems function and how they play out in systems and pair them with occupational science concepts, that can really increase your agency as an OT [02:05:00] because you can see where the limitations and where the opportunities are in those systems that you and your client are inhabiting.

[02:05:06] Josie Jarvis: And it can increase a creative basis for relationship building and reflective practices on how your environment's impacting you as an occupational being and looking at building empowered relationships and impart in partnerships within your ecosystem, your occupational ecosystem. And I think one of the other themes of this conversation is how can we share power and how can we create openings and empower and give leash to yourself and to all of those that you're working with, including those who are the most on the front lines.

[02:05:41] Josie Jarvis: And to move away from addictive patterning, which can look like perfectionism, micromanaging, getting very black and white and rigid, and seeing things as more of a one size fits all. So we've d discussed how. Occupational science, literacy and just building community with broader interdisciplinary professionals [02:06:00] has helped both Kary and I feel like it's not so discouraging to be practicing in these systems because we can see paths and opportunities to find solutions.

[02:06:10] Josie Jarvis: So we've talked about, the advantage of getting some awareness of these concepts. How, we're hopefully modeling for you that we were privileged in these systems. We got connected to people like Doc, Dr. Kristine Haertl, PhD, ACE, OTR/L, FAOTA, right? . Okay. Chuck Curtis Jensen. For me it was John White.

[02:06:26] Josie Jarvis: But now guess what? You have two OT clinician friends, OTPs Josie Jarvis and Kary Gillenwaters. Were clinicians just like you. We wanna be an inroad for you to feel like you can get exposed to this. And we wanna connect you to opportunities to feel like you're at the table. And yes, let's have some of these conversations outside of work where it's more fun, more informal, and everyone's an equal at the table, right?

[02:06:51] Josie Jarvis: And OTAs , I'm including you in this. You have an in now to OS you can reach out to us. And so we've talked about, some of the barriers to [02:07:00] accessing OS in this conversation and how we're resolving that. So this is really gonna be a group effort to address the addictive patterning in the OT community in the systems that we inhabit.

[02:07:10] Josie Jarvis: But we also talked about how if we put in the time to reflect and build community around these questions, we can follow the optimistic pathway of nursing now more empowered than ever, and is really meeting the community-based needs where they live, work, and play, and that we can partner with. So you get to be involved in this conversation.

[02:07:29] Josie Jarvis: We're hoping to host this conversation, inspire more conversations, create new everyone. Let's start a podcast. I think, Harry, you're starting a podcast or something like that, is that right? Yeah. Yep. I 

[02:07:38] Kary Gillenwaters: do have. It's not an official podcast. I have it right on the blog or website tool. Life Occupied. We have lives, occupied lessons from near and far as part of one of our segments.

[02:07:47] Kary Gillenwaters: We're listening to everyday people, OT practitioners, students it's everybody's coming to that conversation. Do 

[02:07:53] Josie Jarvis: you have any events coming up? Later on in this year? 

[02:07:56] Kary Gillenwaters: So March 16th, we've got actually two [02:08:00] new clinicians and former students at our team. Marcy Drayton is an OTD and recent licensed professional.

[02:08:06] Kary Gillenwaters: And then an OTA student who's a recent grad Bailey Healy, are gonna be hosting a conversation for OTAs and OTs to look at how do we collaborate and more, they're also focused in the transition from student to new practitioner. So that's one conversation. We're gonna talk more about rest as healthcare professionals in April, that's gonna be a more interdisciplinary.

[02:08:28] Kary Gillenwaters: factor and we've got a lot of cool stuff coming up down the pike. So that's say, just look at our website or Facebook. If you look up tool life well 

[02:08:36] Josie Jarvis: occupied, you'll find us. Perfect. And Kary is part of the OS empowered ot, which I'm still needing to develop more. So exciting to have you as part of this conversation and my goals for all of you, OTPs and allied disciplines, people, humans in this conversation to, I hope you can feel that.

[02:08:55] Josie Jarvis: I want for you to have an empowered and equitable seat at this conversation. [02:09:00] You're an important occupational being and we are adapting to these challenges together. And we can make the most of it. And you got two allies. Hopefully to model being reflective and accountable and messy. Yeah. Fantastic.

[02:09:13] Josie Jarvis: In these conversations. , and we embrace that and giving ourselves permissions to be messy, which is usually nice if that can be outside of work, even though eventually it's good and okay to bring those insights back to your more professional work environment. And you do have permission to do that with O T O S and our practice framework.

[02:09:29] Josie Jarvis: And over time we'll work together to give each other support and confidence to start shifting and evolving our practice and honestly, our science that influences not just OT but other disciplines all over country. It's a point that we can have really international influence on how we're understanding human beings and their needs in the contemporary modern world that is just getting more and more chaotic over time.

[02:09:52] Josie Jarvis: So acknowledging that is just the first step to being able to support each other through it. Kary, I wanted to thank you so much [02:10:00] for being open to being one of the first guests in the messy stages of the launch of this podcast. And I really wanna just thank you for your work and your bravery and commitment to self-reflection.

[02:10:09] Josie Jarvis: And I look forward to just supporting you as a colleague and helping to amplify this example too, that hopefully we can keep finding other OTs that are really invested in bringing in a more reflective practice and supporting each other and helping to uplift the OTAs and the clients that we work with along the.

[02:10:28] Josie Jarvis: There's so much potential for ot, and I just thank you for investing in this, even before we've had platforms to have these 

[02:10:34] Kary Gillenwaters: conversations. Yes. Thank you. Thank you for inviting me. I feel honored to be among the first people in these conversations, and I would say that it's been interesting to see you.

[02:10:45] Kary Gillenwaters: What when I'm talking about making space for people to be in their genius, when I think of your voice at the table in for occupational science, how it relates to all of us as OT professionals and what you're [02:11:00] creating, I really want people to know, pay attention to what Josie's creating here, because it's for one, what you're doing is it's deep, it's rich, and it allows you to really have this central place to go to understand some core underpinnings of our profession in the sci occupational science, while also the way you've done it and making it so accessible.

[02:11:22] Kary Gillenwaters: I think you just 

[02:11:24] Josie Jarvis: possible. You got to. So Kary is one of the beta testers for the foundations of occupational science course that I have been developing over the past year with my capstone. And I am going through a stage and I need to make space and time to go through some edits and revisions of it to make I almost, to decolonial it a little bit because I had to follow so many academic standards and now I don't have to follow.

[02:11:46] Josie Jarvis: Yeah, exactly. That might be what she's referring to and part of the goal. So I would love to create this platform that we can play with these concepts and have these conversations and really to create space. And sometimes I think that is [02:12:00] the most, one of the most powerful things that we can do as OTPs is even if we're not offering or creating anything, cuz most of what I'm sharing is also the insight from others in creating a platform where it can be shared.

[02:12:13] Josie Jarvis: Sometimes the first thing we can do is just to create space for others to express and highlight their zones of genius, like you're saying. . And that can be the therapy in the system, especially if it's trying to suppress and silence voices that could have insight for changing and getting out of the addictive powering.

[02:12:29] Josie Jarvis: One of that first steps is just making space for those voices to be heard and being open and willing to listen. And if you're listening to somebody, it doesn't necessarily mean that it's has to change your mind. We, some of the best ideas advice I ever got was listen to everyone and follow no one.

[02:12:44] Josie Jarvis: . because you're engaging with another perspective, even if you hate it and it makes you uncomfortable and it makes you angry, it doesn't mean that those ideas are now like what you have to do. Sometimes you just can read and take in new perspectives just to understand right where they're coming [02:13:00] from.

[02:13:00] Josie Jarvis: And it doesn't mean that your opinion has to change or your opinion's invalid. It's just being able to engage and appreciate and understand another human perspective. 

[02:13:09] Kary Gillenwaters: Yeah, no, so it's exciting times, it feels chaotic because it is, but Just like birth, right before you have give birth to something, it gets pretty messy.

[02:13:18] Kary Gillenwaters: So this is what birth feels like. 

[02:13:20] Josie Jarvis: nervous systems are well optimized and honed for chaos. I think humans are pretty good at that. And that's where we can trust sometimes our intuitions about these systems. I look forward to having future conversations with you, Kary. And we can connect on, I think it would be wonderful to highlight aspects of that model that you've been building that has reflections so that way there's some really tangible takeaways from how we can start applying some of these techniques to invest in the future of our practice.

[02:13:46] Josie Jarvis: Now, maybe some of these, insights from these reflections they might pay off in a year, two years, three years, five years, 10 years. But hey, we're plant those seeds. We're investing early. There's no better time than now to start engaging with [02:14:00] these concepts. And hey, it's more fun if you're doing it outside of a university class.

[02:14:04] Josie Jarvis: We don't have to take on those hangups of some of the patterns of academia that most of us didn't love and enjoy while we were in school. Now we get to learn on our own terms, right? Let's just have fun. 

[02:14:15] Kary Gillenwaters: My apologies for all the beeping that's happening. Here's, that's an example of being messy is that sometimes even when you do everything that you think you've shut off everything somehow I'm getting alerts for some other thing on my computer, 

[02:14:26] Josie Jarvis: oh, that's okay. I got some alerts too, and that might might be able to edit them out too. The, there's one platform that does background noise, but this is a great point, like that we're taking imperfect action. This this podcast gonna evolve a lot over time and repetition and we're gonna actively model starting a little bit messy and giving people choice that they can engage in the content the way that they feel comfortable doing so.

[02:14:51] Josie Jarvis: Perfect. I'm wishing you off into a very hopefully restful oh wait, no, it's Monday. I'll be working 

[02:14:57] Kary Gillenwaters: the rest of the day, but I'm good. 

[02:14:58] Josie Jarvis: Yeah, so [02:15:00] Monday is my Sunday now, cause I work on the weekend. So for me, it's my first day off in a while. But wonderful. But these are great questions to sit with you throughout your day and to let your subconscious sort of contemplate on.

[02:15:12] Josie Jarvis: Thank you for everyone that's listening and Kary, let's be in touch soon. Sounds 

[02:15:16] Kary Gillenwaters: good. Thank you Josie. Thank you everyone. I'll just stop.