"Doing" in mental health practice: therapists' beliefs about why it works.

OBJECTIVE: The purpose of this study was to explore the beliefs of occupational therapists working in mental health regarding the therapeutic value of "doing" as a treatment modality. Doing was defined as any activity or action-oriented approach that was identified and used by the participating therapists. METHOD: Eleven occupational therapists working in a variety of mental health areas were observed as they conducted 3 to 6 regularly scheduled therapy sessions. They were then interviewed about their activity-related beliefs. Audiotapes of the 44 treatment sessions and 11 interviews were transcribed and then coded to identify emergent themes and categories of beliefs about activity. RESULTS: Participants used a variety of activities in both task-based and verbally based treatment sessions. Multiple reasons for activity use were cited, particularly in relation to the task-based sessions. Two main themes related to the value of activity were (a) benefits of activity for the client and (b) benefits in facilitating the process of therapy. Categories of client-related benefits included skill development; impairment reduction; self-awareness; positive self-concept; interaction or connection with others; healthy, balanced routines; pleasure; and enhancement of occupational role performance. Perceived effects on the therapeutic process included creating a therapeutic context, enhancing client readiness, facilitating communication, and providing an organizing framework. CONCLUSION: Occupational therapists working in mental health hold diverse beliefs about the value of doing in treatment. Basing practice on clearly identified and evidence-based beliefs will assist in ensuring a viable and valued future for the profession in this important domain of health services.