In Depth with Occupational Therapist Dr. Elysa Roberts
In this episode, we sit down with occupational therapist, Dr Elysa Roberts, to discover why OT can be effective in treating eating disorders.
First, what is an occupation? It’s generally defined as “any activity in which one engages”, which means it’s a lot more than just a job. An occupation can include eating, exercising, working, shopping, socialising, parenting, education, time spent on spiritual practice… the list just goes on. Occupations are all the ordinary and everyday activities of life.
An eating disorder can be considered an occupation, but one that isn’t good for your health or well-being. Recovery could also be defined as an occupation; and that’s why Occupational Therapists can play a key role in a person’s treatment team.
Dr Roberts, an OT since the early ‘90s, says that she realized the importance of OT as a treatment modality through her own lived experience.
“I’d go through waves of treatment, be discharged, recover, and then go through it again all while establishing my OT career. Unfortunately, what wasn’t happening in those days was strong relapse prevention programs, or relapse prevention being included as part of recovery.”
Now things are changing. Dr Roberts describes how OT can help – first by bringing a unique and holistic understanding of an individual’s mental, physical and sensory profile, but also by co-designing practical interventions that can make all the difference to ongoing recovery.
Elysa Roberts 00:06
We’re the ones that are creating the just-right-challenge for someone to face their fears, tolerate the distress of what eating disorder recovery requires, and reconnect back to who am I as an occupational being; who do I want to be?
Sam Ikin 00:27
An occupation is defined by Merriam-Webster as an activity in which one engages. It’s a lot more than a job. It can include eating, exercising, working, shopping, socialising, parenting, education, time spent on spiritual practice, the list goes on. Here’s another one for you; an eating disorder can be considered an occupation, but it’s one that’s bad for your health and bad for your well-being. Recovery could also be defined as an occupation, and that’s why occupational therapists can play such a key role in eating disorder recovery teams.
Elysa Roberts 01:01
I’m Elisa Roberts, and I am an American in Australia is one identity that I really hold. I’m also a senior lecturer at the University of Newcastle in the occupational therapy programme, and I would say I’m a master certified coach, and speaker and a method that really aims to disrupt diet, culture and other socio-cultural patterns in our lives.
Sam Ikin 01:30
We’ve never had an occupational therapist on the show. So we asked Elisa to spend a bit of time in the studio to take us through the role of an OT in recovery from an eating disorder.
Elysa Roberts 01:41
I want to define occupation before I define occupational therapy because it’s really key to understanding what occupational therapy is. So most of us think of occupation when we hear the word as a job or a career, and it is. To us, it really means that meaningful activities that we humans are innately driven to do that build our identities that help us belong to a community and that influence our health and well-being. So it’s far more than a job. And it’s really those meaningful activities that shape who we are. And they influence our health for better or worse. So an occupational therapist is someone who uses occupation as their intervention, as they’re both the means and the end. So we use occupation as our therapeutic tool to work with individuals to help them regain their potential to do occupations. So we’re part of the rehabilitation field, and you know, we help people get back to the skills for the job of living,
Sam Ikin 02:47
That part of the rehabilitation field is probably why we have you here today. We’ll get into that in a minute, but as somebody who is quite an expert on OT, where’s it comes from? Is it a new kind of thing?
Elysa Roberts 02:58
It’s over 100 years old now. So yep, it had its centennial in March of 2017. So occupational therapy was officially coined as a profession in 1917. So we really emerged even before that unofficially, in what would be called the moral treatment movement, which is when individuals started to recognise that people, particularly with mental health conditions, needed to be treated with much more dignity and respect than they had been treated, and that one of the ways that leaders at the time and philosophers and health care providers at the time were recognising that what influenced people’s health was engagement in meaningful activity, and purposeful. And then we really saw ourselves boom during World War One. A whole consortium of, at that time, women were shipped off literally, into the trenches during World War One, much sometimes to the dismay of the generals and such, to basically be entrenched with soldiers who were experiencing either physical injuries due to warfare, or what was known back then as shell shock, or what we would now really understand as combat stress or post-traumatic stress. The intervention that we did back in those days was engaging the soldiers in meaningful activity tasks that were purposeful to the war effort, yet weren’t necessarily on the front line, and, you know, like basket weaving to contain bandages and the medical teams, and other types of occupations, meaningful activities, and they got better. So we came back from there and the profession was formed and we’ve seen ourselves really diversify our practice, to the point where we work within neonatal intensive care units with premature babies all the way through individuals in the palliative or end-of-life experience. So really wide and diverse in mental health and in physical rehab.
Sam Ikin 05:11
I didn’t think that that would be such an interesting answer. But that’s cool. So as an OT, how did you get involved in specifically in eating disorder recovery?
Elysa Roberts 05:24
Well, I’ve been an occupational therapist since the early 90s. And I was studying at that time. I was getting a master’s degree in it, and I discovered occupational therapy a little late in my college career, which is very common for many of us because back then really, people didn’t understand occupational therapy very much either. And I ended up in the field of eating disorder recovery because I found myself in treatment for an eating disorder. So I was probably developing while I was developing my eating disorder for decades, but it didn’t really manifest until I was probably a junior in college, which is a bit of a late bloomer, they would say, according to, you know, myths and trends. But it wasn’t until I was about to go out on my mental health placement, which was already two years into my graduate studies, that it dawned on me that how I was relating to my body and food, and my relationships was – something was awry. And for me to go enter a mental health placement experience where I was going to be helping other people who were also facing substance use challenges or other mental health conditions just made me stop in my tracks and say, “Oh, I think I need help, because I don’t think I’m well enough to do this.” So I rearranged my education and really just told my parents, told my teachers and really sought help to realise that, wow, for several years now, I’ve been experiencing an eating disorder. At that time it was diagnosed as bulimia nervosa. Now, maybe there might have been more of the non-descript or other variations of eating disorders but at the time, that was bulimia nervosa. Unfortunately, I would go through a first wave of treatment and even be discharged, recovered and start my OT career at the same time. And I say, unfortunately, but that was just my first round of treatment. What wasn’t happening in those days in the 90s was really strong relapse prevention programmes or relapse prevention as part of recovery. So while I had to declare to the licensure board that I was recovered because the Americans with Disability Act hadn’t quite trickled down to protect us with mental health conditions in the workplace yet, so I declared I was recovered, and as people would imagine, within a couple of years, because my recovery wasn’t that strong, I ended up relapsing. So I maintained I stayed in a state of relapsing and remitting eating disorder for over 20 years because I didn’t – because of stigma in the times that I was practising and, you know, obviously internalised stigma. And it wouldn’t have been until I moved to Australia, where the damn thing followed me across the international dateline.
Sam Ikin 08:36
Funny how you can’t run away from it, isn’t it?
Elysa Roberts 08:38
Yes, key, you know, limiting belief or a pattern of people with eating disorders sometimes is all our men thinking, right? And I really thought if I just crossed the international dateline, it can’t find me. And it did. And therefore, I had to really face recovering while I was here in Australia, and at that same time, because I took this job in this academic world, I was meant to come here with a research agenda and therefore my research agenda became investigating how do people recover. What is what’s the, I mean, what’s the secret to recovery? What are the ways that we can learn from people with lived experience about how to recover from eating disorders? And what are the ways that my unique thinking as an occupational therapist can add to the evidence to help us, you know, intercept this thing called eating disorder? That’s really interesting. So you used what you were an expert in, to help yourself recover, which makes a lot of sense. So tell me how eating disorder recovery and OT intersect. How does it, how does it work? Well, if we go back to that idea of occupational therapy being this profession that really understands how we, you know, how we use our time, how we, you know, what are the daily occupations that we engage in, what’s the repertoire of our occupational identity, we can imagine that there’s a lot of activities that people do behaviours that people do that construct the identity of having an eating disorder, that relate to how people eat, how people dress, how people relate in social, you know, social occupations, you know, whether or not they’re engaged in work or school. So the way we come in is; basically, our role is to help people reconnect or recalibrate how they’re doing their occupations from being harmful to being helpful. So it’s really one of the areas of practice that almost couldn’t be more well suited for occupational therapists because the thing that’s really hijacking someone with an eating disorder are their thoughts and their behaviours around how they’re doing their day so who better than us to be in the picture to help people to reshape their thoughts and their behaviours and their identity to be engaged in occupations for good instead of harm? So one of the first people I interviewed for this podcast was Carolyn Costin, who’s also American like yourself, and I’m sure you’ve heard of her. You sound a lot like her in your approach to recovery. It sounds similar. Yes, we’ve actually met and we definitely, you know, see quite eye to eye. I think that I, you know, she’s now moved into, obviously, developing eating disorder, recovery coaching as a specialty, and I would say that you know, in some ways, I could give her an honorary occupational therapy degree, as well because of what she stands for, and what she believes in. So we look at, we both look at humans and I would say that I speak on behalf of what occupational therapists think, like I’ve been teaching occupational therapy since 1997 so I, I teach my future colleagues, the same philosophy that we see the physical, the neurological, the psychological, the spiritual aspects of a human, in our clients. And we see how that expresses itself in how they do their occupations, and how they’re influenced by both their cultural environment, their family, environment and office, the physical environment.
Sam Ikin 12:45
How do you work with your clients? What, like, what are some examples of stuff that you do?
Elysa Roberts 12:51
Well, right now, particularly in Australia, you find occupational therapists are in treatment programmes, treatment centres, so they work both one-on-one, and very often, you see occupational therapists working in group settings. We are taught in our education, group dynamics and group process very deeply, along with therapeutic communication. And we are taught around specialties of working in mental health, along with also working in physical rehab or neurological rehab. So you see, occupational therapists in traditional treatment programmes deliver occupational therapy, both one on one and in groups. Often those meal preparation or practical food groups use the occupational therapist or in groups related to somatic types of interventions like reconnecting back to your body. So there might be therapeutic yoga being used those kinds of things, or expressive arts, and you also see some occupational therapists working more in an outpatient setting in a one-on-one standpoint. So that’s where we’re working. What we’re doing is working alongside the multidisciplinary team to help really translate what’s happening, perhaps with a psychologist or even with a dietitian, into real life because occupations happen in real life. So our job is to very much be the guide on the side while someone is engaged in meal prep planning, meal preparation, you know, shopping both for food and or clothing, dressing, you know, reconnecting back to what we call you know, grooming like putting on your makeup putting off if that’s what you feel like wearing. It’s really about reconnecting back to your occupation. So we’re the ones that are creating the just right challenge for someone to face their fears, tolerate the distress of what eating disorder recovery requires, and reconnect back to who am I as an occupational being? Who do I want to be? What am I let go of, or what am I lost occupationally because of this eating disorder? And what do I want to regain? So that’s, we do a lot of creative therapy, I would say.
Sam Ikin 15:20
You’ve just taken me – so in 2010, I checked myself into rehab because I, you know, I knew I had a problem, and I didn’t know what it was. And I checked in, I went in, and I said, I have, I’m a compulsive overeater. They just wrote ED on the form and, you know, admitted me. But the person that I worked the closest with was an OT at the time, so this is something that is, I guess, OTs worked with a lot of people through a lot of different kinds of recoveries. How is it that you look at people or clients in general? Is there some universal factors, like, regardless of the mental illness or regardless of the disorder, I suppose?
Elysa Roberts 16:00
Yes, you’ve really tapped into something that I did want to make sure I highlighted that, you know, we are, we are trained to be mental health specialists, but and physical rehab specialists, then were trained in working in the mental health field, and were trained in physical rehab. And even in physical rehab, you can’t take the mental impact of a condition out of a person. So we’re very much trained in the recovery-oriented mindset, that idea of really having hope and holding optimism and really understanding the holism of an individual. And so we really bring a lot of what we call a therapeutic use of self to our practice, no matter what area of practice we work in, mental health being one of our specialty areas. So I think that we really are trained to meet a client where they are to be very client centred, and also to bring our expertise in which we train our you know, I can speak as a trainer of art my future colleagues, we train our graduates and our future professionals to really negotiate that tension between what a client wants to do and what we understand as what’s beneficial for their recovery, both from our clinical expertise and, you know, an evidence-informed approach. So yes, how we practice in the field of eating disorders is how we practice anywhere in the field.
Sam Ikin 17:36
What is sensory modulation, and this is a word that I’ve only just, you know, been told that we need to talk about, and why is it so important?
Elysa Roberts 17:45
So sensory modulation is the way that we humans, respond to sensory stimuli, sensory stimuli that come in from our internal body and from the environment. So we have sensation, and this is how we modulate that response to sensory input. So it’s how we modulate our response to light to touch, to sound to movement, to the sense of touch on our bodies, to our interoception, in terms of our, you know, internal cues. So it’s how we modulate these this relationship with, with sensation. And some of us modulate, we basically, we all modulate our response to sensory input differently. And there’s a bit of a spectrum of it, you know, some of us love to go skydiving, and some of us, you know, wouldn’t think of doing that because it makes us nauseous just to contemplate that kind of vestibular input of flying on a plane and that kind of experience of freefall, right, so we all have sensory modulation, it’s a human instinct. What we’re noticing, though, is that some of us have a sensitivity, we might be extra sensitive to certain types of sensory input or unresponsive to certain sensory input than the general population, so to speak, and my research, along with several others across both all the continents are recognising that individuals with eating disorders, particularly when they’re symptomatic, show differences in responsiveness to sensory input than individuals who don’t have an eating disorder symptoms or members of the general population. So this matters, just because we’ve also seen as occupational therapists, we’ve been looking at sensory modulation for decades, and we know that for some individuals if you have a difficult time modulating your response to sensory input, it can interfere with function while we know that in other neurodevelopmental experiences, you know, anxiety, other ways of being, we haven’t really explored it very much in the field of eating disorders. But now it’s really gaining popularity.
Sam Ikin 20:17
Among our audience, a whole lot of them are either in recovery or thinking about recovery have recovered. Here. I’m going to ask you if you can give us some advice; what is some advice that you can give us as an OT, who works with a lot of people who are exactly where they are right now?
Elysa Roberts 20:32
Well, for those who aren’t yet working with an occupational therapist, I would explore the possibility of connecting with an occupational therapist, because that occupational therapist is going to help you understand who you are occupationally. So it’s really about the advice to you is to reconnect back to what do you love doing? You know, what makes you outside of the behaviours that you do that perpetuate an eating disorder? So is it that you love writing or drawing or painting? Do you have aspirations to, you know, become a lawyer, or to become an artist, you know? What are those meaningful occupations, those meaningful daily activities, or idiosyncratic activities that make you you, and let that work to build that more into your life, and ways that you can do that, so that you let go of the things that are probably keeping you isolated, socially withdrawn, lonely, and unwell. So that’s one thing. And if you can find an occupational therapist, then they’re probably going to work with you on understanding like I’ve said, you know, understanding your mindset around engaging in, you know, daily activities and self care, but they’re probably also going to give you a sensory profile and understand how your unique modulation of sensory input presents itself and how you can actually use that therapeutically, to, you know, to bridge the gap between being unwell and being in recovery, and creating more healthful ways of coping, than how some of us used the way we treated our bodies as a way of coping.
Sam Ikin 22:26
Yeah, well, what about what about other health professionals? What, what what are some things that you wish everybody knew?
Elysa Roberts 22:35
I wish everybody did know a little bit more about occupational therapy and, you know, didn’t think it was so mysterious. I’m hoping that maybe after this podcast, people will understand, you know, that we really use people’s daily activities as the means and the end, in the multidisciplinary team. So I wish they, you know, get to know an occupational therapist, I also hope that health professionals really begin to educate themselves on eating disorders, and really understanding that there are still a lot of myths around why people develop eating disorders, how they happen, how they present themselves. And lastly, I really, really encourage health professionals to watch their language, because I think we can in the medical model in particular, we can pathologise people’s way of presenting themselves and that is proving to be, I think, pretty detrimental in some of the aspects of eating disorder recovery, particularly around how we name eating disorders, and how we characterise people sizes and shapes and relationship with health. So I think all health professionals can do a bit more of checking themselves in terms of are they perpetuating a weight centric or weights biassed or even fat phobic message to their clients and I’d really invite them to reconsider that because that’s actually I think creating more harm than good.
Sam Ikin 24:11
You’re singing to the choir here. I love it. I could talk to you about that for for ages, but we are out of time, so anyone who wants to find out more about you wants to read some of the things we’ve written or follow on social media, where can we find you?
Elysa Roberts 24:25
They can find me on social media @ElysaRobertsPhD. That’s primarily on Instagram. And then if you google search Elysa Roberts, you’ll find my university web page with lots of information about me and you’ll also find my coaching and speaking web page as well.
Sam Ikin 24:45
That’s E L Y S A Roberts
Elysa Roberts 24:51
Yep. And I guess I do also want to acknowledge that we have several occupational therapists who are credentialed now in terms of having a designated credential as eating disorder specialists, and I think we’re going to put that in the show notes as well. So that’s also a way that people can directly connect with some occupational therapist if they’re not already meeting them in the treatment teams that we’re, we’re on. I think we’ve even just been welcomed into the treatment team up at the residential treatment centre in the Sunshine Coast. So it’s exciting to see us infiltrating, so to speak.
Sam Ikin 25:27
Yeah, amazing show notes checkout to find out more about that. Elysa Roberts, thank you so much, Dr Lisa Roberts. Thank you so much for your time, I appreciate it. If you’ve missed any of Elysa’s details just there, I’ve put them all in the show notes. If you think you need to find out more about occupational therapists and how they could help you or someone that you love, Butterfly can help go to butterfly.org.au or call the Butterfly Helpline at 1800 ED HOPE. That’s 1800 33 46 73. They have a database of professionals who can help you with your recovery journey. Before we go, I’d like to ask you a little favour if you could open the app that you’re using to listen to this show right now, scroll down and find the prompt to leave a review and a rating. Leave us a few stars and a few words and it would be hugely appreciated. Butterfly: Let’s Talk is an Ikin Media production for Butterfly. Our producer is Camilla Becket and you can go to ikinmedia.au to find out more about what we do. I’m Sam Ikin and thank you so much for your company.