Learning from Bessel van der Kolk: A Reflection on Trauma, Practice, and Occupational Therapy

I recently had the opportunity to attend a session with Bessel van der Kolk, and I've been taking some time to reflect on the experience and what it means for my practice as an occupational therapist.

‍

While much of his work focuses on trauma, what stood out to me most wasn't just the theory. It was how strongly it reinforced the work we already do as OTs.

‍

Safety, Connection, and the Permission to Have Fun

One of the biggest reminders was that therapy doesn't always need to go directly into the hardest parts of a person's experience. So often, we feel pressure to address the trauma itself; to work on the problem. But what I took away was something much simpler, and perhaps more powerful: progress often comes from creating moments of safety, connection, and even fun.

‍

In occupational therapy, this is something we are constantly doing.

‍

We use movement, play, and meaningful everyday activities to support regulation and help people engage in their daily lives. These aren't just nice additions to therapy. They are central to how change happens. When someone feels safe and regulated, their nervous system settles. Over time, these repeated experiences support neuroplasticity and create lasting changes in how a person responds to and engages with the world around them.

‍

The Therapeutic Relationship Comes First

Another key message that stayed with me was his emphasis on the therapeutic relationship. Despite all the protocols, strategies, and techniques available to us, he reminded us that working with people is complex. There is no single approach that works for everyone.

‍

He spoke openly about his own journey. Years of trial and error, learning as he went, and adapting his approach based on new knowledge. What stood out was his willingness to say, "I don't know." For someone so experienced, that level of humility was both refreshing and grounding.

‍

It reinforced something I think is essential in our work: we don't need to have all the answers. What matters is that we stay curious, continue learning, and remain responsive to the person in front of us.

‍

It's Not About What's Wrong

‍

His final message captured this perfectly:

"It's not about what's wrong with the person. It's about what works for that person."

‍

That really resonated with me.

‍

As clinicians, we can know countless strategies and techniques, but none of that matters if it doesn't connect with the individual. It shifts the question away from diagnosis and towards understanding:

‍

What makes this person feel alive? What helps them feel engaged, connected, and able to participate in their life?

‍

Often, it's not the diagnosis itself that limits someone. It's the barriers that get in the way of their participation; whether that's trauma, environmental factors, or unmet regulation needs.

‍

Where Occupational Therapy Fits

This is where I believe occupational therapy is uniquely positioned.

‍

As OTs, we look at the whole person. Their strengths, interests, challenges, and environment. Our role is to identify what is getting in the way of meaningful participation and work collaboratively to reduce those barriers. We don't just focus on what's wrong; we focus on enabling people to engage in the roles, activities, and routines that matter to them.

‍

This experience didn't necessarily introduce completely new ideas, but it strengthened my confidence in the work we do every day. It reinforced that occupation; when it is meaningful, engaging, and aligned with the person; is not just an outcome of therapy, but a powerful therapeutic tool in itself.

‍

More than anything, it reminded me why I do this work.

‍