Yes.

In Spain, although the healthcare system and resulting environment differs from the norms in the United States, almost all of the occupational therapy theories, concepts, and methods come from the profession’s country of origin. Therefore, I witnessed and personally applied here what I had learned in school.

At first, the days I spent with my case study clients often felt based on pure intuition. As I reflect, I recognize that while I may not have noticed it at the time, I was always looking through an “OT lens.” Whether it be path finding through the streets of Madrid and the public transportation system, practicing executive functioning and multitasking skills when cooking or baking with each client, observing clients’ PEOP factors (I was invited into their homes, I ate meals with their families, I partook in their daily leisure activities, I helped with obligatory tasks, and I facilitated problem-solving a few challenges that arose), or implementing various therapeutic modes and cueing methods, everything was based on what I have absorbed through my time in graduate school.

The application of concepts was more evident in the individual and group sessions I led, or assisted with, at Polibea. What I particularly loved here was the time allowed to respect the humanity of every individual – when documentation was more or less nonexistent, the time spent on treatment was maximized. This allowed me to truly put all of my time, effort, and full attention into each session. Creativity was vital, as there was limited space, and little to no technology to just hook a client up to while the therapist documents. Group sessions were frequent, from cooking to personal care to cross-stitching to English discussion groups to money management classes. This really helped us all learn from each other and supported the community environment. Polibea is a family, the likes of which I have never seen in the United States. I absolutely loved it.

Lastly, my use of didactic material was most obvious in my discussions with my mentors (María at Polibea and Elisabet at URJC) and their colleagues (other therapists and Polibea staff, other professors, researchers, and students at URJC) about occupational therapy. Our discussions included, but were not limited to:

• The history of OT in Spain and how that continues to have an impact on the profession’s presence (or lack thereof) within each of its autonomous states

• How the historically public, with a relatively recent growth of private, healthcare system impacts practice

• How the education system impacts what is emphasized in the OT curriculum

• How the profession’s base in the United States and other English-speaking countries both aids and limits the profession within Spain, throughout Europe, and on a global scale

These bigger-picture conversations, which I then saw come into actuality throughout my daily practice, all connected to our discussions in school about the complex web that is our profession, serving as a PEOP analysis of OT itself.

Yes.

I still feel a significant sense of imposter syndrome – that I’m quite young, that I’ve been a student for 20 years and that’s all I know how to be, and that I’ve greatly declined in my ability to organize, be timely, and hold myself as a professional. That being said, I am also very critical of myself.

I think acclimating to another culture, with different priorities and ways of being, has been the perfect compliment to my development as a professional. I’ve been able to see how occupational therapy, education, research, and healthcare work in two very different places. I’ve noted what I like, and what I don’t like, about both. In this sense, I’ve had a wide range of reference points to learn from as I form who I want to be as a professional.

However, I have not felt at all confident in my progression from student to entry-level professional. While mentors and friends alike have assured me multiple times that I am on a good path, I am struggling to reconcile my perfectionist tendencies that I’ve had for years, with this new approach of being present in the moment – absorbing my experience while I’m here, and recognizing that I cannot constantly “do, deliver, evaluate, do, deliver, evaluate,” as the American educational system has drilled into me. Yes, these steps must happen, but not at the unreasonable pace I have set for myself.

As capstone pushes us to do, I am learning how to be a self-directed learner, how to be an entry-level professional, and a functioning young adult, all at the same time. This is a lot. And I (unsurprisingly) expected perfection from the very beginning. I will always be growing (though alas no longer in height), and I believe this experience has laid a wonderful foundation for this next stage of my professional life.

On a more technical level, this experience has brought me into the professional world that I aim to be a part of. Simply by meeting people, making connections, maintaining those on LinkedIn no matter how much I despise networking, and just putting myself out there, I have begun to get my foot in the door towards what I want to do.

Yes.

Absolutely. With my case studies, as well as the time I set up working with Lu, part-time jobs with other clients, presentations I organized, and interviews/informal charlas I put together, I really threw myself out there, in all manners of the phrase. This was particularly true given my site, and project focus – my clients, employers, interviewees, and colleagues all spoke Spanish, and those involved in my case studies all had communication challenges. This was an incredible challenge to dive into headfirst, but one I am very grateful that I did.

I felt challenged in daily life as well. Culturally, the expectations, schedules, lifestyles, and modes of communication are quite different. Simply put, Spain is more relaxed. I have always been tightly wound, and have reflected a lot of late on the unrealistic expectations I set for myself. This is true academically, where I try to put everything on my plate, and still complete everything to perfection. This is true in terms of my physical health, where if I wake up at 6.30h, and if I did not run 5 miles already, I begin the day disappointed in myself. This is true in my life management, where I feel irresponsible if I don’t find a way to be productive, or make an income, in the two weeks between capstone and the WFOT conference. I am unbelievably hard on myself.

Now, not every American is, and not every Spaniard is not. However, there is undeniable evidence (a topic I would like to look more into) about the impacts of culture and pace and an individual member’s way of being.

I was placed in a position where continuing with these perfectionist tendencies would in fact be a barrier to my success. This is not true in all contexts, but it quickly became clear throughout my capstone (from conversations with mentors, and from my own personal exhaustion) that the rigid structure I had set was going to prevent me from taking full advantage of my time in Spain. As Dr. Bakhshi put it, “You’re not in Spain to write. You’re in Spain to actually be present in Spain and take as many opportunities as you can. Sitting and reflecting at your desk will not present those opportunities.” Further, in terms of reflection itself, she later said “Reflection takes time, it’s not going to come right away.” So why was I trying to force it? Why was I leaving the people and center I had come so far to be with, because I was so worried about my assignments for school? Battling these two worlds, these two different interpretations of success, was an immense challenge. I still don’t think I’ve done it right, but I’m coming closer to my own interpretation of success.

Academics aside, I was living with a host family. As generous and easy-going as they were, there are still inevitable awkward moments in adjusting to another’s way of life. Add in the language differences, where despite my fluency, I still struggle with accurately communicating my thoughts on interpersonal complexities – such as when the woman I’m living with got COVID, and I had no idea how to communicate my concerns. Throughout the whole summer, I felt like I was constantly intruding, which is something I sometimes feel even when I’m with close friends and family. This pushed me to grow in confidence. To not worry so much about what another thinks of me, because odds are the story I’m making up in my head is a lot worse than the truth.

During capstone, though I did not realize it at the time, I moved further into the “transformative learning” and “critical analysis of occupational therapy as a profession” I read about in preparation. As mentioned above, I subconsciously engaged in a PEOP analysis of occupational therapy itself. Through personal and professional moments of discomfort, I was challenged to critically reflect on my own beliefs, values, and perspectives (Castro et al., 2014, Foronda et al., 2016, Fortune et al., 2019). Whether it be the expectations I laid for myself, the initial questions I had about a healthcare system with much less documentation, learning to embrace (and end up highly valuing) the physical embraces between my colleagues and I, or facing my embarrassment in regards to my lack of experience in keeping a home cool without an air conditioner. (Hint: Pull shades down during the day, following the path of the sun from East to West as the day goes by. Open everything at night to let in the cool breeze). I am still embarrassed that as much as I do to be mindful of reusing and minimizing waste, I paled in comparison to my host-mom. And I felt stereotyped as a careless American. But now I know what to do, and now I know that the comments came more from a place of caring, not judging.

This is all to say, I was challenged every day throughout capstone, whether I recognized it at the time or not. And this does not even begin to mention the shifts in my routine, my perspective on daily life, and my perspective of the world when I moved to Berlin for the 3 months leading up to capstone. Combined with my nation-wide road trip and fieldworks last year, this has been a remarkable 15 months.

Without a doubt, working with my case study clients and the two individuals who I began to work for in the final third of my capstone. I have always felt my true calling in working with people, rather than in research, policy, or advocacy. I felt a sense of pride that I found a way to not only communicate, but also work as a therapist, for individuals who speak Spanish and on top of that who’ve experienced severe brain damage that often impacted their ability to communicate. Even more, I found that the challenges I personally faced with this provided a mutual understanding between us. Being welcomed into another’s daily life, getting to see what motivates them, what challenges them, hearing their stories, getting to be a part of their stories – that is what gives me a sense of purpose. During capstone, this was true both in my work at Polibea as well as the random people I would meet on the street while walking my dog, who would immediately smile, bend down to give him affection, and often tell me a small chapter of their own stories, too.

Culturally, the expectations, schedules, lifestyles, and modes of communication are quite different. Simply put, Spain is more relaxed. I have always been tightly wound, and have reflected a lot of late about the unrealistic expectations I set for myself. This is true academically, in terms of my physical health, and in my overall life management, where I feel irresponsible if I don’t find a way to constantly be productive. As I mentioned above:

I was placed in a position where continuing with these perfectionist tendencies would in fact be a barrier to my success. This is not true in all contexts, but it quickly became clear throughout my capstone (from conversations with mentors, and from my own personal exhaustion) that the rigid structure I had set was going to prevent me from taking full advantage of my time in Spain. As Dr. Bakhshi put it, “You’re not in Spain to write. You’re in Spain to actually be present in Spain and take as many opportunities as you can. Sitting and reflecting at your desk will not present those opportunities.” Further, in terms of reflection itself, she later said “Reflection takes time, it’s not going to come right away.” So why was I trying to force it? Why was I leaving the people and center I had come so far to be with, because I was so worried about my assignments for school? Battling these two worlds, these two different interpretations of success, was an immense challenge. I still don’t think I’ve done it right, but I’m coming closer to my own interpretation of success.

Before my capstone, my time at WashU had already opened me up to a wide world of occupational therapy. We learned about a variety of settings, populations, and models. I learned that the potential paths I could take as an occupational therapist extended far beyond that which I had originally known. However, all of these paths, though different, are based on the same value system. They’re based on trying to prove ourselves to doctors, to other healthcare professionals, to insurance. No matter the label we put on it, our practice is based on documenting use of equipment, on administering assessments, and on calculating scores. That is how we measure success.

In Spain, I was shown a different measure of success. My mentor, María, lives and breathes her work. She embraces, hugs, and laughs with each client and staff member. If that’s not the other’s preferred way of showing affection, María finds what is, and meets them there. Though there’s often more than 150 clients registered at Polibea at a time, María knows every single one. She shares her personal phone number with clients and their families. She knows when “Lupin’s” car part was stolen, and that it’s currently at the shop, limiting his mobility. She knows when “Pomona” had an oncology appointment, and what the verdict was. She knows when “Andrómeda’s” brother had a stroke that morning, and that she therefore might not make it to therapy. María is an integral part of each of her client’s lives, and it is visible how much of a difference she makes.

I am in awe of María, in her work as well as in her roles as mom and friend. Professionally, I am searching to find my own definition of success, what brings me fulfillment, what occupational therapy means to me. Personally, I strive to be both a strong, present member of my family, as well as an invested, caring therapist. My capstone, in particular my many, many hours with María, have helped me take another giant step closer to who I want to be both in work and in life.

***

Many occupational therapists in the United States, as well as researchers in Spain, may not see María as successful.

While sitting with my other mentor, Elisabet, the three of us engaged in a (slightly heated) debate about occupational therapy, research and evidence, quality treatment, and success. María said, “ya no tengo interés ni corazón de hacer esto,” “I don’t have the interest nor the heart to do that [research, reviewing evidence] anymore.”

She adds, “Son incompatibles, la investigación y la humanidad. No hay tiempo, no hay tiempo pagado… Será mejor tener los dos, pero no hay el dinero.” Translated, “They’re incompatible, investigation and humanity. There isn’t the time, there isn’t paid time…It would be better to have both, but there’s not enough money for that.”

María has her own family, including two children. She spends every extra minute she has dedicated to treating each of her clients with dignity and respect. She takes the time to know the intricacies of their lives, to know exactly what they need. She works on 15 years of experience and intuition. Any other time she has, she spends with her own family. Though she could make more money working at Walmart than she does as an occupational therapist (She and my host mom told me so on my first evening in Spain back in April), she chooses to do what she does because she finds meaning and purpose behind it. María feels fulfilled.

***

At the same time, my capstone made me even more grateful for the wide variety of opportunities available in the United States, which I referenced at the beginning of this reflection. In Spain, occupational therapists have a very limited role. The profession’s development is 50 years behind that of the U.S. The World Federation of Occupational Therapy recognized occupational therapy in Spain as a titulado (professional degree) before Spain itself did. The voices and positions we have in the United States (working with people experiencing homelessness, working to combat the climate crisis, etc.) have not crossed the minds of many occupational therapy students here in Spain. Now, this is likely in part due to the medical, documentation-focused, evidence-based approach we have taken. It is also likely due in part to the money which serves as the main force of our healthcare system. This is to say, the same position that María and other occupational therapists sit in, which allows for such meaningful work, also limits them.

Another catch-22 comes into play with our role as international advocates, in being the impetus force behind the changes we hope to see, such as those I mentioned above. How do we do this without having the evidence, the money, the power, behind us? I don’t know.

***

Through capstone, I’ve seen a slight shift in my potential roles as an occupational therapist. I always thought I wanted to focus on being a practitioner. As I’ve mentioned in other reflections, I still do. However, I also find that certain topics invigorate me. They make me want to get involved in a broader scope of occupational therapy. Topics such as our healthcare system, our methods of sharing research and continued education, the power of language, or occupational therapy’s role concerning communication disorders. Perhaps I didn’t originally see myself in one of these roles because I hadn’t come across anything I felt that needed change. Or for that matter, things I felt like I could help in changing. Now, I’m keeping my eyes open to this potential path.

***

In the first few weeks of capstone, I gave my proposal presentation to staff at Polibea. María commented, “you’re not just discerning the type of OT you want to be, but also the type of person you want to be.” She had only known me for a few short weeks at that point, but she was absolutely right.

A common theme for me throughout graduate school has been confidence. I have made significant strides, particularly through being unafraid to be uncomfortable, and in taking constructive criticism and working with it. My past mentors have noticed this, as did María in her evaluations this summer. An even greater challenge for me is feeling proud of what I have done. I tend to overthink things, I’m constantly pushing myself, and I’m never satisfied. When I tell people how I worked to organize my capstone here in Spain, they are impressed. Why don’t I give myself the credit for that, pat myself on the back? Further, I’m almost always trying to do too much. Through difficult moments and subsequent discussion with my mentors, I’ve begun to see that it’s okay, sometimes even necessary, to slow down.

Most importantly, this capstone experience has pushed me to be satisfied with my success, to be proud of myself, without basing it off of external factors. Different value systems from my university and site, from the United States and Spain, made me realize that I couldn’t possibly be “successful” to both systems at the same time. Therefore, I had to decide that for myself. This has begun to take different forms:

Academically – do I feel like I have learned? Professionally – do I feel fulfilled, do I feel like I’m giving the best possible treatment to each of my clients? Personally – do I have faith in myself? Do I know that I am a freaking awesome person, without needing to verify from others? Without needing to check the typical boxes, or receive the typical recognitions?

Capstone prepares us to be independently motivated learners throughout our career, as school will no longer be pushing us. As my initial literature review warned me, my international work would push me even more than a traditional capstone into transformative learning. I had to strengthen my internal drive and define my own methods of personal evaluation, because there were many times where the external values and definitions around me conflicted.

This experience has helped me to be a bit prouder of myself. Stepping a bit farther back, this has been a remarkable 15 months. I embarked on a nation-wide road trip, just me and my dog. I completed fieldworks in two different states, far away from my homes in Arlington, Virginia and St. Louis, Missouri. I picked up and moved to Berlin, Germany for my last semester of graduate school. I initiated, planned, and successfully managed a capstone project in Madrid, Spain. Many of the endeavors I began here are ones I aim to continue throughout my entire career. Thanks to the support I’ve received, and the risks I’ve taken; the opportunities I’ve been given, and those I’ve made; the privileges I’ve had, and my determination to muddle through, I have lots to be proud of.