Mind to Function

By Wieteke Idzerda, Occupational Therapist, CRT Therapist

Progress in mental health isn’t always loud, linear, or easy to measure—and that’s especially true when it comes to cognitive challenges that affect daily life. Occupational therapy offers a unique lens for understanding and supporting this kind of growth, blending practical skill-building with personalised cognitive interventions that help people function with more confidence. In this blog, I reflect on what progress really looks like in this space—often subtle, sometimes surprising, and always deeply meaningful.

Occupational Therapy in Mental Health

So what actually is occupational therapy, you ask? It is a health focused profession that focuses on enabling people across all ages to participate in activities (occupations) that are meaningful and necessary for daily life. Within Mental Health Services we focus on how a person’s mental health affects their ability to engage in activities of daily living and to develop, restore or adapt skills and environmennt to support them to live the lives they choose to (World Federation of Occupational Therapists [WFOT], 2019; OTNZ-WNA, 2021).

While some disciplines focus on symptom reduction, occupational therapy looks at how people live—how they create routines, connect with others, and participate in meaningful occupations. For individuals navigating schizophrenia, bipolar disorder, or/and complex trauma, challenges in functional cognition — the cognitive processes required to perform everyday tasks — often shape their lived experience more than symptoms alone.

My own focused mahi in this area of mental health has allowed me to reflect on my practice and consider various lessons about recovery and what true progress looks like beyond clinical change.

Lesson 1: Recovery is a Journey

Recovery in mental illness is rarely linear. Tāngata whaiora often move through cycles of stability and disruption. Functional cognitive abilities—such as initiation, planning, working memory, and problem-solving—fluctuate alongside these changes.

A tāngata whaiora with schizophrenia may manage meal prep well for months and suddenly struggle to sequence steps during a period of stress or unwellness. A person with bipolar disorder may demonstrate high levels of productivity (with positive or negative outcomes) during hypomania but struggle with executive function during depressive episodes.

Instead of viewing these shifts as setbacks, occupational thearpists frame them as learning opportunities to consider what might be happening, always asking the “why” questions. We wonder what is working well (strengths) and isn’t working well (limitations/ restrictions).  We consider all of the cognitive (process), motor (physical), and environmental factors impacting functioning. Using cognitive supports—visual schedules, checklists, environmental simplification, or technology—helps clients regain stability more quickly. Over time, individuals learn to recognise their own cognitive patterns and proactively use compensatory strategies (metacognition).

Lesson 2: Identity Reconstruction Is a Cognitive Process

Identity adjustment is common in people with serious mental illness, especially after a new diagnosis or repeated hospitalisations or years of stigma. Part of rebuilding identity involves understanding one’s cognitive strengths and limitations.

Occupational performance assessments or functional cognition assessments give clients language for their experiences, for example:

“I’m not lazy; I have difficulty initiating tasks when overwhelmed.
“I lose track of steps, but checklists help me finish meals.”
“Planning isn’t my strength, but I’m great at hands-on problem-solving.”

This reframing is deeply therapeutic. Instead of internalising failure, clients begin to recognise their cognitive profile or diagnosis as something they can work with, not something that defines them. Within Cognitive Remediation Therapy, we can target a person’s metacognition to support them to develop awareness of their own thinking and support them to utilise new cognitive strategies when tackling activities of daily living. Participation in meaningful occupations—gardening, volunteering, working, study, and creative arts—then becoming both identity-building and strengthening cognition.

Lesson 3: Daily Routines Are Cognitive Interventions

With people who experience mental illness, the simplest daily routines often demand significant executive functioning. Bathing requires initiation and sequencing; medication management relies on working memory; cooking needs planning and problem-solving; keeping appointments requires time-management.

When tāngata whaiora build routines, they are strengthening their functional cognition in real-world contexts.

Occupational therapists use occupation-based interventions to support cognitive functioning by:

● Breaking tasks into manageable steps
● Embedding cues into the environment
● Creating predictable patterns and habits that reduce cognitive load
● Teaching compensatory strategies for memory or attention
● Using repetition to strengthen cognitive habits

Progress often appears in these small moments: remembering medication without prompting, completing laundry from start to finish, or anticipating what needs to be done next. These gains provide more day-to-day stability than symptom-focused interventions alone. These gains can mean everything to an individual who’s seeking independence and building their confidence / self efficacy.

Lesson 4: The Therapeutic Relationship Enhances Cognitive Safety

For individuals with trauma histories or serious mental illness, cognitive functioning is profoundly affected by psychological safety. When tāngata whaiora feel judged or rushed, their executive functioning can decrease; when they feel supported and respected, their problem-solving and planning often improve.

A strong therapeutic relationship offers:

● predictability that supports trust between the OT and whaiora.
● a safe space for practicing complex tasks whether this is at home, community, or in the clinic.
● the ability to recognise overwhelm and how to press pause during sessions
● provide plenty of positive reinforcement. It needs to be authentic and allow for perspective taking.

In this sense, the therapeutic relationship becomes a cognitive scaffold just as much as a relational one. This is a significant principle we maintain throughout cognitive remediation therapy.

What Progress Looks Like When You Include Functional Cognition Within Your Practice as an OT:

Beyond symptom reduction, progress may look like:

● Using an activity planner or app consistently
● Sequencing a multi-step task without cues
● Automatically engage in sensory modalities to calm your sympathetic nervous system
● Preparing meals independently
● Anticipating consequences before acting
● Utilise and navigate public transportation
● Adapting routines when symptoms or stress increase

These gains are specific to each individual and overall reflect improved quality of life.

The Essence of the Work as a OT

Occupational therapists help people build lives that feel  purposeful, meaningful and manageable. The work can be slow, relational, creative, and profoundly authentic as it truly maintains the tāngata whaiora at the centre of their treatment. Progress may not always show up on symptom checklists, but in the quiet victories of daily living, OT helps people discover new cognitive capacity, stronger routines, and renewed identity.