The Wizard of OT

Cultivating Presence in Occupational Therapy

9-11-24

Heather Kuhaneck

I first stumbled on the concept of “presence” while viewing a very popular TED talk online. As the talk I was viewing finished, Amy Cuddy’s talk (Cuddy, 2012) started automatically afterwards. Cuddy’s TED talk is one of the top 25 most popular, but I hadn’t seen it. After watching Cuddy speak about the impact of body language I was intrigued enough to downloaded her book on audible. I later read some of her studies and began to consider the importance of leveraging presence in OT. Cuddy’s book Presence: Bringing Your Boldest Self to Your Biggest Challenges offers valuable insights into how individuals can harness their presence to project confidence, competence, and authenticity. This post explores the concept of presence in the context of OT and provides specific strategies for OT educators to teach students how to enhance their presence.

Presence: What is it?

Presence, as defined by Cuddy, is the state of being attuned to and able to express one’s true self in the moment, allowing for authenticity, confidence, and effective communication. It involves being fully engaged, confident, and authentic in any given moment. Presence is not just about how others perceive you, but also about how you perceive yourself. Cuddy’s research on presence centers around the idea that nonverbal behaviors, particularly body language, can influence how people perceive themselves and how they perform in stressful situations.

Cuddy’s research also highlights that those who identify as male or female often experience and project presence differently due to societal norms and expectations. Men are typically socialized to exhibit more dominant, assertive behaviors, which are often associated with presence. Women, on the other hand, may face challenges in projecting presence due to societal expectations of being nurturing and accommodating.

Cuddy’s research suggests that body language influences how we think and feel about ourselves. One of her key findings is that adopting “power poses” (open, expansive postures) even for a brief period can increase feelings of confidence, reduce stress, and improve performance in high-stakes environments like interviews or public speaking. Therefore, our postures can have an impact on our minds.  In adopting a commanding stance, we make ourselves actually feel more powerful. In one of her studies, the participants sat in either a high-power pose (expansive posture) or low-power pose (leaning inward, legs crossed) for two minutes.  Those in the high-power pose felt more powerful and importantly performed better in mock interviews. Power posing changed body chemistry. Those who adopted the high-power pose had an increase in testosterone and a decrease in cortisol. She argues that by deliberately altering our posture, we can influence our mental and emotional state. This concept of “fake it till you become it” suggests that physical presence can lead to an authentic sense of personal power.

Cuddy’s work offers these important points to consider

1. Our body language impacts communication and often expresses more than our words. 
2. Feeling powerless can lead to actual powerlessness.
3. Power and movement/ posture are connected and improving posture is empowering.
4. Power poses can influence how confident you feel.
5. Affirming one’s core values improves resilience and confidence, and makes communication more convincing.

(To be fair here, Cuddy’s work was criticized over the years (see Elsesser, 2020; Loncar, 2021), but she has generally refuted these critiques and a meta-analysis has identified that the core principles from her work were supported (Elkjær et al, 2022). More recent evidence suggests it may be more important to avoid contracted postures than it is to assume expanded postures.)

Why use it?

Presence may directly relate to the advocacy roleof OTs. When OTs advocate for clients’ needs—whether it’s for resources, adaptive equipment, or specific interventions—the concept of presence suggests that feeling confident and connected to one’s purpose can make these interactions more effective. For OTs, embodying presence means not only advocating for the client but also confidently communicating the value of occupational therapy to interdisciplinary teams. An OT’s sense of professional mission aligns with what Cuddy calls “self-assured presence,” enabling them to better express their views assertively.

Cuddy’s research highlights how non-verbal cues (posture, gestures, eye contact) significantly impact how others perceive our confidence and assertiveness. Occupational therapists, who rely on strong interpersonal skills to interact with clients, caregivers, and colleagues, can benefit from being more aware of their own body language. If an OT enters a conversation with hesitant or closed-off body language, it could undermine the perceived strength of their recommendations. Conversely, adopting more open, confident body postures—such as what Cuddy suggests—can help OTs project confidence, encouraging others to take their input more seriously during collaborative work or advocacy situations.

Cuddy’s work also addresses the power dynamics in various settings. Occupational therapists often work within hierarchical healthcare systems/teams, which can sometimes discourage assertiveness, especially for less experienced practitioners. Cuddy’s emphasis on “powerless” versus “powerful” body language can help OTs navigate these dynamics. If an OT perceives themselves as lacking power (e.g., in the presence of more senior healthcare professionals), they might unintentionally adopt passive body language, reinforcing their lower position in the hierarchy. By consciously adopting “high-power” postures and focusing on presence, OTs can shift both their own mindset and others’ perceptions, thereby increasing their assertiveness in team-based settings.

Many healthcare professionals, including OTs, experience imposter syndrome, feeling as though they don’t truly belong or aren’t as competent as others. Cuddy’s work on presence provides strategies to counteract these feelings. Her research shows that by adopting more powerful, confident body language, even when you don’t feel confident internally, you can start to shift your self-perception and gradually build real confidence. This is particularly relevant for newer OTs or OT students, who may feel less assertive due to inexperience. By practicing presence and power posing, they can cultivate a more confident demeanor, helping them become more assertive in both client care and professional interactions.

Gender disparity has been a part of the profession since the very beginning for a variety of reasons (Zellin et al, 2022). In the early days of the profession, during World War I, many men were fighting and not available and early recruitment for OT was targeted at women.  Later, stereotypes and the idea that the helping professions were best suited to women persisted. Notably, a significant majority of occupational therapists still are women, particularly in the U.S. According to the American Occupational Therapy Association (AOTA, Harvison, 2024), for students entering the field at the varied degree levels the percentage of women is 86-92% and according to the BLS, for those currently practicing 88.6% are female (BLS, 2023). This demographic reality shapes the dynamics of the profession in the U.S. in myriad ways, in clinical practice, leadership positions, academia, research, publications, and more (Karaba Bäckström et al, 2023; Maxim, & Rice, 2018; Mendoza-Holgado et al, 2023; Zelin et al, 2022). There is a body of evidence to suggest that there are differences in speech patterns, assertiveness, confidence, and body language between the genders, albeit perhaps small ones (Leaper, & Ayres, 2007; Leaper, & Robnett, 2011; Obidovna, 2022; Vajapey, Weber, & Samora, 2020). Given the high percentage of individuals who identify as female in OT, the perceived and real differences in behaviors between the genders (Goman, 2023; LaFrance, & Vial, 2016), and the frequent and repeated calls over the years for OTs to be more assertive or confident (Cohen, 2019; Clark, 2010; Mays, 1987), it is crucial to empower OT practitioners to develop a strong presence that can enhance their professional interactions and patient care. Cuddy’s research on power posing suggests that adopting expansive, open body postures can increase confidence.

How to Use it?

So, what can we do as educators if we wish to incorporate Cuddy’s findings into OT education?

• Power Posing: Incorporate content on power posing and posture into the curriculum. We can demonstrate poses such as the “Wonder Woman” stance (hands on hips, feet apart) and other open body poses and encourage students to practice these poses before clinical interactions or presentations. They can have students engage in these poses and reflect on their reactions. We can also teach students to become aware of and consider the body postures of others, and what they might mean.  If you are unfamiliar with the power poses, they are described here (https://nextbigideaclub.com/magazine/amy-cuddy-7-power-poses-need-professional-arsenal/2124/ ) and you can google images of them as well.
• Teaching Confidence in Client Interactions and Enhancing Client Communication Skills: We can use Cuddy’s work on body language to help students develop professional confidence when interacting with clients, families, and other healthcare professionals. Exercises based on nonverbal communication can be embedded into modules on professional presence and/or advocacy. We can teach OT students how to read and respond to nonverbal cues in clients, particularly those with limited verbal communication, and how their own body language can impact therapeutic rapport.
• Nonverbal Communication in Interviews and Job Searches: Introduce the concept of power poses and confident body language in career preparation, especially for job interviews and professional networking.  Use role play to help students prepare.
• Building Self-Efficacy in Clients: Students can apply the concepts of power poses to help clients with anxiety, depression, or other mental health challenges to feel more empowered in social interactions or when facing challenging situations.
• Integrate into their Routine: Encourage students to use power poses as part of their own routine, especially before high-stress situations.
• Self-Affirmation Exercises: Incorporate self-affirmation exercises into coursework. Have students write about their core values, past successes, and strengths, and discuss how these can be leveraged in clinical practice. They may also use reflective journaling to help them regularly affirm their values and professional identity, reinforcing their sense of presence.
• Critically Appraise Cuddy’s Work: As part of research or evidence-based practice coursework, students can critically appraise Cuddy’s studies, or discuss the process of scientific discovery and replication, and the 10-year period of critique and reappraisal that occurred in response to her early work. This could also be part of broader conversations about how research from related fields can inform OT interventions.

Summary

Presence may be a valuable attribute for occupational therapists, enabling them to connect authentically with clients, colleagues, and other healthcare professionals. By understanding and addressing the unique challenges related to presence in a profession that is predominantly female, OT educators can empower their students to develop a strong, confident, and authentic professional presence. Integrating strategies such as those above into the OT curriculum can help students cultivate essential skills.

References
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