Our values: Enabling interdependence 

We support people to engage in meaningful activities by fostering skills, confidence, and supportive environments, recognising that wellbeing is often built through connection with others.

Why it matters: Because thriving isn’t about doing everything alone, it’s about having the right balance of autonomy, support, and belonging.

Background

John is a man in his 40s who was referred to The Occupational Therapy Service (TOTS) via his solicitor, after sustaining a brain injury, he had associated health difficulties and a breakdown in his previous role at work.

By the time he was referred, John described feeling:

• Overwhelmed by responsibilities at home and work
• Unsure how to ask for support without feeling he had “failed”
• Detached from activities and relationships that once mattered to him

He was seen jointly by a TOTS specialist occupational therapist and a clinical psychologist. Together, they focused on rebuilding his routines, confidence and support network in a way that reflected our value of enabling interdependence.

Presenting issues

In the early sessions, John described two very familiar extremes:

• On some days he pushed himself to do everything alone, refusing offers of help, then feeling exhausted and resentful.
• On other days he withdrew completely and waited for others to make decisions or solve problems for him, then felt useless or ashamed.

This showed up in several areas of occupation:

• Work and productivity
  John wanted to return to some form of meaningful work but felt paralysed by anxiety and by the idea that he should be able to “slot straight back in” without any adjustments.
• Home and self-care
  He took on a lot of hidden tasks at home, then avoided others entirely when he felt low. He struggled to explain this pattern to family, which led to tension and misunderstanding.
• Leisure and social connection
  John had gradually dropped hobbies and social activities, telling himself he would go back “once everything is sorted”. In reality, his world had become very small.

Shared formulation

The OT and clinical psychologist developed a shared formulation with John:

• Earlier in life, John had been rewarded for being “the strong one” who coped without complaint.
• When his health and circumstances changed, he did not have a clear template for asking for support while still feeling competent and valued.
• He swung between over-independence and over-dependence, without a stable middle ground.

They introduced the idea of interdependence as a working theme:

• John’s wellbeing and identity did not have to rely on doing everything alone.
• Equally, he did not need to hand over responsibility for his life to professionals, family or employers.
• Instead, the goal was to build skills, confidence and environments where he could take an active role, supported by people around him.

Interventions

a) Clarifying what matters to John

Through occupational therapy sessions, John identified:

• Activities that gave him a sense of competence (for example, practical tasks, mentoring younger colleagues, problem solving).
• Relationships where there was potential for mutual support, not just one-way care.
• What “a good week” would look like if he had the right balance of autonomy and help.

This gave a clear occupational focus rather than a vague aim to “feel better”.

b) Building skills and confidence

The OT and John worked on:

• Gradually reintroducing structured daily routines that included purposeful activity, not just “to do” lists.
• Practising communication skills to explain his needs and limits to family and, later, to his employer.
• Planning a graded return to meaningful work, with realistic steps and adjustments.

The psychologist sessions focused on:

• Challenging beliefs that “needing help means I am weak”.
• Exploring where his strong sense of responsibility came from, and how it had helped and hindered him.
• Developing more compassionate self-talk when he was unable to manage everything alone.

Together, this work supported both the practical and emotional sides of interdependence.

c) Creating supportive environments

Alongside individual work, the OT and psychologist helped John to shape his environment:

• At home, he agreed clearer roles and expectations with family, so that tasks were shared instead of taken on silently.
• With his employer, he was supported to negotiate a phased return with adjustments that recognised both his strengths and his limits.
• In his local community, he reconnected with one valued hobby and identified a peer group where there was genuine two-way support.

Rather than “fixing” everything for John, professionals helped to set up environments where he could participate fully with appropriate support.

Outcomes

Over time, John reported several changes:

• He felt more able to say “yes” to help in some areas, while still taking the lead in others.
• He noticed earlier when he was drifting into doing too much alone and could adjust before reaching crisis point.
• His week included a better mix of work, home responsibilities, and activities that gave him a sense of joy and connection.
• Relationships at home felt less strained, as he and his family had clearer expectations of each other.

From a service perspective, this case showed that:

• Joint work between an occupational therapist and a clinical psychologist can support both behaviour change and the underlying beliefs that hold old patterns in place.
• Focusing on interdependence, rather than pure independence, leads to more sustainable outcomes and better quality of life.

How this reflects “Enabling interdependence”

John’s story brings our value to life:

• Fostering skills
  He rebuilt practical and communication skills to manage his day, ask for support and contribute to home and work life.
• Building confidence
  He was able to see himself as capable and resourceful, even when he needed adjustments or help.
• Creating supportive environments
  We worked alongside John, his family and his employer to shape environments that made participation possible, rather than expecting him to adapt alone.
• Balancing autonomy, support and belonging
  John did not return to doing everything by himself, and he did not stay in a place of dependence. Instead, he found a more balanced position where he could take the lead in his own life, held in connection with others.

This is what enabling interdependence looks like in practice.