Tasneem Abrahams is an Occupational therapist in private practice providing support, therapy and/or coaching for adults and teenagers who struggle with executive functioning and emotional and sensory regulation affecting their daily functioning. She uses a client-centered, evidence-based, and neurodiversity-affirming approach. Tasneem is also the founder of the Private Practice Growth Club, developing the mindset and business skills of health professionals, and other coaches in the wellness space through content creation, knowledge-based products and coaching.
Tasneem Abrahams, Occupational Therapist
Hello, Tasneem! Thank you for taking the time to sit down with us today. Could you tell us about your background?
I was born and raised in Cape Town, South Africa and am currently living in Johannesburg with my husband and 4 kids. My professional journey began when I graduated as an occupational therapist from the University of Cape Town in 2002. Through the years I have worked in a variety of settings from mental health, spinal cord injury, neuro rehabilitation, to special education. However, it was in mental health that I found my sense of purpose. I am currently practicing as an Occupational Therapist in private practice and strive to be an ally to the neurodivergent population, providing education and awareness, support, therapy and coaching, to adults and teens who struggle with executive functioning and sensory regulation, with a special interest in ADHD. I am also a founding Director of the NPC, Jozi4Autism.
In addition to my work as an occupational therapist and coach, I am also the founder of the Private Practice Growth Club - a community-building, education and empowerment initiative, for South African health professionals in private practice. As the saying goes: “you can’t pour from an empty cup”, so I am passionate about helping South African health professionals develop the mindset and business skills needed to minimize the struggle and overwhelm of trying to grow a profitable private practice, whilst still making a positive impact on the wellness of others. I am an avid advocate for my profession, as I truly believe occupational therapy is one of the most under-appreciated and misunderstood health professions.
In my spare time, I love reading, spending time with friends and family, I am an avid knowledge-seeker (aka a course junkie), I am passionate about supporting female entrepreneurship and I like to think I always see the potential of every glass to be filled.
What is Occupational Therapy and what is the role of your profession in the health and wellness space?
Occupational Therapy is a regulated health profession. The official definition according to the World Federation of Occupational Therapy is that Occupational Therapy (OT) is a client-centred health profession concerned with promoting health and well-being through occupation.
Anecdotally, I like to refer to Occupational Therapy as ‘Doing Therapy’.
In the OT profession, occupation refers to anything you do, that occupies your time. This includes everything from actions we do without thinking like walking, to more intentional tasks like brushing your teeth, cooking a meal, or going to work. OTs promote health and wellness by working with people and communities to enhance their ability to engage in the occupations they want to, need to, or are expected to do, or by modifying the occupation or the environment to better support their occupational engagement.
OT is a truly holistic profession, with a broad education in medical, social behavioural, psychological, psychosocial and occupational sciences, that looks at the whole being, as well as the micro and macro environment when assessing and developing intervention and support plans. As a result, OTs can be found working with individuals and groups across the lifespan and in a variety of settings, such as one-on-one in individual therapy, in schools, workplaces, rehabilitation centres, hospitals, forensic services, supported accommodation, home-based care, any context where engagement in occupation is restricted.
Occupational therapists believe that participation can be supported or restricted by the physical, social, cultural, attitudinal and legislative environments. Therefore, OTs also have a role to play in advocacy, disability activism, and social justice work.
With such an extensive range of experience and expertise, could you tell us why you chose to focus on executive functioning challenges and adult ADHD?
I have worked in mental health for many years and have always enjoyed working with the adult population. While working at a high school for learners with learning disabilities, I encountered many learners who presented with a diagnosis, or a suspected diagnosis of ADHD. While working with these adolescent learners I started to learn more about executive functioning as the primary cognitive function impacted by ADHD. I also learned that executive functioning dysfunction can be caused by a number of other factors such as trauma, depression, anxiety, or simply never having been taught or supported to develop these crucial cognitive skills and abilities, and that this can sometimes mimic the presentation of ADHD. On the flip side, I also noticed that for some learners their particular blend of executive functioning dysfunction doesn’t present and the stereotypical picture of what society thinks ADHD should look like, and that these individuals offered go un-diagnosed, or mis-diagnosed as having an intellectual disability, oppositional defiance, or labelled as lazy and ill-disciplined. I started to immerse myself in the world of neurodivergence, listening to the lived experience of those who are neurodivergent and looking for ways to be more affirming in my approach.
I started to realise just how much misinformation, misunderstanding and stigma there is around ADHD, particularly in the teen and adult population. My role as an OT at the school included, preparation for transitioning to work, and I became frustrated by the lack of opportunities for these learners, who I referred to as the ‘missing middle’. They were not learning disabled ‘enough’ to benefit from or be suited to sheltered employment or protective workshops, not physically disabled, so do not qualify for the many learnership opportunities for the physical disabled, but also not academically qualified enough to find gainful employment opportunities in the open labour market. I started to realise too, that there are an abundance of OTs offering services to neurodivergent children under the age of 12, but when these children grow up, who supports them then? So, I decided that I would be one of those people to support teenagers and adults struggling to do the things they need to, want to or are expected to do, when they are struggling to do them because of ADHD or executive functioning challenges.
What strategies or approaches does Occupational Therapy employ to help individuals manage and thrive with executive functioning challenges and ADHD in their personal and professional lives?
First it is important to understand what ADHD and Executive Functioning is. Executive functions are what is referred to as the thinking and directing functions of the brain situated mainly in the pre-frontal cortex of the frontal lobe of the brain. It receives information from the other parts of the brain, processes the information, makes sense of it, and then decides what to do with that information and how to do it. Executive functions are like an air traffic control centre directing traffic. Examples of executive functions include: working memory, sustained attention, inhibition, flexible thinking, task initiation, goal-directed persistence, and many more.
Attention Deficit Hyperactivity Disorder (ADHD), despite the name, is not just about struggling to pay attention or struggling to sit still. It is a neurotype characterised by a range of executive functioning challenges that present functionally in behaviours such as procrastination, impulsivity, disorganisation, absent-mindedness, constantly losing things, poor sense of time, etc.
Occupational therapy is rooted in holism, taking into consideration the whole person, as well as the nature of the occupation required of that person, and the context in which it is expected to be engaged in. I like to say that as an OT, I take a whole-brain-body-systems approach to supporting ADHD and executive functioning. Even though executive functions are the thinking brain, as OTs we also consider the sensory brain and how this impacts the thinking brain’s ability to function optimally. We also look at the physical health of the person, such as their lifestyle choices, diet and physical activity. And we do a thorough environment and task analysis on the daily life activities the individual needs or want to do. OT is a very practical profession. Based on our assessment we work with the client to develop personalised strategies to manage daily responsibilities, work tasks and social interactions more effectively. Sometimes this might involve teaching or working with the client to gain or develop specific executive functions, or it might look like making adaptations to the way the task is performed. It might look like empowering the client to advocate for accommodations in school or in the workplace, adapting the task itself, or leveraging assistive technology. We use a combination of coaching, counselling, teaching and facilitation in our therapeutic approach.
You mentioned that you also help other health professionals start and grow their own private practices. Can you tell us more about the services you provide and what inspired you to start this business?
Starting any business can be exciting, but also extremely isolating and anxiety-provoking. There is an abundance of support and information online to support entrepreneurs on their business journey. However, the Health Professions Council of South Africa has very strict ethical rules and guidelines around the business practices of health professionals, which means that many of the marketing strategies and business growth tactics being taught is actually not permitted as a practice owner. I recognized that there was a lack of community support for South African health professionals in private practice, so I initially started a private Facebook group called the Private Practice Growth Club. The group grew rapidly and organically, confirming the need. I started sharing tips and resources from my knowledge and experience in business and marketing in the group. This eventually evolved into workshops, webinars, courses, digital resources, guest speaking and one-on-one coaching and consulting. I also started sharing tips, tools and tutorials on YouTube which has now become my primary platform to support practitioners start and grow their private practice.
It sounds like you have many balls to juggle. How do you manage your time between your businesses, community projects, and personal life?
Having so many roles and occupations to balance, is definitely a test of my own executive functioning skills. There is no perfect strategy, system or technique. What works for me may not work for my clients, and what works for one client may not work for another. However, the strategies I find to be most universal, that I rely on heavily, and teach my clients, is brain dumping, energy monitoring, anchoring and time chunking. I also use the C.A.R.D system to balance all my tasks. Chop what is not a priority or not aligned with my values or goals right now, Automate as much as I can using technology, Routinise recurring tasks using time chunking, and Delegate either to family members or by outsourcing certain functions.
Anchoring involves identifying anchor events in my daily life. These are tasks or activities I identify as non-negotiable and fixed in terms of when they must occur. For example, if I have to fetch my kids from school, these are generally fixed times that I need to anchor into my calendar and everything else needs to revolve around that anchor event.
Time chunking is a process of grouping or categorising all the tasks and activities I need or want to do either according to activity type e.g. admin tasks, or according to energy required, e.g. deep focus work vs low energy tasks. I then allocate into my calendar when the best time is to do each category of activity around my anchor events. For example, if I have identified that writing reports is a high-energy task that requires deep focus, and I know that my brain energy and capacity for deep focus work is best at night when the house is quiet and everyone is asleep, and lowest late afternoon after a day of working with clients back-to-back, I might schedule in 2 nights per week to do my reports and rather end the work day early on those days to do other energising or relaxing activity types.
Brain dumping is a tactic employed in many productivity systems such as the Get Things Done Method (GTD) and Monday Hour One. The idea is that the more information, thoughts or ideas you hold in your head, the more energy this consumes, which is referred to as mental load. Having a heavy mental load reduces your executive functioning capacity. The idea of brain dumping is to offload as much information from your brain as possible, transferring the load onto something else. The key is that where you brain dump must be simple, easily accessible and retrievable and in ONE place. Where you brain dump will be unique to your own preferences. Personally, I use Google Tasks because it integrates well with Google Calendar, and I have access to it all the time via my synced devices. Anytime I have an idea, a task I need to remember to do, or even just something I want to remember, I record it into my Google Task list. Tasks than need to be actioned, gets scheduled into my calendar in the most appropriate time chunk.
I don’t claim to have a perfect system, because perfection is a fallacy, but I have a system that works for me, and when things go off track, it is a system that is easy to reset.
Are there any upcoming developments, expansions, or new services on the horizon from Tasneem Abrahams Occupational Therapist and Private Practice Growth Club?
I would like to maintain a small clinical practice for at least 2 years, before re-assessing my long-term vision for the practice. I don’t have any desire to employ other therapists, but the idea of working in an interdisciplinary environment is very appealing. I do also have goals to contribute positively to the body of knowledge around the role of Occupational Therapy in adult ADHD care and support, and to start offering parent, educator and employer training around ADHD awareness and neurodiversity affirming care. I do offer virtual services and for those seeking support outside of South Africa, I offer coaching as an alternative to therapy. To find out more about my services, one can book a complimentary good-fit video call at tasneem-abrahams-ot.bookem.com
My vision for the Private Practice Growth Club, is to expand my audience to those health and wellness professionals who are established and looking to scale and diversify. In 2024 the focus will shift more toward establishing strategic partnerships to make access to knowledge, resources and skills development accessible to more practitioners. The Private Practice Growth Club will also be offering advertising opportunities to brands and organisations who offer products and services to health professionals. You can find my contact information or sign up for our newsletter via our website.
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