How to Become an OT: The Real Path to Occupational Therapy

I still remember the exact moment I realized occupational therapy was more than just helping people relearn daily tasks. I was shadowing an OT who was working with a stroke survivor, and instead of focusing solely on arm movements, she was helping him figure out how to tie his grandson's shoelaces again. That connection between physical recovery and meaningful life activities? That's when everything clicked for me.

The journey to becoming an occupational therapist isn't just about checking boxes on an application. It's about understanding human occupation in its deepest sense – not jobs, but the activities that give our lives meaning and purpose.

The Academic Foundation (But Not What You Think)

Most people assume you need a specific undergraduate degree to pursue OT. Here's the thing – while many students come from psychology, kinesiology, or biology backgrounds, I've worked with OTs who started in philosophy, engineering, even culinary arts. What matters isn't your major; it's completing the prerequisite courses that OT programs require.

These prerequisites typically include anatomy, physiology, psychology, and statistics. But here's what they don't tell you in the course catalogs: taking developmental psychology will fundamentally change how you understand human behavior across the lifespan. Statistics isn't just about numbers – it's about understanding research that will inform your entire practice.

I spent my junior year volunteering at a pediatric clinic, thinking I was just building my resume. What actually happened was far more profound. Watching children with sensory processing differences navigate their world taught me that textbook knowledge means nothing without understanding lived experience. One child I worked with couldn't tolerate the feeling of grass on his feet. His mother had tears in her eyes when, after months of sensory integration work, he ran barefoot across their backyard for the first time.

The Graduate School Marathon

Getting into OT school feels like trying to solve a Rubik's cube blindfolded sometimes. The competition is fierce – we're talking acceptance rates that make some medical schools look easy. But here's what successful applicants understand: programs aren't looking for perfect GPAs (though those help). They're looking for people who get it.

What's "it"? The philosophy that occupation – meaningful activity – is both the means and the end of therapy. Your application needs to show you understand this at a visceral level. When I wrote my personal statement, I didn't talk about wanting to "help people." I wrote about my grandmother's depression after she could no longer tend her garden due to arthritis, and how an OT helped her adapt her tools and techniques to return to what she loved.

The GRE is another beast entirely. I bombed my first practice test spectacularly. But here's the secret nobody tells you: most programs care more about your verbal and writing scores than math. They want to know you can read research critically and communicate complex ideas clearly. I spent three months doing crossword puzzles and reading academic journals in my spare time. Weird? Maybe. Effective? Absolutely.

Inside the OT Program Pressure Cooker

Graduate school for OT is... intense doesn't quite capture it. Imagine drinking from a fire hose while simultaneously learning to juggle. Your first semester hits you with gross anatomy (yes, you'll work with cadavers), neuroscience, and occupational science theory all at once.

But something magical happens around the second semester. The pieces start connecting. You begin seeing occupation everywhere – in how people brush their teeth, how they organize their workspace, how they play with their children. I remember sitting in a coffee shop, watching a businessman struggle with his laptop bag due to what looked like shoulder impairment, and mentally planning interventions. My friends thought I'd lost it. Maybe I had, but in the best way possible.

Fieldwork is where theory meets reality, often with a resounding crash. My Level I fieldwork in mental health shattered my preconceptions. I thought I'd be doing crafts and activities. Instead, I found myself helping people with schizophrenia develop routines for medication management and supporting individuals with severe depression in rebuilding their daily life structures. One client stands out – a former chef who'd lost all joy in cooking due to depression. We started with just making toast. By the end of my rotation, he was planning menus again.

Level II fieldwork is twelve weeks of full-time clinical work, and it will push you to your limits. I did one rotation in acute care and another in pediatrics. The acute care rotation was trial by fire – evaluating patients immediately post-surgery, collaborating with nurses who moved at lightning speed, and learning to assess someone's entire occupational profile in 20 minutes. Some days I felt competent. Other days I wanted to hide in the supply closet.

The pediatric rotation was different but equally challenging. Working with kids with autism, I learned that progress isn't always linear. Some days we'd have breakthroughs. Other days, we'd spend 45 minutes just trying to get through tooth brushing. But watching a child who couldn't tolerate wearing shoes finally walk into school with sneakers on? Worth every difficult moment.

The NBCOT Exam: Your Final Boss Battle

After graduation comes the National Board for Certification in Occupational Therapy (NBCOT) exam. This test is... well, it's something. Four hours, 170 questions, and your entire future hanging in the balance. No pressure, right?

The questions aren't straightforward. They're clinical scenarios where multiple answers could be correct, but you need to choose the MOST correct one. It tests not just your knowledge but your clinical reasoning. I studied for three months, using practice questions until my eyes crossed. The key is understanding the OT process – evaluation, intervention, outcomes – and applying it to every scenario.

I failed my first attempt by two points. Two. Points. I spent a week eating ice cream and questioning my life choices. Then I picked myself up, identified my weak areas (pediatric development and Medicare regulations, if you're curious), and tried again. Passed with room to spare the second time.

The Reality of Practice

Once you're licensed, the real learning begins. Your first job as an OT is simultaneously terrifying and exhilarating. I started in skilled nursing, which wasn't my first choice, but taught me more about adaptation and creativity than any classroom could.

Working with elderly residents, many with dementia, challenged every assumption I had about therapy. Traditional approaches often didn't work. I learned to enter their reality, to find meaning in whatever moment we were sharing. One resident, a former teacher, couldn't remember my name but would engage fully if I brought worksheets that looked like lesson plans. Another, who barely spoke, would sing entire Broadway shows if I started the first line.

The documentation will nearly kill you at first. Medicare wants specific functional goals. Insurance companies want proof of medical necessity. Your supervisor wants detailed progress notes. You want to actually treat patients. Learning to balance all of this while providing meaningful intervention is an art form that takes months to develop.

Specialization and Growth

After a few years, many OTs specialize. Hand therapy, sensory integration, driving rehabilitation, low vision – the options are vast. I gravitated toward neurological rehabilitation, working with stroke and brain injury survivors. Additional certifications require time, money, and often, questioning your sanity as you study after full workdays.

But specialization isn't just about certificates. It's about developing deep expertise in understanding how specific conditions impact occupation. Working with stroke survivors, I learned that aphasia doesn't just affect speech – it impacts every occupation requiring communication. A client who couldn't order coffee anymore wasn't just frustrated about caffeine; he'd lost a daily ritual that structured his mornings and connected him to his community.

The Stuff Nobody Talks About

Let's be real about some aspects of this profession. The physical demands are significant. You'll transfer patients, demonstrate exercises, and spend hours on your feet. I've tweaked my back more times than I care to admit. Good body mechanics aren't just something you teach patients – they're survival skills.

The emotional toll can be heavy. You'll work with people at their most vulnerable. Some will make miraculous recoveries. Others won't. I've celebrated with patients who walked again and cried in my car after sessions with children whose conditions were degenerating. Self-care isn't a luxury in this field; it's a necessity.

The bureaucracy can be soul-crushing. Insurance denials, productivity requirements, and administrative demands sometimes make you forget why you entered this profession. I've spent entire days fighting for equipment approvals that would clearly improve someone's life, only to be denied because some algorithm decided it wasn't "medically necessary."

Why It's Worth It Anyway

Despite the challenges, I can't imagine doing anything else. Last week, I worked with a construction worker who thought his career was over after a traumatic hand injury. We've spent months on range of motion, strengthening, and work simulation. Yesterday, he texted me a photo from his job site – back at work, modified duties for now, but working.

That's what this profession offers – the privilege of witnessing human resilience daily. You become part of people's recovery stories, helping them reclaim or reimagine their lives. It's not about fixing people; it's about empowering them to engage in occupations that matter to them.

The variety keeps you engaged. Monday, you might be teaching wheelchair navigation. Tuesday, cognitive strategies for someone with ADHD. Wednesday, adapting a kitchen for someone with low vision. No two days are identical, and no two clients have the same goals.

Practical Advice From the Trenches

If you're serious about this path, start observing OTs now. Not just shadowing – really observing. Watch how they think, how they problem-solve, how they communicate with patients and families. Notice the questions they ask. Good OTs are detectives, piecing together how someone's condition impacts their daily life.

Build your communication skills. You'll explain complex concepts to patients with varying education levels, advocate to insurance companies, and collaborate with professionals who might not understand OT's role. I've explained sensory processing to skeptical teachers, justified equipment needs to insurance reviewers, and taught families how to support their loved ones' independence.

Develop cultural humility. You'll work with people whose values, priorities, and occupations differ vastly from yours. What matters to a refugee from Somalia might be completely different from what matters to a suburban soccer mom. Both are valid. Your job is to understand and support their goals, not impose your own.

Stay curious. The field evolves constantly. Telehealth, which seemed impossible for OT five years ago, is now standard practice in many settings. New evidence emerges regularly. The interventions I learned in school have been refined, replaced, or reimagined based on current research.

The Bottom Line

Becoming an occupational therapist requires academic rigor, emotional intelligence, physical stamina, and unwavering commitment to the belief that engagement in meaningful occupation is a human right. It's not an easy path. The education is demanding, the certification process is stressful, and the daily work can be challenging.

But if you're someone who sees the profound connection between what people do and who they are, if you believe that independence looks different for everyone, if you can find creative solutions to complex problems – this might be your calling.

I think back to that moment watching the OT help her patient tie shoelaces again. It wasn't about the physical act. It was about restoring his role as a grandfather. That's occupational therapy. We don't just treat conditions; we treat the human experience of living with those conditions.

The path to becoming an OT will challenge you, change you, and ultimately, if you let it, transform how you understand human resilience and potential. It's not just a career; it's a lens through which you'll see the world differently. And once you see it, you can't unsee it.

Some days you'll go home exhausted, wondering if you made any difference at all. Other days, someone will accomplish something they thought impossible, and you'll remember exactly why you chose this path. Those moments – they make everything worth it.

Authoritative Sources:

American Occupational Therapy Association. Occupational Therapy Practice Framework: Domain and Process. 4th ed., AOTA Press, 2020.

Christiansen, Charles H., and Julie Bass. Occupational Therapy: Performance, Participation, and Well-Being. 4th ed., SLACK Incorporated, 2016.

Crepeau, Elizabeth Blesedell, et al., editors. Willard and Spackman's Occupational Therapy. 13th ed., Wolters Kluwer, 2019.

National Board for Certification in Occupational Therapy. Certification Exam Handbook. NBCOT, 2023.

Schell, Barbara A. Boyt, et al. Clinical and Professional Reasoning in Occupational Therapy. 2nd ed., Wolters Kluwer, 2018.