Nikki Smit

I founded Project Play in 2021 to provide traditional occupational therapy with a difference – to meet my clients where they are, both literally and figuratively.

I might start my day at one of the schools I work with, where I help clients to develop the skills to thrive on their academic journey. Something like handwriting, for example, requires fine motor skills, hand-eye coordination, visual perception, and core stability. Say a client of mine is struggling to pay attention in class. In that case, I would guide them through activities that help with the regulation and understanding of their nervous system. If their movement threshold is high, they might need more movement throughout the day: Perhaps this means they are in charge of opening and closing the classroom door, or perhaps they are assigned a special task, like handing out worksheets. I would talk to their teacher about which adaptations can be made in the classroom, and with their parents about ways to support them at home. I love working with schools because of this potential for collaboration with both teachers and parents.

Other days, I pack my enormous suitcase full of games and toys and hit the road, landing on clients’ doorsteps like Mary Poppins. In this work, no two days look alike: We might spend the day inside, playing games or doing obstacle courses or baking a cake. Perhaps we play outside, in a garden or a swimming pool if there is one available; perhaps we meet at a park and have a picnic, or go to a shopping centre to buy a gift, or have a meal at a restaurant.

These activities, while a lot of fun, might sound run-of-the-mill – and that’s exactly the point. Each offers a valuable opportunity to practise a range of skills in a real-world context. Something as simple as eating at a restaurant uses executive functioning in choosing the restaurant and designing the outing. Walking and getting on and off public transport engage motor planning and gross motor skills. We use sequencing skills to order; fine motor skills to eat and arrange things on the table; and perspective taking skills to interact with the staff. Sitting at a table also requires core stability and the regulation of our nervous systems. Moving in and out of unpredictable environments helps us to understand how we process and react to sensory information, and how to strategise when this becomes overwhelming.

Visiting my clients in the intimacy of their homes offers me a fuller picture of their lives, and allows me the opportunity to build strong relationships with both clients and their families. Parents have a direct line to my Whatsapp; we become a team that supports one other. Often, what makes an occupation meaningful is that it connects us with others, and with a wider community. Using real-world activities as a form of therapy fosters communal awareness, helping us all to feel a part of something bigger than ourselves. The relationship makes the change, and I am no exception: I am changed by each client that crosses my path.

Over the decades, a lot of occupational therapy has tended to separate the development of these skills from the end goal itself – meaning that instead of developing these skills as part of the occupation, clients practice skills-building exercises with the occupation as a remote eventuality. Sadly, too many clinics have become results-driven assembly lines, where skills are isolated and practised in a way that neglects the holistic nature of any given occupation.

My approach takes the occupation as our starting point: in practising everyday activities in a community setting, we not only develop our skills comprehensively, we also understand them in the context of the world around us, giving these activities meaning and giving us a sense of purpose. In using the occupation itself as a treatment, we return to the roots of occupational therapy.

I grew up in multicultural, multivocal, loud, messy and vibrant South Africa, a place close to my heart and which I still call home. I completed my qualification at the University of Cape Town in 2010, and my community service at Helen Joseph Hospital in Johannesburg in 2011.

In South Africa, being outspoken and active in issues of social justice is not only how we face many of the societal challenges with which we’ve been saddled because of our history, it’s also a part of our culture and identity. As a medical professional you quickly learn how to do a lot with a little, and when you’re working with clients who regularly have to choose between bus fare and a meal, you develop a strong sensitivity to difference, especially difference in class and material circumstances.

Part of my work at Helen Joseph Hospital involved working in the garden with the patients. We grew fruits and vegetables, which would be used by the hospital kitchen to prepare meals for staff and patients. Using an occupation like gardening to facilitate change, both as a therapeutic practice and as something that brought meaning to my patients’ lives, lit a fire within me. Years later, I would think back to this formative time when I helped to facilitate a community garden at a high school in Singapore (complete with chickens and a compost heap). It reminded me of all the magic that happens when we connect with a sense of purpose through meaningful occupations.

My background and training in South Africa really informed my approach to therapy: holistic, community-based, inclusive.