Above the Line vs Below the Line Thinking: A Framework for OTs

Occupational therapy is a profession that sits at the intersection of people, systems, emotions, and expectations. Whether you’re a new graduate or an experienced clinician, the way you think and respond in challenging moments can shape not only outcomes for clients, but also your confidence, relationships, and career longevity.

I learned about this above the line / below the line thinking framework last year and ever since, I’ve been a little obsessed with it. I find it extremely useful to support reflective and regulated practice in my practice so I thought I should share it with you all. So who does it work?

What Is Above the Line vs Below the Line Thinking?

This framework comes from leadership, emotional intelligence, and self-regulation models. It defines our emotional and cognitive state throughout the day, the week or even the month.

Above the line thinking refers to a state where you are:

  • Calm and regulated

  • Reflective and curious

  • Open to feedback and learning

  • Accountable and solution-focused

Below the line thinking occurs when you are:

  • Emotionally flooded or defensive

  • Reactive rather than reflective

  • Fixed in thinking

  • Focused on blame, fear, or self-protection

It’s important to understand that everyone goes below the line at times. It’s completely natural to fluctuate between the two states so the he goal is not perfection, but awareness and recovery if you slip.

Why This Matters in Occupational Therapy

As OTs, we regularly work within complexity:

  • High emotional load from families

  • Competing expectations from systems like the NDIS

  • Time pressures, documentation demands, and caseload management

  • Team dynamics and supervision feedback

Without the awareness of our cognitive state, it’s easy to respond to challenges from below the line — even with the best intentions.

Examples of Below the Line Thinking in the Workplace

Below the line thinking might show up as:

  • Taking parent feedback personally

  • Feeling defensive in supervision

  • Avoiding difficult conversations

  • Ruminating after sessions

  • Believing “I should already know this” as a new grad

These responses are often driven by stress, uncertainty, or fear of getting things wrong.

What Above the Line Thinking Looks Like for OTs

Above the line thinking supports:

  • Clinical curiosity instead of self-judgement

  • Collaborative problem-solving

  • Clear communication and boundaries

  • Openness to learning and growth

It allows OTs to remain grounded, professional, and compassionate — both toward your clients and yourself.

How OTs Can Apply This Framework in Practice

1. Notice When You’re Below the Line

Awareness is the first step. Ask yourself:

  • Am I feeling reactive or defensive?

  • Am I avoiding or blaming?

  • Am I emotionally flooded right now?

Naming it can help you shift it.

2. Regulate Before You Respond

As OTs, we know regulation comes before reasoning.
That applies to you, too.

Try:

  • Pausing before replying to emails

  • Taking a breath between sessions

  • Writing drafts you don’t send immediately

3. Shift From Judgment to Curiosity

Below the line: “I’ve failed this family.”
Above the line: “What information do I need to understand this better?”

Curiosity keeps you learning rather than shrinking.

4. Use Reflection, Not Rumination

Reflective practice is above the line.
Rumination keeps you stuck below it.

Reflection asks:

  • What worked?

  • What didn’t?

  • What would I do differently next time?

5. Bring an Above the Line Lens to Supervision

Supervision is a powerful place to practice above the line thinking.

This might sound like:

  • “I’m not sure yet, but here’s what I’m considering.”

  • “I’d like support to think this through.”

  • “Can we explore alternative approaches?”

Supporting Teams to Stay Above the Line

Are you a team leader or supervisor? Your practices and culture in the workplace can intentionally support above the line culture by:

  • Normalising uncertainty for new grads

  • Encouraging reflective discussion over blame

  • Modelling curiosity in leadership

  • Valuing learning over perfection

Why I love it…

For occupational therapists, this framework offers a shared language to support:

  • Clinical reasoning

  • Professional identity

  • Team communication

  • Personal wellbeing

And perhaps most importantly, it reminds us that how we think shapes how we practice.