I thank Dr. Jack R. Sibley of Texas Woman’s University for introducing me to American philosophy. I also thank Dr. Janette Schkade, professor emeritus, Texas Woman’s University and Dr. Sally Schultz, professor and dean, School of occupational therapy, Texas Woman’s University, for stimulating my interest in the philosophy of occupational therapy. Many thanks to my dear friends Frances Punch, John Kiweewa, Susanna Davila, and Dick Curtis for providing valuable feedback regarding this work.
In a study to evaluate the congruity between the intended and actual outcomes of problem based learning, Stern and D’Amico (2001) found that students’ perceptions regarding their learning outcomes were consistent with the faculty’s objectives. However, further examination of the case based learning objectives that were set for the students by faculty indicates that many of them were geared towards medical understanding of the conditions rather than application of occupation as intervention. Out of the 20 objectives for the three case studies, 9 (45%) were oriented towards the medical aspects of the cases. They included objectives such as, “Medical complications associated with cerebral palsy”, “Medical options for managing spasticity”, “Orthopedic management of secondary conditions related to cerebral palsy”, and so on (p. 458). The remaining 11(55%) objectives which might be seen as pertaining to the application of occupation were not explicit regarding what the students were required to learn about application of occupation as intervention. They included objectives such as, “The impact of impairments on functional performance associated with spinal cord injury” (without specifying what ‘functional performance’ meant), “The occupational therapist’s role”, and “The concept of role change”, (The last two more explicitly addressing the application of occupation as intervention) (Stern & D’Amico, 2001, p. 458). While it is desirable that students understand the medical aspects of conditions that therapists address in practice, it seems that according to the objectives set in this study, emphasis was placed on discussing those medical aspects, deemphasizing a thorough study of application of occupation as intervention. Furthermore, students indicated that objectives directed towards understanding of the medical conditions were met more frequently than those directed towards understanding occupational functioning of clients.
In addition, Doyle, Madigan, Cash, and Simons (1998) indicated that since the 1970s, there has been a trend for increasingly fewer therapists choosing to practice in the area of mental health. Penny, Kasar and Sinay (2001) concurred that occupational therapy is becoming less involved in mental health practice. Considering that the practice of occupational therapy historically originated from mental health (Bing, 1981; Peloquin, 1991), the departure from this area of practice indicates the profession’s loss of identity. In order to regain that identity, it is necessary, as Wood, et al. (2000, p. 591) contend, for occupational therapists to engage in an “… in-depth study of the social movements and philosophies that gave rise to the idea of occupation as therapy….in addition to modern approaches to studying occupation…”. Such movements and philosophies include the moral treatment, pragmatism, and the mental hygiene movement (Barton, 1980; Bing, 1981; Bockoven, 1971; Breines, 1986; Dunton, 1957a; Peloquin, 1991; Pinel, 1962; Woodside, 1971). All those movements and philosophies emphasized the role of the mind in enabling human engagement in occupation so as to interact with the environment adaptively.
The purpose of this paper is to present an argument for a proposed conceptual model of practice that is based on the philosophy of pragmatism, which has been suggested to be the philosophy that guided the maturing of the idea of occupation as therapy (Breines, 1986; Hooper & Wood, 2002). Practice based on such a philosophy would be consistent with the occupational therapy roots in mental health because it would provide interventions that are primarily based on the concept of the mind as a means of activating mind-body action through occupation. In the proposed model, the pragmatic construct of instrumentalism (Dewey, 1957; 1996a; 1996b) will be operationalized for application in practice which centers on the notion of the mind as an instrument which can be accessed to facilitate occupational functioning thus promoting the client’s adaptive interaction with his/her environment. The model comprises three phases: The belief establishment, Action, and Consequence Appraisal phases (see figure 1).
The belief establishment phase consists of clarification of beliefs that guide a person’s actions in occupational functioning, in an attempt to enhance instrumental use of the mind in occupational performance. Beliefs that hinder effective occupational performance are identified and occupational activities are presented to assist the client to challenge them. New beliefs that support desired occupational functioning and subsequent consequences (outcomes) are developed when necessary. In the action phase, the client makes a commitment to act in accordance with the newly established, more adaptive beliefs, until such beliefs become ingrained in his/her mind as a guide to the person’s occupational activities. In the third and final phase, the consequences of actions resulting from the newly established beliefs are examined. If such consequences are what the client desired, therapy is considered to have been successful and is terminated. If such consequences are not what the client desired, the therapist guides him/her back to the belief establishment phase. Beliefs are re-examined to determine if they support action that is in accordance with the desired occupational performance, and the therapeutic process begins all over again.
|… In motivating the patients to accept and benefit from occupational therapy, there should be a skillful blending of two important elements: first, meeting the individual interests and abilities, and secondly, providing activity which will attain the prescribed objective in terms of physical and mental treatment. If the former is lacking, the patient might be better handled by exercise alone.|
Copyright © 2003 Hampstead Psychological
Ltd - A Subsidiary of Southern Development Group, SA.
All Rights Reserved. A Private Non-Profit Agency for the good of all, published in the UK & Honduras.