Jennifer Creek

Valuing Occupational Therapy as a Complex Intervention

This opinion piece introduces a framework for understanding and valuing occupational therapy as a complex intervention. The nature of complexity, particularly non-linearity and unpredictability, is summarised. The factors that characterise occupational therapy as a complex intervention are then presented. These include the visible actions that constitute the occupational therapy process; the centrality of activities and occupation in the therapists thinking and actions; the shifts of perspectives in occupational therapy intervention; the client-centred nature of practice; and the importance of the therapists thinking skills. All these factors elucidate why we should be proud of the complexity of occupational therapy and why a simple definition is unattainable.

Occupation and Health: A Review of Selected Literature:

Occupational therapy is based on the belief that people can influence the state of their health through what they do. However, there appears to be a shortage of evidence to support this belief. This paper describes a review of selected literature on the effects of occupation on health. The aims were to review how occupation and health are defined in the occupational therapy literature; to find synonyms for these two terms to enable a search for relevant literature; to review evidence for a relationship between what people do and their health; and to identify factors that mediate the relationship between occupation and health. The review had five main findings: occupation and health are defined in a variety of ways by occupational therapists; there is a wealth of literature, representing a number of disciplines and a wide range of research, that explores the relationship between occupation and health; engaging in occupation carries both potential health benefits and risks to health; there is limited knowledge of the ways in which occupation influences health; and the impact of occupation on health is mediated by a complex range of factors. These findings have implications for occupational therapy research, practice and education.

Towards a Theory of Practice

In occupational therapy, theorising is an integral part of practice and theory is shaped by practice. This paper suggests that we do theory by developing collaborative models of thoughtful practice that work within specific contexts. It begins by looking at how the nature of professionalism is changing in response to social and political changes. It argues that any claim to professional status is based on the ability to make informed and authoritative judgements. Professional judgements are described as complex and morally purposeful and as being made within a social context. The paper then addresses how thoughtfulness relates to professional practice. Three dimensions of thoughtfulness are discussed: the deliberative, the public and the reflexive. The final section of the paper considers what theory means for professional practitioners; that is, how occupational therapists use theory in order to theorise our own practice.

Models for Practice in Occupational Therapy: Part 2, What Use are They?:

The second part of this article presents arguments for the value of models for practice in occupational therapy and suggests some of their limitations. The article concludes by inviting readers to reflect on these two positions.

Models for Practice in Occupational Therapy: Part 1, Defining Terms:

The first part of this article attempts to clarify some of the confusion around the use of language to explain the theory of occupational therapy, including terms such as models, frames of reference and philosophical assumptions. It defines and differentiates between the terms and describes the components of a good model for practice.

The Truth is No Longer Out There

Western scientific endeavour, for the past 200 years, has been directed towards uncovering the laws that govern the physical universe. Truth has been seen as existing independently of human activity, and all that is required to discover it is to make accurate and objective observations which lead to rational conclusions. The second half of the 20th century has been characterised by an increasing awareness that knowledge can never be truly objective. With this realisation, the pursuit of truth has given way to a greater acceptance of diversity, complexity and uncertainty in a shift of perspective called postmodernism. Occupational therapists have been traditionally concerned with the details of everyday life as lived by ordinary people. The goals of intervention are individual, contextual, discrete and diverse. Practice is based on pragmatism rather than on abstract principles. This article provides an introduction to a complex topic and argues that occupational therapy can best be understood and valued from a postmodernist perspective.

The Essential Elements of Professional Motivation

This article explores how the continuing development of occupational therapy has been fuelled by three essential elements: philosophy, theory and practice. It examines how the interplay between these elements maintains and drives the profession and discusses the part that individual therapists play in sustaining the progress of the whole. The profession is vulnerable. Philosophy, theory and practice are becoming disconnected, leading to dampening of energy and distraction from our professional purpose. Possible explanations are suggested, including internal factors, such as the widening split between academics and clinicians, and external factors, such as changes in health policy. Strengthening the links between philosophy, theory and practice will ensure that occupational therapy remains healthy and progressive. The article concludes with some practical recommendations about what can be done to bring the philosophers, theorists and practitioners together, to fire individual motivations and re-energise the profession.

Making a Cup of Tea as an Honours Degree Subject

This article discusses some of the factors that make activity an effective and versatile treatment tool. It looks at the theories and techniques underpinning the use of activity as a therapeutic medium. It considers the challenge involved in teaching therapeutic activity to occupational therapy students. Finally, the article draws conclusions about the danger of teaching staff allowing themselves to focus on outcomes at the expense of process and of failing to teach the use of activity effectively to the occupational therapists of the future.

Is Thinking a Waste of Time

At a recent conference on occupational therapy theory, Professor Jon Nixon of the University of Sheffield spoke about the importance of thinking in professional practice. He claimed that ‘professional practice is not just about doing things, but about doing things thoughtfully’ (What is theory? Unpublished lecture, College of Occupational Therapists, 17 September 2003). Professor Nixon posed a question that all occupational groups who aspire to professionalism should be asking: how can I define within my own career trajectory a space for theoretical reflection? This is a pertinent question for every occupational therapist, whatever field we work in. As a clinician, an educator and a writer, I struggle to find time to reflect on the relationship between what I observe in my practice and the formal theories that I read. Professor Nixon stressed that theory is shaped by practice yet, if we do not think deeply about what we do and why we do it, how can this happen? Following the conference, a colleague gave me a paper to read on how to foster critical reflection within contemporary working life (Dawson 2003). The author, an educator, argued that ‘while educational discourse pays considerable theoretical attention to critical reflection and creativity, the working reality of everyday life in many educational settings seldom affords the kind of “space for silence” that allows them to be nourished or extended’ (p33). A clinician might make the same observation. Occupational therapists have a

Points of View on Working Together: Qualified and Unqualified Staff in an Occupational Therapy Department for Adults with a Mental Handicap

This article describes how a head occupational therapist tried to overcome the problem of a chronic shortage of occupational therapists by redefining staff roles. One of the helpers who was affected by this strategy gives his opinion of its effectiveness and describes what it feels like to be an unqualified member of staff in an occupational therapy department.