Teaching and learning the esoteric: an insight into how reflection may be internalised with reference to the occupational therapy profession

This paper is concerned with the ways in which reflective practice is learnt, taught and assessed within the profession of occupational therapy. It utilises individual experiences of reflection of both students and staff members in university and practice placement settings. The discussion places reflection within learning a profession’s way of being and individual learner’s relation to this ‘sense of being’. It concludes that the ‘rote’ way in which reflection is currently used to demonstrate evidence of reflective practice is detrimental to the development of a reflective professional, in this instance, an occupational therapist.     

The New Occupational Therapy Paradigm: Implications for Integration of the Psychosocial Core of Occupational Therapy in All Clinical Specialties

In this paper, it is argued that the new occupational therapy paradigm includes a core of psychosocial skills, consistent with the profession's historical roots in mental health. It is proposed that contrary to the declining presence of occupational therapy in mental health, psychosocial interventions should be explicitly integrated in all professional practice, such that occupational therapy will become the profession of choice in addressing psychosocial issues of all clients irrespective of clinical specialty. A case study is presented as an example to demonstrate how this explicit integration may be achieved in physical rehabilitation.     

Current and Future Education and Practice

SUMMARY

This article describes a national study conducted by the American Occupational Therapy Association Mental Health Special Interest Section to assess the adequacy of mental health content and fieldwork experiences in occupational therapy educational programs preparing graduates for current and future mental health practice. The results of the study indicate that occupational therapists, especially those who practice in mental health settings, must become more “business-oriented.” This orientation includes educating occupational therapy students about reimbursement issues, legal and political systems, marketing strategies, and advocacy roles. Other recommendations are discussed as possible ways to prepare future practitioners more effectively for roles in community-based settings.     

Experience with malleable objects influences shape-based object individuation by infants

Infants’ ability to accurately represent and later recognize previously viewed objects, and conversely, to discriminate novel objects from those previously seen improves remarkably over the first two years of life. During this time, infants acquire extensive experience viewing and manipulating objects and these experiences influence their physical reasoning. Here we posited that infants’ observations of object feature stability (rigid versus malleable) can influence the use of those features to individuate two successively viewed objects. We showed 8.5-month-olds a series of objects that could or could not change shape, then assessed their use of shape as a basis for object individuation. Infants who explored rigid objects later used shape differences to individuate objects; however, infants who explored malleable objects did not. This outcome suggests that the latter infants did not take into account shape differences during the physical reasoning task and provides further evidence that infants’ attention to object features can be readily modified based on recent experiences.     

Engagement within occupational trainees: Individual difference predictors and commitment outcome

The present study examines occupational entrants' experiences of their vocational training, its relation with relevant internal characteristics, and its proposed impact on commitment to the profession. Particular focus is paid to trainees' engagement, hypothesizing motivation and self-efficacy as predictors, and occupational commitment as a distal outcome. Data were from 247 recent entrants into professional degree programs (architecture, engineering). All hypothesized predictive relations were supported, such that motivation (as both a composite and as solely intrinsic) and self-efficacy are predictive of engagement, and engagement is predictive of occupational commitment among early-stage trainees. Further, engagement partially mediated the relation between self-efficacy and commitment, and fully mediated the relation between motivation and commitment. Squared multiple correlations for endogenous variables indicated substantial variance in engagement and commitment accounted for by their respective predictors. Moreover, two structural equation models were examined and compared, proposing more holistic nomological nets for how these constructs fit together. A respecified model accounting for a sole focus on intrinsic motivation and a direct path between motivation and commitment was an excellent fit, superseding a competing model conceptualizing motivation as a composite and only an indirect motivation–commitment path. Finally, need for achievement moderated the relation between motivation and engagement such that the relation is stronger for individuals high in need for achievement than it is for those low in the desire to grow in their profession. The study contributes to our understanding of how early occupational trainees' experiences of work and individual characteristics impact their commitment to their intended profession.     

Concept and Use of The Social Skills Game to Facilitate Group Interaction

A primary goal of occupational therapy is to improve psychiatric patients' social interaction skills. The role of the therapist, in this effort, is to provide opportunities for patients to practice and learn more effective ways of relating with others. Theorists in the profession have encouraged occupational therapists to consider the use of group games to accomplish this objective. Although the use of games has been reported by occupational therapists who work with menlally retarded children and adults, the use of games with psychiatric populations has received little attention in the literature. This article describes the use of The Social Skills Game to facilitate social interaction and the devcloprnenl of social skills in a psychiatric population.     

The Effectiveness of an Occupational Therapy Program for Chemically Dependent Adolescents

This research study, conducted at a residential treatment center for chemically dependent and emotionally disturbed youth, was designcd to answer the following questions: is occupational therapy effective in producing behavioral change in the adolescent chemically dependent population and, if so, what are the factors producing the change? An assessment tool was designed and used in conjunction with observations to determine each resident's behavioral status before and after involvement in occupational therapy groups. All residents admitted to James- town wcre involved in a Work Skills Group (focusing on pre- work skill development) and/or a Relationship Skills Group (fo-cusing on interpersonal skill development). The behavioral status was measured by the therapist using a defined rating scale in an interview format. The changc in ratings from pre- to post-treatment was used as the basis for the data analysis. Groups of residcnts were compared to each other on the, variables of age, sex, attendance, rate of goal completion, group membership, and completion and type of occupational therapy goals. The results of the study indicate that rcsidents who attended occupational therapy, were involved in both groups, completed their occupational thcrapy goals, and completed the occupational therapy program demonstrated significant behavioral change, especially in relationship skills. Age and sex variables alone did not produce significant behavioral change.     

Integrating expectations,experiences, and psychological contract violations: A longitudinal study of new professionals

This research investigated the relationships among pre‐entry expectations, post‐entry experiences and psychological contract violations. The goal was to clarify the conceptual distinctions between the constructs and to test their differential impact on job satisfaction. In a national longitudinal study, 235 final‐year occupational therapy students were surveyed immediately prior to entering the profession and again 14 months later. Post‐entry experiences regarding supervision were found to predict psychological contract violation. Post‐entry experiences and psychological contract violations were found to jointly predict job satisfaction, with psychological contract violations demonstrating the stronger relationship. Pre‐entry expectations were positively correlated with job satisfaction, but this relationship was fully mediated by post‐entry experiences. Met expectations, as measured by an interaction between pre‐entry expectations and post‐entry experiences, was not a predictor of psychological contract violation. Nor did met expectations predict job satisfaction after controlling for contract violations. The findings reinforce a positive relationship between job satisfaction and turnover. These findings support the use of separate and commensurate measures of pre‐entry expectations and post‐entry experiences, and the integration of all three constructs in models of job satisfaction.     

Factors affecting occupational advice for speakers who do and do not stutter

Factors affecting perceptions of occupational suitability were examined for speakers who stutter and speakers who do not stutter. In Experiment 1, 58 adults who do not stutter heard one of two audio recordings (less severe stuttering, more severe stuttering) of a speaker who stuttered. Participants rated the speaker's communicative functioning, personal attributes, and suitability for 32 occupations, along with perceptions of the occupations' speaking demands and educational requirements. Perceived speaking demand strongly affected occupational suitability ratings at both levels of stuttering severity. In Experiment 2, 58 additional adults who do not stutter heard a recording of another adult in one of two conditions (fluent speech, pseudo-stuttering), and provided the same ratings as in Experiment 1. In the pseudo-stuttering condition, participants' perceptions of occupational speaking demand again had a strong effect on occupational suitability ratings. In the fluent condition, suitability ratings were affected primarily by perceived educational demand; perceived speaking demand was of secondary importance. Across all participants in Experiment 2, occupational suitability ratings were associated with ratings of the speaker's personal attributes and communicative functioning. In both experiments, speakers who stuttered received lower suitability ratings for high speaking demand occupations than for low speaking demand occupations. Ratings for many high speaking occupations, however, fell just below the midpoint of the occupational suitability scale, suggesting that participants viewed these occupations as less appropriate, but not necessarily inappropriate, for people who stutter. Overall, the findings support the hypothesis that people who stutter may face occupational stereotyping and/or role entrapment in work settings. EDUCATIONAL OBJECTIVES: At the end of this activity the reader will be able to (a) summarize main findings on research related to the work-related experiences of people who stutter, (b) describe factors that affect perceptions of which occupations are best suited for speakers who stutter and speakers who do not stutter, and (c) discuss how findings from the present study relate to previous findings on occupational advice for people who stutter.     

Cognitive Behavioral Therapy for Late-Life Depression: Evidence,Issues, and Recommendations

This paper discusses relevant research on structured therapy techniques used in the course of cognitive behavioral therapy (CBT) that are helpful in treating older adults with depressive disorders. These findings are compared and contrasted with clinical observations pertinent to the identification of moderator/mediator and other contextual factors critical to the efficacy of CBT for the treatment of this population. While some of these techniques may be viewed as a specific type of intervention in their own right (e.g., Behavioral Activation and Lifeskills Approach), their underlying theory and specific operations are consistent with the underpinnings of other cognitive and behavioral strategies and may be frequently juxtaposed within a CBT framework, depending on the nature of the problem and the specific available resources. Several common issues identified as being problematic for clinicians new to clinical work with older adults are highlighted, and useful information on how to adapt/modify traditional CBT approaches to augment treatment outcome with older adults is provided. Clinicians who use CBT will be familiar with most components discussed, but one novel augmentation towards the development of an age-appropriate format of CBT, termed Lifeskills Approach, is included. In this approach, clinicians are encouraged to identify and incorporate evidence of prior successful coping strategies to challenges that occur across the lifespan. This approach values and respects how clients have overcome aversive life experiences to facilitate attentional deployment away from a narrative of failure to one of resilience and self-acceptance, thereby down-regulating emotional distress. An important consideration discussed is how to use behavioral activation effectively, particularly with persons who have mild cognitive impairment (MCI) or are in the early stages of dementia.     

Qualified therapists’ experience of personal therapy

Recent work shows that the majority of therapists strongly value personal therapy for what it can bring to their professional practice, and for personal development. The aim of this study was to explore qualified therapists’ experiences of personal therapy. Of the 220 qualified therapists who were contacted via post and asked to take part in a questionnaire study, 48 returned the completed questionnaire, which consisted of a series of closed and open questions. Two‐thirds of respondents had engaged in personal therapy. The two most frequently cited reasons for engaging in personal therapy were personal growth and personal distress. Interpretative phenomenological analysis (IPA) identified two broad domains: impact on the person and impact on the professional. Results show that those surveyed recognised the value of personal therapy to themselves as a form of self‐care and personal development. Personal therapy was valued in professional practice as a form of experiential learning from being in the client role. The limitations of this research included a relatively low response rate, raising the question of whether those most likely to have had positive experiences of personal therapy were more likely to participate. Future research might deliberately seek to understand negative experiences of personal therapy. Other avenues for future research include the need to understand how experiences of therapy relate to gender, profession, and therapeutic orientation.     

Opioid Substance Abuse Among Occupational Therapy Clients

This study examined opioid substance abuse among clients of occupational therapists. A sample of 500 occupational therapists, representing five targeted clinical practice areas, was randomly selected from American Occupational Therapy Association membership. Of these, a total of 182 participants ultimately responded to postal surveys. Results found one third considered opioid substance abuse a problem at their facility, and over half reported having one or more clients known to be or suspected of abusing opioids. Moreover, one in five reported having a client exhibit symptoms of overdose. Recommendations for a concerted response by the profession of occupational therapy to this nationwide epidemic are presented.     

Influencing Health and Well-Being Internationally Using an Occupation-Based Perspective: Reflections From Cambodia

This article describes the experience of two occupational therapy educators who have spent time doing disability-related work in Cambodia, a country that is in the process of rebuilding its economic, education, and health infrastructure after years of war and turbulence. The authors describe their experiences, and reflect on important principles of working overseas including: setting aside assumptions and pre-laid plans; letting the reality on the ground guide decision-making and action; respecting local culture; creating strong programs through local participation and capacity-building; attending to systems issues; building bridges through attention to language and communication; and valuing the unique contributions that occupational therapy can make to international development efforts.     

Creative Occupational Therapist: It's About the Client Using Focus Groups to Explore Creativity in Occupational Therapy

Although creativity is an important aspect of occupational therapy theory and practice, there have been few studies that would explore this concept in the context of the occupational therapy process. This was the first qualitative study of creativity in occupational therapy in Slovenia. It was conducted as part of a larger mixed-methods study and included 22 experienced occupational therapists who participated in four focus groups. The focus of the study was on the exploration of different factors that could contribute to creativity and creative strategies in occupational therapy, in either a positive or a negative way. Since occupational therapy promotes a client-centered therapy approach, the role of the client as the motivating factor was of particular interest to our study. Six factors that can influence the creativity of occupational therapists emerged from the qualitative analysis (Strauss & Corbin, 1990). While the client was identified as the key factor, the potential of other factors was also recognized. This qualitative study increased the understanding of the concept of creativity and creative behavior in occupational therapy, and also provided empirical material that formed the basis for the development of a questionnaire on creativity in occupational therapy.     

Reviving Nostalgia for an Era of Practice: An Illustration of the Therapeutic Use of Projective Methods/Media in Occupational Therapy

Projective methods have long had their roots in psychosocial occupational therapy and they remain valuable to the profession. In this article, the author hopes to reawaken interest for an era of practice that was strongly influenced by psychoanalytic theories. She critiques the conceptual models that inform their use in mental health and argues the importance of having a sound theoretical stance in light of the profession’s unique value in this area. She articulates the methods’ clinical utility and relevance to occupational therapy practice and recovery-oriented care. Using a clinical illustration, she demonstrates the potency of the unfolding process between therapist, client and activity.     

New and Expanded Concepts in Neurophysiology,Psychology, and Sociology Complementary to Llorens' Developmental Theory: Achieving Growth and Development through Occupation for Neonatal Infants and their Families

ABSTRACT

Introduction: This issue expands the Llorens’ Developmental Theory of Occupational Therapy. Llorens drew from multiple theorists from the disciplines of sociology, neurophysiology, biology, ecology, psychology, occupational science, and psychodynamics to provide the profession of occupational therapy with a unified theory to facilitate growth and development for people of all ages—from infancy to old age.

Purpose: The purpose of this issue is to analyze, synthesize, and evaluate the continued relevance of Llorens' theory. In addition, the author evaluates, recommends, and applies updated theoretical premises in the realms of psychodynamics, neurophysiology, contextual ecology, and cognitive science that reflect the relevance of occupational therapy practice for infants and their families in the neonatal intensive care unit.

New Psychological Elements: Through the appropriate use of purposeful occupational activity and affective object relationships, the expanded Developmental Theory of Occupational Therapy provides a unified theory of occupation enablement as intrinsic spatiotemporal adaptation and as extrinsic socio ? cultural and physically contextual occupational adaptation to achieve growth and development across the lifespan.     

The Kawa River Model: Applying Theory to Develop Interventions for Combat and Operational Stress Control

This article proposes the implementation of the occupational therapy Kawa (Japanese for river) model to promote “culturally relevant” client-centered care for combat and operational stress control services provided in the military context. Currently, the occupational therapy literature lacks a culturally sensitive approach to address the military service members’ experiences with combat and operational stress. A review of the Kawa model features are provided within a case study for a military service member affected by combat and operational stress. This theoretical article offers a pragmatic method for infusing occupational therapy theory to address the cultural aspects of military service members in recovery.     

Occupational therapy in neurology--results of 7 years' experience

Indications, mode of referral, therapeutic methods, and documentation of the functional occupational therapy practised in the field of neurology are presented and experiences hitherto existing discussed. For many of neurological diseases, the occupational therapy may be regarded as an equivalent method to the medication and to the physiotherapeutic treatment. When carrying-out as group therapy, it is an economical way of treatment, and most of the patients take this kind of therapy in a positive manner. In addition to this, the occupational therapy renders possible that the state of the rehabilitation can be sized up.