Muriel Driver Memorial Lecture. Change: creating our own reality

A Study of Metaphorical Stories Used by Occupational Therapists to Describe Their Working Lives

Introduction:

This paper describes five metaphorical stories that occupational therapists use in talking about and making sense of health service reforms, and discusses the value of reflecting on metaphorical stories to increase understanding of healthcare practice and concepts of professionalism.

Methods:

A narrative approach was used to examine how occupational therapists define, experience and practice their work, and describe their professional ‘selves’. The empirical research was conducted over a 12-month period across five National Health Service organizations. Fourteen participants were interviewed three times during this period and were asked to keep monthly diaries of critical incidents.

Findings:

Five dominant types of ‘stories’ were identified and given appropriate metaphorical titles: the battle, the love story, the magazine, the journey, and the pantomime. The research article notes the salient features and implicit relationships selected as important in each story. The stories illustrate how occupational therapists relate to and mediate change, by constructing experiences in ways that facilitate making sense of a situation and seeing a possible direction to take.

Conclusions:

The article suggests that exploring metaphorical stories encourages reflexivity and analytical decision making by illuminating the choices available when mediating change.

Optimal Positioning of Occupational Therapy

Background. Occupation is central to occupational therapy. Although occupation is a universal experience, occupational therapists need to consider the risks and opportunities of exploring new roles and maintaining existing services.

Purpose. I propose three questions to guide the optimal positioning of occupational therapy services. First, how proximal is occupation in the role? Second, how strong is the evidence to support occupational therapy in the role? Third, is the timing right for change? These questions are applied to the role of occupational therapy in primary health care.

Key Issues. Occupation is proximal and the evidence is emerging to support an occupational therapy role in primary health care. Reforms make timing ideal.

Implications. If we focus on the underlying principles of primary health care reform, the potential for an emerging role in primary health care is optimal. The same three questions can be used to transform and optimally position occupational therapy.

Occupational balance: exploring the relationships among daily occupations and their influence on well-being

In this lecture, I have reviewed theoretical discussions and definitions of occupational balance, findings from selected studies, and highlighted some methods for measuring aspects of occupational balance. Are any of these ideas directly applicable to occupational therapy practice, education and research? Consider the hassles of everyday life, and add the complicating factors of illness, injury, disability, and limited income. Life, and the pursuit of necessary, desirable and obligatory occupations, can become overwhelming. Given that occupational therapists aim to enable individuals, regardless of ability, to successfully engage in a range of occupations, the answer to the question is yes. Furthering our understanding of occupational balance can improve our ability to serve individual clients and society. In 2001, Fearing stated in her Muriel Driver Memorial Lecture: We will not only recognize and value the skill of maintaining balance, our own and that of our clients, but we will live it. Balance will not be viewed as a set of scales that has equal parts such as work on one side and play on the other but rather the kind of balance that comes from being centred so that we act from a stable base. From that stable base, we will gain a keen sensitivity to rhythm--knowing when to move and when to let go. (Fearing, 2001 pp. 214-215) Perhaps these reflections have added a little coherence to the study of occupational balance. Occupational balance is a relative state, recognizable by a happy or pleasant integration of life activities and demands. There are indicators of imbalance, more so than tangible ways to measure it, and once recognized occupational therapists have the strategies to help restore a sense of occupational balance. Given our collective history and skill in client-centred practice, occupational therapists are capable of both advancing this line of inquiry and attaining occupational balance for ourselves and our clients.