Occupational therapy client-centred practice: a deeper sense of collaboration in client-centredness.




Hermanson, Heather Joan

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This study addressed two questions: (a) how do the various discourses that are at work in everyday practice of occupational therapists inhibit or enhance a collaborative therapist-client therapeutic relationship and (b) what are the ways of strategizing a more client-centred collaborative approach in the midst of the tensions and disjunctures of everyday clinical practice? These questions were addressed by analyzing narratives from the everyday practice of occupational therapy. These narratives were constructed from my own practice in order to provide an insider’s view from the clinician’s perspective, a view that is missing from the extensive literature on client-centred practice in occupational therapy. Guided by an emancipatory interest, the study focused primarily on the tensions between dominant health care discourses that position the therapist as expert and a collaborative, egalitarian therapeutic relationship, which I called “participatory consciousness” after Heshusius (1994). The methodology of critical reflexivity had two parts. The first was the assemblage and interpretations of a collage for the purpose of critically examining my values, beliefs and theoretical predispositions; and the second was the critical reading and rereading of the practice narratives using as analytical tools the concepts of discourse and of occupational therapy clinical reasoning. Discourse refers to ways of thinking, feeling and acting that constitute social and cultural reality. Clinical reasoning refers to how clinicians think in the midst of practice and was the key to identifying how the clinician consciously and/or consciously negotiated or resisted the discourses shaping the clinician-client relationship. The study demonstrated what was entailed in the move to participatory consciousness and offered recommendations to the profession for supporting therapists to move toward a deeper sense of collaboration within client-centred practice.



Occupational therapists, Client-centered