The myth of participation in occupational therapy: reconceptualizing a client-centred approach

Abstract

Participation is often the comprehensive objective of treatment but also an indication of the extent to which the process of occupational therapy is client-centred. The purpose of this study was to explore levels of participation during occupational therapy among clients in the area of mental health from the occupational therapists' perspectives.Additionally we seek to identify factors that might hinder client participation. Postal questionnaires were sent out to 670 Swedish occupational therapists working with persons with mental illness and learning disabilities. The questionnaire required therapists to rate clients' levels of participation during occupational therapy. Findings indicated the most common level of participation for the clients was interdependent meaning that problems, goals, and plans were identified jointly and collaboratively with the occupational therapist.However, more than 20 % of the clients were described as being dependent. Almost 90 % of the occupational therapists rated client participation in therapy to be very important and nearly 70 % claimed that client participation in general needed to be increased. Occupational therapists rated the primary barriers to participation as being clients' inability to participate and organizational and financial problems. Implications of these findings for education in client-centred practice approaches are discussed.

A Shared Viewpoint but Diverse Focus: A Case Study About Teamwork Within Geriatric Home Rehabilitation

“…The participants allowed the clients to direct the visits to a large extent, and they paid conscious attention to the clients' wishes and goals. This is in line with the view that a client-centered approach builds on an interdependent collaboration between the professionals and the client rather than on an independent goal setting (Kjellberg, Kåhlin, Haglund, & Taylor, 2012).…”

Choice and control for people ageing with intellectual disability in group homes

“…The individual´s perspective, needs, and desires should thus be the driving force of support and service. This is also in line with the concept of occupational justice (37) and the person-centred approach within occupational therapy, which recognize an individual's knowledge, strengths, capacity for choice, and overall predisposition toward empowerment (63)(64). Based on this, occupational therapy interventions can and should support choice and control in people ageing with ID.…”

Client-centred practice in occupational therapy: Critical reflections

“…the client". And indeed, these are exactly the barriers to client participation identified by occupational therapists in a recent study (34). Insidious power is expressed in the carefully constructed discourses that protect and promote vested professional interests, thus little attention has been focused on clients' perceptions of those professional practices that constitute barriers to client-centred occupational therapy.…”

“…A considerable quantity of research has explored perceived barriers to client-centred clinical practice from the perspective of occupational therapists (20,34), much of which is premised on the assumption "that clients present many barriers that will inhibit their involvement in client-centred practice" [(93), p. 14]. From his observations of occupational therapy, Abberley [(38), p. 242] accordingly observed that "failure, [of intervention], in so far as it is acknowledged, tends to be attributed to forces beyond the therapist's control.…”

“…Like most professionals, occupational therapists like to evaluate their own services (32) despite the obvious conflict of interest (19,33) and the occupational therapy literature provides examples of occupational therapists exploring their own perceptions of the client-centred nature of their own services [e.g. (34).]. Without apparent irony, Sumsion [ (16), p. 308] observed that a definition of client-centred practice derived from the perspectives of occupational therapists would "allow therapists finally to determine whether or not they are using a client-centred approach".…”