Scandinavian Journal of Occupational Therapy

ISSN: 1103-8128 (Print) 1651-2014 (Online) Journal homepage: http://www.tandfonline.com/loi/iocc20

Editorial To cite this article: (2015) Editorial, Scandinavian Journal of Occupational Therapy, 22:4, 235-236 To link to this article: http://dx.doi.org/10.3109/11038128.2015.1027537

Published online: 20 Apr 2015.

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Date: 05 November 2015, At: 16:53

Scandinavian Journal of Occupational Therapy. 2015; 22: 235–236

Downloaded by [119.1.98.121] at 16:53 05 November 2015

EDITORIAL

We congratulate the Scandinavian Journal of Occupational Therapy (SJOT) for publishing a Special Theme Issue to examine Critical Perspectives on Client-Centred Occupational Therapy. After more than five years of discussion about a Special Theme Issue, we helped to put out a call and selected ten fulllength and three short papers. Our collection merely grazes the surface of a topic that has been profiled for years and will continue to be profiled in SJOT and other venues. In truth, publications and presentations on client-centred practice have appeared around the world since Canada published Occupational Therapy Guidelines for Client-Centred Practice over 30 years ago (1,2) drawing on the ideas of American psychologist Carl R. Rogers (3). The advantage of a Special Theme Issue that emphasizes critical perspectives is that readers will be immersed in thinking critically about the seemingly simple idea that carries such weighty implications for occupational therapists whose good intentions are to be client-centred. It seems that the time is ripe to expand and deepen our critical perspectives with knowledge that occupational therapy and occupational therapists are changing and often challenged to show the global and local contributions and worth of this profession. Over the years, assumptions have arisen in some quarters that occupational therapy is naturally clientcentred and that client-centred practitioners should celebrate the individualization of their practices. The purpose of this Special Theme Issue is to question these assumptions and to stimulate conversations on the contradictions, scope, and obligations for enacting the promise of client-centred occupational therapy. Readers will discover that all papers in this issue articulate or imply four points for client-centred practice: . . . .

an ethical sense of respect, humility, and an obligation to share decision-making power; a call for critical thinking and reflexivity; a commitment to challenge dominant ideology and hierarchical power; and, a focus on macro perspectives that situate clientcentred occupational therapy in national and global contexts.

In some way, each paper questions what one author calls “the illusion of client-centred occupational therapy” in market-driven economies. It is worth noting that occupational therapists are not alone in raising critical perspectives for professionals being “centred” on others. For example, questions raised in this collection resonate with those in nursing and other health-related practices concerning patientcentred and family-centred care (4-9).

Situating critical perspectives in national and global conversations Readers may agree that client-centred occupational therapy is more than a practical technique unique to this profession. The papers in this issue situate critical perspectives on client-centred occupational therapy in global calls to honour and enact obligations for professions to actively, consciously, and publicly educate practitioners to advance human rights and justice in everyday life (10,11), ideas that occupational therapists are also exploring under the concept of occupational justice. The questions raised in this issue are congruent, for instance, with those asked over the years about participatory research (12) and professional approaches to diversity (13). The order of papers in this issue is deliberate. The first six major papers invite the reader to join conversations concerning global issues, citizenship, market forces, education, and the social determinants of health for learning about and enacting client-centred occupational therapy. The last four major papers draw the reader into conversations on particular policies and procedures that narrow and restrict occupational therapy practice in health contexts: referral, discharge, evaluation (using the Client-Centredness of Goal Setting [C-COGS]), and relational autonomy in therapeutic relationships. Three short reports enrich these conversations. One offers insights on the process of practice with children in a health context. Another reflects on student learning with “expert patients” in a university context. The final short report examines practitioners who are learning about client-centred occupational therapy in a non-Canadian context, noting that Canada

This article was originally published with errors. This version has been ammended. Please see Corrigendum (DOI: http://dx.doi.org/10.3109/ 11038128.2015.1056627) ISSN 1103-8128 print/ISSN 1651-2014 online  2015 Informa Healthcare DOI: 10.3109/11038128.2015.1027537

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Editorial

took an early lead to bring client-centred occupational therapy to global attention. Finally, in clarifying the rationale for selecting papers, we note that readers will find interesting ideas regarding methodological considerations for studying the client-centredness (or not) of occupational therapy. Two papers situate critical perspectives in analyses drawn from institutional ethnographies that display how practice works in health contexts. If you wish to study client-centred occupational therapy, consider what can be learned from these papers through an autobiographical essay, a reflective report of educational approaches, or an instrument validation.

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Where to from here? So many more critical perspectives beyond this collection can be brought into conversations on clientcentred occupational therapy. Although the language of the “client” has been questioned for years as market-oriented, a critical examination of this language is still needed. For instance, one could ask if occupational therapists prefer terminology that refers to being resident-centred, worker-centred, or student-centred to name the occupations of those with whom we work, rather than using the generic title that defines the relationship of client to professional. Critical perspectives are sorely needed on client-centred occupational therapy with groups, families, communities, and organizations, with and/or beyond working with individuals. One might ask: Would a change in terminology from client-centred to person-centred practice feed into assumptions that this profession works primarily with individual persons, or would person-centred practices display an ethical sense of respect and humility for persons and personhood? As well, critical perspectives are needed to question how occupational therapists might be client-centred consultants in government, non-governmental, and corporate contexts. With an emphasis in this issue on critical perspectives for practice in health contexts, there is great scope for research on client-centred occupational therapy in other contexts, from housing to transportation and education. Research is needed as well on the client-centred focus in many practice processes or components. There are so many areas

for raising critical perspectives in research, education, and practice. We anticipate hearing and reading many more conversations with critical perspectives on client-centred occupational therapy. Thank you to everyone who responded to our call for papers. Elizabeth Townsend, Canada Gudrun Palmadottir, Iceland Guest Editors

References 1. Canadian Association of Occupational Therapists. Occupational therapy guidelines for client-centred practice. Toronto, ON: CAOT Publications ACE; 1991. 2. Department of National Health and Welfare and Canadian Association of Occupational Therapists. Guidelines for the client-centred practice of occupational therapy. (Cat. No. H39-33/1983E). Ottawa, ON: Author; 1983, (Out of Print). 3. Rogers CR. A current formulation of client-centred therapy. Soc Serv Rev 1950;24:442–50. 4. Entwistle WA, Watt IS. Treating patients as persons: a capabilities approach to support delivery of person-centered care. Am J Bioeth 2013;13:29–39. 5. Manley K, Hills V, Marriot S. Person-centred care: principle of nursing practice. Nurs Stand 2011;25:35–7. 6. Mastro KA, Flynn L, Preuster C. Patient- and family-centred care. J Nurs Adm 2014;44:446–51. 7. Athwal L, Marchu B, Laforêt-Fliesser Y, Castanza J, Davis L, LaSalle M. Adaptation of a best practice guideline to strengthen client-centered care in public health. Public Health Nurs 2014;31:134–43. 8. Hobbs JL. A dimensional analysis of patient-centered care. Nurs Res 2009;58:52–62. 9. World Health Organization. Preparing a health care workforce for the 21st century. The challenge of chronic conditions. 2005. Available at http://www.who.int/chp/knowledge/publications/workforce_report.pdf. Accessed 4 March 2015. 10. United Nations Educational, Scientific and Cultural Organization (UNESCO). Contemporary issues in human rights education. Paris, France: Author; 2011. 11. United Nations (UN). Declaration on human rights education and training. 2011. Available at http://www.ohchr.org/EN/ Issues/Education/Training/Pages/UNDHREducationTraining.aspx. Accessed 4 March 2015. 12. Campbell M, Copeland B, Tate B. Taking the standpoint of people with disabilities in research: experiences with participation. Can J Rehabil 1998;12:95–104. 13. Canadian Association of Occupational Therapists. Joint position statement on diversity. 2014. Available at http://www. caot.ca/default.asp?pageid = 4294. Accessed 4 March 2015.

A special theme issue to examine critical perspectives on client-centred occupational therapy.

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