Scandinavian Journal of Occupational Therapy. 2014; 21: 28–33

ORIGINAL ARTICLE

Paradigms in occupational therapy Previously published in Scandinavian Journal of Occupational Therapy 1994; 1: 53–58

H. TORNEBOHM From the Department of Theory of Science and Research, University of Goteborg, Goteborg, Sweden

Abstract Every field of human occupation teems with patterns, which may be called “paradigms”. This article is concerned with paradigms in the field of occupational therapy. The term “paradigm”, which has become quite popular, perhaps too popular since the publication of Kuhn’s famous book The Structure of Scientific Revolutions, has a complex semantic spectrum. Margaret Masterman has distinguished no less than twenty senses in Kuhn’s writings. My use of the term, which has very little affinity with Kuhn’s uses of it, will be defined in due course.

A view on man

Ingredients in A

A person A in her environment E¢A may be represented by a scheme m¢A = hIiA,P, R; IiE¢A, P¢,R¢; R¢¢i, where IiA stands for ingredients in A; P for properties of and R for relations between ingredients in A; E¢A for an environment of A; IiE¢A for ingredients in E¢A; and R” for relations between A and ingredients in A, on the one hand, and E¢A and ingredients in E¢A, on the other. This scheme suggests a series of questions: What are the ingredients in A? What properties do they possess? How are they related to each other? What is the environment E¢A of A? What are its ingredients? What properties do they possess? How are they related to each other? How is A and its ingredients related to E¢A and its ingredients? Replacements of the components of the scheme m¢A of a person in her environment by answers to these questions transform the scheme m¢A into a model M¢A of a person in her environment.

A person is composed of a body and a mind. This answer to the first question invites difficult and controversial philosophical problems about mind and body. I propose another answer: The ingredients in a person are an ensemble of paradigms. Answers to subsequent questions attached to the scheme m¢A serve to determine the kind of entity a paradigm is and provide information about how paradigms function in the proceedings of a person in her life. Properties of a paradigm A paradigm possessed by a person A is composed of these items: knowledge K in a wide sense, including unsupported as well as corroborated assumptions; interests I; the way O, in which she directs proceedings in her life; and her abilities A to act in accordance with her orientation O.A paradigm may be represented by a quadruple hK, I, O, Ai. A person A possesses several paradigms: a life paradigm, which determines how she copes with

Address for correspondence: H. Tornebohm, Department of Theory of Science and Research University of Goteborg, S-412 98 Goteborg, Sweden

ISSN 1103-8128 print/ISSN 1651-2014 online  2014 Informa Healthcare DOI: 10.3109/11038128.2014.952900

Paradigms in occupational therapy

29

Figure 1.

situations of all kinds in her life; a professional paradigm, which determines how she copes with situations in her professional life; person-oriented paradigms, which determine how she relates herself to other persons that she meets in her life; a family paradigm, which determines how she relates herself to members of her family; an ego paradigm, which determines how she deals with her condition in various situations, in particular in situations in which she suffers from a physical or mental ailment, etc.

Relations between paradigms possessed by a person Let h i be a paradigm possessed by A other than her life paradigm hLi = hK,I,O,Ai. Let h i = hK¢,I¢,O¢,A¢i for example be a professional paradigm, such as that of an occupational therapist. The knowledge component K¢ of h i is part of the knowledge component K of hLi; the interest component I¢ of h i of the interest component I of hLi: the orientation component O¢ of h i of the orientation component O of hLi; and the ability component A¢ of h i of the ability component A of hLi. Conclusion All other paradigms possessed by a person are subparadigms of her life paradigm.

The environment E¢A of a person A What is the environment E¢A of a person A? A first answer is: E¢A is the world at large. This answer is no doubt correct, but it is fairly uninformative. A second answer is: E¢A is the totality of situations, which A occupies throughout her life.

A life world It is appropriate here to introduce the notion of a life world. The life world LW of a person A is composed of all situations in which A is present in her life, and ingredients in them, A herself included. The second answer may be rephrased: The environment of A is the life world of A.

Ingredients in the life world LW of a person A LW is composed of all situations . . .s. . . in which A is present throughout her life. A situation s in LW may contain one or more persons . . .B. . . apart from A herself, one or more activities . . .a. . . and tools and instruments, if such items are used in that or those activities. Situations in LW which are similar in some essential respect may be regarded as being of the same kind. An essential respect, in which situations in LW may be similar and as a consequence be brought together into kinds of situations, is that A plays the same role in them. LW contains inter alia these kinds of situations: learning situations in which A is a student, including situations in which A acquires a professional paradigm; and professional situations, in which A performs activities in her profession.

Relations between A and L W Coping A copes with every situation in her life. She masters a situation if her coping with it is successful. In order to cope with a situation s, A has to acquire knowledge about s and ingredients in s and about how these ingredients are related to each other in s. In order to monitor her coping with a situation s, A has to make decisions about strategies. In order to proceed further in her coping with a situation s, A has to implement her decisions. A¢s knowledge about a situation s; her decision of a strategy; her interests in s and abilities to acquire knowledge about s and to decide on and implement strategies may be regarded as components of a situational paradigm, which may be designated hsi. The components of a situational paradigm hsi are linked together. A decision d¢S of a strategy S, which is the orientation factor in hsi, is based on the knowledge component of hsi containing knowledge in a wide sense about s, and motivated by the interest component of hsi. Implementation i¢S of a decision d¢S of a strategy S brings about a situational paradigm hsi being transformed into a situational paradigm hsi containing modified knowledge about s and a decision d¢S¢ of a new strategy S¢.

30

H. Tornebohm into the paradigms . . . h iA. . . whereby knowledge and other resources in use in A¢s coping with the situation s are transformed into knowledge and other resources at A¢s disposal when she copes with situa- tions in the future. A person learns by doing thanks to transfers of the second type. Figure 2 illustrates transfers of resources from paradigms possessed by a person A and from other sources into paradigms that A builds up as she is coping with a situation, and from those paradigms back into paradigms of the former kind.. . .h iA. . . are paradigms possessed by a person A . . .D. . . are other depots of materials to be used in building situational paradigms . . .hsi. . . The arrows (A +• B) stand for flows. Figure 2.

A view of an occupational therapist A¢s coping with a situation s has a paradigm aspect, which is a sequence hsi of situational paradigms . . .hsi. . .; and a strategy aspect, which is a sequence hi’Si of implementations of strategies . . . S. . . These aspects are linked together. Implementations of strategies link situational paradigms together into a sequence. Implementations of strategies are preceded by decisions that are contained in situational paradigms. Figure 1 shows how the paradigm and strategy aspects are linked. Relations between two kinds of paradigms that are involved in a person’s coping with a situation When A forms the situational paradigms. . .hsi. . . , she makes use of contents in her life paradigm and its subparadigms. She transforms knowledge and other resources at her disposal in those paradigms into knowledge and other resources in use in her coping with a situation s. This is not the only source that she exploits in her building up of situational paradigms. . .hsi. . .. She obtains more building materials by making observations of s and ingredients in s and by communicating with others, in particular with persons who are present in s. Situational paradigms therefore have a content which to some extent goes beyond the contents of her life paradigm and its subparadigms, as they were prior to her entrance into s. Some of this additional content is transferred into A¢s life paradigm and its subparadigms, making them richer in content than they were before A began to cope with s. There are flows from the paradigms. . .h iA. . . into the situational paradigms . . .hsi. . . whereby knowledge and other resources at A¢s disposal are transformed into knowledge and other resources in use in A¢s coping with the situation s. There are flows in the reverse direction from situational paradigms . . .hsi. . .

I will again use the scheme m¢A = hIiA, E, R; IiE’A, E¢, R¢; R¢¢i, where A this time stands for an occupational therapist. The ingredients in A contain a life paradigm hLi and an occupational therapist paradigm hOTi. hOTi may be represented by a quadruple hK, I, O,Ai, where K stands for a body of knowledge in a wide sense at the disposal of A as an occupational therapist; I for her interests in patients and treatments of them; O for her ambitions and engagements in occupational therapy as well as for her professional ideals; and A for her abilities to cope with situations in which she deals with patients. Compatibility between a life paradigm and an occupational therapist paradigm A’s professional paradigm hOTi may fit more or less well into her life paradigm hLi. hOTi fits well into the embedding paradigm hLi in so far as the interest and ability components of the professional paradigm hOTi harmonize with the corresponding components of the life paradigm hLi. This is the case if A cares for people and is keen to help them when they run into difficulties. If A’s occupational therapist paradigm harmonizes with her life paradigm, then developments in one of these paradigms are apt to induce developments in the other one. Environment of an occupational therapist What is the environment E¢A of an occupational therapist A? A first answer is: E¢A is composed of all situations in which occupational therapists perform their professional duties. This aggregate of situations may be referred to as the total arena of occupational therapy and be designated OT. OT includes a part OTH of the caring sector composed of situations where patients receive

Paradigms in occupational therapy habilitation treatment by occupational therapists; a part OTE of the education sector composed of situations in which students acquire occupational therapist paradigms; and a part OTR of the research sector com- posed of situations in which research oriented to occupational therapy is carried out. OT in this wide sense includes situations when A is absent. A second answer to the question above is: E¢A consists of all situations in the total arena OT of occupational therapy in which A is present in her professional life, including learning situations into which she is introduced in her profession. This part of OT may be designated OT¢A. Ingredients in OT¢A OT¢A is composed of: educational situations, in which A is learning to become an occupational therapist; and habilitation situations, in which A deals with patients; and, if A is a teacher of occupational therapy, educational situations in which A teaches students to become occupational therapists; and, if A is a researcher, research situations in which A carries out investigations in a field of research that is oriented to occupational therapy.

31

in paradigms possessed by persons participating in them as students or as patients. Educational situations in OT’A in which A is a student serve to bring about an occupational therapist paradigmhOTi being built into her life paradigm. An habilitation situation in OT’A serves to bring about the life paradigm of a patient B changing, so that she will be able to cope better with situations in her life world, thereby raising her quality of life. Educational and habilitation situations in OT’A serve to improve life paradigms of students and patients, respectively. Relations between situations in OT’A A’s copings with learning situations . . .eA. . . belonging to educational situations . . .e. . . in OT¢A bring about her acquiring an occupational therapist paradigm hOTi enabling her to cope with habilitation situations in OT¢A. A’s copings with habilitation situations. h. . . in OT¢A bring about changes in her occupational therapist paradigm hOTi, so that she is likely to be more successful in her copings with habilitation situations later on. Relations between A and situations in OTh

Properties of situations in OT¢A I confine my attention to educational situations. e... and habilitation situations. h. . .. These are composed of situations occupied by persons playing different roles. An educational situation e with a teacher A and a student B is composed of a teaching situation eA, in which A teaches a subject, and a learning situation eB, in which B learns that subject. Teachers coping with teaching situations interact with students coping with learning situations. These inter- actions tie the two kinds of situations together to form educational situations. An habilitation situation h with an occupational therapist A and a patient B is composed of a situation hA, in which A is an agent, and a situation hB, in which B is an agent. A’s coping with hA interacts with B’s coping with hB. These interactions combine the situations hA and hP into an habilitation situation h. It is appropriate to declare that the situations eA and eB stand in a complementary relation to each other within an educational situation e, and that the situations hA and hB likewise stand in the same relation to each other within an habilitation situation h. Educational and habilitation situations in OT’A share another important property apart from their being composed of situations which are complementary to each other. Their aim is to bring about changes

What I have written about a person’s coping with situations in her life world applies to the copings of an occupational therapist A with situations in her environment OT¢A. A builds situational paradigms. . heAi. . .in educational situations. . .e. . which may be referred to as learning paradigms. They are tied together by sequences of implementations . . .i¢SA. . . of learning strategies . . .SA. . .. A builds situational paradigms . . .hhAi... in habilitation situations. . .h. , which may be referred to as treatment paradigms. They are connected by sequences of implementations . . .i¢SA. . . of treatment strategies . . .SA. . . There is one important difference between a person’s ways of coping with situations when she is alone, and an occupational therapist’s with situations in the arena OT¢A. A is not the only person that copes with a situation in OT¢A. Teachers are present in educational situations where A is a student in occupational therapy. Patients are present in habilitation situations where A acts as an occupational therapist. The dual character of habilitation situations is a good reason for introducing a third scheme in addition to the scheme of a person in a life world and the scheme of an occupational therapist in her professional arena.

32

H. Tornebohm herself, then she needs the professional help that occupational therapists can give her.

The common environment of an occupational therapist and a patient

Figure 3.

A view on habilitation A scheme m¢

~

What is E¢((A +• B))? Let. . .h. . .be habilitation situations with an occupational therapist A and a patient B present. These situations may be regarded as parts of a total habilitation situation which may be designated H. The question above may be answered as follows: E¢((A +• B)) = H.

= h(A +• B)i, E, R; IiE’h(A +• B)i, E¢,

R¢;;R¢¢i, where A stands for an occupational therapist and B for a patient, suggests a list of questions to be dealt with in this section. Paradigms possessed by A and B A possesses a life paradigm and subparadigms in it, including an occupational therapist paradigm hOTi. B possesses a disturbed life paradigm hLiB and an ego paradigm which may be designated hBiB. A disturbed life paradigm A person B’s life paradigm is not disturbed if she is able to cope successfully with situations in her life world that are important to her, such as situations in her daily life, in her family, in her working hours and in her leisure time. She has a satisfactory quality of life to the extent that her life paradigm and life world allow her to master, i.e. cope successfully with situations in her life. If she is inflicted by an injury, if her life world is hit by a severe crisis such as bankruptcy, unemployment or the loss of a loved one, then she faces situations that her life paradigm does not enable her to cope with. It is disturbed and her quality of life is low. She needs habilitation. The ego paradigm of a patient If B is in good health and can cope with situations in her life world that are important to her, then she is not overly much concerned with her bodily and mental condition. She is oriented to cope with situations as they come along. But if she is inflicted in one way or another, then she will focus her interests on her bothersome conditions. Her ego paradigm will be mobilized in her coping with disturbances in her life paradigm. She tries to habilitate herself into a state of well being. If she is unable to do this all by

Properties of H H is a dual situation composed of a situation HA, in which the occupational therapist A treats the patient B, and a situation HB, in which the patient B tries to habilitate herself with the help of A. A and B cope with H in a joint endeavor.

An occupational therapist A’s and a patient B’s copings with an habilitation situation in which both of them are present A’s coping with HA. A’s coping with HA has: a paradigm aspect, which is a sequence (HA) of situational paradigms which may be characterized as treatment paradigms; and a strategy aspect, which is a sequence i¢SA of implementations of strategies. . .SA. which may be characterized as treatment strategies. These aspects are linked as shown in Figure 1. Treatment paradigms. A treatment paradigm hHAi includes a very important subparadigm, which is an alter paradigm hBiA referring to the patient B. This paradigm includes A’s knowledge in a wide sense about B, how she is inflicted; how and why her life paradigm is disturbed; how her life world is affected by whatever has brought about her distress; knowledge about the resources located in B’s ego paradigm that she has at her disposal when she tried to habilitate herself. I have now dealt with the knowledge component in A’s alter paradigm hBiA about B. Its orientation component consists of A’s decisions of strategies to activate B in her habilitation of herslef. The paradigms. . .hBiA. . .include knowledge about strategies to improve B’s life world by making some situations in it easier for B to cope with by supplying her with suitable technical aids, and to improve her life paradigm by means of appropriate training programs.

Paradigms in occupational therapy B’s coping with HB. The patient B’s coping with her compartment HB of the habilitation situation H has a paradigm aspect: ~ hHBi ~, where . . .hHBi. . . are situational paradigms that may be characterized as self-habilitation paradigms, and a strategy aspect: ~ i’SB ~, where. . . i’SB. . .are implementations of strategies . . .SB. . . that may be characterized as self-habilitation strategies. The patient B avails herself of material contained in the habilitation paradigms . . .hHAi. . . in A’s coping with HA when she forms the self-habilitation paradigms . . .hHBi. . . in her coping with HB. The occupational therapist A guides B when she decides on and implements self-habilitation strategies. Figure 3 represents relationships between habilitation and self-habilitation paradigms in an habilitation situation. A view of occupational therapist paradigms I start with a scheme m¢«OT» = hIi«OT», E, R; IiE¢«OT», E¢, R¢; R¢¢i, where «OT» stands for a collection of individual occupational therapist paradigms. . .hOTi. . .. This scheme raises a number of questions: (1) What are the ingredients in «OT»? (2) What are their properties? (3) How are they related to each other? (4)What is the environment E’«OT» of the collection «OT» of individual occupational therapist paradigms. . .hOTi. . ? (5) What are the ingredients in E¢«OT»? (6) What are their properties? (7) How are they related to each other? (8) How is the collective «OT» of paradigms involved in their environment E¢«OT»? The answers to these ques- tions constitute a model M¢«OT» of occupational therapist paradigms. Provisional answers Re question (1): «OT» is composed of individual occupational therapist paradigms. . .hOTi. . . Re question (2): They contain a view of people coping with situations in their life worlds; a view of occupational therapists coping with situations in the arena of occupational therapy; and a view of habilitation. Re question (3): Occupational therapists hold similar but not identical views on the issues mentioned above.

33

Re question (4): The environment E’«OT» is the arena OT on which occupational therapists spend their professional lives. Re question (5): OT is composed of educational, habilitation and research situations; and OT consists of institutions and working places occupied by occupational therapists. Re question (6): Educational and habilitation situations have parts that stand in complementary relation to each other. Educational situations in OT serve to build occupational therapist paradigms. hOTi. . . into the life paradigms of students. Habilitation situations in OT serve to overcome troubles due to disturbances in the life paradigms of patients. Re question (7): Educational situations provide students with occupational therapist paradigms which are involved in their copings with habilitation situations after graduation. Re question (8): Occupational therapist paradigms provide knowledge and abilities that are required for satisfactory copings with habilitation situations. Copings with habilitation situations induce developments of occupational therapist paradigms.

References 1. Björklund A. Arbetsterapiparadigm (Occupational therapist paradigms). Institutionen för medicinsk rehabilitering, Sahlgrenska sjukhuset, Göteborg. 1988 2. Lindström U. Psykiatriska specialskötares yrkesparadigm (Professional paradigms of nurses in psychiatry). Abo Akademi Förlag, Åbo. 1992 3. Molander B. Kunskap i handling (Knowledge in action). Daidalos, Göteborg 1993 4. Rolf B. Profession, tradition och tyst kunskap (Profession, tradition and tacit knowledge). Nya Doxa. Övre Dalkarlshyttan. 1991 5. Törnebohm H. Forskning och yrken (Research and professions). Göteborg 1994; 1: 187, Report from the Department of Theory of Science University of Göteborg 6. Törnebohm H. Komplementaritet i vården (Complementarity in caring). Vård no 3–4. Karolinska institutet, Stockholm 1990 7. Törnebohm H. Livsparadigm och livsvärldar. Göteborg 1989; 2: 95, Report from the Department of Theory of Science University of Göteborg 8. Törnebohm H. What is worth knowing in occupational therapy?. Am J Occup Ther 1990; 45: 5/1

Copyright of Scandinavian Journal of Occupational Therapy is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.

Paradigms in occupational therapy. Previously published in Scandinavian Journal of Occupational Therapy 1994; 1: 53-58.

Every field of human occupation teems with patterns, which may be called "paradigms". This article is concerned with paradigms in the field of occupat...
682KB Sizes 0 Downloads 3 Views