Psychosocial Conceptual Practice Models in Occupational Therapy. Building Adaptive Capability

493 Pages·2007·6.34 MB·English

by  Moses N. Ikiugu

11830 Westline Industrial Drive
St. Louis, Missouri 63146
Psychosocial Conceptual Practice Models in Occupational Therapy: ISBN-13:978-0-323-04182-9
Building Adaptive Capability ISBN-10:0-323-04182-5
Copyright © 2007 by Mosby, Inc., an affi liate of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any
means, electronic or mechanical, including photocopying, recording, or any information storage and
retrieval system, without permission in writing from the publisher.
Permissions may be sought directly from Elsevier's Health Sciences Rights Department in Philadelphia,
PA, USA: phone: [phone], fax: [phone], e-mail: [email protected].
You may also complete your request on-line via the Elsevier homepage (http://www.elsevier.com), by
selecting “Customer Support” and then “Obtaining Permissions”.
Notice
Neither the Publisher nor the Author assumes any responsibility for any loss or injury and/or damage
to persons or property arising out of or related to any use of the material contained in this book. It is
the responsibility of the treating practitioner, relying on independent expertise and knowledge of the
patient, to determine the best treatment and method of application for the patient.
The Publisher
ISBN-13:978-0-323-04182-9
ISBN-10:0-323-04182-5
Publishing Director: Linda Duncan
Editor: Kathy Falk
Developmental Editor: Melissa Kuster Deutsch
Publishing Services Manager: Pat Joiner
Senior Project Manager: David Stein
Designer: Kimberly Denando
Printed in the United States
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Ikiugu_FM.indd iv 11/27/06 9:30:07 PM
This work is dedicated to my mother Elizabeth and my
two wonderful children Ivan and Nora
Ikiugu_FM.indd v 11/27/06 9:30:07 PM
R
EVIEWERS
Rebecca Argabrite-Grove, MS, OTR/L
Special Education Supervisor
Loudoun County Public Schools
Ashburn, Virginia
Jeanenne Dallas, MA, OTR/L, CPRP
Instructor and Clinical Specialist
Department of Occupational Therapy
Washington University
St. Louis, Missouri
Yolanda Griffi ths, OTD, OTR/L, FAOTA
Associate Professor
Department of Occupational Therapy
Creighton University Medical Center
Omaha, Nebraska
Linda Kelly, MS
Occupational Therapy Assistant Program
Delgado Community College
New Orleans, Louisiana
Janice Robinson, MS, OTR/L
Staff Occupational Therapist
AnMed Health
Anderson, South Carolina
vii
IIkkiiuugguu__FFMM..iinndddd vviiii 1111//2277//0066 99::3300::0077 PPMM
Preface
taxonomy of knowledge development, is available
on the instructor's portion of the Evolve Resources
A new occupational therapy paradigm has website. This manual will help the instructor
recently emerged, one that has been described in create educational experiences based on this
the Occupational Therapy Practice Framework textbook and the laboratory manual so that they
and that has also been particularly well articulated are optimally useful to students, irrespective of
by Gary Kielhofner, a leading scholar in the their level of knowledge of occupational therapy
profession. In this new paradigm, theory-based, principles.
occupation-based, client-centered, collaborative, Finally, the reader will notice that many case
and evidence-based practice is emphasized. This examples in this book are derived from Africa
textbook/laboratory manual is designed to fulfi ll (Kenya in particular). This is because my
the mandate of this newly evolved professional experience in psychosocial practice is largely
paradigm. based on my practice in the Kenyan mental health
Many occupational therapists are familiar with system. These examples are also meant to appeal
the complaint among professionals that theory- to the international readership of this textbook.
based practice is impractical, because client Although occupational therapy textbooks portray
problems do not fi t theoretical frameworks taught case examples from the United States and several
in university programs. As many practitioners other parts of the world, Africa is largely under-
often put it, theories taught in occupational represented. The examples used in this textbook
therapy schools do not work in the "real world." are an attempt to help occupational therapists
One reason many therapists hold such a sentiment worldwide develop an awareness of the African
is that there is a scarcity of resources designed to psychosocial occupational therapy experience,
assist them in pragmatically and experientially albeit drawn from only one African nation,
bridging theory and practice. This book is designed Kenya. If after reading this book, potential or
to facilitate establishment of this bridge by clearly practicing occupational therapists become more
defi ning theoretical constructs in such a manner refl ective about how they apply theory in practice,
that they can be applied and then providing about how they use available empirical evidence
specifi c exercises in a laboratory manual to help to support their clinical decisions, and about
the therapist apply those constructs in clinical occupational therapy experiences from other
practice. The book therefore effectively meshes parts of the world, including Africa, then I will
theory and practice in order to facilitate effective have achieved my objective.
theory-based practice.
Rationale
This book is designed to be applicable to
different levels of knowledge and practice skills in This textbook/laboratory manual is intended for
occupational therapy. It is meant for entry-level use in psychosocial rehabilitation courses in
occupational therapy students who want to occupational therapy. As I embarked on this
master the basic assumptions, principles, and work, I was aware that there are numerous
values of the profession; for practicing clinicians textbooks in psychosocial occupational therapy
wishing to deepen their theoretical understanding already in the market. Therefore I had to ask
of what they are doing as occupational therapy myself: "Why write this book? What does it add
practitioners; and for post-professional (advanced) to the already available fund of knowledge in
masters and doctoral level students who want to this area of practice?" In answer to the above
understand the profession's conceptual basis at a questions, I realized that the book was a result
deeper level. To meet those multileveled needs, an of my experience teaching courses on psychosocial
Instructor's Resource Manual, based on Bloom's rehabilitation.
ix
IIkkiiuugguu__FFMM..iinndddd iixx 1111//2277//0066 99::3300::0077 PPMM
x Preface
For many years, I struggled with the process use procedures and techniques effectively to
of seeking information from varied sources, then implement interventions, and (6) to provide me
trying to organize it so that it makes sense and with research evidence demonstrating that his or
meets the requirements of the course. Moreover, her planned interventions have been found to be
since psychosocial rehabilitation is a practice effective.
course, I found myself scrambling in search of This textbook/laboratory manual was designed in
activities and exercises for use in the laboratory an attempt to help produce an occupational therapist
sections. Sometimes I had to devise my own with the above-listed characteristics. It was also
exercises because I could not fi nd published ones written to meet the needs of entry-level occupational
that met the requirements of my students. As I therapy students (by providing clear, practical
continued in this manner, it occurred to me that guidelines for practice with case examples) as well as
other instructors might be having a similar higher level advanced professionals (e.g., doctoral
struggle. I then thought, "Would it not be nice if level students) who desire to deepen their knowledge
most of the course information that my students of the profession (the in-depth philosophical and
needed to access was available in one textbook? theoretical discussions and the critique of models,
And would it not also be nice if there was a for example, were written with these professionals
laboratory manual–somewhat analogous to a in mind).
laboratory manual in basic sciences such as
Organization
anatomy–with systematically developed exercises
and activities that students could use to practice To best explain how this vision was translated
and develop their skills in translating the into a book, I will use an architectural analogy.
textbook's theoretical concepts into practice? Imagine that the profession of occupational
This textbook/laboratory manual was born out therapy is a residential building complex.
of the above thoughts and desires. Psychosocial occupational therapy may be viewed
As I was developing an outline for the book/ as one phase of the building complex's
laboratory manual, I imagined myself or a close development with several housing units (e.g.,
relative being treated by an occupational therapist direct practice with clients who have a variety of
who had taken my psychosocial rehabilitation diagnoses, addressing psychosocial issues of
course. What kind of therapist would I like to clients with physical disabilities, working with
work with in such a context? In answer to the clients' families, working with community
question, I realized that I would like a therapist agencies). The historical development of the
treating my loved one or me (1) to have a clear profession is comparable to the process of leveling
identity as a professional, to be comfortable with the ground so that there is adequate support for
the theoretical principles guiding his or her the entire complex, through all its phases (e.g.,
therapeutic interventions, and to be clear about psychosocial rehabilitation, physical disabilities,
their historical origins and about how occupational geriatrics, home health, pediatrics).
therapy is different from other services that my The philosophy (which I argue is primarily
loved one or I may be receiving, (2) to convince pragmatism) and scientifi c framework (which I
me about the value of occupational therapy for propose to be complexity/chaos theory) constitute
my loved one's or my rehabilitation, (3) to the foundation. This foundation is laid on fi rm
explain the theoretical principles underlying ground leveled by a clear understanding of the
therapeutic interventions being received in such a historical evolution of concepts that are at the
way that they are easily understandable, (4) to basis of the profession so that it is adequately
translate those principles into simple, easily supported. The specifi c practice techniques and
applicable interventions that are effective, (5) to procedures (e.g., skillful use of everyday
IIkkiiuugguu__FFMM..iinndddd xx 1111//2277//0066 99::3300::0088 PPMM
Preface xi
occupations, use of groups and group processes, In Part III, General Practice Considerations in
clinical reasoning, ethical decision making) form Psychosocial Occupational Therapy, general
the building blocks of clinical practice. Active practice considerations are discussed. These
listening and effective communication constitute include client evaluation, use of therapeutic
the mortar that binds together those therapeutic relationship, use of groups and group techniques,
building blocks, and the therapeutic relationship clinical reasoning, cultural considerations in
makes the fi nishing décor that gives the therapy, and ethical decision making. This part
professional structure its aesthetic appearance constitutes the building blocks as well as the
and elegance. Conceptual practice models provide décor of the profession, providing professional
columns and beams that support the entire aesthetics. It constitutes elements of practice that
weight of the structure and transmit this weight have been referred to by some occupational
to the supporting foundation of philosophy and therapy scholars as the art of practice. A therapist
scientifi c framework. Management, consultation, who is skillful in the use of those building blocks
and team building skills form the roof that is admired for his or her elegance in practice.
provides shelter to the contents of the structure Part IV, Specifi c Interventions: Application of
(clients and therapists). Conceptual Models of Practice in Occupational
Bearing in mind the aforementioned structural Therapy, is concerned with select conceptual practice
analogy, the book is divided into fi ve parts. In Part models used by psychosocial occupational therapists.
I, Background, the historical origin of occupational For each model, the theoretical core and guidelines
therapy, from the moral treatment movement up for evaluation and intervention are discussed. Its
to the present, is discussed. I have gone to great consistency with the foundation of the profession
lengths to explicate the social and intellectual (the philosophy of pragmatism and chaos/
context within which the profession developed. complexity theory) is critiqued. Recommendations
The history as presented is meant to level the on how to make the model more consistent with
ground and make it fi rm through a clear this foundation and research evidence illustrating
understanding of our origins and our rich clinical usefulness of the model are presented. Part
intellectual heritage in preparation for laying the IV may be comparable to the structural framework
professional foundation. Psychological theories of a building, with each of the conceptual practice
that have contributed to the development of models constituting a column or beam that supports
psychosocial occupational therapy are also the weight of our professional house.
discussed as the hard core that provides In Part V, Application of Psychosocial
reinforcement in preparation for laying the Occupational Therapy Across the Continuum of
foundation. Care, application of occupational therapy across
In Part II, Contemporary Conceptual the continuum of care, ranging from consideration
Foundations of Psychosocial Occupational of age and developmental stages to application
Therapy, conceptual foundations of the of psychosocial occupational therapy principles
profession are discussed, as are the role of the in the community is discussed. This is comparable
philosophy of pragmatism and the complexity/ to the landscaping that enhances the beauty of
chaos theoretical framework as a basis for our profession.
occupational therapy practice. Finally, the
newly evolved professional paradigm is
Language and Style
articulated. This part of the book forms what
I see as the foundation of the profession, This book is written with the need to help ther-
supporting all psychosocial occupational apists conduct occupation-based, collaborat ive,
therapy practice. client-centered, theory and evidence-based practice
IIkkiiuugguu__FFMM..iinndddd xxii 1111//2277//0066 99::3300::0099 PPMM
xii Preface
in mind. Care has been taken to carefully reduce referring to yourself "is ambiguous and may give
abstract concepts into practical intervention the impression that you did not take part in your
guidelines that can be easily applied in clinical own study" (pp. 37-38). However, because some
practice. Case examples have been used throughout readers are annoyed by too frequent use of the
the book to illustrate how the discussed concepts pronoun "I," in this book it has been limited to
are applied. the following situations: (1) addressing the reader
Regarding the use of language, I am aware directly when I share personal experiences; in
that since the development of phenomenology these instances I am trying to connect with the
by the philosopher Edmund Husserl (1857- reader in a personal way, which I believe makes
1938) and subsequent application in psychology the experiences in the book real and alive, and (2)
by phenomenologists such as Martin Heidegger when I want to make clear that the ideas being
(1889-1976), there has been increasing support presented are my own opinions and not necessarily
of the view that there is no true separation based on consensus derived from literature.
between the observer and the observed, the I think that use of language in this manner
subjective and the objective. (Assumption of allows the reader to differentiate between my
objectivity has for a long time been the basis of own ideas and opinions, ideas and opinions
scientifi c inquiry, which up until very recently derived from interpretation and synthesis of
required scientifi c discourses to be written in the literature, and factual information reported from
third person so as to be perceived to be literature. This makes it easier to judge opinions
objective.) and agree or disagree with them on their own
This trend culminated in the view articulated merit, while still fi nding value in information
by Thomas Kuhn (see Chapter 4) that every reported or synthesized from literature. Finally,
scholar necessarily brings into scientifi c inquiry I realize that in the information age, in which
his or her subjective perceptions of the new information is rapidly being generated and
phenomenon being observed. As such, true ideas are transformed constantly, it is diffi cult
objectivity is really a myth. The publication for any one person to be an authority in an area
manual of the American Psychological Association as extensive as psychosocial occupational therapy
now recognizes this reality, as indicated by its practice. I therefore welcome ongoing con-
recommendation that writers use the fi rst person structive criticism that will help me refi ne and
because using the third-person pronoun when improve this work on an ongoing basis.
IIkkiiuugguu__FFMM..iinndddd xxiiii 1111//2277//0066 99::3300::0099 PPMM
Acknowledgments
I learned from them as much, if not more than
I taught them.
Many people have made this book possible. My My editors Kathy Falk and Melissa Kuster
deceased father, Joseph Ikiugu, and my mother, and the entire Elsevier publication team deserve
Elizabeth Kathuni Ikiugu, sacrifi ced much to special mention for their professionalism and
ensure that I acquired my education. I owe all support. They made this task more painless than
my achievements to them. I could have ever expected. It was a pleasure
My sisters Angelica, Pilippina, Paulina, Justah, working with all of them.
and Micheline, and their husbands contributed I would like to acknowledge in a special way
to my success in many ways, both fi nancially and all my clients in both Kenya and the United
in their undying faith in my abilities. They States. They were a crucial source of the
encouraged me to be all that I can be. experiences that provided the material for this
My friends Arnie and Amy Mindell and the book. I consider them my valuable teachers.
entire process-oriented psychology community I want also to acknowledge my colleagues at the
demonstrated to me what true friendship and University of South Dakota, Department of
generosity mean. I could not have achieved what Occupational Therapy: Barbara Brockevelte, Stacy
I have without their support. Smalfi eld, Angela Anderson, Lynne Anderson, and
My dear friends Susanna Davila and Dick Connie Twedt for their unqualifi ed acceptance,
Curtis are particularly responsible for making my warmth, friendship, and collegiality. Without their
immigration into the United States and my doctoral support, I could not have accomplished this task.
education possible. I consider them my adopted I am grateful to Dr. Elizabeth A. Ciaravino of
United States parents and am forever grateful for the University of Scranton for contributing a
their love, friendship, and immense generosity. chapter in this book. Through the chapter, her
I want to acknowledge my doctoral advisers, expertise in the treatment of clients with substance
Drs. Sally Schultz, Jeanette Schkade, and Jack abuse disorders became available to occupational
Sibley for pointing me in the direction of lifelong therapists who will read this book.
scholarly curiosity and inquiry. Finally, and not in any way the least, I want
My psychosocial rehabilitation students at to thank my partner Marie Anne Ben for her
the University of Scranton and the University of love and unwavering support. She is the reason
South Dakota provided me with a chance to that I was able to complete this project without
explore and develop ideas used in this book. going crazy. I am indebted to her forever.
xiii
IIkkiiuugguu__FFMM..iinndddd xxiiiiii 1111//2277//0066 99::3300::0099 PPMM
PPAARRTT I
Background
P art I consists of three chapters. In Chapters way, occupational therapists need to appreci-
1 and 2, the history of occupational thera- ate the social and intellectual context within
py in mental health is discussed. Chapter 1 which that reform took place. Understanding
begins with the rise of the moral treatment move- this context is essential if we wish to learn what
ment in the late eighteenth century and continues may have remained stable and what has changed
through the arts and crafts movement era at the over time as our profession has evolved, and it
end of the nineteenth century and extends into will provide insights that are crucial as we chart
the beginning of the twentieth century. Chapter 2 our future with authority, self-knowledge, and
deals with the evolution of occupational therapy confidence. As Detweiller and Peyton argue,
from its formal founding at the turn of the twen- a chronotopic study of professions (based on
tieth century to the present. Why devote two Bakhtin’s1 constructs of chronos [time] and
entire chapters to the history of occupational topos [place]) allows professions to keep in view
therapy, especially when the subject is discussed their “stability or transhistorical qualities, as
elsewhere in occupational therapy literature? well as their context-sensitivity or their specific
The answer to the above question is simply reinterpretations in new times and places of use”
that this textbook will cover the profession’s his- (p. 425).2 By keeping in view the stability and
tory in a manner different from other sources. In transhistorical qualities, professionals can devel-
one of the most quoted phrases in occupational op “shared understandings” (p. 429).2
therapy literature, Mary Reilly stated in her The first two chapters of this book are spirited
Slagle lecture that, “One of the greatest ideas attempts to help occupational therapists keep in
in 20th century medicine is that man, by use of view the stability and transhistorical qualities of
his own hands, as they are directed by the mind their profession, and to help them develop shared
and energized by the will, can affect the state understandings that have trickled through his-
of his own health” (p. 2).3 It is put forth in this tory to the present, and which help us maintain
book that to understand this great twentieth our identity and integrity as a profession. I want
century idea, and to come to the full realization to make my contribution toward helping every
of its potential benefits, we must have a clear individual occupational therapist understand
and insightful understanding of its origin. What that which has remained constant through history
Roberts proposed for psychology holds true for even as our profession has evolved over time, so
occupational therapy: “the lessons of the past that every therapist in turn can make insightful
have to be well studied” (p. 12).4 contributions toward the realization of that great
Chapters 1 and 2 are necessary to trace the twentieth century idea that Reilly visualized in
origin of occupational therapy from the moral 1962. Obviously, two chapters cannot do jus-
treatment movement in Europe. In this histori- tice to an in-depth discussion of the history of
cal account, it will be demonstrated that moral occupational therapy. However, an effort will be
treatment was primarily part of a wider social made to discuss as fully as possible, in the limited
reform effort. To understand the origin and space, the rise of the moral treatment movement
development of the profession in a meaningful and the social and intellectual context in which
1
IIkkiiuugguu__CChh0011..iinndddd 11 1111//1133//0066 99::2266::3399 AAMM
2 Part I Background
it was founded, the development of the moral facilitating appreciation of the profoundness of
treatment movement in the United States, the the basic premises of our profession. In Chapter
influence of the arts and crafts movement to the 3, psychosocial theories that have contributed to
development of occupational therapy, the men- the development of psychosocial occupational
tal hygiene movement, the community mental therapy are presented.
health models, and the current community sup-
port movement. To help the reader understand REFERENCES
the multiple interacting contexts of this develop-
1. Bakhtin M: The dialogic imagination, Austin, TX, 1981,
ment, the historical account is summarized in a
University of Texas Press.
diagram (see Figure 1-1).
2. Detweiler J, Peyton C: Defi ning occupations: a chrono-
Also in Chapter 2, considerable space has topic study of narrative genres in a health discipline’s
been devoted to a discussion of the philosophy emergence, Written Communication 16:412-468, 1999.
of pragmatism. This is considered necessary to 3. Reilly M: Occupational therapy can be one of the great
ideas of 20th century medicine, Am J Occup Ther 16:1-9,
help the reader understand the philosophical
1962.
constructs of the profession and where they
4. Roberts N: Mental health and mental illness, New York,
might have originated from. This is part of 1967, The Humanities Press.
IIkkiiuugguu__CChh0011..iinndddd 22 1111//1133//0066 99::2266::4411 AAMM