This week Alice Hortop @LaughingOT is hosting with @Ruth_Hawley on the OTalk account for support, read all about it here……………..
Welcome, thank you so much for reading this blog and hopefully coming to the #OTalk on how we can embrace belong centred practice. Belonging centred practice is the subject of my PhD at Brighton University with Dr. Rebecca Twinley, Dr Channine Clarke and Professor Gayle Letherby of Plymouth University with supported funding from the Elizabeth Casson Memorial Trust. This is an interesting topic to explore, below is a short introduction to whet your appetite and you will have the opportunity to influence its development. We have a Facebook page called ‘The Belonging Movement’.
The presenting concern
As occupational therapists (OT), we feel enlightened due to our positive distinctness from other health professionals who are traditionally guided by the medical model. We feel pride in our advancement through our long-established person-centered paradigm, which is increasingly used by other health and well-being professionals. Our practice models are person-centered built on humanistic principles designed to enable us to see the person we are working alongside as a whole, not their parts (Duncan, 2011). But, what if our feelings of pride at our enlightenment are creating complacency, a cognitive dissonance to the need to continue to evolve to reflect unprecedented levels of loneliness, depression, and high suicide rates? What if our profession reflects patriarchal and capitalist values rather than the inspiring humanity that Creek (2017) describes our socialist, suffrage, and settlement movement roots of our inception?
A brief introduction to belonging-centred practice
Belonging-centred practice shifts the focus from the individual to their belonging group, their independence to their interdependence, participation not function, to look for their belonging, and supports its sustainability. Whalley-Hammel (2009 and 2014) compels occupational therapists to focus on belonging needs as an imperative, saying people are designed to be interdependent in groups for their wellbeing. Belonging-centred practice sees we are inherently connected in complex relationships which need to be visible and honoured in practice. Imagine a child’s mobile with farm animals dangling from its different branches if you disturb any of those dangling animals the whole mobile begins its wobbly adjustment to regain its overall balance. Human differences and life challenges are experienced similarly, rarely would they affect solely an individual yet much of our practice focuses on individual functioning in self-care, productivity, and leisure. Belonging-centred practice enables humans’ autonomy whilst valuing their interdependence, sees beyond the individual and their independence to the important people around them and challenges practice that creates a culture of ableism. A simple example would be, instead of the ‘this is me’ booklet commonly used to support person-centred practice, a ‘this is us’ booklet would also encourage well-being considerations of loved ones. Again, thinking of the child’s mobile, greater stability, and wellbeing in the belonging group would enhance the services we provide.
Why do we need belonging-centred practice?
Belonging centred practice is evolving in response to the negative influences of neoliberalism on the direction of occupational therapy in the last few decades. Until recently campaigning the RCOT (2022) website definition of occupational therapy ended, “Everything we do is focused on increasing independence and wellbeing.” The emphasis on independence alongside wellbeing appears innocuous at first glance, admirable and aspirational even. It is only in recent years I began to question if independence should beat the heart of our practice. Neoliberalism believes a high degree of self-reliance makes a good society, a productive society. Thatcher believed the welfare state created lethargy, entitlement, and worse dependency rather than hard work, competitiveness, and personal initiative (Davies, 2022). Also referred to as self-reliance, self-responsibility, and independence. Westernised governments, also known as ‘global north’, adoption of neoliberalist theories of devolving responsibility to citizens for their welfare influenced the practice of OT, changing the core professional paradigms, language, values, and focus (Malfitano, Whiteford, and Molineux, 2021).
A quick definition search of the word independence included, “If one thing or person is independent of another, they are separate and not connected, so the first one is not affected or influenced by the second.” If you do a dictionary search for the antonyms to independence you will find descriptions of dependence, weakness, reliance, inadequate, impotent, subordinate, helpless and even parasitic. Who would want to identify with those words? Through my OT career I approached the people I worked with offering independence, without considering the implication that is what everyone should aspire to be. I often hear vexed OTs complaining that a client won’t accept a care package or equipment, won’t raise the alarm when they fall or do not share when they are in pain or struggling. Are we really surprised? We approach hailing the virtues of independence and to accept anything less creates an internalised ableism of feeling lesser.
There is a wealth of evidence demonstrating the far-reaching damaging effects of loneliness and disconnection between individuals, communities, and society, not to be confused with solitude which can be beneficial if chosen and balanced. Unsurprisingly, the evidence supporting the benefits of connection, co-regulation, sharing, and reciprocation are plentiful e.g., Psychoneuroimmunoendriconology research recommended by trauma experts, such as Maté, Porges, Dana, Levine, states we are built to coregulate to maintain our health and wellbeing. Our previous OT definition assumed a positive correlation between independence and wellbeing but in reality, independence only describes a level of functioning in an activity, not a state of being, living. Worse hyper independence can be a trauma response and truly none of us are independent.
The rest we will explore through the twitter session…
References
Creek J (2017) Enabling occupational therapy practice in marginal settings. In: D Sakellariou, N Pollard (eds) Occupational therapies without borders: integrating justice with practice, 2nd edition. Edinburgh: Elsevier. pp. 237-244.
Davies, J. (2022) Sedated, how modern capitalism created our mental health crisis. London: Atlantic books.
Duncan, E. (2008) Skills for practice in occupational therapy. London: Elsevier.
Malfitano, S., Whiteford, G., & Molineux, M. (2021). Transcending the individual: The promise and potential of collectivist approaches in occupational therapy. Scandinavian journal of occupational therapy, 28(3), pp 188–200.
Royal College of Occupational Therapy (2022) What is occupational therapy? [accessed 28/06/2022] Available at: https://www.rcot.co.uk/about-occupational-therapy/what-is-occupational-therapy
Whalley Hammell, K. (2014) Belonging, occupation, and human well-being: An exploration. Canadian Journal of Occupational Therapy, Vol. 81(1) pp39-50
Yao, D. P.G., Sy, M. P., Martinez, P. G. V., & Laboy, E. C. (2022). Is occupational therapy an ableist health profession? A critical reflection on ableism and occupational therapy. Cadernos Brasileiros de Terapia Ocupacional, 30, e3303.
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