Background. This descriptive paper offers reflections on power and justice associated with occupational therapy's client-centred practice, now described as the practice of enabling occupation. Framed as a contribution to the sociology of professions, the questions addressed are: How do power and justice work in occupational therapy today? What vision of power and justice guides the profession in implementing the client-centred practice of enabling occupation? Method. The paper opens with an overview of the analytic framework for reflections. Two sources for reflections are highlighted: the development of the Canadian guidelines and, client/consumer and occupational therapy perspectives. To illustrate the discussion of power and justice, two contrasting diagrams are presented, one on late 20th century power relations and the other on potential power relations. Results. Recommendations for research, education, practice, and guidelines development are offered prior to a conclusion that acknowledges the dissonance facing occupational therapists who struggle to focus on occupations in client-centred practice. Practice Implications. The paper offers insights and strategies for addressing power and justice as issues in implementing the client-centred practice of enabling occupation. The analysis may be used in raising awareness and guiding the strategic development of institutional change toward social inclusion and enabling occupation.
BlainJ.TownsendE. (1993). Occupational therapy guidelines for client-centred practice: Impact study findings. Canadian Journal of Occupational Therapy, 60, 271–285.
2.
CampbellM.CopelandB.TateB. (1998). Taking the standpoint of people with disabilities in research: Experiences with participation. Canadian Journal of Rehabilitation, 12, 95–104.
3.
CampbellM.GregorF. (2002). Mapping social relations: A primer in doing institutional ethnography. Toronto, ON: Garamond Press.
4.
CampbellM.ManicomA. (1995). Knowledge, experience, and ruling relations: Studies in the social organization of knowledge. Toronto, ON: University of Toronto Press.
5.
Canadian Association of Occupational Therapists. (1991). Occupational therapy guidelines for client-centred practice. Toronto, ON: CAOT Publications ACE.
6.
Canadian Association of Occupational Therapists. (1997). Enabling occupation: An occupational therapy perspective. Ottawa, ON: CAOT Publications ACE.
7.
Canadian Association of Occupational Therapists. (2002). Enabling occupation: An occupational therapy perspective (Revised Ed). Ottawa, ON: CAOT Publications ACE.
CervaroR.M.WilsonA.L. (1999). Beyond learner-centred practice: Adult education, power, and society. Canadian Journal for the Study of Adult Education, 13, 27–38.
11.
GreenM. Clark (2000). The Canadian Way. OT Now, 3, 3.
12.
CoburnD. (1992). Freidson then and now: An “internalist” critique of Freidson's past and present views of the medical profession. International Journal of Health Services, 22, 497–512.
13.
CoburnD. (Ed.) (2000). Medicine, nursing and the state. Toronto: Garamond Press.
14.
CorringD.CookJ. (1999). Client-centred care means that I am a valued human being. Canadian Journal of Occupational Therapy, 66, 71–82.
15.
DarvilleR. (1995). Literacy, experience, power. In CampbellM.ManicomA. (Eds.), Knowledge, experience, and ruling relations: Studies in the social organization of knowledge. (pp. 249–261). Toronto, ON: University of Toronto Press.
16.
DeeganP. E. (1990). Spirit breaking: When the helping professions hurt. The Humanistic Psychologist, 18, 301–313.
17.
DeeganP. E. (1992). The independent living movement and people with psychiatric disabilities: Taking back control over our own lives. Psychosocial Rehabilitation Journal, 15, 3–19.
18.
DeeganP. E. (1997). Recovery and empowerment for people with psychiatric disabilities. Social Work in Health Care, 25, 11–24.
19.
Department of National Health and Welfare. (1983). Occupational therapy guidelines for client-centred mental health practice, H39–33/1983E. Ottawa, ON: CAOT Publications ACE. (out of print).
20.
Department of National Health and Welfare. (1986). Intervention guidelines for the client-centred practice ofoccupational therapy, H39–100/1986E. Ottawa, ON: Department of National Health and Welfare. (out of print).
21.
Department of National Health and Welfare. (1987). Toward outcome measures in occupational therapy, H39–114/1987E. Ottawa, ON: Department of National Health and Welfare. (out of print).
22.
DevaultM.McCoyL. (2002). Institutional ethnography: Using interviews to investigate ruling relations. In GubriumJ. F.HolsteinJ. A. (Eds.), Handbook ofinterview research. (pp. 751–776) Thousand Oaks, CA: Sage Publications.
23.
DonabedianA. (1966). Evaluating the quality of medical care. Milbank Memorial fund Quarterly, 44, 166–206.
24.
DonabedianA. (1985). Twenty years of research on the quality of medical care. Evaluation & The Health Professions, 8, 243–265.
25.
DriverM. (1968). A philosophic view of the history of occupational therapy in Canada. Canadian Journal of Occupational Therapy, 35, 53–60.
26.
DunstC. J.TrivetteC. M. (1989). An enablement and empowerment perspective of case management. Topics in Early Childhood Special Education, 8, 87–102.
27.
DyckI.ForwellS. (1997). Occupational therapy students’ first year fieldwork experiences: Discovering the complexity of culture. Canadian Journal of Occupational Therapy, 64, 185–196.
28.
EganM. (2001). Canadian occupational therapy research: The little profession that could. Canadian Journal of Occupational Therapy, 68, 143–148.
29.
EganM.DuboulozC.von ZweckC.VallerandJ. (1998). The client-centred evidence-based practice of occupational therapy. Canadian Journal of Occupational Therapy, 65, 136–143.
30.
FayB. (1987). Critical social science: Liberation and its limits. New York: Cornell University.
31.
FisherD. B. (1994). Health care reform based on an empowerment model of recovery by people with psychiatric disabilities. Hospital and Community Psychiatry, 45, 913–915.
32.
ForwellS. J.WhitefordG.DyckI. (2001). Cultural competence in New Zealand and Canada: Occupational therapy students’ reflections on class and fieldwork curriculum. Canadian Journal of Occupational Therapy, 68, 90–103.
33.
FrankL.EngelkeP. (2001). The built environment and human activity patterns: Exploring the impacts of urban form on public health. Journal of Planning Literature, 16, 202–218.
34.
FriedsonE. (1986). Professional powers: A study of the organization of formal knowledge. Chicago: University of Chicago Press.
35.
GageM. (1997). Muriel Driver Lecture: From independence to interdependence: Creating synergistic health care teams. Canadian Journal of Occupational Therapy, 64, 174–184.
36.
GiddensA. (1991). Modernity and self-identity: The selfand society in the late modern age. Stanford, CA: Stanford University Press.
37.
GrayJ.M. (1998). Putting occupation into practice: Occupation as ends, occupation as means. American Journal of Occupational Therapy, 52, 354–364.
38.
Health Canada, & Canadian Association of Occupational Therapists. (1993). Occupational therapy guidelines for client-centred mental health practice. Ottawa, ON: CAOT Publications ACE.
39.
JongbloedL. (1998). Disability income: The experiences of women with multiple sclerosis. Canadian Journal of Occupational Therapy, 1998, 193–201.
40.
KielhofnerG. (2002). Model of human occupation: Theory and application, 3rd Ed.Baltimore, MD: Lippincott Williams & Wilkins.
41.
KinsellaE. A. (2001). Reflections on reflective practice. Canadian Journal of Occupational Therapy, 68, 195–198.
42.
LawM.BaptisteS.McCollM.OpzoomerA.PolatajkoH.PollockN. (1990). The Canadian Occupational Performance Measure: An outcome measure for occupational therapy. Canadian Journal of Occupational Therapy, 57, 82–87.
43.
MalterudK. (1993). Strategies for empowering women's voices in the medical culture. Health Care Women International, 14, 367–373.
44.
MaxwellJ. D.MaxwellM. P. (1983). Inner fraternity and outer sorority: Social structure and the professionalization of occupational therapy. In WipperA. (Ed). The sociology of work: Papers in honour of Osward Hall. Carleton Library series number 129. Ottawa, ON: Carleton University Press.
45.
McCollM. A. (2000). Muriel Driver Lecture: Spirit, occupation and disability. Canadian Journal of Occupational Therapy, 67, 217–228.
46.
McCubbinM.CohenD. (1996). Extremely unbalanced: Interest divergence and power disparities between clients and psychiatry. International Journal of Law and Psychiatry, 19, 1–25.
47.
NelsonG.OchockaJ.GriffinK.LordJ. (1998). “Nothing about me, without me“: Participatory action research with self-help/mutual aid organizations for psychiatric consumer/survivors. American Journal of Community Pyschology, 26, 881–912.
48.
O'DonnellM. (1993). How to enable staff to empower patients. Nursing Standard, 8, 38–39.
49.
PeloquinS. (1997). National Perspective: The spiritual depth of occupation: Making worlds, making lives. American Journal of Occupational Therapy, 51, 161–168.
50.
PolatajkoH. J. (2001). National perspective. The evolution of our occupational perspective. The journey from diversion, throught therapeutic use, to enablement. Canadian Journal of Occupational Therapy, 68, 203–207.
51.
RebeiroK. (1998). Occupation as means to mental health: A review of the literature and a call for research. Canadian Journal of Occupational Therapy, 65, 12–19.
52.
RebeiroK. (2000). Client perspectives on occupational therapy practice: Are we truly client-centred?Canadian Journal of Occupational Therapy, 67, 7–14.
53.
RebeiroK. (2001). Enabling occupation: The importance of an affirming environment. Canadian Journal of Occupational Therapy, 68, 80–89.
54.
ReedK. L.SandersonS. R. (1983). Concepts ofoccupational therapy (2nd ed.). Baltimore, MA: Williams and Wilkins.
55.
ReillyM. (1962). Occupational therapy can be one of the great ideas of 20th century medicine. American Journal of Occupational Therapy, 16, 1–9.
56.
RogersC. R. (1953). Client-centred therapy. Boston, MA: Houghton Mifflin.
57.
RogersC. R. (1965). Client-centered therapy: Its current practice, implications and theory. Boston: Houghton Mifflin.
58.
RudmanD.CookJ.PolatajkoH. (1997). Understanding the potential of occupation: A qualitative exploration of seniors’ perspectives on activity. American Journal of Occupational Therapy, 51, 640–650.
59.
KleinB. Sherr (1997). Foreword. In Canadian Association of Occupational Therapists. Enabling occupation: An occupational therapy perspective. (pp. vii–x). Ottawa, ON: CAOT Publications ACE.
60.
KleinB. Sherr (1998). Slow Dance: A story of stroke, love, and disability. Toronto, ON: Alfred A. Knopf Canada.
61.
SmithD. E. (1974). The social construction of documentary reality. Sociological Inquiry, 44, 257–267.
62.
SmithD. E. (1987). The everyday world as problematic: A feminist sociology. Toronto, ON: University of Toronto Press.
63.
SmithD. E. (1990a). Texts, facts, and femininity: Exploring the relations of ruling. New York: Routledge.
64.
SmithD. E. (1990b). The conceptual practices of power: A feminist sociology of knowledge. Toronto, ON: University of Toronto Press.
65.
TownsendE. (1992). Institutional ethnography: Explicating the social organization of professional health practices intending client empowerment. Canadian Journal of Public Health, 83(S1), S58–S61.
66.
TownsendE. (1993). Muriel Driver Lecture: Occupational therapy's social vision. Canadian Journal of Occupational Therapy, 60, 174–184.
67.
TownsendE. (1996a). Enabling empowerment: Using simulations versus real occupations. Canadian Journal of Occupational Therapy, 63, 113–128.
68.
TownsendE. (1996b). Institutional ethnography: A method for showing how the context shapes practice. Occupational Therapy Journal of Research, 16, 179–199.
69.
TownsendE. (1997). Inclusiveness: A community dimension of spirituality. Canadian Journal of Occupational Therapy, 64, 146–155.
70.
TownsendE. (1998a). Good intentions overruled: A critique of empowerment in the routine organization of mental health services. Toronto, ON: University of Toronto Press.
71.
TownsendE. (1998b). Client-centred occupational therapy: The Canadian experience. In LawM. (Ed.), Client-centred occupational therapy. (pp. 47–65). Thorofare, NJ: Slack.
72.
TownsendE. (2002). Preface 2002. In Canadian Association of Occupational Therapists. Enabling occupation: An occupational therapy perspective. (pp. xvii–xxxi). Ottawa, ON: CAOT Publications ACE.
73.
TownsendE.BirchD.LangilleL.LangleyJ. (2000). Participatory research in a mental health clubhouse. Occupational Therapy Journal of Research, 20, 18–44.
74.
TownsendE.LandryJ.E. (in press). Enabling participation in occupations. In ChristiansenC.BaumC., Occupational therapy: Overcoming human performance deficits. Thorofare, NJ: Slack.
75.
TownsendE.LangilleL.RipleyD. (2003). Professional tensions in client-centred practice. American Journal of Occupational Therapy, 57, 17–28.
76.
TownsendE.WilcockA.A. (2003). Occupational Justice. In ChristiansenC. T. (Ed.), An introduction to cccupation: The art and science of living. (pp. 243–273). NJ: Prentice Hall Publishing.
77.
UnruhA.VersnelJ.KerrN. (2002). Spirituality unplugged: A review of commonalities, contentions, and a resolution. Canadian Journal of Occupational Therapy, 69, 5–19.
78.
WaitzkinH. (1989). A critical theory of medical discourse: Ideology, social control, and the processing of social context in medical encounters. Journal of Social Health and Behaviour, 30, 220–239.
79.
WhitefordG.WilcockA. A. (2000). Cultural relativism: Occupation and independence reconsidered. Canadian Journal of Occupational Therapy, 67, 314–323.
WilcockA. A. (1998a). An occupational perspective of health. Thorofare, NJ: Slack.
82.
WilcockA. A. (1998b). Reflections on doing, being and becoming. Canadian Journal of Occupational Therapy, 65, 248–256.
83.
WilcockA. A. (2001). Occupation for health: A journey from self-health to prescription (Vol. 1). London: British Association and College of Occupational Therapists.
84.
WilkinsS.PollockN.RochonS.LawM. (2001). Implementing client-centred practice: Why is it so difficult to do?Canadian Journal of Occupational Therapy, 68, 70–79.
85.
World Health Organization. (2001). International Classification of Functioning, Disability and Health (ICF). Geneva: World Health Organization.
