Occupational Place in Therapy: Limits to Sharing

My research investigates features of occupational engagement which promote creation of a new life after disability. Many researchers have emphasized the influence of place on occupational engagement, meaning, and redeveloping occupational participation (Hasselkus, 2002: Rowles, 2003 & 2008: Shaw, 2009). Hasselkus described therapeutic occupational place (space in which the emergent process of occupation occurs), as one “of intimacy and connection between therapist and client” (1999, p.78). Odawara reported a psycho-social therapeutic place of intimacy, safety, engagement and sharing, which promotes occupational engagement and establishment of a new life (2006). As part of a study of clinical reasoning of occupational therapists in Japan I conducted, recorded and transcribed interviews and also observed therapy with an expert therapist at a day care program for elderly people with physical disability. After initial analysis of data, I checked my interpretations with her. Results: In two exemplar cases, the therapist strove to make a therapeutic occupational place to promote her clients’ occupational engagement and establishment of a new life. However the success of the occupational place could be differentiated by her ability to share meaningful occupational engagement. Taka (pseudonym)’s offensive attitudes scared people. The therapist engaged him in occupations: self-care activities and jigsaw puzzles. His attitude became less threatening; rather, he enjoyed chatting about completed puzzles. The therapist had succeeded in sharing meaningful occupational engagement and from this occupational place, coached his collaboration with others to establish his new life. In contrast, Jiro (pseudonym), because of cognitive problem, desired only complete bodily recovery to repair the roof of his house. The therapist could not share engagement in this occupation. He would not engage in other occupations. He remained disconnected. The therapist couldn’t develop a therapeutic occupational place for this person. Further research is needed for understanding and overcoming the limits to occupational place as a concept for therapy