NZAOT Clinical Workshops 2011

Waitangi

Marlies Dorrestein

Spirituality and Occupational

Therapy Objectives Introductions: people, topic and consent

Explore our own spirituality / spiritual journeys

Identify a framework to assist a discussion about spirituality

Explore our collective knowledge and experience of spirituality in practice Literature and practice (definition / models / assessment /

interventions / documentation)

Barriers and facilitators

Discuss AUT process and progress to date

Making links and looking to the future

‘Spirit’ embraces a range of emphases.. Depth, immanence, implicate reality,

Greek ‗ideals‘

Mystery: ‗strangeness,‘ that which is beyond grasp, immensity, awe, wonder, ‗nature as the place where I meet the divine‘

Systems: ‗World soul‘, Gaia, self-organising, organismic, evolutionary, directional, ultimately non-random, transcending, ascending,

Connectedness: monistic field, consciousness as fundamental, energy, quantum level reality, the numinous, ‗oceanic‘ states, spirit as the ‗in-between‘, ancestral patterns, morphic resonance

Truth: purpose, meaning, grounded in final reality, making sense (of e.g. suffering or evil), a ‗plan‘, good and evil, a basis for ethics

Life/Vitality: the sustainer of life, the vibrancy of life, the physicomaterial as manifest (Bohm‘s explicate) expression of spirit, creativity, richness, quality, beauty, aesthetic, the Greek ‗forms‘ as manifest ‗ideals‘

God/Gods: the transcendent, the Creator(s), creatureliness, smallness in the face of immensity, the factual basis of I/Thou, the logos, incarnating the logos

Religion: as organised forms of the ‗truth‘, as cultural narratives predicated on an underlying reality, as ‗practice‘ of the spirit, individual/social expression of spiritual reality, as revelation from the Divine

Relational: the lived basis of the I/Thou, the ground of loving, the spiritual quality of intimacy, the sustainer of separateness and closeness, the ground of boundaries, the source of love and hate, sacrifice, forgiveness, hope

Unexplained; that not captured by science or physicomaterialism, the bizarre, the non-normative, the ‗spooky‘, rag-bag for the inconvenient, the ‗edge‘ of normal reality

Other ‘worlds’: ‗unseen‘ layers of reality, the ‗presence‘ of the unseen (angels, ancestors, recently departed dead), reincarnation, after-life, heaven/hell, mediumship, denial of the ‗concrete‘ world, spiritualism

Other: ..............

Content of slide courtesy of B. Broom, AUT Mindbody Healthcare papers, lecture October 2010

Spirituality is increasingly discussed in

health literature from a wide variety of

angles

Spirit and spirituality means (many)

different things to different people….

Famous figures in the

spirituality/ religion/ psychology tradition

William James: ‗performing a function that no other portion of our nature can successfully fulfil.‘

Carl Jung: religion as the experience of the ‗numinous‘ or Holy

Robert Assagioli: spirituality as a vital force in human life and an essential aspect of the psyche

Abraham Maslow: peak experiences - the highest reach of human nature

Stanislov Grof: spirituality emerges during deep self-exploration—vital element of existence

Viktor Frankl: logotherapy - our need and search for meaning defines our being

Content of slide courtesy of B. Broom, AUT Mindbody Healthcare papers, lecture October 2010

Spirituality at the ‗heart‘ of the

person (and the model)

CMOP-E

Ways to think about spirituality

Collective / Inter-subjective / Interior

Interpersonal / relationship / qualities of relationship (client w others, therapist w client, in communities), rituals

Culture / worldview

Collective / Objective /Exterior

(societal / systems) Definition

Conceptual understanding: models /

frameworks

Health system: your service /

Assessment / interventions / outcomes

Education system: OT curriculum /

placement

Individual / subjective/ Interior • (Exploring) individual experience of

spirituality

• Individual explanation of spirituality

(worldview) / meaning (client-

centred focus) / developmental

processes

Individual / Objective / Exterior • Individual‘s practices / occupations /

modes of doing (as expressions of

spirituality or as means to connect

with person‘s sense of spirituality)

(Adapted from Wilber, 2007)

Spirituality and occupational therapy

Still a lot of questions but generally an

agreement that this is a legitimate

sphere of practice (Unruh, A., Versnel, J., & Kerr,

N., 2003).

Many different facets identified /

highlighted by many authors (Wilson, 2010)

There are no articles on spirituality in

NZJOT

Collective / inter-subjective /

interior domain

What does spirituality mean to us in

terms of the interpersonal dimension?

Spirituality and therapeutic relationship:

Creating a space for exploration of what this means for

us as people (lecturers, students, therapists)

Do we model permission to legitimise spirituality in

practice? – do we have a ―right‖ to exclude it? What

about client-centred /―person-centred‖ / holistic practice?

Qualities of kindness, openness, being truly human,

safety, vulnerability, heart centred practice, compassion;

uncovers greater similarity than difference

(therapist/client; lecturer/student; within a team?) –

meeting the person first

―Spirituality is not finally a matter of technical expertise but of shared humanity at

its deepest level ―(Kroeker, cited in Townsend, E., & Polatajko, H., 2007, p. 68)

Conceptual Understandings

Conceptual / Exterior / Observational Individual’s practices / occupations (as expressions of

spiritual rituals, e.g. church/mosque attendance, prayer,

meditation; or as means to connect with spirituality, e.g.

gardening, tramping, work!)

Academic / scientific demands

1. Definition (Mayers and Johnston, 2008; Lipton, J. E., 2011)

2. Conceptual Models / Practice models / frameworks (Durie,

2001; Kang, 2003; McColl, 2003; Smith, 2008)

3. Health system demands: Assessment / measurement /

outcomes (McColl, 2003; Unruh, A., Versnel, J., & Kerr,

N., 2003)

4. Education system: OT curriculum - what do we do with all

of the above? (Csonto, 2009;Thompson & MacNeil, 2006)

To define or not to define..

Most authors try to provide a definition of

spirituality – there is a lack of consensus

throughout

Defining spirituality may limit dialogue and

exploration of what spirituality means for

individuals and what it means in the therapeutic

encounter (Broom, personal communication, 2011)

Offering a definition for spirituality may provide a

useful starting point for discussion (AUT staff

development meetings, personal communications, 2011)

Some definitions

―Spirituality can be defined as the search for meaning and purpose in life, which may or may not be related to a belief in God, or some form of higher power. For those with no conception of supernatural belief, spirituality may relate to the notion of a motivating life force, which involves and integration of the dimensions of mind, body and spirit. This personal belief or faith also shapes an individual‘s perspective on the world and is expressed in the way he/ she lives life. Therefore, spirituality is experienced through connectedness to God / a higher being; and / or by one‘s relationships with self, others or nature‖ (Johnston & Mayers, cited in Mayers and Johnston, 2008, p. 273))

―Spirituality is a deep belief or faith in something about how the world or the universe works, and our place in it‖ (Lipton, J. E., August 25, 2011).

Some models

Smith(2008) – leaves room to include the

client‘s perspective / worldview; fits with

CMOP-E

McColl (2003) – occupation focused

perspective (Canadian)

New Zealand Ministry of Health. (n.d.)–

Maori model of health

Kang (2003) – incorporates an Eastern

perspective / worldview

Assessment

Will we assess spirituality to enable

occupation? Or occupation to enhance

spiritual well-being? (Unruh, A., Versnel, J., & Kerr, N.,

2003)

Some examples of questions /

assessment:

McColl (2003) – spirituality main focus

Puchalski, C. - FICA Spiritual History

Assessment (Bouthot, et al, 2011)

Education

In all articles accessed:

agreement about lack of sufficient

education about spirituality in

occupational therapy education (USA,

Canada, Australia, UK)

given as one of the reasons for not

addressing spirituality in practice.

Where to from here?

Ongoing process within AUT

Making links with practitioners

Mutual information / resource sharing

Including in students‘ placement experience

Enough interest for a Special Interest

Group?

References Bouthot, J., Wells, T., & Black, R. M. (2011) Spirituality in Practice. OT Practice,

16(3), 13.

Bursell, J., & Mayers, C. (2010). Spirituality within dementia care: Perceptions of

health professionals. British Journal of Occupational Therapy, 73, 144-151. doi:10.4276/030802210X12706313443866

Csonto, S. (2009). Occupational therapy students' consideration of clients' spirituality

in practice placement education. The British Journal of Occupational Therapy, 72, 442-449.

Kang, C. (2003). A psychospiritual integration frame of reference for occupational

therapy. Part 1: Conceptual foundations. Australian Occupational Therapy Journal,

50(2), 92-103. doi:10.1046/j.1440-1630.2003.00358.x

Lipton, J. E. (August 25, 2011). What is spirituality? Retrieved from http://www.psychologytoday.com/blog/pura-vida/201108/what-is-spirituality

Mayers, C., & Johnston, D. (2008). Spirituality - the emergence of a working definition for use within healthcare practice. Implicit Religion, 11(3), 265-275.

New Zealand Ministry of Health. (n.d.). Maori health models: Te whare tapa wha Retrieved September 18, 2011, from http://www.maorihealth.govt.nz/moh.nsf/pagesma/196

References cont.

Smith, S. (2008). Toward a flexible framework for understanding spirituality. Occupational Therapy in Health Care, 22(1), 39-54. doi:10.1300/J003v22n01_04

Thompson, B. E., & MacNeil, C. (2006). A phenomenological study exploring the meaning of a seminar on spirituality for occupational therapy students. AJOT: American Journal of Occupational Therapy, 60(5), 531(539).

Townsend, E., & Polatajko, H. (2007). Enabling occupation II: Advancing an occupational therapy vision for health, well-being, & justice through

occupation. Ottawa, Ontario: CAOT Publications ACE

Unruh, A., Versnel, J., & Kerr, N. (2003). Spirituality in evidence-based occupational therapy. In M. A. McColl (Ed.), Spirituality and occupational therapy (pp. 145- 160). Ottawa, Canada: CAOT.

Wilber, K. (2007). Integral spirituality: A startling new role for religion in the modern and postmodern world (Paperback ed.). Boston, MA: Integral Books.

Wilson, L. (2010). Spirituality, occupation and occupational therapy revisited: ongoing consideration of the issues for occupational therapists. British J Journal of Occupational Therapy, 73, 437-440. doi:10.4276/030802210X12839367526219