NZAOT Clinical Workshops 2011 Waitangi Marlies Dorrestein

NZAOT Clinical Workshops 2011 Waitangi Marlies Dorrestein

Spirituality and Occupational Objectives Therapy 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, selforganising, 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 inbetween, 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 nonnormative, 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, afterlife, 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 selfexploration 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

CMOP-E Spirituality at the heart of the person (and the model)

Ways to think about spirituality Individual / subjective/ Interior (Exploring) individual experience of spirituality Individual explanation of spirituality (worldview) / meaning (clientcentred focus) / developmental processes Collective / Inter-subjective / Interior Interpersonal / relationship / qualities of relationship (client w others, therapist w client, in communities), rituals Culture / worldview (Adapted from Wilber, 2007) 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) Collective / Objective /Exterior (societal / systems) Definition Conceptual understanding: models / frameworks Health system: your service / Assessment / interventions / outcomes Education system: OT curriculum / placement

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

A ssessment 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