Occupational Therapy and Life Course Development: A Work Book for Professional Practice - Softcover

Wright, Ruth; Sugarman, Léonie

Softcover

ISBN 10: 047002545X ISBN 13: 9780470025451

Publisher: Wiley, 2009

Synopsis

Occupational Therapy and Life Course Development is an invaluable work book for professional practice. It provides a tool to help both students and qualified professionals develop and enhance a framework for their practice that supports all individuals and settings in a holistic and inclusive way.

Much of the book is organised as a work book based around a single case study.  It includes theory related to life span development and managing change, and also exercises for readers to complete in order to apply the theory to practice.

Chapters span such key topics as the client in context; life events; transition and loss; the management of stress; and planful decision making.

The book emphasises how issues of life course development are as relevant to health and social care professionals as they are to their clients.  A number of exercises invite readers to reflect on their own life course, and there chapters both on becoming and belonging as an occupational therapist, and on developing professional practice.

About this title

About the Author

Ruth Wright is at the Occupational Therapy Department, St Martin's College, Lancaster.

Leonie Sugarman is a Chartered Occupational Psychologist and is Senior Lecturer in?the Department of Applied Social Sciences, St Martin's College, Lancaster.

Excerpt. © Reprinted by permission. All rights reserved.

Occupational Therapy and Life Course Development

A work book for Professional Practice in Health and Social CareBy Ruth Wright Leoni Sugarman

John Wiley & Sons

Copyright © 2006 Ruth Wright and Leoni Sugarman
All right reserved.
ISBN: 978-0-470-02545-1

Chapter One

The Life Course as an Organizing Framework

Whoever your clients are, one thing we can be sure of is that they will be somewhere on the path from cradle to grave, and that where they are in this journey is going to affect their needs. To have an understanding of this journey through the life course, and to be able to use the theories that describe and explain it in order to organize and enhance your interventions, can only be helpful. This chapter introduces the idea of the life course as an organizing framework for thinking about clients' lives. It presents a number of theoretical ideas and practical tools.

By 'the life course' (Cohler & Hostetler, 2003; Elder et al., 2003), we mean the rhythmic and fluctuating pattern of human life over time, marked out by expected and unexpected life events and interactions between the self and the environment. It covers the journey through life from start to finish, including all the stages, roles and key events that the person experiences, along with the reactions of the person to these experiences and the meanings which they attach to them. To adopt a life course framework is not to adhere to a particular, well-defined theory. Instead, it is to take on a world view or perspective that posits an active and agentic individual interacting with and moving through an influential and modifiable physical and interpersonal environment (McAdams, 1993). The specifics of what this means are spelt out in less abstract terms in Box 1.1, and can be thought of as a manifesto for the life course (or lifespan) perspective. You should look at these statements before reading on, and reflect on the questions posed.

For each and every one of us, the life course is a fascinating and complex personal journey, and for those of us who work therapeutically with others it provides a robust framework that helps divide complicated concepts into smaller, logically related and more manageable chunks (Pickin & St Leger, 1993). It can be used as an aide-memoire for health and social care professionals' assessment of client needs, and as a tool for the planning and evaluation of interventions.

Roles across the life course

Client-centred intervention includes the belief that meaningful activity both contributes to and is a source of personal well-being; and occupational therapy is specifically grounded in this belief. A life course perspective locates this and, indeed, all activity in the context of one or more social roles, for example the role of worker, parent, student or, possibly for many of your clients, patient. Turn now to Learning Task 1.1, which will help you begin to build up a picture of the lives of the participants in our case study (pp. 6-11).

Learning Task 1.1 introduces the idea of a person's roles varying across the life course, at least in part dependent on his or her life stage. This can be represented diagrammatically as a life-career rainbow. Donald Super (1980; Herr, 1997), the psychologist who introduced this idea, identified nine roles that together are able to account for most of the roles occupied by most people most of the time: child, student, leisure user, citizen, worker, partner/spouse, homemaker, parent and retiree. Of course, for any particular individual some of these roles may be absent (not everyone is a spouse, for example) or insignificant (there are those for whom studentship comes to an end early in life, has never had much meaning and is never resumed later in life). Similarly, for some people, roles that do not figure in Super's list (for example sibling, client or patient) may be of prime importance. Super identifies four key arenas in which these roles are acted out: home, work, school (or other educational establishment) and community. These are all important parts of the environment or context in which most, although of course not all, individuals live out their lives.

Key issues for occupational therapists and other health and social care practitioners relate to the number, size, nature and personal significance of the constellation of roles that comprise a client's life-career rainbow. Do they represent a good role balance? Are there any significant gaps? Are any roles too demanding for the client? What changes may be indicated in order to further a client's well-being or progress?

The life-career rainbow can indicate more than mere role occupancy. Thus, the width of each band can be varied in line with the time demands of a particular role. Immediately after the birth of a first child, parents may find that the 'parent' role occupies almost all hours of the day (and night), with other roles being compressed into small windows of time, or else dropped altogether. After a while, however, the time demands of the role lessen somewhat, and a more balanced and varied role repertoire can be attained. Illness and disability can likewise disrupt a person's role balance, with hitherto important roles being squeezed out of a person's life. As an occupational therapist, you are uniquely placed to address these issues and to work with your clients using the concept of the life-career rainbow to help them to address their needs. It may, in fact, be helpful to spend some time constructing and talking through your client's life-career rainbow quite formally, using the technique of drawing one out as a basis for mutual planning and agreement about goals, aims and interventions. Box 1.2 uses the idea of a life-career rainbow to depict the life course to date of Katie, one of the case study characters.

In thinking about a person's life-career rainbow, it is vital to note that of possibly even greater significance than the time demands of a particular role is its importance or meaning (or salience, to use Super's term). In terms of the life-career rainbow, this could be conveyed by varying the density of the colouring in each band. The colour density of any one role can then vary as the role waxes and wanes in significance. This, even more than the occupancy or not of particular roles, can be highly individual and idiosyncratic, making it risky for health and social care workers to make assumptions about the relative significance of a client's various roles. Hence, role saliency is not depicted in the life-career rainbow for Katie. Whilst we may be able to hazard a guess at the saliency for her of some of her roles, at least at some points in her life course, this is really for her to decide. Rather than being assumed, role saliency is something that should be explored with clients as part of the assessment process. The ideal scenario, of course, is when those roles represented by a wide band (that is time-consuming ones) have a good degree of colour density (thereby indicating significant salience to the individual). It may be salutary for us to realize how large a part of a person's life the client role may at times occupy. We need to consider how we can ensure that clients experience our interactions as meaningful as well as time-consuming. Clients, like everyone else, are vulnerable to stress and depression as a consequence of performing roles that occupy a great deal of time but have little salience for them. This is particularly true when those roles last for long periods, and even more so when there appears to be no prospect of things changing.

Now that we have made the case for the value of the life-career rainbow as a way of thinking about the life course, it is time for you to try using it yourself. Learning Task 1.2 asks you to construct your own life-career rainbow. Whilst the main focus of this book, with the exception of the final two chapters, is the client rather than the therapist, it is important to remember that the concepts discussed are applicable to all of us. Furthermore, we are each better placed than anyone else to construct our own life-career rainbow, which is another good reason for asking clients to complete their own with you there rather than you attempting to do it for them.

Current roles: a snapshot of the 'now'

Whilst the life-career rainbow is a particularly effective tool for monitoring changes in role occupancy and significance, a snapshot of a client's current role repertoire - in effect, a cross-sectional slice through the life-career rainbow - can more easily be represented in the form of a pie chart. The larger the slice of the 'pie', the greater the time spent in that role. Learning Task 1.3 asks you to complete a pie chart for a client you are, or have been, working with. This can be useful when planning interventions, especially where decisions need to be made about how best your client can spend limited resources of time and energy. As a pre-worked example, we have also included a pie chart of one of the people (Mary) in our case study's current role occupancy. How well balanced do you think her roles seem to be? Are there any that are too great or too small? Which roles does it suggest as being most in need of development or maintenance? How could you, as someone who works with a client-centred approach, try to alter the balance?

During a person's life course, roles exist in an equilibrium that can be affected by illness or disability, and may lead to role imbalance and role underload or deprivation (Creek, 2002), something that can lead to considerable distress. For nearly all clients, this area needs assessment, and possibly intervention. It may be that roles can be rebalanced, or even at least partially restored, by skilful work on the part of therapist and client. Alternatively, new occupations, roles or relationships may be developed. Changing the previous balance and pattern of roles may be very important to your clients. In terms of their perception of their own life, such reconfiguration may allow them to perceive both meaning and purpose in daily life, and to find social acceptance. Social acceptance, in turn, means that social support of the role and activity is much more likely to be forthcoming. The holding of socially normative and acceptable roles is likely to enhance self-esteem and foster relationships, giving energy, opportunity and a positive sense of self to your client. The importance of balanced, fulfilling roles in determining quality of life and self-esteem cannot be underestimated.

Recognition of how the client's place in the life course affects role balance is an essential ingredient in planning intervention. As we grow up, we all develop an awareness (although we may not put it into words) of the nature of different life stages. We develop expectations about what we will and/or think we ought to be doing at different points in the life cycle: 'I ought to be financially independent by the time I'm 25', 'I want to be married before I'm 30', 'I expect to be retired at 65', 'I'll need a bungalow or ground-floor flat when I'm 80' are all commonplace examples. The following section provides some theories and concepts for expressing and debating these assumptions.

Stages and developmental tasks across the life course

All societies divide the life course into stages, and these are reflected in the organization of many health and social care services. Sometimes this is explicit, for example paediatric services, adolescent mental health provision, Sure Start programmes for the under-fours or services for older people. Sometimes it is implicit. Thus, services around maternity care, stroke rehabilitation or occupational training will tend to involve clients within a particular life stage because of the association between life stage and a wide range of significant life events. Occupational training, for example, is unlikely to occur with the under-15s or the over-60s. In the past, maternity care was relatively rare in the over-40s, but this has changed latterly and reminds us that what society considers to be the appropriate age for any given role or activity can vary considerably from community to community, society to society and also across different generations. This is, indeed, one of the tenets of the life course perspective's manifesto. Learning Task 1.4 asks you to think about the typical characteristics of different life stages. Give this activity some attention now, before you read on. You may be surprised both by how much you already know about change and development across the life course and by the way in which some life stages are far easier than others to characterize in this way.

The term 'developmental task' was coined in the 1940s by Robert Havighurst, an American educationalist, who described it as a task

arises at or about a certain period in the life of the individual, successful achievement of which leads to ... happiness and to success with later tasks, while failure leads to unhappiness in the individual, disapproval by the society, and difficulty with later tasks. (Havighurst, 1972, p. 2)

In other words, developmental tasks represent personal developmental milestones and achievements that allow us to progress in society, by easing our way into future tasks and receiving the accolade and approval of those around us. It may be that many of the clients you meet in your professional life are not in a position to conform to these social norms and expectations. They might have been denied many of the day-to-day plaudits that come the way of the majority of the population, and thus may feel that their position in society is tenuous and lacking in value. Arising from this, there may be a sense of powerlessness which will need to be addressed if the person is to make some gains in the quality of their life. It may be necessary to challenge some of the taken-for-granted, normative hallmarks of successful growth and development.

The way in which life events and developmental tasks cluster (or not) around particular points in the life course provides a framework for thinking about life stages that is especially attuned to the goals of most client-centred interventions. Havighurst was interested in the idea of the 'teachable moment': the point or sensitive period in the life course when the person (notably the child) is most receptive to learning a particular skill or type of concept. It is very often the task of the educationalist to identify and exploit this moment. It is not by chance that in many societies formal education begins at the age of five or six years, or that transfer to secondary school occurs between the ages of 11 and 13. These social transitions are timed to coincide with the pattern and nature of most people's cognitive and social development. This can confront the health and social care practitioner with a challenging task. On the one hand, the practitioner wants to facilitate clients' engagement with the tasks with which they would have been engaging, and the attainment as soon and as far as is possible of skills towards which they would have been striving, had they not experienced the life events or circumstances that brought them to the attention of the health and social care professional. On the other hand, this same professional, to a degree that surpasses even that of teachers, is concerned with the uniqueness and individuality of the client. This requires managing the tension between developmental norms and milestones, on the one hand, and the unique competencies and needs of a particular client, on the other. Havighurst's description of developmental tasks as the combined outcome of biological maturation, cultural pressures and individual desires, aspirations and values provides a basis on which occupational therapists and other health and social care practitioners can plan their work with clients.

Because of the involvement of biological and psychological processes that are universal across people, time and place, there will be some commonality of developmental tasks for widely different individuals, families and communities. Because of the involvement of individual differences, varying aspirations, and cultural and social norms in the establishment of developmental tasks, the tasks associated with different life stages will, at the same time, also vary across individuals, cultures and epochs. Thus, whilst Havighurst identified six to nine developmental tasks for each of six age periods, ranging from 'Infancy and early childhood' to 'Later maturity', his recognition of the impact of social, cultural and historical change and difference led him to change and 'update' his list several times during his career. It will, of course, need constant updating and revision long after Havighurst ceases to be in a position to undertake the work, and it will be helpful for those working with it to review it in light of current circumstances and the particular client in question.

(Continues...)

Excerpted from Occupational Therapy and Life Course Developmentby Ruth Wright Leoni Sugarman Copyright © 2006 by Ruth Wright and Leoni Sugarman. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Edition details

• Publisher: Wiley
• Publication date: 2009
• Language: English
• ISBN 10: 047002545X
• ISBN 13: 9780470025451
• Binding: Paperback
• Edition number: 1
• Number of pages: 216