Spirituality in Practice: Using Personal Reflection to Prepare Occupational Therapy Students

Article excerpt


Since the early 1990s, spirituality has acquired increased importance in occupational therapy literature and theory (Wilding 2001). The adoption of spirituality as a core concept within the Canadian Model of Occupational Performance in 1991 sparked debate about whether spirituality lies legitimately within the remit of occupational therapy (Hasselkus 2002). As Wilson (2010) argued, spirituality is an important dimension of practice, amply warranting investigation in a profession that espouses client-centredness (Creek 2002).

In recent years, researchers in occupational therapy have discussed the place of spirituality in practice (Rose 1999) and the attitudes of therapists towards its inclusion (Taylor et al 2000, Egan and Swedersky 2003). Several authors, in both occupational therapy and nursing, have suggested that clinicians who have developed an awareness of their own spirituality are more confident and skilled at addressing such needs (Govier 2000, Kirsch et al 2001, Belcham 2004, Thompson and McNeil 2006).

'Spirituality', however, has a variety of culturally and individually influenced meanings. This ambiguity is mirrored in the debate over the definition of terms such as 'spirituality' and 'religion', seen as early as the turn of the twentieth century (James 1902). From a social work perspective, Canda and Furman (2010) reflected this diversity of meaning in their pluralist description of spirituality as:

   ... a universal quality of human beings and their cultures related
   to the quest for meaning, purpose, morality, transcendence,
   well-being, and profound relationships with ourselves, others, and
   ultimate reality (p5).

Reflecting this elusiveness and diversity, no attempt was made to embed within the present investigation a single definition of spirituality. Instead, Kang's (2003) seven definitions of spirituality were offered to participants as a convenient means of stimulating their personal constructions of the concept. It was felt that this would enhance the personal meaningfulness of the study activities.

The degree to which spirituality is included in practice has been investigated by, for example, Rose (1999), Wilding (2001), Belcham (2004) and Johnston and Mayers (2005). These studies identify a large theory/practice divide. Wilding (2001) attributed this to a lack of understanding about spirituality and how it could be included in occupational therapy practice. Additionally, Enquist et al (1997) and Egan and Swedersky (2003) invoked a lack of confidence or training.

Kirsch et al (2001) and Thompson and McNeil (2006) sought to address these concerns by identifying the best methods of preparing occupational therapy students to address clients' spiritual needs. Both studies involved inviting students to reflect upon their personal spirituality. In Kirsch et al (2001), 63% of the 46 participants agreed that their own spirituality affected their interactions with clients. Many of their participants emphasised how reflection on personal spirituality improved awareness of self and others. Arguably, these data should be treated with caution due to a lack of information about the method of analysis. However, they do provide an interesting insight into the relationship between self-awareness and occupational therapy.

Thompson and McNeil (2006) used focus groups to investigate the lived experiences of 11 occupational therapy students who completed a seminar on spirituality in occupational therapy. Whilst this study lacked acknowledgement of possible subject bias (Robson 1993) arising from the lecturer/student relationship, several participants reported changes in their attitudes towards spirituality as a result of self-reflection.

These studies suggest that education and reflection regarding the use of spirituality improves confidence in addressing clients' spiritual needs. The present authors extend this previous work by focusing specifically on directed study and reflection on personal spirituality, to the exclusion of other educational methods, and by measuring the change that this may produce. …