Academic journal article British Journal of Occupational Therapy

The Professionalisation of Occupational Therapy: A Continuing Challenge

Academic journal article British Journal of Occupational Therapy

The Professionalisation of Occupational Therapy: A Continuing Challenge

Article excerpt

Professions are socially constructed phenomena. Accordingly, an understanding of what is meant by a profession, with its associated social positioning and how that is interpreted, is governed by historical, temporal, cultural and ideological influences. For occupational therapy, such an understanding can be a real challenge. This is because of a dichotomy between its ontological, person-centred approach and the medically dominated constructs prevalent in the professionalisation of all caring professions and still inherent in health care arenas today (Etzioni 1969, Fairhurst 1981, Rivett 1997, Freidson 2001).

As a consequence of this traditionally accepted dominance and the roles ascribed to or enabled by this positioning, the professional identity of occupational therapy can be limited by the politics of power at the organisational level. This can shape how occupational therapy is understood, not only by significant others but also by the profession itself. Professional consistency and cohesion, both inside and outside the profession, could therefore be challenged, unless individual actors, organisational attitudes and social constructs change. There is a need both to confront and to accept the ever-changing nature of professionalism and the meaning of occupation in the postmodern world.

Key words: Professions, occupational therapy, professional identity.

Introduction

An understanding of the concept of a profession is complicated by the contested nature of 'profession' as a term. In one respect, the concept of a profession can be used semantically to differentiate professional (paid employment) from amateur (unpaid) work (Abbott and Meerabeau 1998). Second, the word 'profession' can be used to describe an occupation or group of occupations that share a number of normative traits, which characteristically represent and define what it is to be a profession (Hugman 1991, Saks 1998). Finally, the word 'profession' can be used to denote a process of an occupational group's professionalisation, that is, an attempt to acquire professional status (Hoyle and John 1995). It is this last concept that is explored here.

This paper considers the social construction and identity of occupational therapy as a profession. It is argued that the concept of a profession is both contextually and historically grounded. The corollary of this argument therefore focuses on examining the history and professionalisation of occupational therapy in the United Kingdom (UK), in recognition that the process of professionalisation is tied to both a particular set of socioeconomic circumstances and power relations with other occupational groups, especially medicine as a traditionally powerful force in health care settings. It is posited that the professionalisation of occupational therapy in the UK is influenced by both macro changes to the UK's social and economic structure and the agentic role of the occupational therapy profession itself. Finally, it is suggested that there are both opportunities and threats for the development trajectories of the profession. In the first of these, occupational therapists are strongly positioned to take advantage of shifting ideas about the concept of a profession and its esoteric knowledge and autonomy. However, in the second, the professional identity and value of occupational therapy are challenged by socially defined concepts of occupation and the viewpoints of other more powerful and established professional players. Consequently, occupational therapy could be fundamentally undermined in terms of its identity.

Concepts of professionalisation

There are a number of theories of professionalism and these appear to be classified in different ways by different writers. Brante (1988) argued that there are several different views on professionalisation, ranging from the traditional functionalist views to more neo-Weberian concepts of traits and exclusive knowledge maintained through a system called 'social closure'. …

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