therapy research method
The focus of the work which I did as a coordinator was determined
by the needs which I identified Barry as having after an extended
period of observation. It was clear to me that he had a need for
occupation which was not being met and I set about meeting this
need in the work I did with him. The research questions sprang
directly from the work which I was doing as a practitioner. A
description of the method is given to allay any ethical concerns
which arise when practice and research are so closely alligned.
Having worked with him for ten months I wrote an account of the
first couple of months that I had worked with him. Before writing
this account I spent an intense period looking through the daybooks
which were written as a record to be shared between the team of
facilitators and through the journals which I had kept daily.
I made notes and graphs analysing aspects of what he did and didn’t
do in great detail, before abandoning these and simply began to
what I remembered, on the premise that what I remembered was what
was significant to me as a practitioner. As I developed this account
I realised that I was experiencing it as a series of stories,
each with their own denouement. At the time of writing them, the
stories were not intended to be used as part of the research,
they came to me very easily and fluidly as a product of the intense
involvement which I had had with the protagonist. In a sense,
they presented themselves to me as stories which I simply had
to tell because of my deep involvement.
I began to write a commentary which was shaped by my understanding
of what the stories were saying to me in the light of what I was
now understanding from my continued involvement with the protagonist.
I also added a couple of stories, but these did not seem to require
comment in the same way. The first one came from a presentation
which Barry, Margaret and I did at an occupational therapy conference.
In the leadup to this conference I realised that I could not speak
about Barry as a subject while my prime responsibility to him
was as a practitioner, so I invited both his mother and himself
to present with me. I was pleased with his ease in the situation
and the first story gives some of the context for the rest, while
allowing his voice to be heard more clearly.
It was a breakthrough for me to realise that my research was
constantly informing my practice and was not something separate.
This process continued and my research from this point became
a continuing process of reflecting, which regularly fed back into
my practice. The last story, about the supported employment situation,
was added during the course of the final writeup, when I realised
that I needed a counterpoint to the work stories. There were many
more stories which could have been told, but this one illustrated
something which had a significant relationship with the original
stories. It rounded the other stories off in a way which felt
satisfying and necessary and this seemed like a good point to
bring the work of this thesis to a halt.
It seemed to me that I had begun with a need and ended up with
demonstrating that this need had been met in some way. At this
point I intensified my reading in an attempt to find a framework
which would elucidate what I had done and found that a framework
based on occupation was within my grasp.
The discussion is an attempt to draw together some of the ways
that the content of the stories illustrate this occupation framework.
The stories allude to occupation constantly. I also discovered
that the stories were in themselves a demonstration of the occupation
that I was doing with Barry. This notion of the way that reflection
is part of occupation was an important one in shaping the way
that this thesis was presented.
Evidence of efficacy of occupational therapy in working with
severe brain injury
In the first place it was necessary to do a thorough assessment
of the situation, which I was well qualified to do from my previous
experience as an occupational therapist working with severe brain
injury and having had occasional contact with Barry over the course
of three years. Regardless of the approach which would subsequently
be used it was essential that the assessment move away from the
clinical approach which had so resolutely failed to produce results
over the past several years. He had been massively over-assessed
and underprovided for, and therefore there was never any question
of using a standardised or clinical form of assessment. I assessed
the situation therefore as a participant observer, a method which
I was adequately qualified to use, both from my training as a
therapist and as a folklorist.
As a therapist and coordinator it was not possible to remain
in the position of observer for very long, even if this had been
desirable. I had to become a participant, with the emphasis on
the participation. The mode of participation was strongly influenced
by the occupation framework which was taught at the school of
Occupational Therapy where I was working. This was to say that
I was persuaded to participate in the activity with him, with
the intention of seeing where it would lead. As a practitioner
I had to remain open to possibility that other approaches might
be more appropriate. My experiences as a clinician and subsequently
as a lecturer in neurorehabilitation ensured that I was qualified
to make a judgement about the most appropriate method to use at
all times. I did in fact use a couple of other approaches at different
times, but the predominant one is that described in this thesis.
I believe that the method that I used ensured that the my primary
responsibility as a practitioner was not interfered with in any
detrimental way. Over the course of time I found a way in which
my research could actually feed positively into my work as a practitioner.
I believe that the conference presentation was an illustration
of the fact that I did not allow a conflict of interest to ensue,
but always put his needs first and found that there could be a
happy coincidence in our objectives at times. Our relationship
has not been boundaried by the research that I am doing and has
continued long after the completion of this particular piece of
The boundaries that are around our relationship are practice
boundaries, which put his needs before my own. It would not have
been right to bring our relationship to a close with the end of
a particular piece of academic work. Finally, I hope that I have
given enough evidence in the stories to show that the focus on
occupation which I brought to my work was in his best interests.
In corroboration of this I quote the neuropsychologist report
which was written after I had been working with him for about
is my opinion that Barry has shown some significant gains in
the past 3 years, considering the nature and extent of his disabilities.
The methods currently being employed are likely to be responsible
for much of this gain, and would, in my view, be the best way
to maximise future gains.
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