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AUTHORING LIVES IN A SUBJECT-CENTERED CURRICULUM:
AN INSTRUMENTAL CASE STUDY OF GRADUATE PROFESSIONAL
EDUCATION IN OCCUPATIONAL THERAPY
By

Barbara R. Hooper

A DISSERTATION
Submitted to
Michigan State University
In partial fulfillment of the requirements
For the degree of
DOCTOR OF PHILOSOPHY
Higher Adult and Lifelong Educations

2002

ABSTRACT
AUTHORING LIVES IN A SUBJECT-CENTERED CURRICULUM:
AN INSTRUMENTAL CASE STUDY OF GRADUATE PROFESSIONAL
EDUCATION IN OCCUPATIONAL THERAPY
By

Barbara R. Hooper

While reforms in occupational therapy education implicitly denote subject-
centered learning and student self-authorship as aims for effective curricula, little
research has explored if or how such aims are enacted in professional programs. This
case study explored the beliefs, assumptions, and instructional processes of educators in a
graduate occupational therapy program. Data were collected using semi-structured
interviews, class observations, and document review, and analyzed using an iterative
process of open, axial, and selective coding along with narrative analysis. Results suggest
that the concepts of subject-centered education and self-authorship partially described the
theoretical underpinnings of learning and teaching. Educators used active teaching
methods to center learning on the fields’ core subject; classroom processes promoted
intrapersonal and epistemic development consistent with self-authorship theory.

However, as a theoretical lens on teaching, self-authorship was ultimately limiting
and several dynamics of learning and teaching, beyond those associated with self-
authorship, emerged. The epistemic and intrapersonal development that faculty promoted
did not stand apart from their own biographical experiences or prominent issues faced by
the profession. Faculty invited students into particular “self-projects” that were in part

shaped by how faculty lives had intersected the evolution of the profession. Learning and

teaching incorporated emotional and intuitive processes along with intellectual processes,
even though emotional and intuitive processes remained largely underground in faculty
discourse. Teaching also seemed to provide a context through which faculty continued to
make sense of and author their personal and professional lives.

Therefore, the concept of authoring lives provided a broader frame on teaching
practice and theory. Authoring lives afforded a view of the classroom as a site where
educators provided students opportunities to self-author, and continually authored and co-
authored their own lives. Thus, the concept of authoring lives supported scholars’
suggestions that good teaching includes educators’ ability to frame instructional methods
and content as expressions of their inner lives and as sources for continuing to author
those lives. Faculty development may therefore include explorations into the experiences
that have shaped educators’ journeys to teaching and reflections on teaching as offering
clues to the lives educators are authoring, and the lives they hope to evoke in students.

In addition, the concept of authoring lives afforded a view of the classroom as a
site where faculty advanced rich plots about students’ lives and their professional futures.
Faculty seemed to author students’ lives in accord with a prevailing professional
metanarrative. The term, authoring lives, thus raises questions about whose vision,
power, and politics are preferenced and ignored in subj ect-centered education. The term
also highlights a tension in the presumed constructive epistemological underpinnings of
subject-centered education. That is, teaching was constructive in that knowledge was
presented as evolving and students were invited to construct knowledge in a community,

yet preferred knowledge was partially prescribed by the curriculum’s metanarrative.

Copyright by
BARBARA R. HOOPER
2002

ACKNOWLEDGMENTS

I am deeply grateful to a number of friends, colleagues, and mentors who have

supported this project in small and large ways. In particular, I wish to thank:

Nedra Gillette from the Curriculum Mentor’s Project at the American
Occupational Therapy Foundation who nurtured the original idea for this
research;

Cynthia Grapczynski, Denise Stephenson, Catherine Frerichs, Shailey Mennon
and other members of my writing group at Grand Valley State University for their
review of various sections of this dissertation;

Ann Austin, Steve Weiland, and Rhonda Egidio for their valuable input as
members of my dissertation committee. Each committee member played a unique
and appreciated part in furthering my own epistemic and intrapersonal
development throughout my doctoral program; and

John Dirkx for his guidance and mentoring as my research advisor, and for

introducing me to “soul” in learning and development.

Finally, I especially thank the faculty in the Division of Occupational Science at the

University of North Carolina at Chapel Hill who made room in their busy lives for this

project and graciously opened their educational practices up for observation, analysis,

and reflection: Grace Baranek, Sue Coppola, Ruth Humphry, Cathy Nielson, Jane Rourk,

Carol Seibert, Linn Wakeford, Jenny Womack, and Wendy Wood.

TABLE OF CONTENTS

List of Tables ......................................................................................... ix
List of Figures ......................................................................................... x
Chapter One
Introduction to the Study .................................................................................................... 1
Background to the Study ......................................................................................... 2
Problem Statement .................................................................................................. 5
Research Questions ................................................................................................. 5
Significance of the Study ........................................................................................ 5
Conceptual F rarnework ........................................................................................... 6
Post-Dissertation Reflections .......................................................................... 10
Chapter Two
Literature Review .............................................................................................................. 13
The Evolution of Occupation-Centered Practice and Education: From Paradigm
and Discourse Shifts to Epistemological Trans-form-ations ................................ 14
The Subject-Object Relationship as an Analytical Tool for Exploring the
Evolution of Occupation-Centered Practice and Education ................................. 16
Third-Order Consciousness ............................................................................ l7
Fourth-Order Consciousness ........................................................................... 18
The Founding of a Fourth-Order Discipline: ........................................................ 19
“Having” the Field’s Practice, Philosophy, and Inquiry ....................................... l9
Fourth-Order Discipline, Third-Order Epistemological F orm: ............................ 24
“Having” the Field’s Practice, Being “Had By” Its Philosophy and Inquiry ....... 24
Third-order Epistemological Form And The Mechanistic Paradigm ............. 26
Fourth-Order Discipline, Fourth-Order Epistemological Form: “Having” the
Field’s Practice, Philosophy, and Inquiry ............................................................. 3O
Pedagogy for Self-Authorship .............................................................................. 3S
Beliefs and Assumptions Consistent with Self-Authorship .................................. 38
Implications for the Study ..................................................................................... 39
Chapter Three '
Methodology ..................................................................................................................... 4]
Criteria for Case Selection .................................................................................... 42
The Context for the Case Study ............................................................................ 45
The curriculum. ............................................................................................... 46
The faculty. ..................................................................................................... 46
The students. ................................................................................................... 47
Obtaining Access and Consent ............................................................................. 48
Procedures for Data Collection ............................................................................. 49

vi

Data Analysis ........................................................................................................ 52

Data Organization System .............................................................................. 52
Data Analysis Process ..................................................................................... 53
Interviews and observations ................................................................... 54
Videotaped data. .................................................................................... 55
Document and artifact data. ................................................................... 56
Trustworthiness ..................................................................................................... 56
Chapter Four
Overview and Organization of Research Results ............................................................. 59
Chapter Five
Teaching Centered on the Subject and the Self ................................................................ 62
The Subject-Centered Lab Experience ................................................................. 63
The Subject Centered Classroom Discussion ....................................................... 68
The Subject Centered Lecture ............................................................................... 73
Summary ............................................................................................................... 78
Chapter Six
Constructing a Self in Relation to Others: The Issue of Authority ................................... 80
Constructing a Self in Relation to Others: The Issue of Authority ....................... 81
Honoring And Respecting The Authority Of The Other ................................ 83
Collaborating With The Authority Of The Other ........................................... 87
Declaring One's Own Authority ..................................................................... 91
Epistemic Development Associated with the Issue of Authority ......................... 95
Chapter Seven
Constructing a Self in Relation to the Subject of Occupation: ......................................... 97
The Issue of Personal Experience ................................................................................ 97
Prior Personal Experience as a Basis for Knowing Occupation ........................... 98
Structured Personal Experiences as a Text for Knowing Occupation ................ 102
Epistemic Development Associated with the Issue of Personal Experience ...... 107
Chapter Eight
Constructing a Self in Relation to Knowing: .................................................................. 109
The Issue of Authoring Knowledge ................................................................................ 109
“Making Sense”: Authoring Knowledge for Yourself ........................................ 110
Authoring Knowledge with Others ..................................................................... 118
Epistemic Shift Associated with the Issue of Authoring Knowledge ................. 122
Chapter Nine
Constructing a Self in Relation to Major Change: .......................................................... 124
The Issue of Authoring Practice ..................................................................................... 124
Avoid Being Authored by the Practice Context ................................................. 125
Authoring an Occupation-Centered Practice ...................................................... 128
Epistemic Shift Associated with the Issue of Authoring Practice ...................... 133

vii

Chapter Ten

Sources of Intrapersonal Development ........................................................................... 135
Relationships with Mentors ................................................................................ 135
Struggle and Despair with Occupational Therapy .............................................. 136
Formal Education ................................................................................................ 137
Selecting Work Settings ...................................................................................... 139
Teaching and Working Together as a Community ............................................. 139

Chapter Eleven

Discussion ....................................................................................................................... 141
The Value and Limitations of Self-Authorship as a Theoretical Lens on
Teaching Practice ................................................................................................ 143

Epistemic Development ................................................................................ 143
Intrapersonal Development ........................................................................... 144
Learning and Teaching Processes ................................................................. 146
The Centrality of the Subject ........................................................................ 148
Reflection ...................................................................................................... 149
Beyond Self-Authorship: Learning, Teaching, and Authoring Lives ................. 150
Theoretical Advantages ................................................................................ 1 5 1
Practical Advantages ..................................................................................... 154
Conclusion .......................................................................................................... 154
Future Scholarship ........................................................................................ 155

Appendix A: Guidelines for the First Interview ............................................................. 157

Appendix B. Guidelines for the Second Interview ......................................................... 159

References ....................................................................................................................... 160

viii

LIST OF TABLES

Table 1. Overview of data set

ix

LIST OF FIGURES

Figure 1. Subject-centered education in professional, institutional and personal context.

Chapter One
Introduction to the Study

The promotion of “occupation-centered education” has become a top priority
within occupational therapy, and reasonably so since it is believed that curricula centered
on the construct of occupation will move the field forward as a “self-defined profession”
(Yerxa, 1998a). To date, published scholarship on occupation-centered reforms has been
limited to conceptualizations of the curriculum (Yerxa, 1998a; see also Pierce, 1999), a
description of a curriculum design process used by one program (Wood, Nielson,
Humphry, Coppola, Baranek & Rourk, 2000) and teaching methods believed appropriate
to occupational therapy (e.g. Nolinski & Millis, 1999; Royeen, 1995; Stern, 1997; Stem
& D'Amico, 2001; VanLeit, 1995). Other efforts have included conference presentations
and faculty development workshops on the content, methods and design of occupation-
centered curricula (Krishnagiri, Pierce & Primeau, 1998; Nielson, 1997, 1998a, 1998b;
Pierce, 1999).

These are, of course, important initiatives, but no research has explored the actual
implementation of occupation-centered education. Further understanding educational
aims, beliefs, assumptions, and practices as they are enacted within occupation-centered
curricula is important because educational reforms reflect more than new content or
advanced instructional processes. They reflect a sea change of new assumptions about
what it means to know occupational therapy (Hooper & Wood, 2002). Without further
understanding the beliefs and assumptions within education centered on occupation,

along with the methods and content, the profession runs the risk of building new curricula

on traditional beliefs and assumptions, which as education scholars have indicated can
thwart efforts to become self-defined (Baxter Magolda, 1999).

The purpose of this study was to describe educational practice within a curriculum
centered on the profession’s core subject of human occupation, and explore a deeper
understanding of the nature of occupation-centered education, how it comes to be defined
and structured within an interpretive community of faculty, and what beliefs and
assumptions guide individual educators’ practice of occupation-centered education. This
research involved a case study of graduate occupation-centered education at the
University of North Carolina’s Division of Occupational Science.

Background to the Study

Initially, this project was designed to address the concrete problem of a lack of
research about the actual implementation of occupation-centered education. However,
early on in the data collection process a more specific focus began to emerge that seemed
to subsume the initial aim of describing occupation-centered education. The concrete
question of ‘what beliefs, assumptions and methods are associated with occupation-
centered education?’ gave way to the more specific question of ‘what intrapersonal and
epistemic transformations are embedded within or presupposed by occupation-centered
education?’ This shift in the primary question of the study led me to expand the rationale
beyond a lack of empirical research on occupation-centered education to a need to
examine self-authorship as a possible implicit aim in occupational therapy education.

The idea of self-authorship has a long and interesting history in occupational
therapy and occupational science (which I develop more fully in Chapter II). On one

hand, self-authored lives constitute the aim of the profession’s service to society.

Occupational therapy aims to empower individuals to devise their own versions of health,
meaning, adaptation, and identity through the routines and activities they do everyday
and within the sociocultural contexts in which their lives are enacted. According to Yerxa
(1967, p. 1), “authentic occupational therapy” is rooted in existential ideas of self-
actualization, or a view of the human as capable of discovering and shaping a meaningful
life in response to life experiences and the contexts that have shaped those experiences.

On the other hand, leaders in the profession have regularly called the field to
exhibit the same self-authorship in regards to its relationship to health care that it expects
of its consumers in regards to their individual life challenges. Many leaders have
summoned occupational therapy to take responsibility for generating and substantiating a
knowledge base consistent with its belief in the vital human need to be occupied (e. g.
Reilly, 1962; Wilcock, 1998; Yerxa, 1995). In addition, many have urged professional
educators to focus on principles and concepts that would achieve independent thought
and action among occupational therapy students (e. g. F idler, 1996; Royeen, 1995; Yerxa,
1998a; Wood, et al., 2000). Finally, many have called the profession to recognize the
assumptions upon which the medical system is based and to guard against being authored
by those assumptions (e.g. Friedland, 1998; Rogers, 1982; Serrett, 1985; Shannon, 1977;
Yerxa, 1992).

Hence, while the field has not used the term “self-authorship” per se, much of the
thinking about the developmental needs of the profession has been consistent with Baxter
Magolda’s (1999) definition of the concept. Self-authorship is defined as “simultaneously

an ability to construct knowledge in a contextual world, an ability to construct an internal

identity separate from external influences, and an ability to engage in relationships
without losing one’s internal identity” (p. 12).

The goal of achieving professional self-authorship may have provided part of the
impetus for recent educational and curricular reform initiatives in occupational therapy.
The profession adopted the post-baccalaureate degree as the entry degree for practice,
and established new accreditation standards promoting “occupation” as the central
construct for curriculum design in the field (American Occupational Therapy
Association, 1998). One argument for the post-baccalaureate entry degree has been that
an advanced degree will prepare graduates who appreciate the depth of the profession’s
knowledge and who are capable of expanding that knowledge and creating innovative
service-delivery models that articulate it (Yerxa, 1998a). The graduate occupation-
centered curriculum has been promoted as the basis of a “self-defined profession” that
will “enable graduates to possess the power to discover fresh ideas essential for
developing new models of practice appropriate for tomorrow’s complex and
unpredictable world” (p. 366). The profession has not explicitly utilized a constructive-
developmental framework, but its language and rationales for professional change is
consistent with the development of self-authorship among students and therapists.

It seems reasonable to conclude that some of the conceptual work around
occupation-centered education is implicitly consistent with self-authorship. Yet it is
unclear how the concept of occupation-centered education is actually enacted in
programs claiming to have occupation-centered curricula. Likewise, the ways in which
faculty have or have not considered the theoretical underpinnings of self-authorship in

their educational practices remain unknown.

Problem Statement
Graduate occupation-centered education has been promoted as a top priority for
occupational therapy and is represented as congruent with the constructive developmental
theory of self-authorship. However, no research has been developed to explore graduate
occupation-centered curricula in action or, more specifically, if and how educational
practices in those curricula are aimed at promoting self-authoring professionals.
Therefore, an in-depth case study of a leading graduate occupation-centered curriculum
was conducted to help clarify the beliefs, assumptions, and practices associated with
occupation-centered curricula and to examine the degree to which self-authorship may
serve as an implicit aim in occupational therapy.
Research Questions
1) What methods and instructional processes are associated with occupation-
centered education?
2) What beliefs about learners, learning, and knowing are reflected in the methods
and instructional processes used by faculty in an occupation-centered curriculum?
3) Overall, how do faculty understand occupation-centered education and how have
those understandings developed and changed?
Significance of the Study
In higher education a substantial line of empirical work related to self-authorship
already exists (e.g. Baxter Magolda, 1999, 2000; Belenky, Clenchy, Goldberger, &
Tarule, 1996; Kegan, 1994, 2000; King & Kitchener, 1994; Mezirow, 2000). However,
very few of those studies have explored self-authorship in the health sciences

specifically, or more generally in the context of the issues a profession faces. Moreover,

most of the scholarship focuses on epistemic development at the level of the individual
and does not include an historical analysis of epistemological development in a particular
knowledge community that may impact how self-authorship is defined and to which
individual self-authorship may respond. Finally, much of the work assumes a connection
between classroom activities, learning and self-authorship but does not consider the role
of the faculty's own stance toward the self and toward knowledge.

In occupational therapy, beyond specific calls for educational reform (Yerxa,
1998a) and limited descriptions of graduate occupation-centered curriculum design
process (N ielson, 1998a; Wood, Nielson, Humphry, Coppola, Baranek & Rourk, 2000),
the profession has very little resarch on the nature and practice of occupation-centered
education within a particular institutional context, even as occupation-centered education
is promoted as a tool toward professional change. Such information may help develop a
deeper understanding of occupation-centered education, how it comes to be defined and
structured within the individual and corporate experiences of the faculty, what beliefs and
assumptions guide individual educators’ practice of occupation-centered education, and
what teaching and learning processes manifest the aims of occupation-centered
education. This information may, in turn, contribute to broader investigations of
occupation-centered education, and may have implications for curriculum and faculty
development initiatives in the profession.

Conceptual Framework
The mandate toward occupation-centered education is an intriguing one because it
mirrors the redundancy Wood (1998a) noted about occupational therapy’s use of the term

“occupation-centered practice.” Nevertheless, the terms serve to re-center education,

research, and practice around the field’s core subject—human occupation (the history
behind the need to re-center occupational therapy’s core subject is developed in Chapter
II). Therefore, the term “occupation-centered education”, as it is used to denote the field’s
central subject, seems synonomous with Palmer’s (1998) notion of “subject-centered
education,” which was modified as the initial conceptual framework for this study.

Palmer (1998) distinguished “the subject” from content that helps explain and
understand the subject. The subject is the “great thing that calls us to know, to teach, to
learn” (p. 107). The subject is not the discipline that studies it, not the text that talks about
it, and not the theories that explain it. It is “the great thing” around which a community
gathers. In occupational therapy, the “great thing” is the human drive to occupy time and,
in so doing, to influence his or her own state of health and well-being. Palmer proposed
subject-centered education as an alternative to the excesses of both expert-centered
education, which is sometimes rooted in objectivism, and student-centered education,
which can be rooted in radical relativism. Obj ectivist- or positivist-based education deals
with the subject as if its precise nature were already known. Relativist-based education
deals with the subject as if it cannot be known at all outside one’s personal point of view.
In both ontological scenarios, Palmer argues learners have little incentive to connect
personally with the subject; in one, they simply need to know the facts, in the other, they
can think whatever they want about the subject.

Subject-centered education respects the subject’s own identity, logic, and integrity
that are continually being discovered through ongoing dialogue among a community of
knowers. Knowers within a community who gather together to further understand a

subject—one that possesses its own identity and integrity—enter into a dynamic

conversation with both that subject and each other, guided by the norms of observation,
interpretation, and criticism currently acknowledged within their community (Palmer,
1998). Knowledge about the subject is continually evolving and being revised through
dialogue, conflict, and testing ideas in the open. Subject-centered education promotes a
“passionate and disciplined process of inquiry and dialogue” and a dynamic subject-
focused conversation among a “community that keeps testing old conclusions and
coming into new ones” (p. 104).

In Figure 1, I have represented the elements of subject-centered education as
including the Main Subject in the center, the “little subjects” (or content that helps
explain the Main Subject) that serve as portals into the Main Subject, the Knowers, and
the Teaching and Learning processes that entice Knowers into a dialogue with the subject
and with each other. In occupational therapy, the Main Subject is human occupation; the
“little subjects” may include a wide array of content such as anatomy, occupational
therapy assessment, adult development, research, activity analysis, administration, theory,
or many others. Teaching and Learning processes may involve, but are not limited to,
lecture, labs, cases, and discussion. The Knowers include the graduate students, the
faculty, and the larger community of scholars in the field. I have also situated subject-
centered education in the contexts of the profession, the individual faculty’s biography,
and the institution, all of which may influence who the Knowers are, what constitutes the
Main Subject, the “little subjects,” and what Teaching and Learning processes are

selected.

 

Discipline

Institution

 

Faculty Biography

 

 

 

Human
Occupation &
Its Centrality

In Practice

 

 

 

 

 

Processes Connecting Knowers

 

 

/
\

> Connecting Knowers with Subject

Figure 1. Subject-centered education in professional, institutional and personal context.

 

The conceptual framework was used loosely throughout the study as one way of
seeing and listening to the data. It helped shape some of the questions I asked faculty in
response to what I saw in their classrooms and heard in their interviews. For example, I
asked several faculty to describe the core subject or overall aim of their course and how
individual topics related to that aim. I asked a few faculty to describe student growth and
development implied in their course content and assignments, or to talk about instances
when it seemed faculty assumed a role of co-knower and inquirer, not expert. I also noted
in field notes how faculty seemed to connect individual topics to the core subject of
human occupation, and the processes they used to connect students to each other. The
conceptual framework also provided a starting point for coding both observation and
interview data and it provided some direction for my earlier reading.

Post-Dissertation Reflections

At the beginning of the study, the research problem, background, questions, and
conceptual framework seemed well suited to my interests, perceptions, and prior
experience with occupational therapy education. I began with a strong interest in
occupation-centered education, how it was being defined and enacted by educators, and
how it reflected recent epistemological shifts in occupational therapy. I wanted to describe
what faculty who taught in occupation-centered curriculum actually did as educators. I
wanted to explore the role of faculty beliefs and assumptions within what was being called
occupation-centered education. I wanted to contribute a richer, deeper understanding of
education to the field of occupational therapy. I believe that I accomplished those
purposes. But by the end, I seemed to shift my interest away from the mechanics of how

occupation-centered education was implemented toward the role of the educator’s identity

10

in teaching. I became captivated by the idea that the educators in this study seemed to
define occupation-centered education through their experiences in the field and through
who they are.

In the beginning, I felt the combined concepts of “subject-centered education” and
“self-authorship” would provide an interesting and insightful perspective on the study. And
I believe they did. The results of the study illustrate how educational methods can be
utilized to center learning on a core subject. The results also elucidate the epistemic and
intrapersonal underpinnings of occupation-centered education and open new topics for
discussion in occupational therapy education. But by the end of the study, the terms
subject-centered education and self-authorship seemed limited in their ability to explain the
emerging key role of faculty biography and identity formation in teaching.

Through writing the dissertation, I seemed to come home to the questions that
initially attracted me to occupational therapy and have followed me into education:
namely, how do people author a life, express the life they have authored, and re-write a life
through what they do? It should have been no surprise that I began to see occupation-
centered education as hinged on the identities of those who staffed it, or that occupation-
centered education fell to the background of the inquiry and the intersection of educators’
lives with their teaching practice became the foreground. So while I believe that I did
answer the original research questions, in the end I found the questions and the framework
confining and somewhat instrumental or mechanical.

The shift in the focus of the study is betrayed somewhat in the structure and
progression of my writing. That is, the dissertation begins with a literature review very

steeped in occupational therapy thought and evolution. The results open with a chapter on

11

teaching methods. progress to narrative descriptions of educators’ lives and teaching
practice, and then end with an “epilogue” focused on faculty learning experiences.
Fortuitously, occupational therapy moves from the lead to a supporting role in the study.
Ultimately, occupation-centered education offers a platform for exploring the connections
between teachers’ lives and teaching. In Chapter Eleven, I discuss more about how the
original questions and conceptual framework were limiting, and present a view of the

classroom as authoring and co-authoring lives.

12

Chapter Two
Literature Review

As described in Chapter One, a background issue to this study involves
occupational therapy’s representation of occupation-centered education as a means to
become self-defined. The field’s efforts in educational reform have been described in
language consistent with the theory of self-authorship, but the link remains unexplored.
The first purpose of this chapter is to review the historical literature in occupational
therapy in order to establish a confluence with the theory of self-authorship. The
historical review links recent emphases on occupation-centered education to
epistemological shifts in the profession consistent with self-authorship. Establishing this
link is important to the study because it places the study of occupation-centered education
within the broader context of societal and professional change. The historical review used
here draws heavily upon an earlier analysis of discourses within occupational therapy
(Hooper & Wood, 2002), but the data are reexamined using the framework of
epistemological forms.

The second purpose of this chapter is to review theoretical and empirical work
around the assumptions and learning processes specific to constructive developmental
pedagogy. Overall, this integrative review illustrates a need for research on how faculty
perceive and implement occupation-centered education and to what degree they associate

the ideas of epistemic development that seem prevalent, but implicit, in the field at large.

13

The Evolution of Occupation-Centered Practice and Education: From Paradigm and
Discourse Shifts to Epistemological T rans-form-ations

The term “profession” describes a group of peOple who provide specialized and
societally valued work that is based on theoretical knowledge, skill and judgment not
readily available outside of a prolonged training and education program. Each profession
has the arduous task of remaining viable and maintaining sufficient cohesion “to be able
to undertake common action . . .” to the benefit of society (F reidson, 1994, p. 202). To
maintain cohesion, professions create “social identities to which an ideology of high
purpose is attached” (p. 204). Consequently, professionals do not merely apply a set of
specialized skills but actually come to identify themselves with a professional culture and
its ideology. An ideology, also referred to as a paradigm (Kuhn, 1970), constitutes the
core of professional cohesion, professional identity, and professional activities. That is, a
paradigm, or an implicit mode of viewing the world, underlies and directs the particular
theories and methods that are prominent at any given point in that profession’s history.

However, professions are constantly growing and changing, and, as they develop,
they often experience identity crises in which their ideologies, or paradigms, shift and
transform (e.g. F ensterrnacher & Soltis, 1992; Grob, 1998). Occupational therapy’s
professional culture has been represented as a series of shifting paradigms (Kielhofner,
1997; Shannon, 1977), or alternating discourses (Hooper & Wood, 2002). In fact,
Kielhofner (1997) described occupational therapy’s history of changing paradigms “as
the basic story of the profession” (p. 31). He suggested the field has experienced three
major paradigm shifts since its inception: the paradigm of occupation, the mechanistic

paradigm, and a third "emerging paradigm" that has again "converged on the theme of

14

occupation" (p. 53). My colleague and I described occupational therapy's history as a
course of shifting, yet intermingled, discourses between pragmatism and structuralism,
each discourse preferencing a particular view of knowledge and view of the human as it
rose to prominence in the field (Hooper & Wood, 2002).

Both a paradigmatic analysis and a discourse analysis have been helpful in
understanding occupational therapy's revolving identity over time, but neither considered
the epistemological “form” the profession used across paradigms or discourses. It may be
possible to move from one paradigm to another by incurring changes in what the
profession knows, but without incurring changes in how it knows, or in its
epistemological form. Similarly, while our discourse analysis described epistemological
change associated with various ways the profession has identified itself and honed its
practices, it did not explore the specific form that changes in order for a new
epistemological stance to take hold.

An epistemology’s form is its dynamic architecture that gives shape to various
ways of knowing. The architecture, or form, within a given epistemology “consists of a
relationship or temporary equilibrium between the subject and the object in one’s
knowing” (Kegan, 2000, p. 53). Another way of thinking about the basic story of
occupational therapy is as a story of metamorphosing epistemological forms. Considering
paradigmatic and discourse shifts from the standpoint of an analysis of epistemological
forms may suggest that while the profession adopted different emphases and language for
its practice, education, and knowledge development over time, its epistemological form
remained fairly stable until recently. For the first part of this literature review, I apply

Kegan's (1994) theory of the subject-object relationship, or self-authorship, as an analytic

15

tool to examine the evolution of occupation-centered education. By choosing Kegan’s
theory, I am taking a strong developmental perspective on the field’s evolution,
specifically focused on the field’s development of consciousness. For this review I have
placed less emphasis on a sociopolitical perspective. Yet I recognize that the field’s
evolution has also been in direct response to various social and political forces and
influences, and feel that such an analysis would also be beneficial.

The Subject-Object Relationship as on Analytical Tool for Exploring the Evolution of

Occupation-C entered Practice and Education
According to Kegan (2000), modern life places demands on us, from childhood

through adulthood, to continually renovate the basic mental structure we use to construct
meaning from experience. He refers to the basic mental structure by which we sift,
interpret, and cohere experience as the subject-object relationship. The "subject" in the
subject-object relationship refers to that which “we are run by, identified with, fused
with” (p. 53), and therefore mostly unaware of. The "object" in the relationship refers to
that which “we can look at, take responsibility for, reflect upon, exercise control over,
integrate with some other way of knowing” (p. 53). That which is object in our knowing
we “have”, that which is subject “has us” (p. 53). As the demands of life increase, this
epistemological structure, or form, evolves into new configurations of what we are
subject to versus what we can examine as the objects influencing our experiences. At
each period of development, we, as individuals and as a society, are both "subject" to
certain assumptions and beliefs inherent in our environment and take other assumptions

and beliefs as the "objects" of our thinking. Both individual and cultural development

16

involves the renovation of the subject-object relationship to expand what we can take as
"object.”
T hird-Order Consciousness

One such subject-object configuration is referred to as third-order knowing and is
associated with the demands of adolescence and the demands of traditional society
(Baxter Magolda, 1999, 2000b; Ignelzi, 2000; Kegan, 1994). Because of the unique
subject-object configuration, or form, in third-order knowing, self-authorship is not
possible. This subject-object relationship involves taking as object two or more concrete
categories or experiences and generating abstractions from those experiences.
Interpersonally, the third-order mind can "honor its own subjectivity" and that of others,
making it possible to join a community. Baxter Magolda summarized the achievements
of Third-order knowing as the ability to "reason abstractly and to think hypothetically and
deductively...to hold values and ideals...and orient to shared feelings” (Baxter Magolda,
1999,p.55)

However, while able to act upon abstractions, hypotheses, generalizations, and a
point of view in third-order thinking, the abstractions become the absolutes, the
governors or shapers of action. While able to join a community, the third-order mind
cannot critically reflect on the communities to which it belongs. "The third order mind is
both capable of and subject to socialization" (Kegan, 1994, p. 288). Therefore, the third-
order blind spots are the abstractions or generalizations themselves and the co-
construction of a particular identity with others. Individuals or professions at this stage
may be said to be "subject" to the abstractions they generate, or unable to examine,

defend, or test their abstractions be they ideas, values, beliefs, or identity issues. In sum,

17

the third-order subject-object form, takes concrete experience and the point of view of
others as object, but remains subject to any generalizations made from concrete
experience and to "shared realities with others who are external to the self‘ (Baxter
Magolda, 1999, p. 55).
The triumph of the third order is its capacity to construct the abstracted forms of
generalization, hypothesis, value, ideal. Concrete data can be brought under the
organization of inference. But inference itself cannot be acted upon because the
order of consciousness is no more complex than inference...The third order can
reflect on the world and honor its own subjectivity. It has no internal procedure
for subjecting its inferences into a more complex whole (a formulation) or create
a complex whole that will itself generate inferences. (Kegan, 1994, p. 286)
Third-order knowing seems to parallel what Baxter Magolda (1999) referred to as
independent knowing and King and Kitchener (1994) referred to as pre-reflective
knowing. It also seems consistent with foundational assumptions about knowledge (e. g.
Bruffee, 1993; Cherryholmes, 1999)
Fourth-Order Consciousness
Another subject-object configuration, or form, is referred to as fourth-order
knowing and is associated with the demands of adulthood and the demands of modern
society. The subj ect-obj ect configuration of fourth-order knowing does allow for self-
authorship because not only can concrete data be brought under the organization of
inference, but also the inferences themselves can be brought under the organization of a
complex system. The systematic procedures by which inferences are generated and

evaluated can be held as object in a fourth-order epistemological form. In addition,

18

fourth-order knowing can examine not only its own subjectivity, but also the subjectivity,
values and loyalties of the communities to which it belongs. Fourth-order knowing seems
to parallel what Baxter Magolda (1999) referred to as contextual knowing and King and
Kitchener (1994) referred to as reflective knowing. It also seems to be consistent with a
non-foundational assumptions about knowledge (Bruffee, 1993; Cherryholmes, 1999).

While Kegan applied the evolving subject-object relationship to the analysis of
cultural epistemological development over time, I use it here for the analysis of the
professional epistemological development in occupational therapy over time. The
following discussion examines the evolution of occupation-centered education as an
epistemological story, the key plot being the evolution of the subject-object relationship
by which the profession understands itself, with emphasis on the recent expansion of that
which the profession examines as "object.” While occupational therapy's history has been
portrayed as shifting paradigms and discourses, perhaps its primary epistemological form
remained consistently third-order, interrupting its potential to develop into the self-
defined profession toward which founders pointed and scholars have beckoned (see
Nelson, 1997; Reilly, 1962; West, 1985; Wood, 1998a; Yerxa, 1967).

The Founding of a F ourth-Order Discipline:
“Having ” the Field’s Practice, Philosophy, and Inquiry

At the beginning of the twentieth century and in association with other
movements such as progressivism, feminism, the settlement movement, the arts and
crafts movement, and pragmatism, a group of physicians, nurses, architects, social
workers, and craft persons began to resurrect ideas originally associated with the moral

treatment movement of the nineteenth century for use in a new profession, occupational

19

therapy (Clark, Wood & Larson, 1998; Kielhofner, 1997; Quiroga, 1995). Consistent
with the principles of moral treatment, influential psychiatrists such as William Rush
Dunton and Adolf Meyer, friend and colleague of William James and John Dewey,
championed the fundamental conceptualization upon which occupational therapy was
founded—that health was linked to being occupied, and being occupied supported a
profound and restorative mind-body-environment unity. Moreover, health involved “a
balance between creativity, leisurely diversion, aesthetic interests, celebration and serious
wor ” (Kielhofner, 1997, p. 34), and the disruption of such balance was believed to result
in physical deterioration, demoralization, and the breakdown of habits.

The concepts about health upon which occupational therapy was founded were
developed into “occupations programs” whereby patients in most large state hospitals
between 1911 and 1915 participated in rounds of work, rest, craftwork, and recreation in
order to elicit interest, arousal, and awareness of time. Occupations programs became the
“criterion by which the prestige of individual institutions was measured” (Quiroga, 1995,
p. 61). These founding principles and their broad application first in psychiatry, and
shortly after with patients suffering from chronic physical illness, were the basis for
occupational therapy’s earliest ideology which has been framed as the “paradigm of
occupation” (Kielhofirer, 1997) and as “a pragmatist discourse” (Hooper & Wood, 2002).

The founders of occupational therapy espoused "actual doing" as possessing
potent restorative qualities for those suffering from "problems of living" (Meyer, 1922, p.
4). But founders were not simply calling the profession to establish occupations programs
that engaged patients in meaningful activity, nor did they intend that the profession

explain the rationale for treatment using occupation using broad and untested

20

generalizations, all of which constitute a third-order epistemological form. Instead, they
founders were interested in seeing the profession establish a systematic theoretical and
scientific basis for why occupation was a successful treatment method for individuals
with mental illness (Quiroga, 1995); they therefore took the concepts, generalizations,
theories, and hypotheses of the profession as object, a fourth-order task.

Originally, ideas upon which occupational therapy was founded and the
institution of those ideas in practice were part of a whole system of thought and inquiry.
For example, Meyer (1922) argued that in the first quarter of the twentieth century direct
experience and performace were being adopted across many disciplines as the "best type
of reality" (p. 5). And it was the same idea stream from which occupational therapy was
conceptualized.

Somehow [occupation therapy] represents to me a very important

manifestation of a very general gain in human philosophy. There is in all

this a development of the valuation of time and work which is not

accidental. It is part of the great espousal of the values of actuality rather

than of mere thinking and reasoning and fancy as characteristic of the

nineteenth century and present day. (p. 4)

Meyer’s ideas were also rooted in a system of inquiry that broke ties with scientists at the
time who studied mental illness solely as brain lesions, and established instead a line of
empirical work rooted in observing patients in naturalized contexts, and in comparing
patients in environments that supported only idleness to those in environments with
occupations programs. “For Meyer, psychiatry became the study of the behavior of each

individual in his or her total environment” (Leys, 1990, p. 39). From his observations,

21

Meyer (1922) hypothesized that concrete experience could elicit adaptation among those
suffering from mental illness more effectively than other treatment approaches being
used in psychiatry at the time.

A pleasure in achievement, a real pleasure in the use of one's hands and

muscles and a happy apreciation of time began to be used as incentives in

the management of our patients, instead of abstract exhortations to cheer

up and to behave according to abstract or repressive rules. (p. 3)
Also from his observations, Meyer established a theory that concrete experience with
rhythms of temporality and activity was the means and ends of healthy living.

There are many rhythms'which we must be attuned to: the larger rhythms

of night and day, of sleep and waking hours, of hunger and its

gratification, and finally the big four—work and play and rest and sleep,

which our organism must be able to balance under difficulty. The only

way to attain balance in all this is actual doing, actual practice, a program

of wholesome living as the basis of wholesome feeling and thinking and

fancy and interests. (p. 6)
Meyer was responsible for establishing a new scientific discipline known as
psychobiology and “kindled a spirit of research that awakened psychiatry out of its
stagnation” (Serrett, 1985, p. 15). Committed to a systematic process of inquiry, Meyer
and other founders of occupational therapy were suspect of generalizations that were not
embedded in natural action and supported with empirical evidence.

We all know how fancy and abstract thought can go far afield—

undisciplined and uncensured and uncorrected; while performance is its

22

 

own judge and regulator and therefore the most dependable and influential

part of life. (p. 5)

Therefore, occupational therapy was originally put forward as part of a whole
system of thought, that involved taking as object not only the concrete act of engaging
clients in rounds of activity, but also the source of those ideas in contemporary
philosophy, the theories associated with active occupation, and the hypotheses generated
from observing clients engaged in actual performance. In effect, Meyer and his
colleagues were establishing a fourth-order discipline. But as Kegan (1994) noted, a
fourth-order discipline met with third-order consciousness will be understood as third-
order structures, i.e. "values, opinions, hypotheses, inferences and generalizations" (p.
286). Learning the discipline will become a matter of learning these abstractions, and will
fail to help students "see that the discipline is itself a method, procedure, or system of
interpretation for reflecting on hypotheses, evaluating values, validating knowledge" (p.
286)

Founded upon early pragmatist ideals that elevated the concrete and the
actual above abstractions and generalizations, occupational therapy faced an
interesting dilemma related to third- and fourth-order knowing. Its challenge
would be to establish a fourth-order understanding of the concepts and practice
that involved actual doing and concrete experience as its core treatment method.

Meyer and others called on the young profession of occupational therapy to take
actual doing as its basis for practice, which may have unwittingly set up a
proclivity for third-order knowing from its inception. Based on how occupational

therapy operationalized the ideas upon which it was founded in both practice and

23

 

education it appears as if the profession adopted Meyer's and other’s fourth-order
ideas through a third-order epistemological form.
F ourth-Order Discipline, T hird-Order Epistemological Form:

“Having ” the Field 's Practice, Being “Had By” Its Philosophy and Inquiry

Early occupational therapy adopted craftwork and experiential learning as central
practices in the new field (Quiroga, 1995). Therapists utilized natural rhythms of the day,
and sometimes highly regulated routines in the form of “habit training” (Slagle &
Robinson, 1941), to promote the development of healthy habits and an appreciation of
time; they provided patients creative and challenging opportunities such as games,
weaving, bookbinding, woodworking, music, and work activities including laundry,
grounds maintenance, and kitchen work (Kielhofner, 1997). But the pragmatist-
functionalist school of thought that had originally offered the intellectual context and
initial theories for such occupations did not go forward with the young profession
(Serrett, 1985).

Early occupational therapy education involved craft training, combined with
theoretical lectures and practical clinical experiences. The coursework, known as
“curative occupations and recreations” (Quiroga, 1995, p. 35), was designed to train
attendants in “occupations for the insane” (p. 42), and emphasized an educational
approach, rather than a custodial approach, to the care of the mentally ill. But “the
intellectual nourishment of the founding vision cannot be found in the short training
courses or early curricula of occupational therapy. Emphasis was placed on the doing and
the field attracted people who liked the doing” (Serrett, 1985, p. 19). The rationale, the

system of thought for the doing was provided by “the spirit of the times” (p. 19),

suggesting early occupational therapists remained subject to the system of ideas from
which the field and its daily practices were constructed.

Moreover, in an analysis of occupational therapy’s intellectual heritage, Serrett
(1985) found that primarily the mostly male physicians provided the rationale and system
of thought for the mostly female profession. She related this dynamic to occupational
therapy’s traditional division of labor between men and women, in which the doing of
occupational therapy “belonged to the women. . .and the conceptualizing about the doing
belonged to the men. . .the conceptualizations and intellectual foundations were out of the
boundaries of the profession” (p. 20). An analysis of epistemological forms provides
another way to think about this rupture between doing and conceptualizing. That is,
therapists were able to take as object the field’s practices and were able to use its
principles, but remained subject to the field’s conceptual system and the process by
which its principles were being constructed. The profession remained subject to issues of
power and the culturally driven assumptions that women were the doers and men the
conceptualizers.

Despite the fourth-order epistemological form espoused by its founders,
occupational therapy generally relied upon a third-order epistemological form to teach
and enact its practice during its early years. It was able to take as object the concrete
practices of engaging clients in meaningful occupations and able to espouse the principles
for doing so, but was not able to author its own theoretical and scientific system for
understanding why occupations “worked” to aid the health of patients. Thus did most of
the occupational therapy literature continue to highlight the “acquisition of techniques

and the description of programs” (Serrett, 1985, p. 20). Occupational therapy was not

25

able to take the philosophy of actual doing itself as object and therefore could not create a
system of knowledge based on those values and beliefs nor test the hypotheses they
generated about the connection of doing to adaptation. Nor was the young profession
able, as will be evident in what Kielhofner (1997) called the mechanistic paradigm, to
construct an identity apart from the identity of the growing medical profession.
Remaining subject to its own theories and philosophies and subject to its co-construction
with psychiatrists and physicians suggests that occupational therapy developed within its
initial paradigm or discourse using a third-order epistemological form, rendering the field
incapable of self-authorship at that time.
Third-order Epistemological Form And The Mechanistic Paradigm

Soon after its inception, occupational therapy began distancing itself from
progressive reformers and linking itself to medicine. This liaison was fostered by the
onset of World War I and the call for “reconstruction aides” (Schwartz, 1998). While
often presented as a significant impetus for professional growth and expansion, WWI has
also been identified as the start of a paradigmatic shift in occupational therapy. Hospital-
based physicians at the time, believed to work primarily within a reductionistic paradigm,
focused on clinical problems that entailed impaired neurological or kinesiolgical
structures (Mattingly & Fleming, 1994); they found fault with occupational therapy’s
holistic view of humans as active agents in their own health and dismissed it as
unscientific (Kielhofiter, 1997). Occupational therapy, having concentrated its efforts on
the concrete activities of practice and not on its own theory base or intellectual
authorship, was particularly vulnerable to these ideological shifts toward reductionism

(Serrett, 1985). In addition, as a primarily female profession, “women were accustomed

26

to receiving direction and a raison d ’etre from medical men. When medicine became
engulfed in an overwhelmingly reductionistic thinking mode, energy in the occupational
therapy field became dispersed” (p. 23).

Consequently, occupational therapy began to doubt and lose confidence in its
founding principles, and began to shift the core knowledge of its training programs and its
practice to medical concepts (Hooper & Wood, 2002). Once again physicians proposed the
core ideas for the field suggesting that the field needed to gain a better understanding of,
and more closely attend to, the underlying anatomical, kinesiological, and psychodynamic
structures involved in performing a task (Kielhofner, 1997). For example, in the field’s
earlier paradigm of occupation, craftwork was used as a means to overcome ill-directed
habits, to restore balance and a healthy lifestyle, and to promote adaptation and arouse
interests (Quiroga, 1995; Slagle & Robinson, 1941). In the mechanistic paradigm, crafts
were used primarily to elicit specific types of muscle contractions and degrees of joint
movement (e.g. Licht, 1957). The “internal intrapsychic, neurological, and kinesiological
workings of the person” became the focal point of practice and education in occupational
therapy (Kielhofiier, 1997, p. 41). This particular paradigm has been described as a
mechanistic paradigm and as a predominately structuralist discourse (Hooper & Wood,
2002).

Examining this period in the profession's history, also known as "the derailment of
occupational therapy" (Shannon, 1977, p. 229), from an epistemological standpoint may
suggest that while the content and emphases in the field shifted, the epistemological form
remained the same and quite “on track.” The shift from the paradigm of occupation to the

mechanistic paradigm, from pragmatist to structuralist language, reflected more what

27

Kegan (1994) refers to as "a lateral move in the evolution of consciousness" (p. 289). The
field, working from a third-order epistemological form, continued to take as object the
concrete activities in which it engaged clients and continued to generate inferences about
those activities. But still failing to take the inferences themselves as object or the process
from which the inferences were generated, the profession was vulnerable to simply
substituting craftwork and balanced daily routines with other types of concrete activities
such as rote exercise or steps of craftwork decontextualized from the whole crafi process.
Not able to take its inferences as object, the profession could continue to use the same
holistic principles upon which the field was founded to explain activities that were
anything but holistic.

Similarly, the profession was vulnerable to becoming subject to another set of
inferences about why the activities in which therapists engaged clients were effective. In
her research on the use of crafts as treatment media in occupational therapy, Reed
described how therapists went from engaging patients in the whole craft of woodworking
to engaging them in the motion of sanding, on a level surface or at an inclined table,
without wood or sand paper. Similarly, therapists had clients work at looms but not
participate in weaving. Therapists also used art and pottery but only to analyze underlying
psychic conflict or unfulfilled needs as portrayed through the materials, colors, and process
used by patients (Kielhofner, 1997; Reed, 1986). As time passed, therapists’ use of
activities became even further devoid of context such as stacking a series of small cones,
applying and removing clothes pins around the edges of a square board, finding small
objects in a rice bowl, or placing and removing pegs in a pegboard.

In each of these examples, therapists were able to take as object the activities in

28

which they engaged clients and use inferences that these activities worked because they
improved underlying structures such as shoulder movement, bilateral hand use,
coordination and motor control, visual-perceptual skills, fine motor skills, or sensory
awareness. But therapists remained subject to the inferences themselves, unable to take
them in hand, examine them as the product of a system of thought, or question how they
had come to be constructed or by whom. Therefore, a third-order epistemological form
continued to dominate practice during the mechanistic paradigm as it had in the earlier
paradigm of occupation.

Similarly educational priorities during the field’s mechanistic paradigm or
structuralist discourse, while involving new medical content, remained primarily third-
order. During the earlier years of this period, the length of curricula was extended to
eighteen months and the required time for medical lectures more than doubled from 75 to
165 hours (Quiroga, 1995). Medical content continued to “occupy more and more of the
field’s core curricula over ensuing decades” (Hooper & Wood, 2002, p. 46). Students in
the field were taught new inferences about why occupational therapists used functional
activity as its primary method of intervention. They were not taught to take those
inferences or how they were created as object.

Presseller (1984) identified the creation of a theory-practice dichotomy in
education during this time because “medical sciences, theory and techniques were taught
as disconnected subjects to one another and to their applications to practice” (cited in
Hooper & Wood, p. 46). But such a separation would be consistent with a third-order
discipline which asks students to take as object the methods of practice and to use the

inference that such methods worked because of their impact on underlying structures.

29

third-order education does not ask students to generate a system of thought that would
have united medical sciences, theory and techniques into a cohesive whole. To do so
would require a fourth-order epistemological form. Consistent with Serrett’s (1985)
description of earlier occupational therapy, decisions about educating occupational
therapists still primarily stressed doing. continuing to leave much of the conceptualization
outside the field.

Overall, practice and education during the period in occupational therapy’s
history described as the mechanistic paradigm and as a primarily structuralist discourse
was similar in epistemological form to earlier periods in the field’s history. While core
knowledge, educational content, and practice priorities changed, the field continued to
make sense of its knowledge, education, and practice using a Third-order epistemological
form. Thus the changes during this period were more consistent with what Kegan (2000)
referred to as “informative learning”, meaning the fund of what the profession knew grew
significantly, especially in regard to the medical sciences, but the epistemological form
for how it knew remained unchanged.

F ourth-Order Discipline, F ourth-Order Epistemological Form: “Having” the Field ’s
Practice, Philosophy, and Inquiry

Kegan (1994) suggests that modern society requires a different subject-object
form for understanding experience than traditional society. Modern society not only
demands that concrete experience be taken as object but that the overall system that
shapes and forms those experiences be taken as object as well. A fourth-order
epistemological form requires that those features of experience to which we were subject

in Third-order knowing now become the objects of thinking. By the 1960’s a few

30

insightful and critically evaluative scholars began to recognize that occupational
therapy’s fundamental understanding of the human and of human health and wellness had
been unacceptably altered by the association with biomedicine and thus called for
reforms that would re-establish elements of the field’s first paradigm (Hooper & Wood,
2001). But to even reach this recognition suggests that the field was beginning to take its
co-construction with medicine, to which it had been subject, as an object of its inquiry.
Scholars promoted a return to the principles upon which occupational therapy was
founded, but this time with those principles in hand and under examination.

The profession was beginning to develop the capacity to take the principles of the
earlier paradigms as object. suggesting a dramatic transformation in the field’s
epistemological form from third-order to fourth-order. For example, in 1962, Mary
Reilly’s Eleanor Clark Slagle Lecture hinted at a new epistemological form underway in
the profession. The theme of Reilly’s lecture was “a critical appraisal of the essential
worth of occupational therapy” (p. 1). a fourth-order task of taking the profession itself,
not just its practices, as object. She called on occupational therapy to submit its central
hypotheses “that man, through the use of his hands as they are energized by mind and
will can influence the state of his own health” (p. 2) to critical investigation. Reilly also
took the prevailing cultural ethos of the twentieth century as object, acknowledging that
the profession had largely remained subject to the cultural surround of reductionism; she
called the profession instead to self-authorship, stating “a large part of the power to act on
the hypothesis of course resides with us” 03.2). Reilly’s address may have modeled a way
of constructing meaning that was common for most disciplines but newer to occupational

therapy: a way that took the principles, hypotheses, and systems from which practice

31

emerged as object and self-sufficiently synthesized knowledge to support its practices.

Over the next two decades, Serrett (1985) noted scholars in occupational therapy
began several initiatives to articulate “the larger whole” of the theoretical base for the
field’s practices. However, perhaps reflecting Kegan’s (2000) belief that a change in how
we know is painstaking and difficult, it took several more years before occupational
therapy could recapture, in a formal and systematic way, many of its original themes
within a science of occupation. But since the mid-1980’s, the “paradigmatic conversation
has converged on the theme of occupation” (Kielhofner, 1997, p. 53), and

a new professional culture is seeking to capture the best of both previous

paradigms, achieving a strong sense of professional identity, balancing holism

with precise knowledge, and integrating themes spanning the body, the mind and
the environment. . .within the context of a recommitment to the field’s focus on

occupation. (p. 49)

This developmental phase in the profession, which has been referred to as “the emerging
paradigm” (Kielhofiter, 1997) and as a revitalized pragmatist discourse in the field
(Hooper & Wood, 2002), may also be considered as the emergence of a fourth-order
epistemological form.

The establishment of a science of occupation could be said to constitute a shift in
the field’s epistemological form because it reflects a new capacity to take its principles as
object and to generate a system of knowledge for those principles. Several scholars have,
for example, taken as object the field’s processes for knowledge development (Clark,
Carlson, & Polkinghome, 1997; Yerxa, 1991). Other scholars have taken the concept of

occupation itself as object (e.g. Nelson, 1988; Pierce, 2001a, 2001b; Christiansen, Clark,

32

Kielhofner, Rogers, & Nelson, 1995). Researchers have taken singular aspects of human
occupation as object such as its relationship to: biology (Clark, 1997; Wilcock, 1998;
Wood, 1996b), identity (Christiansen, 1999), competence (McCuaig & Frank, 1991),
adaptation (Wood, 1996a), and the environments in which it occurs (Law, Cooper,
Strong, Stewart, Rigby & Letts, 1996; Rebeiro, 2001; Wood, 1998c). A growing body of
work focuses on developing assessment and outcome tools that are consistent with
occupational therapy’s own knowledge base rather than that of medicine or other fields
(Coster, 1998; Fisher, 1998; Hocking, 2001).

Another significant body of scholarship has focused on the development of
models or theoretical frameworks that synthesize multiple aspects of occupation (e. g.
Dunn, Brown, & McGuigan, 1994; Kielhofner & Forsyth, 1997; Law, Cooper, Strong,
Stewart, Rigby & Letts, 1996; Schkade & Schultz, 1992). These models share in common
a foundation in dynamic systems theory, which Serrett (1985) suggested the founders of
occupational therapy and their pragmatist colleagues anticipated by half a century. But as
Kegan (1994) noted, systems thinking requires a fourth-order epistemological form.
Therefore, its significant presence in occupational therapy models in recent years may
suggest a shift from third to fourth-order knowing. Altogether, this body of work not only
examines concrete occupations as object but, consistent with a fourth-order epistemology,
also examines as object the complex systems from which concrete occupations emerge
and to which they contribute.

The emergence of a fourth-order epistemological architecture is also implied in
recent scholarship in occupational therapy education. Earlier educational practice in

occupational therapy could be described as “informative” (Kegan, 2000). For the most

33

part learners simply expanded their fund of knowledge about techniques and skills. But
education scholars in the mid-1 990’s argued that entry-level technical skills were no
longer sufficient to meet the demands the health care system places upon therapists, and
that a new generation of innovative problem solvers would be needed (Royeen, 1995).
Education began to shift to a “transformative” approach that asked students to critically
evaluate the systems of thought in occupational therapy within which its principles and
practices reside (see Nielson, 1998a; Wood, Nielson, Humphry, Coppola, Baranek &
Rourk, 2000; Yerxa, 19983). Consequently, instructional processes such as problem-
based learning, service learning, case-based learning, and reflective joumaling have been
widely adopted in occupational therapy (e.g. Stern & D'Amico, 2001; Tryssenaar, 1995;
VanLeit, 1995).

What has not been acknowledged, however, is the transformation in
epistemological form these processes entail because they ask students to expand what
they are able to take as object. Problem- and case-based learning ask students to take not
only the concrete case or problem as object, but also the system of thought through which
they address the problem and the assumptions within the solutions and approaches they
generate. Service learning asks students not simply to engage in a concrete experience
with a community agency, but to consider the agency as a system of services and author
ways occupational therapy could enhance those services, or to consider the systems in
society that play a role in the problems encountered by clients served by that agency,
whether homelessness, abuse, care giving, respite or mental illness. Reflective joumaling
asks students to take not only their direct experience as object, but also the assumptions

within which their experience is embedded. Therefore, calls for reforms in curriculum-

34

design and instructional processes, as well as content and overall educational purpose,
seem to constitute a common call toward a fourth-order epistemological form. A fourth-
order discipline that can take its principles, inferences, and system for knowledge
production as object is in a position to become self-authoring (Baxter Magolda, 1999,
2000b; Kegan, 1994, 2000).

Pedagogy for Self-A uthorship

Pedagogy for self-authorship, also referred to as constructive-developmental
pedagogy, aims at nothing less than the same transformations in individual students, as
has occurred in the profession at large. That is, the aim of education is to provide contexts
and experiences through which students transform their epistemic structure from Third-
order to fourth-order. This epistemic transformation involves shifts in the learner’s views
of knowledge and the self equally. Baxter Magolda (20003) argues that without a shift
from seeing oneself as a knowledge recipient to seeing oneself as a maker and constructor
of knowledge, it is difficult to adopt ideas of knowledge as constructed in context. But
what pedagogical practices can assist with such deep-rooted transformations?

In addition to Kegan’s orders of consciousness model, several models explain
epistemic development and teaching practices believed to promote it (Baxter Magolda,
1999; Belenky et al., 1996; Belenky & Stanton, 2000; King, 2000; King & Kitchener,
1994). Rather than using the language of third and fourth-order knowing, however, these
models more commonly discuss epistemic change as transformation from authority-based
views of knowing in which knowledge is considered certain and fixed to a recognition
that knowledge is uncertain, tentative, and personally constructed within specific

contexts. While some scholars place more emphasis on changing views of knowledge

35

(King & Kitchener, 1994) and others on a changing sense of self related to knowledge
(Belenky & Stanton, 2000), assumptions associated with constructive-developmental
pedagogy generally include: 1) Learners’ assumptions about the certainty of knowledge
form the basis for how they learn and what they expect in the learning environment, 2)
Learners’ assumptions about knowledge are inextricable from their assumptions about the
self, 3) Epistemic development is stimulated by one’s interaction with the environment
and through disjunctive experiences in the context of each individual’s background, 4)
Learners’ assumptions about knowledge and the self become more complex over time.
Most constructive developmental models suggest that educators can promote
epistemic shifts through carefully fitting the learning environment and the classroom
process to the developmental tasks of the learner. To assess students’ current epistemic
structure and developmental needs, King and Kitchener (1994) suggest asking questions
such as: What do you think about the issue? On what do you base your point of view?
Can you ever know for sure that your position is correct? How is it possible that people
have such different points of view about the subject? Is one answer in any way better than
another? Using this type of questioning can give the educator an idea of the student’s
epistemic structure and set the climate for the type of thinking expected from students.
Some students’ will be particularly challenged when evaluating the strengths and
weaknesses of alternative perspectives on an issue or synthesizing competing
alternatives. At this stage of student development, King and Kitchener (1994)
recommend that educators design assignments that ask students to compare and contrast
competing points of view, cite evidence, justify which point of view or piece of evidence

is the stronger interpretation, and describe how the authors arrived at their conclusions.

36

Educators provide supports including modeling and explaining appropriate scholarly
inquiry, offering relevant interpretations from different viewpoints, and validating
students’ struggle to arbitrate between competing perspectives.

Other students will appear particularly challenged when constructing a point of
view or keeping their viewpoint open to reevaluation, or grasping that strong conclusions
are justifiable even if constructed. For these students, educators may design assignments
requiring students to develop and defend firm arguments for a particular point of view, to
offer their own organization of a given field of study, or to develop a concept map for a
discipline or course. Faculty can support this process by modeling firm points of view but
openness and tolerance for alternative viewpoints, offering examples of better points of
view and emphasizing the importance of developing and defending arguments about
complex ill-structured problems, as well as the difficulty in doing so.

Commonly, pedagogy to aid epistemic development involves creating a learning
environment that offers confirmation of the learner as knower, validation of the learner’s
prior experience and opportunity for both structure and freedom. Faculty teaching for
self-authorship generally introduce students to ill-structured problems, create
opportunities to examine multiple points of view, teach students to question their
assumptions, informally assess students’ level of development or assumptions about
knowledge, respect the student’s current level of reasoning, understand that students
differ in their level of development and target expectations accordingly, provide both
challenge and support, are cognizant of the epistemic requirements of assignments and

activities, and create an environment that fosters thoughtful analysis.

37

Beliefs and Assumptions Consistent with Self-A uthorship

Pedagogy for self-authorship, or constructive developmental pedagogy, deals with
root beliefs such as one’s presuppositions about knowledge and the self. Thus did Baxter
Magolda (1999) argue that educators may thwart or aid self-authorship among their
students depending upon their own assumptions about knowledge and how they translate
those into educational practice. Examples of such assumptions include: a) students and
content are fixed, separate entities that do not interact; this assumption can result in a
“delivery approach” to content, b) student interest and involvement are sufficient for
learning; this assumption can result in a “naive constructivism” in which students are left
to structure their own learning, c) learning can be separated from application; i.e. what
students learn here can be applied elsewhere, and d) curriculum is a fixed agenda to be
followed.

Instead, teaching for self-authorship is rooted in the assumption that knowledge is
a joint effort between teacher and student, a “consensus among members of a community
of knowledgeable peers—something that people construct...” (Bruffee, 1993, p. 16). This
assumption can guide how educational approaches are selected and implemented.
However, Baxter Magolda (1999), in a reflection on her own educational practice,
discovered how easy it is to adopt constructive-developmental teaching methods such as
active learning, collaborative learning, group discussion, and learning centered on student
experience, but not revise old assumptions about teaching and learning. While actively
engaging students, she realized that she continued to control the agenda directing student
experiences toward certain interpretations and their discussions toward issues she had

pre-deterrnined were important. In her words, “the old assumptions of responsibility to

38

transfer my knowledge to my students, my ability to know what was good for them in
learning, and the traditional expectation to maintain control in the classroom and ‘cover
the material’ inhibited me from truly living what I espoused” (p. 74-75). Kagan (1992), in
her review of the teacher belief literature, agreed that teaching practice is situated in an
educator’s unique belief system, but added that beliefs related to a specific group of
learners and to specific academic material are equally influential to the implementation of
classroom processes (see also Clark & Peterson, 1986; Dirkx, Amey & Haston, 1999;
Dirkx & Spurgin, 1992).
Implications for the Study

I have offered a conceptualization of occupational therapy’s history as a story of a
fairly stable subj ect-object configuration, until the last decade and a half when the field
began to demonstrate signs of transformation from third-order to fourth-order knowing.
Examining occupational therapy’s history in light of metamorphosing epistemological
forms can help situate recent reforms toward occupation-centered education in a broader
context that has not previously been considered, but has significant implications for
research. I have also reviewed pedagogical practice believed to promote fourth-order
knowing. The success of constructive developmental pedagogy hinges, in part, on
particular beliefs and assumptions held by both learners and educators about the self,
knowing, content, and the roles of student and teacher. Whether and how the educator’s
sense of self is implicated in occupational therapy curriculum reform have yet to be
investigated.

While an historical analysis suggests a possible link, it is not clear from recent

scholarship in occupational therapy if the call for educational programs to become

39

occupation-centered means, in part, to adopt a new epistemological form through which
to understand the profession. In addition, little evidence exists to support a connection
between epistemic development, or self-authorship, and pedagogical processes, beliefs
and assumptions in occupational therapy education. The purpose of this case study was to
examine the instructional methods, assumptions, beliefs, and epistemological aims

associated with the practice of occupation-centered education.

40

Chapter Three
Methodology

The purpose of this study was to describe educational practice within a model
graduate occupation-centered curriculum in order to generate a rich understanding of the
nature of occupation-centered education, how it comes to be defined and structured
within an interpretive community of faculty, what beliefs and assumptions guide
individual educators’ practice of occupation-centered education, and the extent to which
those beliefs reflect self-authorship as an educational aim. A qualitative, or interpretive,
research paradigm was used to frame the study (Cresswell, 1998; Denzin & Lincoln,
2000; Patton, 2002). Specifically, within a qualitative paradigm, a case study was utilized
to explore a “bounded system or case over time through detailed, in-depth data collection
involving multiple sources of information rich in context” (Creswell, 1998, p. 61).

The bounded system, or case, for this project included one occupational therapy
program considered a model, or exemplar, for occupation-centered education. The
specific type of case study resembled what Stake (2000) referred to as an “instrumental
case study” (p. 437). That is, a particular occupational therapy program was examined in
order to provide insight into the larger phenomenon of graduate occupation-centered
education, considered by some scholars to be vital to the field’s future viability (e. g.
Wood, et al., 2000; Yerxa, 1998a). Therefore, my concern was simultaneously with the
particular and the general, or, in other words, through a detailed exploration of a
particular program’s institutional context, curriculum design, teaching and learning
processes, and individual faculty beliefs and practices, I hoped to advance a broader

understanding of educational theory and practice in both occupational therapy and

41

education. For the purpose of case selection, occupation-centered education was defined
generally as any program that has self-identified its curriculum design as centered on the
construct of occupation.

Criteria for Case Selection

An instrumental case study requires careful, purposive sampling process in order
to choose a case that offers maximum opportunity for learning about occupation-centered
education. Opportunity to learn is the primary consideration in case selection;
consequently, a number of factors must be considered in identifying a particular case to
study, including the critical phenomena under investigation, accessibility, and even
hospitality (Stake, 2000). The case for this study was selected using “intensity sampling”
based on its potential for providing rich information about the research topic (Patton,
2002). This potential was determined based on: 1) the program's presence in the field's
literature suggesting its standing as a model or exemplar program, 2) corresponding
recommendations from colleagues and leaders in the field, 3) overall fit with additional
selection criteria that assured the program was not in the midst of major change, 4)
overall opportunity to learn about the research questions, 5) accessibility to the researcher
for an eight week period, and 6) faculty willingness to mutually explore features and
practices of occupation—centered education.

At the time of case selection, a literature search on curriculum, curriculum
development, and occupational therapy education revealed only three graduate programs
that had published descriptions of their curriculum or curriculum design process. Only
one of those was published in the last five years, but all were considered as potential

cases for this study. After identifying leading programs as represented in the field's

42

literature, I originally intended to obtain further recommendations from officers and
members of the Accreditation Council for Occupational Therapy Education (ACOTE).
ACOTE is responsible for reviewing all occupational therapy curricula on a regular basis
and granting accreditation on the basis of how completely the curriculum meets the
ACOTE standards for an accredited program. Therefore, ACOTE personnel generally
have firsthand knowledge of flagship curricula, or those programs engaged in innovative,
challenging and groundbreaking work around occupation-centered education. However,
after contacting a few officers and members of the ACOTE, I discovered they were not at
liberty to disclose information about the programs they have reviewed.

A few members, while not able to speak in their role as an ACOTE reviewer,
were able to make recommendations based on their educational consulting role
independent from their role as a reviewer for accreditation. All three programs with a
presence in the field's literature were identified as potentially strong cases for this study,
but other programs were identified as well.

After potential programs were identified through the literature and through
professional colleagues associated with ACOTE, other colleagues were consulted
regarding potential cases most likely to yield rich information about the following
research questions:

0 How do individual faculty understand occupation-centered education?

0 How have current understandings about occupation-centered education developed
and changed?

0 What perceptions do faculty in an occupation-centered curriculum hold about

teaching and learning?

43

0 What methods, processes and overall classroom approaches manifest a faculty's

understanding of occupation-centered education?

0 What assumptions and beliefs are embedded in faculty understandings and

practices related to occupation-centered education?

Two programs agreed upon by more than one professional colleague as representing
“model” programs and considered likely to yield rich data around the questions were
prioritized. The selection criteria for the final list of two programs included:

0 Programs that had not experienced a transition in leadership for at least 2 years,

0 Programs that had no more than one open faculty line,

0 Programs that were not in the midst of significant curricular revisions but had

revised their curriculum within the last five years,

0 Programs that had graduated at least 2 classes of students from the current

curriculum.

These criteria were established to help select a program not in the midst of major changes
that could impact how the curriculum was executed at the time of the study.

The final selection criteria included the program that was accessible to the
researcher and whose faculty supported the research idea and were willing to participate
in interviews, videotaped classroom observations, and reflections on their classroom
activities over the course of eight weeks in the Fall 2001 semester. The University of
North Carolina at Chapel Hill (UNC) was selected on the basis of its presence in the
occupational therapy literature, its recognition by colleagues as a model occupation-
centered curriculum and therefore an information-rich case, its match to the selection

criteria, its accessibility to the researcher and the willingness on the part of its faculty to

44

participate in an eight week project involving interviews and videotaped observations of
classes.
The Context for the Case Study

The University of North Carolina is the oldest state university in the United
States. It is a public, four-year research institution with enrollment of approximately
15,500 undergraduates and 8800 graduate students. Occupational therapy has a twenty-
seven year history at UNC. In 1998, the Division of Occupational Therapy changed its
name to the Division of Occupational Science, reflecting developments in both the
profession at large and the Division’s mission and curriculum. The name change signified
that faculty scholarship at UNC entailed both basic and applied research on occupation
and “that the curriculum goes beyond training clinicians in techniques to building our
graduates' professional understanding of how occupations contribute to development,
adaptation, and wellness” (Retrieved October 2001 from
www.alliedhealth.unc.edu/ocsci/history).

The Division of Occupational Science is a Division in the Department of Allied
Health Sciences within the School of Medicine. The mission of the Division reflects its
intensity about occupation-centered practice and education and its high standards and
expectations for both faculty and students. The Division aims “to produce occupational
therapy's foremost practitioners, scholars, researchers, and leaders”, and to cultivate the
“profession's Ikeenest minds and visionaries” (Retrieved October 2001 from
www.alliedhealth.unc.edu/ocsci/mission). Toward that end, faculty espouse their

responsibility, which they feel is shared by staff and students, as forging an “academic

45

culture that will optimally nurture students' intellectual and ethical development”
(Retrieved October 2001 from www.alliedhealth.unc.edu/ocsci/mission).
The curriculum.

Faculty at UNC engaged in a prolonged process of curriculum development that
involved meeting three to four hours per week between 1995 and 1998. The design
process involved multiple iterative steps, including: 1) environmental scanning of internal
and external contexts to identify new knowledge, trends, supports and barriers to
occupation-centered practice, 2) crafting a shared vision of the future of occupational
therapy, and 3) creating curricular themes such as “the human as an occupational being”
and “the therapist as change-agent and scholar” as the basis for designing learning
objectives and selecting content (Nielson, 1998a; Wood, Nielson, Humphry, Coppola,
Baranek & Rourk, 2000). The design process also involved consistent faculty study and
consultation with leading scholars in the field and at the Center for Teaching and
Learning at UNC.

The resulting coursework requires two years, or six semesters, to complete. The
faculty designed the courses to be tightly integrated and carefully incremental in the
demands made on students (Wood et al., 2000). Faculty strove to build on what students
learned in other classes, to integrate multiple field experience across courses, and to
progress students into more self— and less faculty-structured assignments and experiences.
The faculty.

At the time of this study, the make-up of faculty positions included one clinical
instructor, three clinical assistant professors, two clinical associate professors, one

assistant professor, two associate professors, and one professor. Current faculty have

46

been at UNC from 2.5 to 18 years. Teaching loads varied depending on faculty
involvement in other projects and research. During the semester of data collection for this
project, most faculty taught one class and a seminar, with one faculty member teaching
two classes. The additional activities faculty were engaged in included clinical practice,
special grant projects, developing research, collecting data for ongoing research,
completing writing projects, and fulfilling responsibilities associated with offices and
roles held within the profession.

The Department of Allied Health Sciences functioned on a relatively minimal
budget but was able to secure additional resources through grants and the Graduate
School to support adjunct salaries, graduate assistants, and research assistants. The
overall culture within which the faculty worked both at the institution and department
level valued autonomy among divisions and among individual faculty. There was a
consistent expectation of, and support for, the highest standards in scholarship and
teaching, but with minimum oversight from directors or deans. In the Division of
Occupational Science, individual autonomy seemed carefully balanced with committed
collaboration and shared contribution to the whole.

The students.

The Division admitted twenty-four students per year. Students entered the
program after completing a bachelor’s degree in another field. During my observations,
student participants held degrees in psychology, sociology, biology, exercise science, and
sports medicine; they had an average GPA of 3.36 and their combined GRE verbal and
quantitative scores were above 1000. The Division of Occupational Science website

informs potential students that they are looking for applicants who “already demonstrate

47

commitment to learning, scholarship, and human service and who are open to change
within occupational therapy. . .with a blend of academic ability, experience working with
people, and an understanding of occupational therapy” (Retrieved October 2001 from
www.alliedhealth.unc.edu/ocsci/students).
Applicants are expected to demonstrate sufficient volunteer and work experiences,
experiences in working with people different from themselves and the ability to write
reflectively and analytically about the philosophy of occupational therapy and their
experiences with diversity.
Obtaining Access and Consent

Consent to be onsite at UNC was initiated first through a telephone conversation
with the Director of the Division of Occupational Science. In the telephone conversation,
the purpose and methods of the project were reviewed. Afterwards, at a subsequent
faculty meeting, the Director discussed the research project with the faculty. Before
agreeing to participate in the project, the faculty asked the researcher to respond to a few
questions or concerns through email correspondence. After the faculty concerns were
addressed, official consent to be onsite at UNC for this project was obtained through a
letter to the Division Director, and written consent of each faculty member was obtained
upon arrival to the site and following a more detailed description of the study at a faculty
meeting. Although students were not the focus of the study, their comments were
generally represented in field notes and on videotape; therefore, upon arrival to the site, I
also met with both the first and second-year occupational therapy students to explain the
purpose of the study, explain their involvement and obtain their signatures indicating that

they understood the purpose of the study.

48

Procedures for Data Collection

This research made primary use of well-accepted case study methods, including
semi- and un-structured interviews, videotaped classroom observations, participant
observation, and artifact review (Denzin & Lincoln, 2000; Patton, 2002, Merriam, 1998).
While most case studies involve a secondary process of selecting key informants once on
site (Stake, 2000), in this case all faculty were willing to participate in both interviews
and classroom observations. Therefore, key informants included all nine faculty
members. All classes offered in Fall semester 2001 were observed for a three-week
period and all faculty and curriculum meetings held during the eight-week data collection
period were included in the field note data.

Each faculty member participated in an initial semi-structured interview, adapted
from interviews originally designed by Dirkx (2000) and by Ah Nee Benham & Cooper
(1995) and Colflesh (1996). The first interview (Appendix A) was designed to explore
the educator’s experience and educational background and gain an initial understanding
about the course to be observed and videotaped. The syllabus and upcoming class
handouts were also collected during this first interview.

Following the introductory interview, I attended each interviewee’s classes,
observing classroom processes and content implemented by the educator. Field notes
were recorded during all class observations. A mini-digital video camera was also set up
during all class observations, but only three classroom observations of each interviewee
were actually videotaped. The camera was continuously present in an effort to desensitize
faculty and students to its presence in the learning environment. Faculty were involved in

deciding which class sessions would be videotaped and were fully informed at the time of

49

recording. It was my intention also to inform students each time I was recording, but both
classes decided they would rather not know in case they became more self-conscious of
their class participation with videotaping.

The second semi-structured interview (Appendix B) used stimulated recall and
photo elicitation techniques based on the videotaped observations (Prosser, 1998). The
participants were asked to view and reflect on their pedagogical practices as
demonstrated on researcher-selected segments of the tape. Before each second interview,
I independently reviewed all videotapes for the faculty being interviewed, and selected
segments of tape that captured teaching activities that appeared highly characteristic or
highly uncharacteristic during my observations of that individual. I also selected some
segments for discussion that seemed as if they might be relevant to the initial analytical
codes associated with the conceptual framework.

During the second interview, each faculty was asked to view and think-aloud
about three to four videotaped segments of teaching, considering the actions taken in a
given class, the educator’s thought processes about or during a particular series of
actions, the degree certain actions reflected beliefs about teaching and learning. These
discussions sometimes included former experiences that may have contributed to the
classroom processes selected, thoughts about students’ responses, and other observations
made by the faculty upon watching the tape. The second interview concluded with a more
theoretical discussion, asking each faculty to consider the core principles and beliefs
within her or his teaching and represent them visually on an 11 x 17 sheet of paper.

Finally, other sources of data included artifacts and documents related to each

educator’s class, documents reflective of the overall curriculum design of the program,

50

and field notes from curriculum meetings, faculty meetings, and informal observations of
the overall organizational culture.

Altogether data collected included approximately 112 hours of classroom
observations, 32 hours of structured interviews and approximately 24 hours of videotaped
observations.

Table 1. Overview of data set.

 

 

 

 

 

 

 

 

 

 

Faculty Structured Class-based Videotaped Documents
Interviews Observation Observations
s
1 4.5 hours 18 hours 6 class Syllabi Web
sessions Class handouts materials
Sample Teaching
readings notes
2 3.5 hours 21 hours 3 class Syllabus Sample
sessions Class handouts exam
Teaching notes Sample
readings
3 3.75 hours 9 hours 2 class Syllabus Sample
sessions Study guides readings
Sample rubric Teaching
notes
4 3.5 hours 7.5 hours 2 class Syllabus
sessions Sample handouts
5 3.5 hours 7 hours 1 class session Syllabus Presentation
Web-based packets
materials Sample
handouts
6 3 hours 9 hours 2 class Syllabus Handouts
sessions Web-based Sample
materials readings
7 4 hour 7.5 3 class Syllabus Teaching
sessions Handouts notes
Sample
readigs
8 3.5 hours 7.5 3 class Syllabus Sample
sessions Handouts readings
9 2 hours 2 hours n/a Syllabus Sample
Sample readings
handouts

 

 

 

 

 

 

51

 

Other observations included: ten hours of observation of research seminars, four hours of

faculty meetings, six hours of curriculum meetings, and three hours of student

recruitment activities. Table 1 provides an overview of data sources per faculty.

Differences in hours of observations are accounted for by differences in numbers of

courses taught by each instructor in addition to differing hours of class time per course.
Data Analysis

Data Organization System

Interviews were audio taped and transcribed by a third party. Each audiotape was
labeled and preserved and each transcription was simultaneously saved to a word
processing program and entered into the qualitative data analysis software, Atlas ti
(Muhr, 1993). Hard copies of the transcriptions were given to each faculty to review and
modify any comments they felt needed clarification. Transcriptions were filed into a data
notebook established for each faculty member. The notebook contained interview,
observation, and artifact data per individual faculty.

Observations were recorded using both videotape and field notes. Videotaped
observations were labeled and preserved. Handwritten field notes were enhanced and
transcribed using a word processor within the week of data collection. By "enhanced", I
mean I filled in details I remembered from my observations but had failed to capture fully
in my written notes. Each transcribed observation was simultaneously saved to a‘ word
processing program and entered into Atlas ti. After all interview and observation data
were entered into Atlas ti, separate data “families” were created for all data pertaining to

an individual faculty, for all interview data, and for all observation data.

52

Documents including syllabi, assignments, handouts, and exams were collected as
utilized in each class I observed. Each of these documents were dated and filed in the
data notebook for that individual faculty. A general notebook was established for
additional data such as observations of faculty meetings, recruiting events, student
orientation materials, and others.

Data Analysis Process

The process of data analysis occurred simultaneously with data collection. That is,
each point of data collection also entailed some element of data analysis. Types of
analytical activity interspersed with data collection included reading interview and
observation transcriptions, preliminary coding of interview and observation data, reading
literature related to the conceptual framework for the study, documenting analytical notes
in my research journal, "playing" with concept maps to help make sense of the data as it
was being collected, and engaging in "practice writing" exercises to help establish a
narrative framework for the data. During and after data collection, my data analysis
process with the interview and observation data reflected three types of coding identified
by Creswell (1998) as open coding, axial coding, and selective coding. In open coding,
line-by-line segments of the transcriptions or field notes formed the unit for analysis.
Axial coding examined the data for salient categories of a set of themes characteristic of
educators’ reflections and actions. Selective coding involved building an overall
theoretical “story” that described how the categories related to one another and the
propositions of the theory they forwarded. However, it was not my experience that these
three types of coding occurred in the clear progression that Creswell describes, but rather

as simultaneous and iterative.

53

Interviews and observations.

Following data collection, interview and observation data were analyzed first by
individual faculty member, then across all faculty, using Atlas ti to code and organize
data. Initial analytic codes were generated based on the conceptual framework for the
study and included a series of codes under the code-headings of The Subject, Knowers,
Teaching and Learning processes, and Faculty Biography. The conceptual framework at
this stage provided a crude roadmap that allowed me to enter, and become familiar, with
the data.

Other iterations of coding attempted to bracket the conceptual fiamework and
have the data stand on its on. One such iteration generated a series of codes under the
code-headings of Assumptions, Purpose, Methods, Clinical Experience, Models for
Teaching, and Occupation-Centered Education. Throughout the coding process, grids,
concept maps, and models were developed to help construct relations between codes.
This process was similar to what Creswell (1998) described as paradigmatic analysis
because it served to immerse me in the data as a whole and produced several iterations of
categories out of the common elements across the database and was used to begin
forming several alternative narratives about the case.

In conjunction with several iterations of coding, another process was used with
the interview and observation data from this case. This process was more closely aligned
with narrative analysis and was used to synthesize the data from interviews and
observations into a story line that encapsulated each participant’s experience and her
work as an educator. These analytic activities included reading each participant’s

interview data in its entirety, extracting significant statements to be formulated into a

54

narrative that could help shed light on the research questions (Creswell, 1998). The
primary analytic tool at this point in data analysis, however, was writing itself. Through
writing, I experimented with several story lines that seemed to tell a story about the case.
It was actually through this analytic activity that the focus on the self-constructions of
faculty and their connection to teaching emerged and the initial conceptual framework
was expanded. I saw my role at this point of data analysis similar to that described by
Stake: that while the case researcher seeks the emic meanings held by the people in the
case, the ultimate “story” the case will tell, or what is important for a particular
understanding of the case, is primarily decided by the researcher.

Videotaped data.

The videotapes in this case were used primarily as a data collection tool and not
analyzed directly by the researcher. Videotaped data were used for the process of
stimulated recall or photo elicitation. That is, particular video segments were selected and
replayed for faculty. Faculty reflected on the segments and their reflections were
recorded and analyzed as interview data. Most of the videotaped data were also recorded
as field note data, which were analyzed as described above. Additionally, the videotapes
were used to help refresh my memory in a more three-dimensional way of the details of
each class I observed and to help “re-enter” those classrooms when beginning the writing
process (Patton, 2002). For example, using the videotapes I could remember the verbal
intonations and non-verbal gestures of faculty, the emotional tone of the class, the

physical space, humorous moments, and the students’ level of engagement.

55

Document and artifact data.

Syllabi, assignments, handouts, and exams were reviewed using two analytical
frames. One analytical frame related to the teaching and learning processes portrayed in
the documents. The other analytical frame related to the intrapersonal and epistemic
demands the documents implied for students.

T rustworthiness

Qualitative research employs various procedures to reduce the likelihood of
misrepresenting the data. Triangulation, audit trails, peer debriefing, and member
checking seem to be the most universal methods among qualitative researchers.
Triangulation is the process of using multiple data sources and multiple perceptions to
clarify meaning and “identify the different ways a phenomenon is being seen” (Stake,
2000). To institute triangulation, this project employed multiple data sources including
in-depth interviews, videotaped observations, participant observations and field notes,
and artifacts as the primary data collection tools. As described above, several analytical
frames were also used to experiment with various perceptions on the data.

An audit trail turned out to be easier to implement in earlier stages of data
analysis than in later stages when coding was more inseparable from memo writing,
concept mapping, and draft-writing. In the early stages, codes, code definitions, and new
codes were tracked using Atlas ti (Muhr, 1993). I also found that a research journal that
included dates and research activities was easier to maintain in the earlier stages than
consistently throughout data analysis. While perhaps not as consistent as hoped for, my
journal was used to record ideas, note possible interpretations of data, raise questions

about data or about my telling of the data-story, examine contradictions, and relate

56

readings to data. Therefore, the study did employ a loose audit trail and a research journal
that together support my conceptual process for arriving at the current results from the
case. '

The process of peer debriefing was occasionally used to review my dissertation
with my committee chair. Peer debriefing was also used with key professional colleagues
in order to seek alternative interpretations and meanings.

The nature of the data collection process in this study allowed for continual
member checking throughout data collection. Being on site for eight weeks enabled me to
discuss preliminary interpretations with the faculty through ongoing informal interviews.
I felt as if the faculty played a collaborative role in describing and interpreting and
generating explanations for thoughts and actions related to their educational practice.

A more formal member check was also conducted after data analysis and writing.
A draft of the dissertation was made available to the participants three weeks prior to a
meeting with the faculty as a group. At that meeting, faculty were asked to comment on
my portrayals of their educational practice, respond to and clarify key issues raised by
data analysis, and discuss how they would like to deal with confidentiality as it related to
the program and to individual participants. Faculty comments indicated that they felt the
descriptions of their biographical experience and educational practice were relayed
accurately and that the connection between the two held true for them individually. The
clarifications they offered on key issues from the study are largely represented in the
discussion in Chapter Ten. Involving the participants in decisions about confidentiality

was based on recent changes in research methodology around the issue of confidentiality

(Patton 2002). Formerly, qualitative researchers assumed that programs and individuals

57

would remain confidential through the use of pseudonyms, but in recent years some
participants prefer to be visible in the stories told about them. In this study, participants
were members of a well-known program and highly involved in a rather small field; the
use of pseudonyms would not guarantee confidentiality. Therefore, the faculty in this
study decided to keep their real names in the dissertation. I agreed to revisit their decision

upon publication in journals specific to occupational therapy.

58

Chapter Four
Overview and Organization of Research Results

As discussed in Chapter One, one primary aim within the field of occupational
therapy in recent years has been to develop and promote "occupation-centered"
education. This case study was designed to further explore the meaning and practice of
occupation-centered education, particularly: 1) What methods and instructional processes
are associated with occupation-centered education? 2) What beliefs about learners,
learning and knowing are reflected in the methods and instructional processes used by
faculty in an occupation-centered curriculum? 3) Overall, how do faculty understand
occupation-centered education and how have those understandings developed and
changed?

Generally, the faculty in this study employed a variety of instructional methods
including but not limited to small and large group discussion, labs, case studies, journal
writing, small-group activities, field observations, lectures, interactive lectures, and guest
lectures. Generally, the faculty viewed student experience as central to learning and
supported students using scaffolding and rubrics. Overall, faculty understood occupation-
centered education as a sophisticated synthesis of knowledge across many content areas
and designed assignments to elicit such synthesis. The methods, beliefs, and conceptions
of occupation-centered education in this case study were consistent with principles of
active learning (Galbraith, 1991).

As the study continued, two important shifts occurred that expanded the research
questions somewhat. First, it was apparent early on that faculty consistently used active

learning principles. Rather than simply describe these methods, the more interesting

59

question became: Active toward what? What specifically were faculty actively engaging
students in doing? Second, it became more apparent throughout the study that
instructional methods and processes, beliefs and assumptions, and overall understandings
of occupation-centered education were not separate entities. These were not simply
parallel means to the end of occupation-centered education. Rather the interplay between
an educator’s personal biography, preferred instructional methods, and beliefs and
assumptions played out as important and inseparable elements in occupation-centered
education (Dirkx, Amey, & Haston, 1999).

Through the interplay of personal experience, instructional methods, beliefs, and
assumptions, faculty reflected particular selves and particular stances toward knowledge,
which seemed to parallel an important aim of occupation-centered education for students.
This aim was for students to construct particular selves and a particular stance toward
professional knowledge believed important if they were to “create the future” of
occupational therapy. One faculty shared that students were not simply entering graduate
school to collect information but to change "fundamentally as a person.”

In Chapter Five, I address the research question related to methods and
instructional processes, but frame the methods specifically in terms of what faculty
seemed actively to engage students in doing. Chapter Five describes how three
instructional methods, the lab, classroom discussion, and lecture, were employed to
engage students in connecting with the subject of human occupation. Establishing a
personal connection with the subject also involved exposing students to an image of

themselves as knowledge producers.

60

Chapters Six through Nine place the instructional methods in the broader contexts
of the life of the individual faculty, the faculty as a group, and the issues of the
profession. I will describe how the selves faculty had authored as a result of their
personal and professional experiences, both successes and struggles, were related to the
selves they desired their students author, and how their own stances toward knowledge
called students toward similar epistemic development.

Chapter Ten examines the multiple sources of faculty intrapersonal development.
Finally, Chapter Eleven discusses the advantages and limitations of a constructive-
developmental perspective and offers a broader conceptualization of teaching as
authoring lives.

Therefore, influenced at the time of data analysis by the work of Robert Kegan
(1994, 2000), Marcia Baxter Magolda (1999, 2000a, 2000b, 2001) and Parker Palmer
(1983, 1998), I initially chose two primary “characters” around which the plot of this
study revolved: subject-centered education and self-authorship, both of which played out
before a backdrop of constructivist education. And I have organized the results around a
question slightly different from the original research questions, namely: What
constructions of the self and knowledge were being promoted in this occupation-centered
curriculum and by what means? In this study, I discovered that constructivism had as
many faces as there were faculty in the study, but even so it seemed to constitute an
epistemological engine on which the occupation-centered curriculum ran. Faculty seemed
to presuppose that teaching centered on the subject of occupation involved profound
transformations on the part of students--transformations that required reconstructions of

how students see themselves and how they know what they know.

61

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Chapter Five
Teaching Centered on the Subject and the Self
The purpose of this chapter is to describe familiar teaching methods as they were
used to center content on a core subject and by so doing to engage students actively in
connecting personally to that subject and in “trying on” images of themselves as knowers.
Faculty utilized teaching methods that are common across higher education and adult

learning contexts including small and large group discussion, labs, case studies, journal
Writing, small-group activities, field observations, lectures, interactive lectures and guest
lectures. These methods have been widely discussed for how they can actively engage
learners, but not as much attention has been paid to how faculty employ them to center

1 earning on a core subject or promote epistemic and self development. In the following
discussion, I describe three methods, the laboratory experience, the classroom discussion,

atld the lecture, and how they were utilized to create a subject-centered learning

environment. I have selected these three methods not only because of their familiarity
Within many disciplines, but because of how they illustrate the fluidity of methods,
meaning that lab experiences often included lecture and lecture often included discussion
and discussion often included “lab” activities. I also believe these methods illustrate that,
in this case, neither methods nor content areas were inherently occupation-centered, but

beC—arne so only within how faculty utilized the method and tethered the content to the

subj ect and to the student self.

62

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The Subject-Centered Lab Experience
Lab experiences are common methods by which occupational therapy students
learn human anatomy and the professional tool known as activity analysis (among many
other topics). In this case, knowledge related to anatomy and to activity analysis not only
seemed to be the end the instructors desired, but also the means to connect students to the

larger subject of occupation and convey a way of being in relationship to that knowledge.

":1

Labs were generally planned around a sequence of guided lab preparation, mini-lecture, ,

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structured lab activity, and group discussion—throughout which, faculty consistently
problematized the stand-alone anatomical structure or professional tool and promoted a
closer connection of the structure and tool to occupation.

Stand-alone body structures and professional tools were problematized during lab
preparations using readings, study questions. and assignments. Following a class
presentation on grip-strength testing using a dynamometer, the anatomy instructor
assigned a preparatory reading for the next lab presenting research that strength
measurements alone are not good indicators of occupational performance. In activity
analysis lab, after learning how to apply the process of activity analysis, the instructor
assigned a preparatory reading for the next lab critiquing activity analysis and suggesting
another version of the tool believed more sensitive to occupation as performed by a
specific person in a specific environment. These pre-lab preparations introduced conflict
into content that could easily be taught as non-problematic. Introducing tension was one
way instructors created an opportunity for students to engage in constructing knowledge

around a subject and see themselves as knowers.

63

Stand-alone structures and tools were also problematized during lab-based
lectures using comments interjected to remind students that memorizing individual
muscles or rotely applying activity analysis was not the ultimate goal. In anatomy lab, the
instructor interjected, “I want you to understand the relationships of muscles to a group of
muscles and what those muscles allow someone to do, or what happens to daily function
if someone is having trouble moving a certain group of muscles.” Her comments seemed
to nudge students’ attention beyond the stand-alone anatomical structure to “why it
matters” when an individual is performing a specific task, and to “what practical
difference does this information make?”

In reviewing the anatomy of the hand, the instructor commented:

We will back up and look at the structures of the hand and try to get a sense of the

complexity of it. But you also need to think about the structure in the larger

context of what the hands do for us in life: communication, sensation,
manipulation of the environment.
In that same review session, students feverishly took notes about specific tendons that
supported a hand movement called tenodesis. The instructor carefully added, “but more
important is that you understand that because the tendons cross over the wrist, it impacts
the function of the hand in daily tasks.” Similarly, in her exam review, she summarized:

I want you to understand the relationship of the muscles to each other and what

happens if someone is having trouble moving a certain group of muscles. If I

show you muscles on the overhead, I expect you to see what they do together and

what a person loses if it isn’t working. . .to differentiate the importance of the

muscles rather than knowing the names of all the structures.

64

fl

Interjecting comments like these, the instructor appeared to engage students in
constructing anatomy around the central subject of human occupation.
In activity analysis lab, the instructor presented activity analysis in association with

one occupation-centered model in the field, thus depositing occupation into the center of

activity analysis:
How does activity analysis relate to the Person-Environment-Occupation model M
you’ve been studying? First, the person level: You've already started being able to l
gather information about the person using the Canadian Occupational
Performance Measure [students completed this assessment in an earlier lab].
Second, the environment level: We are going to talk more about environmental
assessments next week. But third, the level of occupation: This is the level where
activity analysis fits and where we will focus over the next three weeks. This is
key to planning and implementing intervention with clients. But why? Why do
activity analysis? One, to understand the occupation. If we understand the
occupation, we can begin to surmise or imagine the meaning it may hold for
someone. Of course, you have to always link it to an individual, but the activity
analysis gives you a general place to start exploring meaning the occupation holds
and how it may be used in therapy. ..

Without hesitation, the instructor identified the primary subject of her lab as “occupation-

centered practice”, the core subject to which the individual topics of the course, such as

activity analysis, pointed.
The instructor also tended to use clinical examples as another way to problematize

and relate activity analysis to the overarching concept of occupation. In the following

65

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example from her practice, the instructor supported the central theme in her overall
lecture that day—she wanted to “make sure that they see how activity analysis is related
to occupation.”
You need to adapt and grade an activity to address a client’s specific goals. But
you need to do that without the activity being contrived. I have a couple of kids
who will string beads as long as there is string [gestured a string as long as both
arms spread out]. Yes, for a child who is having trouble I may use a pipe cleaner
rather than a string, but I don't want it to be contrived. I don't need to keep doing
that just to make the activity harder in order to build strength and coordination.
The goal is to have them do the occupations their classmates are doing using the
same materials. To use it simply to increase strength is on the order of stacking
cones.
In the above example, the instructor problematized rotely applying activity analysis to an
occupation, stringing beads, to accomplish the therapeutic goals of improving strength
and coordination. Instead, she linked activity analysis to enabling clients to engage
successfully in the occupations they want and need to do within naturalized contexts.
Stand-alone body structures and tools continued to be made problematic through
structured lab activities. In anatomy lab, engaging students in a particular class-session
sequence accomplished this problematizing. One lab began with pairs of students
watching each other perform a task and identifying specific movements involved when
participating in the task, which the instructor followed by giving one student in the dyad a
movement limitation such as “unable to supinate the forearm.” The other student was

asked to watch the task performed again, this time with the specific impairment impeding

66

 

the performance, and try to identify the deficit. Afterwards, the instructor reviewed upper
extremity muscle groups and specific assessments of motion. This class sequence
communicated that the occupational therapy process is centered first on the occupations
that clients perform and works backwards to the specific deficits they experience and the
specific structures contributing to those deficits.

Another anatomy lab began by discussing a “functional motion assessment”; that
is, students began class by watching people on videotape move while involved in work,
household, and therapy activities. From the functional motion assessment, students
moved on to identifying possible reasons for the movement problems, which included
naming particular joints, groups of muscles, or innervations that may have been impaired.
Finally, students learned how to measure movement at specific joints and test the strength
of specific muscles. Again, through this sequence of lab activities, beginning with an
individual’s performance, then exploring anatomy specifically as it related to the
occupation, anatomy was reformulated around the subject of occupation.

By highlighting the process these lab instructors seemed to employ, I don’t want
to diminish the fact that students did complete these labs with specific knowledge and
skills in anatomy, biomechanical assessments, activity analysis, and dynamic
performance analysis, among others. Competent performance by students was deemed
highly important, but it was as if the skill development was treated as both ends and
means. As ends, the instructors ensured that students could demonstrate adequate
knowledge of the content and performance of a variety of assessments and interventions.
As means, the instructors set up skill development as a vehicle for creating a subject-

centered learning environment and mirroring a student-self capable of creating

67

 

knowledge about that subject. They selected readings and study questions, interjected
comments during lecture, sequenced content, and structured activities that would
continuously problematize knowledge and tools apart from occupation and situate it
“within the broader context of the human and the environment in which they’re moving
and functioning.”
The Subject Centered Classroom Discussion

As a teaching method, discussion is believed to help students explore diverse
perspectives, increase their tolerance for ambiguity, recognize their assumptions,
encourage respectful listening, learn habits of discourse, become co-creators of
knowledge, develop skills in synthesis of information, and become connected to a topic
(Brookfield & Preskill, 1999). In this study, discussion was used in both whole-class
format with the instructor acting as facilitator and in small student groups without a
faculty facilitator. In both formats, discussion was consistently used as a method for
“building personal and intellectual connections” (p. 29). As in the lab examples above,
classroom discussions were fluid and often combined with in-class activities, cases, or
mini-lectures. Also similar to the lab examples, faculty utilized discussion not only to
convey specific content but also as a means for centering content on the construct of
human occupation. Doing so involved an inductive process in which the faculty engaged
students in discussions of progressively widening foci. To illustrate, I have selected a
series of class discussions on the topic of handwriting because it is a common topic
within occupational therapy education and can illustrate that even common content areas

are not occupation-centered in themselves, but become so in how they are orchestrated

with other content and learner experience.

68

'«t‘. .4

Generally, students prepared for discussions having considered study questions
related to specific reading assignments, questions designed to familiarize them with the
reading and begin their own process of applying the readings to their out-of-class
observations, but not necessarily to be answered verbatim in class. In-class discussion
often began with the instructor presenting the broader context into which the topic at
hand fit. To begin a class discussion on the emergence of handwriting among pre-
schoolers, the instructor explained why she had placed the topic of handwriting within a
unit on literacy; she reviewed arguments within education research about the emergence
of reading and writing and then narrowed down to the “view most consistent with
occupational therapy,” that is, reading and writing emerge together and begin very early
in life.

Following a brief overview of the topography of the topic, discussion generally
began with the readings assigned for that class. At this stage of discussion, the instructor
seemed interested in helping students understand and connect to particular content. The
discussions related to handwriting generally centered on understanding data and
conclusions presented in research articles. For one discussion, the instructor displayed
graphic data from a study on handwriting among three-year old children. She asked
students to examine the data and discuss what capacities were emerging as handwriting
among pre-schoolers became more legible. She also asked what implications were
present for occupational therapy in the findings that the social construction of writing
exists even before children can perform the task.

Following class discussion of specific readings, the instructor broadened the

discussion somewhat to the students’ field experiences. She asked, “what have you seen

69

in your classroom related to writing?” In response, students offered numerous relevant
and some humorous stories. During this time, student experiences were often mirrored
back as examples of, or contradictions to, the research they were reading.

After a period of discussing experiences, the instructor broadened the scope of the
discussion once again to build a bridge from present content and personal experience to
the subject of occupation. Summaries like the one below were typically inserted
throughout discussion and seemed to relate the topic of handwriting to the larger subject
of occupation. m.

Now the researcher, because of her earlier study with adults, interpreted the

results as children using different parts of their brains for drawing a port hole

versus writing the letter “O.” From an occupational point of View, though, I would

interpret it as six year olds producing different performances as a result of

different meanings. . .So if we were looking for evidence of how occupational

performance is embedded in specific meanings attached to the occupation, studies

like this can help. This is an example of pulling occupational performance

information from studies not particularly focused on occupation.

The following extensive excerpt provides of taste of this ever-widening focus of class
discussion from specific readings to experience to occupation, but also suggests that it
does not occur quite so linearly but more as a fluid dialogue involving all three
components.

Instructor: What did you get out of the articles in terms of occupational meaning?

Student: That literacy is embedded in the environment from infancy, socializing

children into its importance.

70

Instructor: How do children know it’s important?

Student: From the environment. Like with this family I know, there are books and
magazines everywhere in their home, there is no television. The children see their
parents reading. So there is a continual stress on literacy in the environment.
Instructor: What did the author mean that ‘literacy is caught not taught?’

Student: Like Diane said, it is everywhere.

Instructor: So what are the environmental conditions for literacy? Sue came up

 

with one—games. What else?

[One student told a story from her day care about how songs are used to teach
letters. “B for Beatles and The Yellow Submarine, C for Cuban music, and so on.”
Another student told a story about the use of j oumaling in daycare. “They can’t write but
they all write in a journal and talk about what they wrote.”]

Instructor: Anyone see an environment where literacy is not present?

[Students offer a few examples]

Instructor: Did you see examples of storytelling? Why is storytelling part of

literacy?

[Students told stories about experiences in the classroom, including how children

pick up books and tell each other stories based on the pictures]

Instructor: Why do so many grow up illiterate?

[Students engaged in a rich discussion about poverty, about media being tailored

to a particular economic class, about family systems that reinforce illiteracy. Instructor

does not interject until students’ discussion wanes]

71

Instructor: Let’s talk about children with special needs. What happens that may
prevent them from developing literacy? Has anyone been a respite worker?
Student: I have. And a lot of times they come home from school and because they
are tired or because the parents have to do other things, there was a lot of
television watching.

[Other students add stories from their experiences]

Instructor: Contrast that with what was going on in your reading.

 

Student: They miss out on a big social component of literacy.

Instructor: I am sure you engaged that child socially, but think abut the difference

in the constructed nature of creating something versus sitting down and practicing

it. So bottom line these readings really help us capture what children need in order
to construct literacy. You can’t just focus on the technical skill of handwriting.

But this also links back to how occupations in general are acquired by children.

These readings are just as much about how occupations are acquired through an

emergent process of meaning. You could apply them to self-care occupations as

well.

The inductive process of beginning with specific readings and broadening to the
subject of human occupation was often matched with a parallel deductive process in the
sequence of class discussion. For example, the class session that began with the broad
context of literacy ended with a very detailed analysis of the mechanics of writing, which
is considered to be a “more traditional” approach to learning handwriting content. This
deductive sequence is similar to that used by the lab instructors. Through a sequence

whereby students come to the mechanics of practice by way of a core subject, the stand-

72

alone topic of handwriting was, in effect, problematized for its potential to become overly
technical and decontextualized, to become an end in itself. In this case, the sequence of
the discussion situated handwriting around the subjects of human literacy and occupation,
thus making the content a means for creating a subject-centered learning environment.

As a significant area of intervention among occupational therapists working with
pediatrics, the mechanics of handwriting, and therapists’ ability to identify specific
deficits limiting a child’s handwriting performance, were not ignored or deemed less
important. Student competence in pediatric occupational therapy remained of paramount
importance, but the content and skills necessary for such competence were also a means
for understanding and connecting to human occupation.

The Subject Centered Lecture

Similar to labs and discussions, lectures were rarely used as the sole method
within a class. Rather, the lecture often merged into discussion, sometimes coming back
around to lecture or other times playing out through ongoing interaction between the
instructor and students. One class, for instance, was structured as three mini-lectures
punctuated between each with a case study that students completed in small groups and
then reconvened for another mini-lecture. The lectures in this case were not unlike labs
and discussions in how they tended to begin. Generally, the instructor provided an
introduction to the topic that situated it in a larger whole, like a lecture I observed on
supervision of employees and another on health care finance. The instructor began by
associating supervision with the overall process of human resource management or
associating finance with environmental and contextual factors in health care and human

services that bear upon financial management of a therapy program. The instructor

73

 

associated both topics with the expectation that students become change agents in
occupational therapy, explaining that human resource and financial management were
two tools that would enable them to enact that role. From the introduction, the lecture
generally included a fluid mix of presentation by the instructor, discussion, questioning,
and reference to supportive materials.

The lectures I describe here were not so evidently centered on the subject of
human occupation, but they seemed to accomplish something similar to what Brookfield
and Preskill (1999) described as “an opportunity for teachers to model the forms of
democratic dispositions they wish to encourage” (p. 46). The presentation was
undoubtedly a means for communicating content, but in addition appeared here to model
scholarly dialogue and offer images of who the student may become in the field. To
illustrate, I have chosen lectures on work, statistics, and supervising employees, all from
separate courses and given by different instructors.

In a presentation on the history of work, the instructor led students through
changing notions of work in the twentieth century as depicted in film clips, songs, and
writings. Her video and CD selections journeyed through the meaning of work from
hunting and gathering, agricultural, craftsman, and urban societies. With each stop along
the way, she asked students what themes they heard in a song or metaphors they
identified in a video clip. After student responses, she asked questions like, “Where do
these themes get played out as cultural myth?” and followed up with, “Have you ever
heard of the family farm? That image is used by lobbyists to justify supports for farmers

even though the money largely goes to industrial farms. F arming is mythic.”

74

During the part of the presentation on artisans, she drew students attention back to
the core subject by interjecting “you could think of occupational therapy as a crafi,” and
“this is part of the way we have thought about ‘doing’, isn’t it?” After reviewing
scientific management in work, she noted, “sounds a lot like our activity analysis, right?”
Through these comments the instructor helped tether the lecture to occupational therapy.
But through the lecture overall, she appeared to model a type of scholarly dialogue

exploring the meaning of occupation within the surrounding culture and how that

ha:
.

meaning is picked up by occupational therapy and translated into various practices over
time. In modeling and engaging the students in this form of dialogue, the instructor
seemed to mirror to the students an image of themselves as capable of such engagement.

In a lecture on research methods, the instructor used PowerPoint to review
common statistics. She reviewed t-tests, chi-square analysis, and analysis of variance,
answering student questions (or more commonly deflecting student questions back to
members of the class). After the review, the instructor projected a table of data fi'om an
article written by occupational therapists in the Journal of American Medical Association
(J AMA). She asked students to use the table to identify types of variables in the study,
then, more specifically the categorical, nominal and ordinal variables, followed by, “what
tests were used in the study?” The instructor projected two other data tables asking a
series of questions about each and engaged students in a discussion about the research,
after which she commented how capable students were of “reading a JAMA article and
making sense of it.”

The lecture returned to a review of other statistics like analysis of co-variance and

veered into a discussion of clinical trial research. The instructor remarked that clinical

75

trial methods have advanced to the point of being able to control for complicating
variables without changing the intervention or the treatment context, “which is why I am
so intolerant of people who do clinical interventions and claim it can’t be studied because
it is too complex.” A student interjected, “but how can you do that and still have a life”?
The instructor responded, “If you are coming up with innovative treatments, then you
take them and put them in the larger context of the literature and scientific meetings and
other practitioners. You may have a family, like to ski, like to play the guitar, walk the
dogs, whatever, but that does not absolve you from acting professionally. Read, go to
scientific meetings, you need to go.” While the content of the lecture-discussion was
statistics, it also seemed to mirror an image of who the students may become in the field.
Another series of lectures focused on human resource management and financial
management. The presentations were well prepared with handouts, overheads, or
PowerPoint and lecture notes but, like most of the lectures I observed, had a very loose
structure, allowing a significant amount of student questions and comments and
flexibility in how the content proceeded. In the presentation on financial management, the
instructor originally arranged students’ desks into pods of three, planning for small group
interactions at intervals throughout the lecture. However, the whole-class discussion in
which most all the class participated was adequately engaging that she scrapped her plans
for small groups, explaining to the class that she “had made a note after last year’s lecture
to add in small group component because they were not talkers and the lecture ended
thirty minutes early. I had forgotten your class is not like that [student and instructor

laughter] and that we probably didn’t need small groups. Don’t take that the wrong way;

you are asking great questions.”

76

in

But as in the methods described above, the lecture-mix seemed to focus not only
on relaying content about administration but also on enlivening the students’
imaginations about who they may become. The following excerpts were taken from the
instructor’s presentation on supervising and evaluating employees. These comments were
artfully interspersed with traditional lecture content such as defining terms and describing
the steps and process of doing a performance appraisal, but illustrate how the instructor
presented these as something the students are doing, thus creating an image of who they
may become:

...And as a supervisor you are responsible for evaluating the performance of the

people you supervise and making decision about promotions, raises, disciplinary

actions, rewards. It is often your first position as you move into a more
administrative structure. It is among the most rewarding. . . .and it is the most
difficult potentially because not only are you giving positive and developmental
feedback, helping someone’s career, there are times when you are dealing with
problems. And you are dealing with decisions that can affect someone’s
livelihood and their continuance in a position. So it can be quite difficult when
you are on the problem side the human resource cycle. . .A lot of our focus today
is on that problem side. . .It is not unlikely that an employee that you recruit,
interview and hire, you find yourself in a problem situation with them. It is
difficult. . .the broader perspective you have about why you do appraisals the more
likely they will be positive. Your ability to do a good appraisal rests in having
done a thorough job in those earlier steps in the HR [human resource] cycle. . .If

you don’t take the appraisal process seriously it is not going to have the power it

77

can have. In that leadership position, you have to set that tone that these are
important...
Across these lectures students were introduced to required content, but equally offered an
image of themselves as scholar, researcher, and leader mirrored through the content.
Summary

Each of the methods described above, lab, discussion, and lecture, was used
consistently with “active” learning principles. That is students were actively engaged in
reading, writing, discussing, questioning, and practicing. But active toward what ends?
Scholars have promoted active learning for the ends of competence, critical thinking,
liberation, community, perspective transformation, voice, citizenship, and others. Here
the methods also seemed employed toward the ends of helping students author
knowledge around the core subject of human occupation and to glimpse an image of
themselves as capable of creating knowledge, participating in scholarly dialogue, reading
research, and leading a therapy department.

Brookfield and Preskill (1999) suggested that teaching methods are not
paradigmatic in themselves but employed in service of a particular paradigm. As means
for constructing knowledge and selves, it could be said that the methods described here
were employed in service to a constructivist paradigm. But even within that paradigm the
methods were directed toward specific constructions of knowledge due to the core subject
of the discipline. Teaching centered on a core subject, in this case, entailed employing
methods to tether content carefully to the subject and mirror a knower-self to learners,

reflecting the dual process that Palmer described: that to enter a relationship with a

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subject also entails becoming a knower and dialoguer and inventor along with that
subject and in community with others.

Thus far, I have presented occupation-centered education as employing teaching
methods as means to connect content to a core subject and reflect potential self-images to
learners. But this portrayal omits other key features of occupation-centered education as

practiced in this case study. The next four chapters describe instructional methods,

1

knowledge construction, and self-authorship within a more complex tapestry, inseparable

fiom the biography of the individual educator and the historical context of the discipline. 1.

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Chapter Six
Constructing a Self in Relation to Others: The Issue of Authority
In the previous chapter, I suggested that as means of constructing knowledge
around a core subject and the ensuing self who engages in that process, teaching methods
in this study were generally employed within a constructivist paradigm. While
constructivism became the overarching story in this study, it was by no means told in the
same way by any two tellers. What exactly students were actively constructing varied
from instructor to instructor and reflected to some degree the key experiences of
individual faculty biographies. The educational biographies faculty told encompassed
stories about who they had become as therapists and educators as a result of positive and
negative experiences in occupational therapy and their lives in general. Across their
biographical stories, the selves they had become bore witness to the self-projects into
which they invited their students.

I am using the term "self-projects" to refer to those areas of self-development
faculty seemed to inspire in their students. Traditionally, occupational therapy education
has promoted self-development through reinforcing behaviors felt appropriate for
professional persons (F idler, 1996). Professional behaviors are often explicit “skills”
association with an external set of standards believed to represent the generic
“professional.” Students often receive counsel about, or even grades on how sufficiently,
their professional behaviors are exhibited. However, the self-projects in this study were
quite different from the traditional emphasis on development of “professional behavior.”
The self-projects described here emphasized desired ways of being over specific

behaviors. The ways of being were not “out there” in the form of an objective checklist,

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but emerged from significant experiences in faculty members’ lives that had become one
of many ethics for their teaching.

Therefore, in this study self-authorship provided another framework, though
mostly implicit, for understanding how faculty helped students develop as a particular
kind of professional. The professional self toward which faculty nudged students was not
a single entity but involved multiple projects, each addressing slightly different issues
and each associated with slightly different epistemological development. Some of these
self-projects included: 1) developing the self in relation to others: the issue of authority,
2) developing the self in relation to occupation: the issue of personal experience, 3)
developing the self in relation to knowing: the issue of authoring knowledge, and 4)
developing the self in relation to transformation: the issue of authoring practice. In order
to keep faculty narratives as whole and continuous as possible, I have assigned one
faculty narrative to each subheading throughout the next four chapters. However, by
using this structure, I do not intend to portray that the issue under discussion was only
exemplified by that individual faculty. Instead, I believe that most faculty exemplified
each issue discussed and recognize several faculty, each with slightly different nuances,
in each of the descriptions provided.

Constructing a Self in Relation to Others: The Issue of A uthority

For their students, faculty envisioned development toward a self in relation to
others that reflected a challenging tension. They desired development of a self that
respects and honors the “otherness” of clients, while respecting and honoring
occupational therapy’s own unique “otherness” in the health care community. This was a

self that recognized when to relinquish authority for the sake of promoting the authority

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clients have over their own lives, and when to hold on to authority for the sake of
promoting and upholding the authority occupational therapists have over their own
knowledge.

Both sides of the tension were embedded in varied and individual experiences
among the faculty—life experiences that, upon reflection, had become guideposts for
teaching. As guideposts, these experiences influenced the methods and instructional
processes faculty employed in the classroom to aid students toward their construction of
such a self. For example, some faculty described key life experiences that propelled them
to feel deeply about issues of respect and authority in the classroom. These faculty tended
to be conscious about student voice and about monitoring their own power or authority-
role in the classroom, inviting students into a collaborative relationship. One goal for
their classrooms was for students to develop selves that were respectful of others and
aware of issues associated with the power and authority they have over clients by virtue
of their position as “professional.”

Other faculty described experiences of frustration over occupational therapists’
own diminishment of what they know. These faculty tended to be conscious about
student accountability for knowledge and students’ ability to articulate and defend their
ideas. One goal for their classrooms was for students to develop selves that were sensitive
to power issues among medical professions and not to allow their knowledge to be
disabused. Both sides of the tension were present in faculty’s stories about themselves,
but one side generally held preference, though not without signs of the other side, in their
classroom approaches. The following examples illustrate how the interplay between

faculty experiences and the selves constructed from those experiences around the issue of

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authority became the selves they desired of students and toward which some of their
instructional processes were directed.
Honoring And Respecting The Authority Of The Other

Sue, having moved during her early high school years from the segregated south
to the desegregated north, learned the importance of openness to others’ experience and
of working to understand the “different worlds” people experience because of their
unique backgrounds. At the same time, her new teachers “were interested in me as a
person, and my view points, and seemed to be more concerned with my growth as a
thinker and a politically active person than I had experienced before.” Because of both
the social climate of the time and the teachers who evoked an aspect of her identity, Sue
experienced “a real transformation from being fearful of anybody different from me to
finding a fascination with people... a curiosity about their experiences and their world.”
Instead of taking the more popular high school history track that year, Sue enrolled in the
minority history track and studied issues of immigration and diversity.

Her desire to listen to others’ voices and understand their experiences carried over
into her early work in elementary education. In working with children, Sue found
pleasure in the relationships she established with them, and from that pleasure, she
learned that social relationships were really her “way of being” both in the classroom
with young children and in the classroom with graduate students. Sue finds in her
teaching a “strong theme of being respectful” and being cognizant of relationships. She
said, “the way I think about it. . ..I’m trying to understand the students from where they’re

coming from, all their worries and goals and secrets and influences, and understand and

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respect their growth in all these ways. . .I want students to know that I see them as whole
people, not just as a student.”

Not only was building respectful relationships with students and promoting
similar relationships among students Sue’s overall “style” in the classroom, she preferred
to play out this style in class processes and assignments in specific ways. Student
experience was highly respected in Sue's classes. Whether the topic was selecting
fieldwork sites, conducting a functional assessment, or working with an interdisciplinary
case study, students were asked to share personal experiences related to the topic at hand.
In a presentation to graduate social work students, Sue and her co-presenter began class
by asking the students to share their experiences working on an interdisciplinary team. In
turn, Sue shared her personal experience with social work. She explained that her mother
was a social worker and how she felt that through her mother she “had learned a great
deal about how social workers think.”

Student experience was not merely an icebreaker for the class with social work
students, but continued to play a vital role as students worked collectively on a case
study. As students discussed elements of the case, Sue carefully related back to the
students’ experience. For example, when discussing that the person in the case would
often choose to go off her medications, Sue said, “I bet many of you have had experience
with people with manic-depression and know the struggle they have with maintaining a
medication routine.” Sue not only related the case to student experience, thereby
validating and respecting their prior knowledge, but also modeled the empathy she

desired students develop for clients’ struggles.

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In another interdisciplinary class on gerontology, Sue’s style of authorizing the
experiences of students stood in interesting contrast to the medical doctor with whom she
was co-facilitating. Students in the class were asked to read a case study from a text co-
authored by Sue and the physician. Following a few responses to the case by students, the
MD. asked students to “turn the page and see what goals we established for the patient.”
But Sue quickly interjected, “you know, let’s have them generate their ideas first. I’m not
even sure I like the chart we created [in the text].” In effect, though an expert herself, Sue
de-authorized her expertise in respect for the students’ capacity to generate their own
ideas, and as the class came to a close, Sue’s final comments translated the respect she
showed for students into the respect she desired students to develop for one another: “no
one discipline owns a particular category such as ‘home evaluation’ or ‘activities of daily
living’. We all address these areas in very different ways and we address very different
issues related to the category.”

Not only did Sue authorize student experience through eliciting their stories,
relating class content to experience and validating their ability to generate ideas, it was
also common to see Sue taking notes on student comments. In a seminar with students
returning from fieldwork, Sue listened carefully and took notes as students relayed their
experiences. At intervals in the discussion she would stop, saying, “let me see if I can
summarize back to you what I hear and what I think I can address with clinical
instructors.”

Sue’s assignments also reflected her desire that students develop a self that could
authorize the experiences of others. She described assignments, journal writing was one

example, that included student reflections on experiencing simulations of vision or

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movement impairments that clients encounter, expecting that students develop empathy
for others. Sometimes assignments were actually graded on the depth of the students’
reflection in hopes that the result of such reflection would be that students “will never
have this barrier that the people who are their clients, are something other than
themselves.” Her desire was that students develop a self that could enter into the
experiences of others respectively’and compassionately, not intrusively or nonchalantly.
“I’m wanting the students to be like me in the way they will relate to patients, and people,
and use their interactive skills.”

While development of a respectful, compassionate self was prominent in Sue’s
teaching approaches, signs of the other side of the authority tension, selves that hold on to
authority, were present as well. In an interdisciplinary class, a conflict ensued between
occupational therapy and physical therapy students. Sue chose not to intervene or insert
herself in the debate. She felt that students would need to represent themselves to other
disciplines and articulate what occupational therapists do countless times across their
career. She also encouraged her students to boldly represent their knowledge on a public
level. Her students presented a series of papers at a state occupational therapy conference
on “The Use of Disability Narratives to Guide Research and Best Practice in
Occupational Therapy.” Students read disability narratives for how autobiographical
experiences could serve as a source of knowledge for research and practice and then
presented that process and its potential to improve practice. Ironically, in that conference
experience, students were simultaneously engaged in developing selves that could give

up authority and enter into the illness experience of clients and selves that could assume

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authority about the relevance of the illness experience, not just the diagnosis, to
occupational therapy practice.
Collaborating With The Authority Of The Other

Like Sue, Jenny had several educational and professional experiences that evoked
her preference for a collaborative, nurturing classroom environment with students. When
Jenny was an occupational therapy student, she experienced instructors who took a
nurturing and collaborative approach with her and her peers. One instrumental instructor
affirmed Jenny’s ability to explain concepts clearly and practically. But the lesson she
learned from those instructors about support and collaboration was enlarged through the
contrast she experienced with another instructor during fieldwork. The fieldwork
instructor was somewhat intimidating and condescending, showing little interest in
Jenny’s ideas and questions except to analyze and sometimes criticize them. Jenny
reflected, “that experience made me want to nurture even more,” even as she recognized
that there are benefits to other, less nurturing classroom approaches.

As an occupational therapist, Jenny had several additional experiences through
which she learned more about herself as a collaborator with others. Specifically, in the
medical setting, she discovered how easy it can be to take on the “authority” role with
clients, but how important it is instead to give clients their own authority and to take on a
partner role in helping them achieve functional goals. This self-awareness happened
through working with clients who were not going to “get better” physically, but who still
had goals for what they wanted to achieve such as to obtain a job or to live independently

in an apartment.

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I think working in in-patient rehab you can get very seduced by the magic of
recovery and what part you play in that—how you might facilitate it, the
placement of your hands, or the way that you use a certain modality might be the
thing that is going to change somebody's life for the better. But these folks asked
for much more of a partnership. They could establish for themselves what the
problem sets were. They knew what the issues in their life were and they knew
what they were trying to achieve. They just needed some resources and some
problem solving help to get there.
Through her relationships with individual clients and through other professional
experiences such as working within a housing community and a transportation
department, or working to change systems like the rituals around dining in a nursing
home, Jenny became someone who could recognize, promote, and work through, the
authority of others.

In the classroom, Jenny told stories to students about her clinical experiences,
stories that highlighted the self as empowering others through the sharing of authority.
She viewed the stories as learning tools, in hopes that students also develop selves
sensitive to the expertise of their clients and to collaborative relationships with families,
staff, and other professionals. Jenny also used her own relationships with students to
model that'relationship, hoping they in turn would develop similar relationships with
clients. She very consciously resisted establishing herself “in a position of power” with
students, assuming a role as fellow-leamer:

...That is the modeling piece. My interaction with them is hopefully one of

respect for where they are, that they bring a lot of experience and exposure to

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various things with them as they come into the program. . .Hopefully that

translates into seeing people that they work with in the same way.

Jenny also shared subj ect-matter authority with students through a question and
answer process that put the students in a position of identifying what they knew and
relating what they knew to what they might do in practice. Jenny filled in with her
knowledge on the topic when she felt students were missing something important. For
example, in the following excerpt from a lab session on range of motion assessment,
Jenny does not simply offer information on measuring joint movement. She joins
students in a shared process of generating the information:

Jenny: If you have full passive range of motion but decreased active range of

motion, what do you suspect?

[Student answers and shows her own hyperrnobile joints in her wrist and fingers,

followed by laughter about her “condition.”]

Jenny: But you bring up a good point—What is normal will vary from person to

person. What is functional range of motion?

[Students answer]

Jenny: So someone may have decreased passive range of motion and active range

of motion but adequate for what they need to do. . . .What is an ‘end feel’ [of a

joint]?

[Student answers]

Jenny: We are going to go through these definitions and then practice them.

Although everyone has different end feels in our body there are generally three

types. What would cause a soft end feel?

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[Students answer]

[Jenny builds on student comments, offers examples, and demonstrates on her

own body.]

Jenny: What are the precautions and contraindications related to these? You’ve

watched someone move in context of an occupation-based task, you’ve decided

you need to measure range of motion, what would be the reasons that would stop
you?

[Students list contraindications]

[Jenny rewords student answers] Why would that be a problem?

In the above example, Jenny shared her own subject-matter authority with the
students’ growing knowledge of range of motion assessment and contraindications. At
other times, she allowed students to fill in gaps for her. In one class a term came up that
Jenny did not know. She turned to the class to see if anyone knew what the term meant.
In response, students looked up the definition and read it for the class. In another
example, Jenny couldn’t remember the exact names for bony structures of the wrist. “The
T’s stand for Trapezoid and Trapeziurn but I can never remember which is where. What
does your book say?” In both examples, Jenny shared knowledge authority with students
thus modeling the particular self she desired they develop in relation to sharing authority
with clients and other professionals.

For Jenny, developing a self that can share, and sometimes relinquish, authority
was significant because in her view such a self was fundamental to client-centered and
occupation-centered practice. In her experience, prioritizing the client’s goals over the

therapist’s goals, genuinely promoting the occupations the client wants or needs to do,

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I.“

discerning the occupational needs of an older adult population in an apartment complex
or the effectiveness of city transportation services for the disabled all required a different
stance toward “the other” than Jenny experienced in her early years in rehabilitation
hospitals. It requires a self that can “give way” to, and merge professional expertise with,
the clients’ and staffs’ expertise.

Paradoxically, though not always as evident, Jenny told other stories and taught
content in ways that reflected a self that could uphold the authority of the occupational
therapist’s knowledge. She told the story of how she acquired a job, not advertised as an
occupational therapy position, by educating the employer about how the knowledge, skill,
and roles of an occupational therapist were well matched to the advertised job
description. In addition as I observed Jenny teaching anatomy, it became apparent that
she taught it in such a way that emboldened students not to give way to the “glamour of
naming body structures” but, instead, to understand and reconstruct anatomy through the
authority of knowledge about occupation.

Declaring One '3 Own Authority

While Sue and Jenny represented different aspects of the self who non-
authoritatively steps into the experiences of “the other”, Wendy represented the other side
of the tension—the self who does “not trivialize” her own knowledge or “give up power
to others.” Like Sue and Jenny, Wendy’s notion of the self was rooted in her experiences
as an occupational therapist and became a guidepost in her teaching, influencing the
classroom processes she employed. Before becoming an occupational therapist Wendy
worked in a camp for children with autism. It was there she saw “occupational therapy as

psychology-in-action” and witnessed the transformative impact daily routines and

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to. l‘_-—‘-T

activities had on those children. But five years later, she was disillusioned with the
profession and making plans to leave occupational therapy. She was disillusioned
because the occupational therapy she experienced professionally was nothing like the
transformative experiences offered the campers. Instead, she observed therapists, caring
and kind therapists, uncritically applying procedures to disabled bodies. The procedures
lacked common sense to her and the selves of the therapists were anything but engaged in

their work or with the children to whom they applied their “magic.” What she

‘ £7? IO4W‘“ 1

experienced was “almost like. . .a complete selling short of how profound OT is.”

Afier several ventures into other employment, Wendy gave occupational therapy
another chance, remembering how buoyed by it she had been earlier. This decision set
her on a trajectory of experiences that again impressed her with the profundity of
occupational therapy. Hence, the contrasts of her career, contrasts between “seeing how
bad occupational therapy can be juxtaposed to how incredible it can be,” ignited a
passion for not selling the profession short in any way. Therefore, one of her guideposts
as an educator became:

“I don't want any graduates in this program ever to trivialize OT. You know, it's

like I'll disown you if you do! Don't ever trivialize this because it's really

important and powerful. And don't give your power away just to fit into a niche.

Don't just adopt techniques and learn how to mimic them."

In class, Wendy used questioning as an instructional method to challenge students
to be accountable for their own intellectual processes and knowledge. She called on
students by name to register their thoughts on a topic, to “stand and deliver.” She

deflected student questions and comments to other students to engage them in dialogue

92

and sometimes disagreement. She commonly asked students, “can you say more about
that?”, “does everyone agree?”, “did everyone hear what she said?”, “can someone
restate what [name of student] just said?”, “who disagrees?” Wendy felt strongly that
students needed to authorize their knowledge through participating in discussion and
debate and she worked to create an authorizing climate in the classroom.

In one research class, a student asked a question about ordinal values. Rather than
offer an answer right away, Wendy attempted to elicit an answer from the student asking
the question. She offered clues and the student formed tentative responses to which
Wendy replied, “I hear you say the words but I’m not convinced you are connecting it.”
The student agreed. Wendy turned to the class and asked, “how many of you feel like
Nicole?” Hands of most of the class went up. “Who did not raise your hand?” One or two
hands went up. “OK, Melanie, could you explain it?” Melanie then explained the
concepts Wendy had tried coaching Nicole through. Then a student asked her peers if
someone could offer a similar explanation of a Chi-Square analysis. Wendy asked that it
be “someone we haven’t heard from today,” encouraging a different student to come
forward with the answer.

In another research class, students struggled to understand the coding process for
qualitative data, asking for clarification about the “steps” for coding and feeling confined
by their original research question and conceptual framework. One student became
concerned she had made the boundaries of her study too narrow. Wendy replied, “yes,
you start with a defined boundary, but as you go, you’ll find things outside that boundary
that are really important. You are allowed to look at things outside the boundary and to

be led by your data. . .It is a very common sense procedure. I am requiring you to put out

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‘ “I

there how you as the researcher focused and why you started one place and went
another.. .You are led in very specific ways, give yourself permission to go outside the
boundaries. . .but get to a very disciplined account of your own thinking.”

When asked after class about students’ struggles with qualitative analysis, Wendy said,
“the struggle is with being accountable to and owning their intellectual process and
commitments they are making. Instead they want to revert to rules and to external notions
about the steps they should take.”

Wendy also told stories from her own clinical experiences that reflected times
when she was faced with her own hypocrisy in relying on others to help her provide solid
therapy to clients instead of standing and delivering that herself. One story she told
contrasted two occupational clinics in which she worked, Clinic A and Clinic B. Wendy
left Clinic A frustrated with occupational therapists who allowed themselves to be
“victims of the system.” At Clinic B, however, she found herself acting similarly to the
victim mentality she had criticized so strongly, until a supervisor challenged her, “if we
don’t have what that patient needs, you’d better find a way of getting it.” Wendy
contrasted the therapy of Clinic A and B on several issues and concluded her story by
explaining that a “new understanding” that has taken hold in the field in the last ten to
fifteen years.

The understanding that you are responsible for the development of your own

knowledge base. It’s not out there that you can have it poured into you, not a

technique you can get mastery of and then you have. You are responsible for a

dynamic process of learning, of clarifying your base of knowledge, of challenging

it, recognizing its deficiencies, and moving forward.

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The self that does not relinquish authority to others was significant to Wendy,
who felt strongly that “the world is in such need for fabulous occupational therapists,
meaning someone whose practice is theoretically sound, is evidence based, is authentic in
terms of relationship building, and is strong in terms of occupational science.” She
wanted to see each of the program’s graduates represent themselves “as occupational

therapists,” whether in traditional or innovative practices, and not as a “less-than

——". ———.'—"

profession.”

But even in her desire that students build selves comfortable with the authority of
their profession were hints that they simultaneously need selves capable of hearing and
respecting the voice of “the other.” She admonished students as researchers to consider
the authority that goes along with that role and find ways to represent, not diminish, the
voice of the children they were observing and with whom they were interacting. She
related the need for “authenticity in relationships” to be the core of good OT. “Form real
relationships. Don't just talk over them like they're not there while you do your things to
them."

Epistemic Development Associated with the Issue of A uthority

Sue, Jenny, and Wendy together reflected an understanding that occupation-
centered education involves helping students become comfortable in both sharing
authority with clients and holding on to the authority of their own knowledge about
occupation with other professionals and in the ways they enact practice. The classroom

methods they utilized generally engaged students in negotiating both sides of this tension.

95

But in order to help students coordinate the donning and doffing of authority, it
seemed the faculty actively engaged students in making an associated epistemic shift. As
faculty nudged students toward both poles of the authority issue, they seemed also to
nudge students from a view of knowledge as something possessed and disseminated by
experts toward an understanding of knowledge as variable and democratic. To grant
authority to the subjective knowledge of clients as well as to their own disciplinary
knowledge about occupation seemed to involve students in actively crossing over to a
view that knowledge comes in many forms and from multiple sources, each of which
required validation, respect, and advocacy. Viewing knowledge as democratic enabled
students to pursue, in a respectful manner, the knowledge within clients' lived
experiences and also to represent their own knowledge, with confidence, as legitimate in
the health and social service arenas.

In addition, Sue, Jenny, and Wendy together helped students understand authority
as a concept that shifts and relocates itself, sometimes resting primarily in others and
sometimes in the students own self. Whose knowledge and what knowledge "counts"—
that is, whose authority is upheld or resisted—is developed within the dynamics of
particular interactions. Therefore, the issue of authority itself becomes constructed and
reconstructed again as students place themselves in changing locations on the continuum

between subjective and disciplinary ways of knowing.

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Chapter Seven
Constructing a Self in Relation to the Subject of Occupation:
The Issue of Personal Experience

The “self” students were asked to develop in relation to others was one who could
enter into the experience and authority of the other as appropriate. The “self” students
were encouraged to develop in relation to the subject of occupation was one who could
enter into his or her own experiences, thus making the subject of occupation neither a
distant, objective, nor pre-packaged subject, but a personal one. I can imagine one of the
more fi'ustrating dilemmas for occupational therapy students is discovering how central
their own lives become as texts for the core subject of the field, human occupation.
Having entered graduate school perhaps anticipating they would acquire a body of
knowledge and set of skills packaged as “occupational therapy,” instructors soon begin
asking students to study the daily routines and rounds of activities of their own lives. The
faculty in this study seemed to nudge students toward the subject of occupation, not as
something “out there”, but as playing out in the midst of students’ own experience.
Students were invited to become partners, to enter into dialogue, with that subject.

Most, if not all, faculty in this study were similar to the following examples
represented by Virginia and Ruth. They were personally connected to the subject of
occupation through the fabric of their own lives. They engaged in an ongoing, habitual
dialogue between personal experience and scholarship in the field as a source of their
own learning and professional development. Through varied experiences, faculty had
constructed selves who, on the one hand, used personal experience as a source of

knowing occupation and, on the other hand, used the scholarship of occupation as a way

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of understanding personal experience. For some, the personal experience-scholarship
dialogue had become another guidepost for teaching. Faculty structured courses and
designed assignments that invited students to develop a dialectical relationship between
personal experience and core subject matter.

Prior Personal Experience as a Basis for Knowing Occupation

Earlier in her career, Virginia had been on the verge of leaving occupational
therapy when she began to learn about emerging scholarship referred to as “the model of
human occupation” (Kielhofirer, 1977, 1983). The model provided a theoretical and
empirical basis for understanding elements of human performance and how those
elements are dynamically assembled to produce occupational behavior. For Virginia, the
fit between the model of human occupation and her own life experience was instrumental
in her decision to remain in the profession.

I think I’d have to say it was the model of human occupation that really pulled me
back into OT. It just made it make sense to me. By then I had a lot of life experience to
draw on. I knew what it was like to be at home with nothing to do except deal with kids
and knowing that I didn’t want to be there doing that in that way—how that felt. I’d also
lived out of the country for a year. These were things that just helped me better
understand the value of occupation. ..

Even much earlier in her life, Virginia’s experience with what she called “the
problem of boredom” reflected an awareness of the value of occupation She described:

I can remember going on family trips when there were six kids in my family and

I’m right in the middle. The older three weren’t around anymore. I would put

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together collections of things for my baby brother and my little sister to do in the

car. So, it’s always kind of been there.

For Virginia, the subject of occupation was not “out there” in objective and
general terms. It was personal. It made sense through the particulars of her occupational
experiences. With a Ph.D. in anthropology, one of Virginia's occupational experiences
and interests was reading from a wide array of literature spanning, among other content
areas, anthropology, psychology, and folk art. She tended to engage those readings in a
conversation with the subject of occupation. A personal experience-subj ect dialogue had
simply become part of what Virginia did: read broadly and bring the readings to bear on
occupation and occupation to bear on the readings. “So, I don’t know, it’s just who I
am. . .I think you can use whatever kinds of things you’re interested in the same way...
that’s what occupation’s all about. I mean it really is.”

In turn, Virginia invited her students into the particulars of their lives asking them
to use their occupational experiences as a source of knowing and asking them to relate
occupational scholarship to their particular experiences. A dialectical relationship with
the subject had become one guidepost for her teaching. One assignment in Virginia's
course especially depicted this guidepost. The assignment had two parts: one, students
created a collage representing “themselves as occupational beings” and presented it in
class to their peers and, two, they wrote a scholarly paper relating their collage to the
course readings. Most students organized their collages to depict their occupations in
three categories, self-care, work and play-leisure occupations. To their peers, they
presented the specific tasks that constituted those occupations in their lives and how the

occupations had changed for them over time. Some talked about the meaning particular

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occupations held for them and most related their individually-experienced activities to
one or more concepts from the course readings.

After the presentations were completed, Virginia asked the class questions to
promote the personal collage as a way of knowing and help students connect their own
experience to the subject of occupation. She asked about gender stereotypes present and
broken in the collage-depicted occupations. She asked questions to note the array of
individual meanings associated with self care occupations; that is, some students
experienced self care as tasks to be gotten out of the way while others experienced these
tasks as expressions of a deep family heritage. Virginia asked the class to consider an
assumption being made about leisure occupations: that play/leisure activities are to be
limited while in graduate school. “Where does that assumption come from? Who
generates it? And what would really happen if you took that hour per day to do the thing
you think you can’t afford time to do?” Virginia also tried to engage the students in a
discussion about "making something" as another way of knowing. But students seemed to
have difficulty shifting their discussion from the content of the collages to what they
came to know through the process.

Through making, presenting, and discussing the collages, not only did Virginia
invite students to enter a dialogue with the subject of occupation through their personal
experience, she also invited them to rearrange their ideas about who they were and to see
themselves as possessing experiences that could lead them to know. Toward this self-
development, Virginia invited them to take their lives, and the assumptions embedded in
their occupations, and use them as a means of entering into a dialogue with the broader

subject of occupation.

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In another class, Virginia again demonstrated the use of personal experience as a
co-text to course readings. In this instance, she used group discussion to help students
reflect on the concept of leisure and the nature of leisure occupations. She began the
discussion by asking students about their own experiences with leisure. As the students
commented, Virginia asked follow-up questions that linked their personal comments to
the subject. She prompted them to comment on the relationships between mental and
physical leisure, restful and unrestful leisure, the reality or myth of “free” time, and the
leisure/work dichotomy. In response, a student shared she found cleaning to be leisure.
Virginia followed the comment by writing “cleaning” on the whiteboard. From there, she
asked students to generate knowledge from their own experience about what makes
cleaning “leisure” and what makes cleaning “work.” Then, using the distinctions made by
students, she reviewed the characteristics listed as work and labeled them as "things that
all deal with time or the perception of time.” Summarizing the discussion, Virginia
stated:

You can take most any occupation and fit it in all three categories [work, leisure,

or self-care]. It is not very neat. That is where occupational performance areas can

be a barrier to understanding the meaning of occupation. So if you are using tools
like the Canadian Occupational Performance Measure, you also need to tease out
what the meanings are. I applaud Jackie for saying cleaning is never leisure for
her.

By contextualizing class readings within the particulars of students’ experience,
Virginia helped introduce students to the subject of occupation as a personal subject, not

a distant body of facts and skills, and she helped introduce them to a revised self who

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could view experiences as sources of knowing. I-ler teaching methods varied, but whether
using an assignment like a collage-and-paper or using group discussion, Virginia nudged
students to develop selves capable of entering a dialogue with occupation through the text
of their lives. Thus a slight paradox became apparent in Virginia’s teaching: in order to
learn occupational therapy, students first learned “that it is not about therapy.” Virginia
intentionally took out readings about “therapy” from her course “because I want them to
appreciate occupation and how it plays out in their own minds and lives of people in
general first. I think that has to be the basis.”
Structured Personal Experiences as a T ext for Knowing Occupation

In Virginia’s class, students were invited to develop a self who valued the
particulars of their prior experience as a source of knowing. They often started with their
personal experience and worked outward into the world of scholarship related to human
occupation and then backward again to new interpretations of their experience. In Ruth's
class, students engaged in a similar personal experience-scholarship dialogue, but Ruth
often began with scholarship related to occupation and asked students to use it as a basis
for interpreting structured learning experiences. Typically, students read literature related
to child development then conducted field observations of infants and young children,
using the scholarship as a frame for interpreting what they observed as well as using their
observations to understand and offer critique of the scholarship.

Ruth’s own learning biography reflected a similar dialogic between research and
observation. As a graduate student, Ruth discovered that she loved “disconnects”; she
learned best by identifying gaps between current research and what she saw and

experienced in her work with children and by entering a conversation with the

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discontinuity. Reading research and watching the children with whom she worked created
interesting disconnects between knowledge and practice, disconnects that kept propelling
Ruth forward to obtain more education and complete her Ph.D.

I started running into ideas that conflicted with the traditional OT

practice. I came from a very strong NDT [neurodevelopmental treatment]

background in the program where I was working...l had done a lot of continuing

education in that domain and so when I went to graduate school I started
discovering new ideas and places where NDT [neurodevelopmental treatment]
didn't work...I realized that the NDT approach was new but what they were
talking about in terms of child development—cognitive, social, emotional aspects
of the child as a person—wasn’t matching what I knew and saw. So, I'd already

started to become dissatisfied with practice. The combined effort of taking what I

knew and adding it to how OT's were practicing at the time was fun...then that's

where I started going "but it wasn't enough." I needed to know more about
families and the research process.

Disconnects between scholarship and practice became a basis for how Ruth
learned and a guidepost for how she taught. Ruth's entire course was structured as a
dialogue between current research and personal experiences with children. In the
classroom, students typically read and evaluated research on topics such as the ecology of
childcare, pretend and imaginative play, constructive play, the zone of proximal
development, or literacy in preschool. Ruth often selected readings around these topics
that, read together, highlighted a tension or a knowledge gap. Then using both small and

large group discussion, Ruth structured questions that encouraged students to address the

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apparent tensions, in part by using the personal experiences they were having
concurrently in child care settings.

Simultaneously with discussing current research in class, students conducted field
observations each week during a three-hour service experience in daycare and preschool
settings. The observations were guided by questions to help students relate the research
topic of the week to the context of their particular experiences with children. For
example, after reading research on the child's development of pretend or imaginative
play, students were to use their structured experiences in early childhood settings to
discover the following:

1. Observe how the environment is constructed by adults to create opportunities
for pretend, dramatic play. Consider the cultural and social messages
associated with objects that might elicit pretend, dramatic play. Relate your
observations to readings for 9/27.

2. Do not feel limited to a designated play space. Watch for times of spontaneous
pretend play (e. g. in the bathroom, on the playground, or at snack time).

3. Review the principles by Concu et al. Why is the concept of environmental
affordances important in supporting pretend/dramatic play? Consider the role
of social and physical contexts to support pretend play.

4. Review thematic content described by Farver & Shin and the principles of
Goncu et al. Can you find examples of your daycare of how these ideas are
reflected in pretend play? If you are not seeing the children’s imagination

running wild into fantastic themes can you propose a hypothesis for why not?

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5. Listen to what teachers say about children’s play. How do they communicate
their adult view of pretend play? Is the curriculum focused around play as a
media to develop components?

6. Select 2 or more children engaged in what appears to be imaginary play.

INTEGRATING QUESTION TO ADDRESS: Select and describe a bout of

pretend, dramatic play that lasts several minutes. In your description include what

the children do (review themes) and the intersubjectivity, how they share or do
not share in story. Analyze the activity regarding multiple levels of occupational

meaning and function. Discuss evidence of individual differences in the way the 2

children engage in and experience pretend play. (remember to reference)

Back in the classroom, Ruth continued to engage students in the personal
experience-research dialogue. Students shared lively stories of children's imaginative
play they experienced in their preschools and Ruth continued to tap those stories for their
potential in helping students understand the occupations of childhood.

In another class on literacy among preschoolers, students not only read related
research, but also were asked to draw upon their experience to analyze data samples from
a study on handwriting among three-year olds. "What I want you to do is to take these
four samples from her data and put them in developmental order. Which is the most
sophisticated and why?" Students placed the handwriting in the same developmental
sequence as had the researcher. After further discussion on the emergence of the
occupation of handwriting before a skill set is developed, Ruth asked, “anyone have an
experience with children writing in day care?” Her question prompted many stories from

students' personal experience. Then she asked the students to use those experience as a

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text for knowing. "What is the teacher constructing? What is going on in your
preschool?" Students again offered lively stories and analyses. Ruth then summarized the
discussion as follows:

So the adults are constructing the environment based on the expectation that

children are going to “get it” before they are even taught how to do handwriting.

Just like we saw in the Pierce article with infants and object use. This is an

important concept—the fact that skill and ability are socialized before the

capacity to perform. What that means is that occupational meaning precedes the

actual doing of the occupation.
Hence in Ruth's class, students participated in structured learning experiences as texts for
seeing current knowledge about child development (and its limits) in action and for
expanding that knowledge. Students were invited to use these experiences as a source of
knowing by entering a dialogue between the scholarship they were reading and what they
were experiencing in working with children.

Similar to Virginia and most other faculty in this study, Ruth had not constructed
a self that stood outside and apart from occupation. Instead the self she constructed
seemed situated in a tripartite circle in which she held current knowledge in one hand and
personal experience in the other. Ruth’s classroom was structured to invite students to
join this circle and therefore to develop a sense of self who does not simply have
experiences as a form of exposure to practice or an opportunity to apply academic
knowledge, but as a means for knowing.

Both Virginia and Ruth, as well as most other faculty, encouraged students toward

the development of a dialogic self. A dialogic self is quite different from an “objectivist”

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self and may constitute a significant transformation among students. Students who see
themselves as recipients of an external, objective body of knowledge remain distant from
the subject. Students who see themselves as engaged in a dialogue with a subject and a
community can enter a relationship with, learn from, and contribute to the subject
(Palmer, 1998).

Epistemic Development Associated with the Issue of Personal Experience
Together Virginia and Ruth represent the two approaches by which faculty
centered learning on student experience, one by drawing on prior personal experience and

one by engaging students in structured experiences related to course content (Baxter
Magolda). In both instructor’s courses, students were often engaged in observing the
particular and in describing observations of specific instances, whether instances in their
own lives or instances that occurred in the context of their field observations. Shifting
toward a self who can draw upon the particulars of one’s own life for knowledge implies
an accompanying epistemic shift. As Virginia explained, knowledge of the particular is a
different way of knowing than knowledge of the general. She seemed to align herself
with a group of inquirers that believe qualitative studies:
yield knowledge of particulars, a kind of practical knowledge that Aristotle called
phronesis. It is characterized by qualities of concreteness, attention to the
contingent features of the case at hand, temporality and openness to doubt. This
kind of knowledge stands in contrast to theoretical knowledge or scientific
understanding (what Aristotle called episteme), which is expressed in general

propositions (e.g. rules, laws, principles, theories). (Schwandt, 1997, p. 59)

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El

In these classes, it seemed students studied personal experience not merely to make the
content relevant or meaningful, but to:
increase the capacity for practical reasoning and deliberation in those many

situations in life that are full of too many details, idiosyncrasies, and exceptional

 

aspects to permit the application of general knowledge...to make it possible to
develop powers of perception and thereby enhance practical wisdom. (Schwandt,

l997,p.60)

 

Along with actively taking their own personal experience as texts for occupation, students
seemed to be actively engaged in an epistemic shift that allowed them to honor what could
be known from the particular instances of their lives.

However, one may argue that knowledge through personal particulars renders the
subject of occupation highly relativistic. But another epistemic shift represented by
Virginia and Ruth was that knowledge from particulars is simultaneously communal. In
Virginia's, Ruth's, and other faculty's classes, students read the texts of personal
experience not to develop a relativistic knowledge base, but to bring what they learned
from personal experience into a dialogue with a larger knowledge community, even if for
the time being that community was their group of peers or a group of authors in the field.
Personal experience, while a source of knowing in itself, did not stand on its own but was
continuously related to a broader dialogue. Therefore, the self-project into which students
were drawn was to construct a self in a reformed relation to personal experience and a
self in a reformed relationship to community. This constructed self could take experience
as an object for knowing and also situate experience in dialogue both with the subject of

human occupation and with a larger community of knowers (Palmer, 1998).

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Chapter Eight
Constructing a Self in Relation to Knowing:
The Issue of Authoring Knowledge

Underlying the invitation to students to develop a personal relationship with
occupation through a dialogue between the texts of their own lives and current
scholarship lay another closely related self-project: the invitation to develop a view of
themselves as knowers—selves who were capable of generating knowledge about and in
occupational therapy practice. This invitation opened the possibility for a very different
relationship to knowing for those students who had previously been socialized into a
recipient view of themselves in relation to knowledge—that is, selves who were expected
to receive knowledge from authorities. The expectation for this intrapersonal shift may
have been a source of confusion to students who sometimes wondered why faculty did
not answer their questions more concretely or give them the specific how-to information
they were anticipating.

Most faculty in this study described experiences through which they came to view
themselves as authors, not just recipients, of knowledge. This self-development was
usually couched in stories about “learning to think,” recognizing a “love for ideas,” or
stories of dissatisfaction with knowledge in occupational therapy and therefore a drive to
“know more,” to "make sense.” But faculty stories seemed to go beyond intellectual
development; each story seemed to imply a transformation toward a self-as-knower, one
capable of creating or authoring knowledge.

The recognition by students of their own same capacity became another guidepost

for teaching among the faculty. Faculty elicited and affirmed students’ ideas in class,

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linked students’ own ideas to knowledge in the field, admonished critiques and
disagreements, sometimes prompted disagreements, and often deflected questions back to
the students to answer themselves. Faculty asked students to synthesize theories in the
field into a comprehensive personal theory that matched their beliefs, to read and critique
publications (some written by the faculty), to make sense of seemingly contradictory
content, or to revise traditional professional knowledge in light of new scholarship or
knowledge from other disciplines. Faculty provided structure but few answers, guidance
but considerable ambiguity. These seemingly ordinary teaching practices are considered
here against the landscape of the faculty’s self and what sort of student self they seemed
to elicit: namely, the self as knower, or the self as author of knowledge.
“Making Sense Authoring Knowledge for Yourself

Cathy wanted students to learn how to make sense of and piece together
knowledge for themselves. She engaged them in making sense through artfully knitting
varying degrees of ambiguity with clear, thorough explanations. Whether using lecture,
case studies, small group activities, or written assignments, Cathy consistently offered
clear, carefully stated information related to the content at hand while providing
opportunities for students to experience the content as ambiguous and complex.
Simultaneously, she carefully elucidated the thought processes students were expected to
impose on the content in order to understand it for themselves.

From her early and professional educational experiences, making sense through a
combination of ambiguity and clarity had become a guidepost for Cathy's teaching. As an
occupational therapy student, Cathy remembered feeling fi'ustrated that her instructors

seemed intentionally to promote ambiguity rather than provide concrete answers. But a

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couple of years after graduating, confronting the ambiguities of practice itself, Cathy
recognized the wisdom of her instructors’ educational design. She understood the
potential lessons in living with the ambiguity of academic knowledge; namely, that
concrete answers did not exist in external authorities like instructors and it was up to her
to create her own knowledge in response to various ambiguous situations, to make sense
of things for herself. Of course, it is unclear if Cathy’s instructors were that conscious
and intentional about their pedagogy; if they were, they did not articulate it for students.
Regardless, Cathy believed the strategy of imposing a certain amount of ambiguity is
well-matched to who she is as an educator and effective for helping students develop a
sense of self as knower, or author of their professional knowledge.

Clearly that is the same approach that we have taken here—‘we are about
teaching you how to think, not about creating recipe cards for you for practice’. I think
had I not been educated that way, I’m not sure I would have chosen to come here or
stayed. There was a match between the underlying educational philosophy that we are not
a technical field and shouldn’t educate technically. Of course, this is a really retrospective
analysis, but seeing how much of me that became, both in terms of how I practiced and
how I practice education—a comfort with ambiguity that was very uncomfortable as a
student, but as I reflected back on it I realized why it had to be. That made it easier for me
to teach that same way.

Ironically, Cathy believed the strategy of ambiguity should be clearly explained to
students:

I think I do it a little more responsively, making it more overt so the student

understands it and I address the student’s discomfort with it. Versus when I was in

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school I was allowed to just muck around in it and no one explained it. So that
experience not only shaped my basic approach as an educator, i.e. ‘I’m not here to
teach you all the facts; I am here to help you learn how to think.’, but for me it is
more refined. . .I really think people need to know in a straightforward way what
this [curriculum] is about. ‘This is what you are going to learn, this is not what
you are going to learn, this is how you are going to be uncomfortable’. I think it

would have made it easier for me [as a student] if I had known that. So I share the

 

philosophy. . .and recognize it is going to be difficult and uncomfortable, and that

has to be in order for students to learn. But I guess I now believe it doesn’t have

to be completely in the dark.

Cathy attentively combined her experiences with learning from ambiguity, and
her structuring of the same opportunity for students, with another key element of her
teaching—her desire and ability to explain things clearly. Cathy’s explanatory teaching
style was evoked early in her educational biography by a mentor, a teacher who was very
skilled at explaining concepts clearly.

She had this gift for teaching in an explanatory way that wasn’t altogether a

lecture but wasn’t participatory either. It was explanatory. I remember feeling that

way when I tutored her daughter, and to this day that is something I feel very
good at—explaining and making sense of things.

Cathy felt that she cautiously balanced her desire and ability to make things clear
for students with her understanding that students needed to experience ambiguity in order
to make things clear for themselves. She balanced this tension through noting after class

how much time she spent talking, or how much “over-explaining” she did, versus how

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much time students were involved in dialogue and other activities. If she felt she had
spent too much time over explaining. she modified the classroom dynamics for the next
session giving students more opportunity to “dig in and make sense of things for
themselves.”

This guidepost for Cathy’s teaching, a balance between ambiguity and clarity
while offering opportunities for students to make sense, was played out in how she
advised students, structured lectures and class activities, responded to students'
uncertainty in the classroom, and developed assignments. In her advising, Cathy felt that,
inevitably, some students’ experience would be disconcerting as they progressed through
the curriculum and as faculty gradually removed external structure and expected more
student-directed structure. Also inevitably, some students would seek advisement at these
disconcerting junctures, feeling overwhelmed by “so many loose ends.” It was precisely
when students were in the midst of this disorienting experience that Cathy believed they
could move toward the self-development she hoped for them. She validated that “what
you are feeling is accurate and here’s why”, and then clearly explained the progression of
intentional ambiguity built in to the curriculum. She explained to students:

There is a contrast between the first year and the second year because the first

year everything is pretty laid out—the assignments are clear, the due dates are set,

everyone does the same one. There are very few decisions you make about what
am I going to do and how am I going to do it. It’s there for you. In the second year
there are more choices to be made. What am I going to do, what’s my research
going to be, what’s my community project going to do, what elective am I going

to take? All of a sudden there are more choices to be made before you even get to

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the work to be done. Then in the work to be done you have to create the structure

and the decisions yourself. They are not completely laid out.

Rather than disregard students’ complaints or try to “fix” their discomfort, Cathy
used students’ experiences to validate the author-self her approach implied. Cathy
validated the student as knower; she affirmed that the student knew what was going on,
and mirrored the student-self that could figure things out.

Some of the lectures I observed were also a means of validating the student self as
knower. During lecture, Cathy explained the concepts, structure, assumptions, and
interdisciplinary influences associated with a given theoretical model. She often began by
acknowledging the complexity of the model and by anticipating and validating students
initial feelings of "wading through" a lot of content. She did not, however, validate their
feelings under the guise that she was, in her lecture, going to help resolve their confusion
for them. Her validation was offered more in light of how the students' confusion was to
be expected at the beginning of their own "discovery process" with a new theoretical
model, and then indicated what thought processes they would need to apply to reach a
clearer understanding of the content.

Regarding one model that students were particularly struggling to understand,
Cathy validated and encouraged the self as knower:

It does take a while with this model in particular. You have to read, to think, to

talk to each other, and to be critical. You have to weigh it in terms of its economy

and efficiency of concepts and make those decisions for yourself.

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As students struggled with the model further, some felt more confused, some felt clearer.
Again focusing on the process and reflecting a self who worked out her or his own
knowledge, Cathy commented:

that is the process you will go through in struggling with new information. It's like

housecleaning, things may get worse or you may make a bigger mess before it

finally takes on some order. It tends to get messier before it gets clearer. The
process of coming to understanding continues like that. You hit a point where it
gets clearer, but then you move to another level and it gets messy again, then it
gets clear again. It's back and forth like that.

Cathy was able to walk a fine line between validating students' experience of
ambiguity and uncertainty through clear explanations, yet not putting herself in a role of
remediating it. Instead, she often placed herself alongside students as one who also
continually tries to reach deeper levels of knowledge in the field. In reference to the
model students found particularly complex, she told the students that she tries to attend
any presentations given by the authors of the model. "I am always looking for the next
level of clarity for myself.” And as she began the lecture on that model, she displayed a
graphic on an overhead projector which she had demarcated in several colors illustrating,
"the cues I have used to help tease out the parts of the model for myself. " Presenting her
self-as-knower, or author, not only communicated that students shoulder responsibility in
their own understanding but also modeled a particular knower-self she desired for
students.

At the end of the lecture, responding to non-verbal communication from the

students, Cathy stated, "some people look puzzled.” One student replied that she was

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puzzled but could not formulate a question at the moment. Cathy again validated the
feeling of ambiguity and offered clear explanations of how the students could next begin
to make sense of the information:

That is an expected place for you to be right now. The case and the questions will

get you to the next level of clarity. Then the group that picks this model to present

next week will get to an even clearer level and through what they present, they
will help us all come up to that level of clarity with the model as well. This is
definitely one that takes some sorting, thinking, and processing.

Following the mini-lecture, students typically worked on a case study in small
groups. Guiding questions were provided, but the purpose of the small group was not
only application of a model to practice. The case study was another means by which
students were expected to create knowledge for themselves. As Cathy rotated among the
groups of students, her comments continued to be an artful mix of clarifying some
content about the model while leaving other content to students’ own understanding, and
clearly explaining what thought processes students could use in order to author
knowledge about the model through the case.

Similarly, in her assignments Cathy asked students to use the assignment to
"make sense" and "go to that deeper level with the content.” Assignments were not
merely assessments of students’ knowledge but another tool by which students were
asked to synthesize knowledge and make it their own. Thus in her assignments, Cathy
again invited the students to change the selfs relationship to knowing from one of

recipient to one of author of their professional knowledge.

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I build it in, as it is time for students to take over responsibility for structuring
their own learning. I did it in class a week ago. The students were doing an
Environmental Scanning project in small groups and I remember actually saying
that ‘this is one of those assignments you are going to have to get into, to structure
yourself. There are going to be moments you will actually be mad at me because

I’m not giving you more structure and direction it will feel just too ambiguous

and messy. That is how it is going to feel. But you’ll get to a point where you’ve

created some structure, things will start to clear up. . ..you still may not like me but
it will feel less messy as you get into it’.

It is important to note that Cathy’s assignments were very clear and well
organized. She did not interpret self-authorship in learning as abandoning students to an
ill-conceived project. Rather, drawing from her own learning style, she provided clear
explanation and structure for the assignments, but told the students, “I can only provide a
certain amount of structure because you need the opportunity to dig in, own it, and make
sense of it.”

Through her advising, lecturing, facilitating class activities, responding to
students’ uncertainty, and assignments, Cathy invited students to make sense of content
for themselves. In so doing, it was as if she asked them to enter a profound
transformation from a self who received knowledge from others, to a self who authored
knowledge through synthesizing ideas across content areas and accepting knowledge as
ambiguous and requiring diligent intellectual work to achieve clarity. Cathy artfully
supported students in this journey by continually validating their experiences and offering

clear guidance in the thinking that was required of author-selves.

ll7

 

 

 

Authoring Knowledge with Others

When Cathy entered practice as an occupational therapist, the value of her
educational experiences became clearer. Grace’s experience after graduating from
occupational therapy school was not as positive or clarifying as Cathy’s had been. Grace
actually felt disillusioned with the profession altogether because the practices she
observed seemed a far cry from that which she believed the profession was capable.
Treatment approaches at the time seemed to be rotely applied and unquestioned even
though, as Grace described, “there was no evidence base for what we were doing.”
Conceivably, Grace had entered a professional culture that did not support the self-as-
knower, or author, but highly valued the recipient self in therapists, a self who received
knowledge and techniques from continuing education "experts" without critically asking
if or why they worked.

Grace, however, was not satisfied with unquestioned and unsupported practice.
Ironically, it seemed that her observations of, and frustrations over, such practice played a
role in furthering the development of her own knower-self. Confronted by all the gaps
between practice and research, Grace took additional neurology courses, became
involved in pilot studies, and gave presentations exploring knowledge about tactile
defensiveness among children with autism. During one presentation, someone in the
audience continually challenged her to support her comments more substantially with
evidence. Once again Grace felt the pull of all that was still unknown in her area of
practice. Afterward, the audience skeptic offered her a fully supported position in a
doctoral program in psychology. In contrast to the culture of occupational therapy at the

time, which seemed to disregard the questioning and creation of its own knowledge,

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YES

the

Pall;

Grace now had a mentor who believed in and supported her ideas and challenged her to
develop them further. It was as if being initiated into a professional culture that devalued
the self-as-knower, Grace was further propelled toward such a self. Since that time, she
has become highly regarded for her work in autism, presenting internationally, publishing
in journals representing several disciplines, and receiving multiple grants including
funding from the National Institutes of Health.

The trajectory of Grace’s self-development toward authoring knowledge seemed
to influence one of the guideposts in her teaching. Grace described one of her educational
aims as helping students become scholar-practitioners who do not accept and apply
therapeutic interventions uncritically, but who question, give evidence for, and use
observations to generate new evidence.

One of the things I'm really trying to get across is the importance of an evidence

base for practice, the importance of critical thinking around issues and not taking

things at face value or making assumptions and not challenging those ...So, I

want there to be some critique and some critical abilities that students do...

For Grace, teaching to promote scholar-practitioners involved modeling how such
practitioners think and act. She structured courses to expose student to recent research
and to the problems recent research fails to address. She carefully modeled and mentored
students in how to understand and respond to research. During my observations, the
research seminar was a good example of this guidepost in Grace's teaching.

In the research seminar, five to seven students worked closely with a faculty over
the course of two semesters. During the first semester, students read research around a

particular topic—autism in Grace’s seminar—and generated questions reflecting how

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current knowledge could be extended. In the second semester, students selected one
question to investigate thoroughly through a literature review. Each week a different
student was responsible for facilitating the seminar discussion. Generally, the student
facilitator prepared study questions, distributed them to faculty and peers a week in
advance, and led a discussion related to the questions.

In the seminar, faculty treated students as colleagues and assumed the role of co-
knower, or co-author, with students. The readings for the seminars were often faculty’s
own work; students were expected to critique and discuss how the work could be
extended. Grace explained:

Part of what we're really trying to do with these courses is to socialize them in the

culture of this is ‘the way scholar practitioners behave. These are the values.

These are the actions. These are the things that we do. These are the things I'm

going to role model for you. But I'm going to do that by immersing you in the

process and treating you that way from the beginning, not as a here's the question,
here's the right answer classroom situation, but this is a seminar. We're here to
discuss. You're a participant. I'm a participant. Our goal is to develop our
knowledge base in this area and to create some depth of understanding in an area.’

And that's scholarly behavior. We're modeling scholarly behavior.’

Grace’s desire for her students, a desire shared by most of the faculty, was that
they develop into “scholar practitioners.” On a technical or skill level, this meant that
students were expected to develop the ability to read, critique, and appropriately apply

research to practice, generate questions from practice and use research to answer those

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questions (at least partially), and engage in creating evidence where little or inadequate
evidence existed.

But simply identifying the skills and behaviors involved in becoming a scholar-
practitioner may fail to acknowledge a deep and significant transformation of the
students’ relationship to his or her self that such skills imply. The work of scholar
practitioners seems rooted in a perception of the self as author, capable of producing
knowledge, either by reading and applying research, questioning accepted practices in
light of empirical observations, or by designing investigations and gathering data.

In the research seminar, Grace wanted “to help them find a connection and to
figure out where they can insert themselves into the spaces that are wide open.” In
essence, the seminar mentored students in the process of authoring knowledge by leading
them to identify innumerable gaps in a body of literature and inviting them to insert
themselves into one of those gaps. However, to assume the role of inserting themselves
into the "wide open spaces" of knowledge presupposes a certain relationship to knowing,
a self that could “see” herself or himself as a knowledge contributor within a community.

Grace acknowledged some students experience a transformation and become
excited about research. She referred to the transformation as newly acquired
“motivation,” but her description hints that students may experience a change with how
they see themselves as someone who can author a problem into research:

Where did this transformation happen? And it's not that all of a sudden they have

found research and have been saved! No, it's they found a passion for a question

or a topic or an issue that meant something to them. And that fueled their

motivation to learn more about it and refi'ame it as research. You can do that with

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a clinical issue. It doesn't have to be research, but finding that motivation to want

to do that.

Both Grace and Cathy, and most other faculty, recognized the difficult and
sometimes painful experience of moving beyond the self as a recipient of knowledge
toward a self as participant in authoring knowledge. They consistently demonstrated the
importance of supporting and nurturing students through these changes. Reflecting on her
early educational experiences, Grace shared,

I think it's very important for me to foster a very nurturing, safe environment

because as I look back, I think it was the places that I didn't feel safe that I

couldn't really grow. . .And I just feel like for students to be able to share and to

find value in their contributions and become the kind of scholar practitioners we
want them to become, they have to feel safe so that they have an environment
with which to grow and to be nurtured. And so that has always been critical to me,
and to be empathic about their situations and their experiences.

Both Grace and Cathy utilized active learning methods. However, the methods
reflected both who the faculty had become through varied experiences and a self they
prompted students to adopt. In relation to knowing, the student was nudged toward a self
who can both figure things out at a personal level and move in alongside other co-
creators of knowledge and make a contribution to what is known.

Epistemic Shift Associated with the Issue of A uthoring Knowledge

It would be difficult for students to be successful at the task Cathy and Grace held

forth without a shift toward self-as-knower. It would also be difficult to be successful if

students held the assumption that professional knowledge is static and fixed, or if they

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viewed published research as somehow finished and not part of an ongoing conversation.
The work Cathy, Grace, and the other faculty asked of students seemed to imply they
adopt a stance toward knowledge as dynamic, tentative, and reflective of a particular time
with its prevailing paradigms and assumptions. It seemed that faculty consistently
presented knowledge as an ongoing conversation, a process in which students could and
should engage. Faculty implicitly asked students to bracket a view of knowledge as
techniques to be applied and shift epistemically to knowledge as an ongoing process in

which they played an active part.

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Chapter Nine
Constructing a Self in Relation to Major Change:
The Issue of Authoring Practice

The faculty in this study possessed an almost evangelical desire that the graduates
from their program be instruments for changing, expanding, and renewing occupational
therapy. They hoped their students would create practices in occupational therapy that
clearly and profoundly reflected core ideas around human occupation. The faculty told
stories about such graduates to their students and colleagues and highlighted these
graduates’ activities on the program website. The theme of “change agents” was adopted
as a key curricular thread and used as a basis for learning objectives in most courses.

As was the case in the preceding chapters of this dissertation, most faculty had
personal experiences with being change agents in specific areas of the field. They
encountered aspects of practice that made little sense or seemed lacking or felt
inadequate, and to which they responded by instituting some type of change. Some of
these change—agent experiences included: instituting a strong theory base in a setting
where none had existed, changing the types of goals being addressed with clients to make
them more functional, changing the focus of therapy from the individual to the needs of
an entire facility, instituting occupational opportunities that reflected the interests of male
clients, educating staff on the opportunities within new legislation, and many others. In
addition, the design and implementation of their curriculum could be seen as a
collaborative project among change-agents, in which this group of faculty took traditional
educational assumptions and practices in hand and wrote a new script for occupation-

centered education. In these and many other experiences, faculty possessed or developed

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a sense of themselves as change-agents. The concept of change-agent is consistent with
the concept of self-authorship. Thus faculty had constructed selves as authors of
practice—another self-proj ect into which they invited their students and that became a
guidepost for their teaching.
Avoid Being Authored by the Practice Context

Carol, an adjunct faculty at the time of this study, taught a class that, at first
glance, seemed to offer students “basic” information about the internal and external
influences on occupational therapy practice. During my observations of Carol’s class,
students reviewed different educational degrees offered in the field and the process of
becoming certified and licensed. They defined acronyms and discussed various
professional roles such as the occupational therapist, the occupational therapy assistant,
and the aide. They identified professional organizations and governing bodies, debated
ethics, and discovered the parameters of reimbursement for therapy services such as
Medicare and Medicaid guidelines. But beneath this content appearing as simply the
need-to-knows, it seemed that Carol’s own sense of self as author desired that this
content empower students to go into practice with their eyes wide open to the external
and organizational presses on practice. She felt that by having a broad understanding of
the pragmatic inner workings of the field, students could resist being authored by the
settings in which they would one day work.

Carol had been a therapist for approximately twelve years and she encountered a
recurring frustration over most of those years: the script-following response of therapists

to changing policy and legislation. Carol observed occupational therapists too often being

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authored by issues like state practice acts, Medicare reimbursement guidelines, or simply
by “the way we’ve always done it.”

I think there’s a history of us sort of riding the back end of changes that are going

on and suddenly scrambling to redefine who we are in response to things that we

feel we’ve been buffeted by; instead of scanning the environment and looking
ahead at what’s out there... knowing where to look means that you have control

as a profession as well as a practitioner and can be a change agent as opposed to

being Chicken Little, running around and saying, ‘oh, my God, the sky is already

down! And why didn’t the AOTA do something about it?’

Carol’s observations and experiences propelled her into political activity on behalf
of the profession. She consistently advocated for particular legislation, urged others to
consider the impact of legislative efforts on occupational therapy and take like action,
interpreted new legislation to therapists, and attempted to understand the rules and
regulations well enough to work within them yet not surrender core aspects of practice to
them. Carol readily identified her own self-as-author that emerged through her experiences
stating, “My middle initial is ‘A.’ My mother would say it stands for ‘agitator.’ The better
way is ‘change agent.’ It took me years to learn that.” From her self-authoring identity,
Carol invited therapists to consider their own complicity in the limits on their practice and
to rethink their responsibility in light of those limits.

A real simple example: you can moan and groan about what Medicare doesn’t

cover... or you can step back and say ‘you know, how does Medicare get changed?

Should I be grousing and complaining about this to my co-workers? If I think it’s

important enough, do I write to my congressman?’ Or you can even step back in

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the bigger picture and say ‘you know. the reality is, Medicare is a finite dollar

source and Medicare doesn’t pay for everything. Neither does any other insurance

cover everything. And so, yes, we might want to change Medicare but we also want
to ask is it a reasonable expectation that any third party payer is going to pay for
everything?’ So, you can keep stepping back. . .if you haven’t become accustomed
to the pragmatic reasoning needed, you get stuck... without ever seeing that that
situation can be changed, or that there’s a different way to frame it than just, you
know, ‘oh, this is my daily irritation.’

Just as self-authorship had become a tacit guidepost for Carol’s practice and
professional activity, it was also implied in how she described her teaching. She invited
students along the same path that she invited clinicians—the path toward a sense of self
that, knowing full well what the issues are, could write and re-write the scripts of practice
accordingly. She described the aims for her course in terms of helping students see the
“forest”:

I love teaching this course because it is a chance at the very beginning of the

curriculum to say ‘yes, this is also an important part of what happens and the more

you understand it, the more you can be a change agent for the pieces of it that you
see as obstacles to effective practice, or as unfair to your clients. But just to
understand the forest that you’re operating in.’
She also used the metaphor of Russian nesting dolls to describe both the understanding and
the inquiry process she believes will aid students in developing author-selves.
The first week. ..I sort of gave them a big overview of what I knew about context

and how there’s a big world of OT practice. But then your state defines OT a

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certain way. . .and then your setting defines OT a certain way. It reminds me of the

little Russian dolls, but it gets more complicated because they overlap in funny

ways. But then what we did is we broke into small groups. They [students] had an

assignment to look at what the different contexts were that shaped their role as a

student here.

While the call to students to move toward selves that authored, and resisted being
authored by, practice appeared to be one guidepost for Carol’s teaching, the methods again
were common active learning methods. She engaged students in large and small group
discussions, asked them to keep journals, used interactive lectures, told stories about her
clinical experiences, provided handouts, and so on. But these common methods seemed to
reflect the self Carol had constructed as an author of practice and to urge students toward a
similarly revised self.

A uthoring an Occupation-C entered Practice

Carol hoped students would know the pragmatics of occupational therapy practice
settings (e. g. payment systems, client referral systems, documentation requirements, role
delineations among rehabilitation professionals, and others) well enough to avoid being
authored by them, or allowing them to dictate entirely what occupational therapy practice
Should be. It was Carol’s hope that students would instead find ways in and around and
through such influences on practice in order to author an occupational therapy rooted in the
principles of the field. Similarly, Linn, and most of the faculty in this case, hoped students

would write a particular script for practice, one whose plot centered on the theme of human

occupation.

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Linn had demonstrated such self-authorship in her own practice as an occupational
therapist and authoring occupation-centered practice became a guidepost for her teaching.
As an occupational therapist working with pediatric clients, Linn's professional experience
involved several experiences in which accepted practice did not make sense to her. She
described one setting where, "kids would come to me with goals like 'will stack ten blocks.’
I needed to know for what reason! Not that I don't want them to stack blocks. but to know
it is for a reason other than to check that box on the Peabody!" At one job in particular,
Linn was skeptical when young adult students with severe disabilities, including cognitive
impairments, were working toward what she believed were irrelevant therapy goals like,
“student will draw 10 straight lines.” “Writing ten straight lines was supposedly related to
writing their name, but if you are sixteen and you still can't write your name, I'm thinking
name stamp (if even that)!” She felt that targeting such rote skill performance as drawing
straight lines did not enable clients to perform meaningful daily tasks in naturalized
contexts. “I was always most concerned with how kids were occupying their time and what
occupations they needed to do and what I could do to facilitate that.”

In that work setting, Linn recognized that there was tremendous support among the
staff, as well as resources in the setting, for improving the daily living skills of these young
students with disabilities. She said, "it was then I decided not to do the motor-sensory
integration there anymore. If this child needs to pour juice at lunch, then that is what we
are going to work on.” However, in attempting to create a new script in that setting, Linn
recognized that some staff and families "had been therapized into the whole way of doing
things" and were worried the students' educational goals would not be met through her new

approach. In response, Linn educated parents, involved them in the goal—setting process,

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and sought their input in structuring daily occupations to allow their child successful
engagement in that part of his or her day. Linn re-wrote the script for occupational therapy
in that setting, establishing new client goals and interventions that were more closely tied
to students completing typical daily routines.

There were several other examples in Linn's biographical stories through which she
had authored occupation-centered practice, and it was to this same project she seemed to
invite students. Without hesitation, Linn identified the primary subject of her lab,
regardless of the individual topic, as “occupation-centered practice.” Her overall desire
was to see students become “good thinkers and good clinicians” and she felt the “good
clinician” cultivates a perspective of, or way of seeing, practice as rooted in, and evaluated
against, the concept of occupation. As she reflected on a videotaped segment of one of her
labs, Linn explained her desire that students piece together several concepts to create an
occupation-centered practice,

What I was hoping to do with the whole discussion was make sure that they see

how activity analysis is related to occupation. . .to humans as occupational beings

simply from the perspective of being client centered. . .The person and the

meaning and the activity or occupation need to somehow converge or what you've

got is not something that's therapeutic.

In class, Linn continually demonstrated the limitations of accepted professional
tools and how those tools changed somewhat when combined with other tools. She
structured lab experiences in which students essentially acted as authors of the tool by
having to reconstruct it, or use it differently, depending on the practice context. It appeared

as if Linn taught students that authoring practice involved not being authored by accepted

I30

tools in the field, but to "think critically and clinically how there are ways you can use
them that are helpful and ways that are not so helpful.” She conveyed that knowledge
about professional tools could not be learned and applied generically, but must be authored
within the specific interaction with an individual and a particular circumstance, and
continuously linked to the larger context of occupation. Linn emphasized that students
were responsible for piecing knowledge together in the practice context and centering
practice on occupation. “With every client, you’re doing something different. . .how you
put your knowledge together with what is already there is what makes it an art.” Linn felt
this improvisational thinking stemmed from who she was:
I think that's partly a function of my personality, my approach to information. It's
never that it's just what it is, but ‘What are the possibilities? What can you use it
for? What other things does it relate to? And, then how can you tie those things
together to look at something from a new perspective or create something new?’
...that's how I think...
In the following class discussion, Linn deauthorizes tools of practice and centralizes the
student’s capacity to author therapeutic intervention apart from specific tools. She reminds
students that each tool has its limitations but not to let their intervention be authored by
those limitations.
Student: The article said if a client isn’t motivated or does not have a good
understanding of a task the DPA [Dynamic Performance Analysis] won’t work.
Does that mean you use a traditional activity analysis in those cases or use a

different tool?

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Linn: That is a great segue into our next topic about the prerequisites for task
performance. If the prerequisites aren’t in place, you are asking what would be
your next step?

Student: Yes.

Linn. Does anyone have an idea about that? What would you do?

[Two students offer ideas]

Linn: So what you two are both saying is that if the person does not have the
motivation or the knowledge, and it is a task that there is still some reason they
need to do, that you want to address these things [knowledge of, and motivation
for, the task] first. You’re right. So if one of these is missing it doesn’t mean you
aren’t going to do intervention. It means your intervention is going to be more
about motivation or understanding the task and the actual performance; their
ability to perform will be addressed later. That is a good question. The DPA was
just published in 2000. . .people can get very focused on the breakdowns related to
sensory-motor issues or cognitive issues—those component problems—rather
than remembering there are performance pre-requisites and intervention is just as
legitimate for those. What is necessary for optimal performance?

Student: A balance between the activity and the supports and demands of the
environment.

Linn: [writes on white board and restates]. The individual’s ability and
environmental press. So this is what you are really looking for. Motivation,
knowledge of the task, ability, and how the environment supports the

performance. Those are all places where you can do intervention.

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Epistemic Shift Associated with the Issue ofA uthoring Practice
Both Carol and Linn cautioned students not to be authored by accepted practice
whether by the pragmatics or the tools of practice. In their cautions, they invited students
into a transformation toward change-agent, or author, of occupational therapy practice.
Undoubtedly, educators in most fields have similar desires that their graduates represent
the knowledge of the field well and that they contribute to the field in small and large,
private and public, ways. The faculty in this study did several things to promote what

constitutes the “skills” related to becoming change agents. They taught content related to

 

management, administration, dynamic systems theory, research, evidence-based practice,
and clinical reasoning. They designed assignments requiring students to conduct needs
assessment, develop innovative practice programs, and scan the environment for untapped
opportunities for occupational therapy. Faculty illuminated the taken for granted authority
of practices in the field that, in their opinion, needed to be questioned and changed. They
led students to see the incompatibilities between some forms of practice and the core ideas
of the profession.

However, the skills and content associated with being a change-agent seemed tied
to a tandem epistemic transformation. Carol and Linn, and most of the faculty in this study,
represented “change agent” consistent with Kegan’s notion of self-author, one who
“writes” the script of practice for a particular setting. But writing or authoring practice
seemed to presuppose that current practice in a given setting was not authoritative. Carol
and Linn seemed to imply that knowledge about practice, rather than being authoritatively

received from the practice setting, was instead an improvisation between extemal,

I33

organizational, political, financial, and client-centered factors. They asked students to

adopt a view of knowledge that was being created and recreated through their actions.

 

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Chapter Ten
Sources of Intrapersonal Development

This chapter functions somewhat like an epilogue to the previous four chapters.
Since teaching methods and aims in this occupation-centered curriculum hinged largely on
faculty members’ relationship to knowledge, the self and the subject of human occupation,
it may be useful to explore some of the means by which faculty experienced development
in these arenas. While the sequence and trajectory of each faculty’s biography were
unique, some developmental experiences shared by two or more faculty included
relationships with mentors, struggle and despair with occupational therapy, formal
education, the selection of work settings, and working together as a community. Faculty
often discussed these experiences as milestones, not so much in their epistemic
development, but in development of self-understanding or self-awareness.

Relationships with Mentors

Palmer (1998) describes the mentor relationship not in terms of a mentor imparting
something to a mentee, but in terms of a mentor evoking in a mentee parts of the self yet
undiscovered. Several faculty in this study had teacher mentors from early in their lives
who held up a mirror to parts of themselves not previously visible. Cathy described a
teacher-mentor whose participatory and explanatory style matched something similar in
her, and stated, “to this day that is something I feel very good at—explaining and making
sense of things.” Wendy had a high school counselor who reflected intellectual potential to
her that she had not seen before:

I don't know what she said, but that my I.Q. was such that I should be an ‘A’

student. And I really wanted to believe her. And I was like ‘oh, somebody thinks

I35

I'm smart!’ And so, in any event, I mean that changed by life because at that point
I was a ‘B’, ‘C’ student and thinking that I was really stupid and I was pretty
worthless. And at that time I started to study and I started to recognize that I
enjoyed learning.
Similarly, a professor mirrored an image of Jenny as someone who “could present
concepts to the class in ways that made them understandable.” Sue’s high school teachers

“were more interested in me as a thinker and a politically active person.” Grace felt that

 

one teacher in particular had given her “permission to become what you could become
individually that also relates to the group experience but that doesn't have to be a clone of
somebody else.” Grace expressed,
And I don't know how much insight I had at the time to why they were doing
what they were doing. But you sure remember the affect of the emotional
consequences of that that have such shaping influences on your memory, on the
way you think, organize your own life, you know, at this point the way I do things
now!
Several faculty in this study described similar experiences with mentors. What mentors
mirrored back to faculty seemed to elicit undiscovered parts of the self, to expand their
self-understanding, to shift the images they held about themselves and, ultimately, to
transform aspects of how they engaged the world.
Struggle and Despair with Occupational Therapy
Several faculty in this study described experiencing frustrations with the field,
some to the point of almost leaving the field altogether. Commonly, frustrations

developed as faculty experienced a lack of theoretical foundation in practice, a poorly

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developed knowledge base supporting clinical practices, a lack of questioning the
rationale behind various interventions, a limited scope of client problems being
addressed, and therapist relationships with clients that seemed less than genuine.

These periods of frustration faced by faculty could be framed as the disorienting
dilemmas that Mezirow (1991, 1997) believes are necessary for initiating transformation of
more complex cognitive structures. But like Kovan and Dirkx (in press) found among
environmental activists, these disorienting dilemmas faced by faculty seemed to be the
result of “a stance toward one’s life” that was in place prior to the experience. The
frustrations seemed to emerge from aspects of the self already present to some degree,
aspects of the self that did not feel authentic in accepted ways of practice in occupational
therapy. Frustrations did, however, trigger rational decision making processes that allowed
for firrther intrapersonal development. In Ruth’s case, a stance toward “loving disconnects”
existed prior to and prompted her dissatisfaction with so many disconnects in occupational
therapy’s knowledge. She was compelled toward another context, graduate school,
whereby addressing disconnects could eventually become a large part of her work.

Formal Education

Dissatisfaction with practice prompted faculty into one of several paths, one
common path being to seek further education, whether through continuing education,
professional networking, or obtaining an additional degree. Interestingly, the activists in
Kovan and Dirkx (in press) work made little mention of formal education as a source of
development. But for several faculty in this study, further education was one means
dissatisfactions were addressed. Formal education not only provided new professional

skills, theoretical foundations felt lacking, and research skills for developing new

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knowledge, but it also seemed to offer an opportunity for developing and expressing core
elements of the self that felt authentic. After a year in practice, Virginia took time off to
start a family and had “decided I wanted to be a potter or almost anything but an OT!”
But she decided to re-enter the field by getting her Master’s degree because new theories
were being developed in the field and “OT started to make more sense to me than it had”
and also at the time “I discovered I liked theory.” Virginia felt it had taken “a while to
figure it out” but she had a love for theory and scholarship. “I think it was just me.”

Grace, too, became disillusioned with occupational therapy practice, which led her
to take additional neurology courses because, “I kind of had a passion for figuring that
out.” She later entered a Ph.D. program in psychology where a mentor respected her ideas
and allowed her to pursue them. But beyond her intellectual development, she entered the
doctoral program with more fundamental questions that had emerged from her work with
severely disabled children.

I had such a passion for working with those kids, you know, the practical

experiences. And the question of "what is going on here?" that weren't even

necessarily OT practice questions, but were just sort of the fundamental nature

of things questions, you know.
For most faculty, additional educational experiences, beyond entry-education into the
profession, were recycled back into practice where they again tried to practice
occupational therapy in ways that seemed more satisfying and more fitting to who they

were as individuals.

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Selecting Work Settings

Work settings provided another site for developing a sense of self-understanding.
Several faculty tended to seek work contexts that allowed them to express their interests in
and beliefs about occupational therapy. Wendy felt she “got better at choosing situations
where I could feel really good about what I was doing as an OT.” Cathy took her first
clinical position based on the opportunity to work out certain questions she had:

I knew that they [staff at her first job] had this approach of studying together,

translating theory into practice, and I liked that. It answered some of the questions

that I had coming out of MCG. I had been exposed but did not know what to do

with it, and here was a place where they were working on what to do with it.
In turn, Cathy’s first job experience led to a second job,

So, it was [part of me] from the very first day I practiced. . .a scholarly aspect, a

theoretical aspect, and translation of that into your actual day-to-day practice. I

believe that that was part of my education at MCG. I couldn't have labeled it as

such, but it was there and I had the good sense to recognize that I needed a

practice environment that reinforced that. . .then went on from there to places that

allowed me to practice that way.

Teaching and Working Together as a Community

Becoming a faculty member and teaching occupational therapy seemed to offer
another context for the expression and development of self-understanding, and the self in
relationship to a field’s core subject. For Jenny, teaching had helped her understand why
her powerful experiences with clients “were so important” to her, and affirrnation from

students had helped her see further potential as a teacher. Cathy, through her teaching

I39

experiences, had reached a point where “I now see myself as an educator. . .Before, I felt
like I was in the role for a long time and now I’ve assumed the identity...pulling it into
the core of how I look at the world now.” Linn spoke about how, through teaching, she
had become more conscious of, and articulate about, her self as a clinician. And one
faculty commented, “teaching is not just about content; it is about commitment. .infusing
in people’s orientation to occupational therapy—making their life count for something.”
Several faculty described their ongoing curriculum development process as a
group as significant to their development as persons, agreeing with one comment that
“the evolution of the curriculum and myself has occurred simultaneously.” Another
faculty commented that cuniculum development:
moved me from thinking about what I do in my class to just seeing what I do as
part of this overall fabric. . .a whole dynamic kind of orchestration that is
producing these results. It's much greater than any one instructor or any one class.
It's, you know, the proverbial the parts are greater - - the whole is greater than the
sum of the parts. So, that was really strong for me.
But identity as an educator was still very much developmental for some faculty in this
study. They had developed very deep and strong identities as occupational therapists, but
struggled to see themselves as educators, and sometimes felt a degree of conflict between
identities as therapists, researchers, and educators—suggesting that self-understanding

and authenticity was continuously being authored as the contexts of their lives shifted.

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Chapter Eleven
Discussion

Initially, the purpose of this case study was to explore the beliefs, assumptions,
and methods associated with occupation-centered education and the extent to which those
are consistent with the theory of self-authorship so often reflected in the field’s language
about education. The results of the study suggest that occupation-centered education
cannot be defined solely as a prescribed set of content nor by particular instructional
methods or curriculum design processes. This is not to say that specific instructional
methods and content weren’t vital to occupation-centered education, but what became
more interesting was how the methods and content did not stand apart from and outside
of the individual and shared experiences of the faculty who implemented them or apart
from prominent issues in the profession.

Therefore, as the study progressed, my focus shifted from the structural elements of
occupation-centered education to the implicit relationship between teaching and who the
faculty were and were becoming. In this study, occupation-centered education reflected a
complex web of relationships that faculty held with the subject of human occupation, the
profession of occupational therapy, the nature of knowledge, and the self. Instructional
methods and content served as tools for expressing these relationships and facilitating the
growth of these relationships among students. Through their experiences with occupational
therapy and their experiences in general, the faculty in this study had constructed particular
selves and particular stances toward knowing that were in some ways consistent with
Kegan’s (1994, 2000) concept of “self-authorship.” It was toward similar self-projects and

associated epistemological projects that they invited their students using an array of

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methods and content. I categorized the self projects and issues as: 1) constructing the self
in relation to others: The issue of authority, 2) constructing the self in relation to
occupation: the issue of personal experience, 3) constructing the self in relation to
knowing: The issue of authoring knowledge, and 4) constructing the self in relation to
major change: The issue of authoring practice.

The centrality of self-proj ects as both means and ends of occupation-centered
education was explored primarily through the theoretical lens of self-authorship, which
provided a useful, but ultimately limited, frame on teaching. Self-authorship was useful
in naming a portion of the cognitive development faculty desired from their students and
some of the self-perceptions they encouraged students to adopt. It was useful in analyzing
the epistemic and intrapersonal requirements within teaching methods, assignments, and
classroom processes. And the theory helped support that a significant part of what faculty
did was to provide a context for students to self-author.

Constructive developmental theory, or the theory of self-authorship, fell short
however in explaining several features of this study, the features that became more
prominent by the end. The theory of self-authorship could not adequately address what
seemed to be a larger backdrop to epistemic and intrapersonal movement. Classroom
practice seemed to play out against the drama of the profession and how individual
faculty’s lives had intersected and been shaped by the best and the worst of occupational
therapy. Educational practice also seemed to offer faculty a context for continuing to
author their stories as clinicians, educators, and scholars or to find ways to coherently
narrate those sometimes contrasting imagoes (McAdams, 1996). Self-authorship seemed

more a sub-set of a teaching practice that offered a broader opportunity for authoring

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lives. Through teaching, educators were not only offering students a context to self-
author, they were also continuing to author their own lives and in some ways author the
lives of students as future occupational therapists. In the following discussion, I review
how the theory of self-authorship was a useful lens on this study and how it was limited. I
then suggest that a broader conception of teaching is needed in order to increase
awareness of other dimensions of classroom practice.
The Value and Limitations of Self-A uthorship as a Theoretical Lens on Teaching Practice
Epistemic Development

Self-authorship is based upon a constructivist stance toward knowing.
Researchers have suggested that in acquiring self-authorship, students develop more
complex cognitive structures through which they come to view knowledge as uncertain
and constructed in particular contexts. Kegan (1994, 2000) emphasizes the development
of cognitive structures that enable the individual to take larger chunks of his or her
experience as objects of reflection. Baxter Magolda (1999) emphasizes the development
of cognitive structures capable of managing uncertainty in knowing. King and Kitchener
(1994) emphasize the development of cognitive structures that enable effective judgment
for evaluating and justifying knowledge. Mezirow (1991, 1997) and Brookfield (2000)
emphasize the development of cognitive structures that enable the individual to reflect
upon, and come to modify, personal assumptions upon which action is taken. Belenky et
al. (1996) suggest that development of cognitive structures is essential to become critical
of, and to balance external and internal authority in, knowledge.

These scholars emphasize epistemic development as a generic transition in one’s

view of knowledge from an authority-based view toward a view of knowledge as

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authored by communities of knowers in specific contexts. This transition is largely
mediated by one’s cognitive structures. Consistent with the constructive-developmental
literature, I believe the faculty in this study promoted epistemic change toward more
complex cognitive structures. In the teaching vignettes described in Chapters Five
through Nine, faculty nudged students away from views of knowledge as static, fixed,
and external toward views of knowledge as continuously being formed and revised, and
as a process in which students were personally engaged.

However, this somewhat generic understanding of epistemic development could
not adequately explain why students were invited toward more complex epistemic
stances around particular themes of authority, personal experience, professional
knowledge and occupational therapy practice. Epistemic change was related to specific
areas in which the faculty felt the profession itself struggled to become self-authoring.
The specific issues faculty believed faced the profession of occupational therapy served
as the means and the ends of developing complex and contextual views of knowledge.
Intrapersonal Development

Scholars working in constructive developmental theory, or self-authorship,
acknowledge the interconnection between epistemic development and intrapersonal
development. Scholars consistently suggest that changes in self-perception, especially
about one’s relationship to others and to knowledge, are co-requisites, maybe even pre-
requisites, to expanding one’s ways of knowing. However, while intrapersonal
development is acknowledged as a tandem process with epistemic development,
emphasis remains largely weighted on development as it supports epistemic change. That

is, epistemic development is often represented at the fore and intrapersonal development

144

in the background in service to epistemic change. Intrapersonal change primarily involves
the adoption of a view of the self as independent from the expectations of others and a
view of the self as knower, both of which are considered necessary to adopting new and
more complex ways of knowing.

The theory of self-authorship helped highlight how faculty validated students as
knowers and engaged them in a process of mutually constructing knowledge. But it did
not adequately explain other important intrapersonal dynamics within teaching practice.
The language faculty used to describe their own intrapersonal development can be
examined both as a critique on theory and as a window on teaching. As a critique on
theory, faculty described their own intrapersonal development not only as a growing self-
perception as knower, but also as an expanding capacity to express themselves
authentically in their work and around the primary subject of their field. Their language
represented development in less conscious aspects of the self such as intuition and
learning what felt consistent, or did not feel consistent, with who they were or were
becoming. Their stories were marked by strong emotional reactions to experiences that
did not feel self-consistent or self-satisfying, suggesting the intuitive, emotional, and
largely subconscious self was as paramount as the epistemic-related self in their
development.

As a window on teaching practice, the language faculty used suggested that being
an educator often involved personal exploration into how teaching fit who they were. The
theory of self-authorship does not eXplain the classroom as both a site for student
development and a site for faculty self-understanding and authenticity. Faculty in this

study tended to tell their stories of developing into educators and scholars using language

145

0f “who I became.” or language about the struggles they still had “seeing themselves” as
educators. Their stories were marked by words like “passion” (and finding contexts to
live out their passions), “love,” “commitment,” “discovery,” and “it’s just who I am.”
Stories of professional dilemmas, intellectual development, and teaching seemed couched
in a broader story of emerging self-understanding, of unfolding aspects of the self that
included, but went beyond, cognitive aspects. The classroom became another site for
discovering and giving expression to requirements of subjective perceptions of the self.
Cathy described her experience as a teacher, and particularly teaching in the context of
UNC, as an expression of who she is, something that “cemented my identity as an
educator.”
Learning and Teaching Processes
The theory of self-authorship suggests that intrapersonal and cognitive
development can be facilitated through effective learning environments. Learning
environments that support self-authorship generally validate students as knowers, engage
students in gathering and evaluating data in order to make sound judgments, immerse
students in ill-structured problems, promote dialogue around complex issues, encourage
Students to own and produce their own views, help students take on others’ perspectives
011 issues, and provide opportunities to work collaboratively. “These approaches focus on
eliciting students’ thinking, engaging them in reflection and analysis, and guiding them in
reorganizing their thinking in more complex ways” (Baxter Magulda, 2000a, p. 95). I
believe that this theory helped explain the instrumental or structural aspects of teaching in

tllis study, as represented in Chapters Five through Nine. Clearly, these faculty utilized

I46

teaching and learning processes that are considered predominant means in the literature
for promoting epistemic and intrapersonal development.

What seems overlooked, however, by the theoretical lens I used was the large
affective dimension of these learning activities and the use of the affective dimension to
promote both epistemic and intrapersonal change. While perspective taking, discussing
complex issues and ill—structured problems, facing uncertainty in knowledge, working
together as a group, and bringing one’s own opinions forward are deeply personal, they
are generally represented as highly cognitive processes with highly cognitive
consequences. “Constructivist, active and experiential forms of teaching and learning,
marked by high levels of uncertainty, ambiguity, contradiction, and paradox invite
expressions of soul” (Dirkx, 1997, p. 82), but the emotional and intuitive dimensions of
these methods often remain out of sight through the lens of self-authorship.

Although somewhat underground in their typical discourse, faculty described
emotional and intuitive dimensions both in their own learning and in their classroom
practice. In their own stories, learning often began with imaginative processes such as
images and feelings, and emerged from a wide array of contexts including academic
settings, clinical practice settings, and everyday life. Faculty described a meaning making
process that, while mediated through cognitive structures, was also mediated through
inner, less cognitive, processes—images, gut feelings, and rightness of fit (Kovan &
Dirkx, in press; see also Boyd & Meyers, 1988; Dirkx, 1997, 1998; Scott, 1997).

In their teaching practice, faculty identified specific teaching and learning
processes through which they evoked not only the students’ intellectual growth, but also

students’ developing self-awareness. These learning processes offered students affective,

147

emotional, imaginal, and intuitive experiences. For example, in case studies faculty
prompted students to connect to the human side of the case, not just the diagnostic
elements. Linn asked students to “pretend the client in this case is someone you know.”
Sue asked students to read illness narratives related to the medical diagnoses studied in her
class. Virginia incorporated anthropological and autobiographical works that portrayed
relevant concepts in narrative form. She described three different papers students read on
dying. Wendy used music, letters, and diary entries in a history course to “elicit the passion
in what people at that time felt called to do.” Most faculty told personal stories about
clinical practice and invited student stories into the classroom. Faculty described
“fieldwork reporting day” as a powerful space where students’ affective experiences and
cognitive experiences each contributed to self-knowledge and to a critical evaluation of the
field.

In addition, faculty utilized socioemotional learning processes when they
acknowledged and made space for student feelings in the classroom. Cathy anticipated and
validated how students were feeling about the curricular process and about being asked to
become more self-directed. Sue often asked students about their emotional responses to
fieldwork, and often had to allow space for strong negative emotions if students
encountered difficulties on internships. As described in Chapter Five, faculty mirrored
images to students that also may have evoked aspects of the self not formerly identified.
The Centrality of the Subject

In Chapter Five, I described how faculty employed common active learning
methods to help students connect with, and author, the core subject of human occupation.

Knowledge and selves were authored in particular ways related to the subject being

148

addressed. The role of the primary subject is largely overlooked in the constructive
developmental literature.
Reflection

Much of the scholarship in constructive-developmental theory and transformative
learning represents development as a product of reflection. But it seems that what is taken
as the object of reflection depends upon which aspects of the self are targeted for
development. With cognitive structures as the primary developmental target, reflection
often focuses on: ideas that challenge former ideas, one’s unquestioned assumptions,
systems within which those assumptions were cast, and academic experiences that
created disj unctures with one’s prior experience.

The theory of self-authorship does not readily support taking other aspects of
experience as objects of reflection such as the feelings, images, and passions that can
emerge and capture one’s attention. In this study, the degree to which emotional,
intuitive, and imagistic content was targeted for student reflection remained limited.
Students were often engaged in experiences that elicited images, feelings, and reactions,
and were encouraged to articulate those experiences. But it did not seem as if these
dimensions of student experience were tapped as learning tools, as additional means by
which students could develop the capacity for critical thinking and for self-understanding.
Students were not asked to take learning experiences such as images that emerged in their
mind’s eye, emotional reactions they experienced, or a sense of personal fit or misfit as
the object of their contemplation to the same degree they were asked to reflect on their
observations, ideas, and assumptions. It didn’t seem as if students were asked to “listen”

to images, emotions, reactions for what these experiences had to teach about self-

149

knowledge or how various aspects of the self were mediated through these inner
processes. Dirkx (1997) recommended enhancing intrapersonal and cognitive
development through imaginal means by attending to both the physical and emotional
environment of the classroom, by explicitly making room in reflection for stories, myths,
ritual, fear, passions, dreams, images, and desires.

Beyond Self-A uthorship: Learning, Teaching, and Authoring Lives

Mostly, the constructive-developmental literature portrays the teaching and
Ieaming process as involving: 1) a learner with a repertoire of prior experiences and
conditioned ways of making meaning, 2) an educator who holds particular assumptions
about knowledge and the learner, and 3) pedagogy that provides opportunity for learners to
grapple with ill-structured problems and multiple viewpoints. The aim, of course, is to
facilitate students’ sense of self as knower and the students’ capacity to construct
knowledge in varying contexts. The traditional classroom environment is one environment
where epistemic development is believed to advance.

The role of the faculty has largely been represented in the constructive-
developmental literature in terms of evaluating and modifying her or his assumptions to be
congruent with self—authorship, selecting pedagogical processes internally consistent with
those assumptions, and managing the classroom environment to create opportunities for
students to experience the uncertainty of knowledge. In this study, however, teaching
seemed tied up in the individual faculty’s biography in a more holistic sense than his or her
assumptions, as well as in the history and core subject of the profession to which the
faculty belonged. As described in Chapters Six through Nine, faculty seemed to teach from

their experiences in ways that often represented events and encounters in their own lives

150

and that gave depth and meaning to what happened in the classroom. The autobiographical
experiences of the faculty helped determine the specifics of what they wanted the students
to author and avoid being authored by. The classroom also served as a means through
which faculty themselves continued to shape and make sense of the events and encounters
of their professional lives. Considering Ieaming and teaching from a lens of “authoring
lives” offers theoretical and practical advantages beyond the theory of self-authorship. It
also has some significant drawbacks.
Theoretical Advantages

The term “authoring lives” offers a conceptualization of teaching encompassing
more characters, plot, agendas, and historical contexts. As a theoretical lens, the term
“authoring lives” can expand the dynamics and tasks within the classroom to include
faculty development, past and present, as well as student development. In this study, what
happened in the classroom was often shaped and made meaningful by the lives faculty had
authored from a rich array of professional and personal experience. In this sense, teaching
was much like Palmer’s (1998) suggestion that “we teach who we are” (p. 2). Palmer
explored teaching as a reflection of educators’ past experiences and deepest selves. The
term “authoring lives” suggests that through teaching, educators continue to understand,
author, and revise who they are. Teaching provides a rich context for personal formation,
which can be understood as storymaking (McAdams, 1996), individuation (Boyd &
Meyers, 1988; Dirkx, 1998), meaning-making (Bruner, 1990), and perspective
transformation (Mezirow, 1991).

In addition to faculty lives, the other lives being authored through teaching are, of

course, the lives of students. Self-authorship theory offers a conceptualization of how

151

 

students’ epistemic lives may be authored, but largely leaves the direction and application
of that development up to the student. Self-authorship does not allow for a broader plot, the
vision faculty hold about the future of the profession and the role they desire their
graduates play in that future. Self-authorship does not take into account that faculty
sometimes have a very clear vision about how students’ emerging self-authorship be
directed. In this study, faculty clearly articulated their vision for students in their mission
statement, in their curricular themes, and repeatedly in each course.

Faculty communicated that the occupational therapy curriculum existed to produce
effective thinkers, the field’s “keenest minds,” and to teach students “how to enjoy
thinking.” Faculty took very seriously the curriculum goal to help students become change-
agents. They felt that part of helping students become change agents required that students
learn to feel strongly and passionately about experiences with occupational therapy that do
and do not seem authentic. One faculty voiced that the curriculum was about graduating
therapists who had developed a “soulful connection” to occupational therapy, who are
“dug in” in commitment and conviction. Faculty described how they model for students
that it is “ok to be passionate” and. in fact, it is not okay to be non-chalant about their
work.

As a theoretical lens, the term “authoring lives” potentially opens teaching as
community of co-authors, beyond the autonomous individual implied (even if not
intended) in self-authorship. The notion of lives being co-authored among a particular
faculty group or between faculty and students is consistent with those who describe
teaching as a community of learners (Palmer, 1998). But the concept adds an additional

task in which the community is involved. Through the frame of authoring lives, a

152

community of learners not only jointly creates knowledge around a subject but also
contributes to each other’s task of forming lives.

Finally, as a literary term, “authoring lives,” allows for “plot” in the classroom that
does not surface using self-authorship as a lens on teaching. In this study, the story opened
with the historical context of the profession and how faculty lives had been impacted by
the field’s history. The plot involved avoiding historical trouble spots and advancing
practice grounded in knowledge of human occupation. Teaching was one means by which
the story moved toward the vision of the profession’s future that faculty shared.

Yet the idea of plot also raises a significant drawback to considering teaching
through the lens of “authoring lives.” As I have presented it here, the term implies a
particular meta-narrative either within the profession as a whole or within the individual
faculty group. Students who buy the narrative and demonstrate progress accordingly may
do well and those that do not may be considered less successful, even less worthy. The
term “authoring lives” also brings into question just how “constructive” occupation-
centered education really is. While occupation—centered education seems constructive in
the sense that knowledge is presented as continually evolving and students are invited to
mutually construct knowledge in the larger community of scholar-practitioners, the
knowledge considered most valuable to construct is partially prescribed by the meta-
narrative of the curriculum. As with any meta-narrative, it becomes important to ask
questions about whose vision, power, and politics are being upheld, ignored, or reacted
against by the meta-narrative, as well as whom the meta-narrative includes and whom it

marginalizes.

153

Practical Advantages

In addition to practice related to pedagogy and content, this study also has
implications for practice related to faculty development. It supports Palmer’s (1998)
conclusion that learning new techniques of teaching and keeping up with knowledge in
one’s field are insufficient for good teaching. Good teaching includes the ability to frame

instructional methods and content as expressions of one’s inner life, authored through

-'.H

varied personal and professional experiences, and as sources for further authoring that life.

Thus in addition to instructional methods and content updates, faculty development

 

involves personal exploration into the experiences that shaped one’s journey to teaching
and reflection on one’s teaching practice as offering clues both to the life being authored
within oneself and to the life one hopes to evoke within students.
Conclusion

The original purpose of this study was to describe occupation-centered education,
an educational reform initiative in occupational therapy. Prominent teaching and Ieaming
processes within occupation-centered education can be described using Palmer’s (1998)
concept of subject-centered education and the concept of self-authorship (Kegan, 1994).
That is, educators used common active learning methods to center Ieaming on the core
subject of human occupation. They also used pedagogy consistent with constructive
developmental pedagogy in order to help students make the epistemic and intrapersonal
shifts implicit in the vision that students will “create the future” of occupational therapy.
The instrumental features of occupation-centered education seemed to stem from

constructivist beliefs about knowledge and personal formation.

154

However, the study of what faculty did, and the beliefs and assumptions within
what they did, fell to the background of the study as less instrumental aspects of teaching
practice came to the fore. The autobiographical experiences of the faculty and how those
experiences intersected the history of occupational therapy and the subject of human
occupation gave depth and meaning to what happened in the classroom. Faculty provided
opportunities for students to self-author, but they also had specific visions for how they
hoped to author students. Faculty also continued to author their own lives through teaching
practice, cohering their experiences and integrating new roles into those experiences.
Neither the concepts of subject-centered education, self-authorship, nor constructivism
were sufficient for describing the multiple formation processes at work in the classroom.
The concept of authoring lives was offered as a wider lens because it makes space in
theory, research, and practice for other important dynamics in educational practice. These
dynamics include the past, present, and emerging identities of the faculty, the historical
context and the core subject of the profession, the institutional context of the faculty group,
and the vision faculty hold for who their students will become; together they afford
possibilities for multiple, and sometimes conflicting, epistemologies.

Future Scholarship

I could see several lines of inquiry following this dissertation, ranging from the
instrumental questions with which it began to the metaphorical conceptualization where it
ended. Instrumentally, I became interested in the subject-centered nature of teaching
methods and what educators do to secure learning to the ultimate subject of concern and
how the subject mediates and alters the content under investigation. I was also fascinated

by the implicit images that faculty mirrored to students through teaching. It would be

155

 

useful to compile a collection of those images and explore if students are aware of the
images forming in the classroom and to what degree those images are internalized and
enacted. At the end of the study, I also see the need for a secondary analysis of the data to
discover processes through which faculty elicited the emotional, imaginative, and intuitive
dimensions of Ieaming and to what ends these dimensions were directed.

Inquiry related to constructive-developmental theory needs to include an
investigation into the developmental timeline of students who graduate from curricula like
the one in this study. Current research suggests that ways of knowing and self-perceptions
consistent with self-authorship develop later in life. But research to date has not considered
the role of the educational culture. For the most part, studies have involved students in and
from traditional educational environments. It may be possible that complex ways of
knowing failed to develop in college because the educational environment did not
consistently promote such change. It may be possible that students graduating from
programs like the one in this case study show similar patterns of development, or
demonstrate quicker transformations to more complex ways of knowing and self-
perceptions.

Finally, this study leaves me aware of the need for more narrative inquiry around
classroom processes (Bruner, 1996; McAdams, 1996). What stories are being authored and
lived out through teaching? What plots are being advanced? What personal myths help
educators integrate their work with who they are? Overall, there is a need for a synthesis of
several psychological models that could account for the autobiographical dimension of the
classroom and further research into the classroom as a dynamic and multidimensional

context for authoring lives.

156

Appendix A: Guidelines for the First Interview

Introduction: As you know, I am here this semester as part of a project to better
understand the nature of graduate occupation-centered education. I see the project as
trying to describe the “lived curriculum”, or the features that serve to fuel a good
curriculum design. During this first interview, I would like to talk with you about you’re
personal “story” as an educator, or the evolution of your educational experiences, and
then about the class/lab I will be visiting. Do you have any questions before we start?

1. Questions pertaining to educational development:

Parker Palmer talks a great deal about teaching as an expression of personal
identity. He believes that we teach who we are. In just a moment, I’m going ask you to
sketch out the important experiences that contributed to your becoming an educator and
to the development of your specific views of OT education. The process I’d like to use to
discuss your experiences is known as a critical moments interview.

But first a story: My friend and I were hiking in New Hampshire this spring. We
set out on this one particular morning looking forward to a full day of rigorous hiking and
being outdoors in the White Mountains. But after hiking for only about 1 hour, along this
great, roaring stream—roaring and fast because it was the rainy season in New
Hampshire—we came to what looked like the end of the trail at the water’s edge. We
checked the map, everything looked right. (My fiiend accused me of not reading the map
correctly. . .you know how that can go). But then we noticed that the yellow trail picked
up again on the other side of the stream and the only way to get across and continue on
the trail was to step along the peaks of several barely visible rocks.

Now I’d like to ask you to imagine yourself crossing a stream on a series of rocks.
You pause on a particular rock in that stream. You are looking back over your shoulder at
the stepping-stones that have led to where you currently stand in this stream. Now think
about this stream as the stream of time and the rocks as the key experiences that have
helped you get to where you are now in your views and practice as an OT educator. As
you look over your shoulder, describe the 5 most significant experiences or “stepping
stones” that have carried you to, not just taking a job as an educator, but to the particular
way you now approach OT education.

Process: Take a few minutes to identify those key experiences on this stream. If there are
more than 5, feel free to have each stone represent more than one key influence.

Possible questions to probe during this activity:

a) How did (the particular experience they describe) contribute to what you believe
or what you do today as an educator 1n OT?

b) Describe how (the particular experience they describe) helped shape how you see
your role as an educator.

c) What do you remember about your own educational experience in terms of what
was useful or helpful? Not helpful?

(I) Talk about the mentoring process in terms of not only what you received but what
was already within you that that person “woke” or “tapped into”?

.157

e) What was it about YOU that the subject of occupational therapy appealed to? And
continues to appeal to?

f) How did your clinical experience help define your work as an educator?

g) How has being an educator changed your perspective on your work as a clinician?

h) Looking at the five experiences as a whole, try to summarize how these
experiences are reflected in your actual work as an educator.

IQ

Were you able to bring an object or artifact you feel represents how you currently see
yourself as an OT educator? [Participants were asked, prior to the interview, to bring
an artifact that captured how they saw themselves and approached their practice as
educators] Tell me about what you brought.

3. Tell me about the course I will be observing.
a. What is the overall purpose of the course? What things do you hope the course
accomplishes?
b. What is the “typical class” like in this course? That is what sorts of things do
you do and what sorts of things do the students do?
c. Anything else you would like for me to know before I attend class next week?

Timeframe: 60-90 minutes.

158

Appendix B. Guidelines for the Second Interview

Introduction: The purpose of the second interview is to reflect together on (name
the specific class or labs observed). But before we begin with the video, is there anything
you would like to add to the critical moments or stepping stones we discussed last time?

Process: The researcher prepares by selecting 2-3 segments of ’videotape for the
participant to review. After viewing these segments jointly with the participant, the
interview will be guided by these questions:

I. Tell me about what is happening and what you were thinking at that particular
moment.

2. In what ways is this particular segment a match or mismatch with your image of “ a
teacher”? Of “successful teaching”? Of “learning? Of “students”? Of what constitutes
“occupational therapy”?

a. Note to Researcher: Key in on metaphors, images, aims, and goals
associated with being a “teacher”. Key in on what “success” means to this
educator and to the frustrations they feel in achieving success. Key in on
descriptions of students’ deficits or potential, images of the “problem
student” or the “model student”. Key in on references to “leaming”——what
Ieaming means, how they judge Ieaming, what impedes Ieaming. Key in
images of occupational therapy practice or the field’s future.

3. How did you decide what needed to be taught and how you would present the
content?

4. The final portion of today’s interview shifts our focus slightly from reflecting upon
your actual teaching to model building about your teaching. Here the participant is
asked to visually sketch and descript her conceptual model of teaching.

Timeframe: 60-90 minutes.

159

 

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