Reflections on my Elizabeth Casson Memorial Lecture

My initial thoughts on being asked to do this reflective blog was ‘where do I start’? Being invited to present the Casson Memorial Lecture was certainly a key highlight of my professional career … so after 21 years, I still have very clear memories of the preparation and presentation. I knew, as I started the preparation, that it had to centre round the importance of person-centred practice; and then some history of occupational therapy, where we were at the present time; and to look forward as we had just moved into a new millennium.

From a very young age I was under the care of Dr RD Lawrence, one of the very first people to be given insulin in the 1920s. He was a medical student at that time. He had to adjust his life considerably but succeeded in becoming a leading consultant in this area. Dr Lawrence went out of his way to explain to each of his young diabetic patients that we were all different, no two people with diabetes are the same. We each had choices to make in lots of areas of our lives and he helped us in our decision making. Therefore, in my early life, I saw the value of person-centred practice and this has guided me right through my life, in all areas, and of course within my professional practice – with users, colleagues and students.

I cannot remember hearing anything on the history of occupational therapy when I was a student though I am sure it was covered! However, once I started lecturing in Dublin, I was given the history sessions to facilitate. This is where I became so aware of Dr Elizabeth Casson and also Dr Meyer. About the time that Meyer was inspiring occupational therapists to make meaningful occupation central to their practice (1920/30s), Dr Casson was graduating as a doctor in the UK. She went to work in the area of psychiatry and was appalled at the idleness of and the lack of meaningful tasks for patients in mental hospitals. She travelled to the USA to see the potential of occupational therapy. Dr Casson returned to establish a residential clinic in Bristol and the first British School of Occupational Therapy was formed. Like Meyer, she certainly appeared to be convinced that meaningful use of the day was central to the physical, social, emotional and spiritual healing of her patients (Richards 1998). I strongly believe this is true.

From my research with community occupational therapists in Dublin and on returning to the UK, I became so aware that practice within Social Services was mainly limited to provision of aids and equipment … but what about the hobbies and interests of the users? This led to my PhD studies, developing a person-centred assessment so that the user could state their quality of life priorities  … and the Mayers’ Lifestyle Questionnaires (1), (2) and (3) came into being (https://www.yorksj.ac.uk/our-staff/staff-profiles/chris-mayers.php). It was in the middle of my on-going research with these instruments that I had the honour of being invited to give the Casson Memorial Lecture (2000). I am sure ‘Wow’ was my initial reaction! I had sat through so many excellent Casson Memorial Lectures in the past and now I had the honour/privilege of presenting one … I knew straightaway that for me to be true to my own personal professional beliefs, it had to be concerned with person-centred practice; but also it was the beginning of a new millennium and so I wanted to encourage occupational therapist to look forward … but I could not do that without having them look back too.

Many important issues came to mind: history, models of practice (very much in vogue at the time), the ageing population, the need for a ‘seamless service’, occupation; and my key underpinning theme of person-centred practice.

With all my ideas buzzing around in my mind, and with the great help of my second-year students at York, a title emerged, ‘Reflect on the Past to Shape the Future’. I compared the anxiety level of preparing this lecture to that of my PhD viva – acutely high! After about the 10th draft copy, I was beginning to feel more secure but I now had to think about the power point (remember I am talking about over 20 years ago!). Colleagues were very patient listening to my practices in order to stay with the 50 minutes allowed. On arriving at Keele, I seemed to lose my normal identity; it became ‘oh you are the one doing the Casson Memorial Lecture’. The presentation was on the final day too but by then I had managed to transfer all my anxiety to my friends/colleagues that were there and I felt quite calm, ready to do the lecture, committed to, and believing in, all that had been prepared.

Back to the content …

Historically, I had seen from reading and experience that the profession had had a rather circular route of development. Meyer and Casson were very concerned with meaningful occupation but gradually we then moved towards a more medical model. However, through the encouragement of occupational therapists like Reilly (1962) and Yerxa (1979), we had come back to more meaningful occupation and consequently person-centred practice being central to what we did/do … and this was central to the first part of the lecture. The client should be involved in the decision making within their occupational therapy intervention. Meaningful activity must be part of this process and this involvement will increase intrinsic motivation to improve his or her quality of life. This is all central to the philosophy underpinning occupational therapy (Mayers 1990). I felt it was necessary to include a shared vision for all occupational therapists within whichever area they were working – our respect for the individual and our valuing of, and belief in, the importance of occupation. I presented this lecture when the profession was very much concerned with models and approaches in order to clearly demonstrate the theory behind our practice. Possibly why Gary Kielhofner was one of the key speakers at this conference.

I wanted to reflect the need for theory and research within our education programmes and practice as I moved into the ‘shaping the future’ aspect of the lecture; particularly in relation to our ageing population. Looking back, 21 years later, I can see how the education programmes have evolved. The value and importance of occupation is very much there within a far less medical model of education and third year students are carrying out relevant research projects with occupational therapists in local hospitals. Placements are not just in hospitals and community practice nowadays.

The UK’s population of over 75-year-olds will increase by nearly 75% over the next 20 years (https://www.nuffieldtrust.org.uk/chart/uk-population-aged-over-75-millions). As predicted, many more occupational therapists are now working with older people, many with mixed pathology and this was one of the reasons why I was asked to develop the Mayers’ Lifestyle Questionnaire (3) about 12 years ago, one designed to enable older people to identify their priority quality of life needs. In the lecture, I suggested that the government needs to consider the quality of life of older people within residential and care homes. Their individual needs and interests should be assessed. I have seen this in practice in some residential homes but we have a long way to go before this occurs in every care home. Paid and voluntary employment in older life and leisure occupations must be considered too for all people referred to our services.

Twenty-one years further on, I am still totally committed to person-centred practice; and the Mayers’ Lifestyle Questionnaires have been translated into a number of European languages. However, if I was giving the lecture again, I am sure I would have majored more on ‘spirituality’ as I now see this as central to the consideration of person-centred practice.

 

My research into this area originated from the fact that over 50% of all people completing the Mayers’ Lifestyle Questionnaires indicated religious/spiritual beliefs were important to them. From research that followed, a definition of spirituality emerged:

  • a search for meaning & purpose to life
  • a search for activities that give meaning and value to an individual’s life
  • a quest for ‘wholeness’, integration of mind, body and spirit
  • a belief in God or some form of higher power
  • a sense of ‘connectedness’ to God, self, others, nature

…. and that these personal beliefs or faith ‘shape’ a person’s perspective of the world & how she/he lives life. (https://www.yorksj.ac.uk/our-staff/staff-profiles/chris-mayers.php). In other words, it is discovering which occupations give each individual ‘a positive buzz’ in their lives, what makes people ‘tick’ … and surely this is a very important aspect of person-centred occupational therapy practice.

Our intervention should include time for the user to reflect on his or her past roles, occupations, motivation and quality of life before, and since, his/her problems occurred, so that together we can work to plan and shape as positive a future as possible for that individual … oh, for the government to provide NHS/community care with sufficient finances to enable this to happen!

Read the original article here

Mayers, C. (2000) The Casson Memorial Lecture

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