Disclaimer: The opinions expressed in this blog are entirely our own and not necessarily those of our employer or any other occupational therapist.

Wednesday, 14 April 2010

On Occupational Balance and blogging out of my comfort zone .....

Over the Easter holidays I was reading an article in the Radio Times written by Nick Baines (Bishop of Croyden) about why he is a "blogger". Something he wrote really touched a nerve within me and made me think about how I blog and what I gain from blogging:

" The blogosphere isn't for the faint-hearted. But what's the point in simply talking to those who agree with you, when you could be arguing your way to a better understanding....".

Hmm, on reflection my online networking has become rather comfortable, interacting through blogs and facebook usually with peers who have a similar view to my own, and possibly students of occupational therapy who may be too polite to disagree given their perception of the power imbalance between lecturer and student.

Whilst I was pondering this situation a coincidental status update by my colleague Sarah Bodell yesterday has created much discussion amongst the international occupational therapy community today and I would like to share some of that here and maybe offer some counter-argument to take things out of my own comfort zone.

The status update asked if the term "Occupational Balance" was an over-simplified euphemism. This has led to comments that can be summarised as follows: (apologies for not attributing the comments to the original source - but until I can ask each one for consent to identify them then I need to respect privacy rules of netiquette- please let me know if you wish to be identified and I will happily insert you!).

  • Is there evidence that occupational balance is/should be a universal aspirational state? I guess we need to consider what we mean by "balance". Traditionally one might imagine a set of scales and balance being achieved when all components register the same (as in equal amounts of work, rest and play?). However, Fearing (2001) summarises that balance should not be viewed in this way but rather as "the kind of balance that comes from being centred so that we act from a stable base.
  • As occupational therapists, if we are presented with someone experiencing occupational imbalance should we automatically assume that they are not healthy or are at risk of being unhealthy? This generated discussion on the perception of client-centredness. Some would view that occupational therapists were obligated to allow people to make their own choices - whether these could be perceived as healthy or unhealthy.
  • would a life of occupational balance stifle? "imbalance makes life interesting"
For me, one of the fundamental issues of occupational balance (OB) is choice. My OB depends on 2 things - opportunity and ability and operates under the umbrella of time.

Opportunity includes:
  • Political, legal, social and cultural climate in which I live/work
  • Environment (human and non human)
  • Financial
Ability includes:
  • physical and psychological ability
  • knowledge and understanding
The concept of time is the umbrella under which all these components sit.

So for example, today I may feel that my work is taking priority over my personal life (I am not alone in that - this is an interesting link to how we may change our view our priorities). I prioritise my work at this time as I am motivated and interested to do so and am driven by deadlines that I choose to keep (and I need to retain employment!). Tomorrow it may become imperative to prioritise other areas of occupation (family committment, social engagements etc). I can do this because I have opportunity and ability to make this happen (usually) and when I complain of "stress" through imbalance it is usually temporary.

I may live in an environment that for whatever reason doesnot allow me such choices, or I may never have gained the skills/knowledge to understand or engage in making such choices. As an occupational therapist working with somone in this situation I would work with the individual in gaining knowledge/skills or enabling them to adapt themselves and/or the environment to ensure that their individual, yet realistic, goals were attained.

So, I guess what I am saying - in a round about way - is that in my view the concept of Occupational Balance should not be a universal aspirational state - but in fact the idea of balance (or as Fearing states "a stable base") is both individual and time bound.

Further research may be required. I am now officially out of my comfort zone and await the challenge with a certain amount of anticipation. As Nick Baines says " this is the first word in a conversation, not the final word of judgement." Anyone is free to argue with me, question me and disagree with me. Over to you.......................


Gail said...

Thanks for blogging, Angela. You can tell that this debate is prompting a lot of pondering on my part. I too feel way out of my comfort zone here, but probably for different reasons - having moved away from OT over the last decade, I am quite out of touch with cutting-edge occupational therapy theory. So I'm really debating this from a perspective of an interested observer, than any sort of expert on these concepts.
Could I ask about this, that you say in relation to client-centeredness: "Some would view that occupational therapists were obligated to allow people to make their own choices - whether these could be perceived as healthy or unhealthy." I'm not quite sure I understand this. Surely OTs are not in a position to "allow" or "disallow" anything? Or have I misunderstood?

Angela said...

Hi Gail thanks for your comment. The quote you mention was from one of the commenters on facebook. I guess the word "allow" is perhaps misused. I believe the point being Hi Gail thanks for your comment. The quote you mention was from one of the commenters on facebook. The point being made was in answer to a thread on client centredness where one commenter suggested that as OTs we should not work on anything with our clients that could potentially be unhealthy ie working towards goals that could end in OB. The counter stance is that if we are truly client centred then we should be working with the client on anything they identified as important and thus "allow" unhealthy behaviour. However I have never beloved in true client centred practice as there are ethical and legal issues that I believe prevent this. Thereby waits another potential post! Hope that clarifies things??

Gail said...

Clarifies, and opens a can of worms! I look forward to your blog on client centredness with real interest. Getting back to occupational balance - I wonder to what extent clients would (a) see it as a problem and (b) be motivated to seek help from (c) an occupational therapist. I'd venture to suggest that the answers would be (a) some, (b) very few and (c) virtually none. I could be wrong, though, and like you, would love to hear others' views.

Kirsty said...

I think this is interesting Angela, if this is outside of your comfort zone you should do more of it! I think you've managed to sum up in an eloquent and academic way my thoughts on occupational 'balance'. I agree that we as individuals or as therapists aren't aiming for a balance in terms of all elements being equal but rather enabling ourselves or others to have the ability and/or choices/opportunities to focus on the occupational areas that are important to them. There are definitely times in my life where paid employment is the main focus of my life and I don't engage as much time on leisure etc, but this is my choice and I'm happy with that. For me occupational inbalance occurs when individuals are unable to engage in an occupation of their choice and it is our job to enable them to do this. If their choice is to engage heavily in one occupation and not others then that is their choice. My final thought is who on this planet has a 'balance' of occupations (the lucky ones I guess) surely most individual's go through 'stages' in life where they focus on a certain occupation more than others. I'm at the stage where my main focus is on paid employment and squeeze in leisure where I can whereas my parents and in-laws are at that well deserved retirement stage where leisure is the name of the game!

Sey said...
This comment has been removed by the author.
Radhika said...

Wilcock's 2006 definition of OB ...
Balance of occupations that leads to well being. Balance may be among physical, mental and social occupations, between chosen and obligatory ones; between strenuous and restful and between doing and being.
Angela you mentioned - if we are presented with OiB should we assume the client is unhealthy. My experience is that OiB is identified as a problem jointly by therapist and client as a part of the assessment process in context. People don't come with this on their referral forms or state it as an issue because (1) it is part of our jargon (2)their focus is on dysfunction, symptoms etc and the loss of balance might be just one of the reasons that some one is experiencing an increase in say symptoms (eg pain), dissatisfaction with their lives etc
I say this from working with people with chronic pain/fatigue who are overdoing in one of the areas that Wilcock refers to (note she doesn't say work, leisure etc)and by pacing and prioritising (which I believe are about bringing about balance specific to the person and their condition) definite benefits are achieved in their overall state of health and well being. (ref Pain management Prog studies)
Balance i believe is also about need satisfaction not just about how many hours one spends say at work or in caring for children. There have been times when work has really been a pleasurable experience for me providing me with a congenial environment and not leaving me feeling drained/unfulfilled and I didn't really have to seek further leisure or social contact elsewhere. On the face of it, it might be judged as an imbalanced state but it served my needs.
At other times I have been miserable in my workplace and have had to balance it with other occupations to satisfy my need for restoration or companionship.
I would be interested in hearing what definitions people use for OB/OiB

Hanna said...

I would like to confess that I am a selfish blog reader who much enjoys reading the interesting thoughts and debates on these pages but has never before contributed! I feel way out of my comfort zone amongst all these articulate arguments but anyway, here goes with my first comments.

I am particularly interested in the discussion about the comments people made on FB around OB and client-centredness. I agree that we should be working with the client on what they identify as important but am not too comfortable with the concept of ‘unhealthy behaviour’. The way I see it is that working with the client on what they see as important can lead to OB for them. Who are we to judge the correct levels of different elements required for OB for an individual and what is healthy or unhealthy for them. Each person’s OB is unique to them and we need to be careful as occupational therapists that we don’t impose our own OB ideals onto our clients. This is particularly relevant for me at the moment working in a hospital where the majority of people are from diverse cultural backgrounds, mainly from around Asia. My personal OB ideals are very different to the majority of my clients and the way I can enable them to work towards OB which is right for them is to try to understand their values and spirituality. So for me one of the key issues of OB is a person’s values. I agree with Kirsty’s comments about not aiming for all elements being equal but rather “enabling ourselves or others to have the ability and/or choices/opportunities to focus on the occupational areas that are important to them”. It seems to me that when a person’s values are incongruent with their current occupational performance the result can be OiB. I believe it is important as an occupational therapist to first and foremost focus on understanding a person’s values and spirituality and enabling them to work on these areas. OB, to some extent, will naturally follow. I use the words ‘to some extent’ as I also agree with Kirsty when she says, “who on this planet has a 'balance' of occupations”.

m said...

I agree with the idea of helping a client to achieve an OB that works for them (being client-centered). But, we also frequently have clients who receive our services because their health, life decisions, current circumstances, etc. result in unrealistic or impractical ideas about OB. In that case, maybe we should focus our efforts on helping clients achieve OB that works for them in theory and practice based on their situation and life goals, and how to go about adjusting their OB when life situations emerge.

Sarah said...

Hello. Having followed the Facebook discussion, and here too I'm left with this. OB/OiB is so individualized it becomes a mute point. It's a concept used to describe an aspect of wellbeing, but not one that offers any generalizable features. I'm also wondering if and how OiB differs from stress, other than by semantics? Or is stress created by OiB?
With regards to client centered practice, I've never been persuaded that it is aspirational rather than truly possible, but need to read more and will also await Angela's thoughts with interest.

Jacob said...

This is great information – its encouraging to see online education is becoming more widely accepted and the benefits are backed up by a range of studies.

Ged schools said...

The point being made was in answer to a thread on client center where one commenter suggested that as OT we should not work on anything with our clients that could potentially be unhealthy either working towards goals that could end in OB.