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In my PhD research one of my methods has been using a combination of an insider position with observation of practice. As an occupational therapist myself, watching other occupational therapists carrying out their mundane behind the scenes work, has been extremely useful and provided myriad options for the direction my analysis could take. By sitting in the corner of an office for a week observing what I used to do myself, the everyday practices that occupational therapists do took on a whole new meaning. As a practitioner, I had been aware of how much of what occupational therapists do is unnoticed, but by using Michel Foucault’s methodologies I have been able to analyse this from a sociological perspective. My PhD has become focussed on materiality of occupational therapy and how this is part of silent discourses and subjugated knowledge (p.82) that are played out in everyday occupational therapists’ work.
Occupational therapists do a lot of work with material things, that are not quantifiable into outcome measures, contracted service specifications or KPIs. This involves modifying equipment or environments by customisation, in a workshop, at the office or in someone’s home. It also involves travelling and trying out things in places they are needed, organising other people to learn how to use things, and monitoring how things work over time. The materiality of practice is time-consuming and detailed and involves many other forms of knowledge that are not immediately visible in the medicolegal environment in which health professionals work. This knowledge is powerful. It has the ability to change the life outcomes for others in ways that the law, economics or science cannot. Committing time and resources to ensure a person can eat independently or to practise what to do to successfully work or join in everyday social or community activities are taken for granted material practices of occupational therapy. How these background activities support other much larger social structures and dominant discourses is difficult to conceptualise when working at this micro-level. By applying a sociological lens to what occupational therapists do I have been able to view our practice in a different way.
The importance of being able to carry out the material aspects of practice is not particularly recognised in the economic and enterprising way health and public services are now funded. Audits, competency frameworks or funding models are not interested in material knowledge and skills such as what type and where one can source the only type of Velcro that is strong enough to hold a wheelchair cushion in place. However, the person in the wheelchair and the people who have to manage that cushion definitely are. Likewise, the law is not interested in how a person in custody can have the opportunity to choose to make a toasted sandwich or eggs on toast as part of their rehabilitation if they are categorised as high risk. The ability for street level bureaucrats such as occupational therapists to practise in ways that influence these sorts of outcomes is an important focus. Materiality is something that goes beyond policy and processes. From my research materiality seems to hold an important place in the power relations that underpin dominant understandings and structural practice, making understanding materiality a prime target for modifying how these are maintained.
One of my other research methods was using a blog as a way of critiquing occupational therapy practice to achieve such modifications. Although the content of the blog was originally intended to provide additional data for analysis, the material practice of blogging has actually been an unintended and productive part of the project. Most of the followers (approx 80) of the blog are occupational therapists. Because of this, it has provided an ethical axis to the research as my critique of our practice has been so open. The political act of writing in public through a blog has also been a new experience for both myself and many of the followers who commented on the blog which has made it a form of critical action. The results of this approach are starting to emerge, but it remains to be seen if using this combination of methods will create any collective change at the street level.
Mary Silcock is a PhD Candidate in Societies and Cultures at The University of Waikato
