Vol. 22 Issue 5
The Culture Behind The Occupation
One therapist's story
A client's culture will have a direct impact on the occupational therapy process. Certain values and beliefs will determine which occupations are more or less meaningful. So it is imperative to design therapy to embrace the client's cultural belief system. It is also wise to understand how your own beliefs and values impact the process.
Currently, I am the program coordinator for the Glad Writings Card Shop Program at Midtown Community Mental Heath Center in Indianapolis. In this innovative program, participants are fully involved in creating, marketing and selling handmade greeting cards. The participants vary greatly in ethnic culture and background, but share the one commonality of being diagnosed with chronic mental illness. Clients participate for different reasons: socialization, creative expression, and/or to increase cognitive skills, find structure or enhance pre-vocational skills.
The card shop also fosters a business-like environment through its marketing and sales. Because there are many different reasons for participating in the program and various tasks are offered, it is important for me to learn each client's cultural background to make the experience more meaningful.
Approximately one year ago, Suzy (not her real name) walked into the card shop program escorted by her case manager to receive a tour of the program. Suzy is a 65-year-old Caucasian woman with a history of major depression. After receiving her tour, she decided she would like to participate.
Suzy was once an artist, an identity we both share. Her love for art was the reason she was initially drawn to the program, and she always chooses to engage in the more creative tasks. Slowly, she began to bring in some of her past artwork, and encouraged others (including me) to bring in theirs. This "show and tell" has become a regular occurrence in the program that everyone seems to enjoy.
Suzy is also very social, and often assists others and encourages them. She is always bright and became somewhat of a leader within the group. She is creative and very resourceful in her work. It is a common occurrence for her to bring in used greeting cards, wallpaper samples, pressed flowers and other "recyclable" materials to use in the creation of the cards. I understood from our conversations that she grew up with a limited income and being resourceful was part of her culture.
I discovered that Suzy married at 16 and was the caregiver for her husband and her five children for most of her life. She often brought in little things for other members, and assisted others with their snacks during break times. Because she spent most of her life caring for others, it was rare for her to take time for herself.
With the support of the program, Suzy began to feel increasingly proud of her creative efforts and began creating art and sewing once again in her spare time. One day she brought in a beautiful purse that she made from vintage material her mother left her. She received feedback from clients and staff that she ought to sell these purses, and she was able to make three sales within the first week. She has continued making these bags and has become fondly known as "the bag lady" at the clinic. Since then, Suzy has sold hundreds of dollars worth of purses and continues to sew with newfound meaning and joy. Each week she excitedly brings in her new styles of purses to share, each with impeccable quality.
While I already understood why she enjoyed the program and why small parts of her culture helped her relate, I decided to interview Suzy to uncover even more significant cultural experiences that make her participation in the card shop program meaningful.
I conducted the interview at the Indianapolis Museum of Art as we walked around. She was drawn to the paintings that reminded her of her hometown in Tennessee and commented on several works of art depicting images of her Cherokee Indian heritage.
Suzy first recalled creating art was when she was six years old. She described how she dug fresh clay out of the earth and made a clay pot that fell apart because her mother refused to let her bake it in the oven. Suzy then recalled drawing pictures in the sand bank, informing me that sand was different colors in the South. She stated that she loved creating art, "but we were so poor that we didn't have crayons or anything."
She began sewing and cooking when she was 10 years old. Common family practices included doing laundry in the creek and cleaning the floors of their home by rubbing sand across the planks with their feet.
Suzy told me, "Early in life, I learned to appreciate beauty in nature and art. I can take a stick and see a woman in it."
When I asked her how she felt about making and selling her purses, Suzy stated, "It makes me feel like I'm making something useful. Also it makes it financially possible for me to finally buy art supplies."
I also discovered that Suzy is very religious. While she was raising her children, Sunday was the only time she had for herself. She would go to church and take the time to read the Bible. She stated, "I used [the Bible] to raise kids and live with a man. Anything I had trouble with, I went to the Bible."
Her religious beliefs also influenced the way she felt about her art. When asked what art meant to her, she reported, "Art comes to me naturally. It makes me feel worthy that I can do something different, like it's a God-given talent." Again, these beliefs supported her success within the card shop program.
Suzy's culture also impacted the occupational therapy process in group dynamics. I was unsure of her past experiences with other races, so I asked her to describe her recollections. She had first seen an African-American man when she was being taken to the hospital for seizures at the age of 10. She recalled asking her mother about this man working in the kitchen. Suzy reported that her mother stated, "Black people have hearts too. The skin doesn't matter."
Her culture supported accepting others, so she had no problems within the card shop group context and always treated others with unconditional positive regard.
Suzy's experience with staff is also positive. She stated, "The staff are exceptional. They have compassion and express it in different ways to different people." This statement makes me recall an article by Peloquin (1990), in which she discusses that patients' positive images of occupational therapy reflect competence and caring. Negative images are reflected when there is a failure to commit personally to caring or competence, or the caring dissipates.
To further show how Suzy's culture impacted the occupations she wanted to perform, I asked her to list the things she values. Her list included, "my children, my home, keeping clean, music, family, sewing, arts and crafts, and my social life."
Suzy still goes to church where she actively participates in singing and music. She also maintains a clean home and is active with her family. But that day she walked into the card shop for the fist time, there were three valued occupations missing from her life. The card shop program made it possible for her to resume participation in sewing, art and social engagement. It fit like missing pieces from a puzzle.
In retrospect, it would have been beneficial to conduct a similar interview at the onset of therapy. While I had the opportunity to work with Suzy for an extended period of time, such is not always the case. Cultural analysis through interview appears to be effective in understanding the client's values and beliefs to improve meaning when providing occupational therapy services.
According to Padilla, Barrett & Walker (2003), it is necessary to take the time to understand the clients on a personal level to understand the meaning of their occupations. Black (2005) also notes that listening is a receptive skill that includes listening with an open mind and eyes, as well as with the ears. It will also be important to "listen" to non-verbal communication as the interview takes place.
Participation in the card shop program has become a meaningful part of Suzy's life, fitting nicely into her past cultural experiences. Working with Suzy has taught me the importance of understanding clients' values and beliefs. I found that if the therapy is more meaningful to the client, I feel more satisfaction and meaning in my occupation as a therapist.
References available at www.advanceweb.com/ot or upon request.
Kristin K. Hubick, OTR, is a 2003 graduate of Indiana University and is currently pursuing a post-professional master's degree at the University of Indianapolis. Readers can contact Hubick at firstname.lastname@example.org.