AOTJ

Leaning into the language of being client-centred

Dr Carolyn Murray Editorial Board Member, Australian Occupational Therapy Journal

To meet the communication standard in the Australian Occupational Therapy Competencies [1], a therapist must:

“practise with open, responsive and appropriate communication to maximise the occupational performance and engagement of clients and relevant others” [1, p. 9]

Communication is a core aspect of occupational therapy practice. It was identified from a Delphi survey by Swan et al. as one of the top three attributes of excellence in Australian acute settings [2] (alongside self-management and critical thinking). A key aspect of communication is our language (both verbal and written). Language needs to show respect for and be inclusive of the people who are recipients of occupational therapy services or participants in occupational therapy research. As such, the Australian Occupational Therapy Journal includes the following statement in the author guidelines.

Terminology. Choice of terminology used to describe a person with an impairment or disorder should reflect respect (e.g., do not use ‘the epileptics’, ‘the mentally retarded’), should protect dignity (e.g., do not use ‘suffering’, ‘case’), and should be free of stereotypes (e.g., do not use ‘confined to a wheelchair’, ‘victim’).

The movement toward ‘person-first’ language was first introduced in 1992 in the United States [3]. Since then, the nomenclature used in health and social care sectors continues to be discussed and debated within the literature [4-7]. These critical conversations are necessary and valuable as they challenge our assumptions about the language we use. As an example, Foley and den Houting [8] explained in their letter to the editor of the Australian Occupational Therapy Journal that some people with autism prefer to be called ‘autistic’ (identity-first) rather than ‘a person with autism’ (person-first). They asked occupational therapists to “seek clarification from the autistic people you work with regarding their language preferences” [8, p. 97] . This letter gives an important reminder of the meaning of being a respectful client-centred practitioner and the weight our language choices carry to the people we serve.

Research published in the Australian Occupational Therapy Journal has showcased how strongly we value being client-centred [2, 9-12]. To be client-centred we need to deliberately look past the diagnosis and demographics (i.e. age) to see the person, and in doing so, draw on multiple forms of professional reasoning (i.e. collaborative and interactive) [13] . An exploration of the literature about expertise in occupational therapy found that conscious critique and communication of our reasoning enables “challenges to our cognitive biases, assumptions and social norms” [14, p. 70]. In a recent editorial in the Australian Occupational Therapy Journal, Laver [15] progressed the conversation by asking occupational therapists to actively avoid stereotypes and prejudice in our language to counter ageism and promote healthy ageing. Being deliberate in our language and reasoning is relevant not only with clients, but also in our documentation and communications with colleagues (i.e. avoid inadvertently referring to people by diagnosis, bed number or behaviour). Doing so, may enable a shift in perspective and therefore client outcomes. In other words, actively changing our language, may change our thinking and the thinking of those around us, to lean even further into deliberately being client-centred practitioners.

As a profession we sustain a reflective stance on our practice, using our core values as a touchstone. Initiatives such as the CORE approach [10] (Capabilities, Opportunities, Resources and Environments), which provides practitioners with a framework for inclusivity, and the development of the culturally responsive goal setting tool ATOMIC (Australian Occupational Therapy Outcome Measure for Indigenous Clients) [12] keep the occupational therapy profession in Australia on track with our client-centred values and ideals. As a collective, occupational therapists can work toward inclusivity and being respectful toward our clients through being deliberate about the language we use in all aspects of our practice, including our written communication.

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