F E AT U R E
A call to action, to be critically reflective of ourselves and our practice Micah Perez
I
n today’s ever-evolving climate, the abuse and/or neglect of human rights of various populations is becoming increasingly evident, thanks in part to brave voices and advocates of social justice bringing this to our awareness. There is, therefore, a real need for us, as OTs, to critically reflect on ourselves and our practice, and the impact of our practice on the rights and needs of our clients. An important part of critical reflection, in my opinion, is to first consider our bias and positionality. Nixon (2019) proposes a coin model of privilege, whereby coins are used to conceptualise systems of inequality that give individuals advantages and disadvantages, depending on what side of the coin they are on. After we have reflected on our bias and positionality, we can then reflect on the impact of these on the way we practice occupational therapy, and the way in which we establish and maintain a therapeutic relationship with our clients. I believe this form of critical reflection is especially important when we work with clients with disability who are neurodivergent (confirmed and suspected) and have culturally and linguistically diverse backgrounds. For example: • Am I biased towards neurotypicality, ableism and Western culture? If so, how does this bias impact my expectations, communication, and interactions with neurodivergent (confirmed and/or suspected) clients with disability, who have culturally and linguistically diverse backgrounds? • Do I come from a position of unearned power and privilege? If so, how
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does my position impact and/or inform my therapeutic relationship and expectations of my clients?
A reflection on the neurodiversity movement
Momentum appears to be gathering for OTs to join the neurodiversity movement. I’m excited about this, because I am very much on a journey of resonating with the neurodiversity movement and moving towards neurodiversity affirming occupational therapy practice. My journey began with a process of critical reflection, like I have outlined in the section above. According to Dallman et al. (2022), neurodiversity affirming OTs must critically question the following: Are your goals targeting reducing or changing diverse behaviours central to your client’s personhood and important for their wellbeing? When I reflected on this question when working with my paediatric clients, it prompted me to think about whether I was being client-centred in relation to the child or the child’s parents, and this has since informed the way I approach goal setting and intervention planning. When I reflected on it when working with adult clients, it prompted me to think about the expectations I had and the basis of those expectations, and to question what wellbeing means for each client. I have since come to appreciate how diverse the definition of wellbeing is for my clients. Proponents of the neurodiversity movement argue current therapeutic and medical
practices often attempt to normalise behaviours and ways of participation that originate from these differences in neurology and contribute to an individual’s sense of identity. Dallman et al. (2022) argue that an ethical and morally just occupational therapy practice should affirm neurodivergent ways of being, and OTs must be agents of change by listening to and collaborating with their neurodivergent clients. A neurodiversity affirming perspective, according to Dallman et al. (2022), requires: 1. Respect for your clients as having a unique style of neurological processing that leads to differences in sensing and operating in their environments; 2. Listening and consulting with neurodivergent individuals to determine the meaning of their behaviours and occupations; 3. Framing neurodivergent behaviours as natural and valid responses to a specific situation, given the skills, abilities, and preferences of each individual; 4. Having goals that prioritise emotional wellbeing and positive engagement, rather than therapy compliance; 5. Respecting the right of neurodivergent individuals to physically engage with a task or move their bodies during therapy; 6. Guaranteeing social agency and the right to socially engage in ways that are comfortable to them; whereby you, as a therapist, must seek to understand neurodivergent social rules, norms and communication styles that can best support your clients; 7. Validating, encouraging, and honouring all forms of communication (e.g., verbal AND non-verbal); and
