Private Practice in Occupational Therapy

Florence S Cromwell

• Publisher: Routledge
• Year: 2013
• Print ISBN: 9780866564120
• eBook ISBN: 9781136550317
• Topic: Medicine
• Subtopic: Health Care Delivery

Valuable insights into the potentials, risks, and excitement of establishing a private practice in occupational therapy. This groundbreaking volume provides general and specific ideas to help guide the OT professional who is considering independent practice.

Wellness: Its Myths, Realities, and Potential for Occupational Therapy

Jerry A. Johnson, EdD, OTR, FAOTA

DOI: 10.4324/9780203056363-13

ABSTRACT The paper presents some of the accepted interpretations of wellness and defines “context” preparatory to an exploration of wellness. Secondly, it discusses a cultural shift in our society that brings forth the possibility of wellness as a context for living. Finally, it provides some thoughts about the potential for occupational therapy in the area of wellness and its implications for our practice.

Interpretations of wellness abound. Insurance companies generally view wellness as a responsibility to be assumed by individuals that will reduce the insurance company's medical payments. However, the majority of insurance companies do not pay for wellness programs because they are considered to be either educational or “unscientific” —unsupported by research. Furthermore, payment for wellness programs is limited in that it has been difficult to prove that an illness or disease has been prevented.

Hospitals with “wellness” programs frequently offer a variety of health promotion programs directed at weight loss, smoking cessation, exercise, nutrition, and/or stress. While these programs are not consistent with each other in philosophy or approach, many are based on the perspective of pathology, disease, and symptom management, with a focus on content rather than context.

The medical community is generally skeptical about “wellness” in that most studies of associations between lifestyle and diagnosis have been established only after a disease process is well established.

Contributing to the confusion surrounding the term wellness are the many individuals who offer “wellness” programs. Many of these individuals include persons who have had life-altering experiences and who want to share that experience with others. Other providers of “wellness” include retailers of vitamins and food supplements, and some are operators of exercise or weight loss clinics. Some health professionals are using a variety of unscientific techniques (e.g., techniques which have little support from research studies). Other health professionals clearly believe that wellness, or health, is a function of integration of mind, body, and spirit.

Business applies the terms wellness to health promotion programs that contribute to improved health, reduced absenteeism and medical claims, and improved productivity by employees. In fact, the greatest clarity about the wellness concept is found in the business community, whose objectives for wellness and health promotion programs include:

1. Increased productivity: that is, better quality of work, more units of work produced, higher morale, reduced absenteeism, and perhaps lower health care costs;
2. Cost savings: less sick time, and reductions in payment for employee health insurance claims; and
3. Improved Public Relations: such as better corporate image, favorable media coverage for employee health promotion programs, and statements by prospective em-ployees that the company's health promotion programs were among their incentives for wanting to affiliate with the company.¹

The President of the Health Insurance Association of America said: “Suffice it to say that wellness programs at the worksite are no passing fad. They are an integral part of management strategy to improve productivity and, over time, trim the costs of doing business.”²

A point to note is that not once is improvement in em-ployee health listed as an objective.

Wellness Defined

What then is wellness? A search of three dictionaries yielded no definitions. Review of many articles produced descriptions of programs, but again no definitions. Finally, in reviewing Time Magazine's Special Advertising Section on June 18,1984, I found the following:

Wellness could be described as a mountain riddled with deep gorges, giant boulders, and dense forests that must be climbed in order to reach the sunny peak of high level wellness, maximum longevity, and enhanced quality of life. The obstacles start with the recognition of negative lifestyles, and go on to include action to reduce them, elimination of risk factors, and adoption of positive lifestyles. This leads to optimum physical, mental, and social functioning. In contrast, instead of ascending, one can take the easier trail and descend into the valley of illness and death. Many people are speeded along this descent by negative lifestyles, symptoms, signs, disease, and disability; at the bottom they fall into premature death.

A complement to Wellness is Health Promotion. It is the process of creating awareness of health risks, influencing attitudes and identifying alternatives. The goal is to motivate people to improve their health and environment in order that they may function at their optimum level. Wellness means fostering attitudes and actions which can lead to health and ultimately, to reduce health care costs for both employer and employee.³

Given this state of confusion in the interpretations of wellness, I first want to provide a context for a more indepth examination of wellness and the wellness movement. The wellness movement is representative of some very significant changes occurring in our society. By seeing wellness within this larger cultural context, we can better grasp the meaning of these changes and comprehend their significance and the possibilities that may exist for the occupational therapy pro-fession in the domain of wellness.

Context, as defined in Webster's dictionary, is “the whole situation, background, or environment relevant to some happening …” It also means to “weave together” —as “the parts of a sentence, paragraph, or discourse that occur just before and after a specified word or passage and determine its exact meaning, as it is unfair to quote this remark out of its context”.

A way of visualizing context is to think of a bowl of salad. The bowl provides the context for its contents, which may include tomatoes, lettuce, onions, and whatever else one puts in salad. In business there are frequent references to the “big picture” which is the context for many specific business activities and decisions. Because context provides a sense of the whole situation, background, or environment relevant to some happening I want to present some thoughts about a shift in cultural changes so that you will have a cultural context for my further discussion of wellness.

Cultural Changes and Wellness

These thoughts originated in a book entitled, New Rules, by Daniel Yankelovich. Yankelovich goes beyond observed trends like those in Megatrends to look at (1) the cultural, or shared meanings of trends and (2) the psychological, or inner and private meaning of trends.⁴

Yankelovich proposes that out of the American search for self-fulfillment there apparently is emerging a genuine cultural revolution, or a revolution in shared meanings. He uses two principles of Hannah Arendt's work to define cultural revolutions.

Arendt's first principle is that a true revolution always begins a “new story” in human affairs: “The course of human history suddenly begins anew, an entirely new story—a story never known or told before—is about to unfold.” Arendt uses the word “story” with great care and implies that the “story” of revolution will have “an inner coherence: a beginning, a middle and end, a plot line, and a meaning.” This story is not mere change, for in Arendt's words, change may become a “Revolutionary shift if and only if the novelty it creates so deeply disturbs the status quo that all the old beliefs, values, meanings, traditions and structures are disturbed and profoundly modified.”⁴

The shift Arendt describes is similar to shifts in perceptions brought about by transformation, paradigm shifts, and experiences with death. In some of these shifts new knowledge has been introduced, but the additive results of this knowledge do not produce the shift, nor can these shifts be brought about by intention, by planning, by intervention, or by action. Rather, as the shift occurs one's perceptions and interpretations are significantly altered, thereby producing a reorganization of values, beliefs, traditions, and thought structure.

Arendt's second principle “is that a genuine revolution will always advance the cause of human freedom” which she carefully distinguishes from liberation. Liberation is usually a product of political revolution, and it is concerned with restoring lost or abused rights. In this regard it is essentially negative: liberation from. Liberation is a right, and it can be demanded, legislated, or granted by political processes. Freedom, on the other hand, is what people do with their liberation once it is available to them. Freedom flourishes only when it involves the larger community, or what we call society or culture. In Arendt's terms, freedom occurs when citizens, in some profound sense, participate in shaping the course of their society. Freedom is elusive, and often, we know that we had it only when it is no longer available.

Within the context of these two principles, (1) the beginning of a new story in human affairs involving modification of old values, beliefs, traditions, etc., and (2) the advancement of human freedom, the founding of Colonial America was a true cultural revolution. It was revolutionary in that “Men began to doubt that poverty is inherent in the human condition…. The conviction that life on earth might be blessed with abundance instead of being cursed by scarcity was pre-revolutionary and American in origin; it grew directly out of the colonial experience …”⁴

According to Yankelovich, the founding of America met Arendt's two criteria of genuine revolution: it started a new story, beginning with the Puritans’ covenant of equality before God and moved on to the translation of abstract rights into a secular society based on political freedom. It established a new chapter of human freedom as the shared meanings of America set themselves against the traditions of European heritage. The revolution was cultural rather than political, in that it revolved around shared meanings and did not result in toppled governments. The shared meaning was that mass poverty can be overcome by free people. When this was combined with other meanings, the themes of political freedom and material well-being emerged, and they have been the basis of the American dream for some two centuries.

What held these shared meanings together was the belief that a way of life built around self-denial and economic growth “paid off” for both the individual and for the country, thereby allowing private and public goals to be aligned. This growth was made possible by a hard-working, well-educated, stable, highly motivated, and product-hungry population. The “glue” that held this together was the belief in self-denial and the belief that one could succeed if one worked hard and saved. The values of acquisition and materialism maintained a strong economy. There also was a clear cut division of labor in the workplace, in homes, and in schools. In essence there was a “giving/getting contract” that worked for individuals and society.

About the turn of this century, and beginning with Taylor's scientific management (or time studies), instrumentalism, or the subordination of workers to machines, came into being. As this practice expanded in industry, we ignored the price we were paying for our industrialization: increasing numbers of giant instititutions with the accompanying depersonalizing, “objectifying,” and alienating tendencies of industrial life. What we lost were the small, human-sized institutions such as local churches, neighborhoods, small schools, and family relationships that provide a sense of community and sense of self, or “the freedom to choose one's life according to one's own design”.⁴

Yankelovich acknowledges the difficulty in defining community, but notes that it evokes in people the feeling that “Here is where I belong, these are my people, I care for them, they care for me, I am part of them, I know what they expect from me and I from them, they share my concerns, I know this place, I am on familiar ground, I am at home.”⁴

This is a powerful emotion, and its absence is experienced as an aching loss, a void, a sense of homelessness. The symptoms of its absence are feelings of isolation, falseness, instability, and impoverishment of spirit.

After World War II and the emergence of Maslow's writings and the Humanistic Psychology Movement, Americans engaged in a quest for self-fulfillment. In this process we concluded that the old contract, based on self-denial and hard work, should be redesigned because it failed to accommodate the existence of sacred/expressive yearnings that people discovered in the search for self-fulfillment.

According to Yankelovich what is emerging now seems to be a cultural revolution based on a new shared meaning: the assumption that it is wrong to subordinate the sacred/expressive side of man's nature to instrumentalism. What we have created is an unbalanced civilization: one in which subordination to the assembly line, to affluence, and to “me-too” has led to “insufficient concern for the values of community, expressiveness, caring, and with the domain of the sacred.”⁴

The old shared meaning that marked America's first cultural revolution said that poverty was not man's destiny. The emerging, or emergent meaning says that instrumentalism is not man's destiny.

The old meaning insisted that political freedom can exist with material well-being and indeed enhance it. The new meaning insists that the personal freedom to shape one's life can coexist with the instrumentalism of modern technological society and can civilize it.⁴

Simplistically summarized, Yankelovich states that we are on the verge of discarding Maslow's theories of self-fulfillment, which have two major flaws: “the idea of self as an aggregate of inner needs and the concept of a hierarchy of being that makes economic security a precondition to satisfying the human spirit.”⁴ He proposed that these theories about the self have kept us from developing a sound social ethic to replace our eroding ethic of self-denial, which brought us to the point of loss of community and self. Basically these theories brought us to a dead end. Self-fulfillment occurs when we are engaged in pursuit of a common goal with others, not when we pursue a goal in isolation.

Yankelovich predicts that an ethic of commitment is emerging now, reflecting a shift away from the self (both in self-denial and in self-fulfillment) and toward connectedness with the world.

This commitment may be to people, institutions, objects, beliefs, ideas, places, nature, projects, experiences, adventures, and callings. It discards the Maslowian checklist of inner needs and potentials of the self, and seeks instead the elusive freedom Arendt describes as the treasure people sometimes discover when they are free to join with others in shaping the tasks and shared meanings of their times.⁴

This embryonic ethic is gathering force around two types of commitments: one is closer and deeper personal relationships and the second is a sw...

Table of contents

• Cover
• Half Title
• Series Page
• Title Page
• Copyright Page
• Table of Contents
• Editor
• FROM THE EDITOR’S DESK
• PRACTICE WATCH: THINGS TO THINK ABOUT
• Tidal Surge and Private Practice: The Historic Eighties
• Community Occupational Therapy Associates: A Model of Private Practice for Community Occupational Therapy
• A New Arena for Private Practice in Occupational Therapy: Worker's Compensation and Personal Injury
• One Person’s Experience in Private Practice: Start to Finish
• Developing Pediatric Programming in a Private Occupational Therapy Practice
• The Airplane: Another Solution to Transportation in a Rural Private Practice
• Occupational Therapists as Publishers and Trainers in the Field of Aging
• Marketing Occupational Therapy Services
• Computers and the Private Practitioner in Occupational Therapy
• Wellness: Its Myths, Realities, and Potential for Occupational Therapy