Transformative Physical Rehabilitation

Thriving After a Major Health Event

Claire-Jehanne Dubouloz Wilner

• Publisher: University of Ottawa Press
• Year: 2020
• eBook ISBN: 9780776629025
• Topic: Medicine
• Subtopic: Physiotherapy, Physical Medicine & Rehabilitation

In adult physical rehabilitation, the transformative learning theory presents the basis for a detailed model of Meaning Perspective Transformation in Physical Rehabilitation based on research evidence, with examples and cases, and presents directives for clinical applications.

Transformative Physical Rehabilitation: Thriving After a Major Health Event draws from the theoretical background of transformative learning in adult education (Mezirow) to discuss the expansion and transfer of knowledge to clinical rehabilitation and community health rehabilitation settings for rehabilitation interventions.

It also presents ground breaking findings of a fifteen-year research project on the process of meaning perspective transformation with client/patient groups. The project generated the first model of transformative change in the field of physical rehabilitation, built on the results of successive, externally funded research projects completed for the first time with various client populations undergoing interventions in occupational therapy, physiotherapy, and other physical health rehabilitation disciplines.

The book is written for clinicians, educators, and students of physical rehabilitation, as well as for those who are interested in helping a loved one deal with personal change.

Published in English.

1 The Theory of the Transformative Learning Process

This chapter presents a transformative learning theory for rehabilitation in health sciences, based on the perspectives and writings of Mezirow,³⁰ upon whose theoretical writings in the field of adult education the transformative theory is based. The theory includes an explanation of the core processes of meaning perspectives transformative change, its concepts, and nature.

Sources

The transformative learning process is a theory of learning. The notion of a transformative learning process is rooted in adult education theory. In 2008, O’Sullivan stated:

Transformative education involves experiencing a deep structural shift in the basic premises of our thoughts, feelings, and actions. It is a shift of consciousness that dramati­cally and permanently alters our ways of being in the world.³¹

This theory is built on Thomas Kuhn’s paradigm theory in the sixties, Paulo Freire’s conscientization theory, and Roger Gould’s psychological perspective in the seventies.³² More recently, the adult educators Merriam and Bierema³³ present a synthesis of transformative learning theories, as Cranton had suggested in her three-part framework that included the cognitive perspective, beyond rational, and social change.³⁴ This present book is framed by Cranton’s cognitive perspective that is defined as a process of learning to try to make sense of what is lived. It is the consensus in the literature that in addition to the cognitive level of making meaning through reflection, there exists a source of understanding significance through the affective dimensions of experience. During a rehabilitation process, both the cognitive and affective dimensions are called upon when learning to modify occupational performance³⁵ and occupational engagement³⁶ for independent living.

Definition

The transformative learning process was defined by Mezirow³⁷ and colleagues in 1991. Educators and proponents of adult learning theory understand that adults can experience significant events in their lives that lead to a process of transformation that then challenge or change pre-existing values, beliefs, and behaviours. This process of transformation can occur at any point in an adult’s life, including when learning to live with a chronic illness and/or disability.³⁸ Transformative learning is an adult learning theory that offers a theoretical framework toward understanding how personal change is manifested in the adult learner. In the first chapter of the third edition of Adult Learning Theory, Taylor³⁹ introduces the evolution of the theory of transformative learning and presents three main perspectives researched in the previous 20 years: the psychoanalytic, the psycho-developmental—both of which address the personal transformation of an individual—and the social emancipation perspective, where the intention is social transformation for a better world. Taylor has identified four additional views on transformative learning that have emerged in the field of education. These are the “neurobiological, cultural-spirit,
race-centric and the planetary.”⁴⁰ In addition, Hoggan⁴¹ has pointed out the importance of distinguishing the specific theories of perspective transformation from the meta-theory of transfor­mative learning that covers a broader range of phenomena. He also suggested that transformative learning contributes to changes in an individual’s worldview, “wherein learners experience a significant shift in their understanding of the world and how it works.”⁴²

Taylor’s first three perspectives present a holistic view of a client and his/her individual psycho-cognitive-social development, and inform how adaptations lead to personal autonomy during rehabilitation intervention. In the present book, the context of this adaptation occurs when a major health event has altered habitual ways of living.

I could argue that neither in occupational therapy nor in physiotherapy has research provided evidence to explain personal change. There are other disciplines that are further ahead, especially
education, which rehabilitation sciences professionals are drawn to studying. An adult education perspective lends itself to the development of a better understanding of rehabilitation science intervention effects and treatment strategies, and Chapter 2 will recount research that integrates education and physical rehabilitation cases. First, though, the theoretical framework for understanding the process of transformation of meaning per­spectives is defined.

General Description of the Theory

Based in education sciences and, more particularly, descriptive of a type of adult learning process, transformative learning theory supports the notions that the learner participates in the construction of knowledge, and that learning is an interactive process of interpretation, integration, and transformation of experiences by the learner.⁴³ Some have stressed specific characteristics of this interactive process in transformative learning. Rosanna Tite⁴⁴ considers this process a dynamic and ambivalent journey, and Anne Burke stresses that it is an exploration of the meaning of loss and renewal. It has also been identified as a gentle praxis by Clan Doyle⁴⁵ that is neither straight nor easy, and which relies on the complexity of self-reflection. These parameters set the tone for what health-care clients experience and live through during their rehabilitation period. The next section presents the central concepts of transformative learning theory^46,47 and places them in the context of the continuum of rehabilitation care to be received by Lisa.

Central Concepts

Transformation

Transformation is simultaneously a process and an outcome. The key elements of transformation in the context of transformative learning theory are: meaning perspectives or frames of reference, habits of mind, meaning schemes or points of view, and critical reflection.^48,49 These concepts were first used and defined by Mezirow in the 1990s and 2000s. Below is a brief overview of Mezirow’s concepts and their evolution as he presented them in various volumes.

Meaning Perspectives or Frames of Reference

Meaning perspectives or frames of reference refer to a structure of assumptions based on meaning schemes that exist within the learner’s cognitive paradigm and that can act to filter perceptions and comprehension of new experiences⁵⁰ (Mezirow used both phrases, sometimes with slight differences in meaning, oftentimes interchangeably). Mezirow noted in 2000:

Frame of Reference is a Meaning Perspective, the structure of assumption and expectation through which we filter our impressions. It involves cognitive, affective, and conative dimensions… It provides the context for making meaning within which we choose what and how a sensory experience is to be construed and or appropriated.⁵¹

A frame of reference is the result of our interpreted experience, and often fits with the dominant cultural paradigm. Mezirow refers to it as collectively held, often originating from our past educative and/or affective primary caregivers. Generally, we intend to embrace frames of reference that complement each other to feel coherent and whole. A frame of reference may include intentional and incidental learning.⁵²

A frame of reference is composed of two dimensions of meaning structure, habits of mind and points of view.⁵³

Habits of Mind

Habits of mind are a set of assumptions that are broad, generalized, orienting predispositions that act as a filter for interpreting the meaning of experience.⁵⁴ They include “a variety of dimensions: sociolinguistic, moral, epistemic, philosophical, psychological and aesthetic.”⁵⁵ Habits of mind become articulated in a specific point of view—“the constellation of belief, memory, value judgement, attitude and feelings that shape a particular interpretation.”⁵⁶

Meaning Schemes or Points of View

Meaning schemes are the expressions of habits of mind. They are specific beliefs, judgments, feelings, and attitudes that act in determining personal meaning and perceptions of experiences. They quietly direct and shape a specific interpretation and determine how we judge and typify objects, and attribute causality. They commonly operate outside of awareness. They arbitrarily determine what we see and how we see … and suggest a line of action that we tend to follow automatically unless brought into critical reflection.⁵⁷ Meaning schemes can be viewed through observations of behaviour and verbal interactions.⁵⁸

Mezirow⁵⁹ has insisted that the capacity to reflect critically on taken-for-granted assumptions is the major difference between learning in childhood and learning in adulthood. Critical reflection in this context involves the adult learner examining the content of a situation at stake for change, looking at the process of problem solving, and, most importantly, questioning the premise underlying the situation.

Critical Reflection

Critical reflection⁶⁰ may be achieved as “self-critical reflection”—a process conducted by “learning to think for oneself (that) involves becoming critically reflective of assumptions, and participating in discourse to validate beliefs, intentions, values and feelings.”⁶¹ For example, for what we are concerned with in this volume, an individual’s own personal experience and history of rehabilitation is key to explore critically. Critical reflection is a consideration of a premise involving questions starting with “why,” and is the only reflection that leads to a transformation of meaning perspectives. It is activated by a disorienting dilemma or crisis event. The individual tries to make sense of this event using his “normal” ways of thinking about his or her reality but realizes that the usual approaches do not lead to solutions. A feeling of discontent develops, a feeling that can be coloured by a “distorted meaning perspective,”⁶² which leads to a generalized examination of meaning perspectives through the process of critical reflection. Then comes the recognition that this distortion⁶³ could be resolved with a transformation of meaning perspectives, and that other individuals around us have been able to make similar changes. This triggers a critical exploration of old ways of being to reformulate newly constructed meaning perspectives, leading to the acquisition of new knowledge and skills, building of competencies in new roles or ways of being (action), and the reintegration of these new ways back into one’s life....

Table of contents

• Cover
• Half Title Page
• Title Page
• Copyright Page
• Contents
• Preface
• Acknowledgments
• Introduction
• 1. The Theory of the Transformative Learning Process
• 2. Understanding of Meaning Perspective Transformation: Research Evidence
• 3. The Model
• 4. Clinical Use of the Model
• And the Upshot is…
• References