“We seek social transformation”: narratives of experiences of social occupational therapy professionals¹

“Nós buscamos transformação social”: narrativas de experiências de profissionais da terapia ocupacional social

Abstract

Introduction

Social injustices and inequalities have become more prevalent worldwide, in recognition of this, occupational therapy and occupational science adopted and developed a social, transformative and critical practices. This has become more prevalent in Brazil, where social occupational therapy professionals, grounded in critical and ethical-political standpoints, have been working with groups and populations to enable justice and rights.

Objective

This study aims to understand the social occupational therapy professionals’ reasoning regarding their practices, and since Social Occupational Therapy (SOT) is a practice from the Global South, we draw some possible links between occupational science and social occupational therapy, which can contribute to the social relevance and impact of the occupational therapy profession in both Western and developing countries.

Method

This study utilized Polkinghorne's interpretive, narrative approach to interviewing 5 social occupational therapists from different regions and work environments in Brazil.

Results

The participants narrative interviews revealed how social occupational therapists focus on the social dimension of their professional reasoning. They have come to embrace a critical perspective, acknowledging the socio-political context of the communities and groups of people they work with, often in situations of vulnerability. This can be understood by the growing discussion of the role of occupational science as critical and socially responsive practice.

Conclusion

These findings can facilitate an intercultural dialogue with other frameworks that also advocate for social transformative work and collective action.

Keywords:
Occupational Therapy; Social Policies; Professional Practice; Personal Narratives

Resumo

Introdução

À medida que as injustiças e desigualdades sociais têm crescido em todo o mundo, a terapia ocupacional e a ciência ocupacional reconheceram a importância de abordar tais questões e adotar uma prática social, transformadora e crítica. No Brasil, profissionais de terapia ocupacional social, fundamentados em posturas críticas e ético-políticas, têm trabalhado com grupos e populações para viabilizar justiça e direitos.

Objetivo

O objetivo deste estudo é compreender o raciocínio dos profissionais de terapia ocupacional social sobre suas práticas profissionais por meio de narrativas de suas experiências. A partir do entendimento que a terapia ocupacional social é uma prática do Sul Global, traçamos algumas possíveis conexões entre a ciência ocupacional e a terapia ocupacional, o que pode contribuir para o desenvolvimento social e relevância da profissão de terapia ocupacional nos países ocidentais e em desenvolvimento.

Metodologia

Este estudo utilizou a abordagem interpretativa e narrativa de Polkinghorne para entrevistar cinco terapeutas ocupacionais sociais de diferentes regiões e ambientes de trabalho, no Brasil.

Resultados

As narrativas dos participantes revelaram como os terapeutas ocupacionais sociais têm seu raciocínio profissional centrado na dimensão social, ao mesmo tempo em que adotam uma perspectiva crítica que reconhece o contexto sociopolítico das comunidades e grupos em situação de vulnerabilidade, o que está alinhado com a discussão sobre crítica e práticas de resposta social que têm sido fortemente apoiadas pela ciência ocupacional nos últimos anos.

Conclusão

Essas reflexões podem facilitar um diálogo intercultural com outras metodologias e abordagens teóricas que também defendem um trabalho transformador social e uma ação coletiva.

Palavras-chave:
Terapia Ocupacional; Políticas Sociais; Prática Profissional; Narrativas Pessoais

Introduction

Global inequalities have been increasingly addressed and protested by the public as well as by social and health professionals (Hujo, 2021). There have been increasingly conflicting perspectives on this topic, including scholars such as Hans Rosling and organizations such as Gapminder (Rosling et al., 2018). While Rosling's work and Gapminder's data visualization tools have contributed to highlighting the progress made to reduce global inequalities, there are still diverse views on the effectiveness of these efforts. Authors such as Hickel (2017a, 2017b) argue that the emphasis on statistical progress can be misleading as it may ignore rooted structural inequalities. Additionally, the UN's reviewed the Sustainable Development Goals (SDGs) have become a subject of debate, as some contend that numerical data may not be enough to quantify certain concepts and address the root causes of inequalities (Swain, 2017). These conflicting perspectives reflect the complexity of addressing global inequalities, emphasizing the ongoing need for deeper discussions and multi-faceted approaches towards this critical issue.

Occupational therapy (OT) and occupational science share a commitment to address injustices and inequalities, by enhancing peoples’ full participation in all aspects of life, and succeed in their social environments through active, engaged activity, and by addressing structural conditions which generate inequalities (Frank & Santos, 2020; Kronenberg et al., 2005; Townsend & Wilcock, 2004; Hocking & Whiteford, 2012). Recently, a discussion surrounding the adoption of a collective, social and transformative practice in occupational therapy, has brought attention to relevance to develop of the profession beyond the Western, biomedical framework. However, this tendency is not new, and such practices and discussions have become more normalized in countries from the Global South (Guajardo et al., 2015; Malfitano et al., 2014; Rudman, 2018).

The phrase “Global South” refers broadly to the regions of Latin America, Asia, Africa, and Oceania. It is one of a family of terms, including “Third World” and “Periphery,” that denote regions outside Europe and North America, mostly (though not all) low-income and often politically or culturally marginalized. The use of the phrase Global South marks a shift from a central focus on development or cultural difference toward an emphasis on geopolitical relations of power (Dados & Connell, 2012, p. 12).

In Brazil, occupational therapists have developed their practice outside of the biomedical framework which dominates the practice in the West (Malfitano et al., 2014). Furthermore, this adds to the discussion of the discipline of occupational therapies which has been developed in the Global South, addressing the importance of their acknowledgement to broaden the vision of occupational therapy and promote a more diverse and international dialogue.

Social Occupational Therapy (SOT): a national practice

The type of occupational therapy which is practiced in Brazil has its roots in the Brazilian culture, without disregarding its significant influence on international and Western frameworks within the biomedical Anglo-Saxon perspectives (Soares, 1991). However, in the 1970s diverse social movements emerged as a response to the political situation of Brazil (Lopes & Malfitano, 2021). There was an increasing mobilization towards the democratization of the country, which led to the expansion of public policies, in addition to greater awareness of rights and citizenship among marginalized populations (Galheigo, 2016; Lopes, 2010; Soares, 1991). Such movements modified and greatly influenced the practice and reasoning which is fundamental to occupational therapists in Brazil (Galheigo, 2012; Lopes, 2010). Before this, the profession of occupational therapy focused on physical rehabilitation, in addition to occupational and functional performance, comparable to the profession in the Global North countries (Lopes, 1990; Soares, 1991). Therefore, in Brazil, SOT was created as a response to the social demands that emerged outside the context of the dominant health-disease discourse, that cannot be addressed with purely a biomedical lens (Barros et al., 2002). Consequently, SOT came into being from the understanding of social inequalities which originate from the structure of a capitalist society. The practice acknowledges the macro-social elements, as well as historical, cultural, social and political factors which contribute to the access to social rights and autonomy of individuals and marginalized populations (Lopes et al., 2015; Malfitano, 2016).

In the 1980s, a national increase in research and scientific publications in occupational therapy outside of the health and biomedical perspective became more prevalent, in combination with the need to define concepts and terms essential to the discipline. Many of these became popular in Brazilian and Latin-American practice and literature, however, is not easily translated into English. One example is the word sujeito (subject) as closest to its meaning can be translated as “subjects/people” in English, however, it does not cover the whole semantic aspect of the word, as the Portuguese meaning goes beyond the individual aspects but has embedded a collective perspective of identity formation (Lopes & Malfitano, 2021). This differentiation is not merely semantic, but on an ontological and epistemological level, where the sujeito is understood from a sociohistorical materialistic perspective (Vidal, 1988, Guajardo & Mondaca, 2016). In 1990, the academic discussions regarding political and social issues continued in occupational therapy as many professionals sought higher education programs such as Masters or Doctorates. Towards the end of this decade, the field of SOT became a legitimate and specific practice within the field of OT (Lopes et al., 2015; Malfitano, 2016). Subsequently, as part of this wider understanding of the discipline, the debate expanded to include the relationship between social issues, inequalities and the capitalist society . This spawned new methodologies, concepts and reasonings that informed the practices in SOT with individuals and populations, such as the ones developed by Rede Metuia – Terapia Ocupacional, which has sparked education, investigation and University-community partnership projects in social occupational therapy (Barros et al., 2007).

In 2011, after a great mobilization and with the support of different professionals and institutions (including the Metuia Project), through advocacy in different spaces of debates such as forums and negotiations, social occupational therapists were recognized as official category of professionals able to work at Sistema Único de Assistência Social – SUAS (Unified Social Assistance System) (Brasil, 2011). As a result of an expansion of the practices in the social field, in addition to more professional hires, since the 2000s the scientific advancements in the social field have increased significantly, mostly led by state universities (Carey et al., 2019; Duarte, 2016). Of which the Brazilian Journal of Occupational Therapy, published by the Federal University of San Carlos, played an important role in the dissemination of knowledge in the field of occupational therapy and social occupational therapy in Brazil. Consequently, many initiatives have developed through the impact of occupational therapies from the Global South, such as the Project ‘Occupational Therapy without borders’ (Kronenberg et al., 2005, 2011; Sakellariou & Pollard, 2016), the launch of the recent book ‘Social Occupational Therapy: Theoretical and Practical Designs’ (Lopes & Malfitano, 2021), and studies that highlight the practices of social occupational therapy in Brazil.

Thus, such reverberation of this field of practice in Brazil and globally has become extremely relevant as part of the current global discussion about inequalities and also contributes to the recent social and political commitment that the profession has incorporated internationally, which shows that exploring this field of practice can contribute to the worldwide understanding that occupational therapy is a profession that has possibilities of action and contribution outside of the biomedical field.

Narratives from the Global South: practices that carry knowledge

In recent years, there has been a growing international interest and discussions about social practices in occupational therapy and occupational science, topics such as the social commitment of the profession, power, and justice have been elaborated by scholars as both occupational therapy and occupational science call for a social commitment (Galheigo, 2011; Gerlach, 2015; Malfitano et al., 2014; Pollard et al., 2008). As a result, concepts such as occupational justice, occupational rights and social transformation have become part of the discussion, and largely debated in the field of occupational science (Wilcock & Townsend, 2014; Vera, 2017). However, it is important to note that these discussions are not new and had already become the norm in the Global South, such as in Brazil.

In Brazil, more widely in Latin America, inequalities and injustices have been a reality since the colonization period (Galeano, 2021), therefore, occupational therapists have a long-established response to the experiences of these unequal structures. The concept of Global South is used as a reference to epistemologies of South, a concept coined by Santos (2007). It is defined as a crucial epistemological critique that seeks social emancipation on a global level. Furthermore, it can also be understood as a metaphor for the consequences caused by colonialism and the dominant cultures of the Global North, which caused suffering and division on a global scale, making certain epistemologies being perceived as more privileged and relevant than others (Santos, 2007). This theoretical perspective is not completely proved by geography. However, the Global South often refers to countries in Latin America and Africa, yet also includes the population in the Global North (Europe and North America) which also suffer exclusion and marginalization (Santos, 2007). This dynamic of Global North and Global South can also cause implications in the context of OT as a profession, as historically the profession has predominantly been adopted in a Western or Global North context, which is often reductionist, individualistic and takes the positivist/postpositivist approach (Galheigo, 2011; Guajardo et al., 2015; Rudman, 2015; Malfitano et al., 2014). According to Guajardo et al. (2015), to avoid institutional monoculturalism in occupational therapy, it is important to acknowledge the various positions of identities and epistemologies which exist as part of occupational therapy.

In that context, social practices developed by SOT professionals in Brazil, can also be understood as a decolonial practice produced in the South (Lopes & Malfitano, 2021). Academic research which considers the knowledge produces by diverse occupational therapies is essential, given the complexity, multireference, transdisciplinary and diversity in the scientific production and practice of the profession (Galheigo, 1999; Lima, 1997, Mangia, 1998). This way of thinking, becoming more inclusive and heterogeneous, contributes to acknowledging a professional identity that is plural, collective and complex, considering the different theories and practices existent in the country and globally.

According to Costa & Almeida (2004), the diverse occupational therapies, throughout Brazil and worldwide, may create conflicts, yet they also might share common factors., Therefore, deeper research into the different fields of SOT, beyond the hegemonic scientific knowledge can help better understand the nuances and diverse ways of performing OT and SOT in Brazil and internationally. Nonetheless, this study aims to understand how SOT professionals develop their reasoning surrounding their practices, and since SOT is a practice from the Global South, we draw some possible links between occupational science and social occupational therapy. This could contribute to the ongoing discussion of social commitment and possibilities of the profession outside the biomedical field, in the arena of social rights and justice.

Methods

This study is based on an interpretative narrative inquiry based on Polkinghorne (1995, 1997) theory of narrative configuration and emplotment. The concept of narrative, according to Polkinghorne (1995), is not merely telling or describing someone’s story, instead, it is a dynamic process of interpretation of events that change and are essential to the understanding how the person got to tell their story. As Polkinghorne (1988) articulates, narratives are “the fundamental scheme for linking individual human actions and events into interrelated aspects of an understandable composite” (p. 13). The understanding of the context, temporality, language and how individual events are connected is proposed by Ricoeur (1997). It contributes to the comprehension of the experiences of social occupational therapists, as practices and interventions, which are embedded and understood through the context and social structure in which the professionals are operating. Furthermore, concerning individual actions, Ricoeur highlights the dynamic of the interaction between the personal, social, and cultural, which are crucial to the process of how individuals make meaning (Ricoeur, 1984). This reasoning is aligned with social occupational therapy values, as professionals are trained to consider the connection between individual and macro aspects in their practices, therefore, narrative tradition provides a useful framework to explore social occupational therapists’ experiences throughout their professional career. This methodology can allow an understanding of the experiences, challenges and advantages that inform social occupational therapy professional practice in Brazil.

Participants

The participants were five occupational therapists self-identified as doing SOT in Brazil (Table 1). The data gathered aligns with the interpretive and narrative approach of this research and provides richness of data from each participant (Morse, 2000; Sandelowski, 1995). Due to geographic dimensions of Brazil, to gather diverse information from professionals with different settings and backgrounds, the interviews happened online, using Skype software or Google Meets. Evidence suggest that the quality of data gathered online is comparable to responses obtained from more traditional methods (Meho, 2006). The participants were chosen by snowball strategy. The first contact was approached by email through the IV Social Occupational Therapy Symposium, an online event organized by UFMG/EEFFTO - Universidade Federal de Minas Gerais/ Escola de Educação Física, Fisioterapia e Terapia Ocupacional (Federal University of Minas Gerais/School of Physical Education, Physiotherapy and Occupational Therapy) and Metuia network-social occupational therapy which took place in November, 2020. The inclusion criteria were occupational therapists that self-identified themselves as performing SOT in their professional lives. They were contacted by email and approached regarding their willingness to be interviewed at a convenient time for them. The interview date, time, and topic were arranged by e-mail along with an introduction that contained the consent form and research preamble.

Table 1
Demographics of the participants (pseudonyms were used to preserve the professionals’ identities).

	Location	Type of Practice	Years of Experience	Formal Training
Anna	Southeast-Brazil	University Teacher – Placement Supervisor	6 years	Master’s degree and PhD
Sabrina	Northeast-Brazil	University Teacher – Placement Supervisor	10 years	Master’s degree and PhD
Sofia	North-Brazil	OT at an Adolescent Shelter and a Home Center for Women that have suffered domestic violence	22 years	Specialization in Psychomotricity
Joel	Northeast-Brazil	University Teacher -Placement Supervisor	12 years	Master’s degree and Specialization in Human Rights

Data construction

This study was conducted in the context of a Master’s of Science dissertation in OT that aimed to explore social occupational therapists’ narratives of their experiences throughout their professional career. Data gathering included semi-structured online interviews and field notes. Each participant and the researcher met once, and interviews lasted between 90 min to 120 min. To produce insight into the data, several broad topics were identified to provide in-depth data on the experience, meanings, challenges and advantages of working in the social field in Brazil. Interviews were conducted in Portuguese, audio-recorded and transcribed verbatim by the first author. Holloway & Wheeler (1995) argue that, when researchers interview their peers, a more meaningful relationship is established, which enables participants to become equal partners during the data collection. This proved to be the case in the present study. Fieldnotes provided critical reflections and peer meetings facilitated the discussion of the insights and critical questions that were raised throughout the research process.

Data analysis

Data were analyzed using an interpretative narrative method based on Polkinghorne (1995) narrative configuration and emplotment. Narratives were used to reflect each participant's story; therefore, each participant’s data and insight were treated independently. The first step was to read the transcribed interviews and field notes to gain an understanding of the whole participant´s stories. Then, a draft was designed to find links between the emplotment, following this, each story was developed with other aspects such as participants’ reflections. The data and stories were returned to a reflected on, to ensure a reliable connection to the complexities of the participants' professional trajectory. An important aspect of this process was the researcher’s immersion into the participants’ deeper purposes and commitment as social occupational therapists, to reveal how this practice helped them evolve as professionals and provide a transformative assistance and benefit to the population they worked with. After the structure was constructed, they were further developed with a plausible beginning, middle and end, according to this process. The analysis process included scanning within and across stories which culminated in an awareness of the bigger picture that the stories created. Despite the differences in contexts, practices, and locations, they were relatable and produced a similar narrative, which can be drawn together. This can be compared to the context of narrative tradition, in which the themes are not repeated constantly, but instead represent a plotline and understanding is gathered from the interpretation of the stories presented.

Ethical considerations

The ethical committee considered that the study was feasible, and its risks and benefits were aligned with its proposal. There were initially some concerns on the confidentiality and anonymity of the participants, with their possibility of withdrawing from the study at any time. Polkinghorne (2007) highlights that these concerns are valuable threats narrative research, when description presented in the individual accounting of experience does not reflect the meaning as interpreted by the participants. Keeping a field diary and data from observations during the interviews and analysis, was essential for adding meaning to the research process. The iterative analysis process, and the peer-debriefed interpretation process with the second author (Polit & Beck, 2008), were strategies used to enhance the credibility and trustworthiness of the results. Pseudonyms were used in the study to protect the identity of the participants.

Findings

The stories of the five participants evolved from their early stages of professional education in university settings, to their current practices and positionings mostly informed by their own journeys and theoretical bases of SOT in Brazil. Participants shared their main experiences as social occupational therapists, in which some key aspects of the practice and the professionals’ critical perspective could be identified, such experiences were interpreted as major plotlines in their stories.

• Story 1 - Pulling a ball of wool

Anna has been working as a teacher of social occupational therapy at the university. Since her undergraduate degree, she has worked in the social department at public schools. Currently, she also supervises occupational therapy students who are developing social practices at a public school with youths people and teenagers at risk from social exclusion. Anna compares her interventions to a ball of wool, as in the group sessions the path of the activities to do is by giving everyone a chance to express their interests, fears and conditions. Sometimes her interventions take completely different directions from what had been planned.

And this goes like...we go like a ball of wool, we pull and pull. And then we get to connect with these young people. And then we can go deep in the individual and collective stories of the group [...] I think the technique is the mediator of the practice [...] It is a collective construction, and I think that is a differential in social OT (social occupational therapy). In fact, we consider people as sujeitos of the intervention. (Anna)

When it comes to theoretical concepts informing her practice, Anna states that the theoretical concepts that she relies on are mostly connected to Brazilian authors and ideas.

I think it is fundamental, essential, that we question ourselves about the terms/concepts. Because I think citizenship, rights, the components of citizenship, social justice, are terms that have been there for a long time, right? It is also about the principle of not accepting, without criticism, what comes from outside... (Anna)

Anna’s story central metaphor of a ball of wool, links her interventions to one of the premises of social occupational therapy: a transformative practice, where the youths are social actors, as she is there to support and create a space that will enable them to reflect and collectively create new possibilities for their lives.

• Story 2 – Going beyond the Center’s walls.

Sabrina is an occupational therapist who works in the social-educational system. With an educational background that did not offer experiences at the social department at university. As a result of this she ended up working with youth offenders at the start of her career as a social occupational therapist. She now works at a Center with young people who are undertaking social-educational measures as part of their custodial sentence. After completing her studies, Sabrina decided to expand her practice, and encourage young people to engage with the wider community other services.

Staying only inside of the center was not possible anymore. We were not being effective as much as we should have bee . And then my practice started to change. In the sense that I tried to involve the boys with the community. Even if they are confined, some of them can still do activities outsides. So first we started with ‘oh, let’s go out with the boys’. Even if it’s just to have a break from the confinement. And then what I started doing was, thinking along with the Unity how we could get involved with the community. (Sabrina)

Sabrina developed her professional reasoning through the understanding that her role was also to create links between the center, and other community based services to start to successfully integrate the youths with the community. Her professional reasoning is grounded on the understanding that social occupational practices can be diverse, as she created her interventions in her daily practice, according to her users’ needs.

• Story 3 – Crossing the train lines.

Martha developed her practice with disadvantaged young people in the situation of poverty, with whom she has been working since her graduation as part of METUIA. She now works as a teacher of social occupational therapy at a university in Northeast Brazil. Her work focuses on preventing adolescents from entering the cycle of violence and drug trafficking in the area, which is dominated by criminal gangs which mark the territory, and consequently restrict people’s lives, as they are not allowed to move freely into other gangs’ territories. Faced with such reality, Martha decided to cross the train lines, the physical barrier that separated the gang territories, and reach the adolescents at risk. She organized spaces where the adolescents could receive the service delivered by Centro de Referência de Assistência Social (CRAS) as well as provide spaces of discussion about their rights, life projects, and other relevant topics for them. Her interventions were rooted in social occupational therapy principles, concepts such as the guarantee of the adolescents’ rights, and social justice are fundamental to achieving social transformation through her practice.

The goal (of the interventions) is to think about transformation, we seek social transformation that is grounded in social justice. It is what we aim for, and we develop the interventions based on those theoretical concepts. (Martha)

Martha’s core story plot is strongly connected to her role of an articulator and advocator for the youths. She embraces the idea that it is possible to create a different reality for those who are in apparently static situations and that social occupational therapy can help to change life stories, and reach the unreachable, and provide transformational change.

• Story 4 – Immersed in layers.

Sofia develops her practice in two different spaces in SUAS, an adolescent-woman’s shelter, and an Emergency Housing for women that have suffered domestic violence. Her education in occupational therapy was mostly through the biomedical path. Currently, at her work place, she facilitates mainly group, but also some individual interventions, Her goals are to help her users establish new life projects, provide access to culture, technology, education, leisure, and ensure their rights and citizenship. Sofia has very critical perspective regarding the contexts and realities of the women she works with Her reasoning is anchored in the principle that we are multifaceted beings, which means there are many layers which must be accessed through every interaction she has, this multifaceted nature should never be neglected, as it is part of who they are.

Our concept of ‘socio-occupational’ is always connected to social inequalities […] Everything is marked by race, class and gender. They are layers. The human being is immersed in layers, so if we look at only one of them we cannot fully understand their situation. (Sofia)

Moreover, her reasoning goes beyond the local context as she conceives that the layers her users are immersed in Brazil are quite unique and different from the context of other people in Western countries, therefore she considers that some concepts and frameworks, just cannot be transferred to the Brazilian reality.

I think that, in Europe, for example, in general, the reality is very different. They will never understand (us) because they don’t experience inequalities in the same way. Our vocabulary, from all the professionals that work in this field, will always be connected to this (reality). So, when people from other countries talk about occupational justice for example, I think they might be talking about another type of justice, it’s not the same justice we talk about here. (Sofia)

Sofia sees her practice as strongly connected to macro processes, and socio-political aspects, as the social issues she deals with in her daily practice also encompass weaknesses and lack of infrastructure in the current well-fare system that has perpetuated situations of inequalities and injustices.

• Story 5 – Building dialogues.

Joel is a faculty member at a university in Northeast Brazil. He has studied a university degree in occupational therapy, where he was not academically connected to social practices. He returned to the university in which he graduated, to develop the social department of occupational therapy, which was lacking in his professional background. He pursued theoretical knowledge from Brazilian authors, in addition to “simply doing” SOT in his daily practice, which provided him with a particular understanding of social occupational therapy and the profession expansion on the ground. He conceives that dialogues between social occupational therapy and other Western frameworks are possible and should be encouraged.

I think there are possibilities of dialogue (with Western frameworks and concepts). The meeting point is the ethical-political commitment of the profession. It is the recognition that nowadays, Occupational therapy can’t avoid this discussion that for a long time was limited to Brazil and other countries in Latin America. (Joel)

Joel’s story addresses the difficulties of doing and studying social occupational therapy in many regions in Brazil, where there is no support and network. The core plot of his story with social occupational therapy is his decision to transform the educational system as well as expand practices of the profession that can eventually inform or engage with other existing frameworks.

Discussion

This investigation attempted to better understand critical aspects of social occupational therapy through the professional experiences of social occupational therapists in Brazil. The participants’ stories represent rich sources of experiences that facilitate the discussion of three major plotlines: a) The social: A central aspect of social occupational therapy, b) Articulator role: connecting micro and macro structures and c) Critical perspectives about occupational centered frameworks.

The social: A central aspect of social occupational therapy.

Participants described the importance of the creation and acknowledgement of social occupational therapy as a specific field of occupational therapy in Brazil. Many highlighted the social dimensions and its relations with their users’ societal context and macro-structures. This puts apart the position of the social occupational therapist from other health professionals with a more biomedical and post/positivist perspective. As articulated by other authors (Crawford, 2006; Gibson, 2016; Illich, 1974), biomedical practices can include practices such as healthism which focuses on the health-related to individuals’ bodies and their exposure to harm/disease, which can create responsibilization and marginalization. Such practices go against the premises of inclusion and assistance, causing a reductionism of social problems to health problems, which is not aligned with social occupational therapy’s holistic view of societal problems (Malfitano, 2020).

It is possible to identify through the participants’ narratives that their reasoning about “the social” is directly linked to an aspect/dimension addressed specifically by social occupational therapy practices, which differs from the traditional and biomedical practices in occupational therapy. Such differences from traditional frameworks/models could be interpreted by the reasoning that models in occupational therapy, especially from Western countries, often use words such as participation, social interaction, and social environment to refer to the social dimensions of individuals and are usually used in the context of biomedical-based interventions (Doble & Magill-Evans, 1992; Kielhofner, 2008; Olson, 2010). This understanding and argumentation does not always address the macrostructures and sociopolitical context of the users.

Therefore, these findings about participants’ particular insights about the social dimension as the central aspect of their social occupational therapy, and its relations with the societal context and macro-processes, can provide evidence towards the recent global discussion of collective and critical/transformative practices in occupational therapy and occupational science. This supports and contributes to the development of decolonial epistemologies and social paradigms (Galheigo, 2021; Morrison, 2018).

Articulator role: connecting macro and microstructures.

As presented in the findings, the participants’ stories, and their experiences in the social department with different populations demonstrate the principle of SOT, and its ability to mediate between macro and microstructures.

Moreover, in the participants’ narratives, this self-perception of the articulator is also connected to a collective perspective of interpreting social problems. They assume the role of an articulator and produce interventions that associate the micro, and individual aspects to the macro structures, enabling access to rights to the population they assist. Such articulation between micro and macro-social aspects has been discussed in the literature, as a response that is present in the technologies and principles of social occupational therapy (Lopes et al., 2014; Malfitano, 2005; Malfitano & Lopes, 2018).

This is presented in the account of Sabrina and the young offenders with the community and services they were connected to. As well as Martha’s account of the adolescents that could not attend the CRAS, as the service of occupational therapy was on the other side of the gang territory, Sofia’s actions to integrate the adolescents in the shelter with education, culture and leisure. Such principle does not involve specific actions nor interventions, instead, each professional applies the articulator role according to their practice, through their experiential and practical knowledge. Such aspect is aligned with the concept of occupational therapies of the South by Guajardo (2016), that includes the social OT. According to Nuñez (2019), such practices enable the understanding that generation of knowledge could also be developed with subjects and communities by methods based on empirical, practical, intuitive and creative practices (Guajardo, 2014; Nuñez, 2019; Ramugondo, 2018). The reflections about the articulator role in social occupational therapy also support the ongoing dialogue that critical authors have raised which questions the individualization of social issues and highlights the importance of acknowledgment of social structures' shape and distribution of power (Farias & Rudman, 2019; Gerlach et al., 2017), which reinforces the ethical-political commitment of the profession.

Critical perspectives about theoretical frameworks: creating a space for dialogue.

Participants referenced a strong connection between their theoretical bases with authors and references from Brazilian social occupational therapy, such as Denise Barros, Ana Paula Malfitano, and the resources of the Metuia group, especially with participants from Southeast and South Brazil, where most of the publications in the social department have been produced.

In addition, some of the participants have developed a critical perspective regarding the adoption of Western theoretical-methodological frameworks, and concepts such as occupational justice have been now entering the discussions surrounding inequalities, injustices and rights in countries from the Global North. Participants mainly expressed a critical position about theoretical frameworks that are not deeply connected to reality, historicity and cultural contexts Martha and Sofia argue that concepts and references used by Brazilian social occupational therapy have been consolidated for a long time and reflect the reality of the country, its issues of marginalization and vulnerability, therefore, they could be understood as more contextualized for the profession in Brazil. In line with these findings, evidence shows that when analyzing Western concepts such as occupational justice concerning social occupational therapy, authors concluded that there are cultural and historical differences regarding to literature and professional development (Malfitano et al., 2019).

Additionally, it is possible to identify through participants’ narratives that social occupational therapy can be acknowledged as a social transformative practice, as Martha addressed, ‘the goal of the interventions is a social transformation that is grounded in social justice’. It supports authors and findings that associate social transformation with social change, as such practices recognize realities that are inside and outside the dominant status quo, as well as acknowledge the systemic and contextual causes of injustices, to create opportunities for social change (Cannella et al., 2015; Gramsci, 1971; Santos et al., 2007).

Moreover, it was also noted that the participants carry an overall critical – theoretical and methodological – perspective in their practices, that goes beyond an individualized and biomedical approach, outside of most common hegemonic and dominant practices where societal contexts are not considered and injustices are perpetuated (Angell, 2012; Farias, 2017; Gerlach et al., 2017). According to Rudman (2013), the adoption of an individualistic perspective has been limited by the profession, and in some contexts this requires a broader social response or impact. Authors have stated that despite the growing acknowledgment that occupational therapy can address social issues, professionals can often disregard the potential of occupation for social transformation and focus on biomedical issues with reduced possibilities of practice (Hocking & Townsend, 2015).

This finding is aligned with the ideas of Galheigo (2021) who states that Brazilian social occupational therapy has been largely influenced by critical bases, which also means that professionals aim to question their assumptions of OT. It also corroborates the ongoing discussion about socially responsive practices that has been strongly supported by occupational science recently (Laliberte Rudman et al., 2009) along with a variety of authors and studies that also advocate for a justice-based, critical and social transformative perspective within the profession (Braveman & Bass-Haugen, 2009; Frank, 2012; Guajardo et al., 2015; Hammell, 2011; Laliberte Rudman et al., 2008, 2009; Magalhães et al., 2019; Hocking, 2000; Rudman, 2013; Townsend, & Wilcock, 2004; Wilcock & Townsend, 2009).

Final Considerations

The stories of the participants highlight the discussion about the unique perspectives regarding the professional reasoning of social occupational therapists through their narratives. The professionals’ reasoning in the study is highly connected to the social aspect of the profession, considering a non-post-positivist/biomedical approach, instead adopting an approach that considers the context or social layers, in which service users are immersed. All the professionals share a commitment to social change, allowing the people and communities they work with, to have access to rights and better opportunities.

The professionals’ stories expressed many similarities despite the locations and different professional settings, which can be indicative that social occupational therapy professionals have different ways of carrying the practices in Brazil which can be similar in general principles and methodologies, but unique actions, as no experience was the same. Such reflection is aligned with the concept of occupational therapies of Guajardo (2016) and highlights the importance of exploring and understanding the multiple and alternative ways social occupational therapy can be achieved with different populations and communities. Therefore, as the social commitment of occupational therapy becomes more recognized, the presented study highlights the need of more research about practices such as social occupational therapy and other social transformative practices in occupational therapy globally, in order to expand the knowledge and broaden the possibilities of practice in the social domain.

It additionally brings attention to the importance of studies and research about the inclusion of social occupational practices during the training of professionals of occupational therapy in Brazil and internationally. In doing this, there will be a greater tendency include a more socially transformative approach to this practice of future professionals. At an international level, the study also creates reflections about the importance of adopting a critical and non-individualist approach to social issues, as part of the practice of occupational therapists. This can inform how occupational therapists can in embrace critical approaches that address the roots of occupational injustices, to promote a transformative practice that envisions social change and justice. Implications of this study to the practice of professionals of occupational therapy include that the examination of plural or non-dominant practices can create possibilities of thinking an OT is not only health-focused but can also be socially responsive and transformative.

• 1
  This study was conducted during the completion of the EuroMaster Program of Science in Occupational Therapy at Amsterdam University of Applied Sciences in 2021. Ethical issues were considered, and the study was approved by the Brazilian National Ethical Committee - 4.611.787.
• How to cite: Siqueira, L. S., & Mondaca, M. (2024). “We seek social transformation”: narratives of experiences of social occupational therapy professionals. Cadernos Brasileiros de Terapia Ocupacional, 32, e3667. https://doi.org/10.1590/2526-8910.ctoAO282136672

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Edited by

Section editor

Profa. Dra. Marta Carvalho de Almeida

Publication Dates

• Publication in this collection
  02 Sept 2024
• Date of issue
  2024

History

• Received
  23 Oct 2023
• Reviewed
  01 Nov 2023
• Reviewed
  15 Nov 2023
• Reviewed
  07 May 2024
• Accepted
  17 June 2024