An exploration of the different forms of theoretical knowledge valued and used by occupational therapists in mental health practice

This thesis adds new insights and understandings about the integration of theoretical knowledge in the personal paradigms of occupational therapists in mental health practice, a previously unexplored area of research. The qualitative research used narrative inquiry to explore the professional histories of nine occupational therapists who worked in mental health practice in a regional area of Australia. Thematic analysis of professional histories highlighted the crucial episodes, practice contexts and social values, which informed the value and use of different forms of theoretical knowledge across time. This study contributed new information about the nexus between occupation-focused models and practice by identifying a spectrum of theoretical knowledge use. Bronfenbrenner's (1979) social-ecological model provided a lens to view the data and to consider the ways in which macro, meso and microlevels environments shape practitioners valuing and use of different forms of theoretical knowledge. If used in tandem, the tacit use of occupation-focused models conceptualised and drove the direction of therapy towards occupational goals, whereas the explicit and instrumental use of psychological frames of reference resulted in visible explicitly psychologically oriented practical actions. Findings suggested professional self-care strategies, including professional socialization and the adoption of negotiation skills, were key responses to environmental tensions, which arose from the practice knowledge discourse, and dominant discourse dimensions. Pressures to adopt biomedical and psychological discourses often diminished the use of the occupational perspective discourse in phronesis and praxis and subsequently on reduction of occupation-based practice. The study identified that drawing upon professional knowledge domains and occupation-focused models appeared to protect professional identities. Professional resilience and identity were crucial in assisting practitioners to resist the pressure to adopt, rather than adapt, psychological modalities. This thesis highlights the need for further research into strategies at the macro, meso and microlevels which maintain the use of occupation-focused theoretical knowledge and the development of professional resilience in mental health practice.