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Abstract

Although client-centred practice has become an essential part of Canadian occupational therapy practice in the last twenty years (Law, 1998; Sumsion & Smyth, 2000), many authors have indicated that therapists do not practice in a client-centred manner (Law, Baptiste & Mills, 1995; Toomey, Nicholson & Carswell, 1995; Hammell, 1998a). Some authors have focused on how therapists are responsible for problems implementing client-centred practice, because they are unwilling to give up power (Sumsion, 1999c; Gage, 1999; Hammell, 1998a; Law, Polatajko, Pollock, McColl, Carswell, & Baptiste, 1994). As power has been identified as an important construct in the literature on client-centred practice, I have conducted an exploratory, qualitative study of occupational therapists' experiences of client-centred practice using standpoint theory and Foucault's work on power to frame the study. Based on a thematic analysis of in-depth ethnographic interviews of nine therapists from acute care and homecare settings three main themes were identified. "Bridging that gap: ideal versus real conceptions of client-centred practice" reveals the tensions that therapists experience between the discourse and practice of occupational therapy. "Related to the service environment: the importance of setting" focuses on how institutional factors shape practice. The final theme "a bit of tension: problems with the client-therapist relationship" describes the client-therapist interaction, which is influenced by discursive and institutional factors. The thesis concludes with a discussion of the theoretical implications, practical applications, limitations and significance of these research findings.