Phenomenological Research Method
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This Resource Note was suggested to me as a follow-up to the last note on storytelling. The first thing beginning this note was to look for a definition of a phenomenological study and found this at the web site of the James Madison University Center for Assessment and Research <http://www.jmu.edu/assessment/> under the Dictionary of Student Outcome Assessment.

Phenomenological Studies
Cross Sources: Qualitative, Critical ethnography, Grounded theory, Case study Definition: The examination of human experiences through detailed descriptions of the people being studied. The procedure involves studying a small number of subjects through extensive and prolonged engagement to develop patterns/relationships of meaning. Reference: Dukes; Oiler (as cited in Creswell, 1994).

Phenomenology
Cross Sources: Qualitative
Definition: Study of objects and events as they appear to the experiencing observer. Reference: Aiken, L. (1994).

I am sure there are other sources for a definition or description of this type of study, but the above made sense to me, so I share it with you. The following two citations provide background reading for interested persons.

Finlay, L. (1999). Applying phenomenology in research: problems, principles and practice. The British Journal of Occupational Therapy, 62, 299-306.

Interest in phenomenological research has been growing steadily over the last decade as researchers have sought to capture the richness of individual experience. However, the sheer complexity of ideas embedded within phenomenology is challenging. Confusions abound as to what phenomenology means, let alone how to apply it as a research method. Misconceptions and contradictions are apparent in the literature. This paper starts with a broad review of some current phenomenological literature relevant to occupational therapy. The key principles of the phenomenological approach are then clarified, followed by an exploration of how these might be applied practically in research.

Gray, J.M. (1997). Application of the phenomenological method to the concept of occupation. Journal of Occupational Science: Australia, 4, 5-17.

Phenomenology began as a movement in philosophy that deals with the essences of objects, or phenomena as they present themselves in human consciousness. The founding father of phenomenology, Husserl, believed that through rigorous examination of objects, as they are presented in one's consciousness, a person could come to intuitively know the essence of those objectivities, or realities. He proposed that other disciplines might benefit from phenomenology as a way of identifying the main objectivities with which the discipline deals, before undertaking other inquiry. The phenomenological method outlines the steps of such an investigation. This paper uses the steps of the phenomenological method to explore the essence of occupation.

I was not familiar with the philosopher Husserl so decided to confirm the spelling and got over 180,000 hits in Google. If you wish to learn more about Edmund Husserl, visit the Husserl Page, <http://www.husserlpage.com> ,. The stated aim of this site is “To provide easy access to those net resources pertaining to the life and work of the 20th century philosopher, Edmund Husserl. “

The following references are from OT SEARCH and include studies in many settings and with varying populations.

Bates P.S., Spencer J.C., Young M.E. & Rintala D.H. (1993). Assistive technology and the newly disabled adult: adaptation to wheelchair use. The American Journal of Occupational Therapy, 47, 1014-1021.

A naturalistic, ethnographic, phenomenological study of adaptation to wheelchair use was conducted with one key informant, a 30-year-old white man with acquired paraplegia who was undergoing acute rehabilitation. Primary staff members served as additional informants. It was found that adaptation to wheelchair use had both pragmatic and emotional components. The latter appeared in alternating phases of resistance and neutrality or detente. Therapist and patient had conflicting goals relative to wheelchair use, which occasioned considerable friction. The patient's initial attitudes regarding wheelchairs were prejudicial, which hampered his ability to see the chair as a useful tool for mobility and independence. Successful pragmatic adaptation hinged in part on emotional acceptance of the wheelchair.

Bontje P, Kinebanian A, Josephsson S, Tamura Y. (2004). Occupational adaptation: the experiences of older persons with physical disabilities. The American Journal of Occupational Therapy, 58, 140-9.

The purpose of this phenomenological study was to explore the experiences of occupational adaptation among a small number of older Dutch persons with physical disabilities. Occupational adaptation was tentatively defined as overcoming disabling influences on occupational functioning. Eight occupational therapy clients, who were living in the community, were interviewed using an open in-depth interview format. A phenomenological analysis resulted in descriptions of occupational adaptation as a process that required these clients' active engagement. The clients recruited already familiar problem-solving strategies and personal resources as well as resources in their social and physical environments to identify prospects of potential solutions and to create solutions to overcome constraints on occupational functioning. Furthermore, participants strived for finding satisfaction through occupations, a meaning theme which emerged as the object of occupational adaptation. Satisfaction through occupations was found in maintaining daily routines and engaging in fulfilling occupations.

Boutin-Lester, P. & Gibson, R. (2002). Patients' perceptions of home health occupational therapy. Australian Occupational Therapy Journal, 49, 146-154.

Home health occupational therapy plays an important and growing role in patients' recovery. Home health treatment is unique in that the therapist is a visitor in the patient's home environment. A phenomenological approach was used to examine perceptions of five individuals who were interviewed twice to collect their impressions of home health occupational therapy. Participants' goals for therapy as solicited by home health occupational therapists and participants perceived goals were not always pursued collaboratively. Therapeutic and compensatory occupations were incorporated less often than purposeful exercise. Participants valued those occupations engaged in, despite limited physical recovery. Participants' perceptions of occupational therapists were generally positive. Participants were unprepared for discharge, which was perceived as significant and they as helpless to prevent it despite desire for continued services. Few occupations reported in their treatment coincided with participants' difficulty distinguishing between occupational and physical therapies. Continued research focused on patients' perceptions of home health occupational therapy would be useful in further examining this phenomenon and would enlighten home health occupational therapy practice.

Brandthill, S.L., Duczeminski, J.E., Surak, E.A., Erdly, A.M., Bayer, S.J. & Holm, MB. (2001). Coping strategies that elicit psychological well-being and happiness among older catholic nuns with physical impairments and disabilities. Physical & Occupational Therapy in Geriatrics, 19(2), 87-98.

This study examined how adaptive strategies described in a study of well older adults by Clark et al. (1996) were being used by four Catholic nuns with physical impairments and disabilities who lived in a continuum of care facility. A naturalistic, phenomenological approach was chosen, and in-depth interviews were conducted to ascertain if, and how, each nun used the adaptive strategies. A cross-classifying matrix was then used to examine common themes among the four informants. Spiritual activity, positive attitudes, and commitment to service were evident themes in this study and the study by Clark et al. (1996). Our findings suggest that the specific constellation of adaptive strategies may be useful for other religious older adults to manage stressors in their daily lives. Spirituality potentiated each of the strategies identified by Clark et al. (1996) in a sample of four physically impaired and disabled older nuns. Future investigation is necessary to determine how spirituality relates to psychological well-being and happiness in older adults from other religious, ethnic, and cultural populations

Darragh A.R., Sample P.L. & Krieger S.R. (2001). "Tears in my eyes 'cause somebody finally understood": client perceptions of practitioners following brain injury. The American Journal of Occupational Therapy, 55,191-199.

OBJECTIVE: The purpose of this study was to identify practitioner qualities and traits that clients with brain injury see as important. METHOD: An opportunistic sample of 51 participants with brain injury was interviewed about perceptions of service access and effectiveness. An interview guide was used to gather data for this phenomenological qualitative study. Four interviewers individually conducted audiotaped interviews, which were then transcribed. Coding and theme development were completed using HyperRESEARCH software. RESULTS: Three themes regarding practitioner qualities emerged from the data: (a) roles of the provider, (b) perceived helpfulness of services, and (c) personal characteristics of the providers. Beneficial provider roles included advocate, friend, mentor, and team member. Perceptions of helpfulness of the services included relevance, meaningfulness, practical application, skill development potential, and whether periodic feedback on progress was provided. Personal characteristics of the provider valued by the participants were clear and honest communicator, supportive, respectful, good listener, and understanding. CONCLUSIONS: Practitioners need to pay increased attention to the perceptions of care and services of clients with brain injury. The current study closely supports previous research related to quality of care in the medical and community arenas and offers some additional suggestions to professionals who work with persons with brain injury, including learning how to time giving information to clients and how to understand client concerns without being prescriptive. Future research in this area needs to focus on and describe providers who demonstrate an ability-through their willingness to don a variety of roles, their helpful services, and their personal characteristics-to meet the unique needs of clients with brain injury.

Dawkins, H. & May, E. (2002). The lived experience of doing a higher degree in occupational therapy from the perspective of five graduates: A phenomenological study. Australian Occupational Therapy Journal, 49, 128-137.

The importance of supporting research activity in occupational therapy through higher degree study is widely accepted. Although completing a higher degree is acknowledged to be a unique and meaningful experience, few studies have been conducted to explore this phenomenon. This phenomenological study aimed to reveal and describe the experience of doing a higher degree from the perspective of five recent occupational therapy graduates. One in-depth interview was conducted with each participant. Analysis of the data revealed five themes. The results suggest that the experience of doing a higher degree was exciting and challenging but also involved personal hardship and sacrifices. Support from supervisors, family, peers, colleagues, employers and friends made completing a higher degree achievable. Doing a higher degree facilitated personal growth and professional benefits, but it was the great sense of achievement and satisfaction apparent upon completion that was also most significant for participants. Implications for occupational therapy and higher education are discussed.

Dougherty, D.S. (2003). Adaptation stressors encountered by elders during residential transition. Denton, TX: Texas Woman's University. (Master’s thesis)

This phenomenological study was conducted to understand the process of relocation and relocation obstacles as experienced by older adults. The method of data collection consisted of two semi-structured interviews. Six participants were selected from the assisted living segment of a continuing care retirement community and included two groups that consisted of "new newcomers" and "old newcomers." Based on analyzed data, the themes that emerged reflected the participants' experiences during the three phases of relocation that included preparation, transition, and adaptation. The themes discovered were decision making, making arrangements, fitting in, making new connections, and finding new interests & new sense of purpose. Stressors and obstacles to relocation were found to relate to the themes. The themes served to answer the research questions of this study for the purpose of contributing to the gerontological and clinical literature of relocation. Implications for occupational therapy intervention, and future research are suggested.

Finlay L. (2001). Holism in occupational therapy: elusive fiction and ambivalent struggle. The American Journal of Occupational Therapy, 55, 268-276.

The profession of occupational therapy is said to have underpinnings of holistic, humanistic, and client-centered values. How does this claim translate into practice? This article reports on a qualitative study in which the practice experiences of 12 occupational therapists in the United Kingdom were explored. Through phenomenological analysis of interviews and participant observation data, the findings revealed that although holism is indeed valued, considerable uncertainty exists about what it actually means. The therapists studied seemed to understand holism and enact it in different, sometimes contradictory, ways. Further, each therapist's practice could be simultaneously reductionistic and holistic, depending on the perceived needs of the situation. Therapists struggled to negotiate the tensions between beliefs and practices and to cope with their uncomfortable feelings when they did not achieve their ideals. Although the occupational therapists in this study strove to be person-centered, the demands of their work context pushed them to be pragmatic and strategic.

Finlay, L. (1997). Good patients and bad patients: How occupational therapists view their patients/clients. The British Journal of Occupational Therapy, 60, 440-446.

Summary: Many studies have highlighted how health professionals tend to categorise their patients in terms of moral evaluations, in particular perceiving patients as 'good' and 'bad'. This article reports on a qualitative study which explored how occupational therapists experienced their patients/clients, investigating what social evaluations were made. Nine occupational therapists were interviewed using a relatively non-directive, phenomenological approach. Although the therapists were reluctant to stereotype their patients/clients, the use of moral and social evaluations was widespread. 'Good' patients were warmly responsive and made the therapists feel valued and effective. 'Bad' patients were manipulative, threatening and resisted change. An additional category of 'difficult' patients emerged which reflected the therapists' ambivalent responses to this patient/client group, who were experienced as positively challenging but hard work. The discussion emphasizes how social evaluations are complex and involve multiple meanings which emerge in different contexts with different individuals.

Finlayson, M. (2004). Concerns about the future among older adults with multiple sclerosis. The American Journal of Occupational Therapy, 58, 54-63.

Multiple sclerosis (MS) is a chronic, progressive neurological disease that causes demyelination of the central nervous system. Typically diagnosed in adulthood, it does not significantly reduce life expectancy. The goal of this exploratory study was to describe the health-related concerns and service needs of 27 older adults with MS, ages 55 to 81 years. Through in-depth interviews using a phenomenological approach, fear of the future was found to be a predominant concern among the participants. Within this fear, participants expressed particular concerns about experiencing further losses of mobility and independence, becoming a burden on caregivers, and having to move to a nursing home. The findings raise three major challenges for occupational therapists that include: (1) developing or modifying interventions that can enable older adults with MS to gain a sense of control over their future, (2) working with families affected by MS together with other disciplines such as psychology and social work, and (3) advocating for more and better community support options for persons with MS.

Gahnstrom-Strandqvist, K., Liukko, A. & Tham, K. (2003). The meaning of the working cooperative for persons with long-term mental illness: a phenomenological study. The American Journal of Occupational Therapy, 57, 262-72.

OBJECTIVE: The objective of this phenomenological study was to understand the meanings of the lived experiences of persons with long-term mental illness at a social working cooperative. METHOD: Eighteen participants were interviewed either two or three times while participating in a working cooperative in a community psychosocial rehabilitation program. Data were analyzed and interpreted using the Empirical, Phenomenological, Psychological (EPP) method (Karlsson, 1993). RESULTS: The findings revealed a meaning-structure consisting of one main constituent that characterized the cooperative as a normalizing life-world. Three phases contributed to the normalization process. In the first phase the participants experienced a shift from an unsatisfying occupational context to an enriching occupational life-world. In the second phase participants had the possibility to satisfy some of their occupational and social needs. During this phase, experiences of being productive and needed, commitment to others, development of their skills, and competence in work tasks and social activities were expressed, all of which contributed to personal growth and a more positive view of self. In the third phase, the meaning of the cooperative changed for some participants, who expressed this through their readiness to leave and take a further step into the life- world outside the cooperative. CONCLUSION: The study emphasizes that the cooperative is an important alternative to employment for participants with severe mental illness who do not have the capacity to be employed in the community or who do not want to leave the life-world of the cooperative that gives them pride, joy, and satisfaction.

Gahnstrom-Strandqvist, K., Tham, K., Josephsson, S. & Borell, L. (2000). Actions of competence in occupational therapy practice: A phenomenological study of practice in narrative form. Scandinavian Journal of Occupational Therapy, 7, 15-25.

This study examined the phenomenon "what are occupational therapists doing when they feel competent". Data were provided by eleven occupational therapists who narrated clinical cases in which they had felt themselves to be competent. The empirical phenomenological psychological (EPP) method was used to analyse and interpret the data. The result revealed that on a general level the experience of feeling competent as an occupational therapist derived from achieving results in the rehabilitation project that were satisfying for both participants (the therapist and the client). The strategies for accomplishing this were related to the empathic competence of the therapists. This competence involved interpreting clinical situations as well as understanding the relationship between motive, meaning, decision and time. Further it involved bringing objects, in the form of adaptations, technical aids, structures, simplifications or compensations, into the clinical situation. These abilities together had a great impact on the therapeutic outcome by shaping the clients' lifeworld to make it richer and more active.

Gillot A.J., Holder-Walls A., Kurtz J.R., & Varley N.C. (2003). Perceptions and experiences of two survivors of stroke who participated in constraint-induced movement therapy home programs. The American Journal of Occupational Therapy, 57(2),168-76.

The purpose of this study was to explore and describe the perceptions and experiences of two survivors of stroke who participated in constraint-induced movement therapy (CIMT) home programs. Data sources were analyzed with a phenomenological approach, and common themes were identified. Themes were translated using the Occupational Adaptation frame of reference as a template. Three themes were generated from the data: (a) motivational factors and expectations represented personal desires to increase functional ability and environmental demands that created a press to participate in CIMT; (b) neurorehabilitation as an ongoing process suggested that rehabilitation should continue as long as functional deficits exist; and (c) perceived changes in function represented perceived changes in efficiency, effectiveness, and satisfaction after CIMT. CIMT was found to help the participants in this study become more satisfied with performance and to increase efficiency and effectiveness of function in daily activities.

Guidetti S. & Tham K. (2002). Therapeutic strategies used by occupational therapists in self-care training: a qualitative study. Occupational Therapy International, 9, 257-276.

Self-care training is one of the most frequently used interventions in rehabilitation. However, there is a need for clear descriptions of what occupational therapists do during self-care training with clients. The aim of this qualitative study was to describe what characterizes the therapeutic strategies used by occupational therapists during self-care training. Twelve occupational therapists working with clients who had had a stroke (n = 6) or spinal cord injury (n = 6) were interviewed and asked to tell a therapeutic story focusing on the self-care training process of one client. Data were transcribed and analysed using the Empirical, Phenomenological, Psychological (EPP) method, a qualitative method that aims to describe the essence, structure and character of the studied phenomenon (that is, therapeutic strategies). The characteristics of eight intervention strategies, used by all participants during self-care training, were identified. Findings showed that the occupational therapists' strategies focused primarily on how to create a relationship built on trust with their clients, how to find the right way to motivate clients, how to support the setting of goals, and how to provide enabling occupational experience and adjust training to the needs of the client, rather than focusing on teaching clients how to use technical and compensatory strategies. The general aim for using the strategies was to support the clients in taking control of their lives again. One conclusion from this study is that occupational therapists could, through understanding the individual's unique situation, vary their strategies and adapt themselves, like a chameleon, to meeting clients' experiences and needs during self-care training. However, the therapeutic outcome of using these strategies needs to be verified in future studies focusing on clients' experiences from self-care training.

Hasselkus B.R. (1998). Occupation and well-being in dementia: the experience of day-care staff. The American Journal of Occupational Therapy, 52, 423-434.

OBJECTIVE: The purpose of this study was to gain understanding of the staff experience of occupation in the context of day care for persons with dementia. METHOD: Narratives of especially satisfying and dissatisfying experiences of care were elicited from a random state-wide sample of day-care staff members. Qualitative methods were used to analyze the phenomenological data. RESULTS: The core meaning of occupation derived from these data was Occupation as the Gateway to Relative Well-Being. A model of the experience of occupation for staff members is proposed that is composed of three phases: the meeting of minds, engagement in occupation, and relative well-being. The skills of the staff informants that bring about the meeting of minds, the many levels of client engagement in occupation, and the indicators of well-being for clients and for staff members are described. The three phases together constitute an occupational space--created by the staff person--and the engagement in occupation itself constitutes an occupational place within that space. CONCLUSIONS: Bringing about indicators of well-being through occupation was a primary source of satisfaction for the day-care staff informants in this study. The model of the staff experience of occupation proposed in this study has application to all areas of occupational therapy practice.

Hasselkus, B.R. & Dickie V.A. (1994). Doing occupational therapy: dimensions of satisfaction and dissatisfaction. The American Journal of Occupational Therapy, 48, 145-154.

OBJECTIVES. A phenomenological study was conducted to gain understanding of the nature of the lived experience of doing occupational therapy. METHOD. One hundred and forty-eight occupational therapists nationwide were asked to describe especially satisfying and dissatisfying experiences of practice. The resulting narrative data were analyzed with dimensional analysis techniques. RESULTS. With the metaphor of therapy as story, three overarching dimensions of practice were derived from the narrative data: Change, Community, and Craft. The dimension of Change is strongly related to the ending or outcome of the story, Community encompasses the harmony or disharmony of the interrelationships in the shared story, and Craft includes both the skills of therapy and the broader core experience of doing therapy. CONCLUSION. These findings are complementary to the three-track mind discussed in the clinical reasoning study and contribute further to our understanding of the experience of doing occupational therapy.

Hasselkus B.R., Dickie V.A. & Gregory C. (1997). Geriatric occupational therapy: the uncertain ideology of long-term care. The American Journal of Occupational Therapy, 51,132-139.

The search for the good life is used as a framework for understanding the meaning of geriatric practice to occupational therapists. Data consisted of a subset of phenomenological interviews drawn from a nationwide study of 148 occupational therapists in all areas of practice. Narratives of satisfying and dissatisfying experiences with older clients were analyzed to understand the uniqueness of therapists' lived experiences in geriatrics. The realities of practice with older clients--the settings, the meanings and symbols of continuity in old age, and the older client's uncertain future--merge to create an uncertain ideology in geriatric occupational therapy. We suggest that a fundamental task of occupational therapists in geriatrics, as they seek the good life for themselves and their older clients, is to reconcile the realities of practice with traditional rehabilitation ideologies by redefining themselves and their roles in practice.

Helm, T. & Dickerson, A.E. (1995). The effect of hand therapy on a patient with a Colles' fracture: A Phenomenological Study. Occupational Therapy in Health Care, 9(4), 69-77.

The purpose of this phenomenological study was to gain an understanding of the effect of disability, specifically a Colles' fracture, and the role of occupational therapy in the recovery of function. On three separate occasions, a person with a Colles' fracture was viewed on videotape. Data from the interviews were transcribed and the emergent concepts were organized into themes. One theme, "just the everyday things" illustrates the participant's frustration with her disability and another, "standard program," addresses the hand therapist's reliance on a canned program. Themes from the study are discussed in terms of the consumer's experience of dysfunction and receiving occupational therapy services.

Ivarsson A.B., Soderback I & Ternestedt B.M. (2003). The meaning and form of occupational therapy as experienced by women with psychoses. A phenomenological study. Scandinavian Journal of Caring Sciences, 16(1), 103-110.

The aim of this study was to illuminate the experiences of occupational therapy interventions in individuals with psychoses. Repeated tape-recorded narrative interviews were conducted with six women participating in occupational therapy immediately after an intervention. The subsequent analyses followed a phenomenological approach. Key constituents integrated in two structures, are the main findings. The meaning of occupational therapy as expressed in the key constituents relief, self-knowledge, belief in the future, capability, resistance and satisfaction formed one structure. The form of occupational therapy as expressed in the key constituents time, environment, guidance, voluntariness and collaboration represented the other structure. These findings confirm and give empirical support to beliefs and assumptions expressed in occupational therapy literature. The results form a conceptual base for developing an evaluative assessment instrument for individuals with psychoses participating in occupational therapy.

Kinnealey, M., Oliver, B. & Wilbarger, P. (1995). A phenomenological study of sensory defensiveness in adults. The American Journal of Occupational Therapy, 49, 444-451.

This article describes the experiences of five adults who are defensive toward sensations of touch, movement, vision, smell, sound, and taste that most people consider harmless. It also describes the strategies that they use when they perceive environmental stimuli to be aversive. These coping strategies are avoidance, predictability, mental preparation, talking through, counteraction, and confrontation. A conceptual framework is presented to enhance understanding and guide further study of sensory defensiveness in adults.

Lampinen, J. & Tham, K. (2003). Interaction with the physical environment in everyday occupation after stroke: a phenomenological study of persons with visuospatial agnosia. Scandinavian Journal of Occupational Therapy, 10, 147-156.

Summary: This study examines how persons with visuospatial agnosia following stroke experience their interactions with the physical environment in everyday occupations. Eight clients with cerebrovascular lesions agreed to participate. These participants were interviewed twice and the data were collected and analysed using the empirical phenomenological psychological (EPP) method. The findings describe three main themes comprising six main characteristics of how the physical world was experienced in a new, unfamiliar, and confusing way that interfered with the participants' occupational performance and also with their experiences of being an individual "self-person". Furthermore, the study highlights their constant strife for mastery over the problematic physical world, a world that did not seem to provide them with support in their everyday occupations. These findings contribute to the growing body of knowledge within occupational therapy concerning the occupational consequences of cognitive-perceptual impairments from the client's perspective.

Lister, R. (1999). Loss of ability to drive following a stroke: The early experiences of three elderly people on discharge from hospital. The British Journal of Occupational Therapy, 62, 514-520.

A qualitative study employing a phenomenological approach was undertaken in South Australia to explore how three elderly people who had been hospitalized with stroke experienced the initial impact of loss of their ability to drive following discharge. In-depth interviews were the primary form of data collection. The main themes emerging from the data were expectation of the loss, acceptance of the loss, lack of acceptable transport alternatives, lack of control over the loss, an altered lifestyle and loss of independence. Many of the reported assumptions in the literature that loss of ability to drive has negative psychological, social and functional implications were supported by the results of this study. However, the findings from this study that the expectation of the loss was variable and that the participants felt that they lacked control over the loss had not previously been reported. The results have several implications for clinical practice, including consideration of the time at which the loss is discussed with older people and the need to prepare them for the loss. Whilst the study has produced data that shed light on the concept of loss of ability to drive, further research is needed using a larger population to check the constructs of the phenomenon.

Lyons, M. & Ziviani, J. (1995). Stereotypes, stigma, and mental illness: learning from fieldwork experiences. The American Journal of Occupational Therapy, 49, 1002-1008.

OBJECTIVES. A phenomenological study explored occupational therapy students' experiences in psychiatric fieldwork. Of particular interest were students' experiences with and perceptions of persons using psychiatric services. METHOD. Data were gathered from 16 informants, via in-depth interviews and participant observation, on multiple occasions throughout the students' fieldwork affiliations in hospital and community psychiatric service settings. Triangulation of data gathering methods and member checking were used to strengthen the interpretive validity of the study. RESULTS. Informants manifested stereotyped preconceptions and associated anxiety regarding persons labeled as mentally ill, though the strength of such beliefs and feelings was found to diminish as fieldwork progressed. Sensationalized popular images of mental illness (e.g., that it is linked with malevolence) and some aspects of academic and clinical education (e.g., a deficit focus) seemed to adversely affect students' perceptions. CONCLUSIONS. Assisting students to acquire a sound appreciation of the humanness of persons with psychiatric disorders is an educational imperative. There is a need to critically appraise academic and fieldwork practices in psychiatric occupational therapy.

Lyons, M. (1997). Understanding professional behavior: experiences of occupational therapy students in mental health settings. The American Journal of Occupational Therapy, 51, 686-692.

A phenomenological study explored occupational therapy students' experiences in psychiatric fieldwork. Of particular interest was students' understanding of professional behavior toward persons who use mental health services. Data were gathered from 16 informants via in-depth interviews and participant observation on multiple occasions during fieldwork affiliations. Emerging from informants' views of professional behavior were difficulties in their reconciling conflicting expectations with regard to emotional and social distance from persons who use mental health services. Additionally, the informants experienced a need to assume authority and maintain control in their dealings with service users. Students' encounters with such issues during fieldwork are indicative of challenges they may face as health professionals in a changing climate of mental health services. These data are stimuli for reflection on features of professional relationships with service users, particularly in response to expectations of persons with disabilities regarding control over their lives.

Morris, A.L. (1995). Listening to older adult learners: the experience of using assistive technology in task performance and home modification. Blacksburg, VA ; Virginia Tech. (Dissertation).

Limited research exists that explores the needs of the burgeoning, well elderly sector of our population. Using a phenomenological approach, this inquiry investigated the lived world of six older women, between the ages of 65 -85 years, struggling to continue living alone. Research was conducted in response to the question: What is the experience for older women learning to use assistive technology for task performance and home modification, and what is the meaning of that experience? Data collection followed the four step, descriptive phenomenological model of Barritt, Beekman, Bleeker and Mulderji (1983). Taped interviews held with the six co-researchers led to the development of individual descriptions and to co-researcher validation of the written description. Extended reflection on the confirmed protocols allowed the development and final confirmation of the older women's experiences of learning to use technology at home. Research findings delved into the complex meanings of daily experiences of six older women learning to use assistive technology in order to better manage chronic disease. This learning experience was described in the context of self-care needs, such as the impact of declining health status, and self-care practices, such as increased motivation for learning to use assistive technology. Co-researchers reluctance to accept extended family help with self-care/home maintenance tasks facilitated their use of learning as a strategy to enhance declining task performance abilities needed to live alone. Learning outcomes strengthened autonomy and encouraged pursuit of familiar social roles. The study delved into the inner experiences of older women living alone and learning to use assistive technology. Findings suggested that future research needs to explore the significance of role participation among men and women in late life. Study findings suggested that access to assistive technology products was seriously limited; that product design was inappropriate; and that written directions for products was frequently unclear. Implications for practice indicates the need for health educators to find ways to increase access to AID education and to move beyond existing barriers that limit diffusion of learning about assistive technology products in task performance and home modification.

Mulcahey, M.J. (1992). Returning to school after a spinal cord injury: perspectives from four adolescents. The American Journal of Occupational Therapy, 46, 305-312.

A phenomenological approach was used to explore the experience of returning to school following a spinal cord injury. Four adolescents who sustained spinal cord injuries and returned to premorbid school environments were interviewed concerning their perceptions, feelings, and experiences of returning to school. The responses were coded into six themes: people, role change, self-image, coping strategies, accessibility, and feelings. The themes were discussed as to their relevance on returning to school following a spinal cord injury. The research participants' suggestions on ways to ease the transition from the rehabilitation environment to the school environment and implications of the study are included.

Olson J. & Esdaile S. (2000). Mothering young children with disabilities in a challenging urban environment. The American Journal of Occupational Therapy, 54, 307-314.

OBJECTIVE: This study examined the occupations of mothering very young children with physical disabilities. METHOD: Two single, urban, Black mothers in their mid-20s were interviewed with a semistructured protocol. The audiotaped, transcribed data were analyzed with a phenomenological method. RESULTS: The context of the challenging urban environment was a constant influence that shaped the participants' occupations of mothering. The major over-arching theme derived from the data was that mothering was "what I got to do" in relation to their particular child. Two sub-themes were identified: (a) mothering as caring and (b) the impact of social supports on the occupations of mothering. CONCLUSION: To plan meaningful, effective interventions, occupational therapy practitioners need to understand the context in which mothering occupations occur and to ensure that mothers' caring occupations and social support needs are addressed in the therapeutic partnership.

Olson, J.A. (1998). A phenomenological study of infant mental health interventions: The mothers' perspective. Detroit, MI: Wayne State University. (Doctoral Dissertation)

Purposes of the Research. There are three major purposes for this study: 1. To describe the experience of a purposive sample of mothers receiving infant mental health services in the state of Michigan; and 2. To systematically examine their experiences to obtain knowledge about prevention intervention which may be useful for clinicians working in all disciplines doing infant mental health; and 3. To identify the co- occupations and behaviors of mothers and infants/children which most commonly require infant mental health services. As the research progressed it became apparent that in order to understand the experience of receiving infant mental health services, it was first necessary to understand the complex and multiple factors which contributed to the unique mother-child relationship within the context of each family. Therefore, a serendipitous result of the aforementioned goals has been a greater understanding of the network of factors which combine to create the mother-child relationship. Focus of the Research. This research focused on the prevention intervention services received by nine mothers of young children who had been involved in programs designated as Infant Mental Health Programs. The data were obtained through long interviews with mothers who had been involved in the High Needs Child Program through a private, not for profit family service agency in Michigan and through the Infant Parent Program, a home visiting program funded by the county community mental health board. (Pseudonyms have been given to all participating agencies and, later in this text, to all the infant mental health specialists.)

Padilla, R. (2003). Clara: a phenomenology of disability. The American Journal of Occupational Therapy, 57, 413-423.

A phenomenological approach was used to describe the lived experience of disability of a woman who sustained a head injury 21 years ago. Data were collected through 11 face-to-face interviews and 72 e-mail messages over the period of 11 weeks. An iterative, fluid process of questioning, information-giving, analysis, and verification was characteristic of the whole study, alternating between analysis of the particular and analysis of the general. Through a process of phenomenological reduction, each interview transcript and e-mail message was divided into meaning units that denoted shifts of meaning. Similar meaning units within a transcript or message were then grouped and summarized in a phrase or word. As new meaning units emerged, additional interviews and e-mail exchanges took place in order to obtain an exhaustive description of the experience of disability. All meaning units obtained from this iterative process finally were “horizonalized” into meaning clusters of nonrepetitive themes. The themes of nostalgia, abandonment, and hope emerged through this collaborative process. A shift in view of life was noted in the participant as the reflective process of this study unfolded; suggesting a phenomenological collaboration between patient and therapist may engender a more genuine connection in which personal meaning is authentically the cornerstone of occupation-centered treatment.

Shanahan, M. (2000). Being that bit older: Mature students' experience of university and healthcare education. Occupational Therapy International, 7, 153-162.

This study used a phenomenological approach to gain insight into the lives of a small number of mature female students on healthcare programmes at university. The qualitative methods used sought to reveal aspects of that lived experience that would explain why mature students lack confidence in their academic abilities. Data were collected from participants using an in-depth interview, a diary/journal, an open questionnaire and group discussion. The emergent themes showed that mature students see education as a catalyst for change in their lives and feel a tremendous pressure to succeed. With the multiple roles they have to juggle there is not enough time in the day to accomplish all the tasks to the high standard they expect of themselves. These compromises leave the women experiencing feelings of guilt, which seems to be expressed as anxiety about the academic demands of the programme. However, experience of life and the world of work is stated as one of the great advantages of being a mature student, and one that adds to their level of confidence as they prepare to qualify and enter the workforce.

Sviden, G., Wikstron, B-M & Hjortsjo-Norberg, M. (2002). Elderly persons' reflections on relocating to living in sheltered housing. Scandinavian Journal of Occupational Therapy, 9, 10-16.

The aim of this study is to analyse the ways in which individuals describe the experience of moving to and living at sheltered housing. Fifty-nine randomly selected elderly persons living in sheltered housing participated in semi-structured interviews. Each individual's narrative regarding their experiences in relation to their new life situation was analysed using a phenomenological approach in order to organize into themes the qualitatively different experiences which were disclosed. The analysis of the interviews showed that moving to sheltered housing meant for a majority of participants that their self-image changed from being self- reliant and independent to becoming dependent and perceiving themselves and their care to be a burden. After having lived at sheltered housing most of the participants expressed they were satisfied with the somatic care they received. However, the analysis also suggests that for some of the participants there are existential issues involved related to mental well-being which need to be attended to.

Tham, K., Borell, L. & Gustavsson, A. (2000). The discovery of disability: A phenomenological study of unilateral neglect. The American Journal of Occupational Therapy, 54, 398-406.

Objective. Clients with right brain damage and unilateral neglect often lack awareness of their disabilities. This study examined how 4 participants with neglect experienced, discovered, and handled their disabilities in the context of their everyday life. Method. The 4 participants were interviewed five to seven times during their rehabilitation process. The data were collected and analyzed using the EPP (empirical, phenomenological, psychological) method. Findings. Findings revealed seven features that described a discovery process for the 4 participants. During this process, each participant began to discover and understand the consequences of her unilateral neglect in the performance of everyday tasks. This increased understanding was a prerequisite to being able to use compensatory strategies. Conclusion. By experiencing meaningful occupational situations, the participants gradually discovered and began to compensate for their disabilities in everyday life.

Tham K. & Kielhofner G. (2003). Impact of the social environment on occupational experience and performance among persons with unilateral neglect. The American Journal of Occupational Therapy, 57, 403-412.

OBJECTIVE: The purpose of this study was to gain an understanding of social environmental influences on occupational experience and performance over the course of rehabilitation of four persons with unilateral neglect. METHODS: The Phenomenological Psychological Method (Karlsson, 1993) was used to gather and analyze qualitative data on four women over a 4-month period. Four women were interviewed five to seven times each and observed during their rehabilitation process. Analysis focused on how these persons with unilateral neglect experienced and responded to their interactions with others in their everyday lives. FINDINGS: As perceived by the study participants, rehabilitation professionals and relatives demonstrated a sequence of strategies for dealing with and helping the women perform despite their unilateral neglect. The sequence of strategies reflects the changing experience of neglect over time. The strategies used by professionals and family members during the rehabilitation process enabled these women to reclaim and occupy the neglected half of the world. Moreover, the women with neglect learned to incorporate others as extensions of their bodies in order to compensate for their ongoing inability to directly experience the left half of the world. CONCLUSION: The results suggest that it is important for others (e.g., therapists, nurses, or relatives) to understand the client's changing experience of neglect and adjust their support and collaboration accordingly. Occupational therapy intervention for persons with neglect could potentially become more effective by systematically incorporating the kinds of strategies identified in this study. Moreover, therapists could consult with others to increase their understanding and effectiveness in interacting with persons who have unilateral neglect.

Tryssenaar J. & Perkins J. (2001). From student to therapist: exploring the first year of practice. The American Journal of Occupational Therapy, 55, 19-27.

OBJECTIVES: The transition from classroom to clinical practice challenges many health professional students. This study used a phenomenological approach to explore the lived experience of rehabilitation students during their final placement and first year of practice. METHOD: Students (n = 6) in occupational therapy and physical therapy wrote reflective journals every 2 weeks during their final fieldwork placement and first year of practice. The researchers independently analyzed the journals for common themes. An independent peer completed a blind analysis of two journals. Data were also compared with published first-person accounts of novice practitioners. RESULTS: The lived experience of the first year of practice included four consecutive stages: Transition, Euphoria and Angst, Reality of Practice, and Adaptation. Themes from the journals included great expectations, competence, politics, shock, education, and strategies. CONCLUSION: Recognizing the stages in the process of transition from student to therapist may assist in educational curriculum development and clinical support and supervision for new graduates. Educators need to continue to make education practice relevant while maintaining a theoretical perspective.

Udell, L. & Chandler, C. (2000). The role of the occupational therapist in addressing the spiritual needs of clients. The British Journal of Occupational Therapy, 63, 489-494.

There is a continuing debate within the health professions on the place of spirituality and the approach to be taken towards spiritual needs within holistic care. In occupational therapy, the need for both a working definition of spirituality and evidence to validate spirituality as a performance component has been identified (Urbanowski and Vargo 1994). The aim of this study was to add to the debate by exploring the experiences of occupational therapists who have encountered spiritual needs in their practice. A phenomenological approach using semi-structured interviews with three Christian occupational therapists explored their understanding of spirituality and experience of spiritual needs in practice. While the therapists interviewed had some difficulty in putting into words the concept of spirituality, they were able to identify spiritual needs in their clients and expressed opinions regarding the possible role of the occupational therapist in dealing with the spiritual needs of clients. It was clear that spiritual counselling was not considered to be appropriate for the occupational therapist, although recognising the spiritual dimension of an individual was important. In the United Kingdom, the occupational therapy profession needs to develop further its view on spirituality in holistic care and the impact that it has on the health and wellbeing of its clients.

Velde B.P. (2000). The experience of being an occupational therapist with a disability. The American Journal of Occupational Therapy, 54,183-188.

OBJECTIVE: This study addressed what it is like to practice as an occupational therapist with a disability. METHOD: Open-ended interviews using a phenomenological approach were conducted with 10 participants until data saturation was achieved. Each transcripted interview was coded for categories, and the common themes across transcripts were identified. RESULTS: These major themes were identified: "I am sensitive to their needs"; "The issue is how to cope with life"; and "Recognize your own strengths and limits." Each theme had several subcategories. CONCLUSIONS: Occupational therapists with disabilities approach their practice from a unique perspective and may be able to motivate and challenge clients in a different manner than therapists without disabilities. Therapists with disabilities perceive themselves as uniquely skilled persons who have developed successful strategies to cope with the experience of disability.

Vergeer G. & MacRae A. (1993). Therapeutic use of humor in occupational therapy. The American Journal of Occupational Therapy, 47, 678-83.

Interviews with five occupational therapists who use humor therapeutically in their practice were conducted and analyzed with a phenomenological method so that the lived experience of therapeutic humor use in occupational therapy could be examined. Sixteen themes were identified through data analysis: The Concept of Therapeutic Use of Humor; Spontaneous Versus Deliberate Humor; Humor, the Great Equalizer; Humor and Professionalism; Contraindications of Humor; Humor Among Co-Workers; Humor and Play; Humor and the Environment; Humor Providing Balance; The Intrinsic Quality of Humor; The Transformative Power of Humor; The Effects of Humor on the Subjects Themselves; Humor as an Evaluation and Treatment Tool; Humor as Therapeutic Use of Self; Humor as a Coping Mechanism; and Other Uses of Humor With Patients. This study revealed that the use of therapeutic humor in occupational therapy is a multifaceted phenomenon, much richer than had been previously presented in the literature.

Ward JD. (2003). The nature of clinical reasoning with groups: a Phenomenological study of an occupational therapist in community mental health. The American Journal of Occupational Therapy, 57, 625-634.

OBJECTIVE: The purpose of this paper is to examine the clinical reasoning of an occupational therapist in group practice in mental health. It emerged from a larger phenomenological study of expert occupational therapy practitioners in community mental health. METHOD: Data were gathered through intensive, semi-structured interviews with 1 day of participant observation. Analysis was an iterative process in which emerging themes were identified for reflection and interpretation. Previously established categories of clinical reasoning were used as a structure for describing the results. RESULTS: A rich description of clinical reasoning in psychosocial task groups is presented using interactive, narrative, conditional, and pragmatic reasoning. The gestalt of community practice is illustrated, as the therapist describes the multiple levels of consciousness used in her consideration of, and response to, clients within the context of the larger environment. CONCLUSION: This study suggests that an examination of occupational therapy with psychosocial groups is a rich area for research to extend our understanding of clinical reasoning in occupational therapy.

March 4, 2004.

Compiled by Mary Binderman, MSLS
American Occupational Therapy Foundation
Bethesda, MD.