Introduction
The purpose of this article is to compare the theoretical concepts of spirituality (from the Canadian Model of Occupational Performance and Engagement) and volition (from the Model of Human Occupation). The author will describe why these two concepts are foundational to an occupational therapy practice, illustrate comparative and contrasting themes between the models’ concepts, and explain the reasons why the author prefers the concept of spirituality over volition in its value to occupational therapy.
The theoretical concepts of spirituality and volition are foundational to occupational therapy practice. While both the Canadian Model of Occupational Performance and Engagement (CMOP-E) and the Model of Human Occupation (MOHO) emphasize the importance of the person, CMOP-E emphasizes spirituality as the main essence of the person whereas MOHO focuses on understanding and developing the person’s volition (or motivation) for occupation. The concept of spirituality, while more complex and abstract in definition, provides a dimension of depth and breadth that adds greater value to the occupational therapy practice.
Spirituality and Volition as Foundational Concepts
Spirituality and volition are important foundational concepts to the practice of occupational therapy. According to Townsend and Polatajko (2013), the Canadian Model of Occupational Performance (CMOP) (a predecessor of CMOP-E), which was created by the Canadian Association of Occupational Therapists, “conceptualizes occupational performance as the dynamic interaction of person, occupation, and environment (p.23).” In this way, the CMOP and its expanded CMOP-E model are illustrating interactions in occupational performance where the person (a triangle) is at the center of the model with three components (cognitive, affective, physical) that include spirituality at the core. Surrounding the person is the environment (cultural, institutional, physical, and social). The person and their environment are connected by their occupation, which is identified within three purposeful areas of self-care, productivity, and leisure. Spirituality is defined by the Canadian Association of Occupational Therapists as “a pervasive life force, manifestation of a higher self, source of will and self-determination, and a sense of meaning, purpose and connectedness that people experience in the context of their environment (Townsend and CAOT, 2002, p.182).” The focus on spirituality is consistently represented in the model’s visual, which places the person, as a spiritual being, as central.
The Model of Human Occupation (MOHO) is an earlier model than CMOP, published more than three decades ago. In MOHO, Kielhofner (2008) describes ‘humans as being made up of the three interrelated components of volition, habituation, and performance capacity. The component of volition refers to the motivation for occupation, and in considering this, it’s important to examine how the environment influences a person’s motivation, as it’s a constant influence on one’s occupation (p.12).’ Kielhofner goes on to explain the ‘content of volitional thoughts and feelings (personal capacity and effectiveness, importance of worth attached to what one does, enjoyment or satisfaction one experiences in doing things); personal causation (sense of competence and effectiveness), values (important and meaningful things to do), and interests (enjoyable and satisfying things to do) (p.13).’ In MOHO, volition is an ongoing process with thoughts and feelings occurring for a person over time. Because of this ongoing process, people experience “thoughts and feelings that emerge in the midst of and in response to performance (Kielhofner, 2008, p.14).” People interpret their experience by “recalling and reflecting on performance in terms of its significance for oneself and one’s world (Kielhofner, 2008, p.14).” People anticipate things in their world by “noticing and reacting to potentials or expectations for action (Kielhofner, 2008, p.14).” And finally, as part of this ongoing process, peoples’ lives are influenced by their activity and occupational choices that consist of both ‘short-term, intentional decisions to enter and exit occupational activities, along with commitments to enter occupational roles while acquiring new habits or taking on person projects (Kielhofner, 2008, p.14).’ The volitional process described in MOHO provides a cycle of experience, interpretation, anticipation, and activity or occupational choices as an integrated and interdependent process with each part of the process flowing in to the next one.
To further convey how spirituality and volition are foundational concepts in occupational therapy, it is essential to look at the definitions of these words, and then to draw some basic connections about their relationship with one other. First, occupational therapy is defined by Townsend and Polatajko (2013) as “the art and science of enabling engagement in everyday living, through occupation; of enabling people to perform the occupations that foster health and well-being; and of enabling a just and inclusive society so that all people may participate to their potential in the daily occupations of life (p.27).” Second, the Canadian Association of Occupational Therapists (2002) define spirituality as a “pervasive life force, manifestation of a higher self, source of will and self-determination, and a sense of meaning, purpose and connectedness that people experience in the context of their environment (p.182).” Third, volition is defined by Kielhofner (2008) as a “pattern of thoughts and feelings about oneself as an actor in one’s world which occurs as one anticipates, chooses, experiences, and interprets what one does (p.16).” Thus, from these definitions, there are some basic connections that can be drawn about the relationship between occupational therapy, spirituality, and volition. For example, spirituality as a concept in CMOP-E, provides a context for both the therapist and client to develop a shared understanding about what is deeply meaningful, both internally and externally for the individual self, particularly as it relates to participation and engagement in occupations in one’s environment. On the other hand, volition as a concept in MOHO provides a context for both the therapist and client to develop a shared understanding of how an individual thinks and feels about themselves in their world. These thoughts and feelings occur before, during, and after they choose to participate and engage in occupations. Without these theoretical concepts, it would be challenging to have models that coherently and effectively illustrate the interactions between a person, occupation, and environment. It might be even more challenging for a therapist and client to engage and participate in the practice and process of occupational therapy, especially without a sense of the meaning and purpose that leads to (and comes from) participation in occupations.
Comparisons of Spirituality and Volition
In comparison, the concept of spirituality in CMOP-E can be understood as the essence of the person, whereas the concept of volition in MOHO can be understood as a process that occurs for the person regarding their personal causation, values, and interests. The similarities between these concepts are interesting. Consider for a moment how the essence of a person (spirit) may contain or be formed through a combination of ingredients that include their thoughts, feelings, sense of competency and effectiveness, values, and interests. In CMOP-E, the essence of a person or their higher spirit, plays a deep and influential role on their cognitive, affective, and physical aspects of performance and engagement. This in turn influences the areas of their chosen occupations in self-care, productivity, and leisure. With occupation, an interactive connection is formed between the person and their cultural, institutional, physical, and social environments. In MOHO, the volitional process of a person experiencing, interpreting, anticipating, and choosing occupations results in a collective interaction and evolution over time. This pattern over time is a complex manifestation of causes, values, interests, habits, roles, capacities, and experiences of the individual. In summary, both models have key concepts that can be grouped or fitted into the broader categories within a person, occupation, and environment interaction. Both models also seem to share a similarity in how a person’s sense of meaning and purpose is an important force for determining their occupational engagement.
Contrast between Spirituality and Volition
In contrast, there are interesting differences between spirituality in CMOP-E and volition in MOHO. One obvious difference is the broad, abstract, and esoteric nature of spirituality, both in the various definitions and meanings for people. Volition on the other hand, seems to be defined with more clarity, specificity, and structure in its meaning. In addition, when looking at the profession of occupational therapy and its concerns with occupational performance and engagement, there are differences in the models’ concepts as they relate to person-occupation-environment interactions. Spirituality is more easily related to a ‘belief in or connectedness to god or a form of higher power; the dimensions of mind, body, and spirit; a faith perspective in the world; and one’s relationship with self, others, or nature (Johnston and Mayers, 2005, p.386).’ Volition seems to be more straightforward and easily related to the motivation, values, and interests of the individual. According to a study by Lee, Taylor, Kielhofner, and Fisher (2008), ‘several patterns of findings on MOHO were identified in self-reporting by occupational therapists. These patterns included the finding that MOHO as a model and its concepts are widely used in practice because of a perception that it supports a holistic, occupation focused, client-centered, and evidence-based practice. Most of these therapists were comfortable with using most MOHO concepts, including volition, and used them in their clinical reasoning (p.112-115).’ In contrast, Johnston and Mayers’ (2005) review of spirituality and how therapists meet spiritual needs, found interesting discoveries about the ‘attitudes and practices of occupational therapists; how therapists assess and respond to clients’ spiritual needs; the use of occupation in relation to spiritual needs; and a number of perceived barriers to incorporating spirituality into practice (p.386-392).’ In short, Johnston and Mayers (2005) found that ‘many clients and therapists felt more comfortable expressing opinions about spirituality using religious language; that there were feelings of confusion over definitions of spirituality and fears of alienating clients by removing religious language; and that there were challenges with therapists’ abilities to recognize the more complex and abstract aspects of spirituality that involved a connectedness with self, others, and nature (p.391).’ The differences in the definitions and understandings of spirituality and volition bear a great weight on the extent to which each concept provides an inclusiveness that can embrace a wide range of therapist and client beliefs.
Preference for the Value of Spirituality
This author argues that the concept of spirituality, while more complex and abstract in definition, provides a dimension of depth and breadth that adds an even greater value than volition, to the occupational therapy practice. At the same time, there is a greater challenge (and perhaps responsibility) in the need for developing a clear understanding, acknowledgement, framework, assessment, and clinical guideline for the application of spirituality. The concept must be inclusive enough to meet clients’ wide range of spiritual beliefs and needs. If spirituality is a driving force behind the motivation to participate and engage in occupations, then the value of the concept to occupational therapy cannot be understated. A large segment of the global population consists of people with spiritual needs related to the rituals and traditions they practice which are associated with Judaism, Christianity, Islam, Bahá'í, Hinduism, Taoism, Buddhism, Sikhism, and other religious faiths. Given the significant number of people worldwide who participate in religious and spiritual occupations, there is a strong case for the need to develop and improve spirituality for the occupational therapy practice.
Conclusion
In conclusion, the author has explored the similar theme in the sense of meaning and purpose that is shared between spirituality and volition as important forces for determining a person’s occupational engagement. Differences in the abstract versus concrete definitions and understandings of spirituality and volition were described as well. These differences vary in the way each concept can embrace a narrow or wide range of therapist and client ideas about meaning, motivation, interests, and values. The author described how these two concepts are foundational to occupational therapy because they provide the therapist and client with a shared understanding of meaning in participation and engagement with occupations. They also provide a context for the reasons why an individual thinks and feels the way they do about themselves in relation to their occupations and the environment. Finally, the author explained the reason for arguing his preference for the value of spirituality over volition due to the complex depth and breadth it carries, the significance of a global population of people participating in spiritually related occupations, and the need for further development, to improve the occupational therapy practice.
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