The ValMO Model Occupational Therapy for a Healthy Life by Doing
Lena-Karin Erlandsson Dennis Persson
The ValMO Model Occupational Therapy for a Healthy Life by Doing
Lena-Karin Erlandsson Dennis Persson T R A N S L AT I O N: R I K A R D E H N S I Ö
Original title: ValMO-modellen: Arbetsterapi för hälsa genom görande (second edition) © The authors and Studentlitteratur 2014, 2020
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Art. No 43420 ISBN 978-91-44-14129-9 First edition 1:1 © The authors and Studentlitteratur 2020 studentlitteratur.se Studentlitteratur AB, Lund Translation: Rikard Ehnsiö Design: Lukas Möllersten/Lyth & Co Layout: Lukas Möllersten/Lyth & Co Cover design: Francisco Ortega Cover illustration: Shutterstock.com Printed by Eurographic Group, 2020
CONTENTS
F O R E W O R D – VA L M O M O D E L 9 P R E FA C E T O T H E F I R S T E N G L I S H E D I T I O N 1 1 INTRO D U CIN G THE AUTH O R S 12 I NTRO D U CTI O N 14 18
Literature
PART 1
Context, basic concepts and dimensions 1. Current occupational therapy – a challenge
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The dilemma of occupational therapists
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Occupational therapy – something self-evident
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Occupational therapy for a healthy life by doing
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The challenge for occupational therapy
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Literature
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2. Why do we need a model describing human occupation?
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How the ValMO model came about
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Occupation analysis
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Categorizing occupations
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Meaning in occupation
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The ValMO model
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Literature
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3. The occupation and the value triads
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The occupation triad
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Occupation and value
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Literature
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4. The perspective triad
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Three time perspectives
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Macro-perspective
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Meso-perspective
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Micro-perspective
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Interaction between the three time perspectives
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Literature
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5. The ValMO model, health and illness Balance in occupation and occupational patterns
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Value, meaning and health in relation to occupations 91 Literature
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6. Measuring aspects of the ValMO model 97 97
Identifying patterns Measuring occupational value
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Final comments
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Literature
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7. Applications of the ValMO model
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The ValMO model for occupational therapists
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The ValMO model for performing a self-analysis of occupations
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The ReDO® method
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The ValMO model in efforts toward occupational justice and 116
health in society
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Literature
PART 2
Occupations, wellbeing and sustainable development 8. The ValMO model in a global sustainability perspective with ethical and existential consequences 121 Sustainable development
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The surface of everyday existence and the depth of life 124 Meaning and change from an individual perspective 126 A new everyday life
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People’s occupation as anethical means of expression 131 Literature
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9. Ecopation – ecoethical occupational awareness
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Machine-ethical occupations
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Ecoethical occupations
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Literature
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10. Ecopation and the concept of glocalization
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Occupational values in eco-occupation
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The perspective triad on the glocal level
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Literature
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Summary
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Occupational therapy and the occupational 165
perspective
I N D E X 1 67
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F O R E W O R D – VA L M O M O D E L
The Value and Meaning in Occupations Model (ValMO) is a unique, occupationally-focused tool that helps people identify what to do, to lead a healthier, more satisfying life. More specifically, it is designed to lead individuals through a carefully paced, structured process that helps them recognise what to do more of and what to do less of; which occupations to develop and preserve in their lives, and which to let go. ValMO achieves that by proposing that all occupations have value. There’s the concrete value of achieving something tangible; the dishes are put away, you got to your destination safely and on time, you learned how to use a new app. There’s also the socio-symbolic value; what an occupation means to you, to others in your social group or community, and its universal meanings. Finally, there’s the self-rewarding value, that is, whether it brings you joy, satisfaction, relaxation, peace, or any other pleasurable and restorative experience. As a therapeutic tool in occupational therapists’ toolbox, ValMO looks beyond enabling performance skills. Rather, it looks to a core occupational therapy concept; the meaningfulness of occupation. Using ValMO, occupational therapists ask people to reflect on “what their doing does”. Is their daily pattern of occupations driving them to exhaustion? Robbing them of moments to appreciate what they have achieved? Never allowing them to complete what they started? The theory on which ValMO sits is not utopian. It carefully acknowledges that not every occupation will be productive, meaningful or feel great. The tangible outcomes may be disappointing or ephemeral, disappearing in a moment. An occupation may carry negative meanings, perhaps disparaged by others or perceived to be irrelevant in the circumstances. Rather than being rewarding, some of the things people do may feel mundane, unpleasant, exhausting or alienating. A little of that is inevitable in all but the most privi-
leged lives. But, ValMO asks, if we take the individual’s pattern of occupation as a whole, is there sufficient tangible, socio-symbolic and self-rewarding value to support well-being in the long-term? If not, what is missing? What might be different? As these questions suggest, the ValMO model raises questions about how people live and suggests ways to rebalance their occupational pattern or reconsider their occupational repertoire to achieve better social, physical and mental health. Even more, ValMO guides people to make ethically and ecologically sound occupational choices, which are increasingly urgent imperatives. Importantly, ValMO is supported by more than 20 years of scholarship, testing in the classroom, and a solid base of research. Erlandsson and Persson, the primary authors of the model, have both contributed ground-breaking ideas to occupational science and drawn from its wealth of insights into occupational balance, occupational justice and occupation as the basis for population health. In the first chapter of the book, they picture occupational therapy as straddling medical and occupational sciences. Their Swedish contribution to occupational therapy’s development is to provide a practical, occupationally focused bridge between our knowledge of occupation as fundamental to health, and medicine’s concern with the restoration of health after disease or injury. ValMO is a gift to occupational therapy that will be treasured internationally. Here at last is a tool that occupational therapists can use with people around the globe to help them reconsider the ways their everyday doing impacts their experience of life and what they might become, the lives of family and community members, and the health of planet earth. Professor Clare Hocking Auckland University of Technology Aotearoa New Zealand
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P R E FAC E TO T H E F I R S T ENGLISH EDITION The ValMO model developed through the close collaboration of researchers and occupational therapy students. Internationally it was first introduced in a publication in 2001 and over the years it has been constantly refined in various ways. The ValMO model is not static, nor is it set in stone; rather, it should be responsive and react to changes in the environment and the different contexts of occupational therapy. Its basic notion is the same, but dialogue and reflection are prerequisites for the model staying relevant and developing over time. Hence, this English edition of the ValMO book is an update of the initial ValMO model, based on the active dialogue about the model taking place amongst occupational therapists in Sweden and internationally. In addition, the model is now taking its first trip abroad, which represents yet another challenge for us. We are honored by professor Clare Hocking’s introduction of the model for our international readers. We hope that you will feel at home with this model and its occupation-based line of reasoning. Lena Karin and Dennis
INTRODUCING THE AUTHORS
Lena Karin Erlandsson is a professor in occupational therapy at Halmstad University and teaches at the occupational therapy program at Lund University at the basic, advanced and postgraduate levels. Her research focuses on the relationships between structure, time and experiences in everyday life and what we do, and how this affects people’s health. Complexity and experiences in everyday life may lead to illness at the same time as this very same everyday life may be adjusted to promote health. Lena-Karin has studied how everyday life affects health and vice versa: how health affects everyday life among, for instance, working-age men and women, mothers and fathers with pre-school children in families where a child has been diagnosed with diabetes, as well as in the group of women on long-term sick leave. She has also developed the group treatment program ReDO, focusing on people in need of changing their everyday lives. Furthermore, Lena-Karin is in charge of the training to certify ReDO instructors, which on a continuous basis enables her to engage in dialogue with many occupational therapists from different organizations. These meetings also play an important role in the development and application of the ValMO model. Dennis Persson is a senior lecturer in occupational therapy and has continuous teaching assignments at the basic and advanced level at the occupational therapy program at Lund University and at the Swedish University of Agricultural Sciences in Alnarp. His research primarily focuses on developing occupational science tools, such as the ValMO model, to deepen our understanding of human occupation and the conditions and factors in everyday life promoting a good and meaningful life, both in general terms and in relation to traumas and disabilities. Examples of his research areas include developing
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methods for measuring occupational values, flow experiences and coping strategies in relation to long-term pain, nature-based occupations as a form of intervention and daily life balance for people suffering from burnout, as well as developing an occupation-based concept with regard to ecoethical awareness and sustainability, so-called “ecopation,” from an everyday individual perspective, local perspective and global perspective.
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This book presents an occupation-based conceptual model simply referred to as the ValMO model. Although the name resembles the name of a Swedish wildflower, it is primarily an acronym of the name of the model in English: the Value and Meaning in Occupations model (Persson, Erlandsson, Eklund & Iwarsson 2001). The ValMO model can be used as a tool for describing and understanding people’s doing: their occupations, how these are perceived and the complexity of these. The book is divided into two parts. Part 1 discusses the context in which the model has been developed, while also presenting its basic concepts and dimensions. Part 2 offers a deeper discussion regarding the model in relation to people’s occupation from an ecoethical sustainability perspective. Our intention is that it should be possible to use the basic model presented in Part 1 independently of Part 2. At the same time, the sustainability perspective introduced in Part 2 is all the more urgent when human occupation is going to have to be based on environmental and ethical considerations aiming to create a sustainable world and future. As a form of assistance to describe the model, we use a fictional character we refer to as Johan. He has worked as an occupational therapist in municipal geriatric care services and also has experience from a rehabilitation clinic. Furthermore, he worked for a while as an occupational therapist at a primary care clinic. In other words, Johan possesses a great deal of occupational therapy experience, but he has only recently heard of the ValMO model. He is somewhat skeptical as to whether and how this theoretical model can actually be used in what he refers to as “the real world”; that is, in his daily professional life where he meets colleagues who are not only occupational thera-
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INTRODUCTION
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pists but also belong to other professions, as well as, obviously, people encountering various forms of difficulties in their everyday lives. On a daily basis, Johan comes across different situations where the role, responsibilities and tasks of occupational therapists are challenged in different ways. We now let him introduce himself.
Hi, I am Johan. I work as an occupational therapist for a municipality in southern Sweden, but I also have several years of experience working as an occupational therapist in a number of different organizations. I will read this book together with you, while also trying to somewhat challenge the authors.
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By letting Johan follow us throughout the book, we hope that what may at first glance seem complicated or difficult to relate to the everyday challenges of occupational therapy will become clearer. This deeper understanding is achieved as we try to answer Johan’s questions, based on the fundamental notions and concepts forming the basis of the ValMO model. We believe that the model is best understood in the context in which it is intended to be used actively (i.e., where occupational therapists work) and as a tool for understanding everyday life. Johan’s thoughts and experiences, which pop up every now and then in the different chapters, are based on experiences and questions from active occupational therapists, researchers and students we have encountered in our work to present the model in different contexts. Moreover, Johan’s points are characterized by our own professional and research experience. This strategy means that the perspective adopted in this book is, to a great extent, influenced by the current Swedish healthcare system and organizational/political systems. At the same time, we also seek to link the reasoning in the ValMO model to a wider, more international and, especially in the last part of the book, global context. We, the authors of this book, are licensed occupational therapists with experience in areas such as psychiatry, primary healthcare, geriatric care and occupational rehabilitation, and we are also teachers and researchers. We have a shared interest in developing theory in the field of occupational therapy and we also have a joint research approach in terms of developing the ValMO model. In the research group where we have worked, we have several colleagues who in different ways carry out research on aspects relevant to the ValMO model. Throughout the book, we refer to results from their research as well. Hence, a much larger number of people than we the authors have contributed to the contents of this book. Above all, we would like to mention Professor Mona Eklund, who has contributed significantly in terms of researching aspects related to the ValMO model.
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T H E VA L M O M O D E L’ S FA C E B O O K PA G E
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Feel free to check out Facebook (in English) to further explore the ValMO model. Here, you may also get in contact with the authors and participate in the continued development of the model and its related tools. Address: www.facebook.com/doingforhealth
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Lena-Karin Erlandsson is a professor of occupational therapy at Halmstad University and Dennis Persson is an associate professor of occupational therapy. They both teach at the undergraduate and advanced levels at Literature Lund University.
Persson, D., Erlandsson, L-K., Eklund, M. & Iwarsson, S. (2001). Value dimensions, meaning, and complexity in human occupation – A tentative structure Occupational Therapy for a Healthy Life by Doing for analysis. Scandinavian Journal of Occupational Therapy, 8(1), p. 7–18.
The ValMO Model
The ValMO Model describes the complexity and meaning-creating values involved in what humans do. This model can be used as a tool to describe and understand our occupations (what we do in our everyday lives). The book includes a description of the different perspectives of the ValMO model as well as sections on health, current research and measuring the value of occupations. It also offers a perspective of global sustainability and justice related to the challenges currently facing humanity. The ValMO Model is primarily designed for occupational therapy students and occupational therapists working in various areas of rehabilitation and preventive healthcare. The book is useful reading for everyone interested in health issues integrating humanistic and medical perspectives.
Art.nr 43420
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