17 British Journal of Occupational Therapy January 2005 68(1) Introduction While the discussion of the explicit place of spirituality in occupational therapy continues, it is important to recognise the implicit spirituality in day-to-day practice (Egan and DeLaat 1997, p120). Although spirituality has held a central position in occupational therapy models and theorising for several years, debates about what it means and how to approach it in practice continue unresolved. Even a recent collection of articles by Canadian authors working in the area of occupation and spirituality (McColl 2003a) abounds with conflicting definitions and falls short of offering a clear conceptual model. At the same time, surveys in Canada, the United Kingdom and the United States all suggest that occupational therapists experience a high degree of uncertainty – and even guilt and embarrassment – concerning the therapist’s role in addressing spirituality (Engquist et al 1997, Rose 1999, McColl 2000, Taylor et al 2000, Collins et al 2001, Farrar 2001, Belcham 2004). On the other hand, when we look at what exactly occupational therapists do in their day-to-day work, it is possible to see in their practices a consistent attention to spiritual concerns (Egan and DeLaat 1997). This research aimed to explore how daily work is described by professionals who delineate spirituality as the core of their practice, comparing the approaches of occupational therapists and pastoral care professionals. The objectives of this paper are to highlight both the similarities and the differences that emerged, investigating how occupational therapists’ daily practice may in fact concern itself with spirituality as well as noting possible limits to this aspect of practice. Literature review Defining spirituality Spirituality holds a central place in occupational therapy theory (Canadian Association of Occupational Therapists [CAOT] 2002), yet the concept has proven problematic for more than a decade (Unruh et al 2002). In their comprehensive review of the health care literature, Unruh et al (2002) reported that the dominant approach in occupational therapy has been the development of secular definitions referring to such concepts as purpose, motivation, vitality, life force, the ‘true essence’ of a person (Egan and DeLaat 1994, p96) or ‘the experience of meaning in everyday life’ (Urbanowski and Vargo 1994, p89). The definition contained in the Canadian Model of Occupational Performance, for example, can be described as secular: ‘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 In the midst of continuing debates about the role of spirituality in occupational therapy, this research asked how descriptions of the daily work of occupational therapists and pastoral care professionals indicate attention to spiritual concerns in similar and distinctive ways. Qualitative interview data revealed therapist commitment to holistic practice, accompanied by a deep respect for client values, desires and dreams, the individual meanings of occupations and the importance of relationships to effective therapy. All of these aspects of practice have been identified in the literature as relating to spirituality. The pastoral care professionals indicated similar understandings of the importance of holism, the centrality of meaning and the significance of relationships, but also suggested noteworthy differences. While the therapists appeared to focus on identifying meaning, the pastoral care professionals concentrated on the search for or creation of meaning; and while the therapists drew on relationship as a tool for effective therapy, the pastoral care professionals viewed relationship as a site for healing work. Pastoral care also extended the understanding of interrelatedness to include a community dimension. The findings suggest important distinctions between two professions that both situate spirituality at the centre of their practice. These distinctions may prove useful for clarifying the scope of occupational therapy practice in this domain. Witnessing Spirituality in Practice Brenda Beagan and Zofia Kumas-Tan 17 British Journal of Occupational Therapy January 2005 68(1) Introduction While the discussion of the explicit place of spirituality in occupational therapy continues, it is important to recognise the implicit spirituality in day-to-day practice (Egan and DeLaat 1997, p120). Although spirituality has held a central position in occupational therapy models and theorising for several years, debates about what it means and how to approach it in practice continue unresolved. Even a recent collection of articles by Canadian authors working in the area of occupation and spirituality (McColl 2003a) abounds with conflicting definitions and falls short of offering a clear conceptual model. At the same time, surveys in Canada, the United Kingdom and the United States all suggest that occupational therapists experience a high degree of uncertainty – and even guilt and embarrassment – concerning the therapist’s role in addressing spirituality (Engquist et al 1997, Rose 1999, McColl 2000, Taylor et al 2000, Collins et al 2001, Farrar 2001, Belcham 2004). On the other hand, when we look at what exactly occupational therapists do in their day-to-day work, it is possible to see in their practices a consistent attention to spiritual concerns (Egan and DeLaat 1997). This research aimed to explore how daily work is described by professionals who delineate spirituality as the core of their practice, comparing the approaches of occupational therapists and pastoral care professionals. The objectives of this paper are to highlight both the similarities and the differences that emerged, investigating how occupational therapists’ daily practice may in fact concern itself with spirituality as well as noting possible limits to this aspect of practice. Literature review Defining spirituality Spirituality holds a central place in occupational therapy theory (Canadian Association of Occupational Therapists [CAOT] 2002), yet the concept has proven problematic for more than a decade (Unruh et al 2002). In their comprehensive review of the health care literature, Unruh et al (2002) reported that the dominant approach in occupational therapy has been the development of secular definitions referring to such concepts as purpose, motivation, vitality, life force, the ‘true essence’ of a person (Egan and DeLaat 1994, p96) or ‘the experience of meaning in everyday life’ (Urbanowski and Vargo 1994, p89). The definition contained in the Canadian Model of Occupational Performance, for example, can be described as secular: ‘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 In the midst of continuing debates about the role of spirituality in occupational therapy, this research asked how descriptions of the daily work of occupational therapists and pastoral care professionals indicate attention to spiritual concerns in similar and distinctive ways. Qualitative interview data revealed therapist commitment to holistic practice, accompanied by a deep respect for client values, desires and dreams, the individual meanings of occupations and the importance of relationships to effective therapy. All of these aspects of practice have been identified in the literature as relating to spirituality. The pastoral care professionals indicated similar understandings of the importance of holism, the centrality of meaning and the significance of relationships, but also suggested noteworthy differences. While the therapists appeared to focus on identifying meaning, the pastoral care professionals concentrated on the search for or creation of meaning; and while the therapists drew on relationship as a tool for effective therapy, the pastoral care professionals viewed relationship as a site for healing work. Pastoral care also extended the understanding of interrelatedness to include a community dimension. The findings suggest important distinctions between two professions that both situate spirituality at the centre of their practice. These distinctions may prove useful for clarifying the scope of occupational therapy practice in this domain. Witnessing Spirituality in Practice Brenda Beagan and Zofia Kumas-Tan