The American Journal of Occupational Therapy 159 Culture Emergent in Occupation Bette R. Bonder, Laura Martin, Andrew W. Miracle KEY WORDS • cultural competence • culture and health • diversity Bette R. Bonder, PhD, OTR/L, FAOTA, is Professor, Department of Health Sciences, Cleveland State University, 2121 Euclid Avenue, Cleveland, Ohio 44115; b.bonder@csuohio.edu Laura Martin, PhD, is Professor, Departments of Modern Languages, Anthropology, and Health Sciences, Cleveland State University, Cleveland, Ohio. Andrew W. Miracle, PhD, is Associate Dean and Professor, College of Health and Urban Affairs, Florida International University, Miami, Florida. This article was accepted for publication under the editorship of Betty Hasselkus. Culture influences occupation as well as perceptions of health, illness, and disability. Therapists are aware of the need to address culture in interventions. However, definitions of culture can be unclear, providing little guidance to therapists about how to recognize its effects in therapeutic encounters. A pragmatic definition of culture as emergent in everyday interactions of individuals encourages reconsideration of the main elements of culture, that it is learned, shared, patterned, evaluative, and persistent but changeable. Understanding of cul- ture as emergent in interaction, including therapeutic intervention, suggests three important characteristics that therapists can cultivate to enhance clinical encounters: careful attention, active curiosity, and self-reflection and evaluation. Bonder, B. R., Martin, L., & Miracle, A. W. (2004). Culture emergent in occupation. American Journal of Occupational Therapy, 58, 159–168. Introduction O ccupational therapists have long acknowledged that culture is an important aspect of occupation, and of perceptions of health, disability, and illness. The founders of the profession emphasized that therapeutic activities should be pre- scribed based on the individual’s personal and cultural values (Dunton, 1918). This recognition has led to many calls for cultural competence in the clinic (Barney, 1991; Dillard et al., 1992; Mirkopoulos & Evert, 1994; Wittman & Velde, 2002), a call now incorporated into standards for education of new thera- pists (American Occupational Therapy Association [AOTA], 1999). It is fair to say that “few occupational therapists are unaware of the importance of considering culture in the provision of occupational therapy services” (Fitzgerald, Mullavey- O’Byrne, & Clemson, 1997, p. 1). Before cultural factors can be addressed in care, therapists must have a clear understanding of what culture is. Anthropologists, who have a primary focus on defining and describing culture, have throughout their history debated the defini- tion of the term and still have not reached consensus (Kuper, 1999). It is therefore not surprising that therapists likewise are somewhat unclear about exactly what the construct means. Too often, race and ethnicity are used as representations of cul- ture. For example, in their book on cultural competency, Wells and Black (2000) discuss what it is that “White American health practitioners” (p. 138) must be aware of in their practice, suggesting that White Americans constitute a single cul- tural group and that race is a central characteristic of cultural group identity. The equation of race or ethnicity with culture leaves therapists to puzzle about whether culture is something that applies only to those who look different from themselves or speak a different language (Pope-Davis, Prieto, Whitaker, & Pope-Davis, 1993). Downloaded from http://ajot.aota.org on 01/10/2019 Terms of use: http://AOTA.org/terms