Professionalism and the disciplinary control of occupational therapists at the margins

Abstract

Occupational therapy’s goal of professional status comes with costs. Sociologists argue that ‘professionalism’ exhorts workers to conform with normative expectations for behaviour and performance, becoming a mechanism of social control. Those performative expectations are established by socially dominant groups, constructing occupational therapists from marginalized groups as notprofessional, unless they can contort themselves to conform. Here we explore the specific behaviours and forms of embodiedness that become encoded as ‘professional’ in occupational therapy, leaving particular groups of occupational therapists subject to discipline through the concept of ‘unprofessional’. We conducted a critical interpretive synthesis of literature indexed in CINAHL and EBSCOhost defining professional behaviour in occupational therapy (n=26). We also draw from in-depth qualitative interviews with 20 Canadian occupational therapists who self-identified as racialized, ethnic minority, disabled, 2SLGBTQ+, and/or from working-class/impoverished family origins, exploring how ‘professionalism’ serves to discipline and control them. For both approaches, we employed reflexive thematic analysis. Texts encode professionalism as specific behaviours and forms of embodiedness grounded in white, western politics of respectability. Some also exhort occupational therapists to never make the profession ‘look bad’. In our interview data, occupational therapists from marginalized groups risked being construed as ‘unprofessional’ by having the ‘wrong’ bodies, appearances, presentation of self, speech language use, emotions, behaviours, and boundaries. When ‘professionalism’ demands assimilation to normative standards that exclude particular kinds of people, we narrow the potential of occupational therapy to encompass diverse valuable ways of doing, being, becoming and belonging. There is an important role for ‘professional resistance.’