A GROUNDED THEORY ANALYSIS OF THE RELATIONSHIP

BETWEEN CREATIVITY AND OCCUPATIONAL THERAPY

by

TINA S. FLETCHER

Submitted to the Faculty of the Graduate School

of Texas A&M University-Commerce
in partial fulfillment of the requirements
for the degree of
DOCTOR OF EDUCATION
May 2010
 UMI Number: 3405818

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 A GROUNDED THEORY ANALYSIS OF THE RELATIONSHIP

BETWEEN CREATIVITY AND OCCUPATIONAL THERAPY

Approved:

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Dean of Graduate Studies and Research

Copyright ©2010

Tina S. Fletcher
 ABSTRACT

A GROUNDED THEORY ANALYSIS OF THE RELATIONSHIP

BETWEEN CREATIVITY AND OCCUPATIONAL THERAPY

Tina S. Fletcher, EdD

Texas A&M University-Commerce, 2010

Adviser: Mary Beth Sampson, EdD

The profession of occupational therapy has long been associated with creativity;

however, there has been neither a uniform definition of creativity nor a conceptual model

to describe the relationships among creativity, the practice of occupational therapy, and

the occupational therapist. This research examined the definition, impact, and

relationships among creativity, the practice of occupational therapy, and the occupational

therapist.

The following questions were explored: How have definitions of creativity in the

context of occupational therapy changed over time? How do occupational therapists

iv
 V

define creativity in the context of occupational therapy? In what ways do occupational

therapists feel their personal creativity impacts their practice of occupational therapy?

What is the impact of practice-related creativity on the occupational therapist? What is

the relationship between occupational therapists' personal and occupational therapy

practice-related creativity?

Based upon occupational therapist participants' input, this research developed a

definition, theory, and conceptual model to describe the relationships among creativity,

the occupational therapist, and the practice of occupational therapy. Key findings were

that relationships among creativity, the occupational therapist, and the practice of

occupational therapy were dynamic and changed both through time, and with personal

and professional maturation. The changing definitions and contexts are best described by

using a dynamic two-factor person/press influences and process/product outcomes model

to characterize the relationships among creativity, the occupational therapist, and the

practice of occupational therapy.

The relationships among creativity, the occupational therapist, and the practice of

occupational therapy also appeared to change relative to the length of career. Over time,

the doer became the thinker, and creative outcomes gradually became less product-

oriented and more process-oriented. Additionally, as the career span lengthened, both

creative processes and products evolved from being object-centered to person-centered.

Creativity also served three primary functions for the occupational therapist

participants in this research. It influenced their decision making regarding client

outcomes, built their skills and knowledge, and facilitated and renewed their engagement

and commitment to work through entertaining, challenging, and restoring them.

 ACKNOWLEDGEMENTS

Now that this dissertation is complete and about to be sent out into the world, I

feel a strong urge to thank the sun, moon, flowers, breeze, my lap top, all ancestors,

religious figures, theorists, participants, teachers, classmates, parental figures, children,

pets, barnyard creatures, and anyone who listened to or put up with me during my

doctoral studies. Then, perhaps, the general and specific thanks should be followed up

with apologies for all the things that didn't get done, were left half-finished, or never

started; the Girl Scout cookies that stayed in the car too long, the town parades that were

forgotten, and the papers that might have been graded too slowly. There is also an

unignorable strange feeling of being incredibly brilliant while being pitifully ignorant.

The siren call of freedom begins. Fantasies of travel, making art, and gardening

begin to sneak into data analyses. The dogs need brushing. There's a really good recipe

clipped to the refrigerator door. Coworkers have neat research and writing suggestions.

The special ed kids need a good Chinese New Year's party. Wedding bells are ringing.

And so it goes.

I've had fantastic teachers, peers, coworkers, friends, and family members lifting

me up and carrying me through this entire process. Most of all, I owe being on this end of

things to my chief bottle washer, nanny, coffee barista, cheerleader, sommelier, research

collaborator, devil's advocate, and proofreader.

Thanks, Rick, from the bottom of my heart.

VI
 TABLE OF CONTENTS

LIST OF TABLES xvi

LIST OF FIGURES xix

Chapter 1

Introduction 1

Background and Context 1

Challenges Inherent in Creativity Research 4

Statement of Problem 6

Statement of Purpose 6

Research Questions 6

Significance of the Study 7

Method of Procedure 7

Data collection and analysis 8

Definition of terms 8

Limitations and delimitations 11

Assumptions 12

Organization of Dissertation Chapters 13

Chapter 2

Introduction 15

Review of Related Literature 15

Values and Beliefs in the Field of Creativity 15

Origins of creativity research 15

Person, process, product, and press models 17

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 viii

The creative person 17

The creative process and the creative press 25

The creative product 28

Values and Beliefs in the Profession of Occupational Therapy 30

The mental health practice model 30

The medical practice model 32

The community practice model 37

The Kawa model as a harbinger of new occupational therapy models .... 40

Researcher's reflection 41

Knitting Creativity and Occupational Therapy Together 43

Historical views of creativity in occupational therapy 43

Changes in beliefs about creativity in occupational therapy 44

New beliefs about creativity in occupational therapy 45

Creativity in occupational therapy: Multiple definitions and meanings.. .46

Creativity can make multiple contributions to health-care practices 48

Conclusion 50

Chapter 3

Method .....52

Introduction 52

Design of the Study 53

Grounded theory as a qualitative research tradition 53

Research designs within grounded theory tradition 55

Establishing trustworthiness in grounded theory 56

 ix

Grounded Theory as the Method Chosen for this Research 58

Sample selection for this research 58

Recruitment of participants for this research 59

Purposeful maximum variation sampling for this research 61

Data Collection 63

Review of literature 63

Data from demographic information sheets 64

Data from assessment and self-reports 64

Data from interviews 65

Session Data Collection and Management 65

Session one data collection procedures 65

Session one data management procedures 68

Session two data collection procedures 70

Session two data management procedures 71

Instrumentation 73

The researcher as an instrument 73

The assessment selected for this research 74

The Abbreviated Torrance Test for Adults 74

The self-report inventories selected fortius research 76

The Myers Briggs Type Indicator 76

The Minnesota Importance Questionnaire 77

Treatment of Data 78

Methods for the analysis and synthesis of data 78

 X

Data treatment and analysis 79

Maintaining trustworthiness 80

Simultaneous methods of ensuring trustworthiness 82

Ethical Considerations for This Research 85

Peer debriefing 87

Conclusion 87

Chapter Four

Case by Case Analyses 89

Background and Context 89

Lynn Tran, Educational Occupational Therapist 94

Jennifer Lopez, Educational Occupational Therapist 104

Carrie Jones, Hospital Occupational Therapist 114

Boriqua Nayali, Hospital Occupational Therapist 122

Countessa Charles, Hospital Occupational Therapist 130

Devon Darrington, Community Occupational Therapist 138

Chatee Cathy, Community Occupational Therapist 149

Carlotta Gomez, Mental Health Occupational Therapist 157

Bea Devil, Associate Professor of Occupational Therapy 166

Conclusion 175

Chapter Five

Cross Case Analyses 177

Introduction 177

Demographic Data 178

 xi

Demographic data, finding one 179

Demographic data, finding two 181

Question One 184

Question one, finding one 184

Question one, finding two 184

Question one, finding three 186

Question one, finding four 186

Question one, finding five 187

Question one, analysis 188

Question Two 192

Question two, finding one 192

Question two, finding two 196

Question two, finding three 198

Question two, finding four 200

Question two, analysis 201

Question Three 204

Question three, finding one 204

Question three, finding two 207

Question three, finding three 208

Question three, finding four 209

Question three, finding five 209

Question three, analysis 210

Question Four 213

 xii

Question four, finding one 214

Question four, finding two 215

Question four, finding three 216

Question four, finding four 217

Question four, finding five 218

Question four, analysis 219

Question Five 222

Question five, finding one 222

Question five, finding two 222

Question five, finding three 223

Question five, finding four 225

Question five, finding five 225

Question five, finding six 226

Question five, finding seven 226

Question five, analysis 227

Conclusion 231

Chapter Six

Analysis, Conclusions, and Recommendations 233

Introduction 233

Summative Findings of the Five Research Questions 234

Recasting Research Question Findings into Analytic Categories 236

Analytic Category One: Participants' Definitions of Creativity 239

Definitions in context 240

 xiii

Definitions based on lived experience 242

Definitions result in a new theoretical model 242

The person/press factor described influences on creativity 243

The process/product factor described outcomes of creativity 247

Struggles with definitions: Creative potential or ephemeral force? 251

Struggles with definitions: Nurtured or nurturing? 253

Struggles with definitions: Examining relevant theories 253

A new definition of creativity 255

Analytic Category Two: Relationships 256

Occupational therapists described their creative attributes 257

Creativity changed with maturation 258

Occupational therapists described practice-related creativity 259

Summary of Key Findings 260

Recommendations 261

Recommendations for occupational therapy education and practice 261

Recommendations for future research 263

Conclusion 264

References 266

Appendix A

Occupational Therapy Workforce Statistics 280

Appendix B

Sample Gatekeeper Contact Letters and Consent Form 283

Consent to Serve as a Gatekeeper for Research 285

 xiv

Appendix C

Research Information Sheet 287

Appendix D

Demographic Data Form 289

Appendix E

Consent to Participate in Research 291

Appendix F

Participant Flow Sheet 294

Appendix G

Data Sources for Research Questions 298

Appendix H

Theoretical Framework to Research Question Matrix 300

Appendix I

Demographic Information Sheet 302

Appendix J

Assessment, Self-Report Research Questions and Theoretical Model Matrices.304

Appendix K

Interview One Questions 306

Appendix L

Interview One Questions Theoretical Framework, Research Questions Matrix.308

Appendix M

Theoretical Framework and Research Question Matrix 310

 XV

Appendix N

Individual Data Collection Set 312

Appendix O

Interview Two Questions and Word List Prompt 317

Appendix P

Content Analysis Research Questions and Theoretical Model Matrix 320

Appendix Q

Preliminary Models 322

Appendix R

Preliminary and Evolved Coding Schemes for Question One 327

Appendix S

Establishing Trustworthiness with Question Two 350

Vita 369
 LIST OF TABLES

Table 1. Aggregated Participant Demographics 94

Table 2. Lynn Tran Myers Briggs Type Indicator Results 96

Table 3. Lynn Tran Creative Strength and Work Values 99

Table 4. Lynn Tran Personal and Occupational Therapy Creativity Words 101

Table 5. Lynn Tran Synthesized Research Question Responses 104

Table 6. Jennifer Lopez Myers Briggs Type Indicator Results 109

Table 7. Jennifer Lopez Creative Strength and Work Values 112

Table 8. Jennifer Lopez Personal and Occupational Therapy Creativity Words 113

Table 9. Jennifer Lopez Synthesized Research Question Responses 114

TablelO. Carrie Jones Myers Briggs Type Indicator Results 116

Table 11. Carrie Jones Creative Strength and Work Values 118

Table 12. Carrie Jones Personal and Occupational Therapy Creativity Words 119

Table 13. Carrie Jones Synthesized Research Question Responses 122

Table 14. Boriqua Nayali Myers Briggs Type Indicator Results 124

Tablel5. Boriqua Nayali Creative Strength and Work Values 126

Table 16. Boriqua Nayali Personal and Occupational Therapy Creativity Words 128

Table 17. Boriqua Nayali Synthesized Research Question Responses 130

Table 18. Countessa Charles Myers Briggs Type Indicator Results 132

Tablel9. Countessa Charles Creative Strength and Work Values 134

Table 20. Countessa Charles Personal and Occupational Therapy Creativity Words.... 136

Table 21. Countessa Charles Synthesized Research Question Responses 138

Table 22. Devon Darrington Myers Briggs Type Indicator Results 143

xvi
 xvii

Table 23. Devon Darrington Creative Strengths and Work Values 145

Table 24. Devon Darrington Personal and Occupational Therapy Creativity Words.... 146

Table 25. Devon Darrington Synthesized Research Question Responses 149

Table 26. Chatee Cathy Myers Briggs Type Indicator Results 152

Table 27. Chatee Cathy Creative Strengths and Work Values 154

Table 28. Chatee Cathy Personal and Occupational Therapy Creativity Words 156

Table 29. Chatee Cathy Synthesized Research Question Responses 157

Table 30. Carlotta Gomez Myers Briggs Type Indicator Results 162

Table 31. Carlotta Gomez Creative Strengths and Work Values 164

Table 32. Carlotta Gomez Personal and Occupational Therapy Creativity Words 165

Table 33. Carlotta Gomez Synthesized Research Question Responses 166

Table 34. Bea Devil Myers Briggs Type Indicator Results 168

Table 35. Bea Devil Creative Strengths and Work Values 171

Table 36. Bea Devil Personal and Occupational Therapy Creativity Words 172

Table 37. Bea Devil Synthesized Research Question Responses 175

Table 38. Participant Demographics 181

Table 39. Participants' Creative Strengths, Work Values, and Personality Types 182

Table 40. Participants' Creative Strengths Measured by the ATTA 183

Table 41. Question One 191

Table 42. Question Two 203

Table 43. Question Three 212

Table 44. Question Four 221

Table 45. Question Five 229

 XVIII

Table 46. Schematic Responses to Question Five 231

Table 47. Abbreviated Preliminary Findings from the Five Research Questions 235

Table 48. Categorized and Abbreviated Analytic Category One Findings 240

Table 49. Relationship of Participants' Ages to Personal Influences on Creativity 244

Table 50. Relationship of Participants' Ages to Press Influences on Creativity 245

Table 51. Descriptors Used by Participants for Person and Press Components 246

Table 52. Relationship of Process and Product Outcomes to Participants' Ages 249

Table 53. Categorized Words Used to Describe Process and Product Components 250

Table 54. Analytic Category Two Components of New Definition 256

 xix

LIST OF FIGURES

Figure 1. Relationship between person and press influences on creativity 243

Figure 2. Relationship between process and product outcomes of creativity 247

Figure 3. Two-factor model of creativity in occupational therapy 248

Figure 4. The relationship between work and personal creativity 260

 Chapter 1

INTRODUCTION

Background and Context

Creativity is a popular topic that has long been associated with occupational

therapy and occupational therapists. Recently, like researchers and theorists in a range of

professions, occupational therapists have begun to consider creativity as a multi-faceted

phenomenon worthy of systematic investigation. Addressing the general need for

research-driven inquiry as an increasingly important facet of occupational therapy,

Rogers (2010) stated:

...the intent of prioritizing intervention, translational, and health services research

is to stimulate research on occupational therapy interventions - particularly those

that are client-centered, occupation-based, and theory-driven. Because the clinical

science of occupational therapy is just emerging, the priority is generic - that is to

say it is not restricted to any age, diagnostic, or occupational area (e.g., self-care,

work). Importantly, it is inclusive and accommodates the preliminary work

leading to efficacy and effectiveness trials, (p.l 1)

Like early occupational therapy pioneers, noted occupational therapy theorist

Hasselkus (2002) observed that opportunities for using creativity in the practice of

occupational therapy should consider not only the patient but also the occupational

therapist. Focusing on what she called "everyday creativity" in her research, Hasselkus

stated her belief that the health promoting aspects of creative activity deserved more

attention in occupational therapy. Echoing this, Blanche (2007) also noted that the study

1
 2

of creativity with its potential to enhance well-being was natural for occupational

scientists.

A range of databases illustrate a growing interest in creativity. A comparison of

the time periods of January 1940-December 1949 to January 2000-December 2009

showed that the number of articles published using creativity as a key word grew from

572 to 14,439 in the Journal Storage (JSTOR) psychology database, from 3 to 14,871 in

the Business Source Complete database, and from 0 to 1,156 in the Science and

Technology Collection database.

However, as this body of knowledge and research grew, there remained a paucity

of research and literature about occupational therapy and creativity, despite assertions

that creative activities had been used in the profession of occupational therapy since its

inception. Griffiths and Corr (2007) specifically noted that creativity had been used by

occupational therapists throughout the history of the profession, that it had attracted both

positive and negative comment, but it had been the subject of very little research.

Likewise, Schmid (2003) also commented on the historical link between arts and crafts

and the practice of occupational therapy, particularly regarding the use of creative

activities as treatment modalities. Acknowledging the controversy that sometimes

accompanied creativity and health, she noted that occupational therapists had generally

been regarded by others as being creative but again pointed to a lack of research by

occupational therapists regarding the efficacy of using creativity in their practices.

A search of the comprehensive occupational therapy database OT Search

Complete from its inception in 1911 through December 2009 located only 70 publications

using creativity, and 258 publications using creativeness as a keyword. Further

 3

examination of these publications also revealed a wide range of uses of the term

creativity, and these uses reflected a lack of distinction between the type of creativity

traditionally associated with use of art materials and the type of creativity associated with

cognitive processes such as problem solving and lateral or divergent thinking. This

suggested that few researchers had systematically used uniform terminology to explore

the creativity in occupational therapists, the practice of occupational therapy, research, or

education.

According to the United States Department of Labor, the profession of

occupational therapy grew by 66% between 1996 and 2006 and was anticipated to grow

another 33% from 2006 through 2016, resulting in the projected number of registered

occupational therapists hovering around 133,000 by 2016 (Silvestri, 1997; U.S.

Department of Labor, 2006). Additionally, increasing emphasis on consistent, improved

patient outcomes has resulted in mandates for occupational therapists to engage in

evidence-based practice. As a result, there has been an emergence of the therapist-

researcher and therapist-scholar.

Cusick and McCluskey (2001) observed that occupational therapists needed to

review their traditional practice values, including their beliefs regarding the efficacy of

using research to guide the practice of occupational therapy and to review their own

knowledge of how to conduct and use research. Without these things, therapists may not

become research sensitive practitioners, change their personal world views, or

incorporate the use of research-based evidence as an aspect of their own professional

identities. With the growing numbers of occupational therapists and the burgeoning
 4

interest in creativity across disciplines, it has seemed inevitable that research on creativity

in conjunction with occupational therapy would occur.

Challenges Inherent in Creativity Research

Creativity has been described as complex and multifaceted and had not lent itself

to simple research. According to Beghetto, Plucker, and MaKinster (2001), creativity

research has moved away from the study of single factors and toward complex

multivariate analyses, which also resulted in new conceptual models and development of

more complex lines of research that reflect this shift (Feist & Runco, 1993; Sternberg &

Lubart, 1999). Coupled with improved methodological techniques, the many lines of

inquiry and methods of analysis produced more models of creativity than were easily

integrated into unifying comprehensive theory. As more has been learned about

creativity, it seemed to be less understood.

Even though the many questions being asked about creativity generated more

findings than were comfortably managed, Mumford (2003) suggested that in recent years

most theorists came to a consensus that creativity could be defined as the production of

novel useful products. He also pointed out that while more recent creativity research

seemed extensive, the majority of it examined factors such as motivation and personality

traits that led to the production of these novel useful products. In response, Mumford

suggested future creativity research:

.. .might, however, ask a different question: Exactly what are the effects of

creativity on the individual, the people around him or her, and the broader social

system? .. .creativity should be viewed as a cause as well as an effect. Careful

examination of these causal relationships, especially the reciprocal causal

 5

relationships that emerge as creative people both act on and are influenced by

their world should, over time, lead to a far more robust understanding of creativity

as a force shaping our daily lives, (p. 117)

While examining the field of creativity may have seemed daunting, it had been

generally agreed that the research had begun to sort itself into general lines of inquiry. Of

these, Runco (2004) noted that one of the most common ways to organize the creativity

literature fell along the scheme first put forth by Rhodes (1987), and he developed a

conceptual model which embodied study of the creative person, process, product, and

press (environment).

Similarly, Simonton (2000, 2003) proposed that creativity research fell along the

lines typified by the distinctive characteristics of a creative person, the development and

manifestation of creativity across the individual life span, the cognitive processes

involved in the creative act, and the social environments most strongly associated with

creative activity. While similar to Runco's organization of the literature, Simonton's

earlier writings did not specifically entail the creative product that was considered such

an essential element of many definitions of creativity. He lobbied for the "p" of

persuasion to be added to the formula (Simonton, 1990), and in the same spirit Runco

attempted to introduce the "p" of potential (Runco, 2003), but these terms were not

widely used in the research literature (Runco, 2007).

As evidenced by these varying lines of inquiry about creativity, there has not been

an agreed-upon model or theory that consolidated them. Gluck, Ernst, and Unger (2002)

noted that no structural framework of the various conceptions of creativity had been

developed and that one of the confounding factors was that definitions of creativity had
 6

often been domain specific. In part, differences in definitions of creativity had also been

dependent on context. Thus, an unrestricted fine arts painter navigated different creative

waters than the occupational therapist who grappled with complex patient care dilemmas.

Likewise, creativity for the occupational therapist who practiced within a constantly

changing active battle zone undoubtedly embodied different meanings than it did for the

occupational therapist who operated within the confines of a neonatal intensive care unit.

Statement of Problem

Occupational therapy is a profession historically associated with creativity.

However, neither uniform definition of creativity in the practice of occupational therapy

or occupational therapists, nor a conceptual model of the relationships among creativity,

the practice of occupational therapy, and occupational therapists has existed.

Statement of Purpose

This research examined the definition, impact, and relationship of creativity to

both the practice of occupational therapy and occupational therapists. This research

aimed to develop uniform terminology, a conceptual model, and emergent theory to

describe the relationships among creativity, occupational therapists, and the practice of

occupational therapy. Without them, it has not been possible to implement practice of

occupational therapy, research, or education related to creativity in a systematic,

consistent manner.

Research Questions

1. How have definitions of creativity in the context of occupational therapy changed

over time?
 7

2. How do occupational therapists define creativity in the context of occupational

therapy?

3. In what ways do occupational therapists feel their personal creativity impacts their

practice of occupational therapy?

4. What is the impact of practice-related creativity on the occupational therapist?

5. What is the relationship between occupational therapists' personal creativity and

practice-related creativity?

Significance of the Study

In occupational therapy, models have bridged theory and practice, and defined

interest areas. The clearly defined terms embodied in a model can be operationalized for

research, which in turn can validate the constructs of the model. Models have also

contributed to the research and philosophical underpinnings of occupational therapy and

provided the needed common vocabulary used to describe varying phenomena of interest

(Reed & Sanderson, 1999).

This research examined the definition and impact of creativity on and between

occupational therapists and the practice of occupational therapy. This research developed

a definition, theory, and a conceptual model of creativity in occupational therapy, which

after validation through empirical studies, could contribute to the enhancement and

utilization of creativity in the practice of occupational therapy, education, and research.

Method of Procedure

This was a constructivist grounded theory study, which according to Charmaz

(2006), assumed that all people including researchers and participants, create their own
 8

reality. Constructivists experience a phenomenon from many points of view and locate it

within its web of opportunities and constraints.

Using maximum variation sampling methods followed by purposeful theoretical

sampling methods (Glaser & Strauss, 1967; Merriam, 1998), data from the Occupational

Therapy Workforce and Compensation Report (American Occupational Therapy

Association, 2006) were used to invite participants from widely varying practice sites to

participate in this research.

Data collection and analysis.

Using Runco's (2004) creativity model of person, process, product, and press

(environment), data were collected from assessments and self-reports, interviews, digital

images of the practice setting, and participant's self-reported demographic data. Other

analysis involved memos and field notes from interviews, facility observations, and

researcher-created diagrams and renderings about relationships, emerging codes, and

descriptions.

Definition of terms.

Arts and Crafts Movement: The Arts and Crafts Movement began in England a century

ago as a response to the mass-produced factory production of goods during the

Industrial Revolution. Its adherents placed value upon simplicity, craftsmanship,

and the belief that form followed function (Reed, 1986).

Assessment: For this research, assessment referred to the researcher's interpretation of

participants' performance on the Abbreviated Torrance Test for Adults (Goff &

Torrance, 2002).
 9

Creative process: For this research, creative process denoted the experience of creativity

in the context of action and time. Creative process involved cognitive or

behavioral manifestations such as memory, attention, and use of knowledge,

strategies, metacognition, and thinking, amongst others. This was consistent with

Blanche's (2007) characterization of creative process which emphasized

experiences where pleasure is derived from the process of engaging in an

occupation, rather than directing the focus to a resultant product or outcome of the

occupation.

Expert participant: For this research, the term expert referred to any participant with

twenty years or more experience as an occupational therapist. This was consistent

with Tennant and Pogson's (1995) definition of expertise as the application of

practical intelligence within the context of a domain of specialized work or

knowledge. Further, they stated that the years of practice and study required for

the attainment of the status of expert was domain specific, and noted that some

domains such as sports, chess, and music tended to have young experts. Other

professions, including law, medicine, architecture, and teaching required the

development of skills over a lifetime of experience to be fully effective

professionals. For the purposes of this research, an occupational therapist was

categorized as an individual who required the life-long accumulation of

experience and practice before being designated as an expert.

Metropolitan area: For this research, all suburbs and engulfed towns that shared a border

with the city selected for the research were defined as part of the metropolitan

area.
 10

Novice participant: For this research, the term novice participant referred to any

participant with fewer than twenty years of experience as an occupational

therapist.

Occupational therapist, registered (OTR): For this research, participants were licensed

and registered occupational therapists who had entered the field with a bachelor's

or master's degree in occupational therapy, had completed clinical internships in a

variety of health care settings, and had passed a national certification

examination. Because these participants all practiced in a state governed by

regulatory policy, they were also regulated by the state board of licensing

examiners. While it is no longer possible to enter the field with a bachelor's

degree, some participants were educated before this educational standard was

created. Additionally, while use of the professional designation OTR often

reflected more formal language, the term OT was frequently used in both formal

and informal contexts to refer to an occupational therapist.

Occupational therapy (OT): While both occupational therapists and the profession itself

were commonly referred to as OT, in this research the term OT or occupational

therapy referred to the therapeutic use of everyday activities (occupations) to

facilitate health and wellness, and ameliorate any outcomes of sickness, injury,

disease that impaired or diminished participation in occupational activities related

to health, well-being, and the quality of life.

Practice of occupational therapy: The practice of occupational therapy is defined as the

exercise of professional duties by an trained occupational therapist, including any

tasks related to professional responsibilities designated by the therapist's work

 11

setting. According to the Occupational Therapy Workforce and Compensation

Report (American Occupational Therapy Association, 2006), in descending time

investment this included patient treatment, administration, consultation,

education, and research.

For this research, the additional construct of occupational therapy milieu

was viewed as a component of the practice of occupational therapy. This included

additional elements such as workplace climate and culture, context, and venues

for continuing education. For this research, the "practice of occupational therapy"

contrasted with the related construct of "occupational therapy practice" which

could have been construed as a therapist-owned and operated business.

Self-report: For this research, participant-supplied responses on the Myers Briggs Type

Indicator (Briggs & Myers, 1998), and the Minnesota Importance Questionnaire

(Rounds, Henly, Dawis, Lofquist, & Weiss, 1981; Stewart, Greenstein, Holt,

Henly, Engdahl, Dawis, Lofquist, & Weiss, 1986) were considered self-reports.

Limitations and delimitations.

Research has inherent limitations, and the following considerations might have

impacted this research: All participants were volunteers. Their responses and information

in the form of self-reports and interviews were only as accurate as the each participant's

honesty, openness, and reactivity to the researcher. Because this research involved

participants who were actively involved in professional activities, time constraints, the

work milieu, and knowledge of the researcher may have influenced self-reports,

performance on the assessment, or responses during interviews.

 12

By reputation, appearance, and unintentional verbal and nonverbal responses, the

researcher may have influenced some of the participant responses that occurred during

interviews, and her own stance may have influenced her analysis and synthesis of data.

Additionally, the use of standardized instruments implied that each had acceptable

reliability and validity to measure stated constructs. In an effort to control bias in

assessment of creativity tests, the researcher became credentialed in administration and

interpretation of the type of creativity test used for this research.

This study had the following delimitations imposed upon it: Acknowledging that

creativity might have been developed, manifested, and accepted in different ways

according to local customs and culture, this study utilized only occupational therapists

who were practicing in one selected metropolitan area from the southern United States.

The practice of occupational therapy occurs in a wide range of settings. The selected

practice venues were limited to schools, hospitals, community, mental health, and

academic settings that were considered representative of typical occupational therapy

practice sites. Additionally, because this study relied extensively on communication

between the researcher and participants, each participant was required to be comfortable

using both conversational and written English while interacting with the researcher and

exploring any intangibles that may have been associated with the topic of creativity.

Assumptions.

1. Participants' definitions of creativity would vary widely (Furnham, & Bachtiar,

2008).

2. Interviews and self-report measures would accurately represent participants.

 13

3. Attributes such as personality type, gender, and expertise might have impacted

participant's creativity.

4. Participants' views about creativity were influenced by external and internal

circumstances, their education, and their practice setting (Amabile, 1996;

Amabile, Hil, Hennessey, & Tighe, 1994; Chen, Himsel, Kasof, Greenberger, &

Dmitreva, 2006; Csikszentmihalyi, 1996; Houtz, Selby, Esquivel, Okoye, Peters,

& Treffinger, 2003; Reis, 2003; Smith, 2008).

Organization of Dissertation Chapters

This dissertation is organized in the following manner: Chapter One includes the

statement of the problem, purposes of the research, introduces the five research questions,

the significance of the study, the definitions of terms used for this research, the

limitations and delimitations of this research, and the basic assumptions of the researcher.

Additionally, the method of procedure is introduced.

Chapter Two follows with a review of both creativity and relevant occupational

therapy literature, including secondary literature review materials that were deemed

necessary to fully develop the meanings of the research findings. Chapter Three details

the methodology that was utilized for this research, including the design of the study,

instrumentation, sampling methods and participant selection, how data were collected,

and how they were analyzed and synthesized.

Chapter Four utilizes case study analyses to present the individual participant data

and findings and their relationship to the research questions. Tables are included to

amplify the assessment and self-report data, demographic data, responses to research

questions, and participant supplied creativity word lists. Chapter Five utilizes a cross-case
 14

analysis format to present aggregated demographic data and the findings, analyses, and

synthesis of participants' responses to each of the research questions. Tables are included

to amplify the meanings of participant responses to each research question. Chapter Six

puts forth definitions, categories, and a conceptual model and theories that emerged as a

result of the process of analysis and synthesis of the research data and findings detailed in

Chapters Four and Five. Additionally, recommendations for occupational therapy

educational practices and for future research are put forth. This dissertation concludes

with appendices that include interview schedules, documentation forms, and schematic

illustrations of creativity models that emerged during the course of this research.
 Chapter 2

REVIEW OF RELATED LITERATURE

Introduction

The aim of this research was to respond to the increase in both creativity and

occupational therapy research by situating occupational therapy creativity research in a

proper context. Much of the creativity research has been driven by the need to produce

objects or ideas that had utility in fields of business and innovation management, and the

researcher operated under the assumption that the task demands of occupational therapy

and occupational therapists were different; namely, that they were driven by process-

oriented rather than product-oriented outcomes. For the occupational therapist, the

ongoing interactions with clients and consumers of therapy services were primarily

focused on their attainment of wellness or optimal function within whatever context they

operated in. To this end, creativity in occupational therapy necessarily involved a client-

centered focus. An additional aspect of creativity supporting and sustaining the therapist

was also explored.

Values and Beliefs in the Field of Creativity

Origins of creativity research

In 1950, president of the American Psychological Association J. P. Guilford

issued a charge to his colleagues, calling their attention to the lack of and need for

research on the topic of creativity, and stated, "I discuss the subject of creativity with

considerable hesitation, for it represents an area in which psychologists generally,

whether they be angels or not, have feared to tread" (1986). He further noted that of the

121,000 titles listed in the Psychological Abstracts from 1927-1950, only 186 of them

15
 16

(.002%) referred to creativity. His audience might have been surprised to know that 60

years later, there was still considerable difference in expert opinion regarding the very

nature of creativity (Kurtzberg & Amabile 2001; Mumford, 2003; Runco, 2001;

Torrance, 2003). Demonstrating the multiple ways creativity is conceptualized, in the

Handbook of Creativity, Sternberg and Lubart (1999) divided creativity and its theorists

into the following categories: mystical (including Jung), pragmatic (such as von Oech),

psychodynamic (such as Freud), psychometric (including Guilford and Torrance),

cognitive (such as Gardner), social-personality (such as Barron), and confluence

(including Amible, Csikszentmihalyi, and Lubart).

According to Beghetto, Plucker, and MaKinster (2001); Feist and Runco (1993);

and Sternberg and Lubart (1999), creativity research has moved from unidisciplinary

approaches to broader systems or confluence approaches. In particular, the confluence

approaches have resulted in a more diverse theoretical and conceptual base that future

contributors may emerge from.

Csikszentmihalyi (1996) produced a different method of classifying creativity

utilizing the designations of "Big C" and "little c". Describing "Big C" creativity as the

type of innovation, idea, or object that changed or transformed a domain, he asserted that

this type of creativity was part of a system based upon acceptance by experts in the

domain. On the other hand, the more familiar "little c" creativity was described as the

everyday innovation individuals used to keep squirrels out of bird feeders.

Simonton (1980) also devised a unique and substantial contribution to the study of

creativity. The development of historiometric analysis methods enabled researchers to

evaluate the creative contributions from previous time periods (Amabile, 1996). Defined
 17

as "application of quantitative methods to archival data about historic personalities and

events to test nomothetic hypotheses about human thought, feeling, and action" (Runco,

2007, p. 244), historiometric analysis of creative individuals has included heads of state,

artists, and presidents. Since the 1980s Simonton also explored broad social factors,

including political strife, turmoil, and war and the effect of Zeitgeist, or spirit of the times,

on creativity. In this context, it may be said that Simonton studied very "Big C"

creativity affecting cultures and countries.

Person, process, product, and press models.

Many compelling frameworks for the study of creativity have existed.

Occupational therapy has been a health care profession concerned not only for the

individual but the context in which they operate, as well as the dynamic processes of

growth, change, and adaptation within the consumer of occupational therapy services.

Occupational therapy's multifaceted beliefs and approaches to patient care have

embodied many of the same elements of Runco's (2004) creativity model. This model

includes the components of person, process, product, and press (environment) and the

interactions that occur between them. For this reason, Runco's model was utilized to

guide this research.

The creative person.

Investigations on creative thought, while largely associated with Guilford's

famous call to research in 1950, trace roots back in time to the works of Dewey (Cutchin,

Aldrich, Bailliard, & Coppola, 2008; Dewey, 1910; Guilford, 1967, 1986; Mumford,

2003), who believed that creative thought served as the foundation for research on

creativity. As conceptualized by Wallas (1926), Dewey's classic stages of problem

 18

solving were represented by feeling a difficulty, locating and defining it, suggesting

solutions for it, weighing out the consequences, and coming up with a solution. This

method of problem identification and analysis formed a framework that became the basis

for Wallas' classic steps in creative production; namely, preparation, incubation,

illumination, and verification.

While Guilford (1967) pointed out that these two models differed by virtue of

Wallas' concept of incubation, he reconciled them and created his own operational model

for problem solving resulting in the structure-of-intellect model. This psychometric

model was acknowledged as foundational to the measurement of cognitive processes. In

this model cognition, memory, divergent production, convergent production, and

evaluative operations were considered to be an integrated system that gave rise to

products which could be neatly ranked and classified, and yielded five types of

operations, five kinds of contents, and six forms of products, including creative problem

solving (Bachelor & William, 1997; Guilford, 1967; Kurtzberg & Amabile, 2001; Ruscio

& Amabile, 1999; Simonton, 1995).

Guilford (1967) theorized that creative problem solving was based upon the

relationship of motivation, incubation, insight, intuition, flexibility, and evaluation. The

creative problem solving process was tied to the individual, but he acknowledged that

some external components could have impacted that person. For example, in discussions

of environment, Guilford observed, "The large-city atmosphere, although the mecca for

the more creative people, is apparently not a good breeding ground from which the

creative individuals of the future are to come". Similarly, he briefly weighed in on the
 19

effects of the family environment, religious persuasion, and working environments on the

creative personality.

Beyond Guilford's (1967, 1986) pioneering contributions, much of the early work

in the field of creativity was heavily influenced by the contributions of Guilford's

contemporary, E. Paul Torrance. Torrance spent 60 years researching, operationalizing,

and promoting creativity, and was known for the incubation model of creativity, creation

of the Torrance Tests of Creative Thinking (1966), and for the development of a

theoretical model that separated the attribute of creativity from general intelligence

(Torrance, 1995).

Guilford (1967, 1986) had previously viewed creativity and intelligence as

integrated components of the same process. A committed devotee to the psychometric

tradition of creativity measurement, Torrance chose to shift the creativity focus from

Guilford's analyses of creative intellect to that of creative process. Utilizing sophisticated

methodological skills, Torrance devised creativity tests for individuals of all ages, and

has remained well-known for his work with gifted children. Many of his tests were still in

use at the time of this research, and under the umbrella of the University of Georgia, the

Torrance Center for Creative Thinking has continued to serve as a clearinghouse for

information related to creativity.

Meanwhile, as psychometrically-oriented creativity theorists searched for the best

methods to operationalize and research creativity, the profession of humanistic

psychology evolved. Humanistic psychology was frequently referred to as a "third force"

in psychology. The two other dynamic forces in the field of psychology included

behavioral psychology which was associated with "black box" methodologist B. F.

Skinner and the field of psychoanalysis which was personified by psychoanalyst

Sigmund Freud and his devotees.

Carl Rogers and Abraham Maslow (Frick, 1971; Kirschenbaum & Henderson,

1989; Maslow, 1970, 1982) served as figureheads for the new and different humanistic

approach to counseling, which was characterized by a philosophy that individuals

naturally moved toward a higher level of evolution and that unconditional, non-directive

support from an empathic listener created a climate that promoted increasing self-

reflection and self-awareness. In 1951, Rogers cited the research and works of Rank,

Buber, Kierkegaard, and his personal collaboration with Maslow as major influences on

the development of his theories. Later writings (Rogers, 1961) placed more emphasis on

the belief that individuals had the capacity for self-understanding and for altering their

self-concepts, attitudes, and behavior if they experienced unconditional positive regard

and empathic understanding. The confluence of these elements also contributed to the

development of positive self-regard, self-actualization, and wholeness. This was debated

by those who theorized that a genetic code was most responsible for the directional

development of organisms. Despite this, Rogers and Maslow firmly asserted that the

move toward self-actualization was impacted by a variety of influences including

genetics, but was never destroyed by them (as cited in Kirschenbaum & Henderson,

1989).

With time, Rogers (1961) studied relationships beyond the patient and therapist,

and included those between clients and caregivers, amongst community members,

spiritual leaders and their flocks, and between marital partners. From these studies he

formed the person-centered counseling approach. Throughout the heyday of behavioral

 21

humanism, the hallmark of this approach firmly held that in an environment characterized

by genuineness, prizing, and understanding, an individual moved away from rigidity,

static living, dependence, and defensiveness toward process living, autonomy, self-

acceptance, and unpredictable creativity.

To this end, it is not surprising that Rogers (1961) also participated in creativity

research. Responding to the social climate of his day, he observed:

.. .a generally passive and culture-bound people cannot cope with the multiplying

issues and problems...Not only individual maladjustment and group tensions, but

international annihilation will be the price we pay for a lack of creativity.

Consequently... investigations of the process of creativity, the conditions under

which this process occurs, and the ways in which it may be facilitated, are of the

utmost importance, (pp. 348-349)

This was a clear departure from Skinner, who believed that creativity was simply

a manifestation of naturally occurring random variations of existing procedures (Catania

& Harnad, 1988). At the heart of these philosophical differences was the understanding

of the role that an individual held in his or her own development. While behavioral

humanists stood firm in their beliefs in the process of self-actualization, Skinner's camp

heralded the environment as the major determinant of human behavior including creative

thinking.

Perhaps in response to the posturing of the Skinnerians, the Rogerian camp

proposed the following definition of the creative process: "The emergence in action of a

novel relational product, growing out of the uniqueness of the individual on the one hand,

and the materials, events, people, or circumstances of his life on the other" (Rogers,
 22

1961, p. 350). Based upon this, Rogers maintained that the creative process was

fundamentally rooted in the drive toward self-actualization.

Decades later, Richards (2007) expanded upon this concept, stating that self-

expression came more naturally to the self-actualized and that creative thinking in this

context may have been more accurately interpreted as a manifestation of self-expression

rather than a type of problem solving also associated with creativity. Operating on the

assumption that self-actualization and ego-strength were related phenomena, Richards

went so far as to offer the theory that enhancing ego-strength rather than cognitive skills

in schools, homes, and organizations was what promoted creativity (p. 100).

The presence of the trait of creativity in individuals has been attributed to more

than just the march toward self-actualization, however. Cropley (1992) referred to it as a

constellation of characteristics, while Albert and Runco (1990) referred to a creativity

complex and Mumford and Gustafson (1988) identified a creativity syndrome.

Charles and Runco (2001) noted a developmental trajectory in creativity that was

similar to Piaget's developmental stages, and many noted the ubiquitous "fourth grade

slump" that occurred in both western and eastern societies. While the reasons for this

slump were not readily apparent, it was theorized that this phase was a manifestation of

what Rosenblatt and Winner (1988) referred to as the conventional stage of middle

childhood, when conformity superseded deviations from the accepted norm. Research of

Charles and Runco (2001) concluded that the manifestations of creativity in children

paralleled and amplified trends in thinking, such as divergent thinking versus convergent

thinking, and while there was evidence to support the existence of a fourth grade slump,

there was also evidence to refute it.

 23

Researchers also posited that the cognitive processes that were reflected in

generation of creative products might have been developmentally linked. Thus, while

Torrance untangled the attributes of creativity and intellect in the early years of creativity

research, there was developing evidence that suggested that like cognitive growth,

creativity also had a stable developmental trajectory (Roskos-Ewoldsen, Black &

McCown, 2008).

Research has also explored the evolution of creativity in aging individuals.

Sinnott (1998) asserted that creativity in the middle years of adulthood through old age

may be the most productive of all. Operating under the assumption that postformal

creativity yielded products that were balanced amalgams of emotion and intellect, and

that older adults were progressively more capable of meeting the demands and challenges

of adult life by devising creative solutions that were both realistic and satisfying, Sinnott

also noted that one of the aspects of this type of problem solving was how to marshal

physical realities associated with aging toward the maintenance of a creative, innovative

lifestyle. She proposed nine criteria for successful, creative postformal thinking;

1. Metatheory shift or defining problems in new or different ways,

2. Problem definition, including the decision to solve problems in certain ways,

3. Shifts between the creative process and the creative product, or utilization of

the creative process as the desired product,

4. Parameter setting where key variables were identified and strategies toward

managing them were put into place,

5. Pragmatism, or practicality in problem solving, including an understanding

why one choice over another is selected,

 24

6. Envisioning multiple solutions,

7. Understanding multiple causes for any given problem,

8. Identifying conflicting demands within the problems, and

9. Understanding one's own thinking processes.

This process is also reflected in Marsiske and Willis' (1998) research on problem

solving in older adults. Defined as a process of fluent, flexible, and original thinking

about problems faced in everyday life, this type of practical creativity manifested itself in

late adulthood when the idea of aging in place becomes important. Real-life

environments present challenges that are manifested in many ways including changing

circumstances, physical realities, and altered beliefs.

Of these creative processes, flexible thinking was believed to be the most

significant to successful creativity. Defined as being able to view something in many

different ways, this attribute superseded the notion of the fluent thinker as most creative.

Fluency, the generation of multiple solutions for a problem or multiple ideas, might not

imply that the ideas are good; they are merely high in number. Operating from a

statistical standpoint, the more ideas that are generated the more likely some are to be

good, but this can be offset by other factors such as repetitive thinking. Originality was

defined as production of new or novel ideas, but this still does not account for the quality

of them.

One more consideration regarding the developmental trajectory of creativity was

that it could also function differently within specific contexts. For example, creative

individuals facing an unfamiliar task in a work environment might not have solved it is a

creative way if they did not possess adequate stores of knowledge to evaluate the task
 25

demands. The process of being able to think creatively, understanding a body of

knowledge, and being motivated to creatively meet the task demand are part of

Sternberg's (2003) developing expertise model. In this model, the continual interaction of

creative personal thinking and knowledge of a domain require creative, practical, and

analytical thinking styles. Sternberg held that these skills also required that creative

individuals have enough understanding and control of their thinking processes to generate

and select from a range of cognitive options. All of these processes, in turn, are nested

within the thinker's context which mediates the outcomes.

The creative process and the creative press.

Other recent lines of creativity exploration included the development of the

creative research environment by Hemlin, Allwood, and Martin (2008), who postulated

enjoyable, positive group and organizational climate, and lively supportive

communication were necessary elements for the creative process to occur. Friedman,

Foster, and Denzler (2007) advanced a feelings-as-information framework which

proposed that positive affect and mood created a feeling of personal safety, and suggested

that tasks which seemed fun and silly augmented performance on jobs that were more

serious or important. By identifying and quantifying creative self-efficacy, creative

personal identity, and cross-application of experiences (intersections of work and off-

work behaviors), Jaussi, Randel, and Dionne (2007) determined that 68% of the variance

in creative performance in work was caused by self-concept and problem-solving,

creative personal identity, and creative performance.

Other supportive research of Pannells and Claxton (2008) found significant

relationships existed between positive personality characteristics of happiness, creativity,

 26

and locus of control. In this context, self-esteem was considered a component of

happiness. But was enhancing creativity more than providing opportunities for fun and

silly task performance?

Theorist Dean Keith Simonton (1999) argued that it was not just happiness,

freedom from stress, or self-actualization that caused a person to act creatively. Simonton

pointed to what he termed "Darwinian creativity" as a significant force in creative

processes. Holding to a multivariate view of creativity, Simonton cautioned that

serendipity and unanticipated events, not freedom from stress or happiness, often lead to

creative performances. Viewed from this perspective, cultures that were lean and hungry

tended to be more innovative then those that were content to maintain a status quo. Many

times, Simonton believed, ideas were held in an individual's mind, incubating, until

conditions lead to a surprising "aha" moment. Oftentimes these moments built

momentum, and a new sociocultural "Zeitgeist," or spirit of the times, was born. Other

professionals or domains responded in domino fashion and created products from their

own worlds, creating a renaissance effect.

A part of Zeitgeist was directly attributable to professional knowledge or expertise

in domains. Echoing Csikszentmihalyi (1996), Simonton (1999) argued that disciplined

mastery of a body of knowledge gave a creative individual something to work with and

spring from. Further explorations by Hunter, Bedell-Avers, Hunsicker, Mumford, and

Ligon (2008) countered that extensive knowledge in a variety of domains helped with

problem solving, but not necessarily idea generation. However, when only one domain of

knowledge had been mastered, the individual tended to produce more innovative ideas in

that area. In other words, the "Jack of all trades, but master of none" might have been
 27

good at fixing things, but would not have been inventive. On the other hand, the

Poindexter and master of a single endeavor would have been more innovative within that

world, and may have even, according to Simonton, been able to shift talents and methods

into other areas of endeavor.

The research of Hunter, et al., 2008 increasingly recognized the distinction

between forming creative ideas and solving problems in a creative way. If the social

climate the person worked and lived in provided support, encouragement, and a feeling of

safety that allowed the creative process to flourish, in turn, they expanded the domain of

their profession's expertise in some way. If their contribution was focused and truly

innovative they may have profoundly changed the existing domain in light of new

understandings or have created an entirely new domain.

Cohen-Meitar, Carmeli, & Waldman (2009) investigated the perceptions of

meaningfulness in workplace cultures, and operated under the hypothesis that a work

environment that fostered strong personal identity with the workplace while still allowing

the employee to have freedom resulted in creative performance. Having defined

meaningfulness as embodying a sense of purposefulness, engagement, and having some

significance, the researchers operated under the belief that creativity emerged when those

criteria were met. They showed that a sense of personal freedom and autonomy

contributed to the perceptions of meaningful employment, and presumed that creative

products were more likely to be generated in work settings that had these attributes.

While broad in scope and mindful of myriad possibilities, many of these findings

continued to utilize the tenants of Rogers's (1961) humanistic theory of self-actualizing

creativity as underpinnings of their own.

 28

The creative product.

Weighing in as a relative newcomer to creativity research was a growing

awareness of the difficulties inherent in trying to quantify and measure a mood or feeling

of creativity. Instead, some suggested that it was more realistic and authentic to measure

the outcome of such a mood or feeling. As cited in Amabile, 1996; Ghiselin (1963)

posited that measuring the intrinsic qualities of an outcome helped to determine whether

something was creative (Amabile, 1996). In 1975, researcher Taylor developed the

Creative Product Inventory which examined generation, reformulation, originality,

relevancy, hedonics, complexity, and condensation of products. Simonton (1980) devised

a method for objectively analyzing the originality of musical scores using new computer

technology, and was followed by the work of Besemer and O'Quin (1986) who

developed the Creative Product Semantic Scale which examined the novelty, resolution,

and elaboration and synthesis of a product.

The problems associated with these techniques were embedded in the very nature

of the attributes they attempted to use as measurement tools (Cropley, 2003). What was

meant by novelty or relevancy, for example? Exactly what criteria should be used to

measure these attributes? Additional concerns were in regard to the presence of bias.

Artistic bias, according to Runco (2007), led one to assume that only individuals with

artistic abilities were creative, and product bias assumed that only tangible objects as a

product sufficed. Such a tight focus on an outcome might have overshadowed the role of

creative potential in individuals who had not produced anything - yet.

Without question Amabile (1996) put the product focus of creativity research into

a format that was generally agreed upon. As a specialist in industrial and environmental
 29

creativity and motivation Amabile developed a theoretical framework to support her

newly devised Consensual Assessment Technique. In this process she held that the

outcome of creativity, whether a product or a response, could be evaluated for its creative

merits if the evaluation was done by observers who were familiar with the domain the

creative product originated from.

The implications of this framework deemphasized process, which according to

Amabile was not as feasible to measure. Instead, an objective evaluation of a product

utilizing agreed-upon merits determined by experts in the field of endeavor was proposed

as a more realistic method of creativity assessment. Admittedly, this method did not

measure anything intangible, such as potential, but it did eliminate the problems

associated with earlier product assessment protocols including operational definitions

such as originality or novelty.

This line of endeavor was also consistent with Csikszentmihalyi's (1996) systems

theory that utilized experts from a domain to provide verification of whether an

individual had been creative. One of the unique aspects of the consensual assessment

technique that Amabile (1996) and Csikszentmihalyi each put forth is that the

determination of creativity must be based upon the experts' determinations. These experts

had to know whether or not something is creative but they did not have to identify why

they felt it was creative. This process allowed them to use intuition or other intangible

factors to guide their decision making. Additionally, for the most authentic assessment

Amabile held that the evaluating experts must operate independently of one another, have

a certain level of expertise in the endeavor they were to measure, and be able to assess the

merit of other attributes such as technical goodness.

 After creating the formula for the Consensual Assessment Technique, Amabile

(1996) turned her efforts to understanding the impact of place and press upon product in

the form of environmental assessment. Additional research continued on the interactions

between individuals who functioned in groups and on the impact of the group processes

such as brainstorming and networking on creativity. Through this research, Amabile also

lent support to the notion of a systems approach to creativity.

Values and Beliefs in the Profession of Occupational Therapy

The mental health practice model.

The field of occupational therapy emerged from the late 1800's-era moral

treatment and mental hygiene philosophies. Defined by Ikiugu and Ciaravino (2007) as

"the art of preservation of the mind and intellect in the face of assault from pernicious

environmental conditions" (p. 17), the mental hygiene movement was born from the

horrors experienced during the Civil War, and held that exercise, healthy eating habits,

adequate rest, and purposeful activity provided a foundation for health and healing.

Additional support for this point of view was provided by psychiatrist and one of

occupational therapy's founders, Dr. Adolph Meyer. As a follower of both Dewey's

psychology of functionalism and of Darwin's theory of evolution Meyer affirmed

Dewey's notions that doing, action, and experience provided a basis for functional

activities and healthy living. This was later echoed Friedland and Silva (2008), who held

that Dewey's learning by doing methods led to the use of handicrafts, which incorporated

art and creativity into holistic educational practices.

As the conceptual base of occupational therapy took root in these tenants, its

diverse group of followers soon included teachers, artists, craftsmen, religious and civic
 31

figures, engineers, nurses, and medical doctors, amongst others (Reed, 2006). Yet, the

new profession still needed organizational support, and in 1918, guiding principles were

created by Dr. William R. Dunton, Jr., who theorized that occupational therapy should

involve activities that emphasized curative work that was interesting, that the patient

should be studied so that any one type of activity would not cause undue fatigue, and also

that the selected activity should be purposeful. Further, he noted that the work should not

only instruct or inform the patient, but it should also provide an opportunity for

socialization, and while a quality product would have been a desired outcome, any efforts

toward that end were better than not having tried at all (Reed, 2006).

While formed by and grounded in the belief that this relatively new idea of

providing humane treatment and selected diversionary activities helped the mentally ill,

members of the fledgling profession of occupational therapy soon found themselves

responding to the needs of soldiers returning from the great World War, to those

suffering from the financial collapse of the Great Depression, and to crushing waves of

poorly assimilated immigrants with a less kind and gentle approach of custodial care. Not

unlike the factory-style schools from the same era, occupational therapists working in

institutions viewed their patients as charges in need of supervisory control.

During this era, according to Kielhofner (1997), the occupational therapy milieu

was a highly regulated environment that enabled patients not only to learn how to live

their lives in the best manner possible, but also allowed them to explore their potential.

Resultantly, therapists engaged in habit training programs, industrial therapy not unlike

contemporary-era vocational training, and provided sheltered workshops to their charges.

Greatest emphasis was placed upon management of the client within a facility-based
 32

context, and less consideration was placed on the relevance of occupational therapy to

life beyond the walls of the institution.

The medical practice model.

Kielhofiier (1997) observed that a paradigm was defined as knowledge developed

in a domain and embraced by a group of like-minded individuals, representing a

professional culture. The culture of occupational therapy has always been to consider the

needs of humans, how they could be served, and how their problems could be solved. A

paradigm could remain in place until a crisis served to dethrone it in favor of ever more

current thinking.

In the case of occupational therapy in the 1930s and 1940s, the medical

establishment led a charge that toppled the paradigm of occupational therapy that was

primarily grounded in mental health care. Although the influences of scientific reasoning

and research certainly had an impact on all rehabilitation therapies, occupational therapy

was also transformed by advent of World War II. Issues of mental health and adjustment

were swamped and overcome by the return of thousands of physically maimed soldiers to

the United States from Europe and Asia. While these unfortunate individuals undoubtedly

had their share of mental health issues related to their military service and newly acquired

physical disabilities, these concerns yielded to more dramatic life-threatening matters of

injuries, disfigurement, and illnesses themselves. In occupational therapy, treatment

focused on medical intervention for appendage loss and wound care (Reed, 2007).

Therapists who had previously paid a great deal more attention to the

management of environments and mental health status were rapidly transformed by

societal need into those embracing a medical model. These therapists were ill-prepared
 33

and undereducated for the transition, and watchful criticism from the medical

establishment was fast, to the point, and clearly reflected medicine's new fascination with

research. The efficacy of therapeutic intervention was often called into question, and

resultantly, therapists in their professional survival mode quickly embraced the

reductionism of medicine.

In fact, Friedland and Silva (2008) noted that the surprising defection of

occupational therapists who founded the profession and grounded it in education and

mental hygiene to the reductive world of medicine was not entirely surprising when

considered from the viewpoint of survival. For example, they theorized that early

occupational therapy pioneer Kidner saw not only professional survival but alliances that

could enable growth and development were likely to result from alliances with a medical

model. For that matter, Dewey's educational models of learning by doing no longer

existed either (as cited in Ruddell & Unrau, 2004). They had also been atomized into a

newer reductionist world famously characterized by forays into phonics and student

ability grouping.

Resultantly, working from the bottom up, occupational therapists began to follow

admonitions such as those put forth by Willard and Spackman (1963), who stated:

Many of the activities used in occupational therapy are not of special value in the

treatment of physical disabilities because they fail to meet the criteria set up to

determine the adaptability of an activity for such treatment. To be adaptable for a

specific exercise an occupation must allow motion to be localized primarily in the

affected joint or joints or must strengthen certain muscle groups. It must also have

a majority of the following characteristics: provide action rather than position,

 require repetition of the motion, and permit gradation in the range of motion of

the joint, resistance, and co-ordination of muscle action, (p. 190)

Consequently, obedient occupational therapists segmented and treated problems such as

patient instability, mobility impairment, motion restrictions, and misalignment; thereby

creating a generation of nearly helpless individuals who were firmly positioned in their

wheelchairs with hips, knees, and ankles flexed to precisely 90 degrees each, and of

children who could no longer "W-sit" because the awkward position was viewed as being

potentially damaging to knee ligaments. Unfortunately, there was little consideration for

these neatly positioned clients' inabilities to function independently.

This reductionist method of thinking was a diametrically opposed to occupational

therapy co-founder Tracy's (1912/1980) early mental hygiene-rooted writings that stated:

The German physician who always worked in the garden with his patients

recognized the surest way to keeping them interested. It is futile to put work into

the hands of the sick and expect them to create an interest in them. A dozen kinds

of occupation may be suggested, material furnished and explanations and

directions given, but without the constant cooperation of the teacher or nurse,

without the daily expression of interest and the stimulus of example, the work is

either never begun, or, if begun, is soon thrown aside. (Tracy, 1980, p. 5)

It was evident that treatment moved away from a process facilitated by the occupational

therapist, to a setting in which it was applied by the occupational therapist to the patient.

The latter typified what Mackey (2007) referred to as a traditional view of professional

identity in occupational therapy. As such, the occupational therapist had a monopoly on

 35

control, and owned the professional knowledge. The knowledge was applied to the

consumer but typically not transferred to or shared with them.

Not surprisingly, most occupational therapists faced identity struggles that

resulted from the sudden catapult into the medical world. Rehabilitators were abundant,

but lacked clear professional identities. Role diffusion set in, and it became difficult to

delineate and separate the identities and roles of the physical, speech, occupational,

recreational, music, and vocational therapists. The American Medical Association

stepped into the fray and determined that a prescription written by a medical doctor was

needed before an occupational therapist could evaluate and treat a patient, and owing to a

practice that started in Veteran's Administration hospitals, occupational therapy

departments were also increasingly headed by physicians. Soon, the president of the

American Occupational Therapy Association was also a doctor.

In response to the ongoing professional role diffusion that emerged over

professional territory and identity, some necessary soul-searching was done. West and

McNary (1956) evaluated occupational therapy educational practices of the post World

War II era and asserted that too many crafts were included in occupational therapy

curricula. They further diminished the importance of media that had been established by

America's earlier Arts and Crafts Movement by asserting that arts and crafts were

unappealing to some, failed to meet the needs of many patients, particularly men, and

were poor choices of modalities to meet the tasks of improving strength or in simulating

job task demands. Instead, Hill (as cited in Reed, 2006, p. 20) exemplified a more

military-inspired milieu with newly minted statements such as,

 System and precision are usually as important as in other forms of treatment.

Dosage should be exact. The object to be attained should be kept in mind and

treatment should not degenerate into mere diversion.

As the conservative 1950s gave way to the progressive movements that sprang

from the 1960s, occupational therapy continued to grapple with uncomfortable growth

pains that emerged from trying to fit a professional stance rooted in the Arts and Crafts

Movement and practices of mental hygiene to the reductive, medical model that had been

fed by research conducted on the many former soldiers who spent their time in the

Veterans Administration Hospitals. With time, Perrin (2001) noted that while crafts still

had their place in some work setting, they were primarily utilized by assistants and

technicians for diversionary purposes, and it became increasingly infrequent for the

occupational therapists to use them to attain a specific therapeutic outcome. Instead, the

occupational therapists were focused on assessment and in treatment that utilized

kinesiology, neurology, and psychology.

While physicians embraced research that was made possible thanks to the many

hospitalized veterans, occupational therapy as a profession struggled with whether or not

to release their old ideals of intervention that necessitated a long convalescence combined

with the seldom operationalized outcomes such as diversion and play. Some occupational

therapists wrestled with the inclination to nurture their charges in the spirit of Jonathan

Livingston Seagull (Bach, 1970) and behavioral humanists like Abraham Maslow and

Carl Rogers, while others trumpeted the benefits of treating individuals suffering from

the effects of nearly-conquered polio and tuberculosis with exacting scientific

 37

methodology. Many weighed in on where they thought the future of occupational therapy

lay.

Influential theorist Mary Reilly provided an influential voice in the paradigm shift

away from occupational therapy as an arts and crafts centered profession when she stated,

"I personally have little trust that we can continue to exist as an arts and crafts group

which services muscle dysfunction or as an activity group which services the emotionally

disabled" (as cited in Reed, 2007, p. 17). Suddenly, arts and crafts as a treatment

modality or professional identifier seemed not only dated and irrelevant, but a little

embarrassing. Evolving professional philosophy emphasized the therapist's

administration of treatment to a client, with the desired outcome in the form of increased

physical and psychosocial function and self-understanding on the client's part. Words

like procedure and treatment replaced earlier descriptors such as satisfaction and

attractiveness. Modern, efficient, lab-coated occupational therapists settled into a new

way of practicing that seemed light years away from the methods the pinafore-clad

attendants had used twenty five to fifty years earlier.

The community practice model.

Interestingly, the next seeds of change in the profession of occupational therapy

were planted not by the medical establishment, but by vulnerable children. While

occupational therapists were self-consciously basking in the glow of modern medical

specialization, popular monikers of the seventies such as "I ain't much baby, but I'm all

I've got" (Lair, 1974) reflected the growing sense that certain population segments of

American society may not have been able to fully participate in this new inclusive,

accepting milieu. Exceptional children became the new concern of occupational

therapists thanks to legislation beginning with the Education for all Handicapped

Children Act (Palfrey, Singer, Raphael, & Walker, 1990), and the population of

individuals served by occupational therapists morphed from those needing strict medical

rehabilitation to those needing help to function more effectively in their homes, schools,

and communities. Therapists hung their white labs in the closet and donned apple and

Scottie dog decorated teacher-style jumpers as they were thrust into a transdisciplinary

mix of educational related services (Reed & Peters, 2008).

Goniometers yielded way to pencil grips and sensorimotor integration became

new therapist buzzwords, and therapists once again found themselves up to their elbows

in paints and glues, handling the very materials that had seemed out of favor during the

modern medicine heyday. Improved studies of brain functions lead therapists to turn

toward issues of cognition and to carve out a new professional identities and

methodologies, while simultaneously reaching back to the roots of Dewey and Meyer

(Cutchin, Aldrich, Bailliard, & Coppola, 2008). Occupational therapists again found

themselves working with individuals on cognitive function, but this time, primarily in the

world of education. Could therapists help children learn more effectively? While

originally serving as medical-model clinicians in schools by straightening bent limbs to

enhance classroom performance and improving the mobility of wheelchair-bound

students, therapists in their new role as special education related service providers

struggled with the most useful way to deliver therapy services. Soon, and perhaps as a

reflection of their predominant practitioner demographics of young, female, and often a

mother, schools became the number one employer of occupational therapists in the 1970s

through 1990s (Reed & Peters, 2008).

 39

At the close of the century, the pendulum took one more swing, and the newest

paradigm found occupational therapists integrated into community settings beyond the

classroom. Not only did the deinstitutionalization movements of the 1980s and 1990s

place a large number of marginalized and vulnerable people on the street, but a cultural

shift spurred on by a decentralized work force created by communication and technology

innovations also placed a greater emphasis on individualization. Fazio (2008) suggested

that natural settings where clients lived and worked in were the best and most effective

arenas for service delivery. Mackey (2007) also noted that diversity within the profession

of occupational therapy often contributed to confusion about the very nature of

occupational therapy, and felt that the essence of what it meant to be an occupational

therapist needed reevaluation.

For therapists, recognition of their client's unique needs and performance contexts

played out in an increasing return to the occupational therapy roots of facilitating

adaptation and purposeful activity, but this time, with a new twist. In postmodern

occupational therapists, hunches and intuition were grounded in research. Cusick and

McCluskey (2001) noted that the shift was primarily from an experientially-based

practice model to an evidence-based practice one. Armed by rapid access to information

systems, the newly-skilled occupational therapy researcher-practitioner kept one eye on

professional philosophy while engaging in innovative and effective evidence-based

research to determine the most appropriate intervention and treatment plans. In keeping

with the new but old mental hygiene emphasis on the individual dignity and self-efficacy

of the recipient of therapy services, occupational therapists were also reacquainting

themselves with the works of Dewey (1922, 1998), who held that human habit was a
complex amalgam of social, physical, moral, and cognitive processes. Resultant habits

freed up energy to allow individuals to engage in occupations, which were viewed as the

activities that formed the underpinnings of lived experience (Cutchin, Aldrich, Bailliard,

& Coppola, 2008). It was in this interaction between the person and the ever-changing

world that postmodern therapists often found themselves.

The Kawa model as a harbinger of new occupational therapy models.

One of the most pressing concerns for many occupational therapists who faced

these changes was that while the world was expanding, it was also shrinking.

Occupational therapists, while embodying a profession conceptualized in Western minds

to describe an American-style philosophy of health care, were finding themselves moving

beyond Western confines, and also treating more clients and patients who themselves

were not Westerners. For example, recalling his own education, Japanese-born Canadian

theorist Iwama (2006) stated:

The occupational therapy I learned at school was based on the medical model that

sees and treats clients accordingly, but my clinical experience gradually made me

aware of the limitations of the medical model and the necessity of a more

comprehensive model that encompasses both the client and the environment. The

Western occupational therapy models that focus on the relationship between

human being, occupation and environment are well-known, but the difference in

culture makes them difficult to use in Japanese clinical practice, (p. 187)

To this end, Iwama (2006) created the Kawa [River] model of occupational therapy. In

this model, rather than the traditional depictions of human, environmental, and

occupational contexts traditionally represented by overlapping circles and arrows to

 41

demonstrate relationships with one another, Iwama conceptualized occupational therapy

intervention by using a dynamic model of life and health represented by a river, life

circumstances as rocks, personal assets and liabilities as driftwood, environmental factors

as river boundaries, and targeted areas for occupational therapy intervention represented

as flow areas between barriers. Using the Kawa model, the occupational therapist co-

created what the river looked like with the recipient of therapy services.

Using a metaphor that was understandable to the Japanese consumer of

occupational therapy services demonstrated the shifting nature of occupational therapy

and health care service delivery. In reflecting on the important uniqueness of the Kawa

model, occupational therapy theorist Christianson (2006) noted:

.. .the Kawa model, by drawing from nature, does such an effective job of

providing a metaphor for the vicissitudes of life. In so doing it provides a readily

understandable way for both practitioners and clients (be they individuals or

collectives) to understand what occupational therapy is trying to achieve as a

service aimed at engendering participation, health and well-being. More

importantly, this different way of understanding should more readily enable

clients and practitioners alike to become engaged in the process of finding

creative, appropriate, and contextually relevant ways of dealing with those life

challenges that create the need for intervention (p. xii)

Researcher's reflection.

This observation underscored the researcher's own experiences while delivering

intermittent occupational therapy services to orphans in a welfare town north of Seoul,

Korea. After implementing Western-style occupational therapy services over a period of

years, the researcher began to implement Kawa-style occupational therapy intervention,

treating more collective needs rather than emphasizing the autonomy of the individuals.

As a testament to the increasing effectiveness of the shift in therapy service delivery, a

small, neatly penned English-language note found its way under the researcher's door

that read, "We want you come back you and family." This had been the only

communication between the researcher and Koreans employees without any mediation

from English-speaking interpreters or administrators.

Occupational therapists have helped individuals to bridge the gap between their

performance abilities and the dynamic, complex environmental systems they lived in, and

recognized that change alone may have been the only constant. Utilizing a new form of

professional identity that transferred power and information to the recipient of

occupational therapy services, and collaborated with rather than administered to service

recipients, occupational therapists have been challenged to transmit needed skill-sets to

individuals in a way that energized and stimulated their efforts without overwhelming

and short-circuiting them (Mackey, 2007).

These factors led to the philosophical underpinnings that firmly asserted all were

capable of learning, that learning was both a social and individualistic process, and that

the scope of rehabilitation must be broad but accurate. Like the paradigm shifts that had

already occurred in occupational therapy history, these too continue to be replaced by

other theories. At the time of this research, the profession of occupational therapy viewed

individuals undergoing rehabilitation as part of a broad personal, social, and political

network that reaches well beyond the occupational therapist, therefore this research
 43

aimed to situate occupational therapy creativity research within a broad historical picture,

and acknowledged that the circumstances and beliefs that anchored it would change.

Knitting Creativity and Occupational Therapy Together

Historical views of creativity in occupational therapy.

The previously noted, the scanty research and writing about creativity and its

relationship to occupational therapy seemed incongruous with the philosophical

underpinnings and history of occupational therapy. Echoing the voices from occupational

therapy's past, Griffiths (2008) wrote that creative activities had been used by

occupational therapists in their practices since the beginnings of the profession. In 1910

occupational therapy theorist Kidner wrote of the value of using handicrafts that could

enable patients to develop eye-hand skills, improve problem solving abilities, and

develop desired attributes such as perseverance, concentration, and creativity (Kidner,

1910; Friedland & Silva, 2008). In a related vein, when considering the attributes of an

ideal occupation instructor early occupational therapist Tracy (1912) praised nurses and

physicians who were naturally resourceful, clever, and were skilled at providing both

useful diversions and occupations for their patients. According to Kielhofner (1997), the

consensus amongst these early theorists was that "the worth of human life was realized

in productive achievements and in creative and aesthetic pursuits.. .Recognition that

humans were fundamentally doers and creators required that they be seen in the context

of engaging in occupations" (p. 37).

Judging by the examples set by these professional pioneers, it seemed that it was

not enough to facilitate creativity in a patient, but that occupational therapists themselves

also engaged in creative behaviors. In 1946, occupational therapy proponent Dunton

 44

wrote of his own role as a physician to nervous ladies, and of his study and explorations

of the modalities of needlework, weaving, quilting, and other home crafts he employed

for the purposes of therapeutic intervention. He penned:

It is easily understood that a nervous lady who is concentrating on making a quilt

block has no time to worry over her fancied physical ill health or even over

wrongs or slights which may be real, so that she is cultivating a more healthy

mental attitude and habit.. .Even for those who must live in state hospitals because

of their mental deterioration, sorting rags, cutting from patterns, and other chores

may bring contentment and aid in retarding deterioration. So quilt-making may

have a decided value in the armamentarium of the psychiatrist and the

occupational therapist, (p. 4-5)

Changes in beliefs about creativity in occupational therapy.

While eschewing the value of mechanistic occupational therapy treatment

dosages, mentions of creativity in the practice of occupational therapy persisted even

during the beginnings of the reductive medical paradigm of the mid-1900s. They

included Willard and Spademan's (1963) observations that "The psychological value of

occupational therapy lies in utilizing the injured parts to do productive or creative work

so that the patient satisfies basic needs" (p. 189). Noted Eleanor Clarke Slagle lecturer

and influential theorist Reilly (1962), while resisting the use of arts and crafts in her

practice of occupational therapy, still advanced the belief that the profession of

occupational therapy remained rooted in creativity by famously stating that, "Man,

through the use of his hands, can creatively deploy his thinking, feelings, and proposes to

make himself at home in the world, and to make the world his home" (p. 81).
 45

In mid-century America, the ebb and flow of what creativity meant to

occupational therapists continued as some theorists touted the benefits of creative

occupational therapy and therapists, while others began to drift away from a culture of

hands-on occupation and related creativity. West and McNary (1956) continued to lobby

for the continued cultivation of creative efforts in the practice of occupational therapy

and called for more imagination and creativity in occupational therapists. Specifically,

they charged occupational therapy educators and fieldwork supervisors to remain vigilant

about the use of creative treatment techniques that emphasized process and growth,

stating that, "The prime importance of maintaining an imaginative and creative approach

among all personnel is vital not only to extending the value of the students' total

educational experience but also to assuring quality of professional contribution" (p. 154).

JVew beliefs about creativity in occupational therapy.

More recently, like creativity researchers and theorists, occupational therapists

had begun to consider creativity as a multi-faceted phenomenon within the context of

occupational therapy. Like early occupational therapy pioneers, noted occupational

theorist Hasselkus (2002) observed that opportunities for using creativity in the practice

of occupational therapy should consider both the patient and the occupational therapist.

Focusing on what she called "everyday creativity" in her own research, Hasselkus stated

her belief that the health-promoting aspects of creative activity deserved more attention in

occupational therapy.

This was echoed in Peloquin's (2007) admonitions that occupational therapists

should evaluate the adequacy of their current official professional ethos to reflect the true

core values of the profession. Conceptualizing a professional ethos as an "interlacing of

 46

sentiment, value, and thought that captures its character, conveys its genius, and

manifests its spirit" (p. 475), Peloquin advocated for the inclusion of the ideal of

imagination into the core values of occupational therapy. In doing so, Peloquin

conceptualized imagination as the act of creating images and ideas, and as a creative

opposing force to the practice of occupational therapy that was lockstep in planning and

action (Peloquin, 2005). This call for the inclusion of imagination into the professional

ethos was consistent with her earlier observations as an occupational therapy educator.

Peloquin noted a trend toward the "vulcanization" of occupational therapy students, an

approach named after Spock, the popular culture icon from the "Star Trek" television and

movie series. As a non-human, Spock followed a path of logical thinking that disregarded

"broader aspects of human reason, such as creativity, imagination, and intuition"

(Peloquin, 2002, p. 71). Peloquin did not besmirch the admirable attributes of logic and

scientific thinking that Spock was known for, but instead called for a balanced curriculum

design that also honored and integrated some of the intangible affective attributes of

students and educators, including creativity.

Creativity in occupational therapy: Multiple definitions and meanings.

The sparse literature that explored the relationship between occupational therapy

and the field of creativity also reflected a lack of distinction between the type of

creativity traditionally associated with use of art materials, and the type of creativity

associated with problem finding or solving and with flexible thinking. Few systematically

explored the impact of creativity on occupational therapy education or practice using any

of these definitions.
 Scandinavian therapist-researchers Josephsson, Asaba, Jonsson, and Alsaker

(2006) explored narrative traditions and their impact on order versus creativity as

perceived by clients, Australian therapist-researcher Schmid (2004) considered the

meanings of creativity amongst professionals engaged in the practice of occupational

therapy, and therapist-researchers Kasar and Muscari (2000) explored the role creativity

has in the professional behaviors of Canadian occupational therapists. Danish therapist-

researchers La Cour, Josephsson, Tishelman, & Nygard, (2007) discussed use of creative

activities, referred to as "A & C" [presumably arts and crafts] as a valuable therapeutic

modality when working with terminally patients. They noted that "creative activity

provides stimulation for participants, on one hand, to take risks and overcome challenges,

and, on the other, to develop constructive and joyful approaches to daily life despite the

difficulties inherent in their current situation" (p. 248). Reed (1986) noted that the type

of creativity associated with the early years of occupational therapy was a reflection of

the Arts and Crafts Movement that was a part of American culture at the turn of last

century. The Arts and Crafts Movement was typified by handicrafts that reflected

discomfort and disillusionment with the predominating industrial society, valued artistic

creativity, and was diametrically opposed to mindless duplication of existent designs.

Additionally, American therapist-researcher Lederer (2007) explored the

differences in critical thinking abilities of occupational therapy graduate and

undergraduate students. Like Simonton (2000), she noted that critical thinking was

associated with openness to new ideas, which some considered to also be a personal trait

of creative individuals. Stating that skillful occupational therapists were creative problem

solvers, Lewin and Reed (1998) explored how creativity could have been used by
occupational therapists in their practice by noting three examples of creative problem

solving, namely the fabrication of an assistive device, selection of treatment media, and

selection of treatment strategies.

Creativity can make multiple contributions to health-care practices.

Reflecting the multi-faceted nature of creativity, five themes related to creativity

in the practice of occupational therapy were proposed by Australian therapist-researcher

Schmid (2004): Creativity is a part of the daily practice of occupational therapy, the use

of creativity in the practice of occupational therapy is a conscious decision, creativity

could involve taking risks, creativity needs environmental support to flourish, and

creativity could be used as an occupational therapy treatment modality. Echoing this,

creativity was seen by others as an important aspect of strategic improvisation, which

reflected the use of adaptive responses to the constraints and opportunities inherent in

patient's circumstances (Cutchin, Aldrich, Bailliard, & Copolla, 2008). Likewise,

Swedish health-care providers La Cour, Josephsson, Tishelman, and Nigard (2007)

proposed that creative activity was a method of adapting and coping with declines in

health or ability. British occupational therapist Griffiths (2008) posited that creative

activities could have increased engagement and restored confidence in mental health

patients.

Research on creativity in the related health care field of nursing had determined

that one of the methods of alleviating the nursing shortage is to prevent burnout. Creative

work environments were empirically associated with work excitement, which was in turn

associated with lower rates of burnout (Berg, Hansson, & Hallberg, 1994; Sandovich,

2005). Kalischuk and Thorpe (2002) determined that creative problem solving served an
important role for nurses by helping them maintain a balance between clinical care,

effective patient interactions, and improved educational practices. Albarron (2004)

further stated that creativity could have increased resourcefulness in patient care and

innovation in practice development.

According to Kasar and Muscari (2000), in the education of physical therapy

students, creative problem solving could have facilitated the development of professional

behaviors. In nursing students, Murphy (2000) determined that a positive relationship

existed among creativity, critical thinking, and the tolerance of ambiguity. Likewise

Walsh, Chang, Schmidt, and Yoepp (2005), noted that creative arts interventions

delivered through instructional programming reduced nursing student stress and anxiety

and lifted their emotions. They further suggested that these results may have a similar

positive result on other student populations.

In innovation research, creativity and work engagement were seen as factors in

the successful integration of workplace demands and resources (Huhtala & Parzefall,

2007), in the generation of new ideas, and in the development of effective leadership

skills (Mumford, Connelly, & Gaddis, 2003). Runco (2004) stated that creativity not only

drove innovation and evolution, which could have been considered the processes of

generating original ideas and options, but creativity could have also been seen as an

approach to life. It could have come in handy when solving problems, but conversely, it

could have also have led to problem avoidance.

Conclusion

This review of the literature shows that the profession of occupational therapy and

the field of creativity research have both been devoted to the study and in some cases, the
 50

augmentation of human performance. Each had its genesis in processes that were

reflections of societal changes, and the changing climate and culture of predominantly

western cultures, especially the United States of America, continued to directly impact

both of them. Each experienced trends of psychometric evaluation, bottom-up study, and

a broadening of their theoretical bases as a reflection on the increasing reliance on and

sophistication of research methodology. Both the profession of occupational therapy and

field of creativity grew dramatically in the last fifty years, and both continue to

experience changes in working definitions and identities.

While creativity lacked a singular clear, unifying definition, and has had homes in

fields of psychology, sociology, and education; the fields of business and technology

have begun to appreciate the utility of innovation and invention associated with

creativity. Similarly, the profession of occupational therapy has also experienced multiple

definitions and identities, and has had homes in the domains of psychiatry, medicine, and

education.

While creativity research often focused on product and idea generation, creativity

and occupational therapy have been inevitably linked by a client-centered emphasis on

innovation, performance, and emphasis on dynamic growth. Research attempting to

clearly define and operationalize the relationship of occupational therapy and creativity

could provide a springboard that researchers could use to unify terminology, avoid

duplication of efforts, and provide more focused ways to disseminate information to

consumers in both fields.

 Chapter 3

METHOD

Introduction

This research aimed to develop uniform terminology, a conceptual model, and

emergent theory to describe the relationships among creativity, occupational therapists,

and the practice of occupational therapy. Data collected from participant interviews, self-

reports, assessments, and researcher-created field notes were used to explore the

following five questions: How have definitions of creativity in the context of

occupational therapy changed over time? How do occupational therapists define

creativity in the context of occupational therapy? In what ways do occupational therapists

feel their personal creativity impacts their practice of occupational therapy? What is the

impact of practice-related creativity on the occupational therapist? What are the

relationships between occupational therapists' personal creativity and practice-related

creativity?

These questions reflect the reciprocal nature of creativity; it both effects and is

affected by circumstances, contexts, and individuals. They were derived from Runco's

(2004) model of creativity, which held that creativity was a reflection of a constellation

of factors; namely, the person, process, product, and press (environment).

This chapter describes the design, sample selection, data gathering,

instrumentation, and treatment of data for this research. Included in these explorations are

the tenants behind grounded theory as a qualitative research tradition and its

appropriateness for this research, sampling method and participant recruitment, the types

of information needed from the data, how and why certain data collection methods were

52
 53

implemented, methods for analysis and synthesis of the data, how trustworthiness was

ascertained, and any potential ethical issues that might have been engendered during or as

a result of this research.

Design of the Study

Grounded theory as a qualitative research tradition.

Glaser and Strauss (1967) have been widely credited with conceptualizing

grounded theory as a valid research method. They introduced grounded theory as a form

of qualitative research method into a world that embraced the positivist methods

associated with quantitative research. Assuming that the closer the relationship between a

theory and its phenomenon was, the more accurately the theory described it; they held

that grounded theory was uniquely important because it derived theory from the

phenomenon of interest itself.

The necessary process of verifying the theory followed its development, and

Glaser and Strauss (1967) pointed out that in grounded theory the processes of generating

theory and verifying data were entwined and multiphasic. In other words, as one

generated theory and then verified it, the next exploration of the phenomenon was built

upon the newer, more evolved starting point. In this manner, the researcher built new

layers of theory and verification upon existent ones. While adherence to these methods

prevented a researcher from inadvertently reinventing the wheel, using this method

caused the ongoing process and divisions between generation and verification to blur.

Simply put, the grounded theory researcher had to embrace flux and recursiveness as

necessary partners in the labor pains that accompanied generation of new theory.
 54

While the fluid nature of this process led some researchers into uncomfortable

territory, Glaser and Strauss (1967) also proposed that development of theory through the

process of grounding it in research gave the investigator a unique set of tools to handle

and manage data by developing emergent categories and hypotheses that were derived

directly from the data. Categories and hypotheses generated from the phenomenon of

study could be operationalized in ways that were most meaningfully relevant. In other

words, the investigator who navigated the fluid, changing nature of grounded theory was

rewarded with a theory that precisely matched the phenomenon.

Lincoln and Guba (1985) further strengthened grounded theory's foothold in the

tradition of qualitative analysis by introducing what they referred to as axioms of

naturalistic research. Defining axioms as basic beliefs that appeared arbitrary and even

counter-intuitive, Lincoln and Guba asserted that the tradition of naturalistic inquiry has

been seen as a reaction to the lock-step scientific method embraced by researchers of the

modern era. According to Lincoln and Guba, these researchers, or positivists, held that

their investigative stance was neutral and value-free, and that they embraced quantitative

methods to atomize, fragment, and dissect a phenomenon into small, discrete units of

information. When all these units were scientifically described, they were reassembled

into a new body of theory. Naturalists responsively asserted that occasionally the body

created by the positivists resembled a young Frankenstein.

In contrast, the naturalistic researcher held that reality was a matter of definition,

and that the researcher became a part of the phenomenon as soon as he or she entered it

for research purposes. The naturalistic researcher acknowledged his or her own biases

and values and, as a human research instrument, recognized that it was not possible to
 55

generate a one-size-fits-all theory. Instead, complex nuances, changing definitions of

reality, and shifting values all contributed to flexible theoretical constructs. These very

elements also made it impossible to generalize the findings from this type of research.

Nesting grounded theory in this context of naturalistic inquiry, Lincoln and Guba

(1985) advanced the following axioms of naturalistic inquiry: (a) There were many

versions of reality, (b) the researcher and their phenomenon of interest effected and were

affected by one another, (c) the process of positivistic generalization was manifested in

the naturalistic tradition as a process of hypothesis formation, (d) it was impossible to

separate causes from effects in research, and (e) it was impossible to engage in value-free

research. In fact, values came not only from the researcher, but also from the guiding

research paradigm, the guiding theory used for data collection, analysis, and synthesis,

and the context of the phenomenon itself.

Lincoln and Guba (1985) specifically held that grounded theory was an open-

ended method of inquiry that both described and explained a phenomenon. Instead of

manifesting processes of deduction and generalization, grounded theory interpreted data

by discovering patterns, relationships, and ferreted out gaps in knowledge bases that

warranted exploration.

Research designs within grounded theory tradition.

There was dissent amongst theorists regarding optimal grounded theory design.

Specifically, common questions entailed how thoroughly familiar a researcher should be

with a topic before beginning data collection and whether the researcher should allow

emergent data or a preliminary literature review to drive the processes of data collection,

analysis, and synthesis. These fundamental questions were explored by Berg (2007), who
 56

posited that the dichotomy between theory-before-research and research-before-theory

models was not as great as many supposed. In fact, Berg contended that qualitative

research was not a linear process but tended toward recursiveness as a result of emerging

accumulated understandings, and the accumulation of new learning that could have been

used to more specifically inform ongoing data collection decisions.

Berg (2007) asserted that in grounded theory research, different phenomena

required varying levels of initial preparation to develop an appropriate research design

and data collection strategies. By allowing the characteristics of the phenomena to guide

but not overwhelm the decision-making process about the most effective research design

also helped the researcher avoid unnecessary duplication of existent research efforts.

Establishing trustworthiness in grounded theory.

Whittemore, Chase, and Mandle (2001) explored how qualitative research

established validity criteria. They noted that determining good validity standards in

qualitative research was even more difficult than the standards applied to quantitative

research and pointed in particular to the challenges associated with the creative

interpretation of phenomena. While quantitative, positivistic research was known for

measures that had to be taken to ensure reliability and validity; qualitative, naturalistic

research utilized a more ambiguous and intangible framework. In fact, Whittemore,

Chase, and Mandle raised the concern that the very nature of qualitative, naturalistic

research prohibited it from having a set of overarching guidelines for ensuring sound

research designs. However, according to Guba (1981), trustworthiness was viewed as an

amalgam of validity (credibility and transferability), reliability (dependability), and

objectivity (confirmability).
 57

Similarly, Lincoln and Guba (1985) stated that trustworthiness in grounded theory

was established by the combined factors of internal validity, external validity, reliability,

and objectivity. Specifically, they put forth the following considerations: How did a

researcher determine whether their findings accurately portrayed the phenomenon of

interest? To what degree could these findings have been replicated when research was

conducted in other contexts or with other participants? If this research had been

conducted with the same (or similar) participants but in another context, would findings

have been similar to those in the original study? How likely were the findings to have

been an accurate reflection of the data, and not the biases of the researcher? While these

questions reflected the aim of research in general, their answers also reflected the unique

spirit of grounded theory.

Whittemore, Chase, and Mandle (2001) posited that Lincoln and Guba (1985)

were forced into an epistemological quagmire while laboring over how to convert the

tenants of validity and reliability seen in quantitative, positivistic research into a

qualitative, naturalistic frame of reference. Earlier work by Guba (1981) determined that

data collection from multiple sources helped to ensure trustworthiness of data. While

Whittemore, Chase, and Mandle observed that Lincoln and Guba struggled with methods

of establishing trustworthiness, their tenants of prolonged engagement, persistent

observation, triangulation, peer debriefing, member checking, thick descriptions, and

auditing were all methods that could have been used to further increase the

trustworthiness of data (Lincoln & Guba, 1985). Because these tenants had been

identified as the gold standards of the field, this research study utilized Lincoln and

Guba's methods of establishing trustworthiness.

 58

Grounded Theory as the Method Chosen for this Research

This research was designed as a constructivist grounded theory study, which

according to Charmaz (2006), assumed that all people, including researchers and research

participants, created their own version of reality. Broadly speaking, constructivists

intentionally immersed themselves in a phenomenon of interest and saw it from multiple

points of view.

While the nature of grounded theory preventes the results of this study from being

generalized to all occupational therapists and practices of occupational therapy, the

uniform terminology and emergent theory can provide a starting point for further research

on creativity and occupational therapy. The decision to use grounded theory for this

research also in part stemmed from an effort to address the struggles that had been

associated with the validity of many creativity research studies, particularly those rooted

in the early psychometric paper and pencil test traditions. Would they measure the

creativity that was experienced in occupational therapy?

Sample selection for this research.

In keeping with its recursive process of establishing theory and verifying it,

grounded theory uses a form of non-probability sampling that does not have a

predetermined number of participants. Cutcliffe (2000) noted that this sampling process

is theoretical rather than purposeful, meaning that as information becomes known, the

researcher continues to sample in a reflexive manner to provide as many widely varying

instances of the phenomenon as possible. More specifically, Cutcliffe described the

process of sampling in grounded theory research as one that begins in the tradition of

purposeful sampling and moves toward the method of theoretical sampling as the
 59

researcher determined categories and hypotheses. In other words, as more is known about

a phenomenon, the researcher seeks out participants who may be be able to further

expand on, interpret, or add to an emerging category or hypothesis. Researchers, so to

speak, throw the net out wide and pull in all the fish they can catch. It is in the study of

the special fish that the process of theoretical sampling takes place.

Operating under the assumption that meaningful and representative information

can be derived from the implementation of maximum variation sampling techniques, this

research utilized purposeful maximum variation sampling for the purposes of identifying

participants. According to the American Occupational Therapy Association's practice

division, the data from nearly 9,000 respondents that comprised the Occupational

Therapy Workforce and Compensation Report (American Occupational Therapy

Association, 2006) were the most current representation of the profession's

demographics (see Appendix A: Occupational Therapy Workforce Statistics). Queries to

the national practice division and the state licensing board yielded no other demographics

for employment trends by state or city, hence, the maximum variation sampling technique

used for this research was derived from the national workforce and compensation report.

Recruitment of participants for this research.

To provide widely varying instances of the phenomenon of creativity and

occupational therapy, representative practice sites were selected for this research using

maximum variation sampling methods (Glaser & Strauss, 1967; Merriam, 1998).

Occupational therapy department heads or designated senior-level occupational therapists

from each selected practice site were selected to serve as a facility gatekeeper via

preliminary email or telephone contact. Following their preliminary assent, the researcher
 60

applied for and received approval to conduct research on human subjects at each practice

site.

Following this, each potential facility gatekeeper was again contacted by the

researcher via email or telephone and sent a digital copy of the gatekeeper's informed

consent form explaining the purpose of the study. Potential gatekeepers reaffirmed their

willingness to serve as gatekeeper via completed gatekeeper consent form, (see Appendix

B: Sample Gatekeeper Contact Letters and Consent Form) and granted the researcher

permission to collect data from interested potential participants from their facility.

Following each gatekeeper's dissemination of researcher-provided information

about the research (see Appendix C: Research Information Sheet) at their practice site

utilizing their preferred communication methods, gatekeepers then provided the

researcher with initial contact information for interested potential participants by

scanning their Consent to Serve as a Gatekeeper for Research form with participants'

names listed and emailing it to the researcher.

The researcher then contacted participants using their provided contact method of

email or telephone, starting with the first name listed on the gatekeeper's list of potential

participants. An audit trail of potential participants was initiated when their contact and

eligibility information was obtained from the gatekeeper (see Appendix D: Demographic

Data Form).

In keeping with delimitations placed on this research, the researcher ascertained

each potential participant's eligibility of English proficiency and employment as an

occupational therapist in the specified practice sites and then verbally provided each

potential participant with more detailed information about this research. If the potential
 61

participant wished to continue and anticipated being able to perform the research tasks

the researcher obtained informed consent (see Appendix E: Consent to Participate in

Research) by mailing them an informed consent form and postage-paid self-addressed

envelope for return of the form to the researcher.

Consistent with maximum variation sampling methods the researcher aimed to

keep the participant practice areas and settings consistent with the Occupational Therapy

Workforce and Compensation Report (American Occupational Therapy Association,

2006) demographics for practice areas and settings. To aid in record keeping an

individual participant flow sheet was created for each participant (see Appendix F:

Participant Flow Sheet).

Purposeful maximum variation sampling for this research.

The Occupational Therapy Workforce and Compensation Report (American

Occupational Therapy Association, 2006) listed the primary work settings of

occupational therapists as schools/early intervention 29.6%, hospital (non-mental health)

23.5%, long-term care/skilled-nursing facility 15.4%, freestanding outpatient 11.2%,

home health 7.2%, academia 6.1%, mental health 3.6%, community 1.6%, and other

1.9%. In keeping with delimitations imposed on this study by the researcher,

occupational therapy practice sites from a city with over one million residents, entirely

bounded by suburbs and with engulfed smaller towns which continued to maintain their

individual governments were selected for the research. Because there were no

ascertainable discernable differences in the occupational therapy practice sites in the city

and its contiguous suburbs and engulfed towns, all suburbs that shared a border with the
 62

city and all engulfed towns were defined as part of the metropolitan area for the research

study

One urban school district and one suburban educational center were selected to

represent 29.6% (schools/early intervention) of the Occupational Therapy Workforce and

Compensation Report (American Occupational Therapy Association, 2006) practice sites.

One urban private pay hospital system and one urban county hospital system were

selected to represent 23.5% (hospitals), 3.6 % (mental health), and 11.2% (freestanding

outpatient) of practice sites. Two facilities that offered a range of residential, assisted

living, Alzheimer's and dementia care, skilled nursing and rehabilitation services

including occupational therapy, licensed nursing care, and both short and long-term

respite care were selected to represent 7.2% (home health), 15.4% (long-term and skilled

nursing care), and 1.9% (other) of practice sites. One school of occupational therapy

nested within a state university system was selected to represent 6.1% (academia) of

practice sites. The school of occupational therapy granted both master and doctoral level

degrees in occupational therapy.

According to the delimitations set for this study, participants were employed as

occupational therapists in the selected metropolitan area. While participants were not

former pupils of the researcher, they may have known of her through her professional

presentations about occupational therapy-relevant topics other than creativity.

Using maximum variation sampling to reflect the Occupational Therapy

Workforce and Compensation Report (American Occupational Therapy Association,

2006), the participant pool was comprised of two participants representing school/early

intervention occupational therapists, three participants representing hospital, and/or

 63

freestanding outpatient clinic occupational therapists, one participant representing mental

health occupational therapists, two participants representing long-term care/skilled-

nursing, and/or community-based occupational therapists, and one participant

representing academia-based occupational therapists/professors. The mental health

representative also held a position as an instructor in the school of occupational therapy

but was interviewed as a representative of mental health practice. Henceforth, the practice

sites are referred to as education, hospital, community, mental health, and academia.

Data Collection

Review of literature.

Calling a literature review a focal, integrative activity, Boote and Beile (2005)

asserted that a thorough literature review was essential for any research. Before

researchers could advance the understanding of any phenomenon they had to be able to

see it in its broadest context, and nest their own research questions in it (see Appendix G:

Data Sources for Research Questions), which required them to summarize and synthesize

what was relevant to their own research without getting bogged down in quagmires of

related literature and research.

Beyond the challenge of maintaining a focus on the research topic at hand, the

researcher evaluated the strengths and weaknesses of the research that had already

explored the phenomenon of interest. Within this area, the researcher also evaluated the

field for gaps in the knowledge base and to determine which studies had lost their

original impact thorough the passage of time or other aspects of the broader research and

historical contexts.
 In keeping with traditions of grounded theory literature reviews, this research

utilized a recursive process of literature review. Using Runco's (2004) person, process,

product, and press model, an initial review of the literature situated the phenomenon of

creativity in a general scholarly context (see Appendix H: Theoretical Framework to

Research Question Matrix). Using a chronological review process, the research also

traced the general philosophical development of the field of occupational therapy. After

data collection began, an additional literature review augmented the emergent categories,

notably with additional reviews of creativity related to wisdom, aging, and expertise.

Data from demographic information sheets.

At the onset of data collection, participants produced a demographic information

sheet (see Appendix I: Demographic Information Sheet), which contained their name,

self-selected pseudonym with a prompt that would enable them to recall the pseudonym,

ethnicity, gender, age, career length, current work location, other careers or employment,

employment outside of the area, educational background, creative activities and hobbies,

self-reported English proficiency, and an interest in participation in the research.

Aside from the delimiting item of written and conversational English proficiency, these

demographics reflected attributes that may have been linked to creativity in occupational

therapists (Amabile, 1996; Amabile, et al., 1994; Chen, Himsel, Kasof, Greenberger, &

Dmitreva, 2006; Csikszentmihalyi, 1996; Houtz, et al., 2003; Reis, 2003; Smith, 2008).

Data from assessment and self-reports.

This research utilized Runco's (2004) person, process, product, and press

theoretical framework of creativity. Data collected from the Myers Briggs Type Indicator

(MBTI) (Briggs, & Myers, 1998) provided information about the participants' personality
 65

type indicators (most notably, the person and process components of Runco's model), the

Abbreviated Torrance Test for Adults {ATTA) (Goff & Torrance, 2002) provided

information about the participants' creative strengths (the person and process

components), and the Minnesota Importance Questionnaire (MIQ) (Rounds, Henly,

Dawis, Lofquist, Lloyd, & Weiss, 1981) provided information about the participants'

work values (the person, process, and press components).

Each of these instruments has been empirically linked to differing facets of

creativity research. The data from these instruments contributed to thick descriptions of

individual participants, generated a broader picture of the participants as a group and

provided participants with materials for reflection and discussion (see Appendix J:

Assessment and Self-Report to Research Questions and Theoretical Model Matrices).

Data from interviews.

Two interviews were conducted with each of the participants to ascertain their

beliefs and experiences related to creativity and occupational therapy. Data from these

interviews also ensured triangulation, improved credibility, broadened concepts, and

provided corroborative evidence for the assessment and self-report instruments (Berg,

2007).

Session Data Collection and Management

Session one data collection procedures.

After providing the researcher with informed consent, participants were

interviewed in a setting of their choice, preferably in proximity to their work setting to

enable the researcher to make observations, take field notes, and photograph the environs

to more fully develop thick, rich descriptions. Citing the confidential nature of her
 66

practice site, one hospital-based participant opted for off-site locations for her interviews.

Both education-based participants opted to be interviewed in education settings that did

not have students present at the time of the interviews.

The timeframe for session one was held to less than one hour. The agenda for the

first session included a discussion of the research, a semi-structured interview (see

Appendix K: Interview Schedule Research Questions, Appendix L: Interview One

Questions to Theoretical Framework and Research Questions Matrix) with accompanying

probes related to the participants' responses, and was followed by administration and

completion of the ATT A in the nine minutes designated by the testing procedures and

protocol.

The initial session interview schedule of questions was comprised of a series of

open-ended questions that were derived from each category of Runco's (2004) creativity

person, process, product, and press model of creativity. Additional questions were

derived from research based upon demographics that were known to impact creativity,

and the remaining queries were based upon Schmid's (2004) research which explored

occupational therapists' beliefs regarding creativity. Additionally, the participants were

asked to describe their practice setting and work responsibilities.

According to Berg (2007), the semi-structured interview format is comprised of a

schedule of predetermined questions asked in a systematic way. While researchers have

particular data they seek from the interview, they also have freedom to digress and probe

for responses from the participants, adjusting the content, language, and style of the

interview to fit an emerging understanding of their unique experiences and beliefs about

the phenomenon. In this research, the use of specialized jargon by the hospital-based
participants was particularly evident. For interview transcript accuracy and to enable a

broader readership to understand the interview responses, participants were asked to

explain specialized terminology or jargon.

Immediately prior to the interview, the participants were provided a copy of the

initial schedule of questions for reference purposes and, at the conclusion of the interview

they were asked to retain the schedule of questions for further reflection. To aid in the

process of data collection, the interviews were audio-taped to insure accuracy in the

transcription process using both digital and cassette recording devices. Participant

responses to the interview queries were saved in digital format and transcribed by the

researcher within seven days of the interview using Dragon Naturally Speaking 10.0

speech-to-text software.

The ATT A was administered at the end of the first session to minimize any bias it

might have created in participants' reactivity to the researcher. The ATTA's novelty and

participant's anticipation of the results being delivered during the second interview

session also served as an incentive for the participant to continue in the research project

through the second session.

While the ATT A appeared to be a light-hearted and unusual creativity assessment,

one novice-level and two expert-level participants reported a degree of performance

anxiety related to completing it. Participants were assured that for this research the ATT A

was utilized only to determine creative strengths, and their scores would not be placed on

a scale comparing their degree of creativity to other participants. Reassured, all the

hesitant participants completed the ATT A without further apparent duress.

 Session one data management procedures.

At the conclusion of the first session, the participants were given oral instructions

to complete and mail both the MBTI and MIQ to the researcher in a provided postage-

paid envelope within seven days. While the MBTI was self-scorable, participants were

assured the researcher would score the MBTI, and if participants returned it scored, the

researcher scored it again to ensure accuracy.

At the conclusion of each first session, the participants were provided a meal. If

participants offered to take the researcher on a facility tour, they were declined with

respect to participant time; however, the researcher took one facility tour because it had

been blocked into the participant's schedule prior to the session.

Immediately after each session, the researcher took field notes using a theoretical

framework and research question matrix (see Appendix M: Theoretical Framework and

Research Question Matrix), took digital photographs of the practice site and environs

with an IPhone® in accordance with the participant's specifications on the informed

consent form, and then verified that the interview recording had acceptable sound quality.

On two occasions, the digital recorder failed mid-interview, but cassette recordings

proved reliable for transcription purposes.

Following receipt of the completed MIQ, each was immediately sent to the

University of Minnesota Department of Psychology Vocational Testing Labs for

computerized scoring. Three participants required one reminder email and telephone

message to return the completed MBTI and MIQ forms. All nine sets were sent to the

researcher within three weeks after the respective initial interview and assessment

sessions. Results of the MIQ, with one exception, were also returned from the University
 69

of Minnesota within three additional weeks from the time they were mailed by the

researcher. All data from the first session, including interviews, assessments, and self-

reports were gathered and transcribed within a ten-week time period.

Following completion of the first interviews, all ATTAs were masked by an

assistant and scored by the researcher. Because the researcher had obtained specialty

certification from the Torrance Center for Creative Thinking in administering and

interpreting the Torrance Test for Creative Thinking (TTCT) (Torrance, 1966), and the

ATT A was reportedly designed as an abbreviated version of the TTCT, the results were

scored in a manner consistent with the researcher's training. Each set of items was scored

without knowledge of which participant completed it. Additionally, the researcher did not

unmask the ATTAs until compiling case reports.

The overall creative index scores in the case study were not reported in case

reports; rather, the researcher reported the scores for originality, flexibility, elaboration,

and fluency that fell in the test score ceiling range referred to as the accelerator range. If

no scores fell in the accelerator range, the highest scores below that range were used to

depict the participants' creative strengths. All scores that had identical highest rankings

were reported.

Upon receipt of the scored MIQ from the University of Minnesota; the transcribed

interview, selected results from the ATT A, MBTI, and MIQ, and field notes were

compiled to create a case report. Case reports were created within seven days of receiving

the MIQ while details were still fresh in the researcher's mind. Drafts for some case

reports were completed prior to receipt of the MIQ and then amended to incorporate any

information from the MIQ that was deemed significant. The case report, complete with
selected results from the ATT A, MBTI, and MIQ, and the transcript of the first interview

were compiled to create a portfolio (see Appendix N: Individual Data Collection Set) for

the participant to review and member check during their second session with the

researcher.

Session two data collection procedures.

The second session was comprised of an interview using a second schedule of

questions and an opportunity for the participant to member check the researcher's case

report. This was followed by the participant producing two lists often words or phrases

that described personal and work-related creativity (see Appendix O: Interview Two

Questions and Word List Prompt).

Charmaz (2006) stated that the researcher can use member checking in the form

of a second interview to take ideas back to participants for confirmation, but the process

can also be used to gather data that elaborate on or expand emerging analytical

categories. With the passage of time and opportunities for reflection, participants might

have unanticipated questions and insights for the researcher.

In this case, after reviewing all materials from the first session with the

participant, the researcher determined that specific participant responses to each of the

research questions would provide more consistent data than that which had been available

from the first interviews, and these were given priority in the second interview. Likewise,

one participant had reflected on the initial session interview questions and had additional

comments related to her own creative attributes which were collected during the second

interview. Additionally, another purpose of the second interview was to give participants
 71

an opportunity to review and respond to the results of the ATT A, MBTI, and MIQ. Each

participant affirmed her case report was a valid synthesis of the data.

During the second session, participants were also asked to supply the researcher

with ten words or phrases for both personal creativity and occupational therapy creativity,

yielding a total of twenty responses. There were no time limits imposed on this task, and

times required for completion of the lists ranged from approximately five to ten minutes.

These words and phrases were used to add richness to the case reports and provide an

additional source of data to further insure trustworthiness.

Following their creation of the word lists, participants were asked if they had any

questions or observations about the research. One participant queried about her facility

remaining anonymous, and three asked if they could assist in future creativity research.

Again, the second session was concluded in less than one hour, and a meal was provided

to the participant as a way of recouping their time spent with the researcher. Participants

were also assured a copy of final results of the research. Likewise, gatekeepers were

notified either in person or by email that data gathering was complete, assured a copy of

final results of the research, and thanked for their assistance in obtaining participants.

Session two data management procedures.

Using the same methods of interview recording and transcription, transcripts were

compiled and field notes were produced. The responses to the request to produce ten

words or phrases for both personal creativity and occupational therapy creativity were

transcribed without modification to conclude data gathering. These were used to

complete individual case reports for each participant, and to assure that all five research

questions and all four components of the theoretical framework had been addressed. In
 72

particular, the unmodified words or phrases contributed to an understanding of the unique

character of each participant.

Content analysis was used to further triangulate data. Content analysis was

defined by Berg (2007) as a process of careful, detailed, systematic examination and

interpretation of objects and other material to have ascertained any emergent categories,

themes, patterns, and even to have elucidated meanings. Like coding text, the process of

content analysis served as a method of interpreting data by sorting the attributes into

categories or themes.

Using the five research questions and four components of the theoretical

framework, content analysis was applied to researcher-created memos and field notes

(see Appendix P: Content Analysis to Research Questions and Theoretical Model

Matrix). Additionally, researcher-created diagrams and renderings about relationships,

emerging codes, patterns, and visual analysis (see Appendix Q: Preliminary Models) of

other elements more easily described by diagramming or rendering instead of by text

were collected and used for reference points when preliminary theoretical models were

being developed.

Through the process of content analysis, these data yielded information that the

participant or researcher might have considered insignificant or failed to discuss. As

patterns emerged from the results of content analyses they also provided the researcher

and participants with additional venues to explore during member checks. Researcher-

created diagrams and renderings were not specific to participants and were studied

separately.
 73

The final methods of data collection and analysis for this research were facility

observations and IPhone® images of facilities. These items were grouped with

participant data and assisted with the process of creating thick participant descriptions but

were not analyzed using content analysis.

Instrumentation

The researcher as an instrument.

While Lincoln and Guba (1985) described humans as imperfect research

instruments they stated that humans do possess by virtue of their adaptability and powers

of reflexive thinking the ability to bring tacit knowledge to the research of any

phenomenon. To do this effectively, the researcher must reflect on their relationship with

what they study, acknowledge their tacit knowledge of it, and consider any potential

biases, values, or experiences that might have informed or impacted the process of data

collection, analysis, and synthesis.

This research had its genesis in the researcher's self-identity as a creator and in

her role as an assistant clinical professor of occupational therapy. Aspiring occupational

therapy school applicants have often professed to her that they were drawn to the

profession because it was creative, and yet, to the researcher, occupational therapy

students themselves did not appear to be particularly creative.

At the time of this research, the researcher had been practicing as an occupational

therapist for thirty years, and possessed an instinctual belief that there is something about

"making art" that facilitated healing or generated a sense of well-being. A decade after

becoming an occupational therapist, she entered art school and spent nine years immersed

in visual research, sandwiching art studio time with the practice of occupational therapy,
 74

and clearly saw that occupational therapy had drifted from its early roots in the Arts and

Crafts Movement. Her white therapist lab coats eventually became paint smocks, and her

cardiopulmonary recessitation patches soon were soon smudged with clay: The

researcher was a health-care provider digging archeologist-style for her professional

roots.

She emerged from the art world with bachelor's and master's degrees in fine arts

and continued to explore the questions of how and why creativity facilitated healing and

wellness. Struggling with ways to facilitate creativity in occupational therapy students,

the researcher undertook doctoral training to explore creativity and its relationship to

occupational therapy. This research reflects that exploration.

Acknowledging that she was very much a reflection of her time and interests, this

researcher was also a trained researcher who anticipated, planned for, and welcomed a

wide range of outcomes that may have profoundly differed from her own formative

experiences and views.

The assessment selectedfor this research.

The Abbreviated Torrance Test for Adults (Goff & Torrance, 2002), an

assessment that utilized both written and drawn responses to prompts, was selected to

provide the participant and researcher with a description of the participant's creative

strengths. Additionally, the ATT A was styled as a fun, low-stress assessment process that

by its uniqueness, could serve as an ice-breaker and rapport-builder for the researcher and

participant. The Torrance Tests of Creative Thinking, or TTCT (Torrance, 1966) had been

a standard for assessment of creative thinking abilities since the mid-1960s. Because all

scoring and analyses of the creativity abilities assessed were consistent with the original
 75

TTCT, the ATTA was considered an alternate, briefer (nine minute) adult version of the

TTCT.

The ATTA assessed four norm-referenced creative strengths of fluency, flexibility,

elaboration, and originality, in addition to fifteen criterion-referenced attributes of

creativity. According to Marsiske and Willis, 1998, practical creativity was defined as

"...the fluent, flexible, and original generalization of solutions to real world problems.

Practical creativity is hypothesized to operate in situations where linear reasoning and

prior knowledge are insufficient for the solution of particular everyday problems" (p. 73).

This had relevance to the processes that occupational therapists engaged in when

managing task demands inherent in their workplace culture, and was considered a valid

representation of many aspects of creativity seen in occupational therapy.

All considerations of both reliability and validity were based on the premise that

the ATTA was designed as an alternate view of the TTCT. Reliability of the separate

ability scores is high, and score consistency was based on the Kuder-Richardson 21

formula, with an overall score of .69 and subtests ranging from .38 (originality), .38

(flexibility), .45 (fluency), and .84 (elaboration). Interrater reliabilities were .95 and

required training and certification (Goff & Torrance, 2002). The validity of the ATTA was

subject to the researcher's definition of creativity, and beliefs regarding whether a paper

and pencil test accurately represented creative thinking. Studies by Horng-Shing (1980)

and Torrance and Safter (1989) provided confirmations of the ATTA's validity. While the

ATTA did not have a specific certification process for examiners because it was

considered an abbreviated version of the TCCT, the researcher became certified by the

Torrance Center to administer and interpret this test.

 76

The self-report inventories selectedfor this research.

The Myers Briggs Type Indicator (Briggs & Myers, 1998) provided the

participant and researcher with a description of the participant's four personality

preferences which, when combined, formed a unique personality type. Research had

linked the MBTI to creativity (Isaksen and Lauer, 2003) and provided the participant and

researcher with information about attributes of their personality that might have

influenced their beliefs about creativity.

While the MBTI-was the most widely used personality type indicator in the world,

according to Fleenor and Mastrangelo (2001), the MBTI manual could be misleading

regarding its reliability, defined as the ability to consistently indicate the same four

preferences in an individual. Some estimates of reliability showed consistent

classification for only 65% of respondents. Like validity constructs related to creativity,

whether the MBTI scores were valid and measured the concepts they were designed to

measure depended upon assumptions that personality preferences could have been

accurately determined by the constructs the MBTI was based on. The MBTI Form Mis a

paper and pencil self-scored 15-20 minutes instrument. It can be scored by either the

researcher or the participant.

Permission for the use of the MBTI Form M was obtained from Consulting

Psychologists Press, Incorporated. The researcher applied for and received "B level"

permission to use the MBTI Form Mby submitting her application, including educational

level, professional organization affiliations, organizational affiliations, organizational

roles, purposes for the use of the MBTI Form M, and the signature of a workplace

supervisor. According to the eligibility form for this assessment, "B level requirements...
[require that the applicant] must either have taken and passed a CPP licensed workshop

OR hold a bachelor's degree and have satisfactorily completed a course in the

interpretation of psychological assessments and measurement at an accredited college or

university" (retrieved from https://www.cpp.com/products/mbti/index.aspx on March 28,

2009).

The Minnesota Importance Questionnaire (Rounds, et al., 1981; Stewart, et al.,

1986) was used to determine the participants' vocational needs and values that were

considered to be important aspects of the work personality. This assessment was selected

to measure the press component of Runco's (2004) theoretical model. Operating under

the assumption that press contributed to creative performance in different ways, it was

assumed that creativity was impacted by the sociocultural and environmental aspects of

work. The MIQ measured the six vocational values of (a) achievement as defined by

ability utilization and achievement, (b) altruism as defined by co-workers, social service,

and moral values, (c) comfort as defined by activity, independence, variety,

compensation, security, and working conditions, (d) safety as defined by company

policies and practices, supervision-human relations, and supervision-technical, (e) status

as defined by advancement, recognition, authority, and social status, and (f) autonomy as

defined by creativity and responsibility.

Over 200 publications have referenced the MIQ. Reliability was demonstrated by

internal scale consistency of .30-.95, with median coefficients from .77 to .81. Test-retest

coefficients were used to assess scale stability for groups plus one additional range from

.19 (nine month retest interval) to .93 (immediate retest). Median internal consistency

reliability coefficients for the 20 MIQ scales for different groups ranged from .77 to .81.
 78

Median scale test-retest correlations for the 20 MIQ scales ranged from .89 for immediate

retesting to .53 for retesting after 10 months. Median profile test-retest correlations

ranged from 95 for immediate retesting to .87 for retesting after 10 months. Lower

reliability coefficients were also reported at various time intervals between testing

sessions (Rounds, et al., 1981).

The discriminate and convergent validity of the MIQ were demonstrated and

presented in the 1971 manual. Additional research had demonstrated the concurrent and

predictive validity of the instrument (Lachar, & Layton, 1992). According to the

Department of Psychology at the University of Minnesota, the ranked form of the MIQ is

a 15-20 minute paper and pencil self-report test and requires mail-in computer scoring.

Permission for use was received from the University of Minnesota, using the VPR

qualification (retrieved from http://psych.umn.edu/psylabs/vpr/qualiform.htm on April

10, 2009). By the University of Minnesota's report, qualifications were in accord with the

American Psychological Association's ethical standards for test use and interpretation.

The researcher was required to submit student status, professional qualifications,

professional credentials, a professional license number, and professional organization

memberships, in addition to stating the purpose for use of the instrument. According to

the website application form, reproduction of her application was prohibited.

Treatment of Data

Methods for the analysis and synthesis of data.

As data were collected, the process of constant comparison was utilized to

compare emerging data with existing data. Each set of data was coded using QSR NVivo

8 qualitative analysis software. In accordance with Charmaz (2006), initial coding

 79

involved naming each word or node of data. During this process, the researcher

maintained an open, neutral stance and allowed data to form emergent categories without

the influence of researcher bias or preconceptions. While interpretations of the meanings

of the data at this early phase of coding did not stray far from the data themselves, the

data were constantly compared.

While Charmaz (2006) advocated focusing initial coding on verbs, because this

research was based on a person, process, product, and press theoretical framework, it

explored the application of coding to all forms of language. Additionally, occupational

therapy had jargon, in vivo, and specialized language that was analyzed for meanings.

Data treatment and analysis.

In the early phases of data analysis, the interview responses, assessment results,

and self-report results were converted into transcripts and case reports using a process of

written descriptions, reactions, and observations. Resulting data nodes were clustered

around the five research questions and Runco's (2004) four-factor model.

The process of coding was used to derive answers to the research questions from

interview transcripts. The initial sorting and preliminary categorization was followed by

more conceptual focused coding. Focused coding involved interpreting and finding

patterns of meaning in the codes that emerged from the initial coding process. Data nodes

were grouped under the person, process, product, and press categories. Additionally,

transcripts were again reviewed and non-essential nodes of dialogue were eliminated for

greater clarity.

Through the focused coding process and constant comparison with other data,

some initial codes were discarded as redundant, some were combined with others to form
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new categories, and some required a return to the initial coding process as new

understandings emerged. Question one posed some challenges to the use of Runco's

(2004) four-factor framework because the sought-after information was historical in

nature; however, as categories were alternately collapsed and expanded, use of Runco's

framework became viable.

This was particularly evident in categorization of the environmental or press

variables. It had not been anticipated that participants' perspectives on the impact of

items considered part of the press would differ so widely. Consequently, allowances had

to be made for nodes that were alternately viewed as both detrimental and instrumental to

creativity. For example, some participants felt time was a deterrent to creativity, and

others perceived it as a stimulant. As a result, the press category evolved from the

"whoa/go" category to a more neutral "influences" category.

Similar subsequent rounds of coding were employed until the transcript data were

reduced to simple categories with few words. Essentially, the process of coding involved

distilling data into small, discrete units that formed discernable patterns (see Appendix R:

Preliminary and Evolved Coding Schemes for Question One for demonstrations of the

coding processes for question one). This procedure was followed for all five research

questions and four parts of the theoretical framework.

Maintaining trustworthiness.

According to Lincoln and Guba (1985), trustworthiness was assured by following

techniques; prolonged engagement in the field, persistent observation, triangulation of

data, peer debriefing, and member checking. Through these processes, the researcher

explored how valuable and truthful the research findings were, the extent to which the
 81

findings of research in one set of circumstances might have applied to other groups or

contexts, the replicability of the research, and whether the research was free of bias.

In the case of prolonged engagement as a method of maintaining trustworthiness,

the researcher relied on her own thirty-year membership in the profession of occupational

therapy as established prolonged engagement. As a result of this, this researcher was

familiar with each of the practice areas under investigation by having served as an

occupational therapist in each area at some point during her career.

For this same reason, the researcher had experienced some passing interactions

with occupational therapists in these practice sites prior to the research. It was possible

that researcher bias might have occurred related to practice sites as a result of the varying

frequency and duration of when her prolonged engagement occurred. For example, at the

time of this research, in addition to her primary role of professor, the researcher, also a

certified school therapy specialist, served as a school-based occupational therapist in a

locale outside of the selected metropolitan area selected for this research. It was possible

that her knowledge and expectations of certain responses from participants may have

affected her ability to remain bias-free toward them.

It was also possible that her appearance, body language, or responses to

participants may have caused bias on the part of the participants. For this reason, the

researcher wore the same type of clothing and carried the same materials and supplies for

all first and second sessions, and made every effort to keep interviews focused on the

schedule of questions. This was an unanticipated challenge when participants' responses

were evocative or of professional interest to the researcher and may have affected her

interpretation of some observations and commentary from the participants.

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Additionally, as an outcome of her role as an occupational therapy educator the

researcher had spoken about occupational therapy-related topics on multiple occasions at

city, state, and national conferences and meetings. For this reason, it was possible that

participants may have had some knowledge of her interests, biases, and skills.

Unexpectedly, in one facility the researcher met several former students who were

employed as occupational therapists working alongside of one of the participants. The

researcher requested that the former students minimize any discussion about the

researcher, including anecdotes or other memories, with the participant until the

anticipated conclusion of the research. Thus, the researcher had prolonged engagement in

the field of occupational therapy, and site specific experiences might have impacted the

research in either positive or negative ways.

Triangulation occurred by use of multiple research methods, including use of self,

generated field notes, memos, and sketches, use of instruments including the A TTA,

MBTI, and MIQ, interview responses, and content analyses of participant-provided

creativity words or phrases. Additionally, completion of a reflexive literature review of

occupational therapy and creativity contributed to triangulation.

Simultaneous methods of ensuring trustworthiness.

According to Lincoln and Guba (1985), peer debriefing "is a process of exposing

oneself to a disinterested peer in a manner paralleling an analytic session, and for the

purpose of exploring aspects of the inquiry that might otherwise remain only implicit

within the inquirer's mind" (p. 308). Likewise, they described auditing the results of the

processes of data reduction, analysis, reconstruction, and syntheses as a major technique

 83

for determining trustworthiness. In this research, series of codes, findings matrices, and

parts of transcripts were reviewed by various individuals.

Peer debriefing proceeded in an ongoing manner during phases of analytic coding,

and as conclusions were drawn and recommendations made. The researcher utilized the

varying skills of different reviewers to not only derive coding and analytic categories but

to provide a neutral stance when she became deeply engrossed in the analytic processes.

To assure that the outcomes of the research stayed focused on occupational therapy, an

occupational therapist reviewed and verified the relevance of the process and outcomes of

the research.

For this research, peer debriefing involved the researcher's ongoing interactions

with reviewers, including an occupational therapist unrelated to any of the research sites,

a physician, a biologist, a linguist with expertise in creativity and teaching, and a

graduate research assistant pursuing a master's degree in literature. This balance of

expertise provided a broad range of viewpoints representing both arts and sciences, which

was consistent with occupational therapy literature. For this research, the processes of

coding, peer debriefing, and auditing became intertwined and recursive, particularly

when analytic categories and definitional answers to research question two were being

developed (see Appendix S: Establishing Trustworthiness with Question Two).

As a preliminary measure of ensuring accuracy, and as a part of the process of

creating case reports, all self-report and assessment scores were verified for accuracy by

the research assistant. After accuracy was ascertained and the case reports compiled, the

physician read all case reports to assure understandability and consistency in presentation
 84

of findings. Minor changes in order of presentation of findings were made in one case

report.

The researcher used initial coding to select data that contributed to an

understanding of research questions. Peer debriefing occurred when the researcher,

physician, and biologist used a word bank created from the initial coding by the

researcher to focus code the initially coded data that were grouped by the researcher

under theoretical framework headings of person, process, product, and press for question

two. As question two involved the definition of creativity in occupational therapy, this

question entailed the largest amount of data. The procedure was as follows: If an

information node was coded identically by all three reviewers, the code was retained. If

two of the three coded the information node identically, it was discussed and either

retained or modified as per group consensus. If none of the three coded the node in the

same manner, the preliminary code was discarded. This process was repeated twice more,

until full consensus was reached.

In the next stage of coding, the linguist was asked to code the same data using the

codes that emerged from the interactions between the physician, biologist, and researcher.

The linguist and the researcher determined that the semantics of some of the codes could

be reworded to more accurately describe specific phenomena.

Utilizing the final question two coding, another phase of peer debriefing occurred

when the occupational therapist was asked to code participant responses to question five.

After minor points of clarification, the researcher and the occupational therapist came to

consensus on all items.

 85

Other peer debriefing occurred when the researcher reviewed the preliminary

findings presented in chapter four with both the linguist and the occupational therapist.

Both agreed that the findings were logical and understandable conclusions drawn from

the data.

A final session of peer debriefing involved a review of the analytic categories

presented in chapter five with the physician. The physician felt that the explanations

underlying the first analytic category were unclear, and following revisions the researcher

and the physician reached consensus regarding the analytic categories understandability.

Ethical Considerations for This Research

It was not anticipated that this research engendered ethical risks that were beyond

those encountered in basic research. Risks that were commonly associated with

participating in research were detailed in the Texas A&M University-Commerce

Institutional Review Board protocol and included the following considerations:

It was possible that participation in a testing situation may have been stressful or

anxiety producing for some participants. To offset performance anxiety or concerns about

privacy, assessments were purposefully selected that did not impart negative information

about creative thinking ability, personality, or employment. Instead, the assessments

generated a neutral profile of creative thinking style, personality type, and preferred work

values. Additionally, the assessment data used from the ATT A were descriptive, not

evaluative, and did not compare levels of creativity. These measures were also all within

the researcher's competencies to explain and interpret their findings.

Scheduling interview sessions caused time constraints for busy participants. To

offset fatigue, hunger, or time pressures, all three instruments were selected for their
 86

brevity. The test developers' reported estimated completion times for the three

evaluations were nine minutes, fifteen to twenty minutes, and fifteen to twenty minutes.

Additionally, the participants were able to complete the longer two of the three

assessments at their convenience after the initial interview and send results to the

researcher in a provided addressed and postage-paid envelope, enabling them to

determine the best time for completing the assessments.

Both sessions, including interview and assessments, concluded before or at one

hour's duration each. After the sessions, the researcher provided lunch or a snack for the

participants with the exception of one participant who worked for a company that had

employment policies which prohibited the practice of receiving any compensation.

Another ethical consideration was the right of participants to privacy.

Confidentiality of results was protected by not using information that allowed the

participants to be identified by name, telephone number, photograph, address, or e-mail in

either print or oral presentations of study findings. To maintain anonymity, self-selected

pseudonyms were used in place of participant names. Participants were informed about

potential breach of confidentiality risks and the steps that were taken to minimize this risk

prior to study participation. Any identifiable information about participants, including

paper documents, computer files, digital images, or audio tapes were stored in an access-

controlled cabinet in the researcher's locked office and were anticipated to be destroyed

five years after the conclusion of the study. Participant confidentiality was protected to the

extent permitted by law.

Additionally, it was not possible for the researcher or participant to have controlled

the possibility of a mailed completed assessment or report being lost by the United States
 87

Postal Service. The participant was instructed to use only their pseudonym on the

assessment instead of personally indentifying information. These names were used to

represent the names of the participants in this study. For the MIQ, the researcher's

address was used as the return address.

As a final measure of confidentiality, participants' potentially identifying

demographic data were masked in the final report. Thus ages and career spans were

reported by decade, ethnicity was reported using broad racial categories of Asian, Latina,

and Caucasian, and practice sites were described by the broad categories of school,

hospital, community, mental health, and academia.

Peer debriefing.

At the conclusion of this research, peer debriefing occurred by providing each

participant with a written thank you for participating in the research and with an electronic

copy of the research report. All participants and gatekeepers indicated a preference for

receiving the report in the mail. A cover letter was provided with each electronic copy, and

the researcher emphasized a willingness to meet with the participant at an agreed-upon time

and location to further discuss the research results.

Conclusion

This chapter described the method of procedure for this research study. It described

the design, sample selection, data gathering procedures, instrumentation, treatment of data,

and methods of ensuring trustworthiness. This chapter also delineated the sampling

method, participant recruitment, types of information needed for the data, how and why

certain methods were implemented, how the data were analyzed, and a discussion of ethical

considerations related to this research. Chapters Four and Five present the outcomes of this
 88

research using both case-by-case and cross-case analyses, and Chapter Six presents the

final analysis, conclusions, and recommendations.

 Chapter 4

CASE BY CASE ANALYSES

Background and Context

This grounded theory research aimed to address the scanty knowledge base

regarding creativity in occupational therapy by exploring the definition, impact, and

relationships among creativity, occupational therapy, and occupational therapists. To

provide the most authentic findings, the research questions were posed to the

occupational therapist participants themselves. Research questions with related queries

were as follows:

1. Research question one: How have definitions of creativity in the context of

occupational therapy changed over time?

• Participant query: Last time we spoke, we discussed creativity in the practice

of occupational therapy. How do you think definitions of creativity in the

practice of occupational therapy have changed over time?

2. Research question two: How do occupational therapists define creativity in the

context of occupational therapy?

Utilizing a person, process, product, and press model as a theoretical framework to

construct a definition of creativity, participants were asked the following queries as

components of research question two:

• Participant query for person component: Tell how you feel your personality

contributes to your creativity at work.

• Participant query for process component: When you describe creativity at

work, what exactly does that mean to you?

89
 • Participant query for product component: What exactly do you create when

you are creative at work?

• Participant queries for press component: How does your work environment

influence your creativity at work? How do work demands influence your

creativity at work?

3. Research question three: In what ways do occupational therapists feel their

personal creativity impacts their practice of occupational therapy?

• Participant query: In what ways do you feel your own personal creativity

impacts your practice of occupational therapy?

4. Research question four: What is the impact of practice-related creativity on the

occupational therapist?

• Participant queries: In general, what is the impact of occupational therapy

practice-related creativity on you? Specifically, what is the impact of

occupational therapy practice-related creativity on your personal creativity?

5. Research question five: What is the relationship between occupational therapists'

personal creativity and practice-related creativity?

• Participant query: We have discussed your occupational therapy practice-

related creativity and your personal creativity. Overall, how would you

describe the relationship between your personal creativity and your

occupational therapy practice-related creativity?

At the time of this study, the nine selected participants were all certified

occupational therapists licensed to practice in the state where this research was

conducted. Each of their practice sites was purposefully selected because they typified
 91

work settings of occupational therapists. Recruited gatekeepers for each of the selected

sites distributed information about the study provided by the researcher. The first

respondent from each site was selected for the research, with the exception of one large

hospital setting, which was represented by the first two respondents. The participants

each had distinctly different professional responsibilities and job descriptions, and

collectively, represented both an age span and a career length span of over thirty-five

years, three different racial backgrounds, and widely divergent personality types, work

values, and creative strengths.

To better understand participants in their own unique contexts, each is presented

in this chapter utilizing a case by case analysis briefly describing significant

demographics of age, race, practice site, and career length. Their primary practice site

and professional responsibilities are described, followed by a description of their

performance on the measure of creativity, the personality type indicator, and the work

values index they completed. As an additional source of data, participants were asked to

create a list often words or phrases related to personal creativity and another list often

words or phrases describing occupational therapy practice-related creativity. These words

and phrases were used to augment other sources of data to complete a broader portrayal

of each participant's beliefs about creativity. Tabular representations of individual

demographics, assessment and self-report data, and creativity words and phrases are

presented in the case studies.

After member checking the participant's perceptions regarding the validity of

assessment and self-report data, a final case study was compiled about each participant.

Participants were given an opportunity to member check the preliminary version of their
 92

case study. All participants responded affirmatively regarding both the results of their

data and the case study. Following each case study, a tabular synthesis of the participant's

responses to the five research questions derived from the related queries from the first

and second interview questions is provided.

To protect the privacy of both the participants and the institutions they worked in,

certain measures were deemed necessary. Because occupational therapy was represented

by a small, tightly-knit professional community that was highly interactive on state,

national, and international levels, occupational therapists knew each other both personally

and through their publications and professional service. It was highly plausible that the

participants could be identified by including some of their demographics or specific

information about the practice settings in this study.

For this reason, participants were allowed to select a pseudonym to represent

themselves in this research. Participants were asked to choose a plausible pseudonym

consisting of both a first and last name. The researcher then requested that participants

refer to themselves on any assessment or self-report measure by using their selected

pseudonyms. Additionally, participants' age ranges were grouped by decade, namely 20s,

30s, and so on; and all ethnicities were reported using broad racial headings. Hence, a

Korean or Thai participant would have been referred to as Asian. Workplace settings

were also similarly grouped. For example, all level-one trauma, county, private, secular,

or faith-based hospitals were grouped under the generic category of "hospital."

The following cases are presented based upon the chronological ages of

participants. The youngest participant is presented first, and the oldest participant is

presented last. This sequence also closely paralleled the length of the participants' career
 93

spans. Only participant Carlotta Gomez came into her career as an occupational therapist

after first working in another field and resultantly had a shorter career span relative to her

chronological age. All other participants became occupational therapists while in their

mid-twenties, and occupational therapy was their only professional endeavor.

Coincidentally, the presentation of cases by chronological ages also resulted in the

automatic grouping of participants by their practice areas. Therefore, both of the youngest

participants who worked in school settings are presented first, followed by the three

hospital therapists, the two community setting therapists, the one mental health setting

therapist, and, finally, the case studies conclude with the oldest participant who works in

an academic setting (see Table 1).

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Table 1

Aggregated Participant Demographics

Participant Age Ethnicity Practice Career Span

Range Site in Years
Lynn Tran 20-29 Asian School 0-9

Jennifer Lopez 30-39 Latina School 10-19

Carrie Jones 30-39 Caucasian Hospital 10-19

Boriqua Nayali 30-39 Latina Hospital 10-19

Countessa Charles 40-49 Caucasian Hospital 20-29

Devon Darrington 40-49 Caucasian Community 20-29

Chatee Cathy 50-59 Caucasian Community 20-29

Carlotta Gomez 50-59 Caucasian Mental Health/ 20-29

Academia
Bea Devil 60-69 Caucasian Academia 40-49

Lynn Tran, Educational Occupational Therapist

Lynn Tran was a woman in her twenties who had been practicing as an

occupational therapist since graduating with her bachelor's degree in kinesiology and

master's degree in occupational therapy. Lynn selected a pseudonym that reflected her

Asian heritage. Her primary employment was as a school therapist, and she also worked

as a hospital inpatient therapist on weekends. Along with her two occupational therapy

jobs, Lynn had also intermittently sold cosmetics through home shows and events. In
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addition to having been recently married, she listed her hobbies as spending time with her

dog, sewing, traveling, and gardening.

Lynn traveled from her urban office to rural communities to deliver occupational

therapy services to children in public school and also to those who were on homebound

status and could not be physically present in a school setting. Her primary responsibility

was direct treatment of special needs children, but she also provided teachers with hands-

on assistance, information, and resources to enhance the students' ability to profit from

their time spent in a learning environment. While she listed the primary diagnoses of the

children she saw as cerebral palsy, autism, mental retardation, sensory issues, and spina

bifida, Lynn also treated others with conditions ranging from rare syndromes to

nonspecific developmental delays.

Interviews were held in her urban office; a large expanse of six neatly arranged

pods, with each pod containing six spoke-like connected office cubicles. Lynn's cubicle

displayed a festive array of ethnic art, photographs of Lynn and her husband, children's

artwork, and other decorations that conveyed a happy, homey feel to an otherwise fairly

generic corporate office setting. During interviews Lynn appeared eager to share her

feelings and beliefs about creativity. She listened intently to all questions and answered

them without hesitation. It appeared that Lynn gave honest and considered responses to

all queries, and put forth good efforts on all self-reports and assessments that she was

asked to complete. Each session lasted approximately fifty minutes. As her first interview

concluded, Lynn hurried to join a meeting of other occupational and physical therapists

that was resuming after a lunch break. Lynn appeared to have abundant energy and a

diligent work ethic.

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Lynn's self-report on the Myers Briggs Type Indicator; Form M(1988) (MBTI)

(see Table 2) showed she was an introverted, sensing, feeling, and judging person (ISFJ).

According to the Myers Briggs, ISFJs are quiet, friendly, responsible, and conscientious

individuals. Committed and steady in meeting their obligations, ISFJs are thorough,

painstaking, and accurate. They are also loyal, considerate, and notice and remember

specifics about others and are concerned with how others feel. ISFJs strive to create an

orderly and harmonious environment at work and at home. Of these indicators, Lynn was

clearly introverted, and a moderately sensing and feeling type, and only slightly a judging

type. As an introvert, Lynn preferred to focus on the inner world of ideas and

impressions, and as a sensor, she focused on information that she gained from her senses.

Sensors can be keenly aware of their surroundings and notice details and other elements

in the environment. Feeling types prefer to base their decisions on values but as a

judging type, Lynn still preferred to follow a schedule and have an organizational plan.

Table 2

Lynn Tran Myers Briggs Type Indicator Results

Overall Introvert Intuition Thinking Judging

Personality or or or or
Type Extravert Sensing Feeling Perceiving
ISFJ: Clearly Moderately Moderately Slightly
Sensing Introverted Sensing Feeling Judging
Introvert

Lynn's performance on the Abbreviated Torrance Test for Adults (ATTA) (see

Table 3) showed her greatest creative attribute to be that of originality, defined as

creating new or unusual responses to prompts. In responding to a problem-solving

prompt, this attribute was evident when she was asked to write about potential issues that
could develop if humans become able to fly. Consistent with her high score in originality,

Lynn speculated that human flight might lead to opportunities for more star or planet

watching but could also create problems such as head injuries or bone fractures as a result

of collisions with birds, the development of sunburns, and breathing problems resulting

from changing oxygen levels, amongst other difficulties. However, being the fun loving

person that she was, Lynn also pointed out some opportunities for being able to greet and

wave to more people than she was able to now. The thought of all the recipients of the

friendly waving must have prompted Lynn to add cautionary thoughts regarding what to

wear as a flyer; "No more skirts or dresses" would be allowed. Typical of Lynn's ISFJ

attribute of judging, she voiced concerns related to the potential for disorderly flight

patterns as a result of the lack of streets and directions.

In another portion of the creativity assessment, Lynn's quiet humor was also

expressed on her quick conversion of a grid of nine equilateral triangles into a family of

pizza slices, each displaying different emotions, such as "Feel Better Pizza," "Jiggy

Pizza," and "Shocked Pizza." Displaying a fluid ability to change from one idea to

another, when Lynn was told she had thirty remaining seconds to continue work on her

response, she quickly converted the pizza slices family into a set of toppings on a bigger

pizza by framing the entire grid with circular lines representing pizza and sauces. Lynn's

additional creative energies were directed to evoking emotional responses, primarily

smiles, expressiveness, and in creating rich imagery through both written and drawn

responses. Lynn's drawn figures showed an economy of efforts, with each mark serving

to amplify the titles. Lynn did not elaborate or embellish but, instead, focused on

engaging the viewer with her funny imagery. This was consistent with her later interview
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observations that she tried to make therapy fun for children. This trait was similar to the

way her office space was organized, with an emphasis on fun and enjoyment.

Lynn's performance on the MIQ showed a wide-ranging pattern of responses

regarding the attributes she held important in her work. The widest ranges of responses in

her self-report were in regard to issues of achievement, needs for the security of steady

employment, a desire for recognition of a job well done, and for employment that was

governed by fair management and policies. Lynn replied more consistently in her values

with regards to independence (moderately valued), creativity (moderately valued),

responsibility (somewhat moderately valued), and authority (not valued).

It appears that while Lynn was firm in her values on some issues, others were less

set. This is consistent with having a relatively new career. Lynn was in many ways still

developing a professional identity, and with employment as an occupational therapist in

two divergent practice areas, she may have placed different values on these attributes,

depending on the situation she was in.

Her relatively high values placed upon social status, being able to feel a sense of

achievement through her work, and desire for recognition could have led Lynn to

experience satisfaction as a airplane co-pilot, securities sales agent, optometrist, and

clinical psychologist. In fact, Lynn reported exploring optometry as a potential career

while she was in college. Lynn's preference for the work values of occupational therapy

showed that she would most likely find her chosen profession rewarding, but it was worth

noting that her ranking of occupational therapy placed it in the likely satisfied range, as

opposed to the fully satisfied range. The MIQ held that generally speaking, occupational

therapists placed value on making use of their own abilities, desired work where they did
 99

things for other people, got to try out their own ideas, and got a feeling of

accomplishment from their work. One final finding resulting from Lynn's self-report on

the MIQ showed that she placed relatively low value on authority, supervision, and

human relations, which may make many professions undesirable to her. These included

being a vocational evaluator, a dietician, and a claim examiner.

Table 3

Lynn Tran Creative Strength and Work Values

ATT A Highest MIQ Lowest MIQ MIQ Creativity

Creative Strength Work Value Work Value Value

Originality Achievement8 Safety" Average

Note. ATTA=Abbreviated Torrance Test for Adults; MIQ= Minnesota Importance Questionnaire.
"Achievement is defined as ability utilization and achievement. bSafety is defined as company policies and practices,
human relations supervision, technical supervision.

Lynn's responses during interviews showed that her beliefs regarding the role of

creativity in her work as a school therapist emphasized energy, helpfulness, and service.

Lynn not only reported placing a high value on working with the children but also with

the teachers and other school personnel. In these situations she emphasized making the

best use of limited time, money, and space resources, and reported being especially aware

of the difficulties inherent in needing special things for students and teachers, then

waiting for so long to get them. Instead, Lynn often rolled up her sleeves and tried to

create a substitute. In fact, she noted that on occasion these hand-crafted items had even

more value because of their personalization. She recalled one particular way she had of

creating social stories for children with autism:

... what I'm also kind of trying to do on my part [is] for the school. I got an idea,

well it's what they are doing; they are using pictures for autism kids. For me when
 I'm trying to work with the student, I make my own pictures or my own kind of

storybook pictures. So I see an idea and I think about what that child needs.

Lynn's interest in creating objects her students could use was also reflected in the

creativity word lists she developed for this research (see Table 4). For both her personal

and professional roles, she emphasized created objects. As a newlywed immersed in the

process of developing a home, Lynn's personal creativity words focused on decor and

other domestic pursuits such as cooking and gardening. This pattern continued in her

professional creativity words in which Lynn emphasized the ideas and suggestions she

generated for others, and included a reference to the use of devices such as electronic

switches that assisted her students in the school environment. It was worth noting that

Lynn reflected an awareness of others in these lists when she chose to capture imagined

conversational responses to her creations, such as, "I love your taste in colors" for a

personal creativity phrase, and "You're the person who I want to get ideas from" as a

professional creativity phrase.

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Table 4

Lynn Tran Personal and Occupational Therapy Creativity Words

Personal Occupational Therapy Practice-Related

1. Unique 1. I never thought of that
2. Different 2. That's a good idea
3. How cool that looks 3. That makes sense
4. The color really compliments 4. I will try that idea next time
5. Love the chicken dumpling 5. How about try it this way
6. Can I have the recipe? 6. That looks so much fun
7. These cookies are so good 7. I want to try that now
8. The flowers are beautiful 8. You're the person who I want to get
9. Your choice in furniture are fabulous ideas from
10.1 love your taste in colors 9. Switch lady
10. Awesome!

Note. To preserve the unique character of individual responses, words or phrases have been reproduced as originally
written by the participant.

Another role Lynn saw the occupational therapist in the schools assuming is that

of a synthesizer. She believed that occupational therapists held a unique place in the

educational world, and said:

I think we bring a different point of view, and you then take that point of view,

and you are creative in that way.. .we are the environment, the person, and their

surroundings. We are different from teachers, PTs [physical therapists],

diagnosticians, [and] the principal. And we kind of bring it all together in a way,

because we look at the whole picture. .. .so my creativity is kind of really different

in a way. Like we come in and see a bigger picture than the other people.

In addition to synthesizing things for school personnel, Lynn seemed to see

herself as a motivator, a coach, and an energizer. When asked to cite an example of when

therapists were not creative, she fell back into her personality role of "sensor" and that of

a novice therapist when she said:

 102

I see a lot when I'm observing. I see a lot of OTs out in the field, and

sometimes we get a chance to also observe our coworkers out in the fields... I feel

like just handwriting with pencil and a simple piece of paper and writing their

name is not fun for the kids. I try to make it fun, I try to add stickers and make it

more visual, make it more colorful, and make it more exciting by my tone of

voice. Like I see a lot of therapists out in the field, and they're working on things

like, "Write the letter A." They don't show excitement like, "Let's go and write the

letter A, and then we can go play afterwards!" You know, showing their

excitement. I think a lot of that is because I'm younger than a lot of the other

therapists, and.. .1 get to bend down and jump up [laughs]. I am more flexible in

that way [laughs].

They've been out in the field so long that they feel comfortable with what

they're doing, and so when I was fresh out of school I learned a lot more

activities, and everything was up-to-date. I hope I don't get to that point where I

feel comfortable, and I'm doing the same thing over and over, like I'm almost too

comfortable. They're comfortable with their work, and they feel like it's the right

thing, but I feel that kids retain more if it's fun.

Lynn followed this observation by reflecting that she also believed what she was seeing

was something akin to burnout, citing therapists who could not retire because of

economic downturns.

While she did not appear fully certain in her own mind on the exact meaning of

creativity in the practice of occupational therapy when she said, "I don't think it takes the

creativity to get there.. .it's more common sense in a way." Lynn had solid views about
 103

what it took to be an effective, engaging, and motivating school therapist. Her combined

compassion for her students was evident when she said, "I'm going to make it functional,

meaningful, motivational, and fun for the kids," and her enthusiasm for communication

with school officials and parents was evident in comments like, "I kind of just pull it in

together and then make suggestions to the teachers." When combined with her ability to

synthesize elements of the child's big picture, this placed her in what she viewed as a

unique role. It is through this role that she appeared to feel most effective, in creating

ideas based on her training and experiences, and the expertise and training of other more

experienced school therapists who mentor her. With her energy levels and desire to stay

fresh, augmented by a penchant for original thinking and the ability to self-monitor, she

said, "I hope I don't get too comfortable, and if I do, I want somebody to tell me." Lynn

would likely remain an effective, compassionate, and frisky therapist that children enjoy

and that school personnel would continue to welcome into their world. A synthesis of

Lynn's answers to all research questions specifically put to her in the first, and second

interviews reflected her beliefs (see Table 5).

Table 5

Lynn Tran Synthesized Research Question Responses

1. Definition of creativity in OT over Changing cultural values and technology

time? have changed OT skill sets
2. Definition of creativity in OT? Creating ideas, making suggestions to the
teachers, using common sense, and making
unique items for students

a. Person: Problem solving, attitude

b. Process: Facilitating, thinking, planning

c. Product: Devices and equipment, treatment activities

d. Press: Student status, time, resources,

management, paperwork
3. How personal creativity impacts A problem solver, she used her hobby skills
practice creativity? with students in the work setting.
4. How practice creativity impacts She believed that creativity in her work
personal creativity? with children would improve her future
parenting skills.
5. Relationship of personal creativity She learned to adapt to a variety of
to practice creativity? environments, work with available
resources, and work when under pressure.

Jennifer Lopez: Educational Occupational Therapist

Jennifer Lopez selected a pseudonym reflective of her Latina cultural and genetic

heritage. She was a woman in her thirties who had been practicing as an occupational

therapist and certified handwriting specialist in this urban area since graduating with her

bachelor's of science degree in occupational therapy twelve years earlier. Since that time,

she had worked in a hospital rehabilitation setting, as a home health therapist, and at a

children's rehabilitation center. At the time of the study, she was working as a school
 105

therapist and had become a level one certified handwriting specialist. She listed her

hobbies as playing soccer and volleyball.

The interviews occurred in the school system's related services offices located in

an inner-city high school. The surrounding neighborhood consisted of a homeless mission

and a nut factory. A steady trickle of men loitered around the mission center, bought

sacks of shelled peanuts at the nut factory, and returned to their stoop at the mission

center to savor them. After the researcher passed the gauntlet of peanut-eating men, she

was admitted to the high school, passed through the metal detector and sign-in and

phone-in stations, and showed identification and her professional card to an unsmiling

uniformed security guard, Jennifer Lopez came to meet and escort her to the related

services offices. Jennifer confidently ushered the researcher through this well-worn high

school to the related services offices and suggested that they talk in the work room, a

busy center lined with labeled boxes filled with goods designed to help occupational and

physical therapists prepare for any eventuality. Laminators and copy machines lined the

walls, chipper bulletin boards enumerated the services provided through various

programs, and there was a steady hum of office personnel from nearby rooms.

The overall impression was of busyness and crowding, yet Jennifer did not seem

to notice or mind the activity or speaking to the researcher within earshot of a few

coworkers. Clearly, this mix of possibilities and crowded settings was familiar territory

for her. As a school therapist, Jennifer noted that she planned for work in unfamiliar

settings, rooms without supplies, or by utilizing whatever she placed in the "box of

magic" in her car.

 Jennifer described her job in two main capacities. First, she saw herself as a

liaison among teachers, personnel, and families to ensure that the students' goals and

objectives were being worked on in a consistent manner between home and school. This

was done with the primary focus placed upon the student's ability to function in the

classroom, as well as in the interest of "teacher parent training." She also ensured that

any medical changes were brought to the attention of teachers and personnel.

Secondly, Jennifer discussed at length her role of therapist in relation to

equipment and technology, and emphasized the need for resourcefulness. She reported

that she and her colleagues "work[ed] with the assistive technology that [students]" used,

from "low-tech aspects such as grips, up onto computer usage." For low-tech needs, the

campuses all shared a storage unit. If a required piece of equipment was not already

assembled, Jennifer would either modify existing pieces or create entirely new ones from

"odds and ends" that she could "piece together."

Jennifer also described her caseload as being comprised of a "rainbow" of

diagnoses. She frequently worked with children with cerebral palsy, spina bifida, autism,

developmental delays, and saw some with more unusual conditions that might have

required internet searches to understand. That school year she estimated that she was

responsible for between thirty-five to fifty students. The number varied, and Jennifer had

some assistance provided by a certified occupational therapy assistant. Because the

assistant was new to school therapy, she also required supervision. For Jennifer, this

resulted in trading one form of supervision for another.

In addition to serving her students and training the occupational therapy assistant,

Jennifer traveled to between ten and fifteen school campuses to deliver her services. Like
 107

the types of medical and education-related conditions that Jennifer saw, the number of

campuses where she worked also changed; she mentioned that it was not unusual for her

to visit three to four campuses in a given day. Additional challenges for Jennifer were in

locating her student charges in any given campus, securing a place to work with a

student, and having adequate time and supplies to implement the student's treatment.

Jennifer's work also required extensive communication skills. She had to be able

to communicate with all school personnel about each student's sometimes complex or

unusual needs, but by virtue of her role as a therapist, Jennifer also had to interface

between medical and educational worlds for both school personnel and families. Because

Jennifer also spoke Spanish, she had the advantage of being able to communicate with

many of the non-English speaking children and their families. She told the researcher:

.. .some of the parents and kids come from Mexico, and parents and kids are in the

schools that only speak Spanish. And sometimes there's a language barrier

because when it comes to talking to a therapist and getting a translator, it's not

always translated in the correct terminology. Okay, so then they see a[n] Hispanic

occupational therapist, and it just really makes them more comfortable. And they

open up a little bit more as far as whether it's truth about an issue or an underlying

issue that connects it to therapy issues.. .1 could see it relates some to creativity, as

the parents may see the grand picture of something that is out there in the stores,

or through a vendor, as to where if we put something together and it works just as

well, which is explained what the outcome is that we're trying to achieve.

Consistent with her self-described roles as school therapist, Jennifer's

performance on the MBTI shows that she described herself as an extroverted, intuitive,
feeling and judging type person (ENFJ). This type of person is described by the MBTI as

a warm, empathetic, responsive, and responsible person who is highly attuned to the

emotions, needs, and motivations of others. ENFJs find potentials in everyone and aim to

help others fulfill them. They may act as catalysts for either individual or group growth,

are loyal friends, and are responsive to praise and criticism. As sociable individuals, they

facilitate others in a group and serve in leadership roles. Many of these attributes helped

Jennifer navigate potentially troubling scenarios in her work environment.

Her own extraversion enabled her to communicate with others, using special

communication skills needed in situations ranging from assisting non-English speaking

students and their families to understand potentially complex subjects, to locating

children in schools, and to seeking assistance with locating needed materials and

supplies. The N of intuition is the MBTI attribute that is associated with creativity, and it

is also associated with an individual's ability to see familiar patterns and possibilities in

their environment. Jennifer's judging type could have provided her with a useful way to

see order in what others might perceive as chaos; the sometimes arbitrary schedules that

children had during their school days, and the additional scheduling demands placed

upon her by admission, review, and dismissal meetings and her own duty to schedule

children for treatment sessions. Holidays, special occasions, state and local testing, and

transportation provided additional challenges to scheduling her students for therapy

sessions (see Table 6).

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Table 6

Jennifer Lopez Myers Briggs Type Indicator Results

Overall Introvert Intuition Thinking Judging

Personality or or or or
Type Extravert Sensing Feeling Perceiving
ENFJ: Clearly Moderately Slightly Moderately
Intuitive Extraverted Intuitive Feeling Judging
Extravert

Jennifer also completed the ATT A. Her performance on this test indicated that her

greatest creative strength as measured on this assessment was in the area of elaboration.

As frequently seen, this was paired with an average score in fluency, which was the

ability to generate multiple responses to any given prompt. In Jennifer's case, her interest

was in "fleshing out" the details of a smaller set of ideas or images. Her tendencies

toward elaboration were evident in her completion of provided line drawings. Given

instructions to "Use the incomplete figures below to make some pictures. Try to make

your pictures unusual. Your pictures should communicate as interesting and as complete

a story as possible. Be sure to give each picture a title," in a three-minute time frame,

Jennifer created two scenarios with titles that evoked rich, positive imagery. "The Flower

of Faith" depicted a leafy, lotus-like flower with a bent and twisted stem, apparently

rising from flame-like vegetation, and "The Beginning" depicted an early-man type

scenario, complete with a snug hut, blazing campfire, furnishings in and around the hut,

and a little figure sitting on a mat or rug. The hut depicted a powerful internal heat

source, and a chimney emitting an energetic plume of smoke. While Jennifer's second set

of figural drawings did not portray the same level of detail in each drawing, she did
 110

included more images, with a variety of subjects, including a steaming teapot, smoking

teepee, curly-tailed dog, tilted-over snow cone, picture frame, and happy little "mat girl."

Jennifer's responses placed her creativity in an above average range, especially

with regards to elaboration and originality of responses. Her ability to generate a number

of images was in an average range, and her use of the images in a number of different

ways was also average. This was consistent with "elaborators," who devote their energy

to making any chosen product the best, most interesting or telling that it can be. With a

three-minute time frame, it is difficult to both generate a wide number of responses and

also elaborately detail each.

Jennifer's responses to interview queries also showed her penchant for elaboration

and working up an idea. When discussing her own creative products at work, Jennifer

noted these concepts:

Creativity at work means starting from the ground up where there is nothing

available, brainstorming on how can you piece things together that you don't have

a piece for, or how can you actually make something with the raw products

around you such as cardboard, you know; tape, Velcro®. So it can go either the

raw products, or there's actually something in place, but you need to add to it. So,

creativity means being able to pull things from left to right, whatever you have in

your environment, to put something together.

Her ability to focus on an end goal and search her environment for whatever tools or

supplies she needed to reach it was an essential survival skill for her as a school therapist.

This was one way Jennifer felt she could use her creativity. She noted that it was not only

school therapists who need to be able to create something from nothing but reported that
she also followed these methods when working in a nursing home. In fact, through her

interview, it became apparent that the challenges of finding available resources and the

frequent need to create something from nothing contributed to her creativity rather than

repressed it. After reflecting a moment on this aspect of her work, Jennifer said:

The meaning of creativity is.. .in the beginning, you're starting from ground zero,

not having anything to work with, knowing which you want the outcome to be,

and starting from there. So, creativity to me means what is it that I want to see

achieved, and what are the things that are available to me, and what are the things

that I'm going to have to put together to achieve this? [And] if it doesn't work,

[then] starting over again.

Jennifer's results for the MIQ reflected the value she placed on achievement, both

in the sense of effectively utilizing her own abilities and in gaining a personal sense of

accomplishment through her work. She also emphasized altruism, indicating a strong

sense of importance placed upon moral values, social service, and security. Almost as

significant was the value Jennifer placed on autonomy, specifically in areas of creativity

and responsibility. Of moderate importance were independence and status. She placed

very little importance upon supervision, policy and authority. Jennifer also reported

placing a high value on creativity in her work, and this was affirmed when she stated that

she felt she was a creative therapist and valued creativity in her work. Her results also

indicated that her values were consistent with attributes associated with occupational

therapists, as well as those of a secondary school agriculture teacher. Jennifer's values

were inconsistent with those of a night school principal or cement mason (see Table 7).
 112

Table 7

Jennifer Lopez Creative Strengths and Work Values

ATTA Highest MIQ Lowest MIQ MIQ Creativity

Creative Strength Work Value Work Value Value

Elaboration Achievement3 Safety" High

Originality

Note. ATTA=Abbreviated Torrance Test for Adults; MIQ=Minnesota Importance Questionnaire.

"Achievement is defined as ability utilization and achievement. bSafety is defined as company policies and practices,
human relations supervision, technical supervision.

There was something of a coach in Jennifer, even in her work. The work ethic of

not giving up in the face of challenges and her comments about the effect of her

personality on the recipient of therapy services showed the value she placed on

therapeutic use of self. In reflecting on the impact of personality on creativity at work,

she emphasized the need to maintain an easy-going demeanor in the face of difficulty,

and the need to remain calm and refrain from getting upset. She noted that a therapist's

own personality "runs through the patient"; it could help or hinder the tone of the

treatment session. An encouraging, unruffled attitude on the therapist's part could lead to

more engagement and persistence on the student. Without that, "they'll give up right

away."

For Jennifer, then, her own abilities to visualize and then execute a needed

treatment plan and outcome, and her encouraging coaching and therapeutic use of self

seemed to be the creative and essential elements in her success as a school therapist. She

had developed an ability to reframe potentially grinding day-to-day issues of scheduling

and supplies into challenges that she was able to meet by virtue of her flexible

personality, tendencies toward original and elaborative creative thinking, and by using

good communication skills. Armed with her "box of magic," Jennifer emphasized being
 113

prepared for any eventuality and student need, and this was reflected in the lists of

creativity-related words that she created for this research (see Table 8).

Table 8

Jennifer Lopez Personal and Occupational Therapy Creativity Words

Personal Occupational Therapy Practice-Related

1. Organization 1. Velcro
2. Lists 2. Duct tape
3. Google clip art 3. Binders
4. Scissors 4. Cement glue
5. Microsoft Word 5. Check lists
6. Internet 6. Pictures
7. Tape 7. Pockets
8. Check lists 8. Rubber bands
9. Foil paper 9. Markers
10. Window markers 10. Stickers

Note. To preserve the unique character of individual responses, words or phrases have been reproduced as originally
written by the participant.

As a busy mother, her work and school lives sometimes overlapped, and she

developed the ability to transfer skills learned in one part of her life to another. All these

assets contributed to her being able to function in a working environment that was both

demanding and rewarding. She reflected on creativity for a moment at the conclusion of

the first interview and said:

I think it's our major role. Creativity is our very major role. I'm the mother of two,

and there is nothing that I can't put together, science project whatever, I have all

the answers. So...if I have to wear a T-shirt it would say Ms. Creative because

you really have to have that creativity. That's a big piece of our profession.

Jennifer's synthesized responses to the research questions are presented (see Table 9):
 114

Table 9

Jennifer Lopez Synthesized Research Question Responses

Definition of creativity in OT over Technology had replaced reliance on

time? materials formerly used in OT and has
changed OT skill sets. The definition of
creativity was changing over time.
2. Definition of creativity in OT? Creating ideas, making functional things,
creating something from nothing, but also
acknowledged she also saw creativity as
"yarn, glue, scissors, paperclips..."
a. Person: Positive attitude and energy

b. Process: Friendly coaching, thinking, planning,

inventing
c. Product: Devices and equipment, treatment activities

d. Press: Time, physical resources, local culture,

student status, management
3. How personal creativity impacts A problem solver, she used her
practice creativity? organizational skills with students at
school.
4. How practice creativity impacts She used technology in the form of
personal creativity? checklists and tangibles she created at work
to increase her organization at home, such
as when paying bills.
5. Relationship of personal creativity Reflecting a belief in the transfer of ideas
to practice creativity? and knowledge, she said she was able to
create and grow ideas in one context and
utilize them in the other. She believed that
ideas spark in one environment but could
be utilized in another.

Carrie Jones, Hospital Occupational Therapist

Carrie Jones was a Caucasian female in her thirties who had been working as an

occupational therapist at the same hospital since graduating from occupational therapy

school ten years before. Commenting that she had selected a pseudonym her sister would
 115

appreciate, Carrie discussed her hobbies of running, reading, and sewing, and said that

she had also returned to school since graduating from occupational therapy school,

receiving a master's degree in liberal arts from a local university. She expressed gratitude

for her employer's willingness to support and pay for her return to school, especially in

allowing her to obtain a degree in liberal arts. Carrie expressed interest and enthusiasm

for research in creativity and noted that she and her sister were both educated in the arts

and placed high value on them. During the course of the interview, Carrie frequently

paused, thought a minute, and commented on her interest in the topic at hand. Carrie

appeared to have a natural curiosity and was able to express herself well. She seemed

both humble and powerful at the same time.

Because Carrie was an intensive care unit therapist, she determined that meeting

off site would be preferable for her. The interviews were conducted at an outdoor

restaurant she selected in a busy, hip part of the city. Carrie walked to the interview site

from her home and appeared physically fit, relaxed, and quietly enthusiastic about the

opportunity to reflect on the topic of creativity. These interviews and her performance on

both self-report inventories and the creativity assessment appeared to be accurate

reflections of her interests and values at this time in her relatively young career.

Carrie's self-report on the MBTI showed that she described herself as an

introverted, intuitive, feeling, and judging type (INFJ). INFJs are described by the MBTI

as individuals who seek meaning and connection in ideas, relationships, and material

possessions. INFJs want to understand what motivates people and are insightful about

others and are conscientious and committed to their firm values. They develop a clear

vision about how best to serve the common good, and are organized and decisive in
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implementing their vision. For Carrie, the tendency toward introversion was her strongest

personality preference, and she preferred a judging approach to life rather than a

perceiving approach to a more moderate degree. This indicated her preference for a

planned, scheduled way to life, rather than one of "flying by the seat of her pants."

According to the MBTI, Carrie preferred to take in her environment using intuition rather

than purely sensing it, and using feeling rather than thinking, indicating a more moderate

approach to how she took in, evaluated, and acted upon the information in her world (see

Table 10).

Table 10

Carrie Jones Myers Briggs Type Indicator Results

Overall Introvert Intuition Thinking Judging

Personality or or or or
Type Extravert Sensing Feeling Perceiving
INFJ: Clearly Slightly Slightly Moderately
Intuitive Introverted Intuitive Feeling Judging
Introvert

Carrie's performance on the ATT A showed highly developed creative strengths in

the attributes of fluency; defined as the abilities to generate multiple solutions for a

problem; originality, defined as the ability to generate new, novel, or unusual solutions

for a problem; and flexibility, defined as the ability to generate different types of

solutions for a given prompt or problem. Her most highly developed creative ability on

this assessment was her ability to elaborate.

When given a three-minute time frame, Carrie was asked to use incomplete line

drawings to create some titled pictures. In this brief time period, Carrie managed to

combine the two provided line drawings into an elaborate scenario she entitled "A
 117

Tornado is Coining." This tiny scene included rows of radiant sunflowers seemingly

oblivious to the building storm clouds and the ominous looking tornado bearing down on

the pastoral scene. To heighten the drama, Carrie included a tiny chicken sailing upside

down through the angry sky, and, to emphasize the contrast between peacefulness and

impending disaster, a tiny hammock was hung between two trees. Nearby, a little garden

planter flanked the front door of a rather surprised-looking house. Working fast, in

another three-minute time period Carrie was able to embellish a series of nine equilateral

triangles she had quickly converted into pictures, including details such as patterns on

clothing, a variety of unusually shaped windows on a house, pepperonis on a slice of

pizza, and a spry little flower perched on a birthday hat.

Likewise, Carrie's written responses to a query about the dangers that might occur

if a person could fly also showed her high degree of fluency and originality. Carrie

mentioned potential problems caused by contacts with power lines, birds, airplanes, and

trees, and voiced concerns about how rain and wind might take her off course, too far out

into space, or past her landing site. Carrie wanted to take control of this unusual situation,

and quickly sized up the potential aspects that might be associated with human flight. In

both of these tasks, Carrie showed a strong ability to utilize rich, colorful imagery, tell a

compelling story, express emotions or feelings, and display an openness to continued

work on ideas, if she had been given the time. Carrie clearly thought and worked fast.

Perhaps this was why she described many of the seemingly complex tasks she discussed

as part of her work on the intensive care unit as "...simple... I do simple things."

Carrie's values as indicated by the MIQ showed a wide array of work-related

values, with high degrees of variability within categories. In general, she placed the
 118

greatest value on altruism and morality, followed next by opportunities for achievement.

Carrie also placed a high value on safety in the work place. In this context, safety was

comprised of working for a company that had fair policies, and that offered excellent

training. Of moderate value to Carrie was autonomy, defined by creativity and

responsibility, and to an even lesser extent, the attributes of comfort and status. It

appeared that Carrie did not mind working hard in the trenches.

This was also consistent with the descriptive characteristics of occupational

therapists put forth by the MIQ. These included a desire to make use of their individual

abilities, work for other people, try out their own ideas, and get a feeling of

accomplishment. Carrie would probably have found careers as an occupational therapist,

in sales, and as a caseworker to be satisfying. She would not have found being a lawyer,

optometrist, or veterinarian to be good fits with her values (see Table 11).

Table 11

Carrie Jones Creative Strengths and Work Values

ATT A Highest MIQ Lowest MIQ MIQ Creativity

Creative Strengths Work Value Work Value Value

Elaboration Altruism8 Statusb Average

Fluency
Flexibility
Originality

Note. ATTA=Abbreviated Torrance Test for Adults; MIQ=Minnesota Importance Questionnaire.

a
AItruism is defined as the ability to be friends with co-workers, social service, and moral values. bStatus is defined as
recognition, authority, and social status.

During her interview with the researcher, Carrie described her creative working

style as, "I'm always trying to think outside of the box. I'm looking at a situation, and

I'm thinking, 'How can I make this better?" Her client-centered thoughts consistently

stayed at the forefront of her thinking, and she appeared to be a careful observer, noting
 119

small details that contributed to a much larger picture. When commenting on a patient's

difficulties with advancing a walker, she considered not only the walker but also the

patient's glasses. Were they sliding down the patient's nose? Could the patient see what

he or she was doing? Carrie had a limited amount of supplies, but she dug into them to

attend to both small details and the more obvious issues. Her creativity-related word lists

amplified these feeling and beliefs (see Table 12).

Table 12

Carrie Jones Personal and Occupational Therapy Creativity Words

Personal Occupational Therapy Practice-Related

1. Appreciating art 1. Thinking outside box i.e. protocols
2. Seeing things as they could be 2. Thinking of simple solutions for simple
3. Thinking of simple solutions for minor pt. issues
household repairs 3. Using splint materials to make sock
4. Creating art work aids, toilet aids, adapted spoons.
5. Sewing 4. Learning a new skill-ex. NDT
6. Gardening 5. Making a "sport band" for a patient's
7. Learning a new skill-ex.how to glasses with Velcro & Velfoam
snowboard 6. Balancing patient care and supervisor
8. Traveling-learning new things about a responsibilities
place 7. Finding equipment (w/c. walkers) for
9. Reading patients without resources
10. Taking photos 8. Time management
9. Mixing many frames of reference to
create your own
10. Going into a pt treatment with plan A,
B,C,D...

Note. To preserve the unique character of individual responses, words or phrases have been reproduced as originally
written by the participant.

Carrie believed that she used creativity to manage constantly changing patient

conditions and status. Crediting her father with instilling "can do" pragmatism in her,

Carrie was comfortable with tool use, commenting that she had similar skill sets similar

to many of the male therapists at her facility. She found challenge and purpose in meeting
the constraints of a parallel set of potential barriers to success: her limited resources of

time and supplies, and patients' limited or nonexistent financial and human resources.

She did not complain about these situations but instead chose to reframe potentially bleak

pictures by noting that even the most limited of patients was not without resources. She

said, "I try to look at it from different ways using the constraints that I have, trying to see

it differently." Utilizing this perspective, Carrie saw that patients came with rich and

multifaceted histories of prior wellness, prior employment, and their own internal values

and beliefs. Being the astute observer, Carrie learned what she could about these hidden

resources, either from the patient, if they were able to communicate them, or from the

family members or patient information. In thinking about this aspect of her work, Carrie

mused:

.. .that's part of what for me the profession is. Certainly there's the science, but

there's also the art of it, as well. You have a diagnosis; that's the science of

things. The art is what tools I am going to use that come from my training, my

knowledge, and whatever else I bring because of the way I was raised and grew

up.

Carrie was a relatively new therapist, but she had already mastered some of the

ways that she would be able to maintain a high degree of effectiveness and compassion

with and for her patients. Her ability to assess a situation quickly and objectively

reflected her performance on the ATT A. She saw both small and large challenges the

patient must manage and then quickly searched her own resources for potential tools that

she could use to facilitate patient healing and growth. Carrie's "bag of tricks" included

not only her professional experiences but also her education, which she continued to
build, her own personal history as a girl who used tools with her father and sewed with

her mother and grandmother, and her ability to use limited supplies in innovative ways.

Carrie also tended to her own well-being by nurturing herself through exercise

and pursuing her hobbies and enjoyment of the arts. Carrie appeared to have a good

understanding of how she could hurdle both professional and personal difficulties, and

her calm, grounded demeanor showed that she had successfully met these challenges.

Her synthesized responses to the research questions reflected this profile (see Table 13).
Table 13

Carrie Jones Synthesized Research Question Responses

1. Definition of creativity in OT over She saw the external constraints as

time? changing, especially related to third-party
reimbursement, but also believed OTs had
increased autonomy.
2. Definition of creativity in OT? Thinking and planning, especially with
relation to devising simple, client-centered
devices and activities.
a. Person: Out of the box thinking style, formative
experiences in childhood
b. Process: Repairing, refitting, repurposing

c. Product: Devices and equipment, treatment activities

d. Press: Time, physical resources, patient status,

management
3. How personal creativity impacts A problem solver, she used skills learned
practice creativity? from both of her parents to create client-
centered objects.
4. How practice creativity impacts Simple task mastery at work contributed to
personal creativity? her sense of personal satisfaction.
5. Relationship of personal creativity She felt that she was born with a creative
to practice creativity? personality, but everyday challenges at
work had enabled her to become even more
resourceful.

Boriqua Nayali, Hospital Occupational Therapist

Boriqua Nayali was a Latina woman in her thirties who had worked as an

occupational therapist in a large metropolitan hospital for nearly thirteen years. She

explained that her self-selected pseudonym reflected her cultural heritage. Noting that she

"likes everything," Boriqua had worked in many capacities at the hospital, but she began

her career as a pediatric occupational therapist in another facility. When her career in
pediatrics lacked the appeal she anticipated, she changed to her current place of

employment and immediately found an affinity for the complex medical issues of a

diverse patient population. While she struggled in her pediatric employment to find ways

to keep treatments fresh and new, in this hospital context she immediately found that the

fast pace, energized environment, while potentially stress-producing for some, turned out

to be the exact challenge she had been looking for.

Interviews were conducted in Boriqua's tiny shared office space, located just off

of the busy treatment area filled with a mixture of highly sophisticated medical

equipment, anatomical specimens utilized in patient education, and a cheery homemade

bulletin board with a decidedly public school flavor to its encouraging slogans and

flowers made from patient handprints. Halloween decor was festooned from door frames

to the ceilings, and the patient treatment room was filled with patients, therapy students,

therapists, receptionists, and patient family members. Despite the high noise levels,

constant movement, and almost chipper atmosphere, there was no doubt that highly

focused, specialized patient care was being conducted. Boriqua seemed comfortable in

this environment, and as the researcher settled into patient treatment chair and set up an

interview station on an adjustable hospital bed table that served as a sideboard for

sterilized, vacuum-packed medical supplies, Boriqua took time to fill out a few

commercial greeting cards. Her brimming desk also reflected a mix of photographs of her

family combined with medical instructions sheets, bulletins, and supplies. The whole

scenario was a mixture of hominess and sophistication, order and chaos, stress and

reflection.
 124

Boriqua completed her self-reports and timed tests on the little hospital bedside

table with an air of confidence and responded to interview queries in much the same

manner. She appeared to give the interviews her full attention, and her responses

reflected thought and consideration. Each of the interview sessions were completed in

one hour.

Boriqua's results on the MBTI indicated that she was an extraverted, intuitive,

feeling and perceptive personality (ENFP). According to the MBTI, ENFPs are

enthusiastic and imaginative individuals who process information quickly and efficiently,

and confidently act upon it. ENFPs desire and seek affirmation from others, and in turn,

reciprocate by giving their own appreciation and support to them. ENFPs are considered

spontaneous and flexible, and rely on their ability to improvise and their verbal fluency

skills to manage challenges that come their way. In addition, the intuitive nature of

Boriqua's personality type is strongly associated with creative behavior, and in Boriqua's

case, her preference for the use of intuition versus sensing as a way of receiving and

processing information was considered clear (see Table 14).

Table 14

Boriqua Nayali Myers Briggs Type Indicator Results

Overall Introvert Intuition Thinking Judging

Personality or or or or
Type Extravert Sensing Feeling Perceiving
ENFP: Clearly Clearly Clearly Very clearly
Intuitive Extraverted Intuitive Feeling Perceiving
Extravert

According to Boriqua's performance on the MIQ, she placed strong emphasis on

the work values of altruism and achievement, closely followed by having autonomy and
safety in a work setting. In addition to having consistently ranked achievement, altruism,

autonomy, and safety as primary work values, Boriqua also placed relatively low value

on comfort as defined by attributes of business, independence, compensation, steady

employment and good working conditions. She also placed a low value on status, which

was defined as an opportunity for advancement, recognition, authority, and social status

in the community. In fact, Boriqua's low values assigned to status and safety were even

less than for most women of her age. Essentially, Boriqua was interested in work that

provided her an opportunity to use her skills in a creative and helpful manner, working in

a capacity where she could serve others in ways that were consistent with her personal

code of ethics, and were in line with her training and need to be treated fairly by her

employer. In a word, Boriqua's work values reflected the Golden Rule: "Do unto others

as you would have them do unto you." To this end, Boriqua would probably have found

satisfaction and fulfillment as a caseworker, secondary school teacher, occupational

therapist, librarian, and, interestingly, as a landscape gardener. Conversely, she would

probably have been dissatisfied with work as a tool-and-die maker, metal pattern maker,

aircraft shop mechanic, and production assembler. Boriqua would have been happiest

with career choices that were connectional and ethical.

Boriqua's performance on iheATTA showed a higher than average ability to

creatively manage a task using flexible thinking and also demonstrated above average

creative strengths of originality and elaboration. This was exemplified by her response to

a request to complete a drawing using an abstract doodle as the centerpiece for this task.

With only three minutes of working time, Boriqua completed a rendering entitled "Last

Supper," an evocative sketch of a predatory bird capturing an unwitting fish in its

 126

oversized bill. The bird's sly gaze at the viewer and the ambiguous use of space [is the

fish in or out of the bird's beak?] was, while lacking in artistic sophistication, an

intriguing study. Other images also reflected her ability to use words well and tell a story

with a minimum of information. Less frequently used in these responses was the creative

attribute of fluency, the ability to think of various solutions for a problem (see Table 15).

Table 15

Boriqua Nayali Creative Strengths and Work Values

ATTA Highest MIQ Lowest MIQ MIQ Creativity

Creative Strength Work Value Work Value Value

Flexibility Altruism* Status" Average

Originality

Note. ATIM=Abbreviated Torrance Test for Adults; MIQ=Minnesota Importance Questionnaire.

"Altruism is defined as the ability to be friends with co-workers, social service, and moral values. bStatus is defined as
recognition, authority, and social status.

This last finding may have been consistent with Boriqua's interview responses, where she

described her earlier struggles with creative behaviors at work using a scenario she

painted of her earlier days as a pediatric therapist. She recalled this strategy:

When I came into this [pediatric] facility, I was more like I have to be in my

analytical, professional way; I'm in that thinking mode. And so, I was

approaching my treatments that way... I was just sort of sitting in one area and

sort of not really getting the effects. I was thinking, okay, I'll do A, then I'll do B,

[and] then I'll do C.

This regimented behavior may have been the result of inexperience because in later times

Boriqua characterized her practice as one of using available resources. She said:

And so we have a problem.. .our therapists were saying, we don't have this, and

we don't have that, and we don't have all the things we need...So I was like, well,
 what do we have? Why don't you think about your space and the patient, and not

think about what we are not able to do?

The theme of working within constraints came up several times during the

interviews, and Boriqua noted that even in the face of abundant resources and adequate

supplies, the occupational therapist may not have exactly what a patient with highly

complex needs would require for an effective outcome. To this end, she frequently

retrofitted, repurposed, or created alternate solutions for them. Citing this complexity as

an energizing factor for her, Boriqua acknowledged that it was not for everyone. She

believed that the intensity of work experience could bring out a creative adaptive

response in a therapist, but the therapist in turn must be willing to handle and manage the

inherent chaos and unpredictability that arises from such a complex working situation. It

appeared that in her mind, creativity came to therapists who were able to manage and

survive the initiation into this workplace culture. It may have been an example of the

classic conundrum of "Which came first, the chicken or the egg?" Is the therapist who

survives in this setting an individual who is creative, or is the creativity developed as a

survival strategy? Boriqua noted that many therapists at this facility believed themselves

to be uncreative, but when their work performance was observed by others, it was

described as creative.

Perhaps, Boriqua reasoned, this was in part due to the traditional distinction of

creativity as a manifestation of an art-related process. For her, creativity could be

described as the ability to visualize a product in her head to enable her to create it, but

Boriqua also believed that in an appropriate context such as mental health care, the more

traditional use of creative art materials could be practical for therapists who were able
negotiate the value systems of third party payers, effectively document an art process as

part of therapeutic intervention, and be able to justify utilizing art materials. Boriqua did

not feel that her facility would enthusiastically support utilization of art materials, saying,

"In general, OT as a whole is moving away from that kind of creative background.

Creativity is changing from what it used to be to what it is now." Boriqua's interest in the

creative process was evident in her creativity word lists, but the distinctions were also

evident. She knew when and how to use her skills most effectively (see Table 16).

Table 16

Boriqua Nayali Personal and Occupational Therapy Creativity Words

Personal Occupational Therapy Practice-Related

1. Expressive 1. Flexible
2. Felt 2. Create
3. Inherent/Ends to a mean 3. Co-operative
4. Wild 4. Adapt
5. Free/Independent 5. Build
6. Color outside of the lines 6. Make
7. Create 7. Need
8. Original 8. Influenced
9. Flexible 9. Problem-solving
10. Imaginative 10. Means to an end

Note. To preserve the unique character of individual responses, words or phrases have been reproduced as originally
written by the participant.

In general, for Boriqua, it appeared that creativity could be represented as a

process of visualizing an outcome and the process necessary to attaining that goal,

utilizing available material and personnel resources to achieve solutions to complex and

multifaceted problems, and the ability to think holistically, avoiding lock-step or rote

solutions to problems. She emphasized that part of the difficulties in understanding

creativity in the occupational workspace may have been related to matters of definition,
and mused that people denied their own creativity while it was observed and noted by

others. Her practical approach to creative problem solving reflected her own personality,

which she described as a mixture of artist and scientist. She described her personality:

I have a good balance of being an analytical math type, that I can problem solve

things concretely, but I love to work with my hands, and to make things, so the

minute something doesn't work the way I want it to I'm thinking how can I rig

this up or make something that will work?

Boriqua seemed confident in her skills and was able to tap into both right and left brain

modes of thinking. Perhaps for her, the mantra for the practice of occupational therapy

could have been her own statement: "We make functional tools to get things

done...There is not any problem that's too complicated. There's always some way to get

around it." Whether Boriqua relied on her own training, or the expertise of those she

worked with, she expressed confidence in her own abilities and her ability to locate the

resources she needed to achieve what she set out to do. Boriqua's synthesized responses

to research questions showed these beliefs (see Table 17).

Table 17

Boriqua Nayali Synthesized Research Question Responses

1. Definition of creativity in OT over She saw changing definitions of creativity

time? and professional roles. While artistry as a
mode of occupation was not used as much
as it had been, she believed that well-
planned documentation that emphasized
outcomes would allow for its utilization.
2. Definition of creativity in OT? Her own blended attributes of being both
analytic and artistic assisted patients in
achieving functional outcomes.
a. Person: She had the ability to conceptualize and
envision outcomes
b. Process: Practical, functional creation of patient
devices
c. Product: Devices and equipment, treatment activities

d. Press: Time, physical resources, patient status,

colleagues, management
3. How personal creativity impacts A problem solver and rule breaker, her own
practice creativity? exposure to diversity, preference for
keeping things fresh and different impacted
treatment choices.
4. How practice creativity impacts Her self-perception changed as a result of
personal creativity? work experiences. Her artistry at home
directly related to needs to regain balance
from work.
5. Relationship of personal creativity Work and personal creativity were seen as
to practice creativity? different. Because her need for creative
self-expression was always present;
expression, in its context-specific form was
necessary for her to feel normal.

Countessa Charles, Hospital Occupational Therapist

Countessa Charles was a Caucasian female in her forties who had worked for her

entire twenty-three year occupational therapy career at this teaching hospital. Like fellow
 131

participant Carrie Jones, Countessa shared that she had selected a pseudonym her sister

would appreciate. She also reported interests in a broad range of endeavors including

reading, playing with her pet, interior decoration, and paper crafts. Her slim, healthy

appearance also reflected stated interests in exercise, nutrition, and cooking. Countessa

seemed to be a cool breeze in a virtual storm of activity. Despite the hectic, ongoing

bustle of both the hospital and the occupational therapy department, it appeared that she

was unfazed by the din. Though Countessa was interviewed in the center of the busy

therapy room, others went about their tasks without disturbing her. In fact, it seemed to

the researcher that she was grounded in a respectful, calm zone that was accorded her by

the others in the department. This busy occupational therapy room reflected an

incongruous mix of medical equipment and anatomical specimens with cheery, hand-

crafted bulletin boards that expressed words of encouragement to patients. Halloween

decorations were suspended from the ceiling and seemed to give the resident skeleton the

dual task of providing holiday decor while also serving as a demonstration model for

impromptu patient instruction. Bursts of laughter punctuated the air, and patients and

therapists all engaged in conversations. In some ways, to the researcher, the occupational

therapy department seemed to be an amalgam of part elementary school, part bus station,

and part laboratory - a mix of friendly coaching with rigorous discipline.

Countessa met twice with the researcher for hour-long sessions, carefully

considered her words, but easily answered all queries and providing succinct information

on the operations of the vast medical complex she worked in. Many of her responses

were peppered with jargon such as ortho [orthopedics], plastics [plastic surgery], pedi
 132

[pediatrics], and JCAHO [Joint Commission on the Accreditation of Hospital

Organizations] that reflected her intimate knowledge of the facility.

According to her self-assessment on the MBTI, Countessa was an INFJ, an

individual who clearly leaned toward introversion, perceived her environment intuitively,

and used feelings to negotiate the complexities of rules and regulations of life. Her INFJ

inventory was consistent with the sometimes solitary leisure pursuits she reported interest

in, and the intuitive aspect of her inventory was also linked by research to creative

behavior (see Table 18).

Table 18

Countessa Charles Myers Briggs Type Indicator Results

Overall Introvert Intuition Thinking Judging

Personality or or or or
Type Extravert Sensing Feeling Perceiving
INFJ: Clearly Slightly Slightly Feeling Moderately
Intuitive Introverted Intuitive Judging
Introvert

Additional information gleaned from her self-report on the MIQ showed that she

had a high interest in work that offered a safe environment and provided her with ways of

attaining her professional goals while serving others in the process. While this assessment

suggested that work in occupations that required hands-on assembly work would have

been most satisfying to her, it reported that her chosen profession of occupational therapy

was likely to provide her with satisfaction. In fact, her demonstrated skills in creating

splints and orthotic devices were not unlike the hands-on work that the MIQ indicated

Countessa valued.
 133

It was also noted that Countessa might have found work which emphasized

comfort as defined in part by inherent variety, security, and good working conditions to

be highly satisfying. Examples of this type of employment included being a bookbinder,

auto interior upholsterer, and an assembler. Conversely, it found work relying on a high

degree of combined achievement, autonomy, and altruism such as being a physician,

optometrist, or veterinarian to be unsatisfactory professional choices for her.

Essentially, both the results of the MIQ and her own report demonstrated that

Countessa placed value on making things and in interacting cooperatively with others.

While not differing significantly from other females in her age bracket regarding work

needs, Countessa appeared to place a greater than average value on her interactions and

relationships with others, and frequently used "we" and "our" instead of "I" and "mine"

in her discussions of the therapy department and hospital workings. This was

substantiated by the enthusiasm she experienced when she welcomed new occupational

therapists into the department, believing them to be helpful sources of information about

how occupational therapy services were provided in areas beyond her realm and noted,

"They bring in their knowledge base, and it expands mine."

A final measure of Countessa's abilities and interests was provided by her

performance on the ATT A. Countessa demonstrated above average creative ability, with

exceptional aptitude for creating original solutions to problems, and an above average

aptitude in both idea generation and flexible thinking. Her creative performance on this

measure was characterized by an ability to keep one inquisitive eye fastened on the

future, while grounding her present experiences in articulate, emotional, and humorous
 134

depictions of fantasy scenarios. In a word, Countessa expressed components of a vivid

imagination (see Table 19).

Table 19

Countessa Charles Creative Strength and Work Values

ATTA Highest MIQ Lowest MIQ MIQ Creativity

Creative Strength Work Value Work Value Value

Originality Safety3 Status" Average

Note. ATTA=Abbreviated Torrance Test for Adults; MIQ=Minnesota Importance Questionnaire.

a
Safety is defined as company policies and practices, human relations supervision, technical supervision. bStatus is
defined as advancement, recognition, authority, and social status.

Interview queries regarding creativity revealed that Countessa was initially

attracted to the profession of occupational therapy when she learned that the student

coursework required successful completion of classes in the arts. She reflected on her

choice to apply for occupational therapy school:

Because there was an opportunity to be more involved in what I considered

creative activities, like the coursework itself sounded fun. It just sounded fun. I

got to take weaving, and ceramics, and art appreciation. Those were things that I

was very interested in. And I liked that that was part of the curriculum, so that's

one of the reasons I chose to go that direction rather than physical therapy, which

was way more science-based, which I also like, but I thought, look what else I get

to do if I go to occupational therapy school; all this fun stuff!

Even though over twenty years had lapsed since she had completed her

professional training, she shared a reflection on the meaning of craft in therapy work,

citing one pivotal moment during her student years when she learned how to interpret a

person's emotional state by analyzing their method of creating a simple magazine paper
 135

collage. Laughingly, she even ventured a guess that it would probably be possible to learn

something about her in this manner since she was a collage and paper craft hobbyist. In

recounting the collage experiences she had with patients, she said, "I thought, I can't

believe how telling doing simple activities like that would be.. .and how much you learn

about a person just by having them do it."

Countessa expressed her affinity for the fine arts and the satisfaction she

experienced when working with her hands when discussing the role of occupational

therapy at her facility. She fluidly discussed her perception of creativity in occupational

therapy: "Well, I immediately think about art and music. Creating anything really,

creating something unique, or different, or new, out of something that didn't exist before.

That's how I define it." Referring to her frequent occupational therapy tasks of creating

splints and other orthotic devices for patients with complex medical conditions,

Countessa likened the process to being in a sculpture or ceramics class, where the

materials require extensive, sometimes messy manipulation combined with skilled

fabrication techniques. This combination of hands-on experience with the ability to meet

the clinical needs of each patient provided Countessa with work that was gratifying on

many levels.

For her, the experience of purposeful creation while meeting and managing the

complex and dynamic needs of patients provided her with tasks that were rich in variety

and complexity. This process also supported her interests in working in a context that

provided her an opportunity to experience professional achievement and security, which

was met by the large government-funded institution itself. The autonomy she desired for

her practice of occupational therapy was reflected in her mutually supportive and
respectful relationships with physicians and was also reflected when she described the

freedom she felt when designing and creating unique, client-centered products. Reflecting

on the healthy relationships the occupational therapists at her hospital had with

physicians, especially those in training, she noted, "I think that because it's a fast-paced

environment, we have to think quickly, and we are also allowed a lot of freedom to do

that here.. .We have good relationships with our physicians. They trust our ideas."

Although Countessa had spent twenty-three years in one job setting, these aspects helped

maintain her interest in and enthusiasm for her work. Countessa's creativity word lists

also reflected her enthusiasm for both using art materials and in maintaining close

connections with her work mates (see Table 20).

Table 20

Countessa Charles Personal and Occupational Therapy Creativity Words

Personal Occupational Therapy Practice-Related

1. Color 1. Imagination
2. Vision 2. Thinking
3. Hands 3. Tools
4. Imagination 4. Collaboration
5. Reading 5. Resources
6. Nature 6. People
7. Happiness 7. Ideas
8. Artistry 8. Study
9. Music 9. Research
10. Ingenuity 10. Hands

Despite the inherent variety in her practice setting, there were still periods of time

when Countessa felt that her work was falling into a routine. Again she cited the positive

aspect of freedom in her employment situation. She noted, "You can really get in a rut.

And one of the good things about being here is that I've had the opportunity to rotate into

different areas. ..I've moved around and done a variety of things."

 137

With each succeeding experience or rotation, Countessa built up her repertoire of

skills and knowledge of how to combine available resources with what each client

needed. She kept records of splints and devices she had created and was able to adapt and

modify these to meet the needs of new patients. In fact, one reason she created new

devices instead of ordering ready-made ones was because of their superior custom fit.

Stating ".. .that's the primary reason we don't use a lot of prefabricated materials; they

don't fit," she reasoned that alteration of an existing item or creation of a new one may

have been more cost effective than using one that was off-the-shelf.

For Countessa, then, creativity in the context of her practice of occupational

therapy may have been rooted in her personal interests in both fine arts and the process of

occasionally playful exploration of materials needed to create a product that improved a

patient's functional capacity and helped them attain desired outcomes. Because she

preferred complexity and was intrinsically motivated to try new things for interest's sake,

she often relied on a "borrow and adapt" tactic of utilizing her own or others' past

experiences and lessons learned to create new, sometimes innovative patient care devices.

Countessa's perceived freedom to do what she intuitively believed to be best

solutions for a patient's needs also contributed to her creativity at work. These elements

of personal experience, motivation, and interests, when combined with institutional

supports of both adequate resources and encouraging personnel and leadership, provided

her with a professional career that was both useful and creative, as shown by Countessa's

synthesized research answers (see Table 21).

Table 21

Countessa Charles Synthesized Research Question Responses

1. Definition of creativity in OT over Felt that OT was becoming more

time? biomechanical, and no longer allowed for
creativity and artistry
2. Definition of creativity in OT? Creating anything unique, different, new,
out of something that didn't exist before,
and art and music
a. Person: An artistic, hands-on, creative, but
methodical person
b. Process: Coming up with her own ideas, trying
things differently, preferring unique
approaches
c. Product: Devices and equipment, treatment activities

d. Press: Time, resources, management

3. How personal creativity impacts She liked making things and getting messy.
practice creativity?
4. How practice creativity impacts She believed work made her a different
personal creativity? person, expanded her exposure to
differences, and made her more open and
tolerant.
5. Relationship of personal creativity She learned new techniques at work that
to practice creativity? she was able take home and utilize in a
different way.

Devon Darrington, Community Occupational Therapist

Devon Darrington was a Caucasian retirement community therapist and

rehabilitation supervisor in her fifties who had practiced as an occupational therapist for

twenty-five years. She smiled and explained that her choice of pseudonym would be

perceived by her daughter as humorous. At the time of the study, she supervised other

occupational therapists at the rehabilitation village where she worked, but she had also
worked conducting functional capacities evaluations, in work hardening [strengthening],

post-acute traumatic brain injury, and acute care general hospital settings. Devon had a

bachelor's degree in occupational therapy. Her leisure interests and hobbies included

reading, golf, and spectator sports.

Devon described her facility as a continuum of care facility. It was located in an

affluent part of the metropolitan area and covered over sixty acres. While not a gated

community, it was clearly an enclave, including streets lined with homes, duplexes, and

apartments, all created from uniform-looking building materials. This community was

characterized by a clean, well-kept look. The streets were wide and generally free of cars,

which were parked either in garages or driveways. There were few pick-up trucks;

instead, most of the cars were sedans. This community was anchored by a well-marked

central complex, and was surrounded by a maze of hospital units, rehabilitation facilities,

and activities areas.

The interior of the central reception area was softly lit, and the walls were hung

with many portraits and paintings bearing ubiquitous bronze "in memory o f plaques.

The portraits depicted Caucasians, generally dressed for success, often posing in their

libraries, near collections of expensive and carefully arrayed objects, or in well-kept

gardens. There was a classic south-central urban American feel to this place; it was both

formal and homey.

As the initial interview between Devon and the researcher commenced in this

central location, uniformed Hispanic staff members efficiently set out tables, cloth table

coverings, and glassware. When queried about the upcoming event, Devon laughed and

replied that it was nearly happy hour time for the residents. Indeed, carafes of wine soon
appeared with small bowls of snack items. While the central reception area and adjacent

billiard room had been empty upon the researcher's arrival, soon the rooms were filled

with happy hour attendees who suavely offered both Devon and the researcher glasses of

wine.

The noise level began to rise and take on a festive atmosphere; this was

apparently a regularly scheduled event. The residents at happy hour appeared to be

empowered, successful individuals, quite possibly the movers and shakers of their day.

Among all of these two dozen or so residents, only one person sat slumped in a

wheelchair with her head down. The rest of the residents moved about without assistance,

or with the assistance provided by a cane or walker. Despite the fact that this was both a

retirement center and nursing home, there were no unpleasant odors commonly

associated with such facilities, and no residents were heard calling out for assistance or

displaying any other behaviors typically associated with some nursing homes.

The researcher accompanied Devon on a tour of the retirement village as she

explained the workings of this large complex, which she estimated to be the home of up

to three thousand residents. She described the complex workings of the village:

At this facility it is a continuum of care. We have residents that may buy

their own home here, an executive home, with two to three bedrooms. They are

big nice houses, and there might have somebody come in occasionally, say four

hours or so, but they are independent people who can come to the main clubhouse

for dinner, or lunch. The next level is that they have cottages or duplexes. So, say

the house is too big, they are still independent but say the house seems too big or

too much work and they need to downsize, so another level of independence can
 141

be in an apartment. We have apartments. Maybe you fall and break your hip. So,

we also have an acute setting, for the first couple of months of rehab and whatever

you need. We have that level. And their goal is to go back to their home. And if

they can't make it, then we have assisted living, so it's independent. Technically,

you still have to be able to do pretty much everything by yourself, like get meals.

We can give them a little bit of help with their ADLs [activities of daily living],

and all their meals are cooked for them, so they really don't even have to cook.

They have to be able to take care of themselves. They might have a companion.

Now, say you need a little more help. They have another level here. They

call it assisted living plus: You're still pretty aware of things, but physically you

may need a little more help, and that's in what we call the health care unit or

skilled nursing facility. They have nursing care, CNA [certified nurse assistant]

help, [and] more help with their ADLs. They are supposed to be able to get to all

meals by themselves.

Then we also have the hospice and eminent end-of-life issues. You don't

leave this program. You don't want to be here. You want to stay in your home

[because] this is where you die. So, I guess we have independence to death.

Everywhere Devon and the researcher visited there was a general air of business,

cheer, and activity. The rehabilitation area was crowded with residents and therapists.

One rehabilitation facility sported a universal design kitchen, allowing access for all

residents regardless of their mobility and ability status. Residents were able to practice

their cooking skills under the supervision of a therapist or therapy assistant. The fitness
 142

center allowed them to regain or maintain their level of fitness while under the

supervision of a therapist or trainer.

The overriding feeling engendered by this complex was that it was a nice place. It

seemed like a safe, homogeneous, and affluent community. Devon had worked in this

facility and others like it for a large portion of her professional career. She seemed

comfortable in this setting, and cheerfully greeted staffers who teased her about her

fiftieth birthday. While her name badge and photo depicted a woman with short, colored

hair, Devon had made the decision to abandon the hair color and let her hair grow long,

pulling it back from her face. She seemed comfortable and content with the idea of being

fifty. Devon appeared relaxed and affable talking to the researcher, and while the ambient

noise level increased as happy hour progressed and made it more difficult to

communicate, the interview seemed to be a reliable and accurate reflection of her views

of creativity and the practice of occupational therapy. In fact, Devon appeared not to

notice the increasing din and crowding as she spoke with the researcher.

Devon's self-assessment on the MBTIindicated she was an extraverted, sensing,

feeling, and judging individual (ESFJ). While leaning only slightly toward extraversion

over introversion, and feeling over thinking as a preferred mode of decision making,

Devon was clearly a person who used her senses to take in the world and act upon this

information, rather than an intuitive type who tended to focus on the future and see things

in patterns. This preference for sensing may have contributed to Devon's choice of

spectator sports as a hobby. Devon also strongly preferred the judging mode of

approaching life. Judges are individuals who like both planning and organization in their

world, rather than the more spontaneous perceivers who tend to remain open to changing
 143

possibilities. In fact, the MBTI describes ESFJs as warmhearted, conscientious, and

cooperative. While they desire harmony, they also feel a sense of commitment to getting

the job done, and have high standards for the work that they undertake. ESFJs notice the

needs of others, try to help them attain what they need, and by the same token, appreciate

it when others note and appreciate what they do (see Table 22).

Table 22

Devon Darrington Myers Briggs Type Indicator Results

Overall Introvert Intuition Thinking Judging

Personality or or or or
Type Extravert Sensing Feeling Perceiving
ESFJ: Slightly Moderately Slightly Feeling Very clearly
Extraverted Extraverted Sensing Judging
Sensing

Devon's scores on the MIQ also showed that she appreciated opportunities to not

only serve others, but to be recognized for a job well done. This differed, however, from

the relatively low value that she placed on status in her work, as defined by opportunities

for advancement, a desire to be an authority figure, and desire to have social status as a

result of her employment. In fact, the only attribute of this status factor that Devon placed

any value on was the aspect of recognition. Again, Devon indicated a preference for

having her contributions recognized. Another relatively important work value for Devon

was safety, defined by work in situations with fair policies, and adequate supervision and

training. Devon also ranked autonomy (defined as freedom to be both creative and make

her own decisions) as an important work value for her. Of less concern to Devon were the

attributes of comfort, defined by activity, independence, variety, good pay, and adequate
job security and working employment, and altruism, denned by the need for friends as

coworkers, doing things for others, and working in situations she viewed as ethical.

It appeared that when Devon's ESFJ personality type was considered with her

work values, Devon's work personality was one of adhering to the stated mission of her

employment, getting tasks done, and doing them well. She did not appear to second guess

or override her directives from administration. Instead, she tried to do well within the

constraints she had been given. To this end, according to the MIQ, meaningful jobs for

Devon would have included being an occupational therapist, vocational evaluator,

carpenter, mechanical engineering technician, librarian, cook, and personnel clerk. She

would not have found value in much of the work of a lawyer or family practitioner, truck

driver, airplane copilot or mechanic, or machine press operator.

Devon's performance on the ATT A showed highly developed attributes of

fluency, defined by generating many solutions to a single prompt, the attribute of

originality, defined by generating unusual or innovative solutions, and the attribute of

flexibility, defined by generating different types of solutions to a prompt. Consistent with

producing a high number of responses to prompts, Devon did not elaborate on her

responses but chose to generate them instead. This capacity for rapid, flexible, and

original thinking was more predictive of creativity than the ability to generate elaborate

but fewer responses. It may be presumed that this occurred by virtue of sheer volume.

The more responses generated, the greater the chance that one or some of them will be

creative.

As an example, when given only three minutes to respond, Devon was able to

generate fifteen different responses to a query asking her to list problems that being able
 145

to fly might engender. Devon had no advance knowledge of the nature of the question or

other test tasks. Her responses included, "to see the beauty of the world/land from

different perspectives," "to watch both kids' activities at one time," "dry eyes," and

"peacefulness." Drawn responses to a request to create a picture from incomplete line

drawings, given the same time frame of three minutes, included a person chasing a shark,

an aerial view of a person picking up trash, a Viking helmet, a jack-o-lantern, a futuristic

car, and a yield sign, amongst others. While lacking decorative embellishment, each of

Devon's images conveyed their content in easily understood renderings that were also

characterized by articulate storytelling, movement, unusual perspectives, and wry humor

(see Table 23).

Table 23

Devon Darrington Creative Strengths and Work Values

ATT A Highest MIQ Lowest MIQ MIQ Creativity

Creative Strength Work Value Work Value Value

Originality Achievement8 Statusb Average

Fluency
Flexibility

Note. ATTA=Abbreviated Torrance Test for Adults; MIQ=Minnesota Importance Questionnaire.

"Achievement is defined as ability utilization and achievement. bStatus is defined as advancement, recognition,
authority, and social status.

Devon's thoughts on creativity also reflected some of her creative strength of

fluency. She described her beliefs about creativity in occupational therapy as, "being able

to think of more than one activity or one way you could do something." She also

exemplified her tendencies toward originality when responding to a query about what she

created when she was working when she said:

 The ultimate creativity would be maybe doing a group activity where you can

involve your patient, maybe a Halloween party, which is coming up in a month or

so. How can you meet treatment goals, have fun, do something that we both

enjoy, outside of the boring what we do every day, and for them too? So that's the

ultimate creativity.

This remark was also consistent with her Myers Briggs personality type. While aiming

for an original and fun situation, she remembered her task and the goals she should have

achieved. In creating a therapy session that was fresh and different, she could honor her

employment demands, respond to her own preference for novelty but also ensure that the

process was fun for the patient. These beliefs were clearly evident in Devon's creativity

word lists, where she also emphasized fun, celebratory activities (see Table 24).

Table 24

Devon Darrington Personal and Occupational Therapy Creativity Words

Personal Occupational Therapy Practice-Related

1. Celebration 1. Outcome oriented
2. Colorful 2. Out of the box thinking
3. Fun 3. Options
4. Short term 4. Always a way
5. Never follow the recipe-totally 5. Solutions
6. Age appropriate-NOT 6. Practice=Generalization
7. Safe 7. Skill-Ability
8. Messy 8. Team
9. Sensory 9. Pushing the limits
10. Variety 10. Patient oriented

Note. To preserve the unique character of individual responses, words or phrases have been reproduced as originally
written by the participant.

Devon also reflected on the meaning of creativity in the practice of occupational therapy

when she said:

 147

I would say everybody thinks crafts; you know, making things; a product. But for

me, it's truly just thinking outside of the box to get where you want to be. And if it

was a craft, great; a game, great; a Wii®, ok. It's probably trying to get on the

same page with the patient, creatively, figuring out what makes them tick, and

what activity can you do with them. That's really when you just have to get

creative. It is not something you can read in a textbook. I learned so much more

after I got out of school... You've got to open up a little bit, and open your mind

up. Be open-minded.

Devon appeared to occasionally experience frustration when others did not hold

themselves to similar standards. While some have may have cited issues of gender,

experience, schedules, or other external realities as potential barriers to creativity, Devon,

typical of her highly developed ability to engage in fluent thinking, simply took another

path. She told the researcher, "...tome creativity is going as a team" and then utilized the

resources at hand, engaged other personnel both with and across disciplines, and even the

administration. It appeared that in her mind, utilizing creativity in therapy practice could

be the choice that could help the therapist overcome barriers to good patient care.

While she did cite issues of manpower and supplies as potential barriers to

creativity, she expressed a concern that lack of motivation on the part of staff therapists

was a greater problem. While apparently rich in material resources, therapists at her

facility were sometimes difficult to convince that use of rote, purposeless therapy

modalities such as pegs or a hand bike might have been unnecessary. In fact, she noted

incidents of low patient compliance or limited patient engagement in therapy. So, for

Devon, it was bucking the status quo that proved oftentimes difficult. Perhaps working
and living in that safe, uniform, and comfortable setting imposed its own constraints.

Devon noted this tension between safety and comfort with monotony and boredom may

have affected not only residents of the facility, but the staff, as well:

I've been practicing twenty-five years. I have seen both ends of the spectrum; new

people just out of school that aren't as creative, because they don't have as

many.. .they aren't experienced, they haven't learned as much in their bag of tricks

yet, they don't know what to do; but then you've also got the people who have

been practicing 20 years that are doing it for different motivations and aren't

creative. They're putting somebody in front of the hand bike, or restorator, or

doing pegs ad nauseum to where literally in the setting right now I have patients

in physical therapy who are saying, I'm not doing a hand bike and I'm not doing

pegs, or I'm not coming to join the activity. So, to me that's people who are not

being creative. They're doing what came easy. They didn't have to put a lot of

effort into it, and so there's a lot of that.

So, despite Devon's lovely working environment, her own intrinsic drive to do

what was right for both patients and her administrators could conflict with a culture of

bland therapy offerings. Her own preference for creating treatment sessions that engaged

and interested both herself and her patients was occasionally in conflict with this

prevailing culture and may have caused her frustration. Despite the fact that Devon

described herself as someone who went with the flow, in her mind, the course of events

should have focused on what was most helpful to the patients. The difficulties inherent in

convincing others of this may have provided Devon some of the greatest obstacles to
creativity. Devon's synthesized answers to the five research questions showed her beliefs

(see Table 25).

Table 25

Devon Darrington Synthesized Research Question Responses

1. Definition of creativity in OT over Saw OT changing over time, and saw one
time? of the greatest differences as the blurring of
professional boundaries, and the increasing
emphasis on holistic treatment
2. Definition of creativity in OT? Thinking outside of the box, increasing
enthusiasm and participation through
celebratory, joyful therapy experiences
a. Person: Flexible, laid-back thinker

b. Process: Having celebratory or fun therapy

experiences
c. Product: Treatment activities and parties

d. Press: Time, resources, management, colleagues

3. How personal creativity impacts Out of box thinking, problem solving, and
practice creativity? idea generation
4. How practice creativity impacts The personal experience of having a family
personal creativity? member receive OT had contributed to her
own role blurring.
5. Relationship of personal creativity Her preference for novelty and excitement,
to practice creativity? ability to facilitate things contribute to
work excitement, but conflict with the
status quo.

Chatee Cathy: Community Occupational Therapist

Chatee Cathy was a Caucasian woman in her fifties who served as a director of

rehabilitation for a continuum of care rehabilitation community. Ostensibly referring to a

talking doll that was popular in the 1960s, she laughingly wrote her pseudonym down for
the researcher and noted, "You'll relate to this one." Chatee graduated with a bachelor's

degree in occupational therapy and had worked as an occupational therapist for over

twenty-five years. She previously served as an occupational therapist on an inpatient

rehabilitation unit, in both outpatient neurological and long term care rehabilitation units,

and as an aquatics therapist. When she was not working, Chatee listed her hobbies as

drawing, scouting, and gardening.

Chatee's facility was located in an urban area that had consistently experienced

economic downturns and had limited political power. Consequently, the facility was

surrounded by an incongruous blend of busy church-affiliated schools, a church that

served as a community anchor, strip centers with boarded up stores, hair braiding salons,

discount stores, and a lone catfish restaurant. Clusters of African American men

congregated in the vacated store parking lots, calling to one another in greeting. Low

rider cars filled with Hispanic men slowly drove through one parking area with their

stereos turned up loud. The neighborhood pulsed with energy, and the gradually

increasing presence of uniformed children being escorted home from school by their

mothers and younger siblings contributed to the activity level. The streets of this

community were lined with large trees and older homes, some of which had been

retrofitted with frilly iron work grates on the windows and painted bright colors in the

style of old Mexico.

The facility was located in the heart of this older, comfortable neighborhood, and

the extensive heavy tree canopy and low-slung buildings gave something of an

impression of a combined summer camp and hospital complex. While clearly demarcated

from the community with fencing, the facility itself sported some of the surrounding
 151

urban shabbiness by way of its irregular parking surfaces and enthusiastic brushy plant

growth. This was offset by crisp, professional signage with references to rehabilitation,

therapy, beauty salons, and residential areas.

The therapy center was located and accessed only after multiple inquiries of

individuals in the parking lot who appeared to be visiting the facility for rehabilitation

services. Eventually the researcher resorted to following a family who knew the "back

way" to occupational therapy. After a friendly greeting from an employee with an

unknown job description, the researcher waited for Chatee in a four by six foot open

cubicle and watched the on-site beautician expertly and affectionately schedule residents

for their hair appointments.

Chatee soon arrived and warmly greeted the researcher. After answering

numerous questions posed her by other employees, she quickly strode with the researcher

through the warren-like passageways, and they eventually entered a calm, tastefully

appointed business area for rehabilitation services. Both interviews were conducted at a

conference table in an office located in the heart of this center. Chatee appeared open for

discussion and focused intently on the questions. She was relaxed and affable, speaking

passionately and forcefully in a masterful mix of vocal modulation and body language. It

occurred to the researcher that she could be a powerful public speaker. Chatee was funny

and appealing to talk with, and completed all requested tests and interviews, but there

was no doubt that she was the boss; a "large and in-charge" person.

Chatee's results on the MBTI indicated that she was an extroverted, intuitive,

feeling, and perceptive person (ENFP). Of these attributes she was most clearly an

extrovert, and to a lesser degree, preferred to take in information about her world and
 152

process it using intuition rather than responding simply to the available sensory input.

This intuitive component of the Myers Briggs is also linked by research to creativity.

According to her personality type on this measure, Chatee also processed and acted upon

information relying on her own feelings and instincts over thinking or strictly adhering to

protocol. To a small degree, Chatee tended to use perceiving over judging to guide her

actions and behaviors. The Myers Briggs describes ENFPs as warmly enthusiastic and

imaginative. By nature, they process information quickly, seeing connections and

patterns. ENFPs both want and give affirmation and support, and are known for their

ability to improvise. They are also known for their verbal fluency (see Table 26).

Table 26

Chatee Cathy Myers Briggs Type Indicator Results

Overall Introvert Intuition Thinking Judging

Personality or or or or
Type Extravert Sensing Feeling Perceiving
ENFP: Clearly Moderately Moderately Slightly
Extraverted Extraverted Intuitive Feeling Perceiving
Intuitive

Chatee's results on the MIQ demonstrated dramatic variances within work value

clusters, though she placed a low emphasis on most items. She placed high value on

security, defined as steady employment, as well as on achievement, defined as the ability

to use her abilities. Next highest (although only of moderately high importance) were

achievement, altruism in the sense of social service, and autonomy in the sense of

creativity and responsibility. Chatee placed a low value on independence, authority, and

co-workers. Taken as a whole, this indicated that while Chatee would have been satisfied

by a career in occupational therapy, she may have found even more satisfaction in those
which place a stronger emphasis on stability and comfort. These could include work as a

CPA, architectural drafter, or hotel/restaurant cook. The questionnaire suggested that

Chatee would have been unsatisfied by professions such as airline co-pilot. It predicted

satisfaction with work as an occupational therapist in particular but not with the overall

cluster of professions its values are consistent with.

The MBTI and MIQ results were consistent with Chatee's performance on the

ATT A. Chatee's creative strengths in this measure were an above average ability to create

original ideas and her flexible thinking skills. In this context, originality was defined as

production of a novel or unique response to a prompt, and flexibility was defined as

multiple types or categories of responses. Chatee's use of elaboration and fluency

(generating volumes of responses) was less evident. She did not produce a high number

of responses or embellish and "dress up" her sketches, but instead she chose to focus on

word-smithing titles for them. Chatee's verbal performances demonstrated her highest

use of creative attributes. When given three minutes to come up with a list of potential

problems that could be caused by an individual's ability to fly, Chatee posed a series of

questions related to logistics such as, "How the heck do I get groceries home?" and being

connectional in nature, considered her relationships with others, saying, "How do I get

the kids to school?" and "Maybe I want to take a friend with me. How would we be able

to talk?" She also considered other issues such as "rubber necking," air sickness, the

ability to stop without drifting, and issues related to agoraphobia, among others. These

responses demonstrated a wide range of original ideas that showed rich imagery,

emotional connections, an ability to consider future events, and her use of quick, critical

thinking. While Chatee was clearly not as comfortable with creating drawn responses to
 154

visual prompts, she again displayed her verbal fluency by creating clever titles for her

sketches, such as "goin[g] shoppin[g]" and "It's that time of year again" when referring

to a drawing with a holiday theme (see Table 27).

Table 27

Chatee Cathy Creative Strengths and Work Values

ATT A Highest MIQ Lowest MIQ MIQ Creativity

Creative Strength Work Value Work Value Value

Flexibility Achievement*1 Statusb High

Originality

Note. ATTA=Abbreviated Torrance Test for Adults; MIQ=Minnesota Importance Questionnaire.

"Achievement is defined as ability utilization and achievement. bStatus is defined as advancement, recognition,
authority, and social status

When queried about her beliefs about creativity, Chatee again reflected her

passions for service and connections. In the three months prior to the interview, she had

ceased to participate in direct patient care and had moved into a position of managing

others. However, in her mind, creativity was still a major factor in her work. Defining

creativity in work as the ability to find alternate solutions to barriers or obstacles, she

viewed creativity as an accelerant. She believed that creativity inspired loyalty, what she

referred to as "buy in," and as an element that inspires others to do their best, but she also

observed that on some occasions, creativity "probably loses the battle" in the face of

external factors such as increased work demands such as productivity standards. Other

factors could have offset these external realities, however. Laughingly referring to herself

as "an old dog," Chatee noted that having experiences in her "bag of tricks" to draw from

was one way to increase creativity. She also observed that each individual had his or her

own bank of experiences, but all, especially the inexperienced therapists, could benefit
from the knowledge and skills of others. She described how her department was designed

in a way that facilitated this type of internal mentoring:

I think we have the luxury here though, that our productivity standards are not as

great as there are in other communities, other facilities; so we do provide

opportunities for our therapists to mentor, to be mentored, to become

creative... we do a lot of internal mentoring.

The results were programs such as "lunch and learn." For Chatee, another aspect of the

development of professional creativity was the development of confidence in the

therapists. She made these observations:

If nothing else, from a Biblical standpoint, people who have some strength of

foundation that's able to trickle down to the people that they work with. And so I

do believe that we facilitate and encourage self-confidence. We actually mentor

that. We action plan that.

While facilitating growth and inspiring confidence in those around her were clearly parts

of Chatee's action plan for the facilitation of creativity in her work place, she made

another significant observation; that occupational therapists were innately drawn to the

profession in part because of a match between their individual skill sets and the task

demands of being an occupational therapist. She noted that creativity "is part of our

gifting.. .1 do think that those that are meant to be in this field actually gravitate to it."

Chatee's diverse activities and beliefs were captured in her complex lists of personal and

practice-related creativity words (see Table 28).

 156

Table 28

Chatee Cathy Personal and Occupational Therapy Creativity Words

Personal Occupational Therapy Practice-Related

1. Getting ready for Christmas 1. Ways to generate motivation with pts.
2. Cooking different dishes/foods 2. Incorporating what the pt & family do
3. Interaction with children at home (prev. living sit.)
4. Household organization 3. New ways to address old prob. (like
5. Needle work/crochet ADL's-bathing)
6. Drawing 4. Various methods to thank & recognize
7. Involvement with church staff members
8. Involvement with school and various 5. Home modification
organizations 6. Equipment modification
9. Dreaming of how to "re-do" porch area 7. Co-treat or bring other disciplines in on
and sitting areas case
10. How to convince myself to diet and 8. How to utilize life enrichment depart
exercise © (activities) to reach an outcome
9. Community outings
10. Use of groups to accomplish goals-as
well as 1 on 1 tx

Note. To preserve the unique character of individual responses, words or phrases have been reproduced as originally
written by the participant.

For Chatee, then, creativity was part of a process of becoming. The patient and

therapist both become more functional. In the case of the patient, they become more able

to engage in the things that matter most to them; resuming their lifestyle, self-care skills,

and pursuing their interests. For the therapist, it was becoming more experienced, more

confident, and more effective. Chatee saw herself as one of the factors in this dynamic

process and used the items from her bag of tricks that she knew worked. Citing images of

a tenacious bulldog that wouldn't let go, Chatee appeared to see her role of facilitation of

others as a calling. As she worked away in her modest surroundings and served the needs

of others, Chatee's passion for this calling was evident.

 As she and the researcher parted, she paused with a final reflection on her own

decision to become a therapist, "I was going to find something. So I enrolled in OT, and I

didn't even know what it was. This is my life. This is the life that was made for me. I was

incredibly lucky." Chatee's synthesized responses to the five research questions reflected

her complex views (see Table 29).

Table 29

Chatee Cathy Synthesized Research Question Responses

1. Definition of creativity in OT over Saw the use of more clinically established

time? techniques as lending OT more credibility
in the medical community
2. Definition of creativity in OT? When confronted with an obstacle, finding
alternate solutions
a. Person: Tenacious, energetic problem solver

b. Process: Encouraging confidence, buy-in, and

facilitating development
c. Product: Loyalty and buy in

d. Press: Time, resources, management

3. How personal creativity impacts Had wisdom as a result of accumulated life

practice creativity? experiences
4. How practice creativity impacts Didn't perceive this transferred from one
personal creativity? domain to the other
5. Relationship of personal creativity Kept personal life separate from
to practice creativity? professional life. Did feel her developing
personal wisdom increased wisdom related
to work.

Carlotta Gomez, Mental Health Occupational Therapist and College Instructor

Carlotta Gomez was a Caucasian woman in her fifties who had practiced as an

occupational therapist for twenty years, following an earlier career as a special educator.
 158

Carlotta shared that she selected a pseudonym that her twin sister would enjoy. She had

held a variety of positions in the field of occupational therapy, including work as a mental

health therapist on a physical medicine and rehabilitation team and as a staff therapist for

both a bone marrow transplant unit, and on oncology and palliative care units. At the time

of the interview she also served as a university instructor in a graduate-level occupational

therapy school, and had contributed chapters to books on caring for cancer survivors. She

had recently received a state award for teaching excellence and was known for her

innovative teaching practices. In her capacity as a clinician at the time of the interviews,

she worked in an on-call basis and had recently provided occupational therapy services to

three patients during their bone marrow transplants. Carlotta was known for her calm

presence and ability to maintain a client-centered focus during her occupational therapy

sessions.

For this interview, Carlotta was multitasking as usual, planning for a class

laboratory experience, eating lunch, and preparing documents for her students. She

appeared tired but willing to share her observations about creativity with the researcher.

Reflecting her multiple roles and responsibilities, Carlotta carried a number of bags with

her, each brimming with an assortment of clerical papers, books, art projects, and

weather-related items such as an umbrella and a coat. Her personal effects also reflected a

mix of interests and responsibilities; a key ring brimming with keys, hand-wrought ethnic

accessories, shoes designed for standing in for long periods of time, and a neck scarf she

knitted for herself.

While preoccupied with the tasks required for the upcoming class, Carlotta took

time to answer all queries and appeared to welcome the opportunity to sit and catch her
 159

breath for a moment while sipping a cup of green tea and attending to her lunch. Her

affable, easy-going manner contributed to a casual, reflective moment in the large, sunny,

and usually busy classroom that was nested in the snug little two-story occupational

therapy school dwarfed by a looming, powerful new hospital complex. As the interview

proceeded, students were heard in the hall, laughing and talking. Carlotta calmly locked

the door and gave the researcher her full attention. Both interviews with Carlotta lasted

approximately forty-five minutes each.

In reflecting on her own beliefs regarding the role of creativity in the practice of

occupational therapy, Carlotta repeatedly mentioned the central importance of the

individual patient and the responsibility each therapist shouldered for creatively engaging

them in the therapeutic process, and helping them to find meaningful and motivating

activities that improved their abilities and level of function. To this end, she felt one of

her own assets that was most essential to a creative, client-centered practice was the

attribute of flexibility and being able to "tap dance;" a process she likened to thinking fast

and being able to modify or adjust a therapy session when something was not working.

She offered:

I think creativity is essential because you have to be a creative problem solver.

People don't come with instructions. I think that you are constantly creatively

problem-solving. First off, how are you going to connect with the person? How

are you going to establish rapport? You really have to be able to come up with a

variety of options. I see it like it's a five-hundred piece puzzle, and you have to

put the pieces together.

 160

Beyond thinking of creativity as a process or series of responsive, client-centered

interactions that occur during occupational therapy sessions, Carlotta described the

outcomes of these sessions as not only helping the client meet their goals but also

mentioned the additional factor of the unusually high degree of intimacy that often

developed between the therapy recipient and herself. Noting several occasions when tears

and moments of great emotion had arisen during the occupational therapy sessions, not

unlike her reliance on multiple bags of supplies for any possibility, she prepared for the

same experiences in patient care.

Recalling an unusual experience when she was asked to dress up as a fortune

teller during a fall carnival for psychotic in-patients, Carlotta reflected, "I thought, good

God Almighty, how am I going to tell fortunes to psychotic people. .. .what am I going to

do that won't be totally sending people off the deep end?" Settling on the use of relatively

generic and benign horoscopes for her "fortunes," she was able to reach out to one

individual in particular who had just lost a spouse of sixty-seven years and was suffering

from debilitating depression. She said, "My fortune kind of related to the fact that he had

lost somebody, and it was a way that we could get him to talk. So, I used it in a

therapeutic way."

To this same end, Carlotta carried multiple supplies with her onto the oncology

units, preparing for any eventuality. She reflected:

.. .1 always carry with me a lot of little notepads that are a variety of kinds, so I let

the client choose something that might have particular significance to them, and I

carry around origami paper. I always carry around tools and things for the client

to engage in. So, if they are too debilitated, I will just give them a paper crane,
 161

and its significance means a lot to them. I had one patient, and when I went to see

her she said, 'Oh, are you the one who did that crane that someone had on their IV

pole? Teach me how to do that.'

Another example of the intimate situations Carlotta found herself in was the unusual task

demand of creating scrotal slings for cancer patients who were receiving treatments that

caused acites, which often cause painful scrotal engorgement that required external

support for increased comfort during movement. Typical of Carlotta, she dubbed herself

"The Scrotal Sling Queen" and easily recounted the experiences she shared with patients

in this potentially awkward predicament, saying "I think it's interesting that they thought

I would be the one who could do this." Carlotta asserted that even this humble process

involved creativity:

It involves creativity because you have to, and pragmatism, in as far as there are

so many factors you have to think about. And how fragile is their skin? Can they

put this on?.. .if they don't have support they can't walk; it's too painful. Most of

the therapists are just like, just put them in a diaper. But I am not going to put a 32

year-old man in a diaper. He doesn't want to be in a diaper.. .even an older person

chooses not to be in a diaper.

While Carlotta prided herself on flexible thinking, she also bridled under

constraints that she felt impaired her creativity. She noted her own aging as a factor in her

career, saying, "I don't have the energy to do the types of activities that I used to do, but

I'm still creative with each client," and she also noted that work and productivity

demands were sometimes daunting for her.

 162

Carlotta ranked her personality preferences on the MBTI as those of an extravert,

intuitive, feeling, and perceiving individual (ENFP), which according to the inventory is

characterized as someone who receives and interprets information very quickly, wants

affirmation from others, and is flexible and spontaneous in his or her thinking and

behavior. These characteristics were in line with Carlotta's self-reported "tap dancing"

and client-centered actions. Additionally, the Myers Briggs type indicator of "N" for

intuition also bears strong associations with creativity, operating under the assumption

that intuitive types assimilate the world and interpret it not only based upon what is

visible to the eye, but also on those things that remain unseen, and perhaps not clearly

understood. According to her self-report on this measure, Carlotta relied heavily on this

characteristic of intuition, as well as having an equally strong preference for dealing with

her world using feelings rather than thinking, meaning that her actions were based on

values and her own beliefs, rather than by rule-bound logic or objective analysis of the

available facts (see Table 30).

Table 30

Carlotta Gomez Myers Briggs Type Indicator Results

Overall Introvert Intuition Thinking Judging

Personality or or or or
Type Extravert Sensing Feeling Perceiving
ENFP: Very clearly Clearly Very clearly Moderately
Extraverted Extraverted Intuitive Feeling Perceiving
Intuitive

Carlotta's interviews were also consistent with her findings on the MIQ, where

she rated the need for business and technical supervision to be relatively unimportant for

her. Consistent with the generic profile of an occupational therapist, she also expressed
 163

high value on not only having employment that utilized her abilities but that recognized

her contributions. She also reported placing value on employment that honored her need

to follow a strong moral code; one that emphasized the patient and the services that they

needed. In the tradition of providing grass roots care, she placed relatively low value on

needing to be in a comfortable job that provided her with status. Instead, she placed value

on autonomy, preferring the opportunity to create new ideas and make decisions for

herself. These values were consistent with those of most occupational therapists, and like

her peers, Carlotta's performance on the MIQ showed that she placed a high value on the

traits that emphasized achievement, autonomy, and to a lesser degree, altruism.

Conversely, professions that rely solely on comfort, as defined by compensation,

security, and working conditions lacked appeal for Carlotta, and amongst other careers,

the MIQ suggested that she would have been unhappy as an assembly worker or a person

who toiled in isolation. Carlotta's work was defined by its human interface.

Carlotta also completed the ATT A and showed unusually high abilities in the

creative attributes of originality as defined by the producing something unique or

different, fluency as defined by the process of generating a volume of relevant responses

or ideas, and flexibility as defined by a process of gathering information and processing it

in multiple ways. Nearly equal to these attributes was her performance on tasks that

require the element of elaboration, defined as the ability to move an idea beyond a core

concept, and to embellish it with detail. Additional scores on this measure noted that

Carlotta showed exceptional talents in figurative creativity (see Table 31).

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Table 31

Carlotta Gomez Creative Strengths and Work Values

ATTA Highest MIQ Lowest MIQ MIQ Creativity

Creative Strength Work Value Work Value Value

Fluency Achievement3 Comfort" High

Originality
Elaboration
Flexibility

Note. ATTA=Abbreviated Torrance Test for Adults; MIQ=Minnesota Importance Questionnaire.

"Achievement is defined as ability utilization and achievement. bComfort is defined as activity, variety, compensation,
security, and working conditions

In general, Carlotta's views about and aptitudes for creativity in the practice of

occupational therapy were characterized by observed and reported elements of her

personality and their responses to the demands not only of tasks to be met but also by

what the environment could have afforded her. She acknowledged her own aging process

and waning energy as undeniable factors but also possessed large measures of the

attributes of flexibility, originality, and fluency. These attributes have provided her with

the ability to meet challenges in ways that allowed her to function as an occupational

therapist in a significant, client-centered way. Meeting these challenges, in turn, gave her

a source of meaning and pleasure. Her ability to "go with the flow" and her recognition

and respect of the individual differences in humans provided her with a calling card in

occupational therapy sessions that provided both safe and effective care for others.

Carlotta's beliefs were echoed by the creativity words she provided (Table 32).
 165

Table 32

Carlotta Gomez Personal and Occupational Therapy Creativity Words

Personal Occupational Therapy Practice-Related

1. Joy 1. Challenge
2. Freedom 2. Problem solving
3. Artistic Expression 3. Innovation
4. Energy 4. Engagement
5. Flow 5. Therapeutic use of self
6. Self-expression 6. Joy
7. Vibrant colors 7. Connection
8. Life force 8. Meaningful
9. Meaning 9. Purposeful
10. Communication 10. Successful

Note. To preserve the unique character of individual responses, words or phrases have been reproduced as originally
written by the participant.

Her enthusiasm for many ideas and activities could have proven to be a detriment

when she got involved in more activities than she could comfortably manage, and yet her

diverse experiences and exposure to different cultures gave her a wide base of knowledge

and experience to draw from. These skills enabled her to provide creative occupational

therapy services that gave her a sense of meaning and pleasure, in a sustaining and

enriching manner. Carlotta's synthesized answers to research questions showed this (see

Table 33).
Table 33

Carlotta Gomez Synthesized Research Question Responses

1. Definition of creativity in OT over Saw the gradual evolution away from Arts
time? and Crafts movement as beginning of the
conflict between artisan and science that
still continues
2. Definition of creativity in OT? Addressing each individual and coming up
with what motivates them, and
collaboration

a. Person: Flexible thinker

b. Process: Collaboration and engagement

c. Product: Both objects and intangibles

d. Press: Patient status, management

3. How personal creativity impacts Was able to see the big picture, and was a
practice creativity? problem solver
4. How practice creativity impacts Learned new skills at work, then wanted to
personal creativity? try them at home
5. Relationship of personal creativity Saw that creativity was a way of centering
to practice creativity? herself and being present in the work
environment.

Bea Devil: Associate Professor of Occupational Therapy

Bea Devil was a Caucasian woman in her sixties who has been practicing as an

occupational therapist for forty years. Smiling broadly while selecting her pseudonym,

Bea appeared to enjoy the verbal parallel of Bea Devil to the verb "bedevil," which is

associated with causing problems or irritation. During this interview, she expressed

surprise that she had been working so long in one field, especially as an academic. Bea

had not only worked as an associate professor but had immersed herself in the workings

of the university system, serving on numerous university-wide committees, school of

occupational therapy committees, and campus committees. She was known for a

tenacious, non-nonsense style and sharp legal mind when it came to interpreting and then

recommending application of policies and procedures. Bea's commitments extended

beyond the university, and as a result of the capacities she had served in the

organizational bodies of the profession of occupational therapy, she had earned the

honorary distinction of FAOTA; a Fellow of the American Occupational Therapy

Association. Beyond her professional responsibilities, Bea also served her community

and church, and maintained an active interest in the lives of refugees living in

neighborhoods around the occupational therapy school, in the United States, and in other

lands. To this end, she had worked in Central America as a health care missionary with

her husband and church members. She maintained an avid interest in culture and health

care, celebrated her own Middle Eastern heritage, and enthusiastically embraced the

event of her daughter's marriage into a family of Hispanic descent.

This interview occurred in the researcher's university office at the end of a work

day. Bea, known for her abundant energy, surprised the researcher by settling into the

reading chair, sitting quietly for a moment, then saying the chair was comfortable enough

to nod off to sleep in. As usual, Bea had spent her day managing the needs of various

student research groups, tending to computer and paperwork, and teaching. The tone of

the interview was relaxed and reflective, and Bea appeared to openly and thoughtfully

address each question, and complete all self-reports and the ATT A, smiling wryly as she

finished each of its timed items.

According to her self-reporting on the MBTI, Bea was an extraverted, intuitive,

thinking, and judging type (ENTJ), which is typified as someone who is a frank and
decisive leader. According to the MBTI, ENTJs are also seen as individuals who excel at

long-term planning and make their focused decisions based upon research findings. To

this end, ENTJs are also assertive in stating their opinions and stance derived from this

information (see Table 34).

Table 34

Bea Devil Myers Briggs Type Indicator Results

Overall Introvert Intuition Thinking Judging

Personality or or or or
Type Extravert Sensing Feeling Perceiving
ENTJ: Clearly Moderately Moderately Very Clearly
Extraverted Extraverted Intuitive Thinking Judging
Intuitive

This description was also consistent with observations of Bea's working style and

with her results on the MIQ, so Bea's results on this measure were considered to be a

strongly accurate reflection of her work-related values. Bea placed a high value on

working in a career which provided her with an opportunity to use her skills, and that also

provided her with a feeling of accomplishment. Ideal for Bea would have been working

in a setting that upheld strong moral values that emphasized service to others, and where

coworkers could and would be her friends. To a moderate degree, Bea also placed value

on careers that provided opportunities for advancement, personal recognition, and

accorded her a degree of social status. Bea also placed a moderate value on autonomy,

which the MIQ characterized as creativity and the freedom for an individual to make his

or her own decisions. Conversely, the need for comfortable work reportedly held minimal

value for her. Comfort was defined in this context as an amalgam of activity,

independence, variety, adequate compensation, and steady employment. Of all these

comfort-related factors, the only aspect that she appeared to place fairly high priority on

was that of good working conditions. Examples ofjobs that have a strong emphasis on

the work values that Bea held include jobs such as being an occupational therapist, a

secondary school teacher, and a fire fighter. Bea would not have found fulfillment in

solitary, repetitive jobs such as being a metal patternmaker, tool-and-die maker, or a

production assembler.

Bea's performance on the ATT A demonstrated her exceptional application of the

creative attributes of fluency, originality, and flexibility when solving problems.

Flexibility was conceptualized as the ability to process information in a variety of

different ways, and described types of performance ranging from verbal (written

responses to story prompts) to figurative (drawn sketch responses to picture prompts). In

Bea's case, her figural responses to prompts, while lacking in artistic sophistication,

reflected an ability to see things from many perspectives and in a variety of different

ways. Originality was defined here as the ability to generate novel or new ideas or

objects rather than more common solutions, and fluency as the ability to create many

solutions, ideas, or plans, as well as represent verbal or drawn responses. As an example

of her integration and application of these three processes, Bea was presented with a

schematic representation of nine equilateral triangles and given three minutes to develop

as many titled drawings using these triangles as she was able to. Bea immediately

combined and converted the triangles into a birthday hat, clothing worn by a girl named

Jane who was on a walk, a three dimensional pyramid, a spinning top in motion, a woven

cloth pattern, flying kite complete with moving tail, and an antique Shiny-Brite®

Christmas ornament.
 170

While Bea excelled in her fluency, originality, and flexibility in her drawn

pictoral responses, her utilization of the attribute of elaboration, defined as the ability to

embellish core or central ideas with detail, was in an average range. It is difficult to

produce both a high volume of responses to a prompt in addition to embellishing it; there

simply may not be enough time for both. In Bea's response to this task, she opted for

generating multiple, unrelated ideas versus elaborating on one or a few of them. There is

a greater mathematical probability that at least one idea may be creative when the sheer

volume of responses is relatively high whereas elaboration of any single idea may not

improve its level of creativity, potential only increasing its complexity instead.

Bea utilized additional methods frequently noted as creativity indicators including

unusual visualization, defined as seeing things from multiple perspectives instead of all

images being perceived from a traditional vantage point, a resistance to premature closure

in drawings as demonstrated by leaving elements open for potential additional detailing,

the use of movements or sound such as seen in the spinning top, swishing kite tail, and a

walking Jane, and drawings and written responses that evoke expressions of feeling and

emotion, such as the potential for a sentimental response to seeing the antique Shiny-

Brite® Christmas ornament or a smile evoked by seeing the birthday boy happily

wearing his equilateral triangle birthday hat.

While Bea showed less creative written responses to a story prompt asking her

thoughts on potential problems that would be caused if she could fly, her responses did

evoke emotions and feelings through her mention of feeling ungrounded and dizzy, and

she used rich, colorful imagery when she expressed concerns about free, uncontrolled

floating. Perhaps Bea's most telling written response to the potential problems caused by
 171

her being able to fly was her concern that she would be unable to connect with others.

This was consistent with Bea's performance on the MIQ when she placed a high value on

her connections with coworkers and voiced her altruistic interests, and was also reflected

by her stated concerns for refugees, her interactions with her occupational therapy

students, and her participation in varied social, professional, and civic activities (see

Table 35).

Table 35

Bea Devil Creative Strengths and Work Values

ATT A Highest MIQ Lowest MIQ MIQ Creativity

Creative Strength Work Value Work Value Value

Fluency Achievement3 Comfort" Average

Originality
Flexibility

Note. ATTA=Abbreviated Torrance Test for Adults; MIQ=Minnesota Importance Questionnaire.

"Achievement is defined as ability utilization and achievement. bComfort is defined as activity, variety, compensation,
security, and working conditions

In response to queries about her how she believed her personality contributed to

her creativity at work, Bea cited her energy level and passion. Noting her preferences for

novelty, Bea recalled a strategy she used when bounded by tasks requiring frequent

repetition:

I like new challenges. I am always looking for new things to learn about.. .1 get

bored doing the same things... [and] if I have to do the same thing, I try to do it in

a different way. So.. .the creative part of it is looking for different ways, and that

probably goes with [a preference for] diversity.

When pressed further, Bea went on to state that her beliefs in creativity differed

from many of the more traditional views of creativity as a process associated with art
materials. She emphasized instead that problem solving and generating novelty were

more closely aligned with her beliefs. For her, the process of creating meant coming up

with new ways to teach students, or how she might have created an environment that

fostered change or facilitated growth. In her words, creativity was, ".. .looking at how to

change the generic and individualize it in some kind of way [and] apply it. It's real

important to me in creativity that there is an application piece. So you don't just pop it

out." This was also evident in her creativity word list (see Table 36).

Table 36

Bea Devil Personal and Occupational Therapy Creativity Words

Personal Occupational Therapy Practice-Related

1. Flexible thinking 1. Problem solver
2. Freedom to choose 2. Person, environment, occupational
3. Moving forward/change analysis
4. Adapt 3. Perceptive
5. New options 4. Integration of more than one factor
6. More than one way 5. Innovator
7. Diversity 6. Adaptation
8. Experimentation 7. Flexible
9. Doing- 8. Client centered
10. Mixing & matching 9. Context related
10. Patterns

Note. To preserve the unique character of individual responses, words or phrases have been reproduced as originally
written by the participant.

Later she elaborated further on this concept, saying that for her creativity was a

process that she could use to help her see things differently, or, in her words, through a

different lens, enabling students to get what she referred to as "a three dimensional

approach to things."

The themes of a preference for novelty, energy, independent thought, expertise,

and unique point of view characterized many of her observations about creativity. Noting
 173

her forty years of experience, she laughingly explained that as an occupational therapist

with such a long work history, "Well, you have a lot to talk about when you do it for a

long time.. .You've got lots in your bag of tricks..." and she also pointed out how she had

integrated creativity with her preferences for diversity over time, saying, "I'd rather meet

at a coffee shop on some occasions versus the board room on others. And I do that. I meet

in different contexts."

In terms of how she described the impact of energy on creativity, Bea noted the

distinction between primary energy and secondary energy. Her belief was that primary

energy was devoted to attending to a set task and that secondary energy could have been

a process that supported creativity, if circumstances allowed it. In Bea's mind, the

introduction of stress into completion of a task was detrimental to creativity, pulling

secondary energy away from it and marshalling the energy toward other purposes such as

reducing stress, responding to autocratic demands from various authority figures or

outside sources, or managing other constraints. For Bea, creativity was a process that

emerged and could not be forced. Because she also felt creativity manifested itself in

ways that were specific to a person's learning style, in Bea's case, she reported that her

creative energy felt kinesthetic. This may have contributed to her frequent mention of

energy and passion when discussing her experience of creativity.

An interesting aspect of Bea's beliefs in creativity came from her observations

about the potential aspect of "hard wiring." Believing that her own creative energy came

in part from her ancestors, Bea noted, "I think being creative is being uniquely yourself

or different..." and mentioned her own Middle Eastern and gypsy heritage, saying:
 174

Well, I think there's probably a genetic program for creativity. I think there's the

nomad in me that comes from a genetic piece that somehow goes way back. And

there's the batterer; I'm always looking. I think those are genetic traits, where

people are going, "You do this. I'll do that. How about this? What about

that?".. .Always having more than one way to solve the problem or reach the goal.

And that bartering aspect of it I think is genetic, and I think the nomad aspect of it

is to pick up your tent and go somewhere else.

At the end of the queries, Bea again took a moment to reflect on her own career as an

occupational therapist. As she concluded her first interview, she recalled her experiences

as an occupational therapy work evaluator and reminisced:

How do you take a person's assets and match them up with the demands of the

job? It requires you to have to create the environments and new activities, and.. ..I

was pretty good at that. So that was the creative part; matching people's assets

with the demands of the job. You did the activity analysis, breaking it down, [and]

fitting the pieces into a whole. That part was from a mechanical basis rather than

an artistic basis. You know, people fit better in one environment over another.

Matchmaking; instead of colors, I am matching occupations.

Bea's synthesized answers to the five research questions demonstrated her strong beliefs

and ideas about occupational therapy and creativity (see Table 37).
Table 37

Bea Devil Synthesized Research Question Responses

1. Definition of creativity in OT over Saw the gradual evolution away from Arts
time? and Crafts Movement as the beginning of
the conflict between artisan and science
that still continued
2. Definition of creativity in OT? Addressing each individual and coming up
with what motivates them, and
collaboration

a. Person: Passion and energy, preferred novelty

b. Process: Collaboration

c. Product: Engagement

d. Press: Tine, resources, culture, government

3. How personal creativity impacts Was able to see the big picture, and was a
practice creativity? problem solver, a visionary
4. How practice creativity impacts Experienced stress, but collaborated with
personal creativity? creative colleagues
5. Relationship of personal creativity Saw the need for research
to practice creativity?

Conclusion

These case reports explored the rich, complex careers of each of the research

participants and her beliefs about creativity. These case reports also demonstrated how

each participant was reflective of her own culture and workplace environment, and

showed how her unique perspectives on life and work, along with her own developmental

processes, all uniquely contributed to beliefs about creativity and occupational therapy.

Chapter Five presents the synthesis of all participants' case reports and the threads

that tied them together, remained separate, or became tangled. It examined the
participants as a group, and explored their commonalities as well as their differences.

Chapter Six synthesized the data from both case by case and cross case analyses, formed

new analytic categories, and made recommendations for future research based on

understandings that resulted from the findings of the new categories.

 Chapter 5

CROSS CASE ANALYSES

Introduction

To better understand participants as a group, this chapter utilizes a cross case

analysis format to describe the aggregated demographics of age, ethnicity, practice site,

career length, self-report, and creativity assessment data. After a brief description and

tabular representation of the aggregated participant data, each of the five research

questions is examined individually utilizing grouped participant response trends.

Each set of findings is followed by a table representing the key points of

information with a preliminary analysis for each question. Sources of information used to

answer each of the research questions are as follows:

Research question one regarding the participant's perception of creativity

changing in the context of occupational therapy over time presents only data from the

participants' responses to the query, "Last time we spoke, we discussed creativity in the

practice of occupational therapy. How do you think definitions of creativity in the

practice of occupational therapy have changed over time?"

Research question two sought to determine participants' definitions of creativity

in occupational therapy. As the broadest of the five research questions, the findings and

analyses of this question are drawn from all interview queries related to the theoretical

framework of person, process, product, and press.

Research questions three, four, and five explored the relationship between

occupational therapy and the participant, and analyzed only the participants' responses to

the specific queries for each question that were put to them.

177
 178

For research question three, participants were asked, "In what ways do you feel

your own personal creativity impacts your practice of occupational therapy?" For

question four, participants were asked, "In general, what is the impact of occupational

therapy practice-related creativity on you?" and, "Specifically, what is the impact of

occupational therapy practice-related creativity on your personal creativity?" For

question five, participants were asked, "Overall, how would you describe the relationship

between your personal creativity and your occupational therapy practice-related

creativity?"

For this cross case analysis, the researcher did not draw inferences unrelated to

the direct responses to these queries or incorporate data from other responses, self-

reports, or assessments for questions three, four, and five.

For each of the five research questions, emergent patterns in the participant

responses were explored. Following each of the questions' findings and preliminary

analyses, key points were presented in tables. Chapter Six follows and concludes the

research with summative findings, analysis, synthesis, conclusions and recommendations.

Demographic Data

Each participant's age, ethnicity, practice area, career span, creative style, work

values, and personality type are presented in this chapter (see Tables 38, 39).

Coincidentally, certain patterns emerged that easily lent themselves to groupings and

patterns but by virtue of their overlapping similarities also created interpretive

difficulties. It became difficult, for example, to isolate the effects of chronological age

from the length of a participant's career span because both followed similar trajectories in
this study's participant sample. It may have been misleading to associate certain factors

with specific demographics simply because they paralleled one another.

For the nine participants of this study, their grouped ages also paralleled

groupings of participants into practice areas, making it hard to determine whether

findings represented the attributes of the participants' practice area, their age, or their

career length. Boriqua and Countessa, two of the hospital therapists, had more variability

in their patterns of responses than most of the other participants, which may have been a

reflection of their maturing from novice therapists into expert therapists.

Likewise, Carlotta, while a participant in her fifties, often reflected trends that

were noted in younger therapists, such as her preference for creating objects in addition

to creating intangible outcomes. These trends might have reflected her recent maturation

past the novice level into the exert level. While some developmental trends varied some

patterns could still be ascertained.

Other factors may were not accounted for by this study but raised interesting

questions such as: Did ethnicity impact performance on self-reports, assessments, or

during interviews? Would participants with different ethnicities have reported different

beliefs or values if they worked in the same practice areas? Would expert or novice skill

levels in a practice area have reflected different beliefs or performance? Would men have

had the same perceptions as the women in this study? These questions hold promise for

future replications of this and other related studies.

Demographic data, finding one.

Participant demographic data fell into patterns based on ethnicities, practice area

(see Table 38), creative strengths, and work values (see Table 39).
 180

1. The youngest four participants represented three ethnicities, whereas the oldest

five were all Caucasians.

2. The youngest two participants were education-based therapists, followed in

ascending age order by the three hospital therapists, the two community

therapists, and two therapists that represented mental health and/or academia.

3. The younger participants manifested their creativity in a fewer ways than the

older participants, who manifested their creativity using a combination of creative

strengths.

4. The education-based participants both placed a high work value on achievement

and low work value on safety. The hospital-based participants placed high work

values on altruism and safety, and low work value on status. The community and

mental health and/or academic participants placed a high work value on

achievement and low values on status (community therapist participants) and

safety (mental health and/or academia).

 181

Table 38

Participants' Demographics

Age Range Ethnicity Practice Career

Area Span
Lynn 20-29 Asian Education 1-9
Tran

Jennifer 30-39 Latina Education 10-19

Lopez

Carrie 30-39 Caucasian Hospital 10-19

Jones

Boriqua 30-39 Latina Hospital 10-19

Nayali

Countessa 40-49 Caucasian Hospital 20-29

Charles

Devon 40-49 Caucasian Com- 20-29

Darrington munity
Chatee 50-59 Caucasian Com- 20-29
Cathy munity

Carlotta 50-59 Caucasian Mental Health/ 20-29

Gomez Academia

Bea 60-69 Caucasian Academia 40-49

Devil

Demographic data, finding two.

Participant demographic data did not fall into patterns based on personality type and

the creativity work value (see Table 39).

a. Collectively, four participants placed a high work value on creativity, and five placed

an average value on creativity. No participants placed a low value on creativity.

b. As a whole, the following participant information was derived from the personality

types. According to the Myers Briggs Type Indicator (MBT1) there were six extraverts
 1

and three introverts, seven intuitives and two sensors, eight feelers and one thinker,

and six judgers and three perceivers

Table 39

Participants' Creative Strengths, Work Values, and Personality Types

Creative Highest Lowest Creativity Personality

Strengths Work Work Work Type
Value Value Value
Lynn Originality Achieve- Safety Sensing
Tran ment Introvert
Average
ISFJ
Jennifer Elaboration Achieve- Safety Intuitive
Lopez Originality ment Extravert
High
ENFJ
Carrie Elaboration Altruism Status Intuitive
Jones Flexibility Introvert
Average
Fluency INFJ
Originality

Boriqua Flexibility Altruism Status High Intuitive

Nayali Originality Extravert
ENFP
Countessa Originality Safety Status Average Intuitive
Charles Introvert
INFJ
Devon Fluency Achieve- Status Average Sensing
Darrington Originality ment Extravert
Flexibility ESFJ
Chatee Flexibility Achieve- Status High Intuitive
Cathy Originality ment Extravert
ENFP
Carlotta Elaboration Achieve- Comfort High Intuitive
Gomez Fluency ment Extravert
Originality ENFP
Flexibility
Bea Flexibility Achieve- Comfort Average Intuitive
Devil Fluency ment Extravert
Originality ENTJ
 183

c. Creative strengths were also broken into the components defined by the ATT A for

further analysis and showed that the creative strength of originality was present in all

participants' responses. The creative strengths of elaboration, flexibility, and fluency

were more broadly distributed amongst the participants, but all the expert participants

possessed the creative strength of flexibility (see Table 40).

Table 40

Participants' Creative Strengths Measured by the ATT A

Elaboration Flexibility Fluency Originality Total

Strengths
Lynn 1
Tran
Jennifer 2
Lopez
Carrie x x 4
Jones
Boriqua x 2
Nayali
Countessa 1
Charles
Devon x 3
Darrington
Chatee X 2
Cathy
Carlotta 4
Gomez
Bea 3
Devil
 184

Question One

How have definitions of creativity in the context of occupational therapy changed

over time?

Question one, finding one.

Participants' lack of uniform terminology for both creativity and occupational

therapy contributed to an unclear picture of the definitions of creativity in the context of

occupational therapy over time (see Table 41). Most of the participants made references

related to the evolving definitions of creativity, occupational therapy, professional

boundaries, and social contexts. Bea expressed doubt as to whether creativity has been

considered as a trait within occupational therapy when she said, "I'm not sure that we

even define it, you know, as a trait within occupational therapy... I don't know that it

jumps out at me."

In considering definitions of creativity in the context of occupational therapy,

participants likened it to the following: Playfulness (Bea), artistry (Boriqua), changing

(Boriqua), being childlike (Countessa), blurring boundaries (Devon), and holistic practice

(Devon). Definitions of occupational therapy also reflected this variability. Participants

described occupational therapy as returning to client-centeredness (Carlotta), changing

incredibly over the last fifty years (Chatee), becoming more biomedical (Countessa),

changing over the last twenty years (Countessa), and becoming more functional and

purposeful (Chatee and Devon).

Question one, finding two.

Most of the participants used medical, scientific, technological, and research-

oriented points of reference when they described the definitions of creativity in the
context of occupational therapy over time (see Table 41). In turn, their own beliefs about

medicine, science, technology, and research colored their views regarding the definitions

of creativity in the context of occupational therapy over time. Perhaps associating

creativity with artistry, Bea firmly noted that, "You do science: the art falls off," but

Carlotta reflected on a broad historical context, and attempted the capture the

multifaceted nature of science by saying, "We went on into the Scientific

Revolution.. .where we tended to see things in black and white," and then countered her

own statement with, "Living with a scientist, I have learned there is an aspect of

creativity to that, too."

Chatee raised another timely issue, saying that use of clinically established

techniques had increased occupational therapy's credibility in the medical community.

While her response was in relation to creativity and occupational therapy, it was unclear

if she was also inferring that creativity had diminished occupational therapy's credibility,

but it did echo Perrin (2000), who noted that, ".. .there is, clearly, still a great deal of

embarrassment at (allegedly) being perceived by the lay person as basket weavers and

fluffy bunny makers" (p. 129).

Countessa also made medical references when she considered the changing

historical context of occupational therapy, saying she felt that occupational therapy had

lost its focus on creativity and moved toward a biomechanical approach. Leaning more

toward technology as a point of reference, both school therapists Lynn and Jennifer

expressed beliefs that technology had changed their practice skills, replacing creative

media use in occupational therapy.

 186

Question one, finding three.

Regardless of their points of view regarding medicine, science, technology, and

research, all participants expressed a belief that creativity in the context of occupational

therapy over time was changing (see Table 41). All participants felt that creativity, when

viewed in its earliest, traditional incarnation of craft use and play/leisure-based activities

in occupational therapy was less evident in the profession now. Boriqua noted, "I think in

general that OT as a whole is moving away from that kind of creative background." This

was echoed by comments from Chatee, while Countessa speculated on whether linkage

remained between creativity and crafts in contemporary occupational therapy school

curricula by saying, "I don't even think in OT school they are teaching some of the crafts

like that anymore."

Again, school therapists Jennifer and Lynn both considered technology in

reference to changing definitions of creativity. Jennifer said, "And now, creativity may be

more like checklists, more of the essence of using the computer ...more technology

versus the actual raw materials that we used," and Lynn followed with a related thought

regarding the changing interests of occupational therapy consumers when she reflected,

"Back then they had to use a lot of games and a lot of gross motor activities like ball play,

and kids.. .enjoyed them more. And then now, kids enjoy more video games and

computer time, and so I think it's changed a lot."

Question one, finding four.

The influences that impacted participants' work experience also influenced their

views of the definitions of creativity in the context of occupational therapy over time (see

Table 41). Participants expressed a wide range of perceptions regarding the potential
 187

influences on creativity including third party payment (Boriqua and Carrie),

documentation (Boriqua), productivity (Carlotta), management (Countessa), resources

(Carrie, Jennifer, and Lynn), technology (Jennifer and Lynn), role flexibility (Chatee and

Devon), and therapist autonomy (Carrie and Chatee).

Generally, participants did not emphasize whether the cited influences had

negative or positive effects on the definitions of creativity in the context of occupational

therapy over time. Participants working in different practice areas also cited different

influences on the definitions of creativity in the context of occupational therapy over

time:

a. School (Jennifer, Lynn): Resources and technology

b. Hospital (Countessa, Carlotta, Boriqua, and Carrie): Documentation, third party

payment, and productivity

c. Community (Chatee and Devon): Role blurring, autonomy, flexibility.

d. Mental health and academia (Bea and Carlotta): None noted

Question one, finding five.

Trends in participants' perceptions of definitions of creativity in the context of

occupational therapy over time appeared to vary by their age or career span (see Table

41). Consistent with Rogers' (1982) concept of generation units, without knowledge of

each other, the younger participants reflected their shared cultural experiences of growing

up in an age with ready access to technology by citing influences such as available

resources. They also had a more limited recall of their own positive or negative

experiences with the creativity, artistry, and craft in the practice of occupational therapy

than the older participants did. Novices discussed technology as a normal, motivating,
 188

and beneficial component of the practice of occupational therapy for both client and

therapist.

In contrast, expert therapists emphasized influences such as being accorded

occupational therapy role flexibility, autonomy, and credibility, recollected their own

experiences with creativity, artistry, and crafts, whether positive or negative, and recalled

themselves or others gravitating to the profession of occupational therapy because of

opportunities to participate in creativity, artistry, and crafts. These participants

specifically mentioned the loss of the utility of the applied modality of creative, artistic,

and craft activities. Significantly, they did not discuss technology.

Question one, analysis.

1. The participants did not reach consensus regarding the definition of creativity in

the context of occupational therapy over time, largely due to ambiguous or

inconsistent use of terminology. Because creativity research and the profession of

occupational therapy were both undergoing rapid change due in part to improved

research methodology, changing social and political climates, and developments

in technology, this is unlikely to change. Definitions will continue to evolve, and

not necessarily in tandem with one another.

2. The participants seemed to have ambivalent feelings about creativity and

occupational therapy in relation to medicine, science, and research. While they

described their chosen profession of occupational therapy in relationship to

medicine, science, and research, they also indicated that creativity seemed to

represent the antithesis of medicine, science, and research. Carlotta, as the only

participant who said anything to counter this, expressed a differing viewpoint that
 189

stemmed from her life spent with scientists. However, even she expressed the

belief that science opposed the flux that creativity embraced, calling the Scientific

Revolution a time when things were seen in black and white. Chatee's remark that

the professional trend toward occupational therapists becoming research-based

practitioners had given occupational therapists more credibility implied that

creativity might make the profession seem less credible.

3. The participants did not appear able to separate their own professional realities

from their perceptions of a larger historical context. Although the university

professors discussed creativity in a broad historical context, Carlotta, the

university instructor who also worked in mental health, fell back on her real-life

hospital experiences when citing productivity demands as an influence on

creativity in the context of occupational therapy over time. This was also

particularly true in regards to the use of technology when Lynn stated a belief that

"It's normal to think of technology."

4. Another less clear but potentially significant finding that emerged from these

participant responses were their views regarding the development of professional

autonomy and of role blurring. The therapists who mentioned those influencers

were expert-level supervisory therapists who practiced in work settings that had

less physical separation from speech and physical therapists, which typified the

disciplines that occupational therapists reported experiencing role diffusion with.

5. An emergent finding was the impact of choice and framing of circumstances.

What one participant construed as an impediment to creativity could be seen as a

benefit by another. The participants maintained a fairly neutral stance and

remained objective regarding the topic of how cited influences impacted the

definition of creativity in the context of occupational therapy over time. This was

consistent with occupational therapists' training on reporting findings objectively

(see Table 41).

Table 41

Question One: How Have Definitions of Creativity in the Context of Occupational

Therapy Changed Over Time?

Changing Beliefs About Changes Press

Definitions Occupational Over Time
Therapy
Lynn Technology had Changes caused Technology
Tran changed skills by cultural values
and technology
Jennifer Creativity Technology had Resources
Lopez replaced materials Technology
Carrie OTs had more Physical
Jones autonomy Resources
Time
Reimbursement
Boriqua Artistry Artistry was not OT was moving Reimbursement
Nayali Creativity used much, from creativity, Documentation
Professional Creativity was Creativity used Task demands
roles site specific, less,
OT drew Creativity seen
creatives but not
documented
Countessa Creativity Crafts and OT had changed Management
Charles creating were in 20 years, OT school
not allowed OT was more curricula
biomechanical,
Chatee Professional Clinical OT had changed
Cathy roles techniques lead in 50 years,
to credibility Historical
OT was context,
functional OTs had more
flexibility
Devon Professional OT was
Darrington roles functional

Carlotta Science OT was client Changes caused Productivity

Gomez centered by cultural values demands
and historical
contexts
Bea Creativity Art vs. science
Devil Systematic
research vs.
creativity

Question Two

How do occupational therapists define creativity in the context of occupational

therapy?

Question two, finding one.

Participants' definitions of creativity varied relative to their age and years of

experience. In regards to the person component of the person, process, product, and press

framework, younger participants mentioned fewer personal attributes related to creativity

than older participants did. Younger participants mentioned their flexible thinking style,

calm demeanor, energy levels, and problem solving abilities. In reflecting on her work as

a school therapist, Jennifer pointed out that:

.. .if you have an easy-going personality, I think that it runs through the patients

that you have in order to work on things that are difficult. Or if you can't solve

something, [then] that personality is going to help you and you're going to go a

long way. If you have a personality that you get upset really fast or just can't deal

with that, then you're not going to have students actually work with certain things.

They'll give up right away.

Another of the younger participants, Boriqua, also reflected on the tasks she engaged in

as part of her work as a hospital therapist and said:

And for my own personality, I'm not the most organized person [laughs], but I

know where everything is. .. .I'm a little bit more of that artsy type. I have a good

balance of being an analytical math type that I can problem solve things
 concretely. But, I love to work with my hands and to make things, so the minute

something doesn't work the way I want it to, I'm thinking how can I rig this up or

make something else that will work?

Older participants mentioned the same attributes and also included beliefs about

how their preferences for novelty, diversity, and avoiding boredom contributed to

creativity. Carlotta said:

I'm not rigid. I can go with the flow. I can think on my feet, and especially when

you know something's not working. I can adapt or modify it to change it.. .Being

busy all the time? Not a priority. Because most of the times I'm too busy all of the

time.

As the oldest participant, Bea provided a summative statement of the impact of

personality on creativity that was representative of all the older participants' responses

when she said:

I'm a good problem solver. If you say problem solver, it puts it in a different

context, a different frame of reference. I like to solve certain problems.. .problems

about people; I don't like to solve mathematical problems. When you say

problem-solving, you have to put it in context. You know, I like to

experiment.. .there are certain things I like to do in set ways, and there are other

things that that I don't like to have to be that detailed about. Fluidity I think, and

creativity may be a cross-context; it's really what makes for a creative person. So

that's in context and not with media.

 Devon, when considering her workplace and its task demands, seemed to imply

that she felt creativity was a process of maturation when she expressed disappointment

with some of her coworkers:

I have seen both ends of the spectrum, new people just out of school that aren't as

creative, because.. .they aren't experienced. They haven't learned as much in their

bag of tricks yet. They don't know what to do. But then you've also got the people

who have been practicing 20 years that are doing it for different motivations and

aren't creative.. .very experienced and seasoned therapists, but they're not being

creative with their therapy. And maybe they never were creative with their

therapy. Maybe they never were. I can't stand just doing rote, the same thing

every day.. .1 don't ever want to stop learning new ways of doing things.

Chatee reflected on her increasing confidence in the workplace as a contributing

factor to creativity:

If I can't find one way for a solution for a problem, then I'll go another

way. I am not one that gets easily stopped. I think because I have more

experience, I think that it's laid a foundation to be able and to feel more confident

in being creative. Generally people who come out and are new, they're so

enthusiastic. And its willy nilly, not everybody, but just let me try it. You're just

working at learning and developing that bag of tricks....

I've treated in different environments with different populations, with

different kinds of therapists with different situations.. ..I feel like I have a stronger

foundation of knowing which are the right buttons to push to be able to be

creative to get the results or the outcomes that I want. You have to have a good
 195

foundation and you have to be self-confident. I've seen it work with this person;

let me see if it will work here with this patient.

Interestingly, while the novice participants represent more racial diversity, Bea and

Devon, both expert Caucasian participants, were alone in expressing a preference for

diversity.

When discussing their perceptions of the creative process of the person, process,

product, and press framework, novice participants emphasized object-related processes

such as fixing, adapting, or repurposing things. Expert participants emphasized

facilitation and application as processes related to people such as generating patient

interest, enthusiasm, and participation. Both groups emphasized thinking, problem

solving, and planning as necessary components of the process of creativity.

When discussing the products they associated with creativity, younger

participants emphasized the creation of objects and treatment activities. Older therapists

emphasized the creation of intangible things that were people-related, such as motivation,

buy in, and support. As a therapist still in the process of learning her craft, Carrie noted:

I think the first thing is just having experiences to draw from and practice in

different situations knowing definitely what will not work [laughs], what might

work, and what I think will work again. There's almost no 100%: it seems like the

more I try something the more I have success with it, like [when I used] Velcro®

and Dycem® to fix the cast. So I think just the experience of knowing what will

work and what doesn't work over time and the confidence to know what will work

[influences creativity].
Regarding the press component of creativity, novice participants cited more

environmental factors as influences to creativity, including patient status, time and

physical resources, management, and governmental support, especially in relation to

locating resources for patients. Older participants mentioned fewer immediate resources

of patient status, time, and physical resources but continued to mention management,

supervision, and government. In the context of her supervisory role, Chatee stated:

I think that that truly is, if nothing else from a Biblical standpoint, people who

have some strength of foundation and that's able to trickle down to the people that

they work with. And so I do believe that we facilitate and encourage self-

confidence. We actually mentor that. We action-plan that.

Older participants mentioned autonomy and trust whereas younger participants did not.

Countessa noted her appreciation of the autonomy she has when she said, ".. .we have to

think quickly, and we are also allowed a lot of freedom to do that here."

Question two, finding two.

Participants emphasized process over product in definitions of creativity in

occupational therapy, and in some cases, the process was the desired product. For

example, in her capacity as a professor Bea observed that the product of her creativity

was the broadening horizons of her occupational therapy students:

[The product is] always to get students to think differently. You know, to take

maybe a common everyday kind of way, and think and look through a variety of

different ways that you could look through a lens and get a three dimensional

approach to things.

As a supervisory therapist in a community facility, experienced therapist Chatee

 197

also mentioned intangibles as a large portion of her creative products:

There's loyalty, there's buy in, there's a lot more... I feel like because of my

creativity that I am able to inspire other people to do their best, and to make sure

that they are advocating and providing the services that are needed for our

residents.

Boriqua integrated a complex problem solving process into products she created

for clients, describing the multilayered relationships between process and product when

she said:

We often create products. We do a ton of splinting. We get lots of trauma, and we

have lots of very, very complicated cases. Nobody ever comes here with one thing

wrong with them. Instead, they come here with like ten or twenty things wrong

with them. So, where somewhere else you might see something and say, well, this

person has a tendon injury and we're going to work on the tendon injury. Except

here all the tendons are lacerated, all the nerves are gone. And all of a sudden,

things go from being basic status quo to having a more dynamic component them.

And then you go into how is this particular individual going to be able to function

and to do their self-care? Because you do the protective thing first, and then you

work toward the functional, so then many times you're creating. It could be an

actual piece of equipment that helps them be able to do something else.

Reflecting a different type of product, as a mental health therapist Carlotta noted:

I had to come up with group activities daily, several. Like one year we had, my

first year working in the psych [psychiatric] unit, the rec [recreational] therapist

decided we were going to have a fall carnival. She asked me to be the fortune
 teller [laughs]. And I thought what am I going to do that that won't be totally

sending people off the deep end? So, I decided to go with horoscopes, and I

picked out ones that were relatively benign.

Participants did not discuss the tangible outcomes produced by patients except in

the case of school children, when handwriting was mentioned. Even in this case, the

emphasis was on the process of learning rather than the outcome. Lynn said:

.. .just kind of coming up with other things like writing paper. If I feel like the

ones that they can get from a catalog are not working, I make my own. And then I

see what works for the students. Like a bunch of writing papers have graphing

lines and a bunch of lines on the paper. A lot of kids are very visual, and so they

get distracted by all these lines, and so I make it simpler. And so I just draw one

or two lines that they need; that kind of creativity.

Question two, finding three.

Participants did not view the press elements in a uniform way. What one

participant viewed as an obstacle, another viewed as an asset to creativity. For example,

Jennifer viewed time constraints as energizing, but Countessa found her creativity was

diminished when time constraints were placed upon her. Likewise, Carrie found limited

supplies and resources to be creativity enhancers, and chose to reframe her definition of

available resources when she had little to work with. She explained that from her

perspective, a patient without any tangible resources still had the internal resources of

prior work history, the experience of being healthy or well, and the eventual motivation

to return to either a prior or optimal level of function:

 I have trauma and the ventilator patients... my patients have almost zero

[tangible] resources. Usually their resources are that their prior level of

functioning was usually good because most of them are young, but typical

trauma-age male, 18 to early 30-40-ish. Those people are pretty healthy ... so it's

usually young, previously healthy, previously maybe working, and have a

background of being functional, and usually motivated. Maybe they're not

[motivated] right away but it will come over time, usually.

Boriqua also noted that equipment and supplies were an ever-present

consideration, and said, "We don't have some of the fancy machines.. .a therapist here

would have to be more creative." She reported her own experiences with trying to help

other therapists reframe their perspectives of environmental influencers, and recalled, "So

I was like well, what do we have? Why don't you think about your space and the patient

and not think about which are not able to do?" Following this, she concluded by saying,

"If you're really limited by which you have, then you have to use what you have

differently."

Likewise, Countessa stated a belief that that a fast-paced working environment

was stimulating, but Lynn felt oppressed when she carried too many students on her case

load. Bea reflected on the impact of stress on creativity and said:

I think stress reduces creativity. I don't think you have as much energy, and I

think you go to that kind of secondary energy versus of the primary kind of

energy. Your primary [energy] is right to the task, where secondary [energy] is

allowing it to be more free-flowing... You can't demand [creativity]. It emerges.

Carlotta also noted an issue related to stress and creativity by noting:

 Well, I find productivity demands to be daunting. [Question: In a mental health

context, how do you define that?] I'm on a mental health team in physical

medicine and rehab [rehabilitation], so it's just people's anxiety, depression, pain

issues, and then there are people on bone marrow [transplantation unit] and

oncology [cancer unit] in general, and also antepartum [before childbirth unit].

And so in antepartum you have all the freedom you can to be creative.

Chatee summed up the impact of environmental influencers on creativity when she

reflected on the impact of choice on how a therapist perceives the circumstances they are

working in:

In any work environment there are barriers, whether it's working with the resident

who has a specific disability or impairment, or that's working with a group of

people who have been here and we've tried that, and it doesn't work anymore. I

think that being creative allows individuals, whether it's actually treating or

actually guiding other people who do treat, into looking into alternative methods.

That you will see a result - if you want.

Question two, finding four.

Chatee implied creativity in the form of engaging patients in the process of

creating objects might have diminished the credibility of occupational therapy as a

profession:

We use craft, but we use a lot more clinically established techniques. So, I think

that [use of clinically established techniques] has lent itself to allow us to being

more credible in the medical community, and I do appreciate the flexibility that

we have now where I don't know that we had it before... We are very blessed in
 201

having the ability to cross the line, and that allows us to be more creative. And

we're not just craft-oriented anymore, but its function.

In her hospital, Countessa also noted a steering away from crafts and activities

that might be construed as play, and recalled:

We're discouraged from using things like those types of activities.. .It's seen as

doing something a child would do, rather than what you would have an adult do.

We don't incorporate more of a craft or creativity...We used to use macrame. It

was a great exercise for the hands, but we're not allowing our patients to create

anything anymore, either.

Others noted that creativity may not be documented as such, but instead may be

described as something else. In other words, creativity might have been a hidden process

or its use may have represented a hidden agenda. Boriqua pointed out:

I think there are people who use that in the occupation of artistry as a means to get

things, that not as much. Little by little, it's harder to incorporate that into rehab-

based facilities, especially when you're dealing with third-party payers and how

you document and all those fun things. The treatment would pose more of a

challenge to having your documentation skills up to par, and to be able to support

that.

Question two, analysis.

A wide range of personal attributes, processes, products, and environmental

components of creativity in the context of occupational therapy were detailed by

participants. They could be grouped into patterns and subcategories (see Table 42).

Components of creativity listed by participants included:

 202

1. Person: Creativity-related personal components included both formal and

informal experience and training, personal thinking styles, beliefs and values,

attitudes, and energy levels, and being a logical/mathematical or

creative/artistic personality type.

2. Process: Object-related processes included thinking and planning, inventing

things, adapting, repairing, and repurposing things, and people-related

processes including thinking and planning, facilitating (such as

communicating or setting the stage), and applying (such as treating,

exercising, or teaching skills).

3. Products: Products were considered objects such as devices and equipment, or

treatment activities such as parties, projects, arts and crafts, and seating

systems. People-related outcomes included things such as increasing loyalty,

engagement, motivation, and being client-centered. Other people-related

things or products included created treatment plans and suggestions, and also

mentoring, teaching, and inservice training.

4. Press: Environmental factors included the immediate factors of schedules,

time, location, the patient, language systems, and prevailing culture. They also

included personnel, management, and colleagues and government systems

which encompassed factors such as reimbursement and policy.

 203

Table 42

Question Two: How Do Occupational Therapists Define Creativity in the Context of

Occupational Therapy?

Person Process Product Press

Lynn Perceptions: People Processes: Outcomes- Immediate:
Tran Thinking style Facilitating Things: Patient status
Personal Object processes: Devices/ Time/Resources
attributes: Thinking/ Equipment Personnel:
Ways of feeling Planning Treatment Management
activities Societal:
Government
Jenni- Personal Object Processes: Outcomes- Immediate:
fer Attribute: Thinking/ Things: Patient status,
Lopez Ways of feeling Planning Devices/ culture,
Energy levels Inventing Equipment Time/Resources
Treatment Personnel:
activities Management

Carrie Perceptions: Object Processes: Outcomes- Immediate:

Jones Thinking style Thinking/ Things: Patient status
Beliefs and values Planning Devices/ Time/Resources
Adapting Equipment Personnel:
Repairing Management

Bori- Perceptions: Object Processes: Outcomes- Immediate:

qua Beliefs and values Thinking/ Things: Patient status
Nayali Personal Style: Planning Devices/ Time/Physical
Left/Right- Adapting Equipment Personnel:
brained Colleagues
Societal:
Government
Coun- Perceptions: Object Processes: Outcomes- Immediate:
tessa Beliefs and values Thinking/ Things: Time/Resources
Charles Personal Style: Planning Devices/ Personnel:
Left-brained Inventing Equipment Management

Devon Personal People Processes: Outcomes- Immediate:

Darring Attribute: Facilitating Things: Time/Resources
-ton Ways of feeling Applying Treatment Personnel:
 204

Perceptions: Object processes: activities Management

Thinking style Thinking/ Outcomes- Colleagues
Planning People:
Buy in
Chatee Perceptions: Object Processes: Outcomes- Personnel:
Cathy Beliefs and values Thinking/ People: Colleagues
Personal Planning Treatment plans Management
readiness: People Processes: Staff support
Experience Facilitating
Car- Personal People Processes: Outcomes- Immediate:
lotta Attribute: Facilitating Things: Patient status
Gomez Ways of feeling Object processes: Treatment Personnel:
Personal Thinking/ activities Management
Readiness: Planning
Experience
Perceptions:
Thinking styles
Bea Perceptions: People Processes: Outcomes- Immediate:
Devil Beliefs and values Facilitating People: Local culture
Personal Style: Applying Buy in Time/Resources
Right-brained Staff support Societal:
Personal Government
Attribute: Energy
level

Question Three

In what ways do occupational therapists feel their personal creativity impacts their

practice of occupational therapy?

Question three, finding one.

When responding to the specific query, "In what ways do you feel your own

personal creativity impacts your practice of occupational therapy?" most participants

emphasized the significance of their personal thinking style. Specifically, of all personal

factors, most noted that their personal problem solving abilities had a direct impact on

their creativity in their practice of occupational therapy, including Devon, who said:

Well, if I can't think outside of the box and problem solve, and in their [the
 205

patient's] world, I mean, I've got to get ideas. Now, whether it's things I do with

my daughter or remodeling of the house or whatever, or whatever, I get ideas. We

all get in kind of a routine, kind of a rut. We all do that. But we have to step

outside of it and think what would this look like without that wall there, what if

we knock it out? So you just have to do something else to make it work. I do think

... that it helps out.

Likewise, Carrie reflected:

I think that I'm just able to look at a problem, or at a situation, work complaint, or

whatever they are bringing to me as a challenge to be creative, and thinking

outside the box. I think that's just who I am, and maybe I think that has improved,

as I have done it time and time again. I've been put in these situations where I

have to think of a solution; problem solving and creativity are just required.

There's just no way, no way around it. So I think they [problem solving and

creativity] really go hand in hand, and I think.. .I'm always getting better at it.

Carlotta noted, "I think it [her personality] has a huge impact [on creativity in the

practice of occupational therapy] because you have to create... you have to creatively

problem solve.. .so that's what I'm saying; my approach is different."

This was echoed by Boriqua, who reflected on how her creative personality

affected her work as a hospital therapist and said:

I think it's been a really good fit, more than anything else because, the things that

I find important, like being able to create and problem solve.. .It's like I'm best at

doing that kind of work. It really is reflective of what I have been doing. The

thing that it affects here is that, yes, we have protocols [laughs], and I am not the
 206

best one about following all the rules, rigidly, you know. I'm very much like, you

know, we live in the gray area, and I live in the gray area. And so, I think that

things here... everybody is opening up to that. That is, you go from this status quo,

that it's really not that big of a deal, especially if you get the same results. But, it's

almost like we don't care how you get there. So, I think in that sense I have a good

fit here, and I don't know if I would have good fit in other places, because of that.

Like Boriqua, Bea also noted that she liked and was good at solving problems,

and said, "I'm a good problem solver. If you say problem solver, it puts it [creativity] in a

different context, a different frame of reference. I like to solve certain

problems.. .problems about people."

Additional comments from participants related to problem solving involved the

process of using common sense. Reflecting on common sense as an outcome of

developing expertise, Chatee affirmed, "If you have no experience in life or otherwise to

be able to use common sense, or to be able to use past applications.. .you don't have

anything to work off of." Similarly, other participants reported relying on trial and error.

Other aspects of personal thinking style that impacted their practice of occupational

therapy included:

• having good organizational skills (Countessa),

• not being organized but still feeling in control (Boriqua),

• a penchant for breaking rules (Boriqua),

• thinking outside of the box (Carrie and Devon),

• thinking confidently (Chatee),

• seeing the big picture when thinking and planning for patient care (Carlotta),
 • being organized (Jennifer), and

• multi-tasking and thinking fluidly (Bea).

Question three, finding two

In terms of how their personal values and beliefs might have impacted their

creativity at work, the novice participants reportedly placed value on making and fixing

things, working with their hands, and pursuing hobbies including:

• "I'm thinking of a hobby, and I'm thinking of how can I try this in my work"

(Lynn).

• "If I create something at work, maybe at one of the centers, then I can go home

and use it when I'm paying my bills and things like that" (Jennifer).

• "I like to do magazine collages and send them to my friends and make them

laugh because they're just nutty. I like to do funny creative things that I know

when my friend gets that, she's just going to laugh. And I like to do

photography" (Carrie).

• "I love to work with my hands and to make things" (Boriqua).

One of the participants who had been practicing longer than twenty years also mentioned

the pleasure she experienced when making things:

[Making things is] my favorite thing to do.. .and getting messy and creating

something new. It's kind of what I like, and it kind of ties back to what I enjoy in

my spare time, which is ceramics and stuff like that... It's almost like I'm playing

[laughs] (Countessa).

Alternately, the group of participants who had been practicing longer than twenty years

reported placing value on less tangible outcomes. In regards to diversity, Bea noted:
 208

I think I'm out in the community because I'm always looking for diversity; to be

around a diverse group of people doing a diverse number of activities, not just

directed toward one goal. So it's kind of multi-tasking, and I think creativity

relates to multi-tasking.

Carlotta chose to focus on practicality, but intoned, "Life is not about putting your

pants on," and Chatee emphasized the development of increasing wisdom as a result of

accumulated life experiences. Devon, as an experienced occupational therapist, also

noted the value of being mindful of getting too comfortable in routines and continuing to

reflect on engaging patients in activities that were filled with celebratory joy.

Question three, finding three.

Half of the participants reported that having practical experience to draw from

was an important factor in how their personal creativity had contributed to their creativity

at work, and exposure to diversity was mentioned as a significant component of this

experience by a third of the participants. Conversely, none of the participants mentioned

formal training or preparation as a factor.

As an additional potential component of personal readiness and experience, Bea

put forth the concept of being hard-wired for creativity. Stating a belief that her Middle

Eastern ancestry contributed to her preference for diversity, she also posited that her

interest in interpersonal and cross-cultural barters and exchanges that she associated with

a creative lifestyle stemmed from the nomads of her genetic past, saying:

Well, I think there's probably a genetic program for creativity. I think there's the

nomad in me that comes from a genetic piece that somehow goes way back

[laughs]. And there's the barterer; I'm always looking... I think those are genetic
 traits, where people are going, you do this, I'll do that, how about this, what about

that, always having more than one way to solve the problem or reach the goal.

And that bartering aspect of it I think is genetic. And I think the nomad aspect of

it is to pick up your tent and go somewhere else... .1 don't know if you're looking

at it [creativity] in terms of ethnicity, but that kind of nature versus nurture...

Obviously, we have learned experiences but... I think there is genetic hardwiring

for some of that. You probably seek that out even in a learning environment in

some kind of way.

Question three, finding four.

Most of the participants who had been practicing as occupational therapists for

over twenty years made some mention of personal energy levels as a component of their

personal creativity that contributed to their creativity at work. Of these, Bea and Chatee

noted the positive impact that their tenacity, passion, and energy had on their creativity,

while Carlotta noted frequent experiences with fatigue and being tired as having a

negative impact. In contrast, when directly asked how their personal creativity impacted

their practice of occupational therapy, none of the participants with less than twenty years

of experience made any mention of their energy levels, passion, or tenacity as a

component of their personal creativity that contributed to their creativity at work.

Question three, finding five.

Bea, with more than twenty years experience, and Boriqua, with less than twenty

years experience, both noted attributes of their personal style that combined a scientific,

analytical personal style with a creative or artistic personal style. No other participants,
 210

when specifically queried about how their personal creativity contributed to their

creativity at work, noted similar aspects of personal style as a factor.

Question three, analysis.

1. All participants seemed to have strong self-awareness when discussing how they

felt their personal creativity impacted work, especially when related to discussing

their thinking styles and preferences. While some of the participants expressed an

interest in hobbies and crafts, all of the participants emphasized problem solving

and thinking as integral components of their personality that impacted their work.

2. While the trend of developmental differences that was evident in participants'

discussions regarding the definitions of creativity in occupational therapy over

time was also evident in responses to question three, there was also no doubt that

the influence of stable personality traits was also present. Personal preferences for

novelty, diversity, and not being bored were clearly evident, and like the

development trajectory noted in responses to question two, the emphasis on

exploratory, hands-on activities seemed to be replaced by increasingly abstract

interests and strengths as participants aged. In this participant group, the doers

eventually transitioned into the thinkers, and their products became their

processes.

3. Interestingly, the mention of energy by older participants rather than the

presumably more energetic younger participants may have been in part caused by

either an awareness of or experience with not having energy and valuing its

presence. This was consistent with the phenomenon that often occurred in middle

years, referred to by Rogers (1982) as "body monitoring." The maturing therapist

 211

may have been more aware of bodily decline and changing physical abilities that

impacted their work habits and preferences. In a similar vein, this may have also

been true of the stated preferences for novelty. The younger participants,

representing three racial groups, experienced diversity as a part of their ongoing,

lived experiences whereas the older Caucasians participants may have actively

sought what was a fact of life for the younger participants.

Participant responses are presented, utilizing the person components of the

theoretical framework that were developed for coding participant responses to interview

queries (see Table 43).

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Table 43

Question 3: In What Ways do Occupational Therapists Feel Their Personal Creativity

Impacts Their Practice of Occupational Therapy?

Readiness: Perceptions: Perceptions: Attributes: Attributes: Style:

Experience Thinking Beliefs and Ways of Energy Analytic
Styles Values Feeling Levels or Artistic
Lynn Problem Was a
Tran solver hobbyist
Jennifer Organized
Lopez
Carrie Knew how Problem Learned
Jones to repair solver, from
things Stepped parents,
back and Was always
thought, improving
Trial and
error
Boriqua Experience, In control, Worked Liked Was both
Nayali Exposed to Problem with hands challenge, artsy and
diversity solver, Kept things analytical
Rule fresh and
breaker, different
Learned
from others
Coun- Liked
tessa playing, and
Charles creating
Devon Thought out Valued
Darring- ofbox, diversity
ton Problem
solver,
Generated
ideas
Chatee Life Confident, Wisdom Tenacious,
Cathy experience Problem from aging Wouldn't let
and skill solver, go
sets Common
sense
 213

Carlotta Saw the big Practical: Experienced

Gomez picture, "Life is not fatigue
Problem about
solver putting your
pants on"
Bea Had life Multitasked Hard-wired Avoided Had energy Was both
Devil experience Fluid for boredom and passion creative and
and a long thinker creativity, analytical
work Preferred Valued
history challenges, diversity,
Problem novelty
solver

Question Four

What is this impact of practice-related creativity on the occupational therapist?

To explore research question four, participants were asked to respond to the

following queries, "In general, what is the impact of occupational therapy practice-related

creativity on you?" and "Specifically, what is the impact of occupational therapy

practice-related creativity on your personal creativity?" and from their responses it was

immediately apparent that answering these queries was more difficult than discussing

how their personal creativity impacted their work, and their responses were briefer and

less exploratory in nature. Notably, the word count of participant responses to question

four was 1,699; less than half of the combined word count used to describe the reverse

phenomenon of participants describing the effect of their personal creativity at work in

question three (3,702 words.) Interestingly, the interview responses to personal creativity

and its impact on the work environment evoked laughter ten times, and yet, the

discussion of work-related creativity on the participant evoked laughter only twice.

Some participants required longer periods of thinking and reflection to respond,

and requested that the queries be repeated. Most of the participants did not distinguish
 214

between the queries about work-related creativity affecting them generally and work-

related creativity affecting their creativity. A few participants struggled to produce any

responses, some responses were off-topic, and others failed to see a connection or

relationship between the two.

Question four, finding one.

The precise impact of practice-related creativity on the occupational therapist was

more difficult to ascertain than the impact of personal occupational therapists' creativity

on their practice of occupational therapy. Some of the participants mentioned that their

creative relationships with colleagues had in some way impacted them personally. Half of

the participants expressed a belief that increased experience levels or changes in beliefs

and values were a resultant impact of practice-related creativity, such as Boriqua, who

described creativity experienced at her hospital:

I think that for people who aren't creative; they will suddenly find they really are

more creative than they thought. That's the nature of the business here. You have

to problem-solve some things outside of the box, thinking outside of the norms,

black and white...the challenge is what tends to draw people to work here because

of the diverse population, because of the multi-level traumas that we see. It's not

because we are really geared to get in there and have to do a lot with a little, but I

think the nature of what we are and what we do forces people outside... they have

to think that way. Or you'll be stuck with the same results. Because a lot of times

you talk to them, and they would say.. .1 would say yes but I'm creative, but I

know a lot of others that would say they're not creative. They would say no, but

I've seen them function in that way and they are creative.
 215

Some participants also made mention of changes in their thinking and planning, of

enhanced personal growth and development, and in their abilities to both create new

objects and engage in unfamiliar activities ranging from producing new organizational

systems to mastering novel hobby techniques as outcomes of practice-related creativity,

such as Jennifer, who remarked on learning how to use computer software at work, "The

use of technology.. .it's actually.. .a little easier on the creativity, but still you need that

background...."

Question four, finding two.

There did not appear to be any notable differences in the responses of participants

with more or less than twenty years of occupational therapy experience when describing

the impact of practice-related creativity on their personal life. The most frequently cited

development of learning new skills and having formative experiences was equally

reported by participants with more or less than twenty years of professional experience.

Novice participant Carrie recalled:

If I can think of a good solution at work that just brings me job satisfaction. But

knowing that I am able to, like yesterday I had a patient, I was checking the chart

to make sure I had orders, and I looked down and saw I got a note that said that

the patient needs me to fabricate a splint. And I am glad I knew about this and I

can make it. I'm just thinking simple mastery. Yes, that comes with my

experience.

One of the more experienced participants, Carlotta, also reported the development

of skills ranging from the aesthetic to the imminently practical:

The creativity that I experience at work? Well, it motivates me to want to create

 216

new things. When I go home I always think about, you know, well, I could do this

a little bit differently. I'm always thinking about what it is that I could create that

would be helpful. So.. .where my personal creativity may be painting or knitting

or something, when I am at work and doing things, I go home and try to think of

how to be creative with things at work still. And, also it reminds me how I can do

things differently at home, in my own [activities of daily living] [laughs]. And the

dryer that isn't working right now. So, I have replaced the heating element before;

I just need to go order and replace it again [laughs].

Similarly, Lynn, as a novice therapist and newlywed, reflected on the useful lessons she

learned from creativity at work when she said:

I'm not a mother yet, but I think it definitely will contribute when it comes to

being a mother. I see a lot of teachers when I work with kids, and I have to teach

them about knowledge and the learning process.. .so I think it will carry over with

my own creativity when I am a mother; I will be able to use techniques and have

things to play with and things like that.

Question four, finding three.

For some participants, the impact of practice-related creativity may be related to

their beliefs regarding the separation of personal and professional life. Carrie, Chatee,

and Devon expressly made mention of this factor. Chatee reflected:

I find that going home weekends, evenings, I do think about things that I could do

differently here, or there's a lot of times I will be at a dollar store and see

something. I'll pick up one of those, and think that looks like fun; I'm sure

somebody will be able to use it. And a lot of times they do. And I do think about
 217

things, but.. .1 don't know that they really impact each other on the reverse side

too much.

According to Devon, however, experiences with her own family members

receiving occupational therapy services resulted in blurred personal and professional

boundaries, especially when interacting with individuals who shared similar interests and

training. She said:

When I had family members that were hurt or injury related to things and needed

therapy.. .1 actually have a hard time separating work and personal, real world.. .1

was at a Softball field the other day at practice, and one of the moms I was with,

this was a mom who is a teacher and she works with special ed [education] kids.

And I was like, well, have you heard about this particular theory or therapy? And

so I guess you do kind of do that, you know?

Citing these interactions regarding discussions of new developments in autism

research with her daughter's softball coach, she felt this blurring was a logical outcome

of her own overlapping worlds. Resultantly, she did not profess to see a sharp distinction

between practice-related creativity and personal creativity.

Question four, finding four.

The impact of practice-related creativity on occupational therapists was described

by the development of positive outcomes related to increasing personal skill sets, adding

to experiences, broadening horizons and world views, and facilitating the development of

positive, creative relationships with others. Only Bea commented on the impact of

practice-related creativity on the occupational therapist was viewed as being potentially

negative, saying:
 218

I get more stressed in an autocratic environment... and I am a policy and

procedure person, but I think you could do that in a less hierarchical kind of way.

So, it stresses me if you had to do only one way for one person, and it doesn't take

in the diversity of the group.

However, she also cited positive benefits of practice-related creativity on her personal life

when she noted interactions with coworkers that lead to the development of creative ideas

and activities.

Question four, finding five.

Creativity could be used by the occupational therapist as method of coping.

Boriqua noted that that the creativity she experienced at home was an intentional

restorative response to her stressful experiences at the hospital:

...there's definitely a lot of that [emotion related to the experience of stress] that

happens here. You know, you get all the spectrum of emotions. You get the really

low lows and the really high highs. Not because of your own internal [emotional

state] but because they are from things that you see, and I think that there's no

way to walk away from that and not have it affect.. .what you're doing outside of

here. I think.. .1 take some of those things, and sometimes you bring them home

with you, and at home I can play my instrument, and I think it very much is

dictated by sometimes like how I'm feeling. It's like; am I going to pull out the

Mozart or pull out something slower? You know, if I'm not in a particularly happy

mood.. .this might not be the day that I actually play my instrument because I tend

to do it more when I'm feeling a little bit more turbulent. So, I think that I use that

expressively at home. I might take from here and what I bring home usually
 219

dictates [the decision to play music]. It might be a day when I don't do anything,

but there's all kinds of stuff, there's so much out there... [sometimes] I just need to

do this, and get it all out. And then I can go on.

Question four, analysis.

1. Participants' struggles to answer question four relative to the ease they

experienced with responses to question three may have been related to the

development of personal attributes and a self-identity as a lifelong process,

whereas development of a professional identity was an adult-onset

phenomenon. However, this observation did not account for the lack of

variance in answers between the younger, novice-level participants and the

older, expert-level participants that is seen in their responses to this study's

other research questions. It could be argued that a majority of time is spent in

non-work personal pursuits; but it could also be argued that a substantial

portion of these non-work pursuits included non-discretionary time such as

sleeping and engaging in required activities of daily living. The explanation

for this finding was inconclusive.

2. A majority of the participants experienced the effect of work-related creativity

on their personal life as a positive factor. Even Boriqua, with a hospital

occupational therapy practice that many would describe as stressful, found

work-related difficulties to be an enhancement of and stimulus to her creative

performances when home. Her intentional use of artistry as a restorative agent

showed her ability to recognize her own emotional state and restore it to

equilibrium using creativity.

 220

Utilizing the person, process, product, and press theoretical framework, a synthesis of

participant responses to question four demonstrates this relationship (see Table 44).
 221

Table 44

Question Four: What is the Impact of Practice-Related Creativity on the Occupational

Therapist?

Person: Process: Product: Press:

Readiness, Objects, Objects, Immediate,
Perceptions, People People Personnel,
Attributes, Style Social
Lynn Readiness:
Tran Experiences at
work will
contribute to her
being a mother
Jennifer Objects:
Lopez Technology and
checklists created
at work increased
home
organization
Carrie Readiness:
Jones Mastering tasks at
work led to
personal
satisfaction.
Boriqua Perceptions: People: People: Personnel:
Nayali Work challenges Restored Work demands Collaboration
changed creative turbulence developed
self-perceptions. experienced at creative thinking
work by engaging
in expressive
creativity at home
Countessa Readiness and Objects:
Charles Perceptions: New skills have
Exposure to been learned at
diversity and work that carry
complexity at over to home
work changed her creativity
values and beliefs
Devon Perceptions:
Darrington Personal
 222

experiences with
OT caused role
blurring
Chatee Personnel:
Cathy Had support of
colleagues in
mind but tried to
separate work
and personal life,
did not see
strong links from
work to person
Carlotta Readiness: Objects:
Gomez Developed new Became
skills at work and motivated to
uses them at home create new things
Bea Attributes: Personnel:
Devil Experienced Sought
stress at work colleagues for
creative
collaboration

Question Five

What is the relationship between occupational therapists' personal creativity and

practice-related creativity?

Question Jive, finding one.

Over time, the directionality of the relationship between personal and practice-

related creativity appeared to change. Younger, novice participants reported learning

from the environment and circumstances they were in. Older, expert participants, while

they still mentioned the effects of their environment and circumstances, emphasized how

their personal attributes and interests impacted practice-related creativity.

Question five, finding two.

Nearly half of the participants expressed a belief that creativity is what they were

born with, gifted with, or blessed with. Regarding innate creativity, Carrie noted, "I think
 223

a big part of this is just your personality and the creativity you are born with, and.. .some

people are just more creative than others." Likewise, Boriqua said,".. .it's just there; I was

born that way." Taking another perspective, Chatee described creativity by saying, "It's

part of our gifting."

Question five, finding three.

Some participants stated beliefs that both personal and practice-related creativity

were reflections of confidence, experience, and wisdom. Resultantly, participants

emphasized growth and development as a function of both accumulated life and work

experiences. Carrie noted, "I think my profession and just the everyday challenges just

make me more creative, it just forces me to think about things differently, or use

whatever resources I have." Chatee weighed in on both life and work experiences. In

regards to her life experiences she pointed out that:

I think that my personal life impacts my ability to be creative at work because I

think that just life in general; the church, and children, school, parents, family,

friends; those kinds of things give you or give me wisdom, and opportunities to

use other peoples' issues, mistakes; the factors to be able to apply them here.

Continuing on the topic of wisdom and experience, she turned her focus to her creativity

at work and said:

I'm an old dog [laughs].. .1 think because I have more experience, I think that it's

laid a foundation to be able and to feel more confident in being creative... As

you're older, as I've treated in different environments with different populations,

with different kinds of therapists, with different situations; I think that I feel like I

have a stronger foundation of knowing which are the right buttons to push to be
 224

able to be creative to get the results or the outcomes that I want. You have to have

a good foundation, and you have to be self-confident.

Devon also exuded this experience-related confidence when she said:

Here our creativity is capped, but we're going to bring it back. If they don't have

the ideas, I'll have the ideas. I'll have the ideas, but they're going to help

implement them.. .To me the world is endless with what we can do.. .I'll solve

your problems for you.

Conversely, Lynn, as a relatively young person and a novice therapist, chose to

emphasize the role her work experiences had in helping her establish her personal

identity, when she said:

.. .the difference between personal creativity and creativity in my work...if I don't

have the proper ingredients and I can substitute in cooking, I have to work with

what I have.. .1 wanted to make a pie, and I only had one egg, and I needed three,

and they didn't specify the size [laughs] so I had a large egg and I thought, well, I

could add a little bit more milk or something to make it more liquidy [laughs]. So

in that way, I think I just use what I have at home. What do I have that will work?

Expert therapist Bea also chose to use cooking as an example of creativity, but

emphasized her preference of steering away from the rule-bound realm of baking, saying:

You know, you can think about creating a meal; and I like to create a meal. I don't

like to follow recipes, and that's why I don't bake well. You have to follow a

recipe exactly. And in a meal, I make entrees, and if I don't have certain

ingredients, I think, well, this will do just as well [laughs]. I like that, but I don't

like creating pastries because you have to do it exactly right.

 225

Jennifer's role as a mother of young children may have contributed to the creative

thoughts she had about the children she worked with. She conceptualized the relationship

between personal and practice-related creativity as of a reciprocal process of growth and

support and noted:

.. .the relationship between the two is.. .having to start somewhere and then just

making that one idea grow... If I see something at one of the centers where I work,

or schools.. .I'll carry that over to home and then elaborate even more there. And

then I can be actually using that idea at home, and then change it when I go to

work.. .an idea might spark, and I think, oh, if I change it like this then it would be

good for this person at school or somewhere else.

Question five, finding four

Some participants expressed a belief that their natural inclinations toward

creativity needed expression, whether in work or in personal endeavors. In regards to her

creativity, Boriqua stated:

.. .it's what I need to feel.. .like I need to do that to feel normal. I feel like I have

to feel that part of me, to do it somehow... If I get away from it too long, I don't

feel comfortable... if F m getting a lot of it here, I need to do less at home... I did a

really long stint on burns and it was really rote. And the treatments were pretty

much the same from day to day, and I found myself at home like okay [laughs], I

want to do something [creative].

Question five, finding five.

Some participants expressed a belief that people gravitate to the profession of

occupational therapy and specific practice settings within the field because they can find
an outlet for creative expression. Boriqua noted, ".. .Creative beings.. .gravitate more to

those types of jobs where they actually can still do that." Chatee said, "I think that by

nature OTs are very creative, just by how we gravitate toward this field."

Question five, finding six.

Some participants expressed a belief that their choice to be creative was a tool

they used to nurture, support, or entertain themselves in either personal or work

environments. Carlotta noted that being creative at work is a way of centering herself,

saying, "I think my personal creativity, when I engage in personal creativity, it allows me

to be present in the work environment," and Boriqua noted that creativity at home was

often a measure of restoring herself after experiencing turbulence at work.

Question five, finding seven.

Some participants emphasized the role of skill transfer. Carrie noted her abilities

to sew and repair objects came from her early life training:

.. .For me it's hard to separate them because so much of who I am here at

home, or at work, is really the same. And so even here, the blinds on the wall

up there, the main crossing piece is broken, so if something like that is broken

at work I would just fix it with tape, which is what I did here [at home.] What

do I have that will probably work? And I will at least give it a try. And so, it's

really similar, it really is. I don't do a lot of sewing at work, but I can if I need

to, and at home I like to. I also really like collages [laughs]. Maybe I should

have been a psych [psychiatry] OT.

 227

Countessa described the reverse of Carrie; the sewing she learned at work in the process

of creating splints and orthotics was something she began using at home to work for

home decorating and fashion:

This is a funny thing to say. You know, what I have learned here, and this is very

concrete but, I learned how to sew here at [the hospital]. I did not know how to

sew before. I had to learn how to sew because I had to know how to make straps.

We had to sew all that strapping for stuff. So I learned how to use a sewing

machine here, which I went out and bought one for home. I thought; I need one of

these at home. I could make all kinds of stuff [laughs]!

Likewise, Carlotta noted the development of hand skills such as knitting that were

learned as treatment techniques soon became hobbies for her. Countessa spoke of the

skills she developed in cooking, speculating on how she had learned to use it as a

therapeutic modality in a hospital treatment setting and at home:

I love cooking, and one of the things I really love to do is cook Mexican food. If I

lived somewhere where that wasn't popular, that might not be what I did. I mean,

we also have a large Hispanic population here and one of the activities that we do

is creating a meal, you know, have them make their Mexican food, such as tortilla

or something of that nature, so I think definitely where you live would influence

the types of things that you would do creatively.

Question five, analysis.

Overall, three different trends were reported by participants:

1. The relationship between personal and practice-related creativity appeared to be a

function of both personal and professional development, and changed over time
 228

with increasing knowledge, experience, wisdom, and confidence.

2. Creativity was described as an attribute that could both lead therapists to work

settings where it could be expressed and also help them find greater satisfaction in

their personal lives and in their practice of occupational therapy.

3. Creativity could build skills that transferred from one environment to the other

(see Tables 45, 46).

 229

Table 45
Question 5: What is the Relationship Between Occupational Therapists Personal

Creativity and Practice-Related Creativity?

Person: Process: Product: Press:

Readiness, Objects, People Objects, People Immediate,
Perceptions, Personnel, Social
Attributes, Style
Lynn Practice on Person: Practice on
Tran Learned new skills Person:
at work that she Adapted to
uses at home and environments,
in future plans used available
resources, and
worked under
pressure
Jennifer Person and Person and
Lopez Practice: Practice:
Believed plans and Created things in
ideas can spark in one context and
one context, then used them in the
be used in the other
other
Carrie Person on Practice: Practice on Person: Person and Practice on
Jones Felt born with the Everyday Practice: Person:
creative challenges at work Home repairs Was more
personality that led made her more using work skills, resourceful as a
her to seek the creative and and sewing at result of her work
good fit she has enabled her to work from skills
with OT think differently she learned as a
child
Boriqua Person on Practice: Person and Inconclusive: Person and
Nayali Felt OTs were Practice: Believed it isn't Practice:
creative beings Personal and work the treatment Felt creativity
who choose OT creativity are activity, but the varies with
then gravitate different. Will not goal that is the practice area.
toward the practice feel normal important aspect With creative
area they need to without being of therapy outlets at work,
be in for creative creative did not need it at
needs somewhere home
Coun- Person on Practice: Practice on Person: Practice on Person: Practice on
tessa Placed a high Was willing to try Made objects at Person:
Charles value on her more things at work, then used Purchased same
 230

creativity and home as a result of them at home, equipment for

using her hands to work experience. surprising others home after she
create things at with her unusual used it at work,
work. abilities such as a sewing
machine
Devon Person on Practice: Person on Practice: Person on Practice: Inconclusive:
Darring- Preference for Implemented Believed a party, Sensed a lack of
ton novelty, strategies to happy, or fun creative
excitement, and facilitate things activity was exploration in
celebration happening, then creativity at work work, including
influenced made them work management and
treatment coworkers.
Chatee Person on Practice: Person on Practice: Inconclusive: Person on
Cathy Believed strong of Action planned Believed that Practice:
foundation, gifting, mentoring, clinically driven Believed
and confidence training, and practice has lead to personal and
impact supporting staffers increased work lives were
competence. to enhance their credibility of OT best kept
Creative types performance. in medicine. separate.
gravitated to OT
Carlotta Person to Practice: Person to Practice: Practice to
Gomez Drive to see how Creativity was a Person:
things work way of centering Productivity
impacted her work. herself and being demands rein in
present in work her creativity.

Bea Inconclusive: Inconclusive:

Devil Research needed Believed
on OTs who have creativity varied
left the field and if in practice areas
creativity
influenced that

The directionality of these creative relationships can be demonstrated through the

use of directional arrows. An arrow pointing away from the participant names represents

the effect of personal creativity on the practice of occupational therapy, an arrow pointing

toward participant names represents the effect of the practice of occupational therapy

creativity on the person, a double-headed arrow represents a reciprocal relationship

between person and the practice of occupational therapy creativity, and an arrow shaft
 231

(line) without arrow heads represents an inconclusive relationship between the two (see

Table 46).

Table 46

Schematic Responses to Question Five Showing Relationship Between Personal and

Work Related Creativity*

Person: Process: Product: Press:

Readiness, Objects, Objects, Immediate,
Preferences, People People Personnel,
Attributes, Social
Style
Lynn Tran
Jennifer Lopez
Carrie Jones •
Boriqua Nayali *
Countessa •
Charles
Devon •
Darrington
Chatee Cathy •
Carlotta Gomez •
Bea Devil

Conclusion

These cross case analyses yielded a total of twenty four findings for the five

research questions and a preliminary analysis of each. Chapter Six examines these

findings to explore the connections and patterns that form a larger picture with

summative findings and new analytic categories. They are interpreted in a way that

addresses the problem and significance originally defined by this research and provide
 232

the basis for conclusions of this research study with recommendations for future research

and related actions.

 Chapter 6

ANALYSIS, CONCLUSIONS, AND RECOMMENDATIONS

Introduction

This research examined the definition, impact, and relationships among

creativity, the practice of occupational therapy, and occupational therapists. This research

aimed to develop uniform terminology, a conceptual model, and emergent theory to

describe the relationships among creativity, occupational therapists, and the practice of

occupational therapy. Utilizing a person, process, product, and press theoretical

framework and five research questions as starting points, the relationships among

creativity, the practice of occupational therapy, and occupational therapists were

examined using both case by case and cross case analyses. The research questions are as

follows:

1. How have definitions of creativity in the context of occupational therapy changed

over time?

2. How do occupational therapists define creativity in the context of occupational

therapy?

3. In what ways do occupational therapists feel their personal creativity impacts their

practice of occupational therapy?

4. What is the impact of practice-related creativity on the occupational therapist?

5. What is the relationship between occupational therapists' personal creativity and

practice-related creativity?

233
 234

Summative Findings of the Five Research Questions

In Chapter Five, the research findings for each of the five research questions were

presented with a preliminary analysis of each finding. The abbreviated preliminary

findings from the five research questions are presented in table format, with each finding

identified by a double numeral code. The first numeral refers to the research question it

corresponds to, and the second numeral refers to the research question finding number

referred to in Chapter Five. Hence a designation of Ql-1 indicates that response is the

first finding of the first research question, Ql-2 indicates the second finding of the first

research question, and so on (see Table 47). This enabled the findings to be placed in

analytic categories while retaining their primary source for reference purposes.
 235

Table 47

Abbreviated Preliminary Findings from the Five Research Questions

Question Question Content

Code
Ql-1 Unclear definitions of creativity and OT resulted in unclear definitions of
creativity in OT over time.

Ql-2 Medical, science, technology, and research-based points of reference were

used when defining creativity in OT over time, and beliefs about them
influenced definitions of creativity in OT over time.

Q1 -3 Definitions of creativity in OT over time were changing.

Ql-4 Influences that impacted participants' work had also influenced their
definitions of creativity in OT over time.

Ql-5 Definitions of creativity in OT over time varied by participants age and/or

career span.

Q2-1 Definitions of creativity changed relative to participant's age and career span.

Q2-2 Process was emphasized over product in creativity in OT, and in some cases
the process was the product.
Q2-3 Participants did not view the person, process, product, or press components in
a predictable or uniform way.

Q2-4 Creativity in OT may have been construed as a threat to credibility. Creativity

in OT may have been a hidden factor.

Q3-1 Thinking styles and problem solving abilities were the most significant
factors of creativity in OT.

Q3-2 Novice participants valued making and fixing things, working with their
hands, and pursuing hobbies. Expert participants valued diversity, client-
centered practicality, and wisdom.

Q3-3 Practical experience, energy, and diversity, but not formal training, were
factors in how personal creativity contributed to work creativity.
Practical experience and being hard-wired for creativity may have
contributed to personal creativity.

Q3-4 Personal attributes such as energy, passion, and tenacity contributed to

creativity at work.
 236

Q3-5 Personal style that combined a scientific, analytical with a creative, artistic

personal style may have contributed to creativity at work.

Q4-1 The impact of creativity at work on the OT was more difficult to determine.

Q4-2 Age or career span did not impact the impact creativity at work on personal
life.
Q4-3 The impact of creativity at work on a person may have been tied to how
much personal and professional lives were separated.

Q4-4 Increased experiences, changes in beliefs and values, thinking and planning
skills, personal growth and development, and abilities to create new
objects and engage in unfamiliar activities were personal results of
creativity at work. Creativity at work may have facilitated positive,
creative relationships with others.

Q4-5 Creativity may have been a method of coping with stress experienced at
work.

Q5-1 Over time, the directionality of the relationship between personal and

creativity at work changed.

Q5-2 Creativity may have been innate.

Q5-3 Both personal and creativity at work are reflections of confidence,

experience, and wisdom.
Q5-4 Natural inclinations toward creativity needed expression, whether in work or
personally.

Q5-5 People gravitated to the profession of OT and specific practice settings within

the field so they could find an outlet for creative expression.

Q5-6 Therapists used creativity to nurture, support, or entertain themselves.

Q5-7 Creativity led to skills that transferred from one domain to another.

Recasting Research Question Findings into Analytic Categories

The five research questions and their findings took on new dimensions during the

course of the data analysis. Question one aimed to explore definitions of creativity as the
profession of occupational therapy developed and matured, and question two aimed to

situate present day definitions and understandings of creativity in the historical context

that question one developed. Both questions paved the way for considerations of the role

creativity may play in occupational therapy in the future. Because questions one and two

explored the definition of creativity in the contexts of past and present time, participant

responses showed strong linkages. Resultantly, questions one and two were merged to

form a single analytic category.

These two questions differed in one singular but important way; when participants

reflected on the historical context of creativity in occupational therapy, they had to

consider and speculate, or if they were old enough, to recall both occupational therapy

and creativity from the past. This contrasted significantly with when they considered and

speculated on their present day occupational therapy and creativity.

What became apparent from participant responses to both questions was the

disparity that existed between novice and expert participants' perceptions. While all

participants attempted to portray an accurate historical context of occupational therapy

and creativity, it was clear that those who lived longer had different understandings and

perspectives than younger participants who had less personal experience to consider.

Additionally, the college instructor and professor had understandings that presumably

resulted from their experiences in teaching historical information as part of their

professional responsibilities.

Despite the discrepancy between expert participants recalling their lived

experiences versus novice participants speculating and reflecting on what they believed

was relevant occupational therapy history, all participants were able to describe the
changes over time that they had seen in their own careers. As such, definitions of

historical context were subtly changed by participants to reflect their own lived

experiences as new reference points. While recasting time in this way clouded the

definitions of creativity in a broad historical context, this pattern of responses persisted

throughout participants' responses to all five research questions: personal and

professional experiences and maturation influence and inform beliefs.

As participants told their own stories and shared their beliefs about creativity in

occupational therapy, their responses did not attain full significance until all findings

were arranged by participant's ages in chronological order. Following this organizational

structuring, findings fell into patterns, formed relationships, and co-created new

meanings. Significantly, these data began to echo findings from previous creativity

research including work by Runco (2004, 2007), Sternberg (2003), and some of the

tenants of the developmental theories of both Piaget and Vygotsky (Sternberg, 2003).

While questions one and two formed an analytic category that explored

definitions of creativity in context, questions three, four, and five explored the

relationships among creativity, occupational therapists, and the practice of occupational

therapy. While these questions seemed to imply that a fairly clear cut structural model

might have been derived to describe these relationships, instead, the participants'

responses to research questions three, four, and five underscored the complexity of the

phenomena. Not only did their described relationships differ from participant to

participant, but they varied according to the definitions placed on creativity, the practice

of occupational therapy, and even themselves.

 Unexpected turns and twists developed when the concept of separating work and

personal lives was explored, such as the blurring of personal and professional roles that

was reported by participants who had experienced occupational therapy from both a

consumer and practitioner standpoint. Each participant's lived experiences formed a

strong foundation for beliefs and contributed significantly to their perceptions of the

relationships among creativity, occupational therapists, and the practice of occupational

therapy.

What became equally clear was that these relationships explored in question three,

four, and five were neither symmetrical nor static, and were subject to many influences.

Examining these three questions individually failed to portray the complex relationships

among creativity, occupational therapist, and practice of occupational therapy. As a

result, these three questions were recast into an analytic category exploring of the

overarching relationships of creativity with occupational therapy. As such, the findings

from the five research questions formed two analytic categories:

1. Occupational therapists' definitions of creativity

2. Relationships among creativity, occupational therapists, and the practice of

occupational therapy

Analytic Category One: Participants' Definitions of Creativity

In analytic category one, research question findings cut across previous categories

and analyses and were grouped topically (see Table 48).

 240

Table 48

Categorized and Abbreviated Analytic Category One Findings

Question Question
Code Content
Analytic Category One Component: Definitions of Creativity

Q1 -1 Unclear definitions

Ql-3 Changing definitions

Ql-2 Unclear relationships to medical and science used as reference points

Q2-4 Creativity seen as a threat to credibility; creativity as a hidden factor

Q3-2 Novices made and fixed, experts thought and valued diversity and wisdom
Analytic Category One Component: Influences on Definitions of Creativity:
Ql-5 Historical definitions varied by age and/or career span

Q2-1 Creativity definitions varied by age and career span

Q5-1 Relationship between personal and work creativity changed with

time/maturation

Q4-3 Impact of work creativity on person tied to how work/personal life was

viewed

Ql-4 Work influences impacted definitions

Q2-3 Person, process, product, press theoretical framework not seen in a uniform

way

Q4-2 Age or career span did not impact effect of work creativity on personal life

Q4-1 Impact of work creativity on the OT was more difficult to determine

Definitions in context.

Participants' lack of uniform terminology for both creativity and occupational

therapy contributed to an unclear picture of the definitions of creativity in the context of

occupational therapy over time. Most of the participants made references related to the
evolving definitions of creativity, occupational therapy, professional boundaries, and

social contexts, and used medical, scientific, technological, and research-oriented points

of reference when they described occupational therapy over time. In turn, their beliefs

about medicine, science, technology, and research influenced their responses.

When reviewing the preliminary findings, it became evident that a significant

factor in defining and describing creativity in occupational therapy involved how

occupational therapists situated their profession in the world of healthcare (Iwama, 2006;

Christianson, 2006). While occupational therapy had long been linked to both creativity

and the fields of medicine, science, and research, there was an uneasy alliance between

these worlds. Occupational therapy theorist Christianson (2006) noted this pull:

There has been a tension in occupational therapy between its qualitative nature

and its existence in a scientific world that values quantitative and positivistic

demonstrations of 'truth.' This tension is aggravated in the current outcome-

oriented, cost-conscious, evidence-driven milieu of health care... occupational

therapy is almost uniquely a profession where the worlds of applied science and

lived experience have been able to come together, (p.xiii)

Whether or not the underlying ambiguity and tension in this relationship

functioned as a stimulant or impediment to the role that creativity plays in occupational

therapy could be in part be determined by how both creativity research and occupational

therapy have met and continue to meet the challenge of actively reinventing themselves

in response to changing cultural beliefs about both creativity and healthcare. Whether

occupational therapy conceptualized itself as a response to illness using a medicine-based

model or through the promotion of wellness using a health-based model will result in
distinctly different ways to describe the relationship between creativity and occupational

therapy.

Definitions based on lived experience.

The participants' explorations of how creativity in occupational therapy had

changed over time also demonstrated that perspective was not only a matter of personal

beliefs, experiences, and wisdom but is also influenced by each participant's training,

practice area task demands, and facility work-place culture. While participants' beliefs

about creativity in an historical context may lack veracity according to textbooks or

occupational therapy historians, participant responses reflected unique viewpoints and

beliefs, stemming from their own lived experiences. Because this research aimed to

achieve an understanding of the participants' definitions of creativity, it was important to

understand how each perceived creativity as an historical facet of their profession's

growth and development, just as this research aimed to understand their professional

growth and development as it related to their definitions of creativity

Definitions result in a new theoretical model.

As this research progressed, it became evident that participants' experiences and

definitions of creativity were most clearly described using a two-factor person/press and

process/product model derived from the theoretical framework's four-factor person,

process, product, and press model. Significantly, the two-factor model reflected the

dynamic impact of growth and maturation on creativity in occupational therapy by

demonstrating how the internal relationships between person/press and process/product

components changed with regard to participant age or maturation.

 243

The person/press factor described influences on creativity.

In the two-factor model, the components of person and press were combined to

form a factor that described their reciprocal influence on creativity in occupational

therapy. In this context, person/press was represented by the occupational therapist as a

creator operating within a realm of influences. With professional maturation, the

occupational therapist internalized more professional knowledge, and was able to solve

new problems using progressively internalized stores of knowledge; reducing the effect

of external influences on creativity as professional capabilities expanded (see Figure 1).

Press Influences:
Immediate (resources, time, patient)
Personnel (colleagues, management)
Social (government, culture)

y / Personal Influences:
/ / Readiness (training, experience)
s^ Perceptions (thinking style, beliefs)
Attributes (attitude, energy level)
Style (artistic, logical/mathematical)
1 1 1
10 years 20 years 30 years
Career Span

Figure 1. Relationship between person and press influences on creativity

In essence, the maturing occupational therapist developed and carried the

knowledge needed to harness or utilize constraints and opportunities that influenced

creativity; being affected less by and requiring less from the circumstances that defined
 244

any given situation. This was consistent with Vygotsky's theories of human development,

which creativity researcher Sternberg (2003) interpreted as a process of progressive

internalization. Vygotsky's concept of socially constructed knowledge also seemed to

hold particular relevance to occupational therapists who work and learn in crowded

environments where informal information exchange was a mode of knowledge

acquisition and facilitated the gradual internalization of both tacit knowledge and

specialized skills that occupational therapy practice sites embody (see Table 49).

Table 49

Relationship of Participants '* Ages to Personal Influences on Creativity

LT JL CJ BN CCh DD CCa CG BD
20s 30s 30s 30s 40s 40s 50s 50s 60s
Readiness: Training
Readiness: Experience x x
Perceptions: Thinking style x x x x
Perceptions: Beliefs x x x x x
Attributes: Attitude x x x x
Attributes: Energy level x x
Style: Artistic x x
Style: Logical/mathematical x
Total Factors 2 2 2 2 2 2 2 3 3

•Note: Participants referred to by initials and age range.

Additional factors related to the success of this shift from external to internal

control were the abilities of the occupational therapist to reframe perceptions of

influences and circumstances and to make decisions regarding how to utilize them. While

one participant observed that a fast pace at work inhibited her creativity, another claimed

that a fast pace was energizing and provided a degree of challenge that facilitated her
 245

creativity. Additionally, some participants viewed their crowded work environments as

places where interactions with peers proved beneficial. They viewed their close personal

proximity as an easy opportunity to tap into their coworker's knowledge bases and skill

sets, rather than lamenting loss of privacy or an inability to remain focused in the midst

of sometimes chaotic circumstances (see Table 50).

Table 50

Relationship of Participants' Ages to Press Influences on Creativity

LT* JL CJ BN CCh DD CCa CG BD

20s 30s 30s 30s 40s 40s 50s 50s 60s

Coll.a Coll. Coll.

Govt.1 Govt. Govt.

Culture Culture

Mgmt.c Mgmt. Mgmt. Mgmt. Mgmt. Mgmt. Mgmt.

Patient Patient Patient Patient Patient

status status status status status

Physical Physical Physical Physical Physical Physical Physical

resource resource resource resource resource resource resource

Time Time Time Time Time Time Time

5** 5 4 5 3 4 2 2 4

•Note: Participants are referred to by initials and age range. **Total factors mentioned by each participant.
a
Coll. is defined as colleagues, bGovt. is defined as government, cMgmt. is defined as management.

Participants described both person and press components in a variety of ways. The person

descriptors formed patterns related to personal readiness, perceptions, attributes, and

style. Press descriptors formed patterns by zones of influence, namely immediate

influences, personnel influences, and broader societal influences (see Table 51).
 246

Table 51

Descriptors Used by Participants for Person and Press Components

Component Descriptor Participant Words

Person: Training Education, book-learning

Readiness
Experience Real-life experience, trial and error

Person: Thinking Thoughtful, intuitive, conceptual, unique perspective, open-

Perceptionsi styles minded, visualizer, outside of box, practical
Beliefs Spiritual (destiny, blessedness, gifting, fate), client-
centeredness, formative experiences, preferences for tool
use and hand work
Person: Attitude Engaged, avoiding boredom, preferring novelty, interested,
Attributes going with the flow, flexible
Energy level Passionate, tired, energetic, laid back
Person: Artistic Being unique, different, novel, diverse
Style
Logical/ Being logical, scientific, linear, mathematical, kinesthetic
mathematical
Press: Physical Space (size and location), facility and patient resources,
Immediate resources budget
Time Scheduling, time for planning, treatment, and research

Patient status Patient condition, prior level of function, communication,

support, motivation
Press: Colleagues Assistants, peers, other disciplines, teams, climate,
Personnel supervising others, students
Management Being supervised, productivity demands, assigned duties,
administrative support
Press: Government Policy, legislation, rules, regulations, reimbursement,
Social insurance, laws, resources
Culture Support, resources, systems
 247

The process/product factor described outcomes of creativity.

In the two-factor model the process and product components of the theoretical

framework's four-factor model combined and formed a relationship that was similar to

the relationship between the person and press components. They became a conjoined

factor that described the outcomes of creativity in occupational therapy (see Figure 2).

Object Products:
Devices/Equipment,
Treatment Activities
People Products:
Buy In, Treatment Plans,
Staff Support
Object Processes:
Thinking/Planning,
Inventing, Adapting, Repairing
People Processes:
Thinking/Planning,
Facilitating, Applying

I 1
10 years 20 years 30 years
Career Span

Figure 2. Relationship between process and product outcomes of creativity

With the lengthening of career span, the processes and products of creativity in

occupational therapy shifted from tangible products and objects to less tangible patient

and therapist processes related to beliefs, values, thinking styles, and attitudes (see Figure

3). The participants' utilization of increasingly more creative strengths measured by the

ATT A (elaboration, flexibility, fluency, and originality) mediated the generation of

creative process and product outcomes.

 _L ±
Product
(Object • Person)

Creative Outcomes

Process
•> Person)

Creative Strengths*
.c&.........m
TLLJ "QXT' •mil
I

Press

Influences on Creativity

Person

1 1 1
10 years 20 years 30 years
Career Span

Figure 3: Two-factor model of creativity in occupational therapy

Note: Creative strengths measured by the ATTA: Elaboration, Flexibility, Fluency, and Originality
 249

Creative outcomes were described differently by novices and experts. Novice

participants frequently mentioned constructed task related outcomes such as orthotic

devices as tangible created products. Expert participants instead chose to focus on more

abstract outcomes, specifically recalling the development of motivation and engagement

although it may be presumed that the patients treated by the expert participants also

received tangible created products such as orthotic devices as part of their occupational

therapy treatment (see Table 52).

Table 52

Relationship of Processes and Product Outcomes to Participants' Ages

Participant* LT JL CJ BN CCh DD CCa CG BD

Age Range 20s 30s 30s 30s 40s 40s 50s 50s 60s
Process Objects Objects Objects Objects Objects Objects Objects Objects *

People * * * * People People People People

Product Objects Objects Objects Objects Objects Objects * Objects *

* * * * * People People * People

*Note: Participants are referred to by initials and age range.

In a fashion similar to the descriptions used in the combined person and press

factor, descriptions used by participants in reference to process and products components

also formed categories. The process descriptors included object-related processes, such as

conceptualizing how to create something, and people-related processes such as getting

engagement or buy in. Object-related products included created devices or orthotics, and

people-related products included enthusiasm and compliance (see Table 53).

 250

Table 53

Categorized Words Used to Describe Process and Product Components

Component Descriptor Words used by Participants

Processes: Thinking, Visualizing outcomes, conceptualizing, thinking abstractly,

Object planning thinking outside the box, finding alternate solutions, thinking
of more than one way, figuring out ways that are different
Inventing Starting from scratch, using raw materials, coming up with
unique ideas
Adapting Changing, modifying, adjusting, individualizing, improving,
adapting to environmental and temporal demands, changing
contexts, recycling, reusing, piecing things together, trying
something different
Repairing Fixing, repairing, rigging

Processes: Facilitating Tap dancing, think on your feet, figuring out what makes
People people tick, communicating, getting engagement, carrying
over, suggesting, using common sense, pushing buttons,
setting the stage, managing time
Applying Treating, training, exercising, walking, teaching, transferring

Products: Devices, Splints, prosthetics, orthotics, "box of magic," positioning or

Objects equipment seating systems, walkers, braces, chairs, beds
Treatment Projects, art and music, something unique, different or new,
activities crafts, games, a party, Wii®
Products: Buy in Interest, motivation, enthusiasm, engagement, connections,
People figuring out what makes others tick, compliance,
participation, cooperation, collaboration
Treatment Follow through, carry over, suggestion
plans
Staff Mentoring others, being mentored, inservice training,
support informal teaching

A dynamic process of this model is the relationship between creative outcomes

and their contribution to the creative cycle by increasing the experience levels of the

occupational therapist, providing more products and outcomes for the therapist to utilize,
 251

and by potentially changing the therapist's beliefs and values. In this way, the creativity

of the therapist grows in response to what they produce.

While not expressly stated, novice participants reflected a process of self-

education. Three participants specifically mentioned fashioning orthotic devices by

utilizing their own records for previously constructed orthotic devices and adapting them

to recreate other custom-designed, client-specific products. Consistent with Sternberg's

developing expertise model (2003), in this way each participant served as her own

teacher and used prior knowledge and skills to manage a work task. With maturation, as

this knowledge becomes internalized, it may be inferred that the therapist requires less

instruction provided by models or records.

An additional consideration entailing novice participant's penchant for citing

created objects as an outcome of creativity is that others in their work environment were

provided with an opportunity to review the participant's created products with them, and

to recognize their new skills as part of their evolving professional identity. While peers

could see, appreciate, and critique a tangible outcome or product, they would be less able

to do so for intangibles such as motivation and engagement. With knowledge

internalization, it is plausible that validation by peers is less necessary to developing and

maintaining a professional identity, further deemphasizing the need for participants to

create tangible objects in favor of creating intangible outcomes.

Struggles with definitions: Creative potential or ephemeral force?

When attempting to define creativity in occupational therapy, participants

reflected a strong belief that individuals were born with creative potential that was

expressed in varying degrees, and as Bea speculated, this potential may even come from
distant ancestral gene pools. Yet, participants also described creativity as an ephemeral

force that inexplicitly drew people to the profession of occupational therapy; even more

specifically, to certain practice sites and job settings which included mention of prisons,

psychiatric facilities, and hospitals. In this way, the creativity may have been

conceptualized as an external attractor that was pursued.

The ambiguity of determining whether creativity was a force that existed within

or outside of the therapist can bring to mind the old adage about blind men describing

various parts of an elephant based upon what they felt and the occasional rejoinder that

the blind men might have also felt a monkey running past the elephant. In this case,

however, it would appear that creativity might have taken the form of Dr. Dolittle's

"pushmi-pullyu," the two-headed creature that ran in both directions at the same time

(Lofting, 1920).

While participants alternately described creativity as a force that was located

either inside or outside of the individual, they shared beliefs about the personal attributes

that were associated with creativity. According to the participants, creativity embodied

energy, passion, tenacity, and critical and problem-solving thinking styles. None of the

participants evoked images of a calm, reflective, meditative creative occupational

therapist. Instead, they emphasized the active, "tap dancing," fluid-thinking therapist

engaged in multitasking, thinking differently, and combining a scientific, analytical

thinking style with a creative, artistic one. Creativity in occupational therapy was

characterized by participants as action, work, and responsiveness.

 Struggles with definitions: Nurtured or nurturing?

Participants also expressed beliefs that creativity needed an outlet. Whether or not

the creativity resided within or outside of the therapist, participants felt that creativity

needed to be expressed or manifested in some way. This appeared counter to the image

that participants created of the energetic, problem-solving therapist. In this case, the

pushmi-pullyu needed to be fed and nurtured to stay well. Again complexity arose.

Participant Boriqua noted both a need to express creativity so she would feel normal and

then reflected that she needed creativity to restore her when experiencing turbulence. In

these cases she both cared for and was cared for by creativity.

Bea noted her belief that creativity was a form of secondary energy that could

only emerge after the primary task demands were met; a process that could not be forced

but encouraged. Chatee, on the other hand, seemed to imply that her creativity was at the

ready, saying, "Sometimes I can just whip it out [laughs]." These conflicting ideas about

the utility of creativity imply similar viewpoints. While Bea and Chatee had different

ways of handling the creative force, both seemed to imply that it laid waiting for

expression.

Struggles with definitions: Examining relevant theories.

A body of research exists that supports participants' characterization of the

creative therapist. Sternberg's (2003) developing expertise theory of creativity held that

individuals working within any given professional domain were always improving,

always developing expertise. This five-component model included the development of

metacognition, learning skills, thinking skills, domain specific knowledge, and

motivation. Significant features of this model were that people not only learned domain-
 254

specific skills such as occupational therapy procedural knowledge but that they were also

able to understand and control their own knowledge acquisition using a combination of

critical, practical, and creative styles of thinking. In this theory Sternberg defined creative

thinking as a process of "...creating, discovering, inventing, imagining, supposing, and

hypothesizing" (p. 74). These processes were consistent with descriptions that

participants provided for thinking processes necessary for creativity in occupational

therapy.

Another perspective on the participants' views of creativity in occupational

therapy could be seen in Sinnott's (1998) work on creativity and postformal thought,

which she described by saying, "Creative thinking can synthesize acknowledge and

emotion and experience, lets the thinker grow in real life social contexts and can lead to a

high volume of high quality, behaviorally productive work" (p. 45). In this type of

thinking, Sinnott emphasized that postformal reasoning and practical creativity must

include two skills; one of intentionally framing situations in a realistic way that still

allowed for creative expression and another of maintaining grounding in the reality of the

situation at present. In other words, the therapist had to meet the task demands inherent in

any work-related situation yet could do so in a way that was imaginative and satisfying.

Using creative postformal thinking, therapists could intentionally have chosen the

perspective they took regarding the external realities they faced. As a result, the therapist

chose how they defined a problem, solved it using multiple perspectives and methods,

and decided whether a process or product was the most appropriate creative outcome.

Like Steinberg's (2003) developing expertise theory, it was assumed that the creator had
all the tools necessary to meet the demands of the task at hand, including the domain-

specific education, self-awareness, and flexible thinking.

A new definition of creativity.

Based on participant explorations in analytic category one, it was clear that no

single sound-bite definition of creativity in occupational therapy existed. However, the

two-factor model posed descriptions of creativity in occupational therapy that

incorporated both personal and professional maturation, changing contexts, and

influences. From these descriptions, a new definition of creativity is as follows:

Creativity in occupational therapy results from the dynamic interaction of the

occupational therapist and context, leading to outcomes that are relevant and satisfying.

Creativity in occupational therapy is both used and experienced by the occupational

therapist: It facilitates client outcomes and informs and sustains the occupational

therapist.

Utilizing this definition, creativity can be seen as a force that exists within both

the therapist and the context of occupational therapy and can be directed toward client

outcomes through the processes of problem solving and planning, and in the creation of

both tangible and intangible client-centered outcomes. Consistent with Rogers (1961) and

Richards (2007), creativity is a growth-related force that can influence the therapist's

decision-making regarding client outcomes, can teach skills and build knowledge, and

can facilitate engagement and renew commitment through entertaining, motivating,

challenging, and restoring the therapist.

 256

Analytic Category Two: Relationships

In analytic category two, research question findings cut across previous categories

and analyses and were grouped topically (see Table 54).

Table 54

Analytic Category Two Components of New Definition

Creativity in occupational therapy results from the dynamic interaction of the

occupational therapist and context...
Analytic Category Two Component: Creative potential within the occupational
therapist:

Q5-2 Creativity may have been innate

Q3-4 Personal attributes such as energy, passion, and tenacity contributed to

creativity at work

Q3-5 Personal style that combined a scientific, analytical with a creative, artistic
personal style contributed to creativity at work

Q3-3 Practical experience, energy, and diversity, but not formal training, were
factors in how personal creativity contributed to work creativity. Practical
experience and being hard-wired for creativity may have contributed to
personal creativity

Analytic Category Two Component: Creativity, maturation, and context:

Q5-3 Both personal and creativity at work are reflections of confidence, experience,
and wisdom

Q4-3 The impact of creativity at work on a person may be tied to how much personal
and professional lives are separated

Q5-1 Over time, the directionality of the relationship between personal and creativity
at work changed

Q4-2 Age or career span did not impact the impact creativity at work on personal life

Q3-2 Novice participants valued making and fixing things, working with their hands,
and pursuing hobbies. Expert participants valued diversity, client-centered
practicality, and wisdom
 257

Analytic Category Two Component: Creative nurture/nurturing:

Q5-4 Natural inclinations toward creativity needed expression, whether in work or

personally

Q5-5 People gravitated to the profession of OT and specific practice settings within
the field so they could find an outlet for creative expression

...leading to outcomes that are relevant and satisfying.

Analytic Category Two Component: Creativity facilitated client outcomes:

Q3-1 Thinking styles and problem solving abilities were the most significant factors
of creativity in OT

Analytic Category Two Component: Creativity informed:

Q5-7 Creativity led to skills that transferred from one domain to another

Q4-4 Increased experiences, changes in beliefs and values, thinking and planning
skills, personal growth and development, and abilities to create new objects and
engage in unfamiliar activities were personal results of creativity at work

Analytic Category Two Component: Creativity at work facilitated positive, creative

relationships with others:

Q4-1 The impact of creativity at work on the OT was more difficult to determine

Analytic Category Two Component: Creativity sustained:

Q5-6 Therapists used creativity to nurture, support, or entertain themselves

Q4-5 Creativity was a method of coping with stress experienced at work

Occupational therapists described their creative attributes.

The complex facets involved in defining creativity in occupational therapy

explained in part why creativity was more easily described from the viewpoint of the

therapist's personal creativity acting upon the workplace rather than the workplace

affecting the therapist. Perhaps because it was easier to understand internal states than

imagined external realities, participants had much more to say about their own creativity
 258

and how it impacted the workplace than how workplace creativity affected them.

Younger therapists emphasized their enthusiasm, interest in hobbies and making things,

and their easy-going personalities. The expert therapists emphasized their experience,

wisdom, and in some cases, energy and passion. The experts preferred diversity, novelty,

and avoidance of ruts and routines. The expert therapists also noted that developing

confidence had a positive effect on their own creativity.

Creativity changed with maturation.

Perhaps as a result of their growing ability to navigate complex patient care and

staff management responsibilities expert therapists exercised their knowledge and skills

in ways that respected potential waning energy and sensory acuities by becoming thought

rather than action-oriented. This is also consistent with developmental creativity

observations of Runco (2001). In response to a need to see meaning in their careers, the

expert therapists may have also chosen to function creatively in ways that allowed them

to tell their stories, share their wisdom, leave legacies, and provide them with a sense of

continuity past their own retirements (Sinnott, 1998).

The young therapists, in turn, expressed their own desire for not only instruction

but also for mentoring and acceptance. Lynn had a new life role as a wife with a husband

and dreams of their offspring, and imagined the impact that work-related creativity would

have on her own family; and Jennifer, as a young mother, saw opportunities to learn with

and from the work settings she operated in. As novice therapists, Carrie and Boriqua,

were also interested in skill building, and while Carrie engaged in newly-learned home

repair techniques, Boriqua responded to the siren call of creativity by playing her musical

instruments as a restorative response to her complex and sometimes stressful job.

 Occupational therapists described practice-related creativity.

While all participants were easily able to say how their personal creativity

affected their work, several balked at the difficulty created by thinking about creativity

beyond their own person. In considering the most typical response - that creativity at

work led to the development of skills that could be utilized in non-work endeavors -

Countessa, Lynn, Jennifer, Carrie, and Carlotta all reported that they had learned from

creative experiences at work, transforming them into activities and processes they could

engage in at home. Lynn, in particular, seemed eager to learn parenting skills from her

working environment, and Jennifer created her own information highway, both receiving

and sending information she scouted from different work settings and utilizing it at home

or other work settings.

Carlotta and Countessa, on the other hand, learned work-related creativity skills

and engaged in them for the sheer pleasure it brought them. They knitted and sewed as a

way to remain centered and happy in their personal lives. Remaining centered and happy

through creative outlets served a significant function for most participants. They learned

from creativity at work, but they also used creativity to sustain themselves. This is

consistent with the research of Hemlin, Allwood, and Martin (2008), who postulated that

enjoyable, positive group and organizational climate, and lively supportive

communication were necessary elements for the creative process to occur. Like Carlotta,

some participants reported using creativity as a way to remain present in the work

environment when they felt under-stimulated by some of the more repetitive tasks they

faced such as wound care and handwriting instruction while other participants like

Boriqua used creativity as a way to restore themselves after experiencing turbulence and
 260

feeling over-stimulated by work tasks such as managing patients with complex traumas.

Central to the transfer of creativity from work to home were the participants'

beliefs about the separation of work and personal life. If they viewed the two as an

integrated whole, creativity in one world could effect and be affected by creativity in the

other world. If the participant professed to maintenance of a distinct separation between

work and personal life, creativity did not migrate between the two worlds (Figure 4).

Effects of Personal
Effects of Work Creativity on Work:
Creativity on the
Person: Genetic Potential,
Energy, Enthusiasm,
Skill Development, Interests, Receptiveness,
Confidence Confidence, Experience,
Building, Wisdom, Mentoring,
Resource Thinking and Planning
Management Skills,
Skills Preferences for
Diversity and Novelty,
Flexible Personality

Figure 4.The relationship between work and personal creativity

Summary of Key Findings

1. Changing definitions and contexts continued to change the relationship of

creativity to occupational therapy.

 261

2. A dynamic two-factor model utilizing a person/press creator and process/product

creation best described the relationship between creativity and occupational

therapy.

3. Creativity in occupational therapy changed with maturation: The doer became the

thinker, and the product became the process. Both processes and products evolved

from object-centered to person-centered.

4. Creativity served three primary functions in occupational therapy: It influenced

the therapist's decision making regarding client outcomes, taught skills and built

knowledge, and facilitated engagement and renewed commitment through

entertaining, motivating, challenging, and restoring the therapist.

5. The relationships among creativity, the occupational therapist, and the practice of

occupational therapy were dynamic and changed both through time and with

personal and professional maturation.

Recommendations

Recommendations for occupational therapy education and practice.

Careful examination of this research has led to the formation of primary

recommendations that at face value may seem counter to much of what creativity

represents. This research suggests that for creativity to be enhanced in the work place the

development of metacognition, problem-solving skills, and a solid professional

knowledge base combined with practical application skills, confidence, and growing

wisdom in occupational therapists can facilitate the development of creativity. This is

consistent with the findings of Hunter, et al., 2008, that extensive knowledge in a variety

of domains helped with problem solving, though not necessarily idea generation, and also
with De Corte as cited in Tennant and Pogson (1995) who asserted that adult learners

must be able to; tap into and flexibly apply a well-organized, domain-specific knowledge

base, have heuristic methods or organized search strategies for tapping into the

knowledge needed for problem analysis, metacognitive skills about one's own cognitive

functioning, and learning strategies that are consistent with personal abilities and content

demands. Successful application of these principles was exemplified by the remarks

Carrie made regarding the reasons for her own successes as a learner:

It's...having experiences to draw from, and practice in different situations

knowing definitely what will not work, [laughs], what might work, and what I

think will work again. There's almost no 100%: it seems like the more I try

something the more I have success with it....

A work environment that enables therapists to generate a large number of ideas

about any given situation may also increase the chances that some of the ideas will be

innovative, creative, and relevant to the task at hand. The work environment should also

provide stimulating tasks and task supports that provide a manageable amount of

challenge without either overwhelming or boring the therapist. Citing the participants'

penchant for novelty and diversity, the work environment should have both. This is

consistent with the research of Pannells and Claxton (2008), who found significant

relationships existed between positive personality characteristics of happiness, creativity,

and locus of control. Tennant and Pogson (1995) also argued that on-going learning was

a necessary response to the evolving required knowledge and skills in a work place, and

required an absence of external constraints for the adult learner to have been able to fully
 263

evaluate what was necessary to learn for the maintenance or increase in competencies,

and what were the best ways to develop them.

Therapists and therapy managers should understand that creative thinking is a

developmental process and that while a creative personality may be a therapist, until they

have mastered a body of knowledge, their practice of occupational therapy will likely not

be creative. Novice therapists need plenty of support to become creative expert therapists,

and likewise, expert therapists need enough autonomy to be allowed to engage in

creativity derived from their own experiences and knowledge. Support can take the form

of environmental influences, supervision appropriate to the task, through mentoring, and

by provision of opportunities for increasing therapists' knowledge acquisition. Jaussi,

Randel, and Dionne (2007) determined that 68% of the variance in creative performance

in work is caused by self-concept and problem-solving, creative personal identity, and

creative performance. Explicit instruction in metacognitive processes can also help

therapists efficiently locate and tap into their increasing knowledge bases.

Recommendations for future research.

This study served as a starting point for research about creativity in occupational

therapy. Because it represented the beliefs and views of nine participants in one selected

metropolitan area, it cannot be said to represent all occupational therapists' viewpoints.

However, it did offer some considerations for future qualitative and quantitative studies.

Not unexpectedly, this research also raised more questions than it answered. The

following questions were raised during this research study:

 1. Would there be significant trends in therapists' perceptions of creativity that

could be accounted for by demographics that differed from this sample,

including:

a. Gender, ethnicity, practice area, level of training

b. Differing career length relative to chronological age

c. Residence in areas noted for differences in levels of creativity

2. What is the nature of creativity that is not inside of the therapist? What is the

factor that draws people to the profession of occupational therapy, that needs

expression, is perceived, but had not been described?

3. What type of influences impact creativity most significantly, and can they be

employed or utilized to increase creativity?

4. How is creativity in occupational therapy measured, quantified, or

operationalized?

5. What is the relationship between creativity and therapist effectiveness?

6. What is the relationship between creativity and therapist burnout?

7. What are the implications for creativity enhancement in professional

education and occupational therapy education?

Conclusion

At the conclusion of this research, it was helpful to review the original problem

that drove this research: Occupational therapy is a profession that has historically been

associated with creativity. However, neither uniform definition describing the

relationships between creativity, the practice of occupational therapy, and occupational

therapists, nor a conceptual model of the relationships between creativity, the practice of
occupational therapy, and occupational therapists existed. The intent of the research was

to examine the definition, impact, and relationships among creativity, the practice of

occupational therapy, and occupational therapists, and to develop uniform terminology, a

conceptual model, and emergent theory to describe the relationships among creativity,

occupational therapists, and the practice of occupational therapy.

As a result of this research, a definition has been formulated and a theoretical

model has been created to describe the relationships among creativity, occupational

therapists, and the practice of occupational therapy. As a human service profession,

occupational therapy differed substantially from many of the professions that placed a

premium on creativity, namely the fields of business and innovation management.

Consequently, models that emphasized production of novel and innovative products did

not fit well with a profession that was primarily engaged in process-oriented outcomes.

The model constructed as a result of this research accounted for these differences and

may have applications for other helping professions. Because it was rooted in the belief

that change is inevitable, this model focused on person-centered processes of growth and

change.

This is not to say, however, that the new model downplayed creativity as an

ephemeral force that also existed outside of the therapist. At the present time,

understandings of this ephemeral creative force remain limited but beg study. Creativity

is a fascinating topic and deserves focused exploration. In this research, creativity in

occupational therapy was viewed as a positive, growth-oriented force, and it can only be

assumed that creativity in this incarnation is desired by and encouraged in professions

like occupational therapy. For this reason, the recommendations of this research were
 266

based on the belief that creativity in occupational therapy is a positive attribute and

worthy of pursuit and enhancement.

"You just do it because you wanna do it. "

-Bea Devil
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 Appendix A
Occupational Therapy Workforce Statistics
 Appendix A: Occupational Therapy Workforce Statistics

In January 2006, surveys were mailed to 8,998 individuals. Of these, 5,000 were

members of the American Occupational Therapy Association, and 3,998 were

nonmembers. A total of 3,003 responses were analyzed and of these, 161 were analyzed

for selected issues. The following statistics describe the primary practice sites for all

respondents:

Primary Practice Sites for Occupational Therapists

29.6% Schools/Early intervention

23.5% Hospital (non-mental health)

15.4% Long-term care/Skilled-nursing facility

11.2% Freestanding outpatient facility

7.2% Home health

6.1% Academia

3.6% Mental health

1.6% Community

1.9% Other

Definitions of Primary Practice Sites Used in the Workforce and Compensation Survey

Academia: Represented by two or four year colleges or universities

Hospital (non-mental health): Included general acute, inpatient hospitals, hospices

located within general hospitals, hospital-based outpatient services, neonatal

intensive care units, pediatric units within general hospitals, freestanding

rehabilitation hospitals, and rehabilitation units within general hospitals.

Mental Health: Included freestanding behavioral health centers, behavioral health units

within general hospitals, community mental health programs, community-based,

not outpatient partial hospitalization programs, and partial hospitalization units

within general hospitals.

Long-Term-Care/Skilled-Nursing Facility: Included subacute units within hospitals, long-

term-care facilities within hospitals with no skilled beds, skilled-nursing facility

with either non-skilled unit, skilled or subacute units.

Schools/Early Intervention: Early intervention programs, early intervention programs

with private practice, pediatrics day-care program, school system including

private schools, and transitional program for high school students.

Home Health: Freestanding home health agencies, hospital-based home health care, and

mobile treatment team/home care services.

Freestanding Outpatient: Included comprehensive outpatient rehab facility (CORF),

physician or optometrist office-based private practice, rehabilitation agency or

clinic locations, and not-for-profit agencies.

Community: Included adult day-care program, area agency on aging, community

residential care facility, environmental modification program/services, group

home, independent-living centers, low vision programs, prevention/wellness

program, retirement/assisted living, senior center, and supervised housing.

American Occupational Therapy Association, (2006). Occupational Therapy Workforce

and Compensation Report. Bethesda, MD: AOTA Press

 Appendix B

Sample Gatekeeper Contact Letters and Consent Form

 Appendix B: Sample Gatekeeper Contact Letters and Consent Form

Hi [XXX],

This is Tina Fletcher from the [XXX] School of Occupational Therapy, following up on our

phone conversation. I want to thank you for allowing me access to a few of your therapists for

my creativity research. I want to verify that this is your email address and that you give me a

tentative nod for this project. If you don't mind, let me know with a brief response. In the

meantime, I will put together more information for you, and send it when the weather is good

and hot, sometime in August. (!)

Thanks again, Tina Fletcher, OTR

/ did receive the email. I will chat with a couple of people in the meantime. [XXX]

Dear [XXX],

In case you think I disappeared off of the map, I am writing you to share the happy

news that I have been given formal approval to begin my occupational therapy and creativity

research! I hope you are still interested in serving as a gatekeeper at your facility and providing

your therapists with this information. After I establish contact with any interested therapists, your

commitment is finished. In fact, you are probably eligible to participate if you are interested.

Essentially, I am looking for English-proficient occupational therapists of any level of

experience. My one exclusion will be any of my former students who know me too well. I have

enclosed an information sheet for your review. If you agree to participate as gatekeeper, I will

ask you to distribute this in any way you choose. In addition, I am enclosing a copy of the

gatekeeper's agreement. I will send you a hard copy for your signature if you agree to it.

Thank you again for your willingness to allow me access to therapists at your facility for

this research. According to my pilot study participants, they thought participation in this research

was both interesting and enlightening, and I have confidence other therapists will, too.

Don't hesitate to contact me if you have any questions at all!

Tina Fletcher, OTR

No problem, I can do that, I will check with the staff next week. [XXX]
 285

Consent to Serve as a Gatekeeper for Research

Title: Occupational Therapists' Beliefs Regarding the Definition and Impact of Creativity
on their Practice of Occupational Therapy: A Grounded Theory Study

Investigator: Tina Fletcher, OTR (903) 450-6283

The Role of Gate Keeper:

You are being asked to serve as a gate keeper for therapists at your facility who may be
eligible to participate in research to determine occupational therapists beliefs regarding the
definition and impact of creativity on their practice of occupational therapy. The gate
keeper distributes information about the research to potentially eligible individuals. When
any potential respondents express interest in this research, the gate keeper provides contact
information to the researcher.
Research Procedures:
For this study, the researcher will conduct interviews with approximately 30 selected
experienced occupational therapists from schools, hospitals, academic institutions, and
retirement centers in the Dallas area. The maximum total time commitment of participants
in this study is two brief (less than one hour) interviews during fall 2009, an opportunity to
attend an optional brief (less than one hour) focus group if they are interested in the results
of this research, and approximately 30 minutes to complete self-reports. To offset the time
participants give this research project, the researcher will buy them lunch or a snack for
each interview.
Confidentiality:
This research is confidential. All results will be protected to the extent that is allowed
by law. No information about the individuals treated at the facility will be a part of this
research. No information that will identify the participant or workplace by telephone
number, physical/e-mail address, digital image, or voice will be in any presentations of
study findings. Fictional names will used to represent the names of the participants and
locations in this research or any related publications or presentations. Any identifiable
information about the participant or workplace including paper documents, computer files,
digital files, or audio tapes will be stored in locked cabinets in the researcher's access-
controlled office and then destroyed after five years according to institutional policy.

I agree to serve as gate keeper for this research. I understand my commitment is to

distribute information about the research to potential participants, and to transmit this
information to the researcher. I understand that I will not have access to confidential
information and research data.

Signature of Gate Keeper Title Date

 286

Research Location Contact Information

yes no I allow my facility to be photographed if there are no identifying

elements.

yes no I would like to see the conclusions of this research.

Thank you for considering your participation in this research. For more
information about it, you can contact the following individuals:

Tina Fletcher, MFA, MA, OTR,

Doctoral Candidate, Texas A & M-Commerce, P. O. Box 3011 Commerce, TX 75429-
3011
(903) 886-5537 TAMU-C, Mobile phone: (903) 450-6283
Email: [email protected] or [email protected]

Mary Beth Sampson, EdD,

Doctoral Adviser, Texas A & M-Commerce P. O. Box 3011 Commerce, TX 75429-3011
(903) 886-5160, Email: [email protected]

Potential Participants

Name: Email Address: Place of Employment:

 Appendix C

Research Information Sheet

 288

Appendix C: Research Information Sheet

Date

Dear Occupational Therapist,

Are you interested in participating in research about the relationship between

occupational therapy and creativity? Tina Fletcher, OTR would like to recruit occupational

therapists to individually participate in two sessions lasting no more than one hour each over

the course of the 2009 fall semester. If you participate, you will be asked to complete a brief

personality inventory, a brief assessment of creativity, and a work values questionnaire. You will

also be interviewed regarding your beliefs about the relationship between creativity and

occupational therapy.

Please don't feel pressured in any way to participate. Tina recognizes that some of you

may be unwilling, uncertain, or uninterested in participating in this research, and also

appreciates the fact that you may feel awkward about being "tested" by a peer. You may worry

that you aren't creative enough. All results will be kept in strictest confidence and any

references to you will be by pseudonym and as a member of an unspecified practice site. Tina

also knows you are busy and plans to provide any participants with a meal or snack to offset the

time given her during each of the two sessions and the focus group.

Thank you for considering this request, and if you are interested in participating,

according to IRB protocol, you can notify Tina's gatekeeper, [XXX], and she will forward the

information along to Tina.

Thank you,

Tina Fletcher, OTR

 Appendix D

Demographic Data Form

 290

Appendix D: Demographic Data Form

Participant Name

Pseudonym

Pseudonym Prompt

Work location?

Career length?

Other OT worksites?

OT work outside of this area?

Educational background

Avocational creative activities?

English proficient?

Agree to participate?
 Appendix E

Consent to Participate in Research

 292

Appendix E: Consent to Participate in Research

Title: Occupational Therapists' Beliefs Regarding the Definition and Impact of Creativity
on their Practice of Occupational Therapy: A Grounded Theory Study
Investigator: Tina Fletcher, OTR (903) 450-6283
Explanation and Purpose of this Research:
You are being invited to participate in a doctoral dissertation research study. The
purpose of this research is to determine occupational therapists beliefs regarding the
definition and impact of creativity on their practice of occupational therapy.
Research Procedures:
For this study, the researcher will interview approximately 30 selected occupational
therapists from schools, hospitals, academic institutions, and retirement centers in the
Dallas area. Interviews will be conducted in an agreed-upon location of your choice with at
least one of these interviews at or near your work location. You will be asked provide
information about your educational background, work experience, and your beliefs about
creativity. To ensure accuracy, interviews will be audio-taped to create transcripts. If you
do not wish to be audio-taped, the researcher will take field notes of the interview. In
addition, you will be asked to complete three brief self-reports during or after the first
interview. Your maximum total time commitment in this study is two brief (less than one
hour) interviews during fall 2009, an opportunity to attend an optional brief (less than one
hour) focus group if you become interested in the results of this research, and
approximately 30 minutes to complete self-reports. To offset the time you give this
research project, the researcher will buy you lunch or a snack for each interview.
Potential Risks:
This research entails no risks greater than those encountered in daily life. Potential risks
related to your participation could include discomfort or performance anxiety during the
interview or when completing the brief self-reports. To offset this, you will have an
opportunity to review the interview questions, and what completing self-reports entails
before you begin. While you are being interviewed or completing self-reports you may take
a break or stop at any time. You may also reschedule the interview or completing self-
reports for a later time or date.
Another possible risk to you as a result of your participation in this study is the loss of
confidential information. Your confidential results will be protected to the extent that is
allowed by law. No information about the individuals you treat will be a part of this
research. No information that will identify you or your workplace by telephone number,
physical/e-mail address, digital image, or voice will be in any presentations of study
findings. Fictional names will used to represent the names of the participants in the study.
Any identifiable information about you or your workplace including paper documents,
computer files, digital files, or audio tapes will be stored in locked cabinets in the
researcher's access-controlled office and then destroyed after five years according to
institutional policy. Interviews will take place in a space agreed upon by you and the
researcher. A code will be used in place of your name on all documents. Only you and the
researcher will have access to this information.

Participant's initials
 293

Participation and Benefits:

Because this is a research study, the researcher cannot predict the outcomes with any
degree of certainty, so there is no guarantee that you will receive any direct personal benefit
from taking part in the study. However, there may be benefit in knowing that they have
engaged in research that may benefit the profession of occupational therapy and field of
creativity research. Additional benefits may include increased awareness of your own
creative thinking ability, personality style, and work values. A professional benefit could be
that participating in research may be considered a form of professional service and as such
be a valued workplace behavior.
Questions Regarding the Study:
You will be given a copy of this signed and dated consent form to keep. If you have
any questions about the research study including how your name and personal information
will be used, you may ask the researcher using the contact information on this form. If you
have any questions about your rights as a participant in this research of the way this study
has been conducted, you may also contact the Texas A & M University-Commerce of
Research and Sponsored Programs, at (903) 886-5200 or via email at IRB@ tamu-
commerce.edu

I give my informed consent to participate in the research study entitled

Occupational Therapists' Beliefs Regarding the Definition and Impact of Creativity on
their Practice of Occupational Therapy: A Grounded Theory Study and allow the
researcher to interview me at my workplace. I understand my participation in not required
and I may withdraw at anytime from the study.

Signature of Participant Printed Name Date

yes no I allow my interviews to be audio-taped.
yes no I allow my work place to be photographed.
yes no I allow field notes to be taken during my interview.
yes no I would like my results at the conclusion of the research.
Thank you for considering your participation in this research. For more information about it, you can contact
the following individuals:

Tina Fletcher, MFA, MA, OTR,

Doctoral Candidate, Texas A & M-Commerce, P. O. Box 3011 Commerce, TX 75429-3011
(903) 886-5537 TAMU-C, Mobile phone: (903) 450-6283
Email:[email protected] or [email protected]

Mary Beth Sampson, EdD,

Doctoral Adviser, Texas A & M-Commerce P. O. Box 3011 Commerce, TX 75429-3011
(903) 886-5160, Email: [email protected]

Tracy Henley, PhD,

Head, Department of Psychology and Special Education
Texas A & M- Commerce Henderson Hall 220, Commerce, TX 75429-3011
(903) 886-5200, Email: [email protected] Participant's Initials
 Appendix F

Participant Flow Sheet

 Appendix F: Participant Flow Sheet
Participant Pseudonym:

Gatekeeper:

Initial Contact:

Response:

Interview Scheduled:

Phase One:

Interview Session One:

Consent Obtained:

Demographic Data Sheet Completed:

Participant Pseudonym:

Interview Schedule Given for Review:

Interview:

ATT A Administered:

ATT A Masked:

ATT A Scored:

MBTI administered or sent with participant with SASE:

MBTI returned via mail from participant:

MBTI Scored by participant or researcher (select):

MIQ taken or sent with participant (select) with SASE:

MIQ returned via mail from participant:

MIQ returned via mail from Minnesota:

Interview One Field Notes:

Transcript completed:
 Initial Coding:

Focused Coding:

Interview One Transcript Completed:

Initial Coding:

Focused Coding:

Data Input into Form:

Case Study Synthesized:

Phase One Lit Review:

Phase Two:

Interview Two Scheduled: Reconfirmed:

Interview Two:

Member check:

Interview one synthesis:

Assessment results:

Preliminary case report:

Interview Two Reflections:

Interview Two Transcript Completed:

Initial Coding:

Focused Coding:

Phase Two Lit Review:

Data Synthesis:

Member Check:

Transcript Member Checking:

 Initial Coding Member Checked:

Focused Coding Member Checked:

Case Study Member Checked:

Debriefing:

How information should be transmitted:

Face to face, Internet, Mail

Thank you for participant:

Letter, Token of appreciation

 Appendix G
Data Sources for Research Questions
 299

Appendix G: Data Sources for Research Questions

Data Source Research Question

One Two Three Four Five
Literature review X X X X X
Interview One, Question 1 X X X X
Interview One, Question 2 X X
Interview One, Question 3 X X X
Interview One, Question 4 X X X
Interview One, Question 5 X X X X X
Interview One, Question 6 X X X X X
Interview One, Question 7 X X X X
Interview One, Question 8 X X
Interview One, Question 9 X X X X
Interview One, Question 10 X X
Interview One, Question 11 X X X X X
Interview One, Question 12 X X X X
Interview One, Question 13 X X X X X
Interview Two, Question 1 X
Interview Two, Question 2 X X X
Interview Two, Question 3 X X X
Interview Two, Question 4 X X X
Interview Two, Question 5 X X X
Interview Two, Question 6 X X X
Interview Two, Question 7 X
Interview Two, Question 8 X
Interview Two, Question 9 X
Interview Two, Question 10 X
Demographic data form question 1 X X X X
Demographic data form question 2 X X X X
Demographic data form question 3 X X X X
Demographic data form question 4 X
Demographic data form question 5 X X X X X
Demographic data form question 6 X X X X X
Instrument 1: ATT A X X X
Instrument 2: MBTI X
X
Instrument 3: MIQ X X X X
Photographs
X X X X X
Field notes
X X X X X
Sketches
X X X X X
 Appendix H

Theoretical Framework to Research Question Matrix

 301

Appendix H: Theoretical Framework to Research Question Matrix

Theoretical Framework Research Question

One Two Three Four Five
Person X X X X X
Process X X X X X
Product X X X X X
Press X X X X X
 Appendix I

Demographic Information Sheet

 303

Appendix I: Demographic Information Sheet

Participant's Name: Age/Gender: Agrees to Comfortable

participate? using English?
Yes / No Yes / No

Pseudonym :

Pseudonym Prompt:

Contact phone, address,

email:

Work location/
job role:

Career length:

Other OT worksites:

Other types of work:

Educational background:

Creative activities/hobbies:

Other comments/thoughts/suggestions:
 Appendix J:

Assessment and Self-Report Research

Questions and Theoretical Model Matrices

 305

Appendix J: Assessment and Self-Report

Research Questions and Theoretical Model Matrices

Research Question
le Two Three Four Five
Abbreviated Torrance Test for Adults X X X X
Myers Briggs Type Indicator X X X X
Minnesota Importance Questionnaire X X X X

Theoretical Framework

:rson Process Product Press

Abbreviated Torrance Test for Adults X X X
Myers Briggs Type Indicator X X
Minnesota Importance Questionnaire X X X
 Appendix K

Interview One Questions

 307

Appendix K: Interview One Questions

1. Tell how you feel your personality contributes to your creativity at work.

2. When you describe creativity at work, what exactly does that mean to you?

3. What exactly do you create when you are creative at work?

4. How does your work environment influence your creativity?

5. Tell how the length of your career impacts your creativity at work.

6. In what ways does your gender impact your creativity at work?

7. How do work demands influence your creativity at work?

8. How does working in the Dallas area influence your creativity at work?

9. What meaning do you give to creativity in your OT practice?

10. What comes to mind when you think about creativity?

11. Think over your time spent with an occupational therapist that involved something

related to creativity. It could be a new idea, experience, or approach. Describe that

experience, and how you were involved with it. Tell how you felt about the outcome.

Share any thoughts, perceptions, and feelings you have about it until you have no

more to say about the experience.

12. Can you describe a situation where you would felt the therapist was not creative in

their practice and could have been? Will you fully discuss how you would have

responded to the situation and why.

13. Can you describe your job situation?

14. Additional open-ended questions generated by discussion of the above listed

questions may be asked for purposes of clarification or elaboration.

 Appendix L

Interview One Questions to Theoretical

Framework and Research Questions Matrix

 309

Appendix L: Interview One Questions to Theoretical Framework and Research Questions

Matrix

Data Source Research Question

One Two Three Four Five
Literature review X X X X X
Interview One, Question 1 X X X X
Interview One, Question 2 X X
Interview One, Question 3 X X X
Interview One, Question 4 X X X
Interview One, Question 5 X X X X X
Interview One, Question 6 X X X X X
Interview One, Question 7 X X X X
Interview One, Question 8 X X
Interview One, Question 9 X X X X
Interview One, Question 10 X X
Interview One, Question 11 X X X X X
Interview One, Question 12 X X X X
Interview One, Question 13 X X X X X

Theoretical Framework

Person Process Product Press

Interview question 1 X
Interview question 2 X X X X
Interview question 3 X
Interview question 4 X
Interview question 5 X X X
Interview question 6 X
Interview question 7 X X X X
Interview question 8 X X X X
Interview question 9 X X X X
Interview question 10 X X X X
Interview question 11 X X X X
Interview question 12 X X X X
Interview question 13 X X X X
 Appendix M

Theoretical Framework and Research Question Matrix

 Appendix M: Theoretical Framework and Research Question Matrix

Synopsis:

1. How have definitions of creativity

in the context of occupational
therapy changed overtime?

2. How do occupational therapists

define creativity in the context of
occupational therapy?

3. In what ways do occupational

therapists feel their personal
creativity impacts their practice of
occupational therapy?

4. What is this impact of Practice-

related creativity on the
occupational therapist?

5. What is the relationship between

occupational therapists' personal
creativity and practice-related
creativity?

Person

Process

Product

Press
 Appendix N

Individual Data Collection Set

 313

Appendix N: Individual Data Collection Set

Participant:

Abbreviated Torrance Test for Adults (ATTA)

Creative Creative Role What This Ability/Role Means

Ability (circle one)
Fluency Collaborator The ability to produce quantities of ideas which are
Contributor relevant to the task. The creative person typically
Accelerator evidences the ability to generate multiple of alternative
ideas and solutions, both verbally and figurally.
Originality Collaborator The ability to produce uncommon ideas of ideas that are
Contributor totally new or unique. A creative person tends to
Accelerator produce such new ideas rather than follow the more
common path.
Elaboration Collaborator The ability to embellish ideas with details. Rather than
Contributor being restricted to the core idea, a creative person tends
Accelerator to provide such embellishment.
Flexibility Collaborator The ability to process information or objects in different
Contributor ways given the same stimulus. Flexible thinking is
Accelerator especially important when logical approaches fail to
produce satisfactory results.
Creativity Verbal:
Indicators Figural:

Role Definitions:

Collaborators position themselves to work with others using this creative ability. They
are best working with others from a group strengths perspective.

Contributors work best when performing creative activities jointly with others using this
creative strength.

Accelerators use this creative strength well. They excel at this creative strength.
 314

Myers Briggs Type Indicator (MBTI)

Preference Type: Score Range and Preference Clarity

Slight Moderate Clear Very
Clear
Extraversion or Introversion 11-13 14-16 17-19 20-21
Sensing or Intuition 13-15 16-20 21-24 25-26
Thinking or Feeling 12-14 15-18 19-22 23-24
Judging or Perceiving 11-13 14-16 17-20 21-22

Description of this Myers Briggs Type:

Minnesota Importance Questionnaire (MIQ)

Logically Consistent Triad (above 33% is considered valid):

C Index for Occupational Reinforcer Patterns (ORPs)
Satisfied = C value greater than .49
Likely Satisfied = Between .10 and .40,
Not Satisfied = Less than .10

Cluster * A B C D E F
Work Value ACH- ACH- ACH- ACH- COM Alt-Corn
(Upper case AUT-Alt Com Aut-Com STA-
indicates a higher
Com
item weighting)
C Index core

Highly Satisfying
Profession
Not Satisfying
Profession
Occupational
Therapy Score
(Cluster A)
*ACH=achievement, ALT=altruism, AUT=autonomy, COM=comfort, STA=status
 315

Percentile of Scale Score Score Underlying Work Related

(-1.0 through +3.0) for Age and Work Value Reinforcer/
Gender Psychological Need
5% 15% 50% 85% 95%
Achievement
Ability Utilization
Achievement
Comfort
Activity
Independence
Variety
Compensation
Security
Working Conditions
Status
Advancement
Recognition
Authority
Social Status
Altruism
Co-workers
Social Service
Moral Values
Safety
Company Policies
Supervision-Human
Relations
Supervision-Technical
Autonomy
Creativity
Responsibility
Notes:
 316

Content Analysis Template: Research Question and Theoretical Framework

Data Source (Interview, Artifact, Field Note, Memo, Correspondence, Image):

Synopsis:

1. Definition of creativity in OT?

2. Definition of creativity in OT over

time?

3. Personal creativity impacts practice?

4. Practice impacts personal creativity?

5. Relationship of personal to practice

creativity?

Person

Process

Product

Press
 Appendix O

Interview Two Questions and Word List Prompt

 318

Appendix O: Interview Two Questions and Word List Prompt

1. Last time we spoke, we discussed creativity in the practice of occupational therapy.

How do you think definitions of creativity in the practice of occupational therapy

have changed over time?

2. I am interested in understanding how creativity in the practice of occupational therapy

is different from personal creativity. In general, how do you define personal

creativity?

3. Can you define your own personal creativity?

4. In what ways do you feel your results on the Abbreviated Torrance Test for Adults

contribute to an understanding of your personal or occupational therapy practice-

related creativity?

5. In what ways do you feel your preferences listed in Myers Briggs Type Indicator

contribute to an understanding of your personal or occupational therapy practice-

related creativity?

6. In what ways do you feel the results from the Minnesota Importance Questionnaire

contribute to an understanding of your personal or occupational therapy practice-

related creativity?

7. In what ways do you feel your own personal creativity impacts your practice of

occupational therapy?

8. In general, what is the impact of occupational therapy practice-related creativity on

you?

9. Specifically, what is the impact of occupational therapy practice-related creativity on

your personal creativity?

 319

10. We have discussed your occupational therapy practice-related creativity and your

personal creativity. Overall, how would you describe the relationship between your

personal creativity and your occupational therapy practice-related creativity?

For the participant provided creativity word lists, the following word list prompt was

read:

"Please list ten words or phrases that come to mind when you think of personal creativity

and occupational therapy practice-related creativity. You can use the same words in each

category if you like."

 Appendix P

Content Analysis to Research Questions and Theoretical Model Matrix

 Appendix P: Content Analysis to Research Questions and Theoretical Model Matrix

Item:

Description:

Source:

1. How have definitions of creativity in

the context of occupational therapy
changed over time?

2. How do occupational therapists

define creativity in the context of
occupational therapy?

3. In what ways do occupational

therapists feel their personal
creativity impacts their practice of
occupational therapy?

4. What is this impact of Practice-

related creativity on the
occupational therapist?

5. What is the relationship between

occupational therapists' personal
creativity and practice-related
creativity?

Person

Process

Product

Press
 Appendix Q

Preliminary Models
 323

Appendix Q: Preliminary Models

Readiness 1

1 immediate
Attributes 1 1 Resources

f personnel
Preferences 1 I Resources

1 Social Resources
Style 1

Figure 1. Representation of the relationship between the person and the press

Figure 2. Early representation of processes of creativity

 •The Bag of Tricks •Starting from
•What You Believe Ground Zero
•The Gene Pool •Rigging it Up
Doesn't Have a Life •Pulling Things from
Guard Left to Right

Who is Doing What They

It are Doing

What you
W
What You
Have to End Have to Do it
up With With
•Visible Things:
Functional things to »Time and Space
get job done •Human Resources
Invisible Things: •Big Picture
• Buy In, Motivation Resources /

Figure 3. Theoretical framework depicted using in vivo and everyday language

Figure 4. Theoretical framework depicted using early coding schemes

 Immediate
Resources,
Personnel
Resources,
Social
Resources

Personal
Readiness.
Personal
Preferences,
Personal
Attributes,
Personal Style

Figure 5. Demonstration of relationship between person and press in late phase of

research
Task Demand of Time and Space Resources
Tangible Outcomes
Human Resources
Task Demand of
Abstract Outcomes Big Picture Resources

Occupational Therapy
Creativity

J
Personal Preparation Process of Generating

Personal Perceptions Process of Adapting

Personal Attributes Process of Facilitating

Figure 6. Model of creativity using person, process, product, and press framework
 326

Influences on Creativity
D Outcomes of Creativity

Person Processes:
• Readiness • Object Processes
• Preferences • People Processes
• Attributes
•Style

Press Products:
• Immediate Resources • Objects
• Personnel Resources • People
• Social Resources

Figure 7. Version one of the two-factor model for creativity in occupational therapy
 Appendix R

Preliminary and Evolved Coding Schemes for Question One

 328

Appendix R: Preliminary and Evolved Coding Schemes for Question One

Selected Portions of Interview Responses

Question One: Last time we spoke, we discussed creativity in the practice of occupational

therapy. How do you think definitions of creativity in the practice of occupational therapy

have changed over time?

Bea:

Well, I'm not sure that we even define it, you know, as a trait within occupational

therapy... I don't know that it jumps out at me, if it's a, you know, an occupational

therapist should be... he I think our literature doesn't also focus on that either are so if

you look in the literature there's probably little... maybe I'm not reading it though, too.

You know, you do science; the art falls off. And I think that's what's happened is that

whole evidence-based, and all of that we've been focusing in more on the empirical, or

that this systematic, more of the science, and less on creativity.

And I think that in this directly, you might think about the definition between play

and playfulness. You know, kind of, you know, what comes in.. .when the whole school

of thought on playfulness really looks creativity without saying creativity, versus playing

to learn. Because that's an example of saying, you know, we bought into, and we still

believe, that play as an occupation is a means for learning, so it's a means and an end. But

when you look at playfulness, that takes you away from the science, the steppage, the

learning, you just do it because you wanna to it. And I think that's more comparable to

creativity, but I don't know that we define it that way.

Boriqua:

I think there are people who use that in that occupation of artistry as a means to

get things that not as much. Little by little it's harder to incorporate that into rehab-based
facilities, especially when you're dealing with third party payers and how you document

and all those fun things. The treatment would pose more of a challenge to having your

documentation skills up to par, and to be able to support that. I just think in general that

that OT as a whole is moving away from that kind of creative background. Creativity is

changing from what used to be to what it is now.

I think that in the beginning that occupational therapy itself probably drew

creative types who like to make things and who like to be creative in the creative sense of

like created an artistic thing. Most people would say that's creativity. You are making an

art product; you're creating something with your hands; a concept that's inside of you and

then you create it. It basically giving those tasks to others to occupy their own minds and

use their bodies to, even if that individual wasn't creative themselves, but it was like this

is a mode of occupation, you are doing something, you are doing using your hands, and

this is a modality, you use it and I am the creative one of who does it. I made this

connection that this helps.

And I think now we've moved to, you know, those kinds of tools are used as

much anymore, especially, like it's really seen in mental health, and maybe prison

systems, or an actual true mental health facilities, still use a lot of that. And you see it

used less and less, maybe it's used by rec therapy, but it's not used by OT as much and I

think it's what third party payers come into play. You know you're having to say this is

what I'm doing and you have to be a little more concrete, and so I think it's turned about

to you don't do those kinds of things as much, and if you choose there you are really

careful about how you document. And I think there are still people who... and I think that

we still use some of those things here, but we are going to document that differently so
there should not a question mark about it. Like what is the purpose of doing this to get

that? I mean, you know what the purpose is, you know that you are trying to..., but at the

same time, but it's not always, you know, the reality of looking at it, are not interested, or

see the value in it.

So it's still used but maybe not, you know, written and I think that now it's like

okay you can use it, but you're not going to document it that way. You're going to

document what you're trying to get out of it, what you, you know, call it an activity, and

not necessarily... but then like I said before that now being the creative beings who like

that kind of thing, people gravitate more to those types of jobs where they actually can

still do that and then you have places where you do more of phys dys, disability kind of

things.

We end up having to be creative in a different mode this job is about creating

something yourself and the therapist is the one that's having to be like the flexible,

creative type to come up with something. The requirements are different. It's not so much

for the activity but the goal, so...

Carlotta:

Definitions of creativity in occupational therapy... well, I think that creativity in

the beginning, because they were so focused on the craft, artisan factors, and reaction to

the Industrial Revolution, that having the abilities to create your own objects etc. was

valued more. And then we went on into the Scientific revolution and aspects where we

tend to see things in black and white. However living with the scientist, I have learned

there is an aspect of creativity to that, too. You have to look at all sides of things, and not

make assumptions.
 331

And I think in the profession of occupational therapy we went from all to nothing,

you know, all to nothing. That's kind of throwing the baby out with the bathwater to

making it more where we got occupation back. And in occupation, we are looking at

individuals. And being client-centered, where you had to engage creativity in finding

what was of meaning and value to the client instead of reaching for the DLM materials,

as well as productivity taking a part in determining which you can and can't do in terms

of being a creative therapist yourself.

But, um, I think that bringing the client-centered part back influences creativity

has helped us return to creativity because you can't... because people aren't cookie-cutter.

That's what I think.

Carrie:

That's interesting. I think the way our profession started out, you know, that in the

early 1900s, so there's got to be a lot of changes in the way patients are managed. And I

think maybe some of the outside constraints over time have changed the way that

therapists have had to be creative. I think now, probably we had more autonomy than we

once did. I think a lot of it has to do with the outside constraints.

I know at my hospital in the 1980s, they had a large psych department with 20

OTs, and they were doing psych groups all day long. And now we don't even have a

psych unit. And so, I think that's one way where we had to be more creative with time

and resources, and having psychiatric patients that maybe should be on a psych unit that

are in another part of the hospital, because we don't have a special unit for them and so,

now they don't even have a unit for inpatients. I know some med surg therapists who

manage them.
 I have a patient, I may have even talked about him the first time we met, I had

really a truly psych patient who had a TBI [traumatic brain injury.] He had beaten up in

his front yard, and he hadn't been on his meds, and so there were a lot of really psych

behaviors that were more psychiatric behaviors than TBI. And I remember thinking, all

right all those psych classes I took, I'm going to have to dust that part off, and think about

how we can redirect him, so we can at least safely transfer him to somewhere. Because he

was really at a point where he had to be four-point restrained in the bed. And you know,

nobody wants that for a patient, especially a young patient; any patient really.

So, I think it was because I had been a therapist ten years, which had been a lot

for me, but I haven't seen a whole lot of changes in this profession other than outside

payers, who were saying were going to have this, and limit this, and not have a psych

unit, because when I very first became an OT, that's when the Balanced Budget Act

became a law first, so there were lots of cuts in therapy and reimbursement and things

like that.

.. .I'm always thinking about what I have and what I can do to make the situation

better. I have simple, simple things. And I think that has developed over time.

I think the first thing is just having experiences to draw from, and practice in different

situations knowing definitely what will not work, [laughs], what might work, and what I

think will work again.

Chatee:

What meaning do I give? As a new OT, back in the day, [laughs], we would

have focused in with a lot of crafts. There was a lot of almost life enrichment,

recreational therapy kinds of components to what we did.

 333

I believe OT just as a profession has changed incredibly over the last 50 years,

going from craft kinds of clinicians if you will, to a lot more... we use craft, but we use a

lot more clinically established techniques. So, I think that has lent itself to allow us to

being more credible if the medical community. And I do appreciate the flexibility that we

have now where I don't know that we had it before in being able to do ADLs, and with

functional mobility, and with feeding in some form. We are very blessed in having the

ability to cross the line, and that allows us to be more creative. And we're not just craft-

oriented anymore, but its function.

Countessa:

I don't know if this is right or not, but I think that, urn, I think that occupational

therapy has moved more toward a biomechanical approach. Um. Rather than activity

based in a lot of facilities, and so people aren't utilizing the same types of activities in

their treatment that they were where they utilized a lot of... I don't even think in OT

school they are teaching some of the crafts like that anymore.

And so people aren't using... in fact we're discouraged from using things like

those types of activities. Ummm...some people... (Laughs.) [Question: Do you mean like

higher ups?]. Yeah, because it's not seeming like a medical treatment or it seems like why

are you using toys or why are you using something a kid would use? It's seen as doing

something a child would do, rather than what you would have an adult do.

So I'm talking about the craft type things. Or weaving, or doing ceramics, or

doing whatever it might be, or even something that patient has a particular interest in that

would do the same thing as just doing an exercise could be. So I think that the types of

things we're doing now are different than what we were using even twenty years ago. We
don't incorporate more of a craft or creativity. We used to use macrame. It was a great

exercise for the hands, but we're not allowing our patients to create anything anymore,

either. That's why I think our approach to our treatment is different than it used to be.

Devon:

OK, I think it's the boundaries that are more blurry than they used to be, in terms

of the differences. So the debate of who does cognition, is it OT or if it's speech's job

but, to me, I don't know how you separate out cognition out from some of the other things

that you do. That, that's how you get creative, for example. Tell me how you get someone

dressed if you aren't working on cognition and can they understand it?

Um.. .Okay I'm trying to think of some more. I heard in PT when I started here I

heard about the new Lee Silverman voice therapy. Well, I found out, okay its voice

therapy, so I thought of speech, right? But then I get here and I find out that it's the PT

who got certified. And so I thought, why not OT, too? I don't know what it is, but certain

things like that become... now I want to focus on and for my boundaries, and I've always

gotten in trouble for stepping over into the PT world any way and now I hear that in

speech too, that there are big debates about who does cognition. And from a creativity

standpoint I say you should use them all.

You should do things more holistically, and I don't do as well with the therapists

who are more biomechanical, or kind of look at it and go, we just need to do these

exercises, and this and that, and then they never pair it with function. And that's where

the creativity really happens, and that's where the creativity happens, you know. Learn a

skill and generalize it.

Yesterday I had a patient open a cabinet and haven't seen anybody doing a thing
 335

like that, you know, we're kind of all like here it's more let's use the arm bike and all the

bells and whistles. Okay, great, but can they stand there and do something with that

hand?

Jennifer:

I think creativity has changed, within time, because before you had to be

more creative with the things that were actually available to you. And now, creativity

may be more like checklists, more of the essence of using the computer, more Internet;

bringing that together, more technology versus the actual raw materials that we use.

Lynn:

I think it's changed a lot because of technology. There's more uses for software; it

is normal to think of technology. We can use it with the kids now, there's more uses. I

think it's more motivating, the technology, personally. In the past there wasn't the

technology. They were unable to use those aspects to get them to do fine motor skills, and

I think that's changed over time. Back then they had to use a lot of games and a lot of

gross motor activities like ball play, and kids were probably more, that they enjoyed that

more. And then now, kids enjoy more video games and computer time, and so I think it's

changed a lot. It's kind of changed our practice skills, too.

Data Findings for Question One: How have definitions of creativity in the context of occupational
therapy changed overtime?
Initial Coding: Significant portions of interviews were placed into initial categories, with
definitional phrases describing the initial categories

Framework Person Person Process/Product Press

Initial Definitions: Beliefs: Changes Over Influences:
categories Uncertainty OT is moving Time: Checks and
and Creativity as from creativity Changing Balances:
descriptive artistry: visualized OT is changing Expectations for (Whoa/Go):
phrases and acted upon Creativity is not OTs:
Playfulness or used as much (Now and Then): Constraints over
 336

childishness Creative OT is time:

job site specific Now: Third Party Payers
Moving Targets: Creative types OT emphasizes: Documentation
Changing are drawn to the Functional Productivity
Definitions: field outcomes Resources and
Creativity OT is gaining Purposeful technology
definitions respect in activities
changing medical Being client Opportunities over
OT roles are community centered time
changing Flexibility
OT boundaries are Artistry versus Then: Autonomy
changing Science: OT Emphasized: Respect
Social values Science and Creativity could be Expertise
change research are an applied
opposites of modality
creativity OT involved use of
Science involves crafts
reductive
thinking
Science can be
creative
Artistry can be
an occupation
I'm not sure that You do science:
we even define it, the art falls off.
you know, as a
trait within We've been
occupational focusing in more
therapy. on the
empirical, or
X (similar idea) that this
systematic,
X (similar idea) more of the
science, and less
The whole school on creativity.
of thought on
playfulness really ...When you look
looks at creativity at playfulness,
without saying that takes you
creativity. away from the
...when you look at science, the
playfulness, that steppage, the
takes you away learning: You
from the science, just do it
the steppage,the because you
learning, you just wanna do it.
do it because you
wanna do it. And I
 337

think that's more

comparable to
creativity.
Boriqua Creativity is 1 think there are 1 think in general Little by little it's
Nayali changing from people who use that OT as a whole harder to
what it used to be that in the is moving away incorporate that
to what it is now. occupation of from that kind of (creativity) into
artistry as a creative rehab-based
(People) who like means to get background. facilities, especially
to be creative in things, but not when you're
the creative sense as much. In the beginning dealing with third
of like created an that occupational party payers and
artistic thing...You 1 think that in therapy itself how you document
are making an art the beginning probably drew all those fun things.
product; you're that creative types who The treatment
creating occupational like to make things would pose more
something with therapy itself of a challenge to
your hands; a probably drew Giving those tasks having your
concept that's creative types to others to occupy documentations
inside of you and who like to their own minds skills up to par, and
then you create it. make things and and use their to be able to
who like to be bodies, too, even if support that.
Maybe it's use by creative in the that individual
rec therapy, but sense of like wasn't creative You are going to
it's not use by OT created an themselves. It was have to document
as much. artistic thing. like this is a mode that differently so
of occupation, you there should not be
...the creative are doing a question mark
beings who like something, you are about it.
that kind of doing using your
thing, people hands, and this is a It's still used, but
gravitate more modality, you use it maybe not, you
to those types and 1 am the know, written and 1
of jobs where creative one of think that now it's
they actually can who does it. like okay you can
still do that. use it, but you're
It's really seen in not going to
mental health, and document it that
maybe prison way.
systems...
You're going to
You see it used less document what
and less. you're trying to get
out of it, what you,
X (similar idea) you know, call it an
activity.
...So it's still used
by maybe not, you ...the therapist is
 338

know, written, and the one that's

1 think that now it's having to be like
like okay you can the flexible,
use it, but you're creative type to
not going to come up with
document it that something.
way.
...the requirements
X (similar idea) are different.
X (similar idea)
X (similar idea)
Carlotta ...We went on 1 think that ...as well as
Gomez into the creativity in the productivity taking
Scientific beginning, because a part in
revolution and they were so determining which
aspects where focused on the you can and can't
we tend to see craft, artisan do in terms of
things in black factors, and being a creative
and white. reaction to the therapist yourself.
Industrial
Living with a Revolution, that
scientist, 1 have having the abilities
learned there is to create your own
an aspect of objects was valued
creativity to more. And then we
that, too. You went on into the
have to look at Scientific
all sides of revolution and
things, and not aspects where we
make tend to see things
assumptions. in black and white.

...in occupation we
are looking at
individuals, and
being client
centered, where
you had to engage
creativity in finding
what was of
meaning and value
to the client...

...people aren't
cookie cutter.
Carrie X (similar idea) I'm always thinking
Jones about what 1 have
and what 1 can do
 339

to make the
situation better. 1
have simple, simple
things, and 1 think
that has developed
overtime.

X (similar idea)

1 think maybe some

of the outside
constraints over
time have changed
the way that
therapist have had
to be creative.

1 think now,
probably we had
more autonomy
than we once did.

X (similar idea)

1 haven't seen a
whole lot of
changes in this
profession other
than outside
payers, where
we're saying we're
going to have this,
and limit this...
Chatee 1 think that (use ...back in the day, 1 do appreciate the
Cathy of clinically we would have flexibility that we
established focused in with a have now.
techniques) has lot of crafts.
lent itself to We're very blessed
allow us to There was a lot of in having the ability
being more almost life to cross the line,
credible in the enrichment, and that allows us
medical recreational to be more
community. therapy kinds of creative.
components to
what we did.

OT just as a
profession has
 340

changed incredibly
over the last 50
years, going from
craft kinds of
clinicians if you
will, to a lot
more...we use
craft, but we use a
lot more clinically
established
techniques.

We are not just

craft oriented
anymore, but it's
function.
Countessa ...It's not seeming We don't 1 don't know if this ...we're
Charles like a medical incorporate is right or not, but 1 discouraged from
treatment or it more of a craft think that, um, 1 using things like
seems like why are or creativity. think that those types of
you using toys or ..We're not occupational (craft) activities.
why are you using allowing our therapy has moved
something like a patients to more toward a
kid would use? create anything biomechanical
anymore, either. approach.

...1 don't even think

in OT school they
are teaching some
of the crafts like
that anymore.

1 think that the

types of things
we're doing now
are different than
what we were
using even 20 years
ago.
Devon The boundaries Pair it with
Darrington are more blurry function, and that's
than they used to where the
be in terms of the creativity really
differences. happens.

1 want to focus on Learn a skill and

and for my generalize it.
boundaries, and
 341

I've always gotten

in trouble for
stepping over into
the PT world
anyway.

From a creativity
stand point...you
should do things
more holistically.
Jennifer And now, creativity 1 think creativity
Lopez may be more like has changed,
checklists, more of within time,
the essence of because before you
using the have to be more
computer...more creative with the
technology versus things that were
the actual raw actually available
materials that we to you. And now
use. creativity may be
more like
checklists, more of
the essence of
using the
computer...more
technology versus
the actual raw
materials that we
use.
Lynn Tran (Technology) 1 think it's changed 1 think it's changed
has kind of a lot because of a lot because of
changed our technology. There's technology.
practice skills, more uses for
too. software; it is There's more uses
normal to think of for software.
technology.
It is normal to think
Back then they had of technology.
to use a lot of
games and a lot of
gross motor
activities like ball
play, and kids were
probably more,
that they enjoyed
that more, and
then now, kids
enjoy more video
 342

games and
computer time and
so 1 think it's
changed a lot. It's
kind of changed
our practice skills
too.

Second Coding: Information nodes taken from transcripts were distilled further, using evolving
categories to guide decisions on what were significant nodes.

Definitions: Beliefs: Changes Over Influences:

Moving Targets: OT is moving from Time: Third Party Payers
Changing creativity Now: Documentation
Definitions: OT is changing Functional Productivity
Creativity Creativity is not used outcomes Resources and
definitions as much Purposeful technology
changing Creative OT is job activities
OT roles are site specific Being client Flexibility
changing Creative types are centered Autonomy
OT boundaries drawn to the field Respect
are changing OT is gaining respect Then: Expertise
Social values in medical Creativity could be
change community an applied
Artistry versus modality
science OT involved use of
crafts
Bea Devil ...not sure we You do science: the
even define it. art falls off.
...playfulness ...focusing in on
looks at empirical or
creativity systematic science,
without saying and less on
creativity, you creativity.
just do it
because you
wanna do it.
Boriqua Creativity is ...use the occupation ... OT is moving third party payers
Nayali changing... of artistry to get away from documentation
...used by rec things, but not as creative ...the therapist is
therapy, but not much. background. the flexible,
OTas much. ...occupational ...occupational creative type to
therapy probably therapy drew come up with
drew creative types creative types... something.
... people gravitate ... this is a mode of ...the
to jobs where they occupation... requirements are
can still do that. ... seen in mental different.
health, and prison
 343

systems...
... used less and
less.
... still used but
you're not going
to document it
that way.
Carlotta ... Scientific ...having the ... productivity
Gomez revolution where we abilities to create
see things black and your own objects
white. was valued, then
... scientist, there is the Scientific
an aspect of revolution where
creativity to that. we see things
black and white.
...in occupation
looking at
individuals, client
centered, finding
meaning and
value to the client

...people aren't
cookie cutter.
Carrie what 1 have and
Jones what 1 can do with
simple, simple
things... developed
overtime.
...outside
constraints over
time.
... more autonomy
...outside payers
Chatee ...clinically ... we would have 1 do appreciate the
Cathy established focused in with a flexibility that we
techniques... more lot of crafts. have now.
credible in the ...life enrichment, ... blessed in the
medical community. recreational ability to cross the
therapy line, that allows us
components to to be creative.
what we did.
... changed
incredibly over the
last 50 years,
...not just craft but
function.
Countessa ... not like ...don't incorporate occupational ... discouraged
 344

Charles medical craft or creativity... therapy has from (craft)

treatment... why not allowing moved toward activities.
use toys like a patients to create. biomechanical.
kid?
... schools don't
teach crafts.

...things now are

different than 20
years ago.
Devon ...boundaries Function is where
Darrington more blurry... creativity
...do things happens.
holistically.
Learn a skill and
generalize it.
Jennifer creativity has ...technology
Lopez changed... versus materials.
checklists,
computer,
technology versus
materials.
Lynn Tran Technology has its changed 1 think it's changed
changed our skills. because of a lot because of
technology. technology.
There's more uses
for software; it is There's more uses
normal to think of for software.
technology.
It is normal to
they had to use a think of
lot of games and technology.
gross motor
activities and kids
were enjoyed that
more,... now, kids
enjoy more video
games and
computer time
 345

Third Coding: Information nodes were collapsed into smaller units, categories were reduced to
topic only.

Definitions Beliefs about OT Changes Over Influences

Time
Bea Devil ...not sure we ... do science: the art
even define it. falls off.
...playfulness like ...focusing on
creativity, you empirical, and less
just do it on creativity.
because you
wanna do it.
Boriqua Creativity is ...use the occupation ... OT is moving third party payers
Nayali changing... of artistry, but not as away from documentation
...used by rec much. creative ...the therapist is
therapy, but not ...occupational background. the flexible,
OT as much. therapy probably ...occupational creative type
drew creative types therapy drew ...requirements
... people gravitate creative types... are different.
where they can still ... a mode of
do that. occupation...
... seen in mental
health, and prison
systems...
... used less and
less.
... still used not
documented.
Carlotta ... Scientific ... abilities to ... productivity
Gomez revolution sees create was valued,
things black and then the Scientific
white. revolution.
... scientist, there is ...in occupation
creativity to that. looking at
individuals, client
centered, finding
meaning and
value to the client
people aren't
cookie cutter.
Carrie what 1 have and
Jones what 1 can do with
simple, simple
things... developed
over time.
...outside
constraints
... more autonomy
 346

...outside payers
Chatee ...clinically ... would have flexibility now.
Cathy established used crafts. ... blessed in the
techniques...more ...life enrichment, ability to cross the
credible in the recreational line, allows us to
medical community. therapy was what be creative.
we did.
... changed
incredibly in 50
years,
...not just craft but
function.
Countessa ... not like ...we don't use craft occupational ... discouraged
Charles medical or creativity... not therapy moved from (craft)
treatment... why allowing patients to toward activities.
use toys like a create. biomechanical.
kid? ... schools don't
teach crafts.
...things are
different than 20
years ago.
Devon ...boundaries Function is where
Darrington more blurry... creativity
...do things happens.
holistically.
Learn a skill and
generalize it.
Jennifer creativity has ...technology
Lopez changed... versus materials.
checklists,
computer,
technology versus
materials.
Lynn Tran Technology has its changed it's changed a lot
changed our skills. because of because of
technology, technology and
software; normal software.
to think of
technology. It is normal to
...Had to use think of
games and motor technology.
activities and kids
enjoyed that...
now, kids enjoy
video & computer
 347

Fourth coding: Key points from information nodes and participants were rearranged to reflect
chronological ages from youngest to oldest

Definitions Beliefs about OT Changes Over Time Influences

Lynn Tran Technology has OT has changed Technology
changed skills OT is client-
Normal to think centered
technology
Jennifer Definitions of Technology Technology
Lopez creativity have replaced materials
changed
Carrie OTs have more Resources
Jones autonomy Time
Reimbursement
Boriqua Definitions are Artistry is not OT is moving from Reimbursement
Nayali changing used much creativity Documentation
Boundaries are Creativity linked Creativity is used Task demands
blurred Artistry is to practice areas less
an occupation OT drew creative Creativity now used
types but not
documented as
such.
Countessa Creativity is like Crafts and OT is more Management
Charles playfulness creating not biomechanical.
Creativity allowed Schools don't teach
conflicts with crafts.
medicine and OT has changed in
science 20 years.
Chatee Roles are blurred Clinical Historical context
Cathy techniques lead OT has changed in
to credibility 50 years
OT is not just OTs have more
craft but flexibility
function.
Devon Roles are blurred Function is
Darrington Creativity is where creativity
holistic happens.
Carlotta Science is black OT is now client Changes were Productivity
Gomez and white centered caused by cultural demands
Science is values and
creative historical contexts
Bea Devil Creativity in OT is Art vs. science
not defined and
Creativity is like Research vs.
playfulness creativity are
mutually
exclusive
 348

Fifth Coding: Further reduction of key points

Changing Beliefs about OT Changes Over Time Press

Definitions
Lynn Tran Technology has Changes caused by Technology
changed skills cultural values and
technology
Jennifer Creativity Technology Resources
Lopez replaced materials Technology
Carrie OTs have more Physical Resources
Jones autonomy Time
Reimbursement
Boriqua Creativity Artistry not used OT is moving from Reimbursement
Nayali Professional roles much creativity Documentation
Artistry Creativity site Creativity is used Task demands
specific less
OTdrew Creativity is not
creatives documented
Countessa Creativity Crafts and OT has changed in Management
Charles creating not 20 years OT school curricula
allowed OT is more
biomechanical
Chatee Professional roles Clinical OT has changed in
Cathy techniques lead 50 years
to credibility Historical context
OT is functional. OTs have more
flexibility
Devon Professional roles OT is functional.
Darrington
Carlotta Science OT is client Changes caused by Productivity
Gomez centered cultural values and demands
historical contexts
Bea Devil Creativity Art vs. science
and
Systematic
research vs.
creativity
 349

Sixth Coding: Final version for Chapter 5: Cross Case Analysis:

Question 1: How have definitions of creativity in the context of occupational therapy

changed over time?
Changing Beliefs about OT Changes Over Press
Definitions Time

Lynn Tran Technology has Changes caused Technology

changed skills by cultural values
and technology

Jennifer Lopez Creativity Technology has Resources

replaced materials Technology

Carrie Jones OTs have more Physical

autonomy Resources
Time
Reimbursement

Boriqua Nayali Creativity Artistry not used OT is moving Reimbursement

Professional roles much from creativity Documentation
Artistry Creativity is site Creativity is used Task demands
specific less
OT drew creatives Creativity seen
but not
documented

Countessa Charles Creativity Crafts and OT has changed Management

creating not in 20 years OT school
allowed OT is more curricula
biomechanical

Chatee Cathy Professional roles Clinical OT has changed

techniques lead to in 50 years
credibility Historical context
OT is functional. OTs have more
flexibility

Devon Darrington Professional roles OT is functional.

Carlotta Gomez Science OT is client Changes caused Productivity

centered by cultural values demands
and historical
contexts

Bea Devil Creativity Art vs. science

Syst. research vs.
creativity
 Appendix S

Establishing Trustworthiness with Question Two

 351

Appendix S: Establishing Trustworthiness with Question Two

Question Two: How do occupational therapists define creativity in the context of

occupational therapy?

Question Two, Coding Version One: Utilizing transcripts (not shown), key words and
phrases were taken from transcripts and placed in initial categories using the theoretical
framework as a category guide, major descriptors added, and key words placed next to
descriptors as definitions for descriptor category. Key words were taken directly from or
inferred from interview transcripts.

Theoretical Descriptors Key Words

Framework: Category
Person: Formal Training, Education, (Not) learned from textbooks
Personal Readiness:
"Bag of Tricks" Informal Experience, Preparation, Planning, Communication,
"Tools" Visualizing, Trial and Error

Person: Thoughts Ideas, Thinking, It has to feel right, Conceptualizing,

Personal Perceptions: Looking at things differently, Being open minded, Common
"Thinking Outside the sense
Box"
Beliefs Opinions

Values Client Needs, Motives, Being unique or different, Coming

up with my own ideas
Person: Affective State Engagement, Boredom, Interest
Personal Attributes:
"Going with the Energy Level Tired, Passionate, Energetic, Laid Back
Flow"
Style Artsy, Creative, Scientific, Kinesthetic, Mathematical, Set
in their ways, (Not) Disorganized, (Not?) Fun, Flexible
Process: New Novelty, Raw Materials, From Scratch, From the Ground
Process of Generating: Up, Not Having Anything. New learning experiences,
"It's not Cookie
Cutter/ Working with Novel Unique, Not Cookie Cutter, Doing and feeling something
My Hands" different, Not getting bored, Challenged by difference

Innovative Innovative, Creative, Problem solving, Seeing things in

three dimensions, Visualizing outcomes

Process: Adapt Change, Modify, Adjust, Rig, Changing the generic,

Process of Adapting: Individualizing, Improve, Adapting to the environment and
"Pulling Things from temporal demands, Change contexts
Left to Right/Making
Things Fit" Repair Fix, Repair
 352

Repurpose Recycle, Reuse, Re-do, Change contexts, Using what you

have
Process: Facilitate Tap Dance, Think on Feet, Client-Centered, Communicate,
Process of Apply, Getting engagement, Carrying over
Facilitating:
"Tap Dancing/Feeding Manipulate Push Buttons, Set Stage
Off of Each Other"
Rehabilitate Rehab, Treat, Train, Walk, Teach, Transfer
Product: Devices Splints, Prosthetics, Orthotics, Tools, Supplies, Materials,
Tangible Outcomes: Supplies, Magic
"Making Functional
Adaptive Tools to Get Equipment Positioning, Seating, Systems, Walkers, Braces, Chairs,
Things Done" Beds

(Not) artsy craftsy, things with an artistic bent, Projects, Art

and music, something unique, different, or new out of
something that didn't exist before, Crafts, Making things, a
Game, Yarn, glue, glitter, scissors, paper clips
Product: Patient Buy In Interest, Motivation, Enthusiasm, Engagement, Connecting,
Abstract Outcomes: Figuring out what makes them tick
"Inspiring Others to
do Their Best" Treatment Plans Compliance, Follow Through, Carry over, Ideas,
Suggestions

Treatment Participation, Cooperation Activities, Collaboration, a

Activities Party,
Practice, Wii

Mentoring
Press: Time Treatment Time, Time to be Creative, Time to Think, Time
Time / Space / Money to Plan,
Resources: Schedules Case load, Other Duties, Follow up, Paperwork,
"Juggling a Case Supervision, Training, Teaching
Load/ Space No Space, Small Space, Spread Out Space, Finding
Doing a Lot with a Patients, Privacy
Little"
Press: Staff Supervision, Assistants, Peers, Other Disciplines, Teams,
Human Resources: Climate, Budget
"Doing a Drive
By/Balancing Things" Management Being Supervised, Administrative Support

Press: Government Policy, Legislation, Rules, Regulations, Reimbursement,

Big Picture Resources: Insurance, Laws
"What They are Culture Privacy, Law Suits, Support, Resources
Willing to Pay
For/Finding
Somebody to Help
Us"
 353

Question Two, Coding Version Two: Highly distilled nodes of information were placed
into theoretical framework categories and the researcher and two other raters assigned
codes to the nodes of information using the more streamlined code key at the end of the
document. All three ratings were then compiled onto this document. If three ratings
agreed, the coding was kept. If two of three agreed, the coding was discussed and either
kept or modified. If no consensus was reached, implications for changing it were
discussed amongst the three raters. The changed coding terminology was then applied to
the document and two new reviewers followed the same process. After this, any
discrepancies were resolved with a linguist experienced in semantics.

CODE 2: PEER REVIEW

Reviewed by: Raters one two and three

Instructions: Below are summaries of interviews with nine therapists describing their views of
creativity in the context of occupational therapy. Please look at the four columns (person,
process, product, and press components of, or influences on creativity) for each person whose
name is listed in the column on the left side (such as Bea Devil, Boriqua Nayali, etc). Come up
with one or two words or phrases at most that would summarize what you read in each box. At
the end of this document are possible word choices that might give you ideas, but you can
definitely put down anything you like. Try not to spend too long thinking about this, instead, put
down your first impression. List this impression in red font at the bottom of each individual box.
Don't spend longer than an hour on this.

Thank you for helping me!

Participant Person Process Product Press

(Personal (The actions or (The outcome of (Circumstances
attributes or other active creativity in the and elements that
factors that might processes that context of might impact
impact creativity might impact occupational creativity in the
in the context of creativity in the therapy) context of
occupational context of occupational
therapy) occupational therapy- they can
therapy) be either negative
or positive in their
impact)
Bea Devil Energy, passion, Getting Getting students Classroom
preference for engagement to see things environment
diversity through putting differently, in a doesn't facilitate
together three dimensional eye contact,
multimedia way, through new personalization,
lectures, not lenses, seeing the and engagement.
 354

forcing it, but extraordinary in Autocratic policy

allowing it to be the commonplace and procedures.
free-flowing, Diversity
kinesthetic, feels
right, feels
different, not
being bored, being
centered to the
person or
population,
adapting to the
temporal and
physical
environment
Impression: Impression: Impression: Impression:
Rater One: values Rater One: novel Rater One: buy in Rater One:space
and energy level and facilitate Rater Two: and human
Rater Two: Beliefs Rater Two: New, abstract/patient resources
and energy level adapt buy in Rater Two:
Rater Three: Rater Three: Rater Three: buy supplies and
values and energy adapt, facilitate in government
level Rater Three: space
and government
Boriqua Not the most Taking what is Products, splinting Diverse patient
Nayali organized but available in the for very, very population,
knows where work setting and complicated cases complex cases, no
everything is. carrying it over standard products
Artsy type, good into the patient to meet patient
balance of being environment with needs. Plethora of
an analytical math whatever supplies materials. May not
type and can are available have money. It
problem solve helps very much
things concretely, here. The
loves to work with challenge. Use the
hands and make people who have
things. been there longer.
You can feel stifled
by it, when it's too
much, the balance
of a little bit of
both. Have to be
 355

very analytical,
time constraints

Impression: Impression: Impression: Impression:

Rater One: style Rater One: adapt Rater One: devices Rater One: time
and new and repurpose and equipment and supplies
Rater Two: Style Rater Two: Rater Two: Rater Two: time,
Rater Three: Repurpose Devices staff
thoughts and style Rater Three: Rater Three: Rater Three: Staff
repurpose Devices and time
Bea Devil Not rigid, can go Addressing each Group activities Courses taught
with the flow, can individual person have helped, being
think on her feet and come up with allowed to do
and know when what motivates whatever she
something isn't them, coming up wanted,
working, can with activities that productivity
change or adapt it you would demands,
collaborate, that freedom, patient
would be status
meaningful, tap
dancing, trial and
error

Impression: Impression: Impression: Impression:

Rater One: style Rater One: Rater One: Rater One:
Rater Two: Style facilitate activities management and
Rater Three: Rater Two: new, Rater Two: schedules
thought and style facilitating treatment Rater Two:
Rater Three: activities Management
facilitate Rater Three: Rater Three:
treatment Schedules
activities
Carrie Trying to think Uses her training, Simple things with Constant changing
Jones outside of the knowledge, and Velcro, transfer Patient status,
box, liking tools whatever else she tape, and Dycem Juggling a caseload
and fixing things, brings, making of unfunded
likes to fix things simple things work trauma patients,
and make things, with everything no patient
the way she was available Thinking resources, the
raised about what she environment and
has and how she learning about new
 356

can use those developments,

simple things to patient's prior level
make things work of function
for a patient, using
simple things and
different
techniques, trial
and error, making
things easier,
stepping back
from the situation
and looking at it
from different
ways using the
constraints, trying
to see it
differently

Impression: Impression: Impression: Impression:

Rater One: Rater One: adapt Rater One: devices Rater One:
informal and and repurpose Rater Two: supplies, schedules
thoughts Rater Two: treatment Rater Two:
Rater Two: style, innovative, adapt activities Schedule, space
values Rater Three: adapt Rater Three: Rater Three:
Rater Three: and repurpose Devices Schedules and
thoughts and style supplies
Chatee Very outgoing, If she can't find Loyalty, buy in, a Specific disabilities
Cathy bulldog that won't one way for a lot more, inspiring or impairments,
let go. With solution for a others to do their working with
experience comes problem she will best and making people who have
confidence and go another way. Is sure that they are been here and
creativity, a good not one that gets advocating and we've tried that
foundation and easily stopped providing the and it doesn't work
self confidence, When presented a services that are anymore,
Biblical barrier or an needed for the Increased work
foundation of obstacle, finding residents demands,
strength of alternate productivity
foundation, gifting solutions, standards,
we have as Looking into mentoring
individuals alternative
methods and
 357

seeing a result-if
you want,
knowing which are
the right buttons
to push to be able
to get the
outcomes. Strong
foundation down
to the people you
work with. Action
plan mentoring.
Pushing limits,
aiming for
functional, getting
buy in
Impression: Impression: Impression: Impression:
Rater One: beliefs Rater One: adapt Rater One: buy in, Rater One: staff.
and style and manipulate staff support schedules
Rater Two: Rater Two: Rater Two: patient Rater Two: staff,
Beliefs, informal innovative and buy in, treatment practice
Rater Three: manipulate plan Rater Three:
informal and Rater Three: adapt Rater Three: Schedules and staff
beliefs and manipulate Mentoring, buy in
Countessa Enjoys work Figuring out ways Custom devices Fast pace,
Charles where we are that work that for patients, freedom, good
making and might be different positioning relationships with
putting things from what she's patients in bed physicians, trust
together, enjoys done before. placed in them,
getting messy, can Unique, coming up autonomy,
create and adapt with unique ideas teaching
while working environment,
with her hands diversity in
cultures

Impression: Impression: Impression: Impression:

Rater One: New, Rater One: novel Rater One: devices Rater One:
innovative and innovative and equipment management and
Rater Two: Rater Two: New Rater Two: staff
informal, style Rater Three: Novel Devices and Rater Two: staff,
Rater Three: equipment practice area
thoughts and Rater Three: Rater Three: Staff
 358

affective state Equipment

Devon Flexible, laid-back, Thinking outside A group activity Caseload, number
Darrington not rigid the box, trying where the patient of patients,
personality, things differently, can be involved supplies,
thinking outside going with the that meets goals administration,
the box, open flow when and is fun, staff, experience
mindedness scheduling, setting enjoyable, not levels, effort of
treatment plans, boring staff, space,
doing whatever supplies, the
you can to help atmosphere, work
people meet their demands,
goals. Going in as supervisory versus
a team, being treatment time
holistic, treating a
person as a whole
Impression: Impression: Impression: Impression:
Rater One: Rater One: Rater One: Activity Rater One:
thoughts and style facilitate, adapt, and treatment schedules and
Rater Two: style, rehabilitate activities management
informal Rater Two: New, Rater Two: Patient Rater Two:
Rater Three: style rehabilitate buy in, treatment schedules and staff
and thought Rater Three: plan Rater Three:
Innovative and Rater Three: management and
Adapt Treatment schedules
activities
Jennifer Easy going, not Starting from the Non slip surfaces Being out in the
Lopez upsettable, ground up when inclines and walls, students
nothing is or different things environment, no
available, in the specific room to
brainstorming environment for work from, using a
about how you handwriting, vehicle and box of
can use the raw Getting a web magic, supplies,
products around space, improvised demands for
you, putting foot stools, output, different
something something from diagnoses,
together, knowing nothing cultures, languages
the outcome and
starting from
there, visualizing,
making things like
art supplies
 359

functional
Impression: Impression: Impression: Impression:
Rater One: style Rater One: Rater One: devices Rater One: space,
Rater Two: innovative and and activities supplies
affective state, new Rater Two: Rater Two: Space,
style Rater Two: New, Equipment supplies
repurpose Rater Three: Rater Three:
Rater Three: New, activities, devices space, supplies
adapt
Lynn Tran Not being stuck Creating ideas, Writing paper for Caseload, logistics
on one thing, making specific students, of gathering
willing to try suggestions to building things like resources and
different things, teachers, trying grips for crayons, materials,
pulling things in things out, using storybook meetings,
common sense, pictures, what paperwork, office
learning from children need work, training,
others, having a workshops, money
different point of funds and
view, considering resources, time,
the environment, paperwork,
the person, and adapting for
their special needs
surroundings, the
whole picture,
having a different
perspective,
interpreting it for
others in terms
they understand,
providing an
additional
viewpoint,
stepping outside
of the box, coming
up with different
ways to think of
new approaches,
looking for other
ways
Impression: Impression: Impression: Impression:
Rater One: Rater One: novel Rater One: devices Rater One:
 360

thoughts, style, and facilitate Rater Two: schedules, space

new Rater Two: New Activities Rater Two:
Rater Two: Style, and facilitate Rater Three: schedules, and
informal Rater Three: Novel activities, devices supplies
and facilitate Rater Three:
schedule

Possible Codes the Rater Can Use

Category Descriptors Key Words

Personal Readiness: Formal Training, Education, (Not) learned from textbooks
"Bag of Tricks
Threes" Informal Experience, Preparation, Planning, Communication,
"Tools" Visualizing, Trial and Error

Personal Thoughts Ideas, Thinking, It has to feel right, Conceptualizing,

Perceptions: Looking at things differently. Being open minded,
"Thinking Outside Common sense
the Box"
Beliefs Opinions, Destiny, Being blessed, Gifting, Fate

Values Client Needs, Motives, Being unique or different,

Coming up with my own ideas
Personal Attributes: Affective State Engagement, Boredom, Interest
"Going with the
Flow" Energy Level Tired, Passionate, Energetic, Laid Back

Style Artsy, Creative, Scientific, Kinesthetic, Mathematical,

Set in their ways, (Not) Disorganized, (Not?) Fun,
Flexible
Process of New Novelty, Raw Materials, From Scratch, From the
Generating: Ground Up, Not Having Anything. New learning
"It's not Cookie experiences, Coming up with ideas on my own,
Cutter/ Working figuring out ways that work that are different from
with My Hands" before, creating ideas
Novel
Unique, Not Cookie Cutter, Doing and feeling
something different, Not getting bored, Challenged
by difference, Finding alternate solutions, Thinking of
more than one way,
Innovative
 361

Innovative, Creative, Problem solving, Seeing things

in three dimensions, Visualizing outcomes,
Conceptualizing, Abstract thinking, Coming up with
unique ideas, Trying something different, Thinking
outside the box, being open minded,
Process of Adapting: Adapt Change, Modify, Adjust, Rig, Changing the generic.
"Pulling Things from Individualizing) Improve, Adapting to the
Left to Right/Making environment and temporal demands, Change
Things Fit" contexts, Using trial and error
Repair
Fix, Repair
Repurpose
Recycle, Reuse, Re-do, Change contexts, Using what
you have
Process of Facilitate Tap Dance, Think on Feet, Figuring out what makes
Facilitating: them tick, Communicate, Apply, Getting
"Tap engagement, Carrying over, Mentoring, Making
Dancing/Feeding Off suggestions, Using common sense
of Each Other"
Manipulate Push Buttons, Set Stage, Managing time

Rehabilitate Rehab, Treat, (Space for) Training, Exercising, Walk,

Teach, Transfer
Tangible Outcomes: Devices Splints, Prosthetics, Orthotics, Tools, Supplies,
"Making Functional Materials, Supplies, Magic
Adaptive Tools to
Get Things Done" Equipment Positioning, Seating, Systems, Walkers, Braces,
Chairs, Beds

Activities (Not) artsy craftsy, things with an artistic bent,

Projects, Art and music, something unique, different,
or new out of something that didn't exist before,
Crafts, Making things, a Game, Yarn, glue, glitter,
scissors, paperclips
Abstract Outcomes: Patient Buy In Interest, Motivation, Enthusiasm, Engagement,
"Inspiring Others to Connecting, Figuring out what makes them tick
do Their Best"
Treatment Plans Compliance, Follow Through, Carryover, Ideas,
Suggestions

Treatment Participation, Cooperation Activities, Collaboration,

 362

Activities a Party,
Practice, Wii

Staff Support Mentoring

Time / Space / Time Treatment Time, Time to be Creative, Time to Think,
Money Resources: Time to Plan, Period of time to treat or teach,
"Juggling a Case Managing time
Load/ Schedules
Doing a Lot with a Case load, Other Duties, Follow up, Paperwork,
Little" Supervision, Training, Teaching, Scheduling patients,
Treatment plans
Space
No Space, Small Space, Spread Out Space, Finding
Patients, Privacy, Manipulating the environment
Supplies
Fancy machines, materials, Piecing things together,
Raw products, things in place, whatever you have in
your environment, things
Practice area
Mental health, pediatrics
Human Resources: Staff Supervision, Assistants, Peers, Other Disciplines,
"Doing a Drive Teams, Climate, Budget
By/Balancing
Things" Management Being Supervised, Administrative Support

Big Picture Government Policy, Legislation, Rules, Regulations,

Resources: "What Reimbursement, Insurance, Laws
They are Willing to
Pay For/Finding Culture Privacy, Law Suits, Support, Resources
Somebody to Help
Us"
 363

Question Two: Coding Three

After both sets of reviewers and final review by a linguist, the text and information nodes were
removed, leaving only descriptors.

Participant Person Process Product Press

(Personal (The actions or (The outcome of (Circumstances
attributes or other active creativity in the and elements that
factors that processes that context of might impact
might impact might impact occupational creativity in the
creativity in the creativity in the therapy) context of
context of context of occupational
occupational occupational therapy- they can
therapy) therapy) be either negative
or positive in their
impact)
Bea Devil Personal Style: People Processes: Outcomes-People: Physical resources
Left brained Facilitating Buy In Government
Personal People Processes: Outcomes-People: Local culture
Attribute: Applying Staff Support
Energy level

Boriqua Personal Object Processes: Outcomes-Things: Patient status,

Nayali Preference: Thinking/Planning Devices/Equipment physical/time,
Beliefs and Object Processes: colleagues,
Values Adapting government
Personal Style:
Left/Right
Brained

Bea Devil Personal People Processes: Outcomes-Things: Patient status,

Attribute: Facilitating Treatment Activities management
Ways of Feeling Object processes: Things: treatment
Personal Thinking/planning activities
Readiness:
Experience
Personal
preferences:
thinking styles
Carrie Personal Object Processes: Outcomes-Things: Patient
Jones Preference: Thinking/planning Devices/Equipment status/resources,
 364

Thinking Style Object Processes: management

Beliefs and Adapting,
Values Repairing

Chatee Personal Object Processes: Outcomes-People: Colleagues,

Cathy Preference: Thinking/planning Treatment Plans management
Beliefs and People Processes: Outcomes-People:
Values Facilitating Staff Support
Personal
readiness:
experience

Countessa Personal Object Processes: Object Processes: Time,

Charles Preference: Thinking/planning Devices/Equipment management
Beliefs and Object Processes:
Values Inventing
Personal Style:
Left-brained

Devon Personal People Processes: Outcomes-Things: Time, physical

Darrington Attribute: Facilitating Treatment Activities resources,
Ways of feeling People Processes: Outcomes-People: management,
Personal Applying Buy In colleagues,
Preference: Object processes:
Thinking style thinking/planning

Jennifer Personal Object Processes: Outcomes-Things: Resources,

Lopez Attribute: Thinking/Planning Devices/Equipment management, local
Ways of feeling Object Processes: Outcomes-Things: culture, patient
Personal Inventing Treatment Activities status
Attribute:
Energy levels

Lynn Tran Personal People Processes: Outcomes-Things: Patient status,

preference: Facilitating Devices/Equipment time/resources,
Thinking style Object processes: Outcomes-Things: management,
Personal thinking Treatment Activities government
attributes:
Ways of feeling
 365

Possible Codes the Rater Can Use

Category Descriptors Key Words

Personal Readiness: Formal Training, Education, (Not) learned from textbooks
"Bag of Tricks"
"Tools" Informal Experience, Preparation/Planning, Communication,
Visualizing, Trial and Error
Personal Thoughts Ideas, Thinking, It has to feel right, Conceptualizing,
Perceptions: Looking at things differently, Being open minded,
"Thinking Outside Common sense
the Box"
Beliefs Opinions, Destiny, Being blessed, Gifting, Fate

Values Client Needs, Motives, Being unique or different,

Coming up with my own ideas
Personal Attributes: Affective State Engagement, Boredom, Interest
"Going with the
Flow" Energy Level Tired, Passionate, Energetic, Laid Back

Style Artsy, Creative, Scientific, Kinesthetic, Mathematical,

Set in their ways, (Not) Disorganized, (Not?) Fun,
Flexible
Process of New Novelty, Raw Materials, From Scratch, From the
Generating: Ground Up, Not Having Anything. New learning
"It's not Cookie experiences, Coming up with ideas on my own,
Cutter/ Working figuring out ways that work that are different from
with My Hands" before, creating ideas

Novel Unique, Not Cookie Cutter, Doing and feeling

something different, Not getting bored, Challenged
by difference, Finding alternate solutions, Thinking of
more than one way,

Innovative Innovative, Creative, Problem solving, Seeing things

in three dimensions, Visualizing outcomes,
Conceptualizing, Abstract thinking, Coming up with
unique ideas, Trying something different, Thinking
outside the box, being open minded,
Process of Adapting: Adapt Change, Modify, Adjust, Rig, Changing the generic,
"Pulling Things from Individualizing, Improve, Adapting to the
Left to Right/Making environment and temporal demands. Change
Things Fit" contexts, Using trial and error
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Repair Fix, Repair

Repurpose Recycle, Reuse, Re-do, Change contexts, Using what

you have
Process of Facilitate Tap Dance, Think on Feet, Figuring out what makes
Facilitating: them tick, Communicate, Apply, Getting
"Tap engagement, Carrying over, Mentoring, Making
Dancing/Feeding Off suggestions. Using common sense
of Each Other"
Manipulate Push Buttons, Set Stage, Managing time

Rehabilitate Rehab, Treat, (Space for) Training, Exercising, Walk,

Teach, Transfer
Tangible Outcomes: Devices Splints, Prosthetics, Orthotics, Tools, Supplies,
"Making Functional Materials, Supplies, Magic
Adaptive Tools to
Get Things Done" Equipment Positioning, Seating, Systems, Walkers, Braces,
Chairs, Beds

Activities (Not) artsy craftsy, things with an artistic bent,

Projects, Art and music, something unique, different,
or new out of something that didn't exist before,
Crafts, Making things, a Game, Yam, glue, glitter,
scissors, paper clips
Abstract Outcomes: Patient Buy In Interest, Motivation, Enthusiasm, Engagement,
"Inspiring Others to Connecting, Figuring out what makes them tick
do Their Best"
Treatment Plans Compliance, Follow Through, Carryover, Ideas,
Suggestions

Treatment Participation, Cooperation Activities, Collaboration,

Activities a Party,
Practice, Wii

Staff Support Mentoring

Time / Space / Time Treatment Time, Time to be Creative, Time to Think,
Money Resources: Time to Plan, Period of time to treat or teach,
"Juggling a Case Managing time
Load/ Schedules
Doing a Lot with a Case load, Other Duties, Follow up, Paperwork,
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Little" Supervision, Training, Teaching, Scheduling patients,

Treatment plans

Space No Space, Small Space, Spread Out Space, Finding

Patients, Privacy, Manipulating the environment

Supplies Fancy machines, materials, Piecing things together,

Raw products, things in place, whatever you have in
your environment, things

Practice area Mental health, pediatrics

Human Resources: Staff Supervision, Assistants, Peers, Other Disciplines,
"Doing a Drive Teams, Climate, Budget
By/Balancing
Things" Management Being Supervised, Administrative Support

Big Picture Government Policy, Legislation, Rules, Regulations,

Resources: "What Reimbursement, Insurance, Laws
They are Willing to
Pay For/Finding Culture Privacy, Law Suits, Support, Resources
Somebody to Help
Us"

Final version of question two with participants arranged in chronological age from youngest to
oldest participant. Definitions for categories were removed and only theoretical framework
categories were listed. Each theoretical framework category utilized a category and key words
to describe category.

Person Process Product Press

Lynn Personal preference: People Processes: Outcomes-Things: Immediate:
Tran Thinking style Facilitating Devices/Equipment Patient status
Personal attributes: Object processes: Treatment Time/Physical
Ways of feeling Thinking/Planning activities resources
Personnel:
Management
Societal:
Government
Jennifer Personal Attribute: Object Processes: Outcomes-Things: Immediate:
Lopez Ways of feeling Thinking/Planning Devices/Equipment Time/Physical
Energy levels Inventing Treatment resources
activities Local culture
Patient status
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Personnel:
Management

Carrie Personal Preference: Object Processes: Outcomes-Things: Immediate:

Jones Thinking style Thinking/Planning Devices/Equipment Patient status
Beliefs and values Adapting Time/Physical
Repairing resources
Personnel:
Management
Boriqua Personal Preference: Object Processes: Outcomes-Things: Immediate:
Nayali Beliefs and values Thinking/Planning Devices/Equipment Patient status
Personal Style: Adapting Time/Physical
Left/Right-brained resources
Personnel:
Colleagues
Societal:
Government
Countessa Personal Preference: Object Processes: Outcomes-Things: Immediate:
Charles Beliefs and values Thinking/Planning Devices/Equipment Time/Physical
Personal Style: Inventing resources
Left-brained Personnel:
Management
Devon Personal Attribute: People Processes: Outcomes-Things: Immediate:
Darrington Ways of feeling Facilitating Treatment Time/Physical
Personal Preference: Applying activities resources
Thinking style Object processes: Outcomes-People: Personnel:
Thinking/Planning Buy in Management
Colleagues
Chatee Personal Preference: Object Processes: Outcomes-People: Personnel:
Cathy Beliefs and values Thinking/Planning Treatment plans Management
Personal readiness: People Processes: Staff support Colleagues
Experience Facilitating
Bea Devil Personal Attribute: People Processes: Outcomes-Things: Immediate:
Ways of feeling Facilitating Treatment Patient status
Personal Readiness: Object processes: activities Personnel:
Experience Thinking/Planning Management
Personal preferences:
Thinking styles
Bea Personal Style: People Processes: Outcomes-People: Immediate:
Devil Right-brained Facilitating Buy in Time/Physical
Personal Attribute: Applying Staff support resources
Energy level Local culture
Societal:
Government
 VITA

Tina Fletcher was born in Billings, Montana, and, in the course of her years, has

lived in seven states. She received a bachelor's degree of occupational therapy from the

University of Texas Medical Branch in Galveston, Texas, a master's degree in allied

health education from the University of Alabama at Birmingham, and bachelor's and

master's degrees in fine arts and a doctorate in education from Texas A&M University-

Commerce. She also holds an advanced certificate in school-based occupational therapy

practice from Texas Woman's University.

Her professional experiences have included serving as an occupational therapist

for rural school systems in Texas, Alabama, and Idaho, at the Texas School for the Blind

and Visually Impaired, Paintrol Pain Management Center in Idaho, and for Etowah

County, Alabama, and Washington County, Oregon, county health agencies. She

currently serves as a volunteer occupational therapist for Ilsan Welfare Town in South

Korea and as an occupational therapist for rural school systems in northeast Texas.

In addition to her clinical occupational therapy practice, Dr. Fletcher has served as

an assistant professor of occupational therapy at Pacific University in Forest Grove,

Oregon, and currently serves as an assistant clinical professor of occupational therapy at

Texas Woman's University in Dallas, Texas.

Dr. Fletcher is a member of a large extended family and has been married to Rick

Selvaggi, MD for twenty-eight years. They are the proud parents of Rose Fletcher

Selvaggi and Lily Jiang Mei Mei Selvaggi.

Permanent address: 3376 CR 4403

Commerce, TX 75428

369