Feminist occupational therapists and therapeutic relationship: a discourse analysis with a Foucaultian perspective

Abstract

Introduction  Considering the researching gap and the socio-political context in which we find ourselves, discussing feminism and the therapeutic relationship in occupational therapy contributes to the development of a critical disciplinary perspective.

Objective  This research aims to identify distinctive elements in the discourse of feminist occupational therapists regarding their therapeutic relationship, through an understanding of discursive formations related to power relations.

Method  A post-qualitative design was used, with a methodological framework grounded in a critical approach to hegemonic occupational therapy and post-structuralist feminist epistemology, aiming to explore discourses on the therapeutic relationship from a decentralized and flexible perspective, using open interviews as the information production technique.

Results  Through the analysis of results, three categories are presented: Construction of the Feminist Occupational Therapist Individual, Feminist Occupational Therapists and Therapeutic Relationship, and Tensions between Feminist Occupational Therapists and the Socio-labor Context. Findings highlight the experience of feminist occupational therapists as a valuable source of knowledge, challenging dominant narratives and proposing the co-construction of spaces of resistance in the therapeutic relationship.

Conclusion  Additionally, reflective and interventional tools related to self-monitoring and active listening are introduced, promoting situated practices that are relevant to political and social contexts from a counter-hegemonic perspective, valuing the diversity of knowledge in praxis.

Keywords:
Occupational Therapist; Professional-Patient Relations; Feminism; Address

Resumen

Introducción  Frente a la brecha investigativa y el contexto sociopolítico en el que nos encontramos, discutir sobre feminismo y relación terapéutica en Terapia Ocupacional es un aporte al desarrollo de la perspectiva crítica disciplinar.

Objetivo  Esta investigación busca identificar los elementos distintivos en el discurso de terapeutas ocupacionales feministas respecto a su relación terapéutica, mediante la comprensión de formaciones discursivas referidas a las relaciones de poder.

Método  Se utilizó un diseño postcualitativo, con un marco metodológico fundamentado en un enfoque crítico de la Terapia Ocupacional hegemónica y la epistemología feminista postestructuralista, buscando explorar los discursos sobre relación terapéutica desde una perspectiva descentrada y flexible, usando como técnica de producción de información la entrevista abierta.

Resultados  A través del análisis de resultados se presentan tres categorías: Construcción del Sujeto Terapeuta Ocupacional Feminista, Terapeutas Ocupacionales feministas y Relación Terapéutica, y Tensiones entre Terapeutas Ocupacionales Feministas y Contexto Sociolaboral. Los hallazgos destacan la experiencia de las terapeutas ocupacionales feministas como una fuente valiosa de conocimiento, desafiando las narrativas dominantes y proponiendo la co-construcción de espacios de resistencia en la relación terapéutica.

Conclusión  Además, se introducen herramientas reflexivas e interventivas vinculadas a la autovigilancia y escucha activa, promoviendo prácticas situadas que sean pertinentes a los contextos políticos y sociales desde una perspectiva contrahegemónica, valorando la diversidad de saberes En La Praxis.

Palabras-clave:
Terapeuta Ocupacional; Relaciones Profesional-Paciente; Feminismo; Discurso

Resumo

Introdução  Diante da lacuna investigativa e do contexto sociopolítico em que nos encontramos, discutir sobre feminismo e relação terapêutica em terapia ocupacional é uma contribuição para o desenvolvimento da perspectiva crítica disciplinar.

Objetivo  Esta pesquisa busca identificar os elementos distintivos no discurso de terapeutas ocupacionais feministas em relação à sua relação terapêutica, por meio da compreensão de formações discursivas referidas às relações de poder.

Método  Utilizou-se um desenho pós-qualitativo, com um marco metodológico fundamentado em uma abordagem crítica da terapia ocupacional hegemônica e na epistemologia feminista pós-estruturalista, buscando explorar os discursos sobre relação terapêutica a partir de uma perspectiva descentralizada e flexível, usando como técnica de produção de informações a entrevista aberta.

Resultados  Através da análise de resultados são apresentadas três categorias: Construção do sujeito terapeuta ocupacional feminista, Terapeutas ocupacionais feministas e relação terapêutica e Tensões entre terapeutas ocupacionais feministas e contexto sociolaboral. Os achados destacam a experiência das terapeutas ocupacionais feministas como uma fonte valiosa de conhecimento, desafiando as narrativas dominantes e propondo a coconstrução de espaços de resistência na relação terapêutica.

Conclusão  Além disso, são introduzidas ferramentas reflexivas e interventivas vinculadas à autovigilância e escuta ativa, promovendo práticas situadas que sejam pertinentes aos contextos políticos e sociais a partir de uma perspectiva contrahegemônica, valorizando a diversidade de saberes na práxis.

Palavras-chave:
Terapeuta Ocupacional; Relacionamento Terapêutico; Feminismo; Discurso

Introduction

Current social movements are advancing toward building a more equitable society that guarantees human and social rights. Considering the international atmosphere of political, ideological, and emotional polarization, it is fundamental to adopt a critical approach within our profession. In this way, we aim to foster dialogues that broaden the ways of practicing and producing knowledge, problematizing the discourses on the therapeutic relationship issued by feminist occupational therapy professionals with a territorial focus in Latin America, specifically in Chile and Mexico, thus constructing alternative interpretations of reality and new fields of action (Farias, 2022).

Under this premise, it is pertinent to consider social occupational therapy, based on Critical Occupational Therapy (Farias, 2022), which allows us to shape a disciplinary action beyond the biomedical and dichotomous field. Therefore, the role of social articulation is reinforced, accompanied by an ethical, social, and political commitment, in which the social structure and the way in which different forms of exclusion and inequality are produced are discussed and questioned, seeking, instead, to favor and facilitate the relationship between the structure, the collective individual, and social everyday life (Farias, 2022). In this context, the 'the social' field makes possible the Southern Occupational Therapies (Guajardo Córdoba, 2016), whose political nature urges us to assume an ethical-political role, which allows us to question the power relations present in the therapeutic relationship, and understand our role as facilitators of social transformations (Valderrama Núñez, 2019).

Consequently, Southern Occupational Therapies adopt a critical and reflective social approach, presenting feminism as its main topic (Valderrama Núñez, 2019). In this context, this approach is understood as “[…] political knowledge and practices that, like threads, allow us to weave a much denser, more forceful, and counter-hegemonic emancipatory project” (Valderrama Núñez, 2019, p. 676). In this sense, it invites us to decolonize knowledge, recognizing subjugated groups as “[…] bearers of knowledge” (Valderrama Núñez, 2019, p. 674). Based on the above, feminism is presented as an enriching position in the way we practice occupational therapy, as it is a political action that allows for dialogues and discussions that enable new ways of positioning ourselves politically and ethically as a discipline, and reshaping the way we do our professional work (Grandón Valenzuela, 2017; Morrison & Araya, 2018).

On this matter, the therapeutic relationship stands out as a central aspect of praxis, key to the therapeutic process and to the adherence that clients have to it (Solman & Clouston, 2016; Valenzuela León et al., 2022). In the academic literature there is a wide variety of articles that address the interrelationship between feminism and the therapeutic relationship, however, this comes mainly from disciplines such as psychology, psychiatry and psychoanalysis, which reinforce the importance of working from feminist perspectives in therapeutic processes, to the extent that they allow addressing experiences of oppression and inequality, and incorporate into practice elements such as diversity, empowerment, resistance, search for equity and analysis of power relations (Conlin, 2017; Rutherford & Pettit, 2015; Wright & Wright, 2017).

As stated above, from occupational therapy, research on the therapeutic relationship comes mainly from the Eurocentric and Anglo-Saxon academic tradition, revealing its importance for professional practice (Bonsaksen et al., 2013), identifying the phases and strategies to establish it (Price, 2011), and integrating the therapeutic use of oneself as an essential part of the relationship (Morrison & Smith, 2013). Furthermore, there is research that has been interested in addressing this issue from the Intentional Relationship Model, as it provides an approach of reasoning and interpersonal skills that guide practice (Solman & Clouston, 2016; Taylor, 2016). Similar results are found in Ibero-American articles, which highlight the use of the self as a therapeutic tool as a fundamental pillar of praxis (Valenzuela León et al., 2022); Likewise, research that reinforces the importance of a gender perspective in therapeutic interventions and relationships is presented, along with the idea of ​​professionals as agents of change (Cabanas et al., 2020).

Although the evidence presented above represents a useful contribution to our discipline, the topics have been poorly developed (Solman & Clouston, 2016), even more so considering the proposal that intersects feminist and Critical Occupational Therapy perspectives. Consistent with the above, there is a need to study the discourse of feminist occupational therapists regarding their therapeutic relationship, with the aim of understanding how this positioning emerges during interaction with others. In this sense, we believe that the discussion would be enriched by recognizing experiences and perspectives situated in the South and proposing an opportunity for critical reflection.

In this context, and in the face of the research gap, we propose a perspective situated from a post-structuralist feminist epistemological approach, which, in line with what has been proposed by Critical Occupational Therapy and Southern Occupational Therapies, questions the claim of objectivity and truth of science (Olivares-Aising & Mayorga Rojel, 2023), emphasizing discursive systems and how they configure experiences (Wigginton & Lafrance, 2019) and supporting “[…] the emergence of a different matrix of thought, one that constructs a diverse and changing individual” (Olivares-Aising & Mayorga Rojel, 2023, p. 11). Likewise, both feminist and post-structuralist theory encompass power and the relationships that arise from it as a basic element for understanding society and our interactions. These approaches allowed us to get closer to the experiences of occupational therapists, materializing them through language, which is used to reconstruct and express them, also giving them numerous meanings (Weedon, 1987), given that each of these experiences constitutes unique knowledge in itself.

In this regard, discourse is presented as a key element in the research, through which “[…] effects of truth are articulated and power relations are deployed” (Restrepo, 2020). Thus, discourse, in the health field, is presented as a clear reflection of the knowledge/power relationship (Estrada-Mesa & Cardona-Arias, 2018), which is materialized through “[…] norms, order, and hierarchy” (Alvarez & Gutierrez, 2022, p. 8). Therefore, faced with the research gap and the sociopolitical context in which we live, and considering the historicity of the biomedical nature of occupational therapy (Oropesa Roblejo et al., 2014), we seek to understand, through discourse, how occupational therapists construct their therapeutic relationships through subjectivity, how they manage the power relations existing in the process, and how a feminist position emerges in the therapeutic relationship, perhaps shaping itself as a strategy for change.

Consequently, a perspective that involves post-qualitative research aspects is proposed, allowing us to question modern/Cartesian/binary categories, the established and the taken for granted, giving way to the new, to a “[…] decentered way of accessing what we call reality” (Olivares-Aising & Mayorga Rojel, 2023, p. 10), to collective constructions that enable, through a “new grammar” (Preciado, 2022), new ways of understanding and transforming the world. Considering the uncertainty surrounding our rights, it is necessary to reflect and discuss, but above all, to create spaces of resistance in our professional practice.

Theoretical Framework

Critical, Social, and Southern Occupational Therapy

Critical theories “[…] challenge conventional ideologies and assumptions, affirming that theories are never objective or politically neutral, and expose power imbalances such as those present in the professional/client, theorist/theorized, and researcher/researched relationships” (Hammell & Iwama, 2012). In this regard, the so-called Critical Occupational Therapy allows us to move toward social transformations that go beyond the individual, considering the environment (Hammell & Iwama, 2012), as it invites us to reflect and question not only what we take for granted in our daily lives, but also the very epistemological foundations of the discipline (Morrison et al., 2016). This critical positioning in occupational therapy offers us numerous possibilities and alternatives for understanding and addressing the different specific conditions of the daily lives of individuals and groups (Galheigo, 2020).

In this context, the so-called Social Occupational Therapy emerges from questioning previously dominant knowledge, “[…] with the aim of proposing more critical and emancipatory actions” (Farias, 2022). Thus, it is characterized by actions that seek to address both personal and collective problems, far removed from the exclusively biomedical field, acting from decolonial and emancipatory perspectives, always considering the mutual influences between the macro and micro social spheres (Farias, 2022). This is the case with the role of theoretical arguments, which, according to Galheigo (2020), should inspire and contribute to generating critical perspectives on occupational therapy.

Thus, in the social field, Southern Occupational Therapies are made possible, through which “[…] the diversity of the discipline and the profession is manifested” (Guajardo Córdoba, 2016, p. 116), being understood as all the knowledge and practices that are developed in opposition to the hegemonic ones in the discipline (Valderrama Núñez, 2019), that is, those that do not come from the dominant occupational therapy, described as “English-speaking, produced by white, well-educated, urban middle-class men and women, with a Judeo-Christian religious preference” (Valderrama Núñez, 2019, p. 672). The dominance and globalization of this knowledge on professional practice has given rise to the reproduction of knowledge and methodologies alien to the realities of the countries where they have been implemented (Valderrama Núñez, 2019). In this way, although significant progress has been made in recent decades, there is still a need to generate knowledge and study current practices in Latin America so that these contribute to the development of critical and contextualized professionals.

Feminisms

Feminism is inherently political, aimed at transforming existing power relations in society, those that structure all areas of life: family, education and well-being, the world of work and politics, culture and leisure, determining who does what and for whom, who we are and what we can become (Weedon, 1987). In this sense, it advocates destabilizing binary hierarchies of power and gender, embracing the complexity and multiplicity of experiences and identities, thereby transforming knowledge systems (Haraway, 1991).

During the 21st century, feminisms have been at the forefront of their struggles “[…] against forms of violence against women, including sexual violence and prostitution” (Aguilar Barriga, 2020), and raising awareness of the production and social reproduction of care work (Grandón Valenzuela, 2021), among other issues. Phenomena such as #MeToo and the feminist uprising of May 2018 in Chile marked this era and are distinguished by the use of new ways of protest, such as performances and batucadas in different demonstrations, the use of social media and the internet in general, among other forms (Garrido Rodríguez, 2021). In this regard, in relation to the aforementioned social movements,

[…] feminism provides a political, methodological, and epistemological framework that allows us to challenge power against the different systems of oppression that plague us, such as patriarchy, capitalism, colonialism, classism, speciesism, ableism, and others (Cortés & Martelo, 2021, p. 40).

Under this contextualization, feminisms are presented as a significant contribution to the praxis of our profession, because “[…] it allows us to mobilize from our naturalized practices and question them, asking questions that problematize the traditional practices of the profession” (Morrison & Araya, 2018, p. 61).

Poststructuralist feminism

Considering the opposition of Southern Occupational Therapies to hegemonic knowledge and its “[…] situation in a specific context, ... critical and with the objective of influencing and transforming social practices” (Díaz & Loredo, 2016, p. 411), the epistemological approach of poststructuralist feminism is presented as a pertinent perspective, as it questions the claim to truth and objectivity of classical science (Olivares-Aising & Mayorga Rojel, 2023). This approach is based on the foundations of constructionism: discursive constructions, shared knowledge in communities, and their influence on the production and reproduction of reality (Sandoval, 2011).

Thus, feminism and poststructuralism converge in the need to de-construct and rethink language, analyzing social and discursive constructions (Zambrini & Iadevito, 2009), reflecting on how society and culture, through discourse, establish the way in which individuals understand and make sense of the world through language, social practices, and other symbolic systems, reproducing and maintaining essentially dichotomous and binary characteristics that influence reality itself (Beiras et al., 2017; Wigginton & Lafrance, 2019).

As a result, through concepts such as différence and the notion of deconstruction, value and recognition are given to heterogeneity and diversity, questioning binary and universalist structures through a critical analysis of language and the structures of meaning (Derrida, 1989). In addition, the concept of subjectivity has been addressed and enriched by different authors, such as Teresa de Lauretis, Luce Irigaray, and Judith Butler, who point out and emphasize the existence of an identity metamorphosis, which is constructed based on an immense number of narratives, perspectives, and discourses that, together with social and cultural parameters, shape the individuals' conception of identity.

As a result, these concepts, as well as many others originating from this theoretical-philosophical current, manage to provide conceptual tools that enable an understanding of the world, promoting the questioning of social and discursive constructions, destabilizing and challenging established norms, power structures, and social practices. This, in turn, allows for critical reflection, providing a theoretical framework that enables us to address oppression, exclusion, and inequality through discourse analysis, in order to generate changes, transformations, and strategies within our profession.

Discourse

Following the guidelines proposed in previous sections, discourse is a key element to consider in the development of this research. This is because “[...] reality is discursively constituted” (Restrepo, 2020, p. 140); more than simply words, discourse “[...] involves practices, individual positions, concepts, objects, and struggles, with effects of truth and in specific power relations. … It has material effects on specific corporalities, spatialities, technicalities, and subjectivities” (Restrepo, 2020, p. 141). Therefore, it is pertinent to discuss power relations. From a Foucauldian perspective, power is relational, an ever-changing force that becomes evident when it is exercised (Bischoping & Gazso, 2016), differing from states of domination since they imply the exercise of freedom (Castro, 2004).

On the other hand, when analyzing discourse, it is relevant to define the concept of discursive formations, which refer to “[...] a series of statements [that] respond to the same rules of constitution” (Castro, 2014, p. 74), that is, they are not produced in isolation, but respond to contexts and rules of organization; in this regard, discourse is understood as “[...] an instrument and effect of power” (Rojas Osorio, 1984, p. 49). Within the framework of the above and considering the counter-hegemonic nature of the feminist position, subjugated knowledge is presented, understood by Foucault (1979, p. 129) as those “[…] knowledge classified as incompetent, or insufficiently developed ... hierarchically inferior to the level of knowledge or the required scientific nature”.

In this way, healthcare discourse organizes assessments, interventions, and protocols, situated within the realms of knowledge and power, acting through norms, order, and hierarchy (Alvarez & Gutierrez, 2022). Consequently, it is pertinent to analyze, from a discourse perspective, the power relations that characterize the therapeutic relationships of feminist occupational therapists, who present themselves as part of a profession whose historical conditions of origin link it to a biomedical discourse (Oropesa Roblejo et al., 2014). In addition, it is necessary to understand how the feminist position emerges and is articulated within this relational framework, as it opposes the system of patriarchal subordination and oppression (Hooks, 2017) and presents itself as a space of resistance to the discourses of knowledge and power (Piedra Guillén, 2004).

Therapeutic relationship

Finally, another concept to explore is the therapeutic relationship, understanding that establishing a relationship with another individual is a creative and interdependent process that involves attention, trust, respect, and the creation of shared meanings about what the therapeutic process entails for a person's future (Clark, 1993; Clark et al., 1996, as cited in Price, 2011). Conversely, from the occupational therapy perspective, the importance of the bond and interaction that happens between clients and therapists has emerged. This topic has been called by numerous names, the most common being, for the purposes of this research, the therapeutic relationship, which constitutes “[…] a key aspect of the therapeutic process of occupational therapy and a catalyst for change” (Price, 2011, p. 329).

Based on the above, relationships are a complex phenomenon that requires diverse interpersonal and communication skills and abilities for their construction (Price, 2011). These skills do not respond to protocols or techniques (Price, 2011), but rather the opposite, since they arise spontaneously in a real and dynamic interaction. From this, the therapeutic use of self emerges, which refers to “[...] therapists' deliberate efforts to improve interactions with their clients” (Taylor, 2016, p. 427) and includes the planned use of the professional's personality, vision, perception, and judgment throughout the therapeutic process (American Occupational Therapy Association, 2008; Punwar, 2000, as cited in Taylor, 2016).

From this perspective, the Intentional Relationship Model (IRM) emerges, which seeks to complement the existence of other models and not replace them, providing a reasoning approach and a range of interpersonal skills to guide professional practice towards building the relationship between therapist and client (Solman & Clouston, 2016; Taylor, 2016). Now, in order to understand how therapists and clients develop a therapeutic relationship, Price (2011) proposes that it happens in stages, taking shape interdependently with the therapeutic process. Each of these incorporates strategies related to sharing experiences and interests and co-creating stories; as well as therapist skills linked to the adoption of different roles, the delivery of undivided attention and the transmission of genuine interest, among others (Price, 2011); recognizing the lasting impact that the quality of the therapeutic relationship has on therapist and client (Price, 2011).

Methodological Framework

Epistemological positioning of the research

For this research, we have positioned ourselves from a critical perspective of occupational therapy, as we believe it is necessary to continue producing knowledge from Southern Occupational Therapies, with the goal of utilizing the collected elements to implement relevant and meaningful therapeutic processes for individuals and communities contextualized in our country.

From a Feminist Epistemology perspective, it is worth highlighting the multiplicity of perspectives or conceptions linked to it, from a historical and social perspective that allows us to analyze its influence on current events and on our academic discipline specifically. In this way, we position ourselves from the perspective of poststructuralist feminism, which allowed us to critically and reflectively delve into the discourses of feminist occupational therapists, their therapeutic relationships, and experiences, analyzing how their discursive form and practices undermine or, on the contrary, revalue the experiences of their clients.

Based on the onto-epistemological positioning already mentioned, the objective of this research was to identify the distinctive elements in the discourse of feminist occupational therapists regarding their therapeutic relationship, by understanding discursive formations referring to power relations.

Research design

As mentioned in previous sections, the research design was post-qualitative, allowing us to question established notions from a decentered and flexible perspective, accessing the underlying reality (Olivares-Aising & Mayorga Rojel, 2023) in the discourse of feminist occupational therapists regarding their therapeutic relationship, based on an analysis from a Foucauldian perspective.

In this regard, our research design included the following stages:

1. Interview awareness-raising through expert consultation: three feminist occupational therapists linked to academia, with the aim of raising awareness of the thematic body of open interviews conducted with six occupational therapists dedicated to professional practice.

2. Open call via social media and selection of participants to constitute a convenience sample.

3. Conducting open interviews with six participants: feminist occupational therapists.

4. Transcription of the interviews and analysis of the data produced. For the latter, open coding (Charmaz, 2006; Gaete Quezada, 2014) was used, milestone by milestone. Subsequently, categories emerged from the codes obtained (Gaete Quezada, 2014), which allowed us to approach discursive formations and, through a process of discussion and problematization, identify distinctive elements linked to the emergence of hegemonic and feminist discourses on the therapeutic relationship.

Data production technique

During the first stage of this research, the interview was used as the data production technique. This constitutes a relevant technical instrument in post-qualitative research, as it is presented as an effective method that, unlike a questionnaire, enabled the emergence of a greater quantity and depth of discursive elements from the interviewees (Díaz-Bravo et al., 2013). In this sense, the type of interview used was open-ended and individual, characterized as a conversation in which “[...] there is a purpose that guides the discursive interaction” (Montañés Serrano, 2010, p. 3). In addition, as mentioned above, these interviews had a previously defined thematic outline, based on the recommendations of experts in the field of knowledge of this study.

Thus, an online interview lasting approximately one and a half hours per participant was conducted with a total of six feminist occupational therapists, defined as a convenience group, in order to gather as much information as possible. The flexibility that characterizes these interviews allowed for modification and adaptation of each question based on the time context and the emerging issues addressed by the interviewees.

Ethical considerations

Participants' voluntary participation was considered, and they were allowed to withdraw at any time during the research. Regarding the benefits, the interviews were considered an opportunity for reflection on the professional practice of occupational therapists. Likewise, this research provides society with a critical and reflective perspective on the therapeutic intervention process, opening spaces for discussion of new forms of feminist and Latin American praxis.

Although participation in this research does not present major risks, the identities, opinions, and information provided by the participants were treated anonymously and confidentially, with access only to the researchers. Their names were replaced with numbers to protect their identity.

Participants

During this research, six people who were willing to be interviewed by the researchers participated and signed informed consent forms. These participants were required to meet certain criteria, which will be detailed below: first, they must be occupational therapy professionals; second, they must have at least one year of professional experience, to ensure they had enough experience to share their experiences and thoughts on the question posed. In addition, participants were required to identify as feminists, since the emergence of this position in practice is what we wished to research. For this reason, exclusion criteria included teaching and research during their professional careers.

Regarding the characteristics of the participants: 5 identify as women and 1 as non-binary; their ages range between 25 and 35; 3 are Mexican and 3 are Chilean; dedicating themselves to work in different areas and populations: hospital, community, with children, seniors, mental health, among others.

Strategies for analyzing the results

First, we read the interview transcripts, labeling those elements of the textual material that seemed relevant to us. Then, we conducted an open coding process (Charmaz, 2006; Gaete Quezada, 2014) based on the labels. From this, we obtained codes, which were organized into categories. These allowed us to approach the discursive formations that emerged from them. From this, we sought to analyze the emergence of feminist discourse in the statements and discursive formations of the occupational therapists interviewed. Discourse analysis aims to establish the links between hegemonic discourses with feminist positioning and the power relations that emerge in the context of the therapeutic relationship.

It should be mentioned that at the post-qualitative level, discourse analysis follows a recursive process, as it sought to interpret and deeply understand the occupational therapists' discourse. Non-linearity was critical, as it allowed us to repeatedly move back and forth through the corpus, enabling a panoramic view of the categories and their relationships to discursive formations.

Results

This section presents the results obtained from six interviews with occupational therapists. These results have been organized into three categories that emerge from the identified discursive formations: construction of the feminist occupational therapist individual, feminist occupational therapists and the therapeutic relationship, and tensions between feminist occupational therapists and the socio-labor context.

For the transcription of interviews and subsequent citation, the following coding was used to protect the participants' identities.

Pp: Participant + number from 1-6

Example:

Okay, I don't remember all of them, but at the beginning, I started with the basics, such as the introduction to rehabilitation, musculoskeletal anatomy, general anatomy, and pathological processes (Pp 3).

Construction of the feminist occupational therapist individual.

Under this category, the goal was to understand how feminist identity is constructed and manifested in the context of occupational therapy and how this affects the participants' professional practice.

First, we investigated the interviewees' experiences regarding their first encounters with feminism. These included significant life events and their family and non-family environments during childhood and adolescence, as well as their experiences after entering the program. In this way, we identified experiences in the interviewees' family environments, primarily linked to patriarchal family dynamics and even situations of domestic violence. These experiences interrelate with the daily experiences of other women, both within and outside of professional practice, bringing us closer to concepts of intersectionality.

There's a patriarchy in my home... so I guess, based on my own experience first, and then, seeing it with women, Indigenous women, whom we surveyed, who told us their stories, and from there we started... (Pp.3).

Preliminary research sought to identify whether higher education institutions offer and/or incorporate feminist perspectives in the training of occupational therapists. In their speeches, the participants emphasized the lack of academic training on feminism in their curricula, reinforcing that feminism was not specifically addressed in the courses they took at their universities.

In contrast, only one of the participants, a Mexican national, mentioned that, during her undergraduate studies, she had access to some seminars and courses that opened up feminism, but that these were not explored in depth or addressed again during her training.

Consequently, it is observed that most training in feminist issues comes from the individual's own initiative as students and occupational therapists, and is understood as a subjective process for each individual.

We never had a class that talked to me about feminism, but they did talk to me about Human Rights, for example, about the critical paradigm that clearly includes feminism, so there… we were able to include it through self-education (Pp.6).

Thus, the need to resort to self-education to acquire knowledge on the topic is recognized, highlighting the lack of a direct focus on feminist subjects in the academic curriculum and contrasting this with the presence of related topics.

On the other hand, the participants' position regarding feminism and some of its main referents was made visible, seeking to investigate how this position shapes their way of seeing and understanding the world. Based on this, it is concluded that most of the interviewees have a similar position, identifying themselves with feminism, specifically with two of its currents, described by the participants as “liberal” and “intersectional”. Meanwhile, one of the professionals, in her self-critical but revealing speech, claims to be unaware of the currents within this movement, expressing that she has engaged in a form of self-deconstruction within the limits of her own comfort and self-reflection.

The above proves a lack of confidence in naming feminist positioning, due to a limited understanding of the different currents, theories, and approaches within the movement. According to the participants, this issue arises from a lack of academic training. Thus, it is suggested that the way they position themselves within this perspective is mediated by the validation of academia, and with it, by structures of knowledge and power. Although we recognize the need as feminists to permeate spaces from which we have been historically restricted, as well as to question assumptions in science and academia, it is inevitable to question how the appreciation of feminist positioning is sought through these devices that hierarchize and determine truths.

Feminist occupational therapists and the therapeutic relationship

This section aims to present the findings regarding the link between feminist positioning and the therapeutic relationship, as well as highlight those results that refer to feminist practices and actions in the co-construction of this relationship, considered a key element of the therapeutic process. First, the participants' discourse highlights dimensions that deepen and enrich the emergence of a therapeutic relationship based on trust and empathy, such as horizontality and approaching the clients' situation from a situated perspective, considering and giving political meaning to the therapists' affectivities, detaching themselves from the pretense of neutrality, questioning what has been normalized, and co-creating safe therapeutic spaces.

If you are a feminist, you clearly cannot connect from the knowledge-power relationship in your therapeutic relationship. You assume a horizontality as such and also a role… of co-education (Pp.6).

At the same time, elements that point to self-monitoring and active listening are identified in the discourse, in order to avoid the reproduction of sexist behaviors, evoking self-compassion and self-improvement from a feminist perspective based on empathy and with an eye to human rights.

I try to learn, as much as possible. I understand that I'm not perfect as a feminist. Every day I discover something new, something that can help me to be better… I always question things, I always ask myself, 'Was I right or wrong?'… Reaching out, empathy, that's the first step in reaching a person. Second, explaining how to assert their rights, explaining the process, knowing how to listen (Pp.1).

On the other hand, what we have called implicit strategies stand out, as they address actions and practices that can be considered feminist, avoiding detection by their professional environment. These include those related to the transformation of power relations through the provision of therapeutic space and the use of themselves as a therapeutic tool by questioning claims of neutrality, as well as those actions with a gender perspective related to the subtle degendering of occupations and roles.

Imagine I have to serve you across the desk, which already creates a barrier, right? Then all the formality... being in uniform, with the ID, and me evaluating you... you start perceiving those little things... I mean, if I don't stand behind the desk and stand to the side where I don't create a barrier, where maybe I'm wearing random clothes... So I've tried to work on that kind of hierarchy (Pp.5).

Now, the gender perspective is part of the discourse on implicit strategies of some of the participants, so we believe it is necessary to state that by making a distinction between feminism and gender perspective, other feminist issues and themes are left out that are key when intervening through a more informed approach focused on critical aspects, such as power relations and the effects of the patriarchal and neoliberal system on individuals who do not identify as women.

Tensions between feminist occupational therapists and the socio-labor context

The work context was widely discussed by the interviewees, so this category seeks to encompass, first and foremost, the influence of the work environment on the professional performance of feminist occupational therapists. It emphasizes the multidisciplinary team's lack of knowledge regarding occupational therapy and feminist practices, perceiving this as acquiescence to the patriarchal order in healthcare institutions, which not only hinders professional performance but also the relationship with their clients. As Participant 5 states:

Work teams are... we are, I include myself... very much perpetuators of stereotypes and the patriarchal system, which is not questioned; and, instead, it is strengthened.

Likewise, the existence of sexist behaviors that persist in the workplace is problematized, such as prioritizing the opinions of cisgender male colleagues while simultaneously invisibilizing and reducing the space for women in discussions, harming teamwork. Similarly, these behaviors are associated with a stigmatization of feminist positions, which permeates the institutions where the interviewees work, highlighting prejudices by bosses, colleagues, and clients, who disapprove and predispose a negative attitude toward this issue, labeling those who identify with the movement as troublemakers.

Similarly, in the interviewees' discourse, different ways of struggle and resistance against these patriarchal practices in the workplace are recognized, reinforcing the importance of generating spaces for reflection that sensitize the work team on issues related to the movement, promoting understanding and equity, and raising awareness about dynamics that keep this structural inequality that arises in the workplace, as explained by participant 1:

I've had moments where I've discussed these things with my colleagues. Once I said to one of them, 'Are you clear that you have more rights over me, right?' and they said, 'Yes, of course,' and it's not like we've argued, but we have reflected a lot on the topic... I feel like those things are missing... that those spaces should be created.

Based on the above, the implications of the sociopolitical context in our discipline were visualized transversally, pointing concerns and challenges facing the patriarchal and neoliberal system existing in Latin America, which prioritizes profit over principles such as equity, social justice, and collective well-being, affecting both the health of professionals and their clients.

The greatest threats you can face are the dehumanization of your therapeutic processes, the pathologization of your therapeutic processes, the biomedicalization of your therapeutic processes. These are things that have been deeply embedded in the development of the healthcare system, such as ‘serve care quickly, meet goals, write reports, otherwise you won't have your bonus at the end of the month’… institutional practices that also affect your personal environment… we clearly live in a very neoliberal capitalist society (Pp.6).

In this way, it becomes evident how the system upholds biomedical logics that leave no room for discussion and questioning, deepening the reproduction of different forms of inequality and exclusion. Faced with this, the interviewees propose the importance of professional performance based on counter-hegemonic practices, with a feminist perspective and a focus on rights, which will empower clients, transform power relations, and permeate institutions and the system so that it responds to the needs of the population by providing equitable access to healthcare services.

Discussion

Based on the previously established categories and discussions with academic occupational therapists, distinctive elements regarding the visibility of patriarchy in professional practice are recognized in the discourse. Therefore, “[...] more critical and emancipatory actions” are proposed (Farias, 2022, p. 6): the idea of ​​feminism as a way in which human relationships are established and understood and, consequently, the co-creation of spaces of resistance in the therapeutic relationship, through reflective and interventional tools linked to self-monitoring, active listening, dialogue of knowledge, and situated knowledge, according to the interviewees.

The analysis highlights concern about the absence of feminism in occupational therapy curricula, which seems to influence the students' subjective construction of feminism. In this sense, feminist training is based on the participants' personal and professional experiences, closely linked to their position within this perspective, which is mediated by academic validation and knowledge/power structures. This gap raises questions about the assessment of feminist positions through academic mechanisms that prioritize truths; and, on the other hand, it compels us to question the reproduction of hegemonic practices in occupational therapy through current curricula.

Regarding the therapeutic relationship, the analysis of the discourses suggests that the inclusion of this feminist position could provide new dimensions to professional practices by deepening the understanding of clients' experiences from a critical and situated perspective, which recognizes the relations of power and knowledge/power in the therapeutic space, seeking to transform them. Although most of the feminist strategies or actions proposed by the participants are implicit or subtle, interventions based on this perspective are seen as enriching, highlighting elements such as questioning the established order, creating spaces for resistance, and a contextualized view of the environments in which they work.

The interviews revealed a series of significant challenges and tensions that influence their professional performance and, therefore, their therapeutic relationships. Highlighting, on the one hand, the persistent lack of recognition and understanding by the multidisciplinary team regarding occupational therapy work and associated feminist practices, which translates into stigma and sexist behaviors by the staff, perpetuating gender inequalities and affecting not only teamwork but also the well-being of the population with whom they work. Accordingly, the implications of the sociopolitical context on the feminist practices of the discipline are revealed, where the patriarchal and neoliberal system transversally permeates professional practice and training. This, in turn, limits the space for the emergence of counter-hegemonic and transformative practices on which critical perspectives and Southern Occupational Therapies urge us to reflect, reproducing the power relations they seek to transform.

The experience of occupational therapists who consider themselves feminists, whose training in the subject arises outside of the curriculum, constitutes a valuable foundation of knowledge for their professional work. To the extent that diverse ways of knowledge are recognized and valued, beyond those traditionally associated with academia or formal expertise, the personal and professional experience of the participants is highlighted as a source of deep and meaningful knowledge production in their praxis. Consequently, the position and experience of those who produce knowledge not founded by academia are recognized, as well as the power relations and social dynamics that influence this knowledge (Haraway, 1995), challenging the dominant narratives and discourses that have historically been privileged over lived experiences. This perspective supports the construction of situated practices relevant to the political, cultural, and social contexts in which we work.

The above leads us to reflect on the practice of feminism in occupational therapy through the lens of what Foucault proposes as subjugated knowledge (Foucault, 1979), insofar as the sociopolitical context and the institutions in which they emerge disqualify them, labeling them as naive (Foucault, 1979). The counter-hegemonic nature of feminist practices in occupational therapy is then based on the opposition “[...] against the effects of centralizing knowledge that has been bequeathed to institutions” (Foucault, 1979, p. 130). In this manner, we believe that initiatives similar to this research would allow us to rescue diverse knowledge in our praxis, without aiming to generate a homogeneous body of knowledge, but rather valuing its diversity, thus giving way to an insurrection of feminist knowledge in occupational therapy.

Conclusions

Among the results, a multiplicity of topics and situations were discussed with the interviewees. First, elements related to the participants' subjective construction of feminism were identified, revealing similarities in self-education experiences and currents, as well as in concerns regarding academic training in feminism. Second, the interviewees' intention to co-construct therapeutic relationships that transform knowledge/power relations in the therapeutic space was evident, from a situated perspective and a non-neutral position, through feminist strategies implicit in their praxis. Finally, and related to the implicit, tensions between the therapists and their work environments, which are permeated by patriarchy, also emerged within the results, reinforcing the consequences this has on their professional performance and the therapeutic relationships they build.

In developing this research, we were able to answer the initial questions, as different distinctive elements present in the discourse of feminist occupational therapists were observed and analyzed, particularly regarding the therapeutic relationship. Ethical and political positions also emerged, as did the actions taken in the workplace and in patient care. However, among the limitations of the research process is, first and foremost, the limited reach obtained through the open call on social media, hindering visibility and, consequently, the participation of potential professionals. On the other hand, while there is a research gap on the topic, we believe that the results obtained are consistent with those of studies on feminist perspectives in other disciplines (Conlin, 2017; Wright & Wright, 2017; Rutherford & Pettit, 2015).

Thus, this research has provided a perspective from the emergence of knowledge on the potential impact of the feminist perspective in the field of occupational therapy. By materializing its discourse and embodying the practice of professionals who identify as feminists, it promotes the reproduction of counter-hegemonic, critical, and emancipatory practices within our profession. In this sense, it is necessary to rethink the spaces we inhabit as a profession and how they are permeated by the patriarchal and neoliberal system, from healthcare institutions to those responsible for professional training. The transformation of structures depends not only on questioning them, but also on their de-construction through discourse and social practices, thereby overcoming stigmas and opening safe therapeutic spaces for a feminist occupational therapy that goes beyond implicit strategies.

Finally, we highlight the importance of conducting further research that allows for the systematization of feminist practices in occupational therapy, through the recovery of the discourses and experiences of feminist occupational therapists and clients, as they are presented not only as a way of combating the knowledge established by the dominant power structures, but as a bridge between the reflections proposed from critical perspectives and the embodied practice of a truly transformative and counter-hegemonic occupational therapy.

• How to cite:
  Donoso Lobos, D., Navarro Lucic, C., Ríos Peña, M., Rosas Díaz, R., & Olivares-Aising, D. (2025). Feminist occupational therapists and therapeutic relationship: a discourse analysis with a Foucaultian perspective. Cadernos Brasileiros de Terapia Ocupacional, 33, e3960. https://doi.org/10.1590/2526-8910.ctoAO405539602

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Edited by

• Section editor
  Profa. Dra. Daniela Edelvis Testa

Publication Dates

• Publication in this collection
  19 May 2025
• Date of issue
  2025

History

• Received
  01 Oct 2024
• Reviewed
  21 Feb 2025
• Accepted
  05 Mar 2025