Faculty members Tessa Milman, Janet Gunter and Jennifer Jones in conversation with USC Chan Magazine editor Mike McNulty about dismantling occupational therapy’s colonial ideologies and practices.
By Mike McNulty ’06, MA ’09, OTD ’10
Mike McNulty (MM): Let’s start at the beginning: Decolonization is a term that’s very much in the Zeitgeist right now; where did it first gain your attention?
Tessa Milman (TM): We were working on the Justice, Equity, Diversity and Inclusion (JEDI) curriculum thread within the entry-level Occupational Therapy Doctorate program and had been looking at literature on diversity, access and equity. [Faculty member] Arameh Anvarizadeh said, ‘What we really need to be talking about is decolonization.’ That sparked a deep dive into the concept — people were into learning more, and those who were familiar with decolonizing practices seemed excited. That doesn’t mean everyone had an expert grasp of the concept. But people agreed it was the right way to take the Entry-OTD curriculum and the JEDI thread.
Then, our clinical reasoning teaching team — Janet, Jen and I — piloted some of the ideas related to decolonization in this course to see how students would respond, how it would impact the class and how it could impact us.
Janet Gunter (JG): We had very positive reactions from students to the concept. But there has been some confusion from faculty about what exactly it is. ‘Is decolonization just a renaming of what we’re already doing?’ Maybe we have been doing parts of it, but it’s a very intentional process and is more than just taking global perspectives beyond a Westernized perspective — for example, when analyzing occupations or creating treatments plans. It goes a step beyond that. Unless you engage in deeply intentional reflection of your own perspectives and really consider the person you’re working with from this broader viewpoint, then I don’t think you’re truly doing it.
TM: I’ve heard critiques that the decolonization idea is just a trendy label or that people like to throw it around in a performative way. But like Janet said, there is a deeper way to really think about it and reflect on its meaning.
MM: Can you say more about that meaning — how do you conceptually define decolonization? Does it help to consider it in contrast to what it means to be colonized?
TM: You have to start with the history of colonization and contemporary impacts from Western countries’ colonization and subsequent control and oppression of non-Western countries. A certain way of life and living was imposed, a way of thinking about what is important about being a human being, and assumptions made about who should get a good quality of life, what kind of medicine is appropriate and what kind of knowledge is valid. All of those are products of the colonization of Southern Hemisphere countries, what are labeled as “developing” countries, and they continue to impact us today in the way that Western ideas are more often valued than other ideas.
So for us, to decolonize is to question assumptions about independence and productivity, about what makes good medicine and valid knowledge. It’s not as if we want to get rid of those assumptions, but we have to deeply reflect on their utility in particular situations, and whether or not they’re useful for the people we work with. Decolonization also involves critiquing current forms of oppression that people experience, whether they are [Black, Indigenous and People of Color] people or disabled people or LGBTQ people.
MM: Can you outline some examples, in an ideal world, of what decolonized practices look like?
Jennifer Jones (JJ): I’ve been doing clinical work with a young adult who is coming into her own with her disability identity, and she’s realizing, ‘No, I actually don’t want to be completely independent, and it’s OK that I’m not; I’m not going to be independent in certain occupations; I’m going to accept care and support on some of these things so that I can do those occupations I’m more interested in.’ It takes time to do that, and time is one of the biggest barriers in clinical practice. But I’ve seen how much power a decolonized perspective gave back to this client, and how much it supported her own mental health and self-efficacy. To be able to assert control in that way has been a really transformative process for her. Decolonization involves critiquing structural factors, being an advocate, spending time with clients to really understand things from their perspective and doing underground practice that doesn’t necessarily get documented.
JG: It’s not new for us, as occupational therapists, to ask the people we work with, ‘What do you want to work on? What are your goals?’ But something gets lost in translation from those conversations to what gets funded and what parents and families are actually concerned about. Parents may not know what they actually want to work on. So they ask us, the quote-unquote experts, ‘What should my child be working on?’ Parents’ own expertise is overshadowed by cultural factors. It’s hard for parents to have this conversation because they’re so used to the experts in the room saying, ‘This is what your child should be doing.’
TM: We talked a bit about questioning the assumption of independence. But the alternative, embracing interdependence, is so important, whether that’s trying to support people as they build their networks outside of therapy, or identifying and using different supports, if that’s what they want. We don’t have to always feel like independence is the way to go, but can instead try to help clients increase networks of support.
MM: If occupational therapy takes an honest look at itself and its own history, will it see an inherently colonizing profession? Or at least, a profession that’s a product of colonized systems?
JJ: Occupational therapy obviously has its roots in Western medicine and ways of knowing. From a colonized perspective, the clinician has a knowledge set that is seen as inherently more powerful than what the client brings to the table — the authority of research, the esteem of science, the social capital that professions have — as opposed to the client experience, which has been traditionally less valued.
TM: A lot of our assessments focus on deficits related to performance, productivity and independence, so clinicians should always be watching out for client strengths. That’s part of the occupational therapy process in general, but really leaning towards that is an important part of decolonization to me. Those could be strengths in their environment, strengths in their culture or strengths in their community.
JG: It is so heavily embedded in our daily lives in the clinic because colonialism is built into funding — payers are looking for outcomes of ‘doing,’ and if patients don’t improve their ‘doing’ during therapy, you lose funding. To be reimbursed for services, so much of what I focus my intervention on is ‘doing,’ and because I’m in pediatric practice that’s usually embedded within Western ideals of what a child should be doing at any given age. So instead of what they want to be doing, we resort to a developmental checklist — they should be doing skill A, B or C. A lot of the time, clients may also care about performance, independence and productivity — and that’s wonderful, I’m not suggesting those are a problem in themselves — but problems arise when we, as clinicians, assume that’s what everybody always wants.
MM: In higher education, what do decolonized approaches look like in classroom environments, learning activities or course content? How is decolonization reflected in a syllabus, or play out during a class?
TM: For years in our clinical reasoning course we’ve used Stephen Brookfield’s critical thinking protocol to help students think critically by questioning their own assumptions. We built decolonizing perspectives into that content — students learn about the protocol, analyze their assumptions and read about decolonization. It lets them think about their own assumptions related to colonial ideas of independence, productivity, morals, values and habits and routines. Our experiences teaching the protocol influenced our own understanding of decolonization, because we immediately saw it as a deep and intentional process of questioning assumptions.
For me as an educator, it’s filtered into a lot of things. Whenever I’m in a situation that involves a dilemma or someone is behaving in a way I don’t quite understand, I try to step back and ask myself, ‘What assumptions am I making here? How are those assumptions influencing the way I’m thinking about this situation?’ Let’s say a student critiques my class because they feel like there’s too much group-based work. I have to confront my own assumption that group dialogue and peer interaction is one of the best ways of learning.
JG: Once you start talking about assumptions, students often jump to, ‘Oh, I had this assumption, and it’s so wrong or it’s so bad.’ No, assumptions aren’t bad; they’re just rooted in your past experiences, your culture, your family, your education, et cetera. They’re not bad; we just have to be aware of them. Once you start hearing different perspectives, it solidifies the concept of multiple simultaneous perspectives — people can have different opinions than me that are just as valid and matter just as much as my own opinions. I think that those classroom conversations are so important.
JJ: We’ve also been rethinking the ways that students can demonstrate their understanding. In academia, the traditional way students demonstrate mastery of a concept is by writing a paper or essay. Instead, we’ve been trying to shift some assignment formats to expand the ways students demonstrate their learning. As opposed to writing an essay, our students are allowed to record verbal audio reflections or prepare a presentation. Looking forward, we have more ideas on how to continue doing that — maybe it’s a sit-down discussion with the instructor to talk about what they’ve learned, or a visual representation of conceptual understandings.
MM: Has a more diverse educational experience led to students having “aha!” moments or breakthroughs in ways that they may not have previously?
JG: I’ve had students come back from fieldwork experiences saying, ‘You know, that goal or activity we were working on was not necessarily coming from the client’s intrinsic desire or motivation.’ They realized that perhaps the client would have participated if only the student had first checked-in to ask whether it was something the client actually wanted to work on, versus using labels afterwards like “noncompliant patient” or that the “client refused therapy.”
JJ: There’s been some discussion about best timing to introduce decolonization to students, and some of the initial feedback was that students need to really learn what occupational therapy is before they can decolonize it. But our response was that it’s easier to identify assumptions and ask critical questions from the very beginning of one’s education, as opposed to unlearning practices later on. So maybe it feels a little muddy to students at the beginning of the semester, but there’s so much more understanding and nuance by the end of the semester.
We can also start by thinking about how to remove the power differential in the classroom. As instructors, we believe that we’re learning together alongside our students, and recognize that we as instructors don’t always have the answer. The classroom can be a collaborative place for mutual growth, as opposed to one led by an instructor with a definitively “right” or “wrong” way.
TM: That comment about unlearning is spot on. For example, say you’re learning about an assessment in mental health that measures cognition. As you’re learning about it, you can take a decolonized stance to acknowledge this assessment is based on the idea that society values people with higher cognitive capacity, or ask whether we’re learning this assessment in order to determine how the person can maximize independence.
Another issue I’ve heard from a few students is that it’s hypocritical to talk about decolonizing when higher education is so expensive and restricted to people who are able to afford it, and whether peoples’ ability to pay tuition or not is based upon historical patterns of discrimination and oppression: ‘How can we decolonize when we’re part of a colonized institution?’ I answer first with validation to acknowledge that, yes, this institution is embedded in coloniality. But the first step is always questioning. We may not have control to change the financial structure or conditions, but we can start with a dialogue that questions assumptions.
MM: What are the next steps on your decolonizing agenda, and what do you see as potential long-term impacts of taking decolonized approaches?
TM: I think that a lot of students today really want to make sure that the care they provide is more than just culturally considerate, but is proactively anti-racist and anti-oppression. I think they have a huge desire to provide services as future clinicians in this way. My hope is that this content will be more threaded throughout our new Entry-OTD program. Each class has some component that addresses JEDI, which builds on decolonization ideas which we introduce in the very first semester. Then, through the Reflective and Responsive Practitioners curriculum thread, students will continue talking about, learning and applying it.
JG: I’m in the clinic the majority of the time, and deficit-based reimbursement — the Westernized concept of using deficits as the qualification basis for OT services — is such a huge hurdle. But I do believe that embedding these concepts into our professional education program prepares USC Chan students to be clinicians who can push back when confronted with colonialism in practice. And when they go out into the world, they can question everything rather just emulate and perpetuate what’s already happening.
JJ: We presented on this topic at the 2022 AOTA Conference, with a focus on both education and clinical practices. The majority of attendees were faculty members from different institutions, and we had a lot of really powerful conversations about what’s working, what’s not and the facilitators and barriers in certain institutions. That was really fruitful conversation, and everyone was so hungry to share their experiences and support each other in order to do more in their programs — it was really inspiring!