The Canadian Model of Client-Centred Enablement: Reflections from diverse occupational therapy practitioners

This article is the third of a series of articles that in-troduces new models and concepts presented in the latest set of Canadian occupational therapy guidelines entitled, Enabling Occupation II: Advancing Occupa-tional Vision for Health, Well-Being and Justice through Occupation (Townsend & Polatajko, 2007).In Enabling Occupation II, the Canadian Model of Client-Centred Enablement (CMCE) is presented. This model is “a visual metaphor for client-centred enable-ment” (see Figure 4.3) (Townsend et al., 2007, p. 109) and depicts the relationship between therapist and client, as well as an array of enablement skills used in therapeutic relationships. Chapter four of Enabling Oc-cupation II describes how the CMCE, “embraces enable-ment as the core competency of occupational therapy” (Townsend et al., p. 109). The chapter is exciting to read because it makes explicit the ideas about enablement that have implicitly guided occupational therapy prac-tice for years. The CMCE displays ‘what’ occupational therapists ‘do’ with their clients who may be individual, families, groups, communities, organizations or popu-lations. Furthermore the CMCE defines a spectrum of enablement skills that include the actions of adapt, ad-vocate, coach, collaborate, consult, coordinate, design/build, educate, engage and specialize as the key skills for client-centred, occupation-based enablement. A fascinating idea portrayed in the CMCE is that enablement may fall on a continuum. While we would wish for all enablement to be effective, there are a “continuum of possibilities from ineffective to effective enablement” (Townsend et al., p. 128). Four decision-making points for the enablement continuum have been established and include; ineffective enablement, missed enablement, minimal enablement and effective enablement (see Figure 4.4). The text encourages us to critically reflect on enablement, recognizing that “com-plex practice conditions as well as therapist choices determine possibilities for enablement” (Townsend et al., p. 130). Last fall, the CMCE and the enablement continuum was discussed with a group of occupational therapists with diverse practice backgrounds. These 15 thera-pists were participants in a distance-education theory course at Dalhousie University’s School of Occupational Therapy. Here are some of the comments they made in their on-line discussion. *****

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