A Narrative Phenomenological Approach to Transformative Learning: Lessons From Occupational Therapy Reasoning in Educational Practice

Abstract

Transformative learning involves the questioning of worldviews and underpins shifts in values and identity that are integral to critical occupational therapy practices. Cognitive theories of transformative learning name, but do not address, the experiential dimensions of transformation. The aim of this article is to conceptualize transformative learning from the perspective of narrative phenomenology in occupational therapy. An argument is presented that draws on research in occupational therapy professional reasoning and that makes visible the dimensions of transformation that are inherently experiential and meaning oriented. Three key concepts for a transformative pedagogy are defined and illustrated: scenes, emplotment, and embodied metaphors. The article concludes with the types of learning objectives for which this approach is suited and the pedagogical values that underpin these teaching practices. This article adds to the domain of health care education by defining and illustrating experiential and meaning-based practices as signature pedagogies for transformative learning.

An occupational therapy curriculum is intended to provide a means to becoming an expert in enabling occupation and to “embod[y] the aspirations for the kind of society we wish to see” (American Occupational Therapy Association [AOTA], 2009, p. 804). In a time of globalization and an increased focus on inequities, occupational therapy educators need to enact relational values and pedagogical practices for occupational justice and cultural safety, whereby the social, political, and historical dimensions are accounted for in understanding occupational issues as well as in naming one’s own lens (Andrzejewski & Alessio, 2005; Beagan, 2015; Fleming-Castaldy, 2015). Critical occupational therapy calls for an open and reflexive stance that, at the highest level, promotes a reconstruction of the self and transformation of worldviews to promote equitable and effective actions within complex environments (Robertson et al., 2015). This position is in alignment with the goals of transformative education to maximize human potential and to build human relationships (O’Sullivan, 1999). To transform the world of clients, students and teachers must experience and model a questioning and transformation of their own fields of view as well as integrate and apply a critical and relationship-centered ethical perspective within the educational process (Lévesque et al., 2013).

The aim of this article is to conceptualize transformative learning from the perspective of narrative phenomenology in occupational therapy. In December 2017, a search of key words in educational databases revealed that although phenomenology is used to understand shifts in meaning and experience as outcomes of transformation, minimal attempts have been made to integrate any variation of phenomenological understanding into transformative learning theory itself. Drawing on philosophy and research, I present an argument for the need for phenomenology and the unique contribution of occupational therapy reasoning and practice in transformative learning theory. This claim is followed by illustrations of three key concepts and their implications for pedagogy. This understanding of transformation acknowledges cognitive–constructivist notions and complements these concepts with a deeper understanding of the embodied and interpretive dimensions of learning-as-occupation. In doing so, this article responds to AOTA’s (2014) educational research priorities of theory building and identification of signature pedagogies.

Argument

Transformative learning is said to occur when one goes through “cognitive dissonance” and reflexively questions one’s taken-for-granted frames of reference through personal reflection and dialogue with others (Mezirow, 2003). Transformative learning has been conceptualized from a variety of perspectives, including cognitive–developmental theories, social transformation, spirituality, and neurobiology (Taylor, 2008). One ongoing critique of traditional cognitive conceptions is the lack of theorization and attention to the embodied, emotional, and relational dimensions of reflexivity (Merriam, 2004), with the need “to elaborate on the crucially important roles and relationships of affective, intuitive, and imaginative dimensions” of transformative learning (Mezirow, 2004, p. 70).

Within occupational therapy professional reasoning, attention to the experiential, embodied, imaginative, and relational dimensions of therapeutic practice has been developed through narrative phenomenology. Whereas phenomenology refers to the structure of bodily experience (Dreyfus, 1991), narrative refers to how people make sense of troubling events (Bruner, 1990). Therefore, narrative phenomenology is an approach that can focus on “the way moments of possibility and community are cultivated and cherished across formidable divides” (Mattingly, 2010, p. 39). This body of work provides a language to understand the often invisible dimensions of meaning and experience and to plot moments of “becoming” and hopeful transformation with and for others (Mattingly, 1994; Park, 2012).

From a narrative phenomenological paradigm, transformation hinges on significant experiences that call people to engage with relational and moral challenges (Mattingly, 2010). Significant experiences are profoundly lived—there is a “before” and an “after” of a particular event that matters (Jackson, 2005). These moments of suspension (verticality out of the assumed known) and liminality (at a threshold) are characterized by ambiguity, uncertainty, and perhaps even the horror of being toppled into a view—or horizon—that threatens the grounds of one’s current perspective (Crapanzano, 2004). One can either retreat from such moments or take a risk and engage in the challenge of questioning and restorying what really matters professionally and personally (Mattingly & Lawlor, 2001).

When conceptualized in this way, the cognitive activity of constructivist learning moves from the logical and rational—or in the head (Duffy & Cunningham, 2001)—to the bodily and imaginative dimensions required to transcend one’s current understanding (Boleyn, 2013). The “courage to teach” (Palmer, 2007) is the ability to create a safer space for students to be vulnerable enough to participate in transformational learning. Educators can draw on narrative phenomenological concepts to foster the possibility of significant learning experiences. These concepts highlight the story-telling nature of people’s experiences and actions (e.g., scenes, plots, possible selves) and the metaphorical meanings that can be embodied in activities.

Illustrating Three Narrative Phenomenological Concepts

Scenes and Improvisations

Melissa Park (2008) drew on the work of Kenneth Burke to describe how the scene people are in orients them toward particular narratives and actions (see Burke, 1945/1969). Thus, changing the scene can also change what stories are possible among actors. Whereas academic and clinical scenes may have a prescribed set of actions that are deemed appropriate, other symbolized or real scenes can lead to improvisational actions that leave a space for imaginative possibilities (Park, 2012). This type of contextual and interpretive creativity can also shift power dynamics and promote students’ experience of power sharing, which is central to client-centered and culturally safe practice.

While I was teaching in a new international occupational therapy program, my understanding of students’ active participation was different from their culturally framed understanding of their role. Despite articulating my student-centered philosophy with in-class activities, it was difficult to shift them from their expectation of a didactic model of teaching. I decided to change the academic scene. One morning, I led them out of the classroom to just beyond the outdoor campus cafeteria where they often spent their breaks. We sat on old stone benches underneath banyan trees that were more than 100 years old, and here we practiced occupational interviewing. Now that I had joined them in their social space, the possibilities shifted. They began joking, spontaneously took off in pairs to different parts of the garden to practice interviewing, and shared their opinions for the first time. The circular seating arrangement under the trees, alongside our snacks and coffee mugs, promoted a picnic scene where they could now engage in shared discussion and embody a different understanding of teacher–student relationships.

Plotting for Possible Selves

Occupational therapy practitioners design activities on the basis of imagining what someone might want or desire and who this person could possibly (want to) be, such that the activity experience can become integrated into and influence a person’s unfolding narrative of his or her life (Bruner, 2002; Mattingly, 1994). This process can be translated into designing in-class activities while envisioning students already as occupational therapy practitioners and colleagues as well as considering the class as only one chapter in a student’s life. An in-class experiential activity that pushes against the expected boundaries of a scene can transform (even if temporarily) a student into an occupational therapy practitioner, a leader, or a teacher.

I teach an undergraduate occupational therapy course on mental health that aims to foster a connection to professional identity. To do so, I invite graduate students taking a course on community-based occupational therapy practice to lead professional reasoning seminars in the undergraduate course. A dozen graduate students volunteer to do this activity each year. I approach them as though they are already my peers as teachers and mentors, include their feedback and comments in refining the seminars, and trust them to equitably share in the organization and facilitation of five classes with 35–40 undergraduate students. They then receive a formal university certificate acknowledging their teaching. Graduate students have shared that this experience is a significant moment for them in shifting from student to mentor, with realizations such as “I always thought of becoming a therapist, but I’m also going to be a teacher out there,” and that the mentoring experience made them “feel very valued . . . as well as appreciate the vulnerability of teaching.” In seeing senior students entrusted with mentoring and teaching, the undergraduate students reported feeling empowered and closer to becoming professionals themselves. These experiences build across-cohort community, responsibility toward one another, and the educator dimension of professional identity.

Activities as Embodied Metaphors

“Embodied metaphors are those novel associations between bodily actions and cultural symbols, where the meaning of the metaphor emerges from the actions of particular actors (often with others) during significant experiences” (Park, 2012, p. S40). Action and activity are the central tenets of the occupational therapy profession, and when conceptualized as embodied metaphors, they can be deployed within academic curricula with great creativity and transformational effects.

Park spearheaded an interdisciplinary art appreciation activity within a museum for our graduate course, focused on developing reflexivity and professional reasoning. For several of the occupational therapy students wandering the museum, this scene was unfamiliar. They stood up taller, took notes on their clipboards, and spoke in hushed tones. They sat in small groups around a piece, discussing possible interpretations of abstract paintings, figurative sculptures, classical works, or Indigenous art. They became art students and cultural critics. In this activity, they experienced the ambiguity of multiple perspectives, unpacked their assumptions about the time and culture of the artist, and tolerated uncertainty. Thus, an art appreciation activity was reflected on during the class debrief as an embodied metaphor for the complexities and multiple meanings in interpretive reasoning. One student shared,

Experiencing dissonance in class [but after the museum], I had a significant experience. I listened to a mother give a presentation about raising two children with cerebral palsy. . . . I think it can be easy to get wrapped up in developmental milestones and forget about all the strengths and dreams of the person in front of us. . . . It was just wonderful for me to sit there listening and interpreting differently . . . about how this mom found hope.

Reflections on Implications

In the literature on transformational learning, only three of the nine proposed precursor steps leading to practice changes are bodily–experiential in nature. The other six steps are focused on cognitive–rational thought processes and discussion-based learning. When empirically examining the correlation between all these steps and transformative learning in university education, Brock (2009) found that only three of the proposed steps are significantly associated with transformation, of which two are experiential in nature (Table 1). That is, the embodied and experiential dimension—although undertheorized—seems to be the most important and works well when coupled with the space and language to question one’s taken-for-granted assumptions. The three implications that draw on narrative phenomenology for a pedagogy of transformative learning are discussed in the next sections.

Table 1.

Mezirow’s 10 Steps for Transformative Learning

No.	Step Description
1.	A disorienting dilemma about actions or social rolesa,b
2.	Self-examination with feelings of guilt or shame
3.	Recognition that one’s discontent and the process of transformation are shared and that others have negotiated a similar change
4.	Exploration of options of new roles, relationships, and actions
5.	A critical assessment of assumptionsb
6.	Provisional trying of new rolesa,b
7.	Planning of a course of action
8.	Acquisition of knowledge and skills for implementing one’s plans
9.	Building of competence and self-competence in new roles and relationshipsa
10.	Outcome: Reintegration into one’s life on the basis of conditions dictated by one’s new perspective

Note. From Mezirow (1991).

^aBodily–experiential step.

^bStep is empirically correlated with transformational learning (N = 255; Brock, 2009).

Learning Objectives

A narrative phenomenological approach to transformative learning is well suited for objectives that address the cultural, implicit, and embodied aspects of therapeutic relationships (e.g., power dynamics and awareness of privilege), professional values and identity (e.g., enacting a relational ethics of care), narrative and ethical reasoning (e.g., apprehending ambiguous meanings and tolerating uncertainty), and human rights and diversity (e.g., worldviews). These objectives are facilitated by embodied–affective significant experiences that widen horizons and foster the active interrogation of one’s interpretive frames and actions (Kinsella, 2012; Mezirow, 1998).

Critical Reflection

Experience needs to be narrated and explicitly linked to conceptual understanding. This process involves teaching a language for reflection and critical dialogue that includes marginalized discourses alongside dominant ones for true reflexivity (Kincaid, 2010). Having the words to name one’s worldview, experience of transformation, and learning and reflection style is necessary to promote critical reflexivity. For example, the student who acquired the term “dissonance” was able to reflect on what needed to shift to be able to hear a mother on her own terms. Individual and shared reflective activities (e.g., automatic memos, themed journals, discussion groups, anonymous online postings, artistic expressions) are important to integrate significant experiences with explicit learning objectives.

Ethical Stance

Transformation emerges in a teaching climate that recognizes the personal challenge of this type of learning and that it might be scary to question the grounds of one’s position and worldview. The cultivation of safer classrooms is necessary for both educators and students to be open to change and has been shown to promote transformative learning across significant moments without disorientation or dissonance (Sohn et al., 2016). Educators can promote this environment by sharing their own stories of transformation, failure, or uncertainty. Stating that contradictory opinions are welcome—people can disagree with one another’s opinions without diminishing one another—can be made the norm when included in course outlines. Planning moments of slowing down during a semester—and collectively reflecting on how the classroom process, climate, and content are evolving—can also be helpful. In anonymous course feedback, students have shared that they learn to hear their peers, to “help others the way they need as opposed to how I would need,” and to “accept my own vulnerability if I expect my clients to do so.” Professional development in theories that inform inclusive and critical pedagogies is suggested for teachers (e.g., feminist, antioppressive, de/anticolonial, queer, hermeneutic). When educators model vulnerability and question their own positionality and views out loud, they allow students to identify with these values and practices.

Conclusion

Students are transformed by teaching practices that foster an embodied and critical questioning of their worldviews, of self-as-professional, and of their relational ethics of practice. Such significant experiences can be crafted using the concepts of scene, plotting possible selves, and activities as embodied metaphors. These concepts make visible the dimensions of transformation that are inherently experiential (phenomenological and activity based) and meaning oriented (narrative). This theoretical and empirically rooted approach to transformative learning for critical occupational therapy should be considered and examined as a signature pedagogy for educational practice.