Australian Occupational Therapy Journal (2008) 55, 133142

doi: 10.1111/j.1440-1630.2007.00700.x

Research Article
Blackwell Publishing Asia

The meanings of craft to an occupational therapist

Emma Harris
Occupational Therapy Department, Central Gippsland Health Service, Sale, Victoria, Australia

Aim: Craft was the first therapeutic occupation of occupational therapy. Since the early days of the profession, the value of craft in practice is a topic that has been discussed with fluctuating interest. Recent discussions by occupational therapists have reinforced that although craft is relevant to occupational therapy, there are uncertainties about its place in contemporary practice. Presently, scholars have identified that occupation is both the center of human experience and the core of our profession. Therefore, this study aimed to begin to clarify the meaning of craft to practice today by gaining a deep understanding of the meanings that one occupational therapist attributes to craft. Methods: Using narrative inquiry, data were gathered through a conversation held between the research participant and myself. A reflexive journal was also kept to support this data gathering process. Narrative analysis enabled intimate engagement with the data and the emergence of themes and sub-themes. Results: The findings, in the form of an interpretive story, suggest first, that craft-making has therapeutic value; second, that reasoning about the therapeutic use of craft is similar to reasoning about other therapeutic activities; and third, that personal experience with craft-making can influence the selection of craft as therapeutic media. Conclusions: From this study, further research into the impact personal and professional experiences can have on choice of therapeutic media and an analysis of the sociopolitical context of the meanings that occupational therapists attribute to craft-making is suggested. KEY WORDS craft, meaning, occupational therapy.

Introduction
That man [sic], through the use of his hands as they are energised by mind and will can influence the state of his own health. (Mary Reilly, 1962, p. 2)

Emma Harris BHScOT (Hons); Chief Occupational Therapist. Supervisors: Sally Denshire, Anita Barbara, and Dr Suzy Gattuso. Correspondence: Sally Denshire, School of Community Health, Charles Sturt University, Box 789, Albury, NSW 2640, Australia. Email: emma_harris04@yahoo.com.au Accepted for publication 21 February 2007. 2007 The Author Journal compilation 2007 Australian Association of Occupational Therapists

The therapeutic use of occupation by occupational therapists is being affirmed and re-evaluated (Whiteford, Townsend & Hocking, 2000). Occupation refers to the activities that comprise our life experience (Larson, Wood & Clark, 2003, p. 16) and therefore occupy peoples time and give meaning to their life (Neidstadt & Crepeau, 1998, p. 5). This modern understanding of occupation can be expanded by remembering Mary Reillys classic hypothesis. Thus occupation, or doing with the hands, can be seen as an integral part of experiencing a meaningful life. Craft was the first occupation used as a therapeutic tool by occupational therapists (Breines, 1995). It is defined in the Oxford English Dictionary as ... A branch of skilled work ... An art ... requiring special skill and knowledge; esp. a manual art ... (Simpson & Weiner, 1989, p. 1104). In the early days of the profession, crafts such as basket weaving and woodwork were believed to have a curative effect on people with mental health problems because of their goal-directed nature (Levine, 1987). When occupational therapists began working in physical rehabilitation, crafts were used to improve function (Breines) through the biomechanical challenges craft-making presented (Bissell & Mailloux, 1981). However, in the middle of the twentieth century, the philosophy of health care shifted towards a reductionist view of people based on the medical model (Anderson & Bell, 1988; Schemm, 1994). This created the need for occupational therapists to validate their practice within the health-care profession, resulting in a division among occupational therapists regarding the use of craft as a therapeutic tool. Thus, the place of craft within occupational therapy practice has been discussed over and over with fluctuating interest over time. Recent discussions (Holder, 2001; Perrin, 2001; Stancliff, 1996) including ambivalence about art and craft as useful modalities, and therapists possible feelings of unease about using them because of their low technological status, suggest this topic is once

134 again an area of interest. A lack of research remains, however, into the underlying reasons as to why craft is or is not used by occupational therapists. This gap in the literature gives rise to the question, What meanings do occupational therapists attribute to craft? Research answering this question would contribute to our understanding of the place of craft in contemporary practice. Thus, the purpose of this study was to develop an indepth understanding and knowledge of the meanings that one occupational therapist attributes to craft-making. This research was undertaken as a requirement of an Honours Degree in Occupational Therapy at Charles Sturt University in 2003.

E. HARRIS

Craft in contemporary occupational therapy

Various occupational therapy text books and journal articles discuss the historical use of craft by occupational therapists as therapeutic media (e.g. Bissell & Mailloux, 1981; Breines, 1995; Thompson & Blair, 1998). Modern studies show that some occupational therapists still use craft therapeutically (Craik, Chacksfield & Richards, 1998; McEneany, McKenna & Summerville, 2002), although stigma and uncertainty about craft use have been identified (Bissell & Mailloux; Williams, Harrison, Newell & Holt, 1987). Occupational therapists beliefs about the values of craft have been challenged in a recent discussion paper by Holder (2001) and in an opinion piece by Perrin (2001). These authors gave their personal views on the worth and importance of craft as a therapeutic tool, referring to supporting literature and their personal experiences with craft-making. An active response from the readership of the British Journal of Occupational Therapy indicates craft is still of interest to occupational therapists today, and it is interesting to note that many respondents expressed gratitude to these authors for articulating the value of craft and creative activities for human beings and our professional practice (Cracknell, 2001; Martin, 2001; Pool, 2001; Stead, 2001). A recent study by McEneany et al. (2002) was the only research article located that identified craft use in contemporary Australian occupational therapy practice. An aim of this study was to explore the treatment media used by occupational therapists in adult physical practice (p. 117). The authors found that less than 5% of therapists surveyed used craft activities often or mostly as their choice of media for therapeutic intervention, suggesting that a minority of Australian occupational therapists in adult physical settings choose craft as therapeutic media. International studies indicate that occupational therapists working in mental health settings use craft more often as a therapeutic tool when compared to therapists working in physical rehabilitation settings (Eliason & Gohl-Giese, 1979; Taylor & Manguno, 1991). No studies on craft use by Australian occupational therapists working in mental health could be found.

Mee and Sumsion (2001) have explored the personal meaning and value attributed to occupation by clients of two mental health settings: a drop-in centre offering unstructured leisure activities, and a workshop offering woodwork (a type of craft). Data were gathered through participant observation, talking with clients, and indepth interviewing. Findings suggest that occupational engagement has an important role in generating motivation, building competence, and developing self-identity. However, as the findings from both settings were discussed together, it is difficult to determine whether engagement in specific, structured craft activities (i.e. woodwork) produced different meanings from engagement in a range of less structured pastimes. From the limited research available and recent comments from occupational therapists, it appears that, although some therapists continue to use craft, we have not been able to clearly identify through research the underlying meanings craft holds for us as therapists. Such findings would contribute to understanding why craft is, or is not, used in occupational therapy practice today.

Aim of the study

Thus, the aim of my study is to address this gap in our research by developing an in-depth understanding and knowledge of the subjective meanings that one occupational therapist attributes to craft.

Research questions
1 2 3 What meanings does an occupational therapist attribute to craft? What shapes these meanings, including the therapists own experiences of craft-making? In what ways do these meanings influence an occupational therapists reasoning about the therapeutic use of craft in practice?

Research method and process

My study was situated in the interpretive paradigm guided by the phenomenological approach (Taylor, 2000). Narrative inquiry was the chosen research method as it is well suited to studies of subjectivity and identity (Riessman, 1993). Narrative processes have temporal and interpretive scope, in that narrativisation tells not only about past actions but how individuals understand those actions, that is, meaning (Riessman, p. 19). Therefore narrative inquiry was chosen because it was congruent with the aim of this study to develop a deep understanding and knowledge of the subjective meanings that an occupational therapist attributes to craft.

The research participant

As the purpose of sampling in qualitative research is to select the most appropriate group or situation for the phenomenon that we wish to study (Llewellyn, Sullivan & Minichiello, 1999, p. 174), purposive sampling (Patton, 1990) was used to select the research participant.

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135 while telling his story, allowing for intense and phenomenological exploration (Taylor, 2000) as Joseph contemplated the meanings of craft within the context of his specific craft-making experiences. The conversation finished when it came to a natural ending. The conversation was tape-recorded and no notes were taken to give the researcher greater freedom to participate in the conversation (Clandinin & Connelly, 2000). The conversation was held in a place nominated by Joseph that allowed privacy to be maintained throughout its duration.

Although, I acknowledge that having several research participants may have allowed for greater understanding of the phenomenon, logistical constraints prevented this from occurring. To participate in the research the occupational therapist had to (i) be trained and qualified in occupational therapy, (ii) identify as an occupational therapist, (iii) use, or have used craft in practice, (iv) promote craft in practice, and (v) name craft-making as a therapeutic modality. Four occupational therapists were contacted by phone as possible participants for the study. The research participant chosen, a male therapist who is Anglo-Saxon and 42 years old was located using professional contacts. It may be argued that his gender and postgraduate qualifications make him a special case rather than typical of a profession that is predominantly women. Nevertheless, he met the five selection criteria and chose to be named as Joseph in this study. Joseph has a Bachelor of Applied Science (Occupational Therapy) and a Masters of Arts (Creative Arts). Therefore, purposive sampling allowed the research participant chosen to be an experienced expert and authority on the particular experience or phenomenon (Patton, 1990), which in this study, is craft-making. He has worked in physical and mental health settings and his position at the time of this research was as an occupational therapist at a metropolitan inpatient mental health service.

Reflexive journal
The journal kept was an adapted version of the reflexive journal proposed by Laliberte-Rudman and Moll (2002) and comprised of three sections: theoretical notes, methods log and field log.

Layers of data analysis

Data analysis was a collaborative process between my principal supervisor and myself, with some input from the research participant. Layers of narrative analysis accrued from the beginning of the conversation, through the transcription process, and during storying and re-storying of the transcript. This analysis culminated in the identification of narrative themes and subthemes, presented in this study as an interpreted story (Goodfellow, 1997). My steps for narrative analysis (Table 1) were influenced by Emden (1998, p. 35) and the methods of Molineux and Rickard (2003) of narrative analysis.

Processes of data gathering

This approach involved gathering data in the form of a conversation (Clandinin & Connelly, 2000) held between the research participant and myself. As discussed by Fontana and Frey (2000), the conversation was an active interaction between the research participant and myself, creating a negotiated, contextually based outcome. A reflexive journal was also kept to increase the rigour and trustworthiness of the study.

Ethical considerations and trustworthiness

Several measures were taken to ensure confidentiality during all stages of data gathering, data analysis and reporting. This included attaining Ethics Committee approval from Charles Sturt University, obtaining informed consent from the research participant and storing all research data securely in a filing cabinet or on an electronic database that could only be accessed by my principal supervisor and myself. Providing deep and co-constructed descriptions and interpretations of the meanings and experiences described by the research participant helped to ensure credibility of the findings. The accuracy of these descriptions was enhanced through member-checking (Krefting, 1991; Lincoln & Guba, 1985) of the smoothed transcript and peer review received from my supervisors during data analysis. Finally, the reflexive journal provided an audit trail that can be followed by others (Krefting; Lincoln & Guba) and contributed to the depth of data analysis reached.

Conversation
Conversation involves the research participants telling of his or her experiences in story form, allowing sensemaking of the experiences spoken about to occur (Goodfellow, 1997) as the meanings of the experiences are made manifest, discovered or created, and communicated (Reason & Hawkins, 1998). For this study, conversation allowed Josephs personal and professional experiences of craft-making to surface while uncovering the meanings that craft held for him, and how these meanings related to his use of craft as an occupational therapist. An interview guide was used to provide a loose structure (Grbich, 1999) for the conversation. However, most of the key areas identified came up naturally. To encourage the story-telling process, Joseph was asked to bring one or more craft artefacts with him that he or a client had made and which held personal meaning, and to tell their story. This story-telling process was strengthened by Joseph holding the artefacts in his hands

Accounting for subjectivity

Goodfellow (1997, p. 63) states that we bring our own contextual knowledge and personal experiences to the interpretative process. Thus, to enhance the trustworthiness of the research, I felt it was important to

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TABLE 1: Steps for narrative analysis

E. HARRIS

1. Reading the full transcript several times over several weeks and reading my reflexive journal. 2. Identifying preliminary subthemes from key ideas within the text. 3. Omitting words such as well, um, hmmm that did not contribute to the key idea of the sentence or group of sentences spoken by the research participant to produce a smoothed text. 4. Returning the smoothed text to the research participant for validation, and making changes to the text as requested. 5. Omitting all questions and reflections spoken by the researcher that did not contribute to the key ideas expressed by the research participant. 6. Revising preliminary subthemes within the smoothed and validated text. 7. Choosing key experiences that meaningfully highlighted the subthemes. 8. Synthesising the text relating to each subtheme. 9. Combining subthemes to create narrative themes (intrinsic and extrinsic influences). 10. Storying and re-storying of the data by re-reading the interpreted story for sense, and to ensure that all key ideas are retained within each narrative theme, returning to the full transcript as often as necessary for re-checking. 11. Writing a final interpretive story.

acknowledge from the outset the meanings that I attribute to craft. The following is an excerpt adapted from my reflexive journal 20022003:
For me, craft-making creates a space where I can breathe, express my emotions and thoughts, be creative and re-connect with self. It creates a space for me to be while doing. When making craft with others, opportunities for shared experiences and learning about one another take place. The end product is an artefact that you can see, touch, and sometimes smell. It can be a reminder of seemingly small yet important achievements, and can help transport you back to the place and time when you made it, allowing you to reconnect with the feelings that emerged while engaging in the process of making.

TABLE 2:

Narrative themes and subthemes

Intrinsic influences on the meanings of craft to an occupational therapist The value of craft-making Reasoning about craft in practice The confluence of personal and professional experience Extrinsic influences on the meanings of craft to an occupational therapist De-institutionalisation of occupational therapy workplaces Time restraints in acute settings Lack of research evidence for using craft in occupational therapy

Findings
Findings emerged from within the data in the form of one main narrative theme, and one minor narrative theme, each consisting of three subthemes (see Table 2). This paper reports and discusses the main narrative theme, intrinsic influences. Discussion of the minor theme, extrinsic influences, is not included in this paper. This is because although Joseph acknowledged that these influences are present within his experience of using craft therapeutically, they did not strongly influence the meanings he attributed to craft-making. Before beginning the story, it is important to clarify Josephs understanding of the definitions of craft and art as occurring as a continuum. At the craft end of the continuum, set steps are followed and choices are limited if you want to achieve an anticipated outcome. At the art end of the continuum, although you might have an idea about what you want to create, you dont go in with a preordained plan. According to Joseph, in art there has to be an expressive component, something about bringing the inner experience out and not just making things.

The boundary between whether a finished product is craft or art becomes blurred when the creation of the artefact involves aspects of both craft- and art-making. As Joseph uses creative activities that can fall at different points along the continuum, some meanings that may be related to art are also included in the interpreted story that follows.

Doing with the hands: The value of craft as occupation

Josephs personal experiences of craft-making have given him a knowledge and understanding of the feelings of satisfaction that can be gained from making craft. Joseph told the story of some weaving that he did while at a family property. The satisfaction that he gained from this experience was beautifully demonstrated to me in the way Joseph gently considered his weaving by feeling it, turning it over with his hands, and studying it with his eyes. He was reconnecting with the weaving and the experience of making it, suggesting that the satisfaction from making a product can be abiding and long lasting ... because usually the thing is there for a long time.

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137 this! Look at what Im doing! It can also be seen in his clients behaviour, such as reverently put[ting] it somewhere to dry so people dont disturb it, and wanting to own it and take it with them. Except for the very unwell person, Joseph also sees that craft-making has a really crucial role to play in their self esteem, and that sometimes craft has a role in helping people become well. That is, engaging in creative making can run in parallel with the clients recovery. Sometimes the recovery is enabling the person to be engaged with art or craft or, sometimes as Ive said to them [the team], art and craft may be leading recovery. Its not that frequent, but I think you can make a plausible argument that its making a real difference, its whats helping the people move forward. In this way Joseph believes that engagement in creative making can be health promoting. Through these experiences and Josephs personal experiences of craft-making, Joseph is confident to tell clients that it is worth trying this [activity] because you could get this wonderful sense of achievement and satisfaction and ... you might feel better about yourself. He has also witnessed how qualities of satisfaction, selfesteem and sense of efficacy ... [can] ... generalise across all the different craft forms. He knows this happens from personal experience and ... from observing and asking patients about their experiences. Joseph identifies the confluence between his personality and the appeal of occupational therapy. That is, he sees himself as someone who dabbled and was proficient in a number of things, and in occupational therapy, you were never a specialist in one thing and there was a broad range of people stuff ... doing with your hands and ... thinking involved. A similar dynamic is also apparent in his choice of media when working with clients. Here, Joseph has always been drawn to that kind of thing [making and doing] and has always tried to offer it [creative activities] as part of my practice as an OT. Most of the craft and art activities he suggests to clients are also ones that he is proficient in, demonstrating the influence his experience, knowledge and skills with particular activities have on his practice as an occupational therapist. This confluence was apparent in a positive craftmaking experience that Joseph shared. Joseph was thinking of some new activities to do and came up with the idea of weaving, based on his knowledge that you could weave with naturally found garden fibres. He invited someone to look at the plants available at the setting he was working in and she found there were some wonderful plants for weaving. Then she sat down under a tree, and there were some Aboriginal men there and one said, My grandma used to do this, and ... they got in, and did some really simple stuff, like plaiting. He found that working with the natural fibres really excited the Aboriginal people and found the experience really great to see how wonderful it was for the clients who participated.

Joseph has also seen this satisfaction with clients. Some students and a group of clients made some friendship (wrist) bands. The patients loved it! It was something they could make and then they had it to wear. This tangible nature of craft, of being able to make it with your hands, to display it, and to keep it can serve as a memento of efficacy for the maker. It can also give people something to take away and say Look, I did that and I made that . In this way, it can create a meaningful experience for the person where they can feel special about being able to make something. Making craft artefacts can also give people hope. Joseph sees this in the creation of origami, which has a fragile beauty about it, and just something that might serve the purpose of reminding them of hope. This creation of hope is important because many of the people at the inpatient unit are despairing when they are in here, and making something pretty, and nice, and delicate, contrasts with this despair and other aspects of their life that may not be very pleasant. Thus, creating artefacts can give a little door of openness where a person can go and be a person, and by being able to say this is something I have made, making something can be a way of saying, Im here . Joseph also sees that craft and art have a role in maintaining people, that they sort of hold people together a bit. He talked about a man who was very thought disordered and a bit harassable, a bit bad tempered sometimes. But he would go down and draw a lot ... and he felt good about his drawing and you could talk to him about his drawing ... My sense was that when he didnt have the art work he became more irritable and ... I just think it had a positive effect on him. This experience illustrates the importance of expression and exploration as aspects of the art-making process. At the craft end of the continuum, Joseph experiences the process of craft-making as a cycle with a start, middle and end. By providing a concrete activity thats continually moving forward, the person knows what they are doing, what they are going to do next, and what they will have at the end when the cycle is complete. This process can help focus the thoughts through its prescribing nature. Joseph also describes that when making craft, people progress through a cycle of emotions from uncertainty and how am I going to create this thing? to satisfaction, pride and a sense of efficacy by the end. Some people do, however, get stuck at the first stage of this cycle and dont continue in the craft-making process. But others jump into it. Through engagement, the process begins to make more sense as the person starts to see his or her progress and meet the challenges that the making process presents. Hopefully, the person gets through to the end, resulting in the creation of a finished artefact. Clients relate the sense of efficacy and satisfaction created through this act of doing and producing with the hands to Joseph in the comments people make, such as Oh, I can do this! and ... this is great! Have a look at

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138 Joseph expressed some negative experiences of craftmaking in terms of clients making something and not keeping it, not finishing things or not being interested. Often this is because the activity is too hard or not quite right, so the person leaves the activity and does not get that experience of successfully finishing it. It may also be because that the client is not genuinely into it or doesnt value craft in the same way. To motivate people to do craft, Joseph also recognises the importance of good craft examples, like a nice, beautiful, simple basket or weaving that someone has done so that people can be inspired to say yeah, wed like to do that. Consistent with Josephs knowledge that his skills, knowledge and abilities with different crafts impact on his clients choice of activity is the need for Joseph to maintain his skills in these areas. He sees this as important if he is to continue to enable others to do by presenting them with tools and opportunities to assist them to become proficient in the activity. However, if clients were interested in crafts that Joseph is not proficient in, he would still encourage them to try such crafts. This is because Joseph tends to pretty much go with what people express as an interest with craft. This interest may be informed by prior knowledge of the clients interests, through a team member informing him, through observing the clients doing, or through Joseph sitting with the client and exploring their interests with them. Other times he uses deduction to help him decide what to offer, looking at a persons age, culture, work history and the problem craft may assist a person with. For example, Joseph may decide to try clay with someone who experiences thought disorder, and show him or her how to make a coil pot that might help decrease some of the symptoms of his or her disorder by focussing his or her thoughts on a concrete activity that is continually moving forward. Joseph also considers what is interesting, not boring ... [or] ... daggy, whats in at the time. Because of the lack of evidence-based practice for occupational therapists working in psychiatric settings, deciding on what craft modality to offer is a process of making hypotheses and testing them. Joseph uses his knowledge of the client, common sense, instinct, or his implicit sense that picks up on ... what would be useful to do, together with trial and error to help guide his decisions. Previous experiences and the experiences of his occupational therapy peers, and nursing peers complement this approach. In Josephs experience, there are some crude distinctions between using craft in physical when compared to psychiatric settings. In physical settings, there is a mechanical, physical objective for doing the activity. There is also a mechanicalised [sic] extension into the cognitive level that is, goals could also include increasing spatial awareness, concentration or sequencing tasks. In psychiatric settings, you can also be clear about the reasons you offer craft. Some goals may be similar to those in physical settings, such as to focus concentra-

E. HARRIS

tion. The difference is that other goals might be to help people understand they have skills and talents, and to help them identify that they can do. In addition, art in psychiatric settings can be used as a tool for connection and exploration, and can help people to reframe their thoughts and beliefs about themselves or the world. Joseph sees that each modality can register a different quality of recovery such as more organised thinking and more reliable expression of feeling states, or more able to accept negative feeling states. Art helps us develop insight into feeling states broadly speaking while craft operates more in the domain of cognition, motivation, [and] self-esteem. In this way, Joseph sees that although craft is not used as often as other forms of intervention, craft could be potentially as good a barometer of progress as some of those other practical things [interventions]. He also thinks that craft and art are equally valid and equally easy to discern change and progress because it is out there in front of you. Overall, craft and art are important parts of Josephs practice as an occupational therapist in his current setting. Although he could fill his days without including craft and art, he does not think he would be allowed to because people would be bored and ... needing to focus. If no creative activities were offered by the occupational therapist, Joseph thinks there would be people out there finding stones and scratching pictures on the bricks! Joseph sees this as an innate need thats occurring the need to use the hands and be active. Joseph feels that mental health settings will always call out for creative outlets, and that craft is essential to mental health practice and always will be because the need arises from the population. That is, Joseph sees that its a very human need to make and create, to express. [For] some of these people [the clients] ... the experience of being unwell has made them very present or real ... and so they do respond to that need, that instinct quite strongly. He also believes that craft has always been a part of treatment in mental health as people have always needed to do things with their hands when recovering from mental illness, possibly because people always need to do things with their hands no matter where they are. Towards the end of the conversation, I asked Joseph to summarise the meanings he attributed to craft from any perspective that we had discussed that afternoon. The following is what he said.
To me it [craft] is of value because it is something essentially human and grounding and connecting to tradition for people. There are fundamental needs for people with mental illness, like connectedness, centredness, groundedness, and I think the craft creates, encourages and affirms that. So its those qualities. First, the most powerful qualities [are] when its working well, that craft has got that you dont from medicine, you dont get from counselling.

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139 The finding that engaging in craft-making has a health-enhancing role is also consistent with Holders (2001) craft-making experience. She wrote by doing with my hands, I was influencing the state of my own health; after starting the [lead-lighting] session feeling that I no longer had the capacity to cope with the difficulties I was experiencing, I finished feeling refreshed in body and mind, ready to resume my normal occupations (p. 105). Clients in the study by Mee and Sumsion (2001) also identified the physical and mental benefits of working with their hands. In this way, the therapeutic and holistic use of craft can be clearly identified, and therefore justified as a medium that could provide an avenue for achieving goals that are client centred and occupation based. Thinking more broadly about the scope of craft-making, the challenge and mastery involved are grounded in an understanding of crafts as organised activities (Barris, Cordero & Christiansen, 1986) that require an intimate engagement with materials used (Velde, 1999). In this way they place kinaesthetic, sensory and aesthetic demands on the creator, and require focus and the manipulation of time according to the type of craft being created (Velde). Gaining a sense of purpose, experiencing achievement and acquiring skills were some of the benefits clients described from engaging in woodwork projects (Mee & Sumsion, 2001). This study has identified with many of the benefits of craft-making described in the literature, suggesting that the therapeutic nature of craft is diverse.

Theres an earthy quality about it its concrete, tactile. You can touch it and feel it, theres a sense of permanence. I think theres a need to do that and thats about becoming fulfilled as a human being and links to being able to be engaged in something creative, an activity well, with craft.

Discussion
The value of craft
Using craft therapeutically with clients creates a variety of opportunities for different client-centred goals to be achieved. That is, craft-making allows clients to do in a way that can be both purposeful and meaningful to the client. This finding is consistent with the literature that suggests that crafts have a variety of meanings for many people, from creating a role for the person as a craftmaker, to enabling people to leave tangible pieces of themselves through their work, and allowing people to exercise control in their lives (Velde, 1999). If this understanding of what craft-making can offer people is considered in more depth, we see that as human beings, we have an innate need to make and create. Thompson and Blair (1998, p. 54) discuss how humans are continually trying to heal the divide between their inner world and their external reality and that this tension impels humans to engage in imaginative and creative processes ... that can for brief moments, give us a sense of balance and our deepest consolations and greatest glories. This phenomenon was described by Joseph several times during the conversation, and he highlighted that craft-making can be a means of providing a sense of hope and efficacy. Holder (2001), an occupational therapist, also identifies with this symbolism of craft artefacts providing a sense of efficacy. In her experience of craft-making, she stated that my stained glass window will represent the time when I overcame the most trying of circumstances to achieve my goals (p. 105). Craft as a symbol of hope, and a way of saying Im here has been described as symbolic and indirect messages that are integrated into the process and actions used to create crafts (Velde, 1999). Thus, the tangible nature of craft provides an avenue for creating a sense of permanence and achievement during the craft-making process, as well as a reminder of these feeling states as a tangible end-product. It is important to acknowledge that when discussing the value of craft, Joseph mostly drew on experiences he had working with a client who experienced mental ill health. He suggested that the experience of being unwell can amplify this need for people to make and create and be active, and in terms of providing his clients with a creative outlet and as a way to prevent boredom. The significance of occupying time to avoid boredom was also found by Mee and Sumsion (2001), and in this way craft- and art-making can be seen as health enhancing and have a role in maintaining people.

Therapeutic reasoning about craft

As occupational therapists, our choice of intervention is guided by a range of factors including our clients occupational needs, interests, abilities and values. It can also be influenced by our knowledge and skill base. Therefore, our decision to offer craft as a therapeutic activity may be influenced by our knowledge of what craft can offer our clients (that is, what goals engaging in craft-making can achieve), as well as our own skills in being able to guide our clients through the craft-making experience. Josephs therapeutic reasoning regarding the type of craft/s he will offer is consistent with reasoning detailed in the literature. For Joseph, it is based on the clients previous or current interest in a craft, or deduction is used to decide which craft may be appropriate to address some of the symptoms of the persons disorder from an occupational perspective. This process is carried out with the persons age, culture and occupational history in mind. Such reasons are supported by Stead (2001) and by Estelle Breines, a recognised authority on the therapeutic use of crafts, who when asked why she continues to use arts and crafts during treatment, commented that if craft motivated clients and they found craft interesting, then she provided therapeutic opportunities for these clients to participate in craft-making (Stancliff, 1996, p. 51).

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140 However, several occupational therapists have pointed out that craft-making is not suitable for all clients. As with all activities, it has been proposed that when using craft therapeutically it is important that the craft is meaningful to the client (Finlay, 1997; Holder, 2001; Mayers, 1990), appropriately addresses the clients interests, values, and beliefs (Breines, 1995) and meets social and/or cultural needs (Fidler & Fidler, 1978). Currently, our profession endorses both a holistic view of the person and a client-centred practice. Joseph discussed how in his experience, therapists working in physical settings predominantly use craft to achieve physical and cognitive goals, and in psychiatric settings, craft is mostly used to achieve psychosocial goals. Other studies support these findings also (see Bissell & Mailloux, 1981; Williams et al., 1987). Although my study did not address the relationship between practice settings and goals of therapeutic occupations in the context of these current practice views, it is interesting that the settings in which therapists work seem to determine the therapeutic goals of occupation, such as craft. Perhaps by focussing instead on the experience of occupations for clients, we could demonstrate our recognition of simultaneous goal achievement in physical, cognitive and psychosocial areas when engaging in meaningful occupation.

E. HARRIS

Overall, literature suggests that some experience in craft-making is integral to occupational therapists choosing to use craft as a therapeutic modality. This experience not only provides therapists with the skills to perform in craft-making and therefore assist clients to engage in the process but also gives the therapist opportunities to experience the potential benefits that making craft can have for a person.

Scope and limitations of the study

The main limitations lie in the nature of interpretation. It is never possible for all interpretations to be made (Goodfellow, 1997), and it is acknowledged that not everything about the narrative can be understood (Stake, 2000). The participants feedback regarding the final interpreted story would have strengthened the findings. Unfortunately, this was not possible because of time constraints. Transferability of findings relates to generalising the findings about the subject of the research (Krefting, 1991). I anticipate that through disseminating these findings, therapists who read the study will have the opportunity to identify with some of the meanings the research participant attributes to craft, locate these meanings within their own contexts, and use the findings as a stimulus to re-evaluate their own attributed meanings.

The confluence of personal and professional experience

The therapists personal experience of craft-making was found to be another important factor when deciding whether to use craft therapeutically with clients. For Joseph, this connection strongly influences the meanings he attributes to craft. This interplay and flow between personal and professional experiences and meanings is a phenomenon Denshire (2002) has called personal professional confluence (p. 213). Holder (2001) also found that through the process of making in her stainedglass window-making course, she developed an appreciation for the full potential and value of creative therapy. This influence was so strong that she stated, as a result of this experience, I am determined to incorporate creative activities into my own practice (p. 105). Her resolve resonates with the confidence Joseph has in promoting craft-making to clients because of the benefits he has personally experienced. Consistent with the findings in this study also is that therapists who use craft therapeutically are more likely to have had previous experience with the particular crafts they use (Barris et al., 1986; McEneany et al., 2002). For Joseph, he acknowledged that he would still encourage clients to pursue crafts that he is not proficient in, but understands that his preferences do influence the crafts he offers to clients. As a therapist who enables people to do, Joseph recognises the importance of providing clients with the tools needed to participate in craft-making. In this way, Joseph feels that occupational therapists need to maintain their skills in the media they use with clients.

Conclusions and recommendations

This qualitative study makes a valuable contribution to the professions literature through Josephs discussions about the value and meanings of craft-making for himself, his clients, and human beings generally. Through narrative methods, my study has demonstrated the depth and richness of the meanings that one occupational therapist attributes to craft-making. The main findings reported in this paper were that first, craft-making is of therapeutic value; second, that reasoning about the therapeutic use of craft is similar to reasoning about other activities; and third, that personal and professional experiences can impact on the selection of craft as therapeutic media. Within these findings is the notion that craft-making is an important occupation to human beings because of our innate need to be creative and to make and to do. Therefore, Josephs understanding of the need for people to make with their hands affirms Mary Reillys (1962) hypothesis and reinforces our professions theoretical base that values occupation as being central to human life and occupational therapy. The finding that professional and personal experiences have an important role in forming one occupational therapists attributed meaning of craft may have possible implications for other occupational therapists. This finding invites therapists to reflect on their own practice, as Joseph did, on the media they use, why they use them, and what meanings media hold for them in personal and professional life spaces.

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Eliason, M. L. & Gohl-Giese, A. (1979). A question of professional boundaries: Implications for educational programs. American Journal of Occupational Therapy, 33, 175 179. Emden, C. (1998). Conducting a narrative analysis. Collegian, 5, 34 39. Fidler, G. S. & Fidler, J. W. (1978). Doing and becoming: Purposeful action and self actualization. American Journal of Occupational Therapy, 32, 305 310. Finlay, L. (1997). The practice of psychosocial occupational therapy (2nd ed.). Cheltenham, England: Stanley Thornes. Fontana, A. & Frey, J. H. (2000). The interview: From structured questions to negotiated text. In: N. K. Denzin & Y. S. Lincoln (Eds.). Handbook of qualitative research (pp. 645 672). Thousand Oaks, CA: Sage. Goodfellow, J. (1997). Narrative inquiry: Musings, methodology and merits. In: J. Higgs (Ed.). Qualitative research: Discourse on methodologies (pp. 6174). Sydney: Hampden Press. Grbich, C. (1999). Qualitative research in health: An introduction. Thousand Oaks, CA: Sage. Holder, V. (2001). The use of creative activities within occupational therapy (Letter). British Journal of Occupational Therapy, 64, 103105. Krefting, L. (1991). Rigor in qualitative research: The assessment of trustworthiness. American Journal of Occupational Therapy, 45, 214 222. Laliberte-Rudman, D. & Moll, S. (2002). In-depth interviewing. In: J. V. Cook (Ed.). Qualitative research in occupational therapy (pp. 24 57). Albany, NY: Delmar. Larson, E., Wood, W. & Clark, F. (2003). Occupational science: Building the science and practice of occupation through an academic discipline. In: E. D. Crepeau, E. S. Cohn & B. A. B. Scholl (Eds.). Willard and Spackmans occupational therapy (10th ed., pp. 15 26). Philadelphia, PA: Lippincott. Levine, R. E. (1987). Looking back: The influence of the arts and crafts movement on the professional status of occupational therapy. American Journal of Occupational Therapy, 41, 248 254. Lincoln, Y. S. & Guba, E. G. (1985). Naturalistic inquiry. Newbury Park, CA: Sage. Llewellyn, G., Sullivan, G. & Minichiello, V. (1999). Sampling in qualitative research. In: V. Minichiello, G. Sullivan, K. Greenwood & R. Axford (Eds.). Handbook for research methods in health sciences (pp. 173 199). Frenchs Forest, Sydney: Addison-Wesley. Martin, M. (2001). Channeling our creative energy into our profession. British Journal of Occupational Therapy, 64, 206. Mayers, C. A. (1990). A philosophy unique to occupational therapy. British Journal of Occupational Therapy, 53, 379 380. McEneany, J., McKenna, K. & Summerville, P. (2002). Australian occupational therapists working in adult physical dysfunction settings: What media do they use? Australian Occupational Therapy Journal, 49, 115 127. Mee, J. & Sumsion, T. (2001). Mental health clients confirm the motivating power of occupation. British Journal of Occupational Therapy, 64, 121128. Molineux, M. & Rickard, W. (2003). Storied approaches to understanding occupation. Journal of Occupational Science, 10, 52 60.

Recommendations for future research include further inquiry into the impact personal and professional experiences have on an occupational therapists choice of media. An analysis of the socio-political context of the meanings that occupational therapists attribute to craftmaking is also suggested. Relevant topics for investigation include the de-institutionalisation of occupational therapy workplaces, time restraints in acute settings and lack of research evidence for using craft in occupational therapy. As occupational therapy is a profession predominantly of women, narrative research with both new graduate and more experienced female therapists concerning the meanings that they attribute to craft would enable the meanings of craft to our profession to be further understood. Research on the use of craft in mental health settings, a study of curriculum implications for craft, and a study to determine whether Australian occupational therapists feel that there is stigma associated with using craft therapeutically would inform the existing literature. Finally, this study affirms the value of craft as a valuable therapeutic medium that may be suitable to use with some of our clients to achieve a number of personcentred goals. With these findings in mind, we would invite therapists to re-consider craft as part of our range of therapeutic media, and to experience the craftmaking process for yourselves.

Acknowledgments
I wish to thank my supervisors, Sally Denshire, Anita Barbara and Dr Suzy Gattuso, for their support and valuable contributions during this research process. I especially wish to acknowledge Sally who has mentored me through this research, from its conception through to its published form.

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