Community Paper

Reflections on Transformation through Occupation: An occupational therapy textbook co-edited by Swartz

Eve M. Duncan

Received: 18 Feb. 2025; Accepted: 23 May 2025; Published: 30 Nov. 2025

Copyright: © 2025. The Author Licensee: AOSIS.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction

Published in 2004, Transformation through Occupation is an occupational therapy textbook co-edited by the late Ruth Watson and Leslie Swartz that positioned occupational therapists as contributors to social change in post-Apartheid South Africa. Occupation, or the ordinary and extraordinary things that people do every day, is central to the way we live our lives – what we are, who we become and how we achieve our dreams and aspirations. (Watson 2004:3)

Although the nature of occupation has long been the subject of study and practice by the profession in developed countries, there were few textbooks at that time by occupational therapists working in developing countries. The text challenged readers to envisage community-orientated, occupation-based practices beyond conventional individual therapeutic interventions in clinical settings. This article captures the reflections of chapter authors on writing the textbook and its impact on scholarship. In so doing, it acknowledges the visionary role of Swartz as a co-editor in publishing a ‘gift to the profession of occupational therapy’, as it was described by Betty R. Hasselkus, emeritus professor, University of Wisconsin-Madison, USA, in the foreword (Watson & Swartz 2004:xiv).

Disability studies and occupational therapy theory share conceptual synergies in recognising that issues of importance to people with disabilities are not typically medically-oriented, but rather socially- and environmentally-orientated (Harrison et al. 2021; Sheth et al. 2021). Conceptual synergies also exist with the discipline of occupational science that promotes investigation of the nature of occupation, how people occupy their time and how occupation affects health and well-being (Christiansen & Townsend 2010; Yerxa 2009). Working for broader social change, occupational therapists and occupational scientists integrate disability studies into education, research, and practice by prioritising people’s lived experiences, applying critical approaches, and using occupation-based participatory methodologies (Harrison et al. 2021; Sheth et al. 2021).

Occupational therapy has historically been linked to individual rehabilitation and the medical model of disability because of its focus on the therapeutic use of activities to effect a remedy for a person’s inability to do things because of illness or injury (Kielhofner 2005). The profession has also been linked to community development and the social model of disability because of its focus on promoting occupational justice in groups, communities and populations that experience disempowerment, exclusion, and barriers to participation (Booi, Dabula & Duncan 2024; Watson & Swartz 2004). Occupational justice focuses on the inherent right of humans to participate in occupations, construed as their personally meaningful and goal-directed use of time (Stadnyk, Townsend & Wilcock 2010). Occupational injustice occurs when a person or a group of people including those with disability is denied, excluded from or deprived of opportunity to pursue meaningful occupations or when unchosen occupations are imposed upon them (Hocking 2017; Stadnyk et al. 2010). Viewing humans as occupational beings foregrounds the shared concern of disability studies, occupational therapy and occupational science with disability as a human rights and development issue (Harrison et al. 2021). Occupation-based approaches for social inclusion are being used to promote community development and redress occupational injustice (Van Bruggen, Kantartzis & Pollard 2020; Sakellariou & Pollard 2016).

Background

In the early 2000s, Professor Ruth Watson, then head of the Division of Occupational Therapy at the University of Cape Town (UCT) invited Professor Leslie Swartz to support the occupational therapy team of clinicians, academics and researchers during a leadership transition. The outcome of the invitation was a textbook that documented the team’s occupation-centred research and practice in the post-Apartheid South African context. Applying disability theory, occupational science concepts and occupational therapy interventions in a series of case studies the authors described how a socially transformative niche for the profession may be realised. Hasselkus, an international occupational therapy scholar, described the textbook as:

[A] seamless text in which the authors speak in a unified voice as they tell the story of occupational therapy and South Africa, and, thus, the story of developing countries around the world … In this book we have substance, complexity and deep understandings. (Watson & Swartz 2004:xiv)

Approach

For this article, a two-pronged quantitative and qualitative approach was used to highlight the contribution of Professor Swartz. Quantitative data pertained to the number of citations attributed to the textbook between 2004 and 2024. Numeric data were collected through the Web of Science and Google Scholar online portals using relevant search words. Qualitative data were obtained by inviting chapter authors (n = 12) via an email to submit written reflections on the textbook writing project. The email explained the purpose of the Swartz festschrift of the special edition of the African Journal of Disability, and invited authors to submit a Word document (unspecified wordcount) with free-association reflections on working with Professor Swartz during the project and the subsequent impact of the textbook on their practice and the profession. Authors were not given specific questions or guidelines for reflection. The email invitation also indicated that submission of the reflection as textual data would be considered ethical approval for the inclusion of anonymised quotes in this article. One author indicated that she would prefer her quotes not to be anonymised. Nine authors submitted reflections. Three authors expressed interest, but were unable to meet the January 2025 submission deadline. Five pages of textual data were received and thematically analysed through a ‘process of recovering the theme or themes that are embodied and dramatised in the evolving meanings and imagery of the work’ (Saven-Baden & Major 2013:440). In keeping with the thematic analysis method, repeated intuitive handling of the data allowed patterns of ideas and ‘a general sense of the information to emerge’ (Saven-Baden & Major 2013:440). Member checking was used to establish trustworthiness by sending a draft of the thematic analysis to the authors. Minor adjustments were made after which a draft was sent to Professor Swartz, requesting his response to the perspectives of the contributing authors.

Acknowledging Swartz’s contribution

The textbook is only available as a hard copy paperback. The absence of an eBook version meant that there are no citation metrics from Scopus, PubMed and EBSCOhost databases that include indexes of occupational therapy and occupational science journals. Web of Science (WoS) and Google Scholar were used to identify the number of citations attributed to the textbook as a whole. The functionality of the WoS (Core Collection) reported 93 citations. This figure is not a true reflection of citations, given that WoS does not focus on occupational therapy research and does not index occupational science journals. Google Scholar reported 136 citations for the textbook as a whole. Three themes with substantiating quotes emerged from the qualitative data namely ‘expanding potential’, ‘contagious curiosity’ and ‘igniting scholarship’. These themes describe author’s perspectives on the contribution of Professor Swartz to the textbook writing project.

Theme 1: Expanding potential

In this theme, contributors describe Swartz’s ability to recognise and harvest latent academic potential:

‘When Leslie meets people, he instantly recognises their potential and proceeds to establish a relationship on the basis that the person is already performing at the level that he believes them capable of – he then expects to be surprised by the person’s next act of brilliance; all this while downplaying his own abilities and the role he plays in supporting the person’s competence. When working with Leslie, I always feel myself being shifted to within my zone of potential development (as per Vygotsky). Curiously, without experiencing performance anxiety, as one might expect, possibly because Leslie already factored in my ability to succeed in the way he relates the me. Leslie instils confidence when working with people as they transcend to their next challenge and level of performance, seemingly without setting any expectations.’ (Author A, academic, occupational therapist)

‘He empowered and enabled each therapist to believe that they had a unique and important contribution to make to occupational therapy discourse and to believe in their ability to write in a professional, scientific manner.’ (Author C, practitioner, occupational therapist)

‘Leslie’s belief in our potential and the collaborative environment in which the book was conceptualised and developed provided the impetus for my colleagues and me to start realizing our capabilities.’ (Author D, academic, occupational therapist)

‘Contributing to the writing of this book was an innovative, reflective and recognition experience, resulting for me in further research in obtaining a PhD.’ (Author E, academic, occupational therapist)

The writing project captured the:

‘shift in my thinking and practice from being an occupational therapist to becoming an occupational development practitioner and academic in Disability Studies. I had witnessed first-hand the marginalisation, oppression and poverty that persons with disabilities and their families experienced, and their struggles with accessing services and resources for health, education, livelihoods and social inclusion. Working with disabled people’s organisations conscientised us to a different paradigm of community development and collaborative practice across sectors.’ (Author H, academic, occupational therapist)

‘What is particularly remarkable about the book is that it is the first of its kind in South Africa to present a collective voice of occupational therapists in academia, some of whom had just completed their master’s research and were only just beginning to contemplate doctoral research. The book is thus a great example of what can be achieved through collegial academic mentorship and collaboration, and a masterpiece in academic leadership.’ (Author I, academic, occupational therapist)

Theme 2: Contagious curiosity

In this theme contributors highlight Swartz’s inquiring mind, leadership and collegial attitude as fundamental to shared learning through the exchange of ideas:

‘What makes Leslie truly exceptional is that he uses the same (humble) attitude when working with other professions. He instantly recognised the potential occupational science has in providing a foundation for trans-professional work and immersed himself in further development of these ideas.’ (Author A, academic, occupational therapist)

As a psychologist:

‘he just understood occupational therapy and had a wonderful way of working with all who were involved in bringing the book to fruition. He had the ability to engage, encourage and empower us on many different levels – from theory to practice.’ (Author B, practitioner, occupational therapist)

‘Leslie immersed himself in the beliefs, values, principles and methodologies of occupational therapy, coming to a comprehensive and insightful understanding of the profession and what it has to offer – most unusual for someone who is not a member of the profession.’ (Author C, practitioner, occupational therapist)

‘Despite my initial skepticism about having anything meaningful to say, Leslie’s persuasive can-do attitude left no room for opting out. Leslie’s insistence and his confidence in our abilities were undeniably compelling.’ (Author D, academic, occupational therapist)

‘I remember Leslie’s warm friendship, compassion, humility and very strong leadership in this process. He created a strong focus on getting the job done.’ (Author E, academic, occupational therapist)

‘With remarkable intellectual curiosity, Swartz ventured into learning about the concept of occupation as an innovative conceptual territory for examining the complexities of disability in African societies.’ (Author F, academic, occupational therapist)

‘Leslie was open to us questioning and challenging his assumptions about occupational therapy practice, and the experiences we had in working with disabled people’s organisations on the ground. Professionals are used to holding positions of power. We wrote about shifts in power dynamics. The space the editors created allowed reflection on our own practice, how we were able to facilitate meaningful and sustained transformation in teaching, learning, research and how we engaged with disabled people, their families and communities.’ (Author H, academic, occupational therapist)

Theme 3: Igniting scholarship

In this theme, contributors acknowledge the impact of the textbook on the profession and the role that Swartz as co-editor played in making South African scholarship accessible to an international audience:

‘His leadership, his mentorship to others and the legacy of his work in this textbook had lasting influence and far-reaching scholarship impact and in shaping the professional discourse around disability and rehabilitation.’ (Author B, practitioner, occupational therapist)

‘Swartz inspired authors to foreground the tenets of an African professional identity by describing the realities of working in a context very different from the prevailing Western occupational therapy discourse. He guided scholarship that positioned the profession in an alternate worldview that is focused on the collective, rather than the individual, and which is rooted in an appreciation of human diversity, interdependence and Ubuntu.’ (Author C, practitioner, occupational therapist)

‘I never imagined that we could collectively author a book. It made us realize that we, too, could contribute to the scholarship of our profession by offering an alternative perspective, paving the way for further academic opportunities.’ (Author D, academic, occupational therapist)

‘Watson and Swartz were visionaries – the content of this book is still relevant today. Sad to say that a lot of the challenges we experienced then still prevail … making me realize the importance of identifying metrics for measuring progress in our work as occupational therapists. I am still working on how best to do this.’ (Author F, academic, occupational therapist)

‘Swartz’s editorial partnership with Watson encouraged authors to critique the dual academic concerns of practice methodology and professional epistemology when describing the impact of structural barriers on occupational participation from a policy perspective. Documenting practice in this way created a useful reference for occupational therapy in other developing contexts.’ (Author G, practitioner, occupational therapist)

‘The spaces that Leslie and Ruth created for critical reflection and writing enabled novice researchers to pair up with more experienced researchers. The collaborative writing process meant that we were supported in translating our practice into theoretical concepts aligned with international and national policies. The writing processes strengthened implementation practice and produced reading material for the undergraduate occupational therapy programme, including practice learning, as well as postgraduate courses.’ (Author H, academic, occupational therapist)

‘The publication of Transformation through Occupation ten years after the first democratic elections that allowed the majority black population to vote for the first time in South Africa carries great historical significance. It created a moment for the profession of occupational therapy to reflect on how it served the South African population under Apartheid, deemed a crime against humanity by the 2002 Rome Statute of the International Criminal Court. The profession had the opportunity to reflect on whether it sufficiently inoculated itself against the excesses of a brutal oppressive regime or merely became complicit. This was important for the coming to being of South Africa as a nation. As editors of the book, Professor Ruth Watson and Professor Leslie Swartz played a significant part in helping mainly new authors to reflect on this moment, the role of the profession, and their own contributions as practitioners and academics.’ (Author I, academic, occupational therapist)

‘Framing occupational therapy around occupation as a key focus of study and practice was crucial but equally so was the community-oriented approach to practice. It is this framing that enabled me as a budding researcher and author, to firmly locate my work with children and mothers living with HIV and Aids, centred on intergenerational play and playfulness, within occupational therapy practice. This being groundbreaking work in scholarly terms, broadly, contributed to the visibility the book garnered internationally. I was also able to co-author a second chapter on spirituality in occupational therapy, another area of global interest then, and now.’ (Author I, academic, occupational therapist)

Considering textbook impact

As a psychologist and disability advocate Swartz’s collaboration with an occupational therapy community of practice highlighted the academic and service-related benefits of inter-professional collaboration and transdisciplinary theorising. Critical reflections on occupation-based practice at the time of textbook project raised awareness of the conceptual synergies between disability studies, occupational therapy and occupational science. All the chapters, in one way or another, incorporated aspects of the social model of disability, foregrounding the contribution of the profession to the development of an inclusive society (Watson & Swartz 2004). The passage of time since the textbook was published suggests that more work is needed to strengthen the disability studies-informed foundations of the profession that place emphasis on overcoming environmental barriers to participation (Harrison et al. 2021). The recent Occupational Therapy Practice Framework: Domain and Process (4th ed.) (AOTA 2020:61) describes the disability advocacy role of the profession, including ‘efforts directed toward promoting occupational justice’ in working for broader social change. Sheth et al. (2021), reflecting on progress towards the inclusion of disability studies in occupational therapy in the United States of America since 2005, report gradual shifts in practice that distinguish between ‘context-changing’ versus ‘person-fixing’ approaches in occupational therapy. They argue that the profession can benefit from a balance between structural-level analysis and personal-level analysis of the occupational issues confronting people with disability. By 2004, South African occupational therapy had already embraced this balance (Watson & Swartz 2004).

Similarly, critical disability studies literature reflects engagement with occupational science and occupational therapy theory, highlighting how privileging certain types of knowledge (e.g., how constructs such as ‘independence’ and ‘participation’ are defined) perpetuates epistemic injustices (Desormeaux-Moreau et al. 2024). An underlying tenet of the politicisation of disability is the idea that disability is created by society. Researching and theorising human occupation and humans as occupational beings in their lived environments (Brown et al. 2024) offers disability studies a unique angle from which to describe power structures at play that curtail human flourishing.

Response by Swartz

Swartz’s words in response to the article were:

I am of course delighted and grateful to read this piece. Thank you very much indeed. Transformation through Occupation has turned out, by many metrics, to be the most successful book I have written or edited. I have been hugely influenced by the experience of working on this book, and I use occupational science and occupational justice principles in a lot of my work. I was indeed asked to help with the transition the occupational therapy team at UCT were going through with the retirement of Ruth Watson (who remains a role model for me). What struck me when I met with the team was the worry that after Ruth went, all that she and the team had built up would be lost or forgotten. In my memory, it was when I heard this said a few times that I suggested that we work on writing together – to create something lasting that others can use. What I saw in the team was a group of highly competent, exceptionally creative trend-setters in their field, but for many reasons (which I think relate to gender, being occupational therapists in a faculty in which medicine is much more prized as a discipline, and, crucially, being South Africans working at population level in a field dominated by excellent clinical work in wealthier countries), not recording and sharing fully and forcefully what they were doing. For me, the work on this book was an intervention in the fields of epistemic exclusion and the politics of voice. These are key issues in many areas, including of course, disability studies in the majority world, and doing this book, for me, was part of the work I have done around epistemic exclusion on the basis of race, gender, disability, access to education, location (Global North and Global South), and so on. From the outside it seems to me that contributors to the book have gone on to unsettle taken-for-granted power relationships in global occupational therapy and occupational science – they have changed who speaks to whom and about what. This work in occupational therapy, for me, links to what we need to keep doing to change disability studies to reflect postcolonial realities. I am so lucky to have played a small part in what South African occupational therapists have achieved. (L. Swatrz, pers. comm., 11 February 2025)

Conclusion

At the root of this discussion is the implication of disability studies and occupational therapy having as their primary concern the things people have difficulty doing, with each field conceptualising their version of ‘difficulty doing things’ in different but complementary ways. McColl (2021), writing about the shared concerns of disability studies and occupational therapy asks:

So why have they historically resisted this opportunity? Why have they tended to operate in isolation from one another, and to treat one another with distance and suspicion? Why have they to date failed to recognise and rally around a sense of shared mission? (p. 9)

Watson and Swartz and the team of authors illustrated the possibilities for a powerful conceptual and practical alliance between the academic disciplines of occupational therapy, occupational science and disability studies. In so doing, they opened vistas of possibilities for the profession locally, regionally and internationally to promote contextually responsive practices. It is time to celebrate what has already been achieved and to envisage new inter-professional and cross-disciplinary projects emanating from Africa.

Acknowledgements

The author would like to acknowledge the contributions of the chapter authors and their feedback on the first draft of the article. The technical assistance of Roberto Sass, the librarian at the Faculty of Health Sciences, University of Cape Town, in the search for citations is also acknowledged.

The author declares that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

E.M.D. is the sole author of this research article.

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Data are available from the author E.M.D., upon reasonable request. Documents are stored in a password-secured digital file.

The views and opinions expressed in this article are those of the author and are the product of professional research. It does not necessarily reflect the official policy or position of any affiliated institution, funder, agency, or that of the publisher. The author is responsible for this article’s results, findings, and content.

References