Mindful Crafts as Therapy Engaging

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learning while reading and reflecting, and Chapter 4,
“Establishing Readiness for Practice,” invites learning
by doing—whether individually, in pairs, or in groups.
Chapter 1 The Mindfulness That Empowers Crafts
The rationale chapter. Discussion within this chapter
touches first on lessons drawn from instances of mind-
less practice. In contrast, mindfulness in occupational
therapy emerges as an attentive and careful engagement
in understanding, activity analysis, and synthesis. The
understanding needs to be deep, the analysis logical,
and the synthesis imaginative so that these functions
can together help practitioners humanize daily prac-
tice, set a scope and direction for sound therapy, and
show clients that they care. Throughout the chapter,
interactive features, historical highlights, and practice
stories elaborate the mindfulness of these functions.
Best practice reaches past the hands of clients—the
purpose of therapy—to engage their hearts—the mean-
ingfulness that clients seek. Basic to such practice is
a process of “really getting” the profession’s guiding
beliefs and then enacting principles from holistic and
client-centered models. The PEO model, with its call for
goodness of fit, and the recovery model, with its press
for empowerment, inform the logic of our analysis and
fuel the imagination in our synthesis, turning crafts
into best practice occupational therapy.
This chapter’s discussion culminates in a step-by-
step analysis of one craft within a well-considered
intervention. To assure deep understanding, readers
engage in a parallel analysis of a second craft interven-
tion, attending to the 12 points of consideration that
structure the guidelines in this book. The authors’ views
of both analyses yield helpful feedback. Following the
analyses, readers engage in an introduction to imagina-
tive synthesis, with author feedback.
Chapter 2 Making Craftwork Therapeutic
The intervention chapter. Discussion within this
chapter turns to how imaginative synthesis “works,”
how practitioners connect with the client and make
modifications to fit each person uniquely. Elaboration of
therapeutic measures occurs within practice scenarios
that illustrate (1) therapeutic use of self; (2) goodness
of fit among clients, environments, and crafts; and (3)
positive shifts toward health. Concrete examples, inter-
active features, and helpful hints move discussion of the
PEO and recovery models from theoretical principles
to practical applications.
A practitioner’s use of self can reflect many therapeu-
tic intentions. Resources in this chapter apply constructs
from the Intentional Relationship Model to show how
using the self can “work” during crafts. When making
Preface vii
a good PEO fit among client, craft environment, and
craftwork, practitioners make modifications related
to the physical environment, social environment, and
contextual influences surrounding a client’s views.
Numerous examples, whether related to lighting, guests
in the treatment room, or gender differences, illustrate
these adjustments.
Modifications also occur because of client challenges
in motor, process, or social interactional skills, as well
as to emotional and sensory functions. Practitioners
modify or grade craft demands to make them more
challenging for skill development or less difficult to
enable performance. Casework, practice examples,
and appendices featuring physical and mental health
conditions elaborate purposeful grading and its effects
on outcomes.
When engaged in individualized craft interventions,
clients make positive shifts in health, becoming craft-
ers with choice while occupied in productive work.
Mindful crafts can enhance such outcomes in most
group types through a process of therapeutic framing,
crafting, and meaning making, which are well detailed
in this chapter. A comprehensive checklist for leading
mindful craft sessions concludes this discussion.
Chapter 3 Making Craftwork Feasible
The pragmatics chapter. Discussion within this chapter
targets practical matters associated with using crafts to
include opposing attitudes, administrative challenges,
and constraints in resources such as supplies, space,
and time. Practitioners successful in implementing
craftwork adopt and promote mindsets that foster
openness and creativity. They engage in cognitive,
interpersonal, and marketing strategies that support
craft programs. Numerous examples of these strategies
appear in this chapter.
Practitioners of crafts gain administrative support.
They enact mindful approaches to honoring the institu-
tion’s culture, sharing evidence about crafts, securing
reimbursement, and respecting financial constraints.
For each approach discussed, readers will find examples:
a strategy for writing proposals aligned with mission
statements, a craft-based documentation process for
writing goals and recording progress, an excerpt from
a letter of appeal, a sample of a budget for supplies,
a listing of low-cost materials and free discards, and
ideas for organizing and improvising work spaces and
storage. Management of time constraints includes a
process for minimizing or dividing mindful crafts to
accommodate 15- to 20-minute sessions. A starter kit
of crafts that use only coloring or collage may appeal
to those starting from scratch. Because of this chapter’s
viii Preface
aims, all points of discussion or interaction help make
crafts do-able.
Chapter 4 Establishing Readiness for Practice
The application chapter. This chapter offers in three
parts opportunities to practice logical activity analysis
and imaginative synthesis that includes therapeutic
modifications. This chapter shows how purpose and
meaning can come together. Part 1 offers resources that
make mindful crafts replicable. Each of 10 application
tables is followed by an interactive exercise that pro-
motes its use. The interactive exercises consider imple-
mentations of mindful crafts among a woman combat
veteran, a man with bipolar disorder, an older woman
with arthritis, a group in an assisted living facility, a
middle-aged man with traumatic brain injury, a young
mother on bed rest, a group of individuals with spinal
cord injury, and an older man with left cerebrovascular
accident. Author feedback follows the exercises. Part
2 presents photos of 14 therapeutic modifications in
action, with a request that readers identify client chal-
lenges to skills or functions that might warrant these
adjustments.
Part 3 consists of realistic practice challenges that
promote integrative thought. The seven challenges,
with the client noted parenthetically, are these: Analyze
three crafts and select the best (bipolar disorder in a
young man), record observations and suggest modifi-
cations (developmental delay and low vision in a young
woman), grade tasks and give environmental supports
(deconditioned status in an older man), identify client
interests and therapeutic crafts (outpatient group for
a variety of conditions), consider safe practice in a
restricted environment (conduct disorder in a teenaged
boy), resubmit a SOAP note for reimbursement (post-
surgical hand and posttraumatic stress syndrome in a
middle-aged man), and lead or co-lead a mindful craft
group using guidelines in this book (peers in student
groups or clients in fieldwork settings). Again, author
perspectives on each challenge offer helpful feedback.
Chapter 5 The Evidence That Supports Crafts
The research chapter. This chapter consists of a review
of published research on handcrafts used therapeuti-
cally. The chapter models a professional literature review
while interspersing salient historical and anecdotal nar-
ratives as special features. Research on mindful crafts
used among clients and students leads the discussion.
Informative tables clarify research results on mental
and physical health outcomes and will be helpful to
readers.
Highlights from the review include the following.
Despite challenges associated with their use, randomized
control trials (RCTs) and other quantitative inquiries
have occurred in highly diverse contexts, from clinical
settings to research think tanks. Studies of handcrafts
used therapeutically among individuals with diverse
conditions have used a broad range of designs; RCTs
are the least represented, qualitative methods the most.
Research findings about the benefits of craftwork
support most assumptions made in early chapters of
this book. The assumption that crafts benefit social
interactional skills is borne out, but effects on process
and motor skills need more investigation. The following
earned support: Handcrafts meet diverse preferences,
unique needs, and wide-ranging goals; are engaging,
from mildly absorbing to causing flow; divert attention
from anxiety, sorrow, and other disruptive challenges;
transform a client into an active and productive doer;
invite expression of the self; are purposeful and mean-
ingful in their process and outcomes; and affirm an
individual as a maker. The preponderance of evidence
related to handcrafts in health care to date supports
its positive effects on health of the mind regardless of
primary presenting condition.
The Craft Sections
Sections II, III, and IV each include two craft chapters.
Together these chapters offer 80+ craft guidelines
organized according to the PEO model.
Section II: Craft Interventions With the Person
in Mind
Chapter 6 Crafts With Interwoven Reflections on
Personal Themes
Chapter 7 Crafts With Preparatory Reflections on
Personal Themes
Section III: Craft Interventions With the Person’s
Environments in Mind
Chapter 8 Crafts With Interwoven Reflections on
Environmental Themes
Chapter 9 Crafts With Preparatory Reflections on
Environmental Themes
Section IV: Craft Interventions With the Person’s
Occupations in Mind
Chapter 10 Crafts With Interwoven Occupational
Reflections
Chapter 11 Crafts With Preparatory Reflections on
Occupational Themes
Each craft chapter offers an introductory overview, an
index of 12 to 15 crafts with a difficulty rating, pho-
tographs that showcase crafts and clarify instructions,

and detailed guidelines for conducting interventions,
grounded in the PEO and recovery models and reflect-
ing these points of consideration:
♦ PEO focus for the intervention
♦ Mindful theme that names and frames the session
♦ Required actions within the craft that point to an
appendix of related skills and functions
♦ A cue to formulate client-specific skill-building
goals
♦ Mindful goals for the intervention
♦ Introduction that sets the stage for a mindful
session
♦ Questions or exercises that prompt person-
centered reflection on the mindful theme
♦ Identification of tools and supplies (and patterns
if needed)
♦ Sequential instructions directed at the participant
♦ Troubleshooting tips that alert practitioners to
potential challenges
♦ Comments to foster reflection during quiet
moments
♦ Suggestions for an interactive conclusion
♦ Variations possible when planning the session
The learning-by-doing craft chapters. All six craft
chapters are designed to be used by readers, whether
students or practitioners. Distinctions between the two
complementary craft chapter types within each section
are these:
Chapters 6, 8, and 10 with
interwoven reflections
♦ The typical time for conducting each session is 60
minutes. Some interventions may require more
than one session.
♦ In these sessions, most didactics and client-
centered reflections are informal and woven into
the intervention. This format accommodates
clients for whom formal written work and
discussion might be overly challenging or
distancing. For clients preferring more formal
learning strategies, practitioners may formalize
this interwoven work into written exercises and
discussion periods, as seen in Chapters 7, 9,
and 11.
Chapters 7, 9, and 11 with
preparatory reflections
♦ The ideal time for conducting the full session is 90
minutes. All interventions take one session.
♦ During the first 30 minutes of these sessions,
clients complete a written didactic or reflective
exercise and engage in a brief discussion. This
Preface ix
format appeals to those seeking educational
content in occupational therapy. If practitioners
prefer 60-minute sessions, they may invite clients
to complete the written exercise before the session.
Additionally, both the exercise and discussion may
be transformed into interwoven work, as seen in
Chapters 6, 8, and 10.
The Appendices
Expedite key functions. The appendices can prompt
a swift implementation of the mindful crafts in this
book while helping practitioners to easily generalize a
process that will make many other crafts mindful.
Appendix A: Broad Required Actions With
Performance Skills and Body Functions
Analyze potential. This appendix is the outcome of an
analysis of all of the actions required during completion
of the crafts in this book. Forty required actions, such as
cut with scissors and stir liquid, were then further ana-
lyzed to specify their demands on performance skills
and bodily functions. Practitioners can use this resource
to consider and tap the therapeutic potential of crafts.
Appendix B: Modifications to Address Challenges
With Required Actions
Meet client needs. Alongside the actions required by
the crafts in this book, this appendix notes various
modifications that enable client performance. This
logical and imaginative resource can guide practi-
tioners in making adjustments to accommodate client
difficulties with process, motor, and social interactional
skills and sensory as well as emotional functions.
Appendix C: Analysis of Distribution of Required
Actions for Crafts in This Book Organized by
PEO Themes
Capture purpose and meaning. This index identifies at
a glance some 5 to 20 actions required by each mindful
craft, depending on its complexity. The organization of
the index highlights themes from the PEO model that
imbue crafts with meaning: person (self-concept and
self-determination), environment (physical, social, and
societal and cultural), and occupation (self-maintenance,
self-fulfillment, and self-expression). Using this resource,
practitioners can readily choose interventions with
purposeful actions and meaningful themes.
Appendix D: Actions and Skills Tapped by Craft-
Related Housekeeping Tasks
Enable adjunct occupations. Part 1 of this resource
examines the demands of several daily living tasks such
as wipe surfaces clean and deposit trash in receptacle that
x Preface
surround and support craft use. Part 2 offers modifica-
tions that make these tasks do-able despite performance
challenges with process, motor, and social interactional
skills or sensory and emotional functions. Practitioners
can use this integrative work to plan sessions that
enhance participation and affirm occupation.
Appendix E: Group Facilitation and Leadership
Rating Version A
Get or give feedback. This rubric allows an individual
to acquire or give feedback on performance in leading
a mindful craft session. The form allows the rating of
some 60 practitioner functions clustered into 6 catego-
ries. The Likert scale (5 = performed exceptionally well
to 2.5 = performed fairly well) is skewed in a positive
direction. Instructions specify a method of noting
functions well done or in need of improvement.
Appendix F: Group Facilitation and Leadership
Rating Version B
Give or get feedback. This rubric also allows an indi-
vidual to give or acquire feedback on performance in
leading a mindful craft session. Performance of some
45 practitioner functions clustered into 5 categories can
be rated using a clear checklist format. Points allotted
to each category and totaling 100 translate readily to
an academic grade.
The Book’s Special Features
Your Turn and Our View
In Chapters 1 through 4, Your Turn features offer
pauses in the reading that focus and provoke thought.
These features mimic exchanges that many educators
use at 15-minute intervals during interactive lectures.
Your Turns invite critical thinking to fuel discussion or
reflection that leads to awareness.
Working in tandem with the Your Turns are the
Our View features. These follow discrete sections of the
chapter and share author feedback related to clusters
of Your Turns. Not to be construed as rigid “answers,”
Our Views are just that—views of two seasoned practi-
tioners on the Your Turn prompts. Although typical of
how many practitioners might respond, Our Views are
not beyond question and invite discussion.
At the end of Chapter 1 and throughout Chapter 4,
the Your Turns become more complex opportunities
for the kinds of application that deepen knowledge and
understanding. In these instances, Our Views continue
to offer practitioner perspectives as opposed to fixed
solutions.
Drawing our Past Forward
In Chapters 1, 2, 3, and 5, boxes titled Drawing our Past
Forward showcase historical narratives linked to the
discussion. Here, founders, professional leaders, and
practitioners from different decades describe perspec-
tives or practices from earlier times. These highlights
draw forward into the present a still-keen insight.
A Story
In Chapters 1, 2, and 5, boxes titled A Story feature
sometimes inspiring but always interesting anecdotes
about clients engaged in crafts or practitioners involved
in research. A few stories are ours, but most are contri-
butions that have come from colleagues eager to share
a story.
Ancillaries
For the Instructor
Assets housed on DavisPlus and available through
your instructor’s login include an Instructor’s Guide,
PowerPoint slides for Chapters 1 to 5, additional Prac-
tice Challenges similar to those in Chapter 4, an Image
Bank that includes all photographs in the book in their
original full color, and test questions.
 REVIEWERS

Alma R. Abdel-Moty, PhD, Hector Huerta, MS, OTD,

MS, OTR/L OTR/L
Clinical Associate Professor Occupational Therapy Department
Occupational Therapy Florida International University
Florida International University Miami, Florida
Miami, Florida
Joanne T. Jeffcoat, OTR/L,
Susan Baptiste, MHSc OT[C] MEd
Reg., FCAOT Professor
Professor Occupational Therapy Assistant Program
Rehabilitation Science Community College of Allegheny County/Boyce
McMaster University Campus
Hamilton, Ontario, Canada Monroeville, Pennsylvania

Susan Lee Cheng, MS, OTR/L Stephanie Johnston, MA, OTR

Assistant Dean, Allied Health; Program Director, Professor and Fieldwork Coordinator
OTA Occupational Therapy Assistant Program
Health Technologies Lone Star College-Tomball
Durham Technical Community College Tomball, Texas
Durham, North Carolina
Linda Kelly, PhD, LOTR,
Tina Sue Fletcher, EdD, MFA, OTA
OTR Occupational Therapy Assistant Program Director
Assistant Professor Allied Health
Occupational Therapy Delgado Community College
Texas Woman’s University New Orleans, Louisiana
Dallas, Texas
Carol Marcus, MS, OTR/L
Jennifer L. Geitner, COTA/L, Clinical Coordinator and Instructor
BS, AFWC Occupational Therapy Assistant Program
Academic Fieldwork Coordinator/Faculty Durham Technical Community College
Occupational Therapy Assistant Durham, North Carolina
Pueblo Community College
Pueblo, Colorado
Nancy Ranft, OTD, OTR/L
Assistant Professor of Occupational Therapy
Nancy Schneidenbach Green, Occupational Therapy
MHA, OTR/L The Sage Colleges
Program Chair Troy, New York
Occupational Therapy Assistant Connie Rooks, MAT, COTA/L
Cabarrus College of Health Sciences Program Director, Assistant Professor
Concord, North Carolina Allied Health, OTA Program
Western New Mexico University
Silver City, New Mexico

xi
xii Reviewers

Janeene Sibla, OTD, OTR/L Callie Schwartzkopf, OTD,

Occupational Therapy Program Director and OT/L
Professor Associate Professor
Occupational Therapy Occupational Therapy
University of Mary College of Saint Mary
Bismarck, North Dakota Omaha, Nebraska
Barbara Ellen Thompson, JoAnne Wright, PhD, OTR/L,
OTD, LCSW, OTR/L, CAGS CLVT
Professor Professor (Clinical)
Department of Occupational Therapy Division of Occupational Therapy
The Sage Colleges University of Utah
Troy, New York Salt Lake City, Utah

We should certainly count our blessings, but we should also make
our blessings count.
—Neal A. Maxwell
The act of acknowledgment turns on gratitude. To
acknowledge others is to recognize them, declare a
receipt of gifts from them, disclose positive truths about
them, and express to them deep thanks. In the spirit
of being mindful, we acknowledge others in the full
sense of the word. We recognize, declare, and disclose
the generosity of many, and we express to them our
deepest thanks.
We first acknowledge the power that an occupation
can have in bringing people together. We discussed
writing a book once during casual conversation at a
state conference. We had never before worked together,
but we had both come to a similar understanding of
how adding deeper meaning to crafts enhanced their
worth. Our two years spent in the making of this book
have forged a friendship for which we are grateful.
We acknowledge our photographer, Ann Nikirk,
who captured so well the images of our crafts and our
grasp of mindfulness. Ann’s developing belief in the
power of occupation and mindful crafts was a resound-
ing endorsement that moved us toward completing our
work. We asked Ann to share an image of herself while
at work and in flow, and that photo appears in Figure
1-4 in Chapter 1.
We acknowledge the influence of those individuals
who led each of us to the idea of infusing meaning into
crafts—whether intellectual or emotional. For Cynthia,
that idea germinated while working among able team
members who forged an ever-increasing clarity about
the benefits of using metaphor to add meaning to
craftwork. These individuals include Martha Diskin,
MA, OTR; Anna Olson, MOT, MBA, OTR, CLT; Susan
Ennist Dobbs, MOT, OTR; and Claudette Fette, PhD,
OTR, RCC. For Suzanne, preparing to work with a new
population was the prompt. The prospect of making
crafts meaningful for what might be a tough and
mixed audience—women recovering from addictions,
ACKNOWLEDGMENTS
whether immersed in careers, living on the streets, or
newly released from prison. Adding symbolism to each
project seemed a good way to forestall complaints about
the irrelevance, condescending nature, or childishness
of crafts. The idea worked beautifully!
We acknowledge those who guided us in the making
of this book. We launched and finished the work with
the help of able editors. F.A. Davis senior acquisitions
editor Christa Fratantoro saw promise in our proposal,
shepherded it to acceptance, and helped us set a path.
Jill Rembetski, our developmental editor, organized
and led the review process, anticipated and answered
endless questions, and guided our steps with gentle
insight. We thank Margaret Biblis and George Lang
for their leadership and direction. We thank design
editor Carolyn O’Brien and art editor Kate Margeson
for enhancing the visual appeal of our work and Sharon
Lee and Lisa Thompson for moving our work toward
production. We also acknowledge F.A. Davis staff Alisa
Hathaway and Nichole Liccio who helped us to make
necessary connections without which the book would
not have emerged.
We acknowledge individuals who met our need for
expertise in practice areas that complement our own.
These clinicians and educators include Beatriz C. Abreu,
OTR, PhD, FAOTA; Kira Beal, OTD, OTR; Debbie
Buckingham, OTR, MS, CVE, CCM, CRC; April C.
Cowan, OTR, OTD, CHT; Barbara M. Doucet, OTR,
PhD; Tina Patel Gunaldo, PhD, PT, DPT, MHS; and
Shama Lawji, MOT, OTR. We hope that these experts
see that we used their suggestions to good advantage.
We acknowledge the generosity of others to whom
we turned for help. We thank practitioners who
shared experiences with crafts that became Our Story
features. The clinical stories of Beatriz Abreu, OTR,
PhD, FAOTA; Whitney-Reigh Asao, PhD, OTR; and
Paula McComb, OTR added to the deep understanding
xiii
xiv Acknowledgments
that we sought. Another group deserving our thanks
is a circle of friends in Northern Texas who willingly
engaged in many of our crafts, helping to tweak our
instructions and make samples that let us capture crafts
“in progress” with photos. These individuals include
Vivienne Pitts; Carol Griffith; Shann Shubert; and
Madeleine, Julianne, and John Nikirk.
We acknowledge the work of graduate occupational
therapy student assistants Megan Gay Crisson, Emily
Miller, and Dora Alcacio. Their devotion to this book
was clear in their search and review of literature, format-
ting and reformatting of documents, data management
from student surveys, and feedback on the clarity of
craft instructions. When this book comes to print, all
will have moved on to practice where we hope that they
use mindful crafts.
We acknowledge with deep thanks the support of
friends and family who encouraged us and understood
our need to spend time in “book mode.” We acknowledge
our mothers in a special way. Cynthia thanks Darlene
Biondi Evetts, whose longtime engagement in crafts,
whether in making home life festive or making con-
tributions within the community, taught her children
the worth of crafting. When in rehabilitation during
the last months of our writing, Mrs. Evetts used crafts
suggested by Cynthia and then taught them to others
in the setting. Suzanne is grateful to Loretta Bernier
Peloquin, whose able hands as hair stylist and gardener
turned to satisfying artwork in her brief retirement. Her
giving nature and gentle soul are well-remembered by
all who knew her. The nurturing spirits of these two
strong women course through our book as we aim to
gently persuade and imaginatively lead.
We hope that we have made count of the bless-
ings that we have received. The greatest blessing that
might come from this book is a widespread embrace
of mindful crafts, in which case our gratitude will turn
to readers like you.
 TABLE OF CONTENTS
SECTION 1: Mindful Principles and Modifications to the Craftwork 53
Processes 1 Attend to Personal Relevance 53
Consider the Suitability of Tools 54
Chapter 1: The Mindfulness That Empowers Consider Objects and Their Properties 54
Crafts 3
Think About Sequence and Timing 55
Mindfulness and Mindlessness 4
Mindfulness Defined, Described, Attend to Safety Issues 55
and Illustrated 4 Grade Crafts With Two Directions
Mindlessness in Health Care 6 in Mind 56
Mindlessness in Occupational Therapy 8 Make a Fit That Leads to Performance:
A Case 60
The Understanding That Empowers
Occupational Therapy 9 Modifications Within the Person:
Understanding Persons and Their Positive Shifts Toward Health 62
Occupational Natures 10 A Healthy Shift in Role 63
Understanding Our Guiding Beliefs 11 A Healthy Shift in Participation 64
Insights From Holistic Person- Group Approaches to Craftwork 67
Centered Models: Person- Formal Population-Centered Groups 68
Environment-Occupation and Informal Population-Centered Craft
Recovery 12 Groups 71
Understanding Ourselves 14 Formal Setting-Specific Therapy
The Logical Analysis and Imaginative Groups 71
Synthesis That Empower Informal Setting-Specific Groups 72
Occupational Therapy 16
Informal Social Gatherings 72
Logical Assumptions About the
Therapeutic Potential of Craftwork 16 The Process of Mindful Craft Groups 73
Framing 73
Analysis of Each Craft 22
Crafting 75
Analysis of Each Craft Intervention 28
Meaning Making 77
Imaginative Activity Synthesis 29
Establishing Client-Centered Purpose 34 Summary 84
Discerning Meaning as Part of
Synthesis 35
Chapter 3: Making Craftwork Feasible 87
Personal Mindsets That Make Crafts
Summary 38 Do-Able 88
Create New Categories 88
Chapter 2: Making Craftwork Therapeutic 41 Be Open Minded 90
The Therapeutic Process Within Crafts 42 Take Control Over Context 92
Therapeutic Use of Self 42
Be Process Oriented 92
Creating a Good Fit 43
See Oneself as Savvy: Enhance
Modifications to the Craft Environment 47 Personal Skill 93
The Physical Environment 48
Mental Locks That Put Crafts at Risk 96
The Social Environment 49 Pathways to Administrative Support 98
Influential Contexts 50 Honor Institutional Culture 98

xv
xvi Table of Contents

Heed Administrative Directives: Perceptions Among

Evidence, Documentation, and Students 197
Finances 99 Research on the Therapeutic Use of
Pathways to Abundant Resources 115 Handcrafts 200
Secure Supplies: Starter Kits, Dual Focus 200
Discards, and Bright Ideas 115 Search Process 201
Secure Places and Spaces: Challenges in Securing Evidence 201
Organization and Improvisation 119
Contexts Within Which Evidence
Summary 124 on Handcrafts Has Mattered 203
Additional Research Findings
Chapter 4: Establishing Readiness for Organized Within a Recovery
Practice 127
Framework 214
PART 1: Resources That Lead to
Readiness 128 Discussion and Future Directions 224
Resources: The Purposeful Core Summary 226
of Crafts 128
SECTION 2: Craft Interventions With
Resources: The Meaningful Core the Person in Mind 231
of Interventions 142
PART 2: Photographs of Modifications 157 Chapter 6: Crafts With Interwoven
PART 3: Practice Challenges That Reflections on Personal
Develop Readiness 160 Themes 233
4-1 Analyze Three Crafts and Select Crafts With the Person in Mind:
the Best One—Bipolar Disorder 160 Self-Concept 235
4-2 Record Observations and 6-1 Cracked Pot—Reframing Flaws 235
Suggest Modifications— 6-2 Purple Hearts—Acknowledging
Developmental Delay and Low Pain and Suffering 237
Vision in a Young Woman 169 6-3 Mixed Emotions—Identifying
4-3 Grade Task and Environmental Internal Conflict 239
Supports—Deconditioned Status 171 6-4 Knock, Knock. Who’s There?
4-4 Identify Client Interests and Inside/Outside Emotions 242
Therapeutic Crafts—Outpatient 6-5 Treasure Boxes—Value
Group for a Variety of Conditions 175 Clarification 246
4-5 Consider Safe Practice in a 6-6 What’s Your Superpower?
Restricted Environment—Conduct Adventures in Life 248
Disorder in a Teenaged Boy 177
Crafts With the Person in Mind:
4-6 Resubmit a SOAP Note for Self-Determination 250
Reimbursement—Postsurgical 6-7 Layers—Reflecting on Personal
Hand and Posttraumatic Stress Development 250
Disorder 179
6-8 Get Real—Telling My Story 255
4-7 Lead or Co-Lead a Mindful Craft
6-9 Review, Appraise, Plan—Past,
Group 181
Present, Future 259
Perspectives on the Challenges 182
6-10 Totem Fetishes—Character
Summary 192
Strengths and Aspirations 261
Chapter 5: The Evidence That Supports 6-11 What’s in Your Wallet?
Crafts 195 Identity 264
Research to Date on Mindful Crafts 196 6-12 Refocusing, Letting Go,
Perceptions of Satisfaction and Moving On—Recycling
Engagement 196 Unpleasant Memories 267
 Table of Contents xvii

Chapter 7: Crafts With Preparatory 8-5 Interpersonal Relations—Inside/

Reflections on Personal Outside Box 367
Themes 271 8-6 Blast From the Past—
Crafts With the Person in Mind: Environmental Impact 369
Self-Concept 272
8-7 Social Ties—Strengthening
7-1 Having a Positive Sense of Self 273
Relationships 371
7-2 Scratching Past the Surface 277
8-8 Friendly Bouquet—Individuals
7-3 Amazing Grace 282 in Community 374
7-4 Windows Into the Soul 286 Crafts With the Environment in Mind:
7-5 Taking a Lighthearted Perspective 290 Cultural and Societal Environment 378
7-6 Taking Pride in Being or 8-9 Best-Laid Plans—Coping With
Honoring a Real Woman 294 Change 378

7-7 Taking Pride in Being or 8-10 Not So Trivial Trivets—

Honoring a Real Man 299 Adaptation to Change 380

7-8 Spring Holiday Reflections 8-11 What’s Bugging You? Problem

About Recovery 303 Solving 383

7-9 Winter Holiday—Joy 309 8-12 Who Am I? Communication

and Interaction Skills 384
Crafts With the Person in Mind:
Self-Determination 313
7-10 Reinventing the Self 313 Chapter 9: Crafts With Preparatory
7-11 Having Purpose and Motivation 317 Reflections on Environmental
7-12 Transformations in Life 322
Themes 389
Crafts With the Environment in Mind:
7-13 Pieces to Peace 327 Physical Environment 390
7-14 Spring Holiday—What Are 9-1 Being in a Safe and Accessible
You Hatching? 331 Place 391
7-15 Holding on to Friendship 338 9-2 Seeds of Recovery 397
9-3 It’s in the Bag 401
SECTION 3: Craft Interventions 9-4 We Fly and Crawl 406
With the Person’s 9-5 Winter Holiday—The Little
Environments in Mind 347 Things 410
Crafts With the Environment in Mind:
Chapter 8: Crafts With Interwoven Social Environment 415
Reflections on Environmental 9-6 Being Among Supportive Others 415
Themes 349
Crafts With the Environment in Mind: 9-7 What Are You Banking On? 419
Physical Environment 351 9-8 Being Real 423
8-1 Welcome/Keep Out—Protecting 9-9 Being in a Nurturing Place 428
Well-Being 351
9-10 Halloween—Web of Support 435
8-2 Doors—Interpersonal
Crafts With the Environment in Mind:
Boundaries 356
Cultural and Societal Environment 440
8-3 Boxes to Baskets— 9-11 Respecting Boundaries 440
Repurposing—Accepting
9-12 Square One 444
and Embracing Change 360
9-13 Halloween—Healthy Tricks or
Crafts With the Environment in Mind:
Treats 448
Social Environment 364
8-4 Parts of a Whole— 9-14 Catching the Sun in Your Life 453
Acknowledging Influential Others 364 9-15 Weaving a Balanced View 457
xviii Table of Contents

SECTION 4: Craft Interventions 11-4 Coping With Courage and

With the Person’s Heart 516
Occupations in Mind 461 11-5 Holding On, Letting Go 519
Crafts With the Occupation in Mind:
Chapter 10: Crafts
With Interwoven Self-Fulfillment 523
Occupational Reflections 463
11-6 Bucket List 523
Crafts With the Occupation in Mind:
Self-Maintenance 464 11-7 From Broken to Whole 527
10-1 Framed—First Impressions 465 11-8 Valentine’s Day—Life’s Patterns 531
10-2 Guardian Angels—Risky 11-9 Tearing Apart, Rebuilding 534
Behaviors 467 11-10 Swimming Strong 538
10-3 Getting It Together—Problem- Crafts With the Occupation in Mind:
Solving Process 470 Self-Expression 543
10-4 Keep On Keeping On—Routine 11-11 Developing Healthy Habits 543
Building 472 11-12 Essential Tools for Growth 547
Crafts With the Occupation in Mind: 11-13 Winter Holiday—Giving Real
Self-Fulfillment 475 Gifts 551
10-5 Holding it Together—
11-14 Giving Thanks 557
Catch-All Can 475
11-15 Mother’s or Father’s Day—
10-6 To-Do List Accountability—
Making Parental Connections 563
Seven-Day Log 477
10-7 Symbolic Reminders—Visual
Appendix A: Broad
Required Actions With
Cues 480
Performance Skills and Body
10-8 An Extra Pocket—Taking Time Functions 571
for Self 482
Crafts With the Occupation in Mind: Appendix B: Modifications
to Address
Self-Expression 486 Challenges With Required
10-9 Spiritual Expressions—Prayer Actions 591
Beads 486
10-10 Magic Wands—Expressing Appendix C: Analysis
of Distribution of
Yourself With Style 490 Required Actions for Crafts
in This Book Organized by
10-11 Personal Business: Profiling
PEO Themes 613
Strengths 494
10-12 DIY (Do-It-Yourself) Book— Appendix D: Actions
and Skills Tapped by
Explain Yourself 498 Craft-Related Housekeeping
Tasks 623
Chapter 11: CraftsWith Preparatory
Reflections on Occupational Appendix E: Group
Facilitation and
Themes 503 Leadership Rating Version A 635
Crafts With the Occupation in Mind:
Self-Maintenance 504 Appendix F: Group
Facilitation and
11-1 Eating With a Design in Mind 505 Leadership Rating Version B 637
11-2 Carrying Responsibilities 509
Index 639
11-3 Thinking Little 513
SECTION ONE

Mindful Principles
and Processes
 CHAP TE R

1
The Mindfulness That
Empowers Crafts
Guided by the belief that occupational therapy is a personal
engagement, we enable occupations that heal.

LE A R NING O U TC O MES
1. Distinguish between mindful and mindless health-care practices.
2. Identify longstanding aspects of mindfulness in occupational therapy practice.
3. Elaborate a deep understanding of persons and their occupational natures.
4. Identify the guiding beliefs and person-centered models that shape best practice.
5. Describe the relationship between conscious and therapeutic use of self.
6. Offer logical assumptions to support the therapeutic use of crafts.
7. Apply logical activity analysis to a given craft.
8. Describe the principles of imaginative activity synthesis.
9. Elaborate the manner in which crafts can be made mindful.

When it comes to making interventions work, practi-
tioners must be mindful. To be true to the meaning of
the term, they must be attentive and aware. They must
be careful. They must heed the mindful functions of
practice. More specifically, occupational therapy prac-
titioners must honor three dimensions of mindfulness:
(1) a deep understanding of persons and therapy, (2)
logical activity analysis, and (3) imaginative activity
synthesis. In this chapter, we elaborate the meaning of
each after sharing this overview.
Consider first the need to understand or “really get”
some things. As occupational therapy practitioners, we
must understand persons, their occupational natures,
and the unsettling disruptions that occupational chal-
lenges cause in a life. This aspect of mindfulness human-
izes therapy. We must next understand the guiding
beliefs of occupational therapy and the action-oriented
principles drawn from person-centered models. This
understanding sets the depth, scope, and direction
of therapy. And we must also turn inward so as to
understand ourselves and how we work with others.
This aspect of mindfulness helps us become caring.
Beyond this threefold understanding, our mindful-
ness extends to logical analysis and imaginative synthe-
sis. We must use logic to analyze the demands of an
occupation, activity, or task and identify the skills and
functions needed to meet those demands. This aspect
of mindfulness gives purpose to our therapy. We must
then turn to those who seek our care. Clients bring
to therapy unique needs and strengths. Clients tell us
what has meaning. We must work imaginatively with
them to synthesize our knowledge of therapy and their
grasp of their situations. This aspect of mindfulness
individualizes therapy and makes it engaging. The
ensuing goodness of fit—best practice—has healing
power.
Can practitioners use craft interventions mindfully?
This book is our “Yes!” In this chapter, we make our
3
4 SECTION ONE ✍ Mindful Principles and Processes
approach transparent. We share a practice of deep
understanding, logical analysis, and imaginative syn-
thesis. We showcase mindful crafts. Our bottom line is
this: You can make crafts work.
Your Turn 1-1
Look at Figure 1-1. Before reading any further,
write within each loop in the figure a number
from 1 to 5 (with 5 indicating very familiar
and 1 not so familiar) to answer this question:
What number would you use to rate your
familiarity with each of the three dimensions
of mindfulness named in the figure? If, for
example, you think that you are somewhat
familiar with logical activity analysis, you
might write the number 3 within that loop.
Deep
understanding
of persons and
therapy
Logical
activity
analysis
Imaginative
activity
synthesis
MINDFUL
CRAFTWORK
FIGURE 1-1 The mindfulness that empowers crafts.
Mindfulness and Mindlessness
We turn to a discussion of mindfulness because we
believe that framing occupational therapy interventions
in terms of mindfulness awakens us to vital functions of
practice. We believe that we are at risk of being pulled
or lulled into mindlessness in today’s health systems.
Our aim is not to flaunt a trendy term but to deeply
consider the grounding in mindfulness that the best of
occupational therapy has always been.
Mindfulness Defined, Described,
and Illustrated
Definitions of mindfulness and its opposite are impor-
tant preludes to a discussion of mindlessness in health
care. The term mindful is defined as “attentive, aware,
and careful.” Synonyms include “heedful,” “thoughtful,”
and “regardful.” When we hear the term mindless, we
rightly deduce that inattentive, unaware, and careless
apply. The dictionary notes that heedless, thoughtless,
and disregardful also fit.
Mindfulness, then, means being attentive to, aware
of, and careful about something—some idea, function,
or person. Mindfulness helps us to do safely and well
the things that we choose to do. See Figure 1-2 for one
of those things.
We all claim to be dutifully mindful. We likewise
admit that mindlessness “happens.” Consider driving.
Complex enough to warrant a license and dangerous
enough that criminal charges attach to recklessness,
driving can occur mindlessly. Long stretches of highway
can pull us from active driving. Suddenly “brought
back” from musing about other things, we fear we’ve
passed our exit. So skilled are most of us at steadying
the wheel and checking the mirrors that we drive a
two-ton vehicle on autopilot.
FIGURE 1-2 Mindful threading of a needle.
 CHAPTER 1
FIGURE 1-3 Mindless application of toothpaste.
Your Turn 1-2
Identify an activity other than driving during
which you find yourself acting on autopilot.
Which, if any, adverse consequences can
follow?
Most are less attentive during basic self-care. The
precise steps and motions in applying deodorant or
tying shoes all move to the background until some
occupational challenge thwarts their attempt. As occu-
pational therapy practitioners, we stay mindful of daily
activities, aware of their demands and dimensions.
Others turn to us for help because we heed the realm
of daily performance, staying mindful on their behalf.
See in Figure 1-3 the result of a mindless moment.
Mindfulness, then, is the adaptive state of being
attentive and aware. It allows us to do carefully whatever
we need to do. Fables and fairy tales portray mindful-
ness in ways that move past its value in daily activities
into matters of life and death. Little Red Riding Hood
(Lang, 1891) and a later rendition called The Little Girl
and the Wolf (Thurber, 1939) offer contrasting views.
Little Red Riding Hood features a young girl setting
out with a basket of goodies to take to her sick grand-
mother. Along the way, she meets and chats with a wolf,
mindlessly disclosing to him her destination. This Big
Bad Wolf takes his leave of the girl and lopes ahead to
make a satisfying if hurried meal of the grandmother.
Astute wolf that he is, he sees in the approach of
the child a chance for a second meal. He dresses in
granny’s bedclothes, slips into her bed, and greets the
girl. She exclaims over oddities in the wolf ’s voice and
features, heedless of their meaning. Her last comment,
✍ The Mindfulness That Empowers Crafts 5
“Grandmother, what big teeth you have,” elicits a deadly
response. Mindlessness can be deadly.
James Thurber’s fable, The Little Girl and the Wolf
(1939), introduces a young girl of a different ilk.
Thurber takes liberties with Lang’s tale:
She had approached no nearer than twenty-five
feet from the bed when she saw that it was not
her grandmother but the wolf, for even in a
nightcap a wolf does not look any more like
your grandmother than the Metro-Goldwyn
lion looks like Calvin Coolidge. So the girl took
an automatic out of her basket and shot the
wolf dead. (p. 5)
The moral of Thurber’s story is this: “It is not so easy
to fool little girls nowadays as it used to be” (Thurber,
1939, p. 5). Mindfulness can save us.
Most of us can point to bodily nicks and scars,
evidence of mindless moments turned unsafe. Mind-
lessness can hurt feelings, too. Read what author May
Sarton (1988) had to say about her experience at a
hairdresser’s:
While Donna was securing my hair into curlers,
an old lady who was waiting to be picked up
came and stood beside us and talked cheerfully
about herself and her daughters and Donna
responded. It was as though I did not exist, was
an animal being groomed. (p. 235)
Sarton felt disregard when her hairdresser attended to
another. In similar circumstances, some of us might feel
the same. Others of us might feel no dismay and take
our thoughts elsewhere. Perceptions of mindlessness
as rude can differ.
Your Turn 1-3
Would the behavior described by May Sarton
bother you if you were at the hairdresser’s or
barber shop? Explain.
We’ve established our familiarity with mindfulness
and its opposite. Two more points of discussion seem
salient: the absorbed state that mindfulness can cause
and the mindfulness revolution.
Absorption
First, consider the deep absorption that mindfulness
can produce. Psychologist Mihaly Csikszentmihalyi
(1990) named this positively energized state flow. He
described flow as an intense mental state when one
6 SECTION ONE ✍ Mindful Principles and Processes
FIGURE 1-4 Engagement in flow during photography.
engages in a just-right challenge. Some ignore food
or drink when in flow. Flow can occur with artwork,
sports, or playing an instrument (Fig. 1-4). The sense
of being swept away on water led to the naming of
flow. Passive activities cannot elicit flow; they evoke
boredom or anxiety (Csikszentmihalyi, 1975). Many of
our clients can name activities that absorb them, and
we should stay mindful of these. If we strive to occupy
our clients, we should be skeptical of methods that are
downright boring.
What can we say about an activity that, although
still absorbing, tends to calm us? Such engagement
is mindful in that we stay present to the activity, but
the mental state is not intense. We often switch from
intense tasks to those that tax us less. Some call these
“mind-flushers.” Benefits can follow an easy mindful-
ness that diverts us from stress and pain. We bristle
when others call occupational therapy diversional.
Our work, we say, is therapeutic. But diversion can be
therapeutic. Removal from anxiety about the future or
sorrow over the past offers a healthy reprieve. Individu-
als find reprieve in different tasks, from tidying shelves
to grooming pets (Figure 1-5).
FIGURE 1-5 Absorption in pet grooming.
Time spent in simple stitching or sanding can be
restful steps in craftwork. We note this calmly absorbed
state alongside that of flow because they both affect our
well-being in time. If Csikszentmihalyi’s flow is like
being swept away in time, restful absorption is like a
gentle floating. Bays (2011) described the floating well:
“The mind needs rest, too. Where it finds rest is in the
present moment, where it can lie down and relax into
the flow of events” (p. 6).
The mindfulness revolution
A second point about mindfulness seems important
to our discussion: the mindfulness revolution. Strate-
gies for achieving mindfulness fill the psychological
literature as part of healing and living well (Boyce,
2011). The practice of mindfulness derives from
Eastern philosophies and from cognitive behavioral
therapy (Boyce, 2011). Prompts from this practice, such
as staying in the moment and living life to its fullest,
align well with occupational therapy. All of this merit
aside, our focus is neither on the mindfulness revolu-
tion nor in trying to prompt a meditative state. Rather,
our view of mindfulness targets the common view of
attentiveness, awareness, and care in using occupations
that has characterized best practice since our incep-
tion. We target the construct because the challenges to
stay mindful nowadays are on the rise, particularly in
health care.
Mindlessness in Health Care
We see mindfulness as the force behind best practice.
We especially note the need to be mindful of the persons
who seek our care. Currents in care systems shape an
 CHAPTER 1
undertow that can pull us from such regard. Stories
shared by those seeking care suggest that caregivers can
be mindless. We hear such stories at family gatherings,
on elevators, and in waiting rooms. In stories thought
uncaring, concern for the person’s experiences, feelings,
and needs is not primary, preempted by matters thought
more pressing (Biro, 2000; Casillas, 2006; Cole, 2004;
Gazella, 2004; Hill, 2006; Ivančić, 2006; Martensen,
2008; Sonkë, Rollins, Brandman, & Graham-Pole, 2009;
Srivastana, 2011). Surely no caregiver intends harm,
but many engage in hurtful behaviors. In a hallmark
statement, physician Seymour Sarason (1985) wrote:
In a vague, inchoate way, people feel and
know that the clinical endeavor has become
problematic, that those who are in helping roles
are both cause and victim, that something is
wrong somewhere, and that far from getting
better, it seems to be getting worse. (pp. 203–204)
During the 1980s and 1990s, many individuals went
public with health care narratives that clarified the
problem and shed light on its nature and causes. Those
stories decried actions thought uncaring: (1) failure to
see injury, illness, and chronic conditions as having
deeply personal consequences; (2) failure to attend to
that which patients want to share; (3) establishment of a
distance that feels cold and dismissive; (4) withholding
of information that patients deem important; (5) use
of brusque manners; and (6) misuse of professional
power (Peloquin, 1993a). More recent stories affirm the
same complaints (Biro, 2000; Casillas, 2006; Cole, 2004;
Gazella, 2004; Hill, 2006; Ivančić, 2006; Martensen,
2008; Sonkë et al., 2009; Srivastana, 2011). Each com-
plaint targets a form of being inattentive to or unaware
of something, of being careless toward someone.
A narrative seems apt, and Arnold Beisser’s (1989) is
a classic. A physician and former tennis champion who
contracted polio just months before the vaccine hit the
market, Beisser thought his hospital time quite grim:
I would call the nurse and ask for another
blanket to cover me. The room seemed
comfortable to her, so she would doubt my
judgment. In order to check, she would usually
reach down to feel my leg. Then she would say
something like, “Oh, it’s all right, you’re not
cold.” (pp. 18–19)
His perceptions of feeling cold were dismissed. His
bodily experience was ignored. The nurse’s attention to
his room and skin temperature preempted his discom-
fort. Professional coldness prevailed. How differently
might Beisser have felt with the gift of a blanket!
✍ The Mindfulness That Empowers Crafts 7
Thankfully, instances of caring occurred, even during
difficult times. This one affirms a hasty handcraft:
As I slept, a nurse took the cloth wrapping
off a sterile instrument. He smoothed out the
material. He painted with a blue flow pen a
moon face with wide eyes and an enormous
crescent smile. He climbed over my bed. He
climbed over my plants and hung this banner
down from my window, using the extra-wide
masking tape. It was the first thing I saw in the
morning. (Lee, 1987, p. 111)
In most cases of uncaring, a regard for something other
than the patient’s concerns prevails. Note Sarason’s take:
Helpers are both cause and victim (1985). Caregivers
struggle. They name societal and institutional forces
that pull them from caring. Three seem dominant:
(1) an emphasis on logical fixing; (2) an overreliance
on methods and protocols; and (3) a health-care system
driven by business, efficiency, and profit (Buckly, 2011;
Crossen & Tollen, 2010; Frampton, 2009; Gazella, 2004;
Muñoz, 2006; Peloquin, 1993b; Sonkë et al., 2009;
Srivastana, 2011).
Each of these three dominant forces carries a concern
vital to best practice. Health-care problems must be
solved; sound methods must shape treatment; institu-
tions must have business sense. But when logical fixing,
scientific methods, or profit-first ideas stand at the
center, patients feel displaced. Even when unintended,
the mindlessness hurts. Often client and caregiver feel
pain, as in this more recent example:
Five months of clerkships had shown me that
the ideal patient-doctor relationship ... crumbles
under the demands of ward work. I had already
begun to place my efficiency, interests, and
performance ahead of the patient’s feelings and
questions. ... I felt ashamed that we had neither
listened, nor made her feel comfortable, nor
prepared her in the slightest for a diagnosis that
we knew she wouldn’t understand. (Muñoz,
2006)
Reform has accelerated since the “unraveling of health
care” in the mid-1990s when the “miracle of the managed
care marketplace did not deliver” (Morrison, 2000).
Changes have included a proliferation of satisfaction
surveys, accountability proposals, “customer training
workshops,” and recognition and reward programs for
caring behaviors. We have a long way to go, with Press
Ganey Associates’ (2013) special reports affirming the
need for a deeper understanding of client sentiment
than that offered by satisfaction measures.
8 SECTION ONE ✍ Mindful Principles and Processes
In the context of this discussion, Planetree, a non-
profit facilitator of patient-centered care in settings
worldwide, is worth noting (Frampton, 2009). In an
effort to transform hospital stays into healing events,
developers envisioned Planetree hospital designs, both
architectural and programmatic, as venues for patient-
centered care. Seeing hospital wards as prison-like,
designers reimagined them as healing spas. Planetree
centers offer massages, greenery, and airy spaces filled
with stunning artwork. In many sites, arts and crafts—
from scrapbook making to using craft kits—reflect the
belief that art enhances outcomes. Relationship-centered
care is a dominant theme in Planetree philosophy, and
deeply human connections are encouraged (Frampton,
2009; Harvey Picker Center, 2013; Ulrich, 2009).
Your Turn 1-4
Call to mind any instance during a health-care
event when you experienced or saw real
caring. What was it about the behavior that
seemed caring to you?
Mindlessness in
Occupational Therapy
Occupational therapy practitioners have shared angst
similar to that faced among medical caregivers. Some
have asked:
Are occupational therapists today meeting the
needs of the rehabilitation population ...? Or
are we compartmentalizing our services on the
basis of our own need for neat tidy treatment
plans that fit our expertise and selective mission
of our institution? (Boyle, 1990, p. 941)
Because we argue that crafts can be mindful, we first
share three cases of craftwork run amuck. Later, we’ll
explore the manner in which each case might have
been mindful. The first case concerns a writer with
Guillain-Barré syndrome, the second a bright woman
in a nursing home, and the third a professional leader
with cerebral palsy. In each case, therapy missed its
mark.
Heller and Vogel (1986) described Heller’s experi-
ence with occupational therapy for Guillain-Barré
syndrome. As soon as he could complete seven steady
repetitions of sanding on a block of wood, the therapist
replaced the sandpaper with a coarser grade, increas-
ing the difficulty of his work. Heller wrote of those
repetitions, “It was just as punishing for me to have
to execute them as it had been in the beginning” (p.
167). He had hoped to savor gains, but the protocol for
strength discouraged him.
A patient’s poem, “Occupational Therapy” (McClay,
1977), featured an elderly woman’s case and her reflec-
tion about her therapist. Consider this excerpt:
Preserve me from the occupational therapist,
God ...
“Please open your eyes,” the therapist says,
“You don’t want to sleep the day away.”
As I say, she means well ...
She wants to know what I used to do,
Knit? Crochet?
Yes, I did all those things,
And cooked and cleaned
And raised five children,
And had things happen to me.
Beautiful things, terrible things,
I need to think about them. ...
Arrange them on the shelves of my mind.
The therapist is showing me glittery beads,
She asks if I might like to make jewelry. ...
She’s a dear child and she means well,
So I tell her I might
Some other day. (pp. 107–108)
Because the therapist never heard this woman’s needs,
attending to them was impossible.
Your Turn 1-5
What suggestion do you have about
something that this young therapist might
have said or done differently?
A case described by Diane Parham (1987), rounds out
this triad. Parham spoke of June Kailes, director of
an independent living center, as a “talented and intel-
ligent woman who happened to have cerebral palsy”
(p. 556). Parham reflected on Kailes’ time in occupa-
tional therapy.
Her recollection of therapy is that she was
asked repeatedly to drill on tasks like putting
beads into jars, presumably for coordination:
“Anybody could see that wasn’t going to be my
thing!” Why had no one attempted to help her
channel her considerable intellectual abilities
toward more satisfying goals? (Parham, 1987,
p. 556)
 CHAPTER 1
Occupational therapy was meaningless rote, Kailes’
grasp of its purpose notwithstanding.
In the face of such stories, we must ask: Have occu-
pational therapy interventions become like mindless
driving on familiar highways? Are we so skilled in
routine methods that we intervene on autopilot? Do
we ask the same questions and use the same methods
without seeing diverse preferences, unique needs,
and wide-ranging goals? Or have we been swept into
mindless currents in health care? Do we narrow the
depth and scope of our practice when pressed to first
and foremost fix problems, honor protocols, and rack
up productivity? Do our expertise and institutional
bottom lines trump patients’ needs? Does our daily
practice pull us from caring?
Thankfully, mindful occupational therapy has always
occurred and sometimes using a craft. Therapist Betty
Baer (2003) introduced us to J., a Vietnam veteran with
a high-level spinal cord injury (SCI). J. lived in a remote
part of Texas and called himself a “Mountain Man.”
Self-conscious about a tracheotomy scar, he wanted a
beaded choker. Unable to bead because of paralysis,
he and his therapist made this plan: Because J. had to
direct his caregivers well, Baer proposed that he design
a necklace and tell her how to bead it, step by step. She
later wrote:
Our View 1-1 Feedback on Your Turn Responses to Mindfulness and Mindlessness
1-1: The numbers that you wrote on this
figure will vary depending on your
experiences, whether in school or in
practice. Our hope is that after reading
this chapter, any low numbers will
increase. Come back to check these
numbers when you finish the chapter!
1-2: Most responses to the question of
when you become mindless will mention
familiar activities or ones that are simple
or repetitive. You may have mentioned
basic activities of daily living or leisure
tasks, but it’s not unusual to go into
autopilot during instrumental activities of
daily living (such as driving) or educational
and work activities (such as sitting in long
lectures).
1-3: Whether you might feel offended by
this hairdresser or a barber will vary
depending on your expectations, your
✍ The Mindfulness That Empowers Crafts 9
This was a big challenge to both of us. ... To
our mutual amazement, the choker ... looked
great. J. wore it with pride and received many
compliments. This activity not only transformed
a handful of beads into a necklace, but it also
transformed J.’s role from a passive patient
to an active teacher. It was a truly wonderful
experience ... one I will never forget. (p. 5)
The Understanding
That Empowers
Occupational Therapy
Earlier we laid out the mindfulness that makes inter-
ventions “work.” We noted that we must start with deep
understanding. Here we explore the dimensions of the
understanding that we must have. Understanding is a
full appreciation; it is a hard-earned familiarity. When
we understand, we comprehend or grasp things com-
prehensively. Understanding moves us past knowing
to really getting.
Recall the three dimensions of understanding that
occupational therapy practitioners need:
1. We must understand persons, their occupational
natures, and the unsettling disruptions that
personality, and your comfort with
receding quietly into the background.
May Sarton felt that she should
have been acknowledged. A simple
introduction might have pleased her.
1-4: We hope that you can recall many caring
experiences in health care. Usually,
descriptions of caring experiences
include caregiver attitudes and behaviors
that convey respect, consideration, and
understanding. Having been heard makes
a large impression.
1-5: We’re pleased if you thought of
a suggestion to foster this young
therapist’s mindfulness of her patient’s
needs. For our view of how this
conversation might have gone, read
our reframing of the exchange in the
section on Understanding Ourselves
(p. 14).
10 SECTION ONE ✍ Mindful Principles and Processes
occupational challenges can cause in a life so as to
humanize therapy.
2. We must understand our guiding beliefs and
action-oriented principles from person-centered
models in order to set the depth, scope, and
direction of our therapy.
3. We must understand ourselves. We must know
how to use our unique selves so as to become
caring. These three aspects of understanding
support our science and our art.
Your Turn 1-6
Which of the three dimensions of
understanding noted is the one that you feel
you possess and demonstrate the most? To
what do you attribute your capacity?
Understanding Persons and Their
Occupational Natures
To intervene well, occupational therapy practitioners
must understand persons, their occupational natures,
and the unsettling disruptions that occupational chal-
lenges can cause in a life. The strong link between the
human spirit and occupation is well stated by Janet
Petersen (1976) in this snippet from her poem.
There is a shouting SPIRIT
deep inside me:
TAKE CLAY, it cries,
TAKE PEN AND INK
TAKE FLOUR AND WATER,
TAKE A SCRUB BRUSH
TAKE A YELLOW CRAYON
TAKE ANOTHER’S HAND—
AND WITH ALL THESE SAY YOU,
SAY LOVING
So much of who I am
Is subtly spoken in my making (p. 61)
Our grasp of human making lets us see past the sim-
plicity of daily occupations to their deeper meaning.
Philosopher Elaine Scarry (1985) saw in occupation a
world-making function:
As one maneuvers each day through the realm
of tablecloths, dishes, potted plants, ideological
structure, automobiles, newspapers, ideas about
families, streetlights, language, city parks, one
does not at each moment actively perceive the
objects as humanly made; but if one for any
reason stops and thinks about their origins, one
can with varying degrees of ease recover the
fact that they all have human makers. (p. 312)
Occupational challenges force individuals to stop and
think about the making in their lives. Individuals in
our care grasp anew the meaning of the daily doing
that gives them purpose and helps them belong. A
grandmother may grieve because making a family meal
is impossible. A recent graduate may despair over her
lost chance to make a mark at work. A preteen may be
embarrassed that he can’t make himself presentable. We
must stay mindful of such sorrows.
Your Turn 1-7
Name a world-making function that you
would be devastated to lose if injury, illness,
or a chronic condition were to compromise
your capacities.
A practitioner’s understanding of the meaning of
being well occupied can foster an empathy that lessens
sorrow. While thinking of practical ways to help, we can
imagine what it is like to need help with the simplest
or most private of tasks. Such empathy prompts our
hallmark brand of care. Characterized as doing with
another, it stands in high contrast against interventions
that are a doing to (Peloquin, 1995). When we support
the spirit of those who hope to resume their occupa-
tions, we help them remake their lives.
Heller’s occupational therapist, who upped the
grade of sandpaper with the regularity of a machine,
lost touch with our hallmark doing with. Heller found
occupational therapy punishing, and empathy got
lost. Heller was a famous writer, caught in the bind of
Guillain-Barré. Mindless therapy worsened his state:
As soon as he began to sand with rhythm, his task was
made harder. He had hoped to feel success but was
stymied instead. In an ironic twist, his occupational
therapy was a power-down doing to. With the wisdom
of hindsight, we think of things more helpful to Heller.
Sanding sections of a bookend or paper tray might
have given him strength; products related to his writing
might have sparked energetic work and conveyed real
hope. A more recent story of similarly mindless therapy
appears in A Story 1-1.
No practitioner described the enactment of empathy
in occupational therapy better than did Ora Ruggles,
a Reconstruction Aide and pioneer occupational
therapist. We find a legacy in one of her stories. As she
 CHAPTER 1
A STORY 1-1: A Story of Mindless Therapy
as Punishment
From the Life of Cynthia Evetts
The two boys, Mitchell and Marshall, joined their
mother in a visit to their paternal grandmother
in a rehabilitation facility after she had fallen and
injured her hip. The boys were 18 and 12 years
old. When they arrived, their grandmother was
not in her room, so the family went to see her
as she worked on her rehabilitation program
among several others in the same large gym.
The boys saw their grandmother astride a sta-
tionary bicycle, that in itself a rare sight. They also
saw other patients doing therapy: One patient
placed clothespins on a wire. When they were
all placed, the therapist instructed the patient
to remove them all and repeat the process.
Another patient placed geometric shapes into
a box with matching holes. Yet another tossed
beanbags through holes. A fourth placed pegs
into a board. The boys saw that as each patient
finished, the task was either to undo and repeat
or trade tasks with someone nearby. Over and
over, the tasks recurred.
entered the barracks at Fort McPherson, her friends
noted her silence. Ruggles said that her quiet came from
a simple yet huge discovery. She said: “It is not enough
to give a patient something to do with his hands. You
must reach for the heart as well as the hands. It’s the
heart that really does the healing” (Carlova & Ruggles,
1961, p. 59). We hope to enact her vision.
Understanding Our Guiding Beliefs
The second dimension of understanding that makes
therapy work relates to our really getting occupational
therapy. Our essential character lies within the profes-
sion’s ethos. Each guiding belief sets the depth of our
therapy. Each is deeply mindful:
1. We believe that time, place, and circumstance open
paths to occupation. Acting on this belief and
doing the best of what we do, we are pathfinders.
2. We believe that occupation fosters dignity,
competence, and health. Acting on this belief
and doing the best of what we do, we enable
occupations that heal.
✍ The Mindfulness That Empowers Crafts 11
As the boys left the facility, one, earnestly
supported by affirmations from the other, but
not prompted by his occupational therapist
mother, said, “Did you see that? That was awful!
It’s like they were all in purgatory!”
The comment about purgatory begs elabora-
tion. Purgatory, in some belief systems, is a
place where those who have led a life of grace
but are still possessed of sin upon dying expiate
their sins through suffering. Redemption will be
theirs to claim after a period of suffering com-
mensurate with their sins. The term has come
to mean any place of temporary punishment.
Applied to this scenario, rehab practitioners
inflict torment.
Mindless therapy can feel punishing. Although
some therapeutic procedures can cause physi-
cal pain that we may regret, it seems reasonable
that we do our best to change boring approaches
that punish the spirit.
3. We believe that occupational therapy is a personal
engagement. Acting on this belief and doing the
best of what we do, we co-create daily lives.
4. We believe that caring and helping are vital to our
work. Acting on this belief and doing the best of
what we do, we reach for hearts as well as hands.
5. We believe that effective practice is artistry and
science. Acting on this belief and doing the best
of what we do, we are artists and scientists at once
(Peloquin, 2005).
When mindful and doing our best, we enact the
profession’s genius. The contours of our genius are
clearly stated in our guiding beliefs. If we examine the
contours of our daily interventions and hold these up
against those of our genius, we can see whether we are
doing what we profess to do (Fig. 1-6).
Long ago, craftwork was thought to honor nine
curative principles that psychiatrist and founder
William Rush Dunton, Jr. (1921) thought essential
to occupational therapy. Note in Drawing Our Past
Forward 1-1 the early contours of our genius. As we
12 SECTION ONE ✍ Mindful Principles and Processes
FIGURE 1-6 Questionable application of the
occupational therapy genius.
Drawing Our Past Forward 1-1
The Curative Principles of
Occupational Work
William Rush Dunton, Jr., was one of the founders of
the National Society for the Promotion of Occupational
Therapy (NSPOT) who became its president at its Second
Annual Meeting in 1918. A psychiatrist by profession,
Dunton was prolific in writing about his new profession.
He identified nine principles that he thought essential to
occupational work, whether to restore physical or mental
functioning (Dunton, 1919). The principles were these:
1. The work should be carried on with cure
as the main object.
2. The work must be interesting.
3. The patient should be carefully studied.
4. One form of occupation should not be
carried to the point of fatigue.
5. It should have some useful end.
6. It preferably should lead to an increase in
the patient’s knowledge.
7. It should be carried on with others.
8. All possible encouragement should be
given the worker.
9. Work resulting in a poor or useless
product is better than idleness. (p. 320)
We find it notable that the use of mindful crafts almost
a century later still honors these principles to a great
extent.
Dunton, W. R. (1919). Reconstruction therapy. Philadelphia: Saunders.
enact that genius in our time, we reclaim our heart
(Peloquin, 2005).
Insights From Holistic
Person-Centered Models:
Person-Environment-Occupation
and Recovery
Our understanding of occupational therapy must press
further than “getting” our guiding beliefs. If we seek
to implement those beliefs in ways that work well, we
must act on them. We must understand action-oriented
principles drawn from holistic and person-centered
models. Such principles set the scope and direction for
best practice. Holistic models set our scope of concern
wide, capturing the richness of persons as occupational
beings. And person-centered models direct us to see our
clients as experts in framing their needs. We discuss
two models: The Person-Environment-Occupation
(PEO) model (Law, Cooper, Strong, Stewart, Rigby, &
Letts, 1996) and the recovery model (Deegan, 2001;
Onken, Craig, Ridgway, Ralph, & Cook, 2007). Both
embrace holism; both center on clients as primary
agents.
Understanding the
person-environment-occupation model
The PEO model captures the fullness of persons as
“composites of mind, body, and spiritual qualities”
(Law et al., 1996). The model further considers the
influences outside of persons that shape everyday
doing—the occupation itself as well as the environment
within which performance is expected. Because the
model includes the richness and complexity of personal
performance, it is holistic.
When in an analytical frame of mind within this
model, we can tease the discrete ways in which the
person (P), environment (E), and occupation (O)
shape any performance. We might call each of the three
components, whether P, E, or O, an agent—a person
or thing that brings about a result. In this case, the
result is performance of an occupation. The PEO model
proposes that person, environment, and occupation
have a relationship that is transactive, meaning built
on mutual agency. Any performance is “the outcome
of the transaction of the person, environment, and
occupation” (Law, et al., 1996, p. 16).
Let’s consider the PEO transaction further. Consider
P and E and O as influential agents, each with potential
for hindering or supporting occupational performance.
One observable performance—successful hammering
of a nail—seen in its complexity, might be this: Chuck
 CHAPTER 1
Cawshun, a 30-something man, stands poised to
hammer a 2.5″ nail into a 12″ × 12″ pine beam in his
dimly lit garage. He has carpal tunnel syndrome. He
wears two wrist cock-up splints that hold his wrist in
a neutral position. He holds between his knees an 8″ ×
8″ decorative metal sign reading Man Cave. An open
can of blue paint, the lid, a can opener, and a wooden
paint stirrer lie on newspaper 6 inches behind Chuck’s
right foot. A tabby cat sits about 2 feet to Chuck’s right,
licking its paw.
The person (P) in this case is Chuck Cawshun, a
30-something man. He holds a hammer in his right
hand and a nail in his left while wearing carpal tunnel
splints. Pressed together, his knees hold a Man Cave
sign. According to the PEO model, Chuck, as P, is “a
unique being who assumes a variety of roles ... brings
a set of attributes and life experiences to bear on
the transaction ... including self-concept, personality
style, cultural background, and personal competen-
cies” (p. 16). Chuck’s parents used quirky humor
when naming him; he takes well any plays on “Chuck
Caution.”
The environment (E) in this case is the dimly lit
garage and everything in it. But the environment can
be described much more broadly to include social,
cultural, and socioeconomic considerations (Law et
al., 1996). We might benefit from knowing that Chuck
owns his home and garage and gathers there with
coworkers in a computer-programming firm to play
poker every Friday night. He and his wife agree that
the garage is his domain.
Within this model, persons pursue occupations for
the sake of self-maintenance, self-expression, or fulfill-
ment. Chuck’s Friday night games fulfill his need for
male bonding. By the model’s standards, Chuck’s occu-
pation in this moment has hierarchical distinctions.
The broad occupation (O), the decoration of Chuck’s
garage, is “a cluster of activities and tasks in which a
person engages in order to meet his intrinsic needs
for self-maintenance, expression, and fulfillment”
(p. 16). The narrower task is hanging a Man Cave sign
on an upright beam, one of a “set of purposeful activi-
ties in which a person engages” (p. 16). And the specific
activity is narrower still—hammering the nail, or “the
basic unit of any task” (p. 16).
We can predict possible outcomes for this transac-
tion. Wrist pain (P) might distract Chuck. Hitting the
mark with the hammer (O) might be awkward with
splints. The open can behind Chuck in this dimly lit
space (E) might lead to spillage. The cat (E) might bolt
at the crack of the hammer. We’d hope that Chuck’s
humor and coping style (P) would support him.
✍ The Mindfulness That Empowers Crafts 13
Your Turn 1-8
Consider one daily task or activity in which
you engage. Using our example of Chuck,
analytically tease out the PEO agents and
describe the transaction that occurs during
your performance.
The PEO model holds as central that occupational
therapy aims to maximize the fit among the three
transacting components—person, environment, and
occupation—so that optimal performance will occur
(Law et al., 1996). Practitioners work with clients
to structure interventions—PEO transactions—that
enhance performance. For a good fit to occur, interven-
tions often enable changes within the person, the envi-
ronment, or the occupation that support performance.
If Chuck Cawshun were to seek input on his approach
to hammering a nail, an occupational therapist would
explore with him possible changes—whether related to
the use of his wrist (P), the state of his garage (E), or the
way in which hammering might occur (O)—in order to
enhance goodness of fit and his success.
Two other principles from the PEO model are
key to our discussion of mindful crafts and to their
manner of effecting change: (1) “Consider interven-
tions that target the person, environment, and occupa-
tion in different ways,” and (2) “Consider the option of
using multiple avenues for eliciting change” (Law et al.,
1996, p. 18). These considerations prompt us to plan
interventions creatively. They direct us to a variety of
enabling methods that can include crafts.
If used with June Kailes, these principles from
the PEO model would have taken her past drills in
bead sorting. June’s coordination would have stayed
important, but the intervention would have honored
June’s intelligence (P) as well as her leadership in the
Independent Living Center (O and E). A mindful
occupational therapist would have collaborated with
June to find a meaningful way to tap coordination. A
practitioner’s craft suggestions might have been (1) a
motivational office poster using stencils and markers,
(2) a collage on freedom decorating a manila folder
or bookmark, or (3) any craft requiring coordinated
assembly that June considered useful. A practitioner
who really gets the PEO model chooses interventions
that honor the richness and complexity of persons. If
the focus of an intervention must at a given time be on a
person’s strength or coordination, the scope of the PEO
14 SECTION ONE ✍ Mindful Principles and Processes
model can hold that focus while also capturing the big
picture of all else that matters to that person.
Understanding the recovery model
In the past 15 years, a recovery approach to mental
health has emerged in the United Kingdom, North
America, Australia, and New Zealand (Ralph, 2000;
Spandler, Secker, Kent, Hacking, & Shelton, 2007). The
Substance Abuse and Mental Health Services Admin-
istration (SAMHSA, n.d.) describes recovery as a
“journey of healing and transformation.” Occupational
therapist Patricia Deegan (2001) first used the journey
metaphor while characterizing helpers in this model
as facilitators who support self-direction and skill in
managing illness. The idea of “fixing” chronic illness
is not a central aim. Rather, the aim is living life well
when illness is present.
Onken et al. (2007) characterized this idea of
recovery as an integrative paradigm or model. Note
how their analysis of the recovery model recalls the
PEO model and several guiding beliefs in occupational
therapy:
Recovery is a product of dynamic interaction
among characteristics of the individual (the
self/hope/sense of meaning and purpose),
characteristics of the environment (basic
material resources, social relationships,
meaningful activities, peer support, formal
services, formal service staff ), and the
characteristics of the exchange (hope, choice/
empowerment, independence/interdependence).
(p. vii)
In a review of the literature, Davidson et al. (2005)
clarified this dynamic interaction, offering guiding
principles for those engaged in recovery: (1) renew
hope and commitment, (2) redefine the self, (3)
incorporate illness as but one aspect of the self, (4)
be involved in meaningful activities, (5) overcome
stigma, (6) assume control and become empowered,
(7) manage symptoms, and (8) be supported by others.
In a professional fact sheet, the American Occupational
Therapy Association (AOTA) has endorsed the model’s
congruence with practice in mental health (2016). We
propose that the model works for most occupational
therapy practice when one considers the components
thought to characterize the journey.
Ten fundamental components of recovery appear
in the national consensus statement published by
SAMHSA (n.d.). The components remind practitioners
and clients to support actions that align with these
perspectives: (1) self-direction, (2) individualized and
person centered, (3) empowerment, (4) holistic, (5)
nonlinear, (6) strengths based, (7) peer support, (8)
respect, (9) responsibility, and (10) hope. We illustrate
in Box 1-1 each recovery component as enacted in
Baer’s intervention with J., “The Mountain Man.”
The person-centered influences of the recovery
model can shape best practice in occupational therapy.
That claim seems clear in Box 1-2, where we showcase
the potential of the recovery components in shaping
daily interventions.
Well-elaborated recovery components reflect a
definition of recovery that resonates with occupational
therapy: “It is a way of living a satisfying, hopeful, and
contributing life, with or without limitations caused by
the illness. Recovery involves the development of new
meaning and purpose in one’s life” (Anthony, Cohen,
Farkas, & Gagne, 2002).
Your Turn 1-9
Of the 10 components drawn from the
recovery model, which do you think might
be the easiest for you to enact in practice
and why?
Understanding Ourselves
The third dimension of understanding vital to occu-
pational therapy comes from our turning inward to
understand ourselves and how we can work with
others. This aspect of mindfulness helps us become as
caring as we are skilled. Mindful practice first requires
a conscious use of self. This passage explains:
The fact is that wherever one goes, one’s “self ”
goes there too. To know that self, to cultivate
the best of one’s abilities in order to help, is part
of therapy. Some practitioners are especially
good listeners, some are witty, some can charm
a crowd. Some have deep patience, some sing
well, and others love sports. When practitioners
consciously use themselves and their talents
to meet needs that arise in therapy, that action
becomes a tool. Likewise when one knows and
monitors one’s less helpful responses, that, too,
is a conscious use of self. Some practitioners are
moody; some are sensitive to criticism, some
tend to be impulsive. When practitioners note
these tendencies, when they apologize if they
surface unexpectedly, their actions are tools in
therapy. (Peloquin, 2000)
 CHAPTER 1
Box 1-1 | Recovery Components in the Case of
J. the Mountain Man
Self-direction: J. identified his need for a beaded
choker.
Individualized and person centered: The necklace
would cover J.’s tracheotomy scar, eliminating
his embarrassment.
Empowerment: J. directed the therapist as he
would need to direct his caregivers.
Holistic: J.’s necklace was familiar to those in his
age group in Texas (E). He had the intellect
and communication skills to direct another
(P). Beading was a familiar task (O).
Nonlinear (meaning nonsequential in process
with a mix of growth and setbacks): The
occupational therapist called the process
challenging. We imagine back-and-forth
exchanges to get the directions clear and the
beading right. Craftwork here is a metaphor
for recovery.
Box 1-2 | Recovery Components Possible in Occupational
Therapy Practice
We can support the self-direction of our clients.
We can affirm their capacity to make choices
and to find unique pathways to self-determined
lives.
We can assure that our interventions are
individualized and person centered. We can find
the unique strengths of clients as we help them
to meet their needs.
We can attend to the empowerment of our
clients. We can assure that they collaborate in
therapeutic decisions and find a renewed sense
of personal control.
We can be holistic in our perception of client
needs. We can focus on discrete problems while
also respecting an individual’s whole life, to
include mind, body, spirit, and community.
We can remind clients that progress can
be nonlinear. We can help them accept that
✍ The Mindfulness That Empowers Crafts 15
Strengths-based: Paralyzed from the neck down,
J. lacked hand function but used his other
skills and experiences.
Peer support: J. and Baer functioned as peers,
at once giving and getting support.
Respect: Baer respected J.’s capacity to
“transform himself from a passive patient to
an active teacher.” J. took pride in the piece
and heard many compliments.
Responsibility: J. and Baer collaborated, each
responsible for discrete aspects of the work.
J. took on the design and directions. Betty
lent J. her hands.
Hope: Baer’s idea that they make a choker
together was a strong affirmation of hope.
J.’s acceptance was equally hopeful.
although setbacks may occur, overall growth is
part of the journey.
We can hold a strengths-based mindset. We
can prompt our clients to focus on capacities
while developing relationships built on trust.
We can foster peer support among our
clients. We can encourage them to engage in
mutually supportive exchanges that yield a
sense of belonging.
We can uphold mutual respect as our central
norm. We can foster dignity and promote
inclusion and participation.
We can shape responsibility. We can
encourage clients to set personal goals and to
embrace the actions that achieve them.
We can foster hope. We can convey the belief
that individuals can meet most challenges when
they stay positive and focus on possibilities.
16 SECTION ONE ✍ Mindful Principles and Processes
Conscious use of self comes first. When awareness of
self turns helpful, therapeutic use of self emerges.
To be therapeutic in the sense of the word, we must
learn how to use the “self ” in a way that promotes
health and well-being. Renée Taylor’s (2008) discussion
of the intentional relationship helps enormously with
that learning. We note high points of her work here
and elaborate them in subsequent chapters. We recom-
mend her book for the sake of deep understanding.
Taylor, although not an occupational therapist, knows
our practice well. She brings from her psychological
practice keen insights into ours.
Taylor (2008) interviewed and videotaped occu-
pational therapists at work, choosing individuals
thought by peers to be skilled in use of self. She then
elaborated the modes of interaction most common in
occupational therapy: advocating, collaborating, empa-
thizing, encouraging, instructing, and problem solving.
She described each mode to include its applications,
strengths, and weaknesses. She identified client disposi-
tions that invite or discourage one mode over another.
She suggested ways to handle “inevitable interpersonal
events” and “empathic breaks (rifts in understanding
between client and therapist)” lest they thwart our
practice (Taylor, 2008, p. 51).
A core principle of Taylor’s intentional relationship
model (2008) is that we heed the therapeutic relation-
ship. Her model leads us to seek a good fit not just
in our interventions but also in our interactions. She
proposed that, both in advance of and in the moment,
we align our intentions well among those with diverse
preferences, unique needs, and wide-ranging goals. We
must also respond flexibly, as in a partnered dance. It
would be mindless, for example, to choose one mode
and use it exclusively because it “felt natural.” To get
stuck in a problem-solving mode, for example, risks
turning us into caregivers thought to fix more than care
(Peloquin, 1993b). The challenge to learn and use the
modes well is large. But if we really “get” therapeutic
use of self, client perceptions of our caring will grow.
The poem that starts, “Preserve me from the occu-
pational therapist, God,” speaks to the use of self. The
patient calls the therapist a “dear child who means
well,” noting her good intentions. But empathic breaks
occur. The therapist sees closed eyes and perceives a
dozing woman. She chides, “You don’t want to sleep
the day away.” This woman is not dozing. Her thoughts
reveal her need: “Yes, I did those things, and cooked
and cleaned, and raised five children and had things
happen to me ... I need to think about them, rearrange
them on the shelves of my mind.” This need escaped her
young OT.
What if the therapist had used herself differ-
ently? The exchange in Box 1-3 might have occurred
instead:
There is comfort in knowing that the best of caregiv-
ers have empathic breaks. Ruggles (Carlova & Ruggles,
1961) shared hers: “He hadn’t done very well when I
first started with him, but he’s doing fine now. I asked
myself why, and the answer suddenly came to me—the
patient had improved because I had. I had become truly
concerned about him” (p. 69).
The Logical Analysis
and Imaginative Synthesis
That Empower
Occupational Therapy
In the previous section, we noted that practitioners
must use deep understanding if interventions are to
“work.” This section explores the logical analysis and
imaginative synthesis that we must also use. Let’s start
with logic, otherwise known as sound reasoning and
good judgment. Throughout our discussion of under-
standing, we appealed to your logic while making key
points about practice turned mindless. On the edges of
our discussion has been the assumption that craftwork
is a viable intervention. Before we move into logical
activity analysis, we will target the logic of the assump-
tion that crafts have therapeutic worth.
Logical Assumptions About the
Therapeutic Potential of Craftwork
When considering craftwork as mindful therapy in the
light of logic, we might ask: (1) Can craftwork reflect an
understanding of persons, their occupational natures,
and the disruptive effects of occupational challenges?
(2) Can craftwork reflect the guiding beliefs of occupa-
tional therapy and the action-oriented principles drawn
from the PEO and recovery models? (3) Can craftwork
invite practitioners to use themselves both consciously
and therapeutically? We believe so. In our discussion,
we showcased craftwork run amuck and then done
right. We made logical assumptions about how and why
crafts might work therapeutically. Those assumptions
are featured in Box 1-4. We offer two more reasons to
propose craftwork as therapeutic. These reasons, also
grounded in logic, relate to (1) the nature of craftwork
and (2) the profession’s longstanding use of occupations
favored within the culture.
Occupational therapist Beth Velde (1999) examined
the nature of craftwork extensively in her review of
the literature on crafts. She reminded us that many
occupations include a crafting process, from camping
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 DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI

Newala, too, suffers from the distance of its water-supply—at least

the Newala of to-day does; there was once another Newala in a lovely
valley at the foot of the plateau. I visited it and found scarcely a trace
of houses, only a Christian cemetery, with the graves of several
missionaries and their converts, remaining as a monument of its
former glories. But the surroundings are wonderfully beautiful. A
thick grove of splendid mango-trees closes in the weather-worn
crosses and headstones; behind them, combining the useful and the
agreeable, is a whole plantation of lemon-trees covered with ripe
fruit; not the small African kind, but a much larger and also juicier
imported variety, which drops into the hands of the passing traveller,
without calling for any exertion on his part. Old Newala is now under
the jurisdiction of the native pastor, Daudi, at Chingulungulu, who,
as I am on very friendly terms with him, allows me, as a matter of
course, the use of this lemon-grove during my stay at Newala.
 FEET MUTILATED BY THE RAVAGES OF THE “JIGGER”
(Sarcopsylla penetrans)

The water-supply of New Newala is in the bottom of the valley,

some 1,600 feet lower down. The way is not only long and fatiguing,
but the water, when we get it, is thoroughly bad. We are suffering not
only from this, but from the fact that the arrangements at Newala are
nothing short of luxurious. We have a separate kitchen—a hut built
against the boma palisade on the right of the baraza, the interior of
which is not visible from our usual position. Our two cooks were not
long in finding this out, and they consequently do—or rather neglect
to do—what they please. In any case they do not seem to be very
particular about the boiling of our drinking-water—at least I can
attribute to no other cause certain attacks of a dysenteric nature,
from which both Knudsen and I have suffered for some time. If a
man like Omari has to be left unwatched for a moment, he is capable
of anything. Besides this complaint, we are inconvenienced by the
state of our nails, which have become as hard as glass, and crack on
the slightest provocation, and I have the additional infliction of
pimples all over me. As if all this were not enough, we have also, for
the last week been waging war against the jigger, who has found his
Eldorado in the hot sand of the Makonde plateau. Our men are seen
all day long—whenever their chronic colds and the dysentery likewise
raging among them permit—occupied in removing this scourge of
Africa from their feet and trying to prevent the disastrous
consequences of its presence. It is quite common to see natives of
this place with one or two toes missing; many have lost all their toes,
or even the whole front part of the foot, so that a well-formed leg
ends in a shapeless stump. These ravages are caused by the female of
Sarcopsylla penetrans, which bores its way under the skin and there
develops an egg-sac the size of a pea. In all books on the subject, it is
stated that one’s attention is called to the presence of this parasite by
an intolerable itching. This agrees very well with my experience, so
far as the softer parts of the sole, the spaces between and under the
toes, and the side of the foot are concerned, but if the creature
penetrates through the harder parts of the heel or ball of the foot, it
may escape even the most careful search till it has reached maturity.
Then there is no time to be lost, if the horrible ulceration, of which
we see cases by the dozen every day, is to be prevented. It is much
easier, by the way, to discover the insect on the white skin of a
European than on that of a native, on which the dark speck scarcely
shows. The four or five jiggers which, in spite of the fact that I
constantly wore high laced boots, chose my feet to settle in, were
taken out for me by the all-accomplished Knudsen, after which I
thought it advisable to wash out the cavities with corrosive
sublimate. The natives have a different sort of disinfectant—they fill
the hole with scraped roots. In a tiny Makua village on the slope of
the plateau south of Newala, we saw an old woman who had filled all
the spaces under her toe-nails with powdered roots by way of
prophylactic treatment. What will be the result, if any, who can say?
The rest of the many trifling ills which trouble our existence are
really more comic than serious. In the absence of anything else to
smoke, Knudsen and I at last opened a box of cigars procured from
the Indian store-keeper at Lindi, and tried them, with the most
distressing results. Whether they contain opium or some other
narcotic, neither of us can say, but after the tenth puff we were both
“off,” three-quarters stupefied and unspeakably wretched. Slowly we
recovered—and what happened next? Half-an-hour later we were
once more smoking these poisonous concoctions—so insatiable is the
craving for tobacco in the tropics.
Even my present attacks of fever scarcely deserve to be taken
seriously. I have had no less than three here at Newala, all of which
have run their course in an incredibly short time. In the early
afternoon, I am busy with my old natives, asking questions and
making notes. The strong midday coffee has stimulated my spirits to
an extraordinary degree, the brain is active and vigorous, and work
progresses rapidly, while a pleasant warmth pervades the whole
body. Suddenly this gives place to a violent chill, forcing me to put on
my overcoat, though it is only half-past three and the afternoon sun
is at its hottest. Now the brain no longer works with such acuteness
and logical precision; more especially does it fail me in trying to
establish the syntax of the difficult Makua language on which I have
ventured, as if I had not enough to do without it. Under the
circumstances it seems advisable to take my temperature, and I do
so, to save trouble, without leaving my seat, and while going on with
my work. On examination, I find it to be 101·48°. My tutors are
abruptly dismissed and my bed set up in the baraza; a few minutes
later I am in it and treating myself internally with hot water and
lemon-juice.
Three hours later, the thermometer marks nearly 104°, and I make
them carry me back into the tent, bed and all, as I am now perspiring
heavily, and exposure to the cold wind just beginning to blow might
mean a fatal chill. I lie still for a little while, and then find, to my
great relief, that the temperature is not rising, but rather falling. This
is about 7.30 p.m. At 8 p.m. I find, to my unbounded astonishment,
that it has fallen below 98·6°, and I feel perfectly well. I read for an
hour or two, and could very well enjoy a smoke, if I had the
wherewithal—Indian cigars being out of the question.
Having no medical training, I am at a loss to account for this state
of things. It is impossible that these transitory attacks of high fever
should be malarial; it seems more probable that they are due to a
kind of sunstroke. On consulting my note-book, I become more and
more inclined to think this is the case, for these attacks regularly
follow extreme fatigue and long exposure to strong sunshine. They at
least have the advantage of being only short interruptions to my
work, as on the following morning I am always quite fresh and fit.
My treasure of a cook is suffering from an enormous hydrocele which
makes it difficult for him to get up, and Moritz is obliged to keep in
the dark on account of his inflamed eyes. Knudsen’s cook, a raw boy
from somewhere in the bush, knows still less of cooking than Omari;
consequently Nils Knudsen himself has been promoted to the vacant
post. Finding that we had come to the end of our supplies, he began
by sending to Chingulungulu for the four sucking-pigs which we had
bought from Matola and temporarily left in his charge; and when
they came up, neatly packed in a large crate, he callously slaughtered
the biggest of them. The first joint we were thoughtless enough to
entrust for roasting to Knudsen’s mshenzi cook, and it was
consequently uneatable; but we made the rest of the animal into a
jelly which we ate with great relish after weeks of underfeeding,
consuming incredible helpings of it at both midday and evening
meals. The only drawback is a certain want of variety in the tinned
vegetables. Dr. Jäger, to whom the Geographical Commission
entrusted the provisioning of the expeditions—mine as well as his
own—because he had more time on his hands than the rest of us,
seems to have laid in a huge stock of Teltow turnips,[46] an article of
food which is all very well for occasional use, but which quickly palls
when set before one every day; and we seem to have no other tins
left. There is no help for it—we must put up with the turnips; but I
am certain that, once I am home again, I shall not touch them for ten
years to come.
Amid all these minor evils, which, after all, go to make up the
genuine flavour of Africa, there is at least one cheering touch:
Knudsen has, with the dexterity of a skilled mechanic, repaired my 9
× 12 cm. camera, at least so far that I can use it with a little care.
How, in the absence of finger-nails, he was able to accomplish such a
ticklish piece of work, having no tool but a clumsy screw-driver for
taking to pieces and putting together again the complicated
mechanism of the instantaneous shutter, is still a mystery to me; but
he did it successfully. The loss of his finger-nails shows him in a light
contrasting curiously enough with the intelligence evinced by the
above operation; though, after all, it is scarcely surprising after his
ten years’ residence in the bush. One day, at Lindi, he had occasion
to wash a dog, which must have been in need of very thorough
cleansing, for the bottle handed to our friend for the purpose had an
extremely strong smell. Having performed his task in the most
conscientious manner, he perceived with some surprise that the dog
did not appear much the better for it, and was further surprised by
finding his own nails ulcerating away in the course of the next few
days. “How was I to know that carbolic acid has to be diluted?” he
mutters indignantly, from time to time, with a troubled gaze at his
mutilated finger-tips.
 Since we came to Newala we have been making excursions in all
directions through the surrounding country, in accordance with old
habit, and also because the akida Sefu did not get together the tribal
elders from whom I wanted information so speedily as he had
promised. There is, however, no harm done, as, even if seen only
from the outside, the country and people are interesting enough.
The Makonde plateau is like a large rectangular table rounded off
at the corners. Measured from the Indian Ocean to Newala, it is
about seventy-five miles long, and between the Rovuma and the
Lukuledi it averages fifty miles in breadth, so that its superficial area
is about two-thirds of that of the kingdom of Saxony. The surface,
however, is not level, but uniformly inclined from its south-western
edge to the ocean. From the upper edge, on which Newala lies, the
eye ranges for many miles east and north-east, without encountering
any obstacle, over the Makonde bush. It is a green sea, from which
here and there thick clouds of smoke rise, to show that it, too, is
inhabited by men who carry on their tillage like so many other
primitive peoples, by cutting down and burning the bush, and
manuring with the ashes. Even in the radiant light of a tropical day
such a fire is a grand sight.
Much less effective is the impression produced just now by the
great western plain as seen from the edge of the plateau. As often as
time permits, I stroll along this edge, sometimes in one direction,
sometimes in another, in the hope of finding the air clear enough to
let me enjoy the view; but I have always been disappointed.
Wherever one looks, clouds of smoke rise from the burning bush,
and the air is full of smoke and vapour. It is a pity, for under more
favourable circumstances the panorama of the whole country up to
the distant Majeje hills must be truly magnificent. It is of little use
taking photographs now, and an outline sketch gives a very poor idea
of the scenery. In one of these excursions I went out of my way to
make a personal attempt on the Makonde bush. The present edge of
the plateau is the result of a far-reaching process of destruction
through erosion and denudation. The Makonde strata are
everywhere cut into by ravines, which, though short, are hundreds of
yards in depth. In consequence of the loose stratification of these
beds, not only are the walls of these ravines nearly vertical, but their
upper end is closed by an equally steep escarpment, so that the
western edge of the Makonde plateau is hemmed in by a series of
deep, basin-like valleys. In order to get from one side of such a ravine
to the other, I cut my way through the bush with a dozen of my men.
It was a very open part, with more grass than scrub, but even so the
short stretch of less than two hundred yards was very hard work; at
the end of it the men’s calicoes were in rags and they themselves
bleeding from hundreds of scratches, while even our strong khaki
suits had not escaped scatheless.

NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAHUTA

I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
 The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.

MAKONDE LOCK AND KEY AT JUMBE CHAURO

 This is the general way of closing a house. The Makonde at Jumbe
Chauro, however, have a much more complicated, solid and original
one. Here, too, the door is as already described, except that there is
only one post on the inside, standing by itself about six inches from
one side of the doorway. Opposite this post is a hole in the wall just
large enough to admit a man’s arm. The door is closed inside by a
large wooden bolt passing through a hole in this post and pressing
with its free end against the door. The other end has three holes into
which fit three pegs running in vertical grooves inside the post. The
door is opened with a wooden key about a foot long, somewhat
curved and sloped off at the butt; the other end has three pegs
corresponding to the holes, in the bolt, so that, when it is thrust
through the hole in the wall and inserted into the rectangular
opening in the post, the pegs can be lifted and the bolt drawn out.[50]

MODE OF INSERTING THE KEY

With no small pride first one householder and then a second

showed me on the spot the action of this greatest invention of the
Makonde Highlands. To both with an admiring exclamation of
“Vizuri sana!” (“Very fine!”). I expressed the wish to take back these
marvels with me to Ulaya, to show the Wazungu what clever fellows
the Makonde are. Scarcely five minutes after my return to camp at
Newala, the two men came up sweating under the weight of two
heavy logs which they laid down at my feet, handing over at the same
time the keys of the fallen fortress. Arguing, logically enough, that if
the key was wanted, the lock would be wanted with it, they had taken
their axes and chopped down the posts—as it never occurred to them
to dig them out of the ground and so bring them intact. Thus I have
two badly damaged specimens, and the owners, instead of praise,
come in for a blowing-up.
The Makua huts in the environs of Newala are especially
miserable; their more than slovenly construction reminds one of the
temporary erections of the Makua at Hatia’s, though the people here
have not been concerned in a war. It must therefore be due to
congenital idleness, or else to the absence of a powerful chief. Even
the baraza at Mlipa’s, a short hour’s walk south-east of Newala,
shares in this general neglect. While public buildings in this country
are usually looked after more or less carefully, this is in evident
danger of being blown over by the first strong easterly gale. The only
attractive object in this whole district is the grave of the late chief
Mlipa. I visited it in the morning, while the sun was still trying with
partial success to break through the rolling mists, and the circular
grove of tall euphorbias, which, with a broken pot, is all that marks
the old king’s resting-place, impressed one with a touch of pathos.
Even my very materially-minded carriers seemed to feel something
of the sort, for instead of their usual ribald songs, they chanted
solemnly, as we marched on through the dense green of the Makonde
bush:—
 “We shall arrive with the great master; we stand in a row and have
no fear about getting our food and our money from the Serkali (the
Government). We are not afraid; we are going along with the great
master, the lion; we are going down to the coast and back.”
With regard to the characteristic features of the various tribes here
on the western edge of the plateau, I can arrive at no other
conclusion than the one already come to in the plain, viz., that it is
impossible for anyone but a trained anthropologist to assign any
given individual at once to his proper tribe. In fact, I think that even
an anthropological specialist, after the most careful examination,
might find it a difficult task to decide. The whole congeries of peoples
collected in the region bounded on the west by the great Central
African rift, Tanganyika and Nyasa, and on the east by the Indian
Ocean, are closely related to each other—some of their languages are
only distinguished from one another as dialects of the same speech,
and no doubt all the tribes present the same shape of skull and
structure of skeleton. Thus, surely, there can be no very striking
differences in outward appearance.
 Even did such exist, I should have no time
to concern myself with them, for day after day,
I have to see or hear, as the case may be—in
any case to grasp and record—an
extraordinary number of ethnographic
phenomena. I am almost disposed to think it
fortunate that some departments of inquiry, at
least, are barred by external circumstances.
Chief among these is the subject of iron-
working. We are apt to think of Africa as a
country where iron ore is everywhere, so to
speak, to be picked up by the roadside, and
where it would be quite surprising if the
inhabitants had not learnt to smelt the
material ready to their hand. In fact, the
knowledge of this art ranges all over the
continent, from the Kabyles in the north to the
Kafirs in the south. Here between the Rovuma
and the Lukuledi the conditions are not so
favourable. According to the statements of the
Makonde, neither ironstone nor any other
form of iron ore is known to them. They have
not therefore advanced to the art of smelting
the metal, but have hitherto bought all their
THE ANCESTRESS OF
THE MAKONDE
iron implements from neighbouring tribes.
Even in the plain the inhabitants are not much
better off. Only one man now living is said to
understand the art of smelting iron. This old fundi lives close to
Huwe, that isolated, steep-sided block of granite which rises out of
the green solitude between Masasi and Chingulungulu, and whose
jagged and splintered top meets the traveller’s eye everywhere. While
still at Masasi I wished to see this man at work, but was told that,
frightened by the rising, he had retired across the Rovuma, though
he would soon return. All subsequent inquiries as to whether the
fundi had come back met with the genuine African answer, “Bado”
(“Not yet”).
 BRAZIER

Some consolation was afforded me by a brassfounder, whom I

came across in the bush near Akundonde’s. This man is the favourite
of women, and therefore no doubt of the gods; he welds the glittering
brass rods purchased at the coast into those massive, heavy rings
which, on the wrists and ankles of the local fair ones, continually give
me fresh food for admiration. Like every decent master-craftsman he
had all his tools with him, consisting of a pair of bellows, three
crucibles and a hammer—nothing more, apparently. He was quite
willing to show his skill, and in a twinkling had fixed his bellows on
the ground. They are simply two goat-skins, taken off whole, the four
legs being closed by knots, while the upper opening, intended to
admit the air, is kept stretched by two pieces of wood. At the lower
end of the skin a smaller opening is left into which a wooden tube is
stuck. The fundi has quickly borrowed a heap of wood-embers from
the nearest hut; he then fixes the free ends of the two tubes into an
earthen pipe, and clamps them to the ground by means of a bent
piece of wood. Now he fills one of his small clay crucibles, the dross
on which shows that they have been long in use, with the yellow
material, places it in the midst of the embers, which, at present are
only faintly glimmering, and begins his work. In quick alternation
the smith’s two hands move up and down with the open ends of the
bellows; as he raises his hand he holds the slit wide open, so as to let
the air enter the skin bag unhindered. In pressing it down he closes
the bag, and the air puffs through the bamboo tube and clay pipe into
the fire, which quickly burns up. The smith, however, does not keep
on with this work, but beckons to another man, who relieves him at
the bellows, while he takes some more tools out of a large skin pouch
carried on his back. I look on in wonder as, with a smooth round
stick about the thickness of a finger, he bores a few vertical holes into
the clean sand of the soil. This should not be difficult, yet the man
seems to be taking great pains over it. Then he fastens down to the
ground, with a couple of wooden clamps, a neat little trough made by
splitting a joint of bamboo in half, so that the ends are closed by the
two knots. At last the yellow metal has attained the right consistency,
and the fundi lifts the crucible from the fire by means of two sticks
split at the end to serve as tongs. A short swift turn to the left—a
tilting of the crucible—and the molten brass, hissing and giving forth
clouds of smoke, flows first into the bamboo mould and then into the
holes in the ground.
The technique of this backwoods craftsman may not be very far
advanced, but it cannot be denied that he knows how to obtain an
adequate result by the simplest means. The ladies of highest rank in
this country—that is to say, those who can afford it, wear two kinds
of these massive brass rings, one cylindrical, the other semicircular
in section. The latter are cast in the most ingenious way in the
bamboo mould, the former in the circular hole in the sand. It is quite
a simple matter for the fundi to fit these bars to the limbs of his fair
customers; with a few light strokes of his hammer he bends the
pliable brass round arm or ankle without further inconvenience to
the wearer.
SHAPING THE POT

SMOOTHING WITH MAIZE-COB

CUTTING THE EDGE

 FINISHING THE BOTTOM

LAST SMOOTHING BEFORE

BURNING

FIRING THE BRUSH-PILE

 LIGHTING THE FARTHER SIDE OF
THE PILE

TURNING THE RED-HOT VESSEL

NYASA WOMAN MAKING POTS AT MASASI

Pottery is an art which must always and everywhere excite the
interest of the student, just because it is so intimately connected with
the development of human culture, and because its relics are one of
the principal factors in the reconstruction of our own condition in
prehistoric times. I shall always remember with pleasure the two or
three afternoons at Masasi when Salim Matola’s mother, a slightly-
built, graceful, pleasant-looking woman, explained to me with
touching patience, by means of concrete illustrations, the ceramic art
of her people. The only implements for this primitive process were a
lump of clay in her left hand, and in the right a calabash containing
the following valuables: the fragment of a maize-cob stripped of all
its grains, a smooth, oval pebble, about the size of a pigeon’s egg, a
few chips of gourd-shell, a bamboo splinter about the length of one’s
hand, a small shell, and a bunch of some herb resembling spinach.
 Nothing more. The woman scraped with the
shell a round, shallow hole in the soft, fine
sand of the soil, and, when an active young
girl had filled the calabash with water for her,
she began to knead the clay. As if by magic it
gradually assumed the shape of a rough but
already well-shaped vessel, which only wanted
a little touching up with the instruments
before mentioned. I looked out with the
MAKUA WOMAN closest attention for any indication of the use
MAKING A POT. of the potter’s wheel, in however rudimentary
SHOWS THE a form, but no—hapana (there is none). The
BEGINNINGS OF THE embryo pot stood firmly in its little
POTTER’S WHEEL
depression, and the woman walked round it in
a stooping posture, whether she was removing
small stones or similar foreign bodies with the maize-cob, smoothing
the inner or outer surface with the splinter of bamboo, or later, after
letting it dry for a day, pricking in the ornamentation with a pointed
bit of gourd-shell, or working out the bottom, or cutting the edge
with a sharp bamboo knife, or giving the last touches to the finished
vessel. This occupation of the women is infinitely toilsome, but it is
without doubt an accurate reproduction of the process in use among
our ancestors of the Neolithic and Bronze ages.
There is no doubt that the invention of pottery, an item in human
progress whose importance cannot be over-estimated, is due to
women. Rough, coarse and unfeeling, the men of the horde range
over the countryside. When the united cunning of the hunters has
succeeded in killing the game; not one of them thinks of carrying
home the spoil. A bright fire, kindled by a vigorous wielding of the
drill, is crackling beside them; the animal has been cleaned and cut
up secundum artem, and, after a slight singeing, will soon disappear
under their sharp teeth; no one all this time giving a single thought
to wife or child.
To what shifts, on the other hand, the primitive wife, and still more
the primitive mother, was put! Not even prehistoric stomachs could
endure an unvarying diet of raw food. Something or other suggested
the beneficial effect of hot water on the majority of approved but
indigestible dishes. Perhaps a neighbour had tried holding the hard
roots or tubers over the fire in a calabash filled with water—or maybe
an ostrich-egg-shell, or a hastily improvised vessel of bark. They
became much softer and more palatable than they had previously
been; but, unfortunately, the vessel could not stand the fire and got
charred on the outside. That can be remedied, thought our
ancestress, and plastered a layer of wet clay round a similar vessel.
This is an improvement; the cooking utensil remains uninjured, but
the heat of the fire has shrunk it, so that it is loose in its shell. The
next step is to detach it, so, with a firm grip and a jerk, shell and
kernel are separated, and pottery is invented. Perhaps, however, the
discovery which led to an intelligent use of the burnt-clay shell, was
made in a slightly different way. Ostrich-eggs and calabashes are not
to be found in every part of the world, but everywhere mankind has
arrived at the art of making baskets out of pliant materials, such as
bark, bast, strips of palm-leaf, supple twigs, etc. Our inventor has no
water-tight vessel provided by nature. “Never mind, let us line the
basket with clay.” This answers the purpose, but alas! the basket gets
burnt over the blazing fire, the woman watches the process of
cooking with increasing uneasiness, fearing a leak, but no leak
appears. The food, done to a turn, is eaten with peculiar relish; and
the cooking-vessel is examined, half in curiosity, half in satisfaction
at the result. The plastic clay is now hard as stone, and at the same
time looks exceedingly well, for the neat plaiting of the burnt basket
is traced all over it in a pretty pattern. Thus, simultaneously with
pottery, its ornamentation was invented.
Primitive woman has another claim to respect. It was the man,
roving abroad, who invented the art of producing fire at will, but the
woman, unable to imitate him in this, has been a Vestal from the
earliest times. Nothing gives so much trouble as the keeping alight of
the smouldering brand, and, above all, when all the men are absent
from the camp. Heavy rain-clouds gather, already the first large
drops are falling, the first gusts of the storm rage over the plain. The
little flame, a greater anxiety to the woman than her own children,
flickers unsteadily in the blast. What is to be done? A sudden thought
occurs to her, and in an instant she has constructed a primitive hut
out of strips of bark, to protect the flame against rain and wind.
This, or something very like it, was the way in which the principle
of the house was discovered; and even the most hardened misogynist
cannot fairly refuse a woman the credit of it. The protection of the
hearth-fire from the weather is the germ from which the human
dwelling was evolved. Men had little, if any share, in this forward
step, and that only at a late stage. Even at the present day, the
plastering of the housewall with clay and the manufacture of pottery
are exclusively the women’s business. These are two very significant
survivals. Our European kitchen-garden, too, is originally a woman’s
invention, and the hoe, the primitive instrument of agriculture, is,
characteristically enough, still used in this department. But the
noblest achievement which we owe to the other sex is unquestionably
the art of cookery. Roasting alone—the oldest process—is one for
which men took the hint (a very obvious one) from nature. It must
have been suggested by the scorched carcase of some animal
overtaken by the destructive forest-fires. But boiling—the process of
improving organic substances by the help of water heated to boiling-
point—is a much later discovery. It is so recent that it has not even
yet penetrated to all parts of the world. The Polynesians understand
how to steam food, that is, to cook it, neatly wrapped in leaves, in a
hole in the earth between hot stones, the air being excluded, and
(sometimes) a few drops of water sprinkled on the stones; but they
do not understand boiling.
To come back from this digression, we find that the slender Nyasa
woman has, after once more carefully examining the finished pot,
put it aside in the shade to dry. On the following day she sends me
word by her son, Salim Matola, who is always on hand, that she is
going to do the burning, and, on coming out of my house, I find her
already hard at work. She has spread on the ground a layer of very
dry sticks, about as thick as one’s thumb, has laid the pot (now of a
yellowish-grey colour) on them, and is piling brushwood round it.
My faithful Pesa mbili, the mnyampara, who has been standing by,
most obligingly, with a lighted stick, now hands it to her. Both of
them, blowing steadily, light the pile on the lee side, and, when the
flame begins to catch, on the weather side also. Soon the whole is in a
blaze, but the dry fuel is quickly consumed and the fire dies down, so
that we see the red-hot vessel rising from the ashes. The woman
turns it continually with a long stick, sometimes one way and
sometimes another, so that it may be evenly heated all over. In
twenty minutes she rolls it out of the ash-heap, takes up the bundle
of spinach, which has been lying for two days in a jar of water, and
sprinkles the red-hot clay with it. The places where the drops fall are
marked by black spots on the uniform reddish-brown surface. With a
sigh of relief, and with visible satisfaction, the woman rises to an
erect position; she is standing just in a line between me and the fire,
from which a cloud of smoke is just rising: I press the ball of my
camera, the shutter clicks—the apotheosis is achieved! Like a
priestess, representative of her inventive sex, the graceful woman
stands: at her feet the hearth-fire she has given us beside her the
invention she has devised for us, in the background the home she has
built for us.
At Newala, also, I have had the manufacture of pottery carried on
in my presence. Technically the process is better than that already
described, for here we find the beginnings of the potter’s wheel,
which does not seem to exist in the plains; at least I have seen
nothing of the sort. The artist, a frightfully stupid Makua woman, did
not make a depression in the ground to receive the pot she was about
to shape, but used instead a large potsherd. Otherwise, she went to
work in much the same way as Salim’s mother, except that she saved
herself the trouble of walking round and round her work by squatting
at her ease and letting the pot and potsherd rotate round her; this is
surely the first step towards a machine. But it does not follow that
the pot was improved by the process. It is true that it was beautifully
rounded and presented a very creditable appearance when finished,
but the numerous large and small vessels which I have seen, and, in
part, collected, in the “less advanced” districts, are no less so. We
moderns imagine that instruments of precision are necessary to
produce excellent results. Go to the prehistoric collections of our
museums and look at the pots, urns and bowls of our ancestors in the
dim ages of the past, and you will at once perceive your error.
MAKING LONGITUDINAL CUT IN
BARK

DRAWING THE BARK OFF THE LOG

REMOVING THE OUTER BARK

 BEATING THE BARK

WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

SOFT

MANUFACTURE OF BARK-CLOTH AT NEWALA

To-day, nearly the whole population of German East Africa is
clothed in imported calico. This was not always the case; even now in
some parts of the north dressed skins are still the prevailing wear,
and in the north-western districts—east and north of Lake
Tanganyika—lies a zone where bark-cloth has not yet been
superseded. Probably not many generations have passed since such
bark fabrics and kilts of skins were the only clothing even in the
south. Even to-day, large quantities of this bright-red or drab
material are still to be found; but if we wish to see it, we must look in
the granaries and on the drying stages inside the native huts, where
it serves less ambitious uses as wrappings for those seeds and fruits
which require to be packed with special care. The salt produced at
Masasi, too, is packed for transport to a distance in large sheets of
bark-cloth. Wherever I found it in any degree possible, I studied the
process of making this cloth. The native requisitioned for the
purpose arrived, carrying a log between two and three yards long and
as thick as his thigh, and nothing else except a curiously-shaped
mallet and the usual long, sharp and pointed knife which all men and
boys wear in a belt at their backs without a sheath—horribile dictu!
[51]
Silently he squats down before me, and with two rapid cuts has
drawn a couple of circles round the log some two yards apart, and
slits the bark lengthwise between them with the point of his knife.
With evident care, he then scrapes off the outer rind all round the
log, so that in a quarter of an hour the inner red layer of the bark
shows up brightly-coloured between the two untouched ends. With
some trouble and much caution, he now loosens the bark at one end,
and opens the cylinder. He then stands up, takes hold of the free
edge with both hands, and turning it inside out, slowly but steadily
pulls it off in one piece. Now comes the troublesome work of
scraping all superfluous particles of outer bark from the outside of
the long, narrow piece of material, while the inner side is carefully
scrutinised for defective spots. At last it is ready for beating. Having
signalled to a friend, who immediately places a bowl of water beside
him, the artificer damps his sheet of bark all over, seizes his mallet,
lays one end of the stuff on the smoothest spot of the log, and
hammers away slowly but continuously. “Very simple!” I think to
myself. “Why, I could do that, too!”—but I am forced to change my
opinions a little later on; for the beating is quite an art, if the fabric is
not to be beaten to pieces. To prevent the breaking of the fibres, the
stuff is several times folded across, so as to interpose several
thicknesses between the mallet and the block. At last the required
state is reached, and the fundi seizes the sheet, still folded, by both
ends, and wrings it out, or calls an assistant to take one end while he
holds the other. The cloth produced in this way is not nearly so fine
and uniform in texture as the famous Uganda bark-cloth, but it is
quite soft, and, above all, cheap.
Now, too, I examine the mallet. My craftsman has been using the
simpler but better form of this implement, a conical block of some
hard wood, its base—the striking surface—being scored across and
across with more or less deeply-cut grooves, and the handle stuck
into a hole in the middle. The other and earlier form of mallet is
shaped in the same way, but the head is fastened by an ingenious
network of bark strips into the split bamboo serving as a handle. The
observation so often made, that ancient customs persist longest in
connection with religious ceremonies and in the life of children, here
finds confirmation. As we shall soon see, bark-cloth is still worn
during the unyago,[52] having been prepared with special solemn
ceremonies; and many a mother, if she has no other garment handy,
will still put her little one into a kilt of bark-cloth, which, after all,
looks better, besides being more in keeping with its African
surroundings, than the ridiculous bit of print from Ulaya.
MAKUA WOMEN