Navigating Reconciliation in Occupational Therapy: Alberta Practitioners’ Experiences and Insights

Building Relationships with Indigenous Communities

There was a clear tension in how participants formed relationships in practice, which we describe as being there versus going there. Being there—when therapists live and work within the community—fostered stronger, more generative relationships, characterized by deeper trust, ongoing collaboration, and a sense of mutual investment. In contrast, going there—traveling into communities for periodic visits—often limited relationship-building to more surface-level or transactional interactions.

Being There: Living and Working in Close Proximity

Several participants shared experiences of working in rural and remote locations. Rural areas include countryside homes or small towns with few people and lots of open space. Remote locations are isolated or hard-to-reach areas, often lacking easy access to services and infrastructure. Some participants worked in Canada's territories before transitioning to urban areas. Urban areas are cities with many people, buildings, and services. In these rural and remote communities—typically small both in population and geographical area—close-knit relationships were described as forming more naturally, creating opportunities for deeper and more sustained connections over time. These connections were described as notably reciprocal; therapists not only got to know community members, but community members also came to know the therapists as people beyond their professional roles, learning about their families, daily routines, and personal preferences. This mutual familiarity fostered a sense of trust and accessibility.

Abbie reflected, “in the Territories, you all live together…everybody knows everybody,” emphasizing how shared spaces and close proximity blurred the lines between what the Western world defines as professional and personal life. Therapists and community members encountered each other in not only clinical or formal settings but also at grocery stores or local celebrations, where casual interactions often sparked meaningful conversations. This speaks to the visibility and informality that can make therapists more approachable and trustworthy.

Participants emphasized the value of living within rural Indigenous communities, where traditions, ceremonies, and gatherings played a central role in deepening both relational and cultural connections. Ellis highlighted that proximity facilitated more organic engagement, noting that community members often extended invitations to her on their own, rather than waiting for her to express interest or request inclusion. In turn, attending these gatherings and consistently showing up signaled to community members that she was genuinely invested in them and their community. This visibility allowed relationships to grow more naturally and reciprocally, with community members gradually opening up and initiating connections with her as well.

Similarly, Ramona recounted that her colleague found visiting an Indigenous community to be “a far more enriching experience than some of the basic conversation even with [colleagues],” underscoring how immersive, culturally grounded interactions could deepen relationships beyond surface-level exchanges. Abbie also noted accessing Elders and informal community guidance helped her navigate cultural expectations and values—supports she now misses since moving to an urban setting.

Across these accounts, participants consistently underscored the importance of community immersion—not just for their ability to engage more meaningfully, but for the ways it allowed community members to engage with them as whole people. This mutual connection, in turn, laid the foundation for more trusting and responsive therapeutic relationships.

Going There: Traveling to Rural and Remote Communities

Urban occupational therapists who travel to Indigenous communities described the travel as exhausting, with Ellis calling it “particularly arduous.” According to participants, the mentally and physically taxing schedule contributes to ongoing therapist turnover and burnout. In turn, this impacts the relationship with the community. Further, long hours of driving and limited time in community means therapists often conduct brief assessments and sessions, which hinders rapport-building and reduces the potential for meaningful follow-up or positive long-term outcomes.

Participants emphasized that face-to-face engagement with community members and stakeholders is essential to effective therapy and genuine understanding, as it signals a commitment to working in partnership with communities and to grasping the local context. Ellis reflected that without adequate time and collaboration, they feel they “are not able to really provide people with the support they need,” highlighting the limitations of fly-in, fly-out models in fostering sustainable and strength-based interventions.

Ramona stressed the importance of building deeper, immersive relationships, noting that “the history of Canada and Indigenous Peoples is put in a museum behind a piece of glass,” a metaphor that speaks to the disconnect many feel when engagement remains surface-level. While the data centered on therapists’ perspectives, their reflections point to the relational limitations of itinerant models of service delivery. The absence of community member perspectives in this study limits our ability to comment on whether this disconnect is similarly experienced by Indigenous clients—an important consideration for future research that centers community voices.

Learning from Indigenous Knowledge and Resources

Participants recognized their personal and professional obligation to engage in ongoing self-education, especially in light of the growing availability of resources focused on Indigenous histories, cultures, and perspectives. This self-directed learning was seen as foundational to their active engagement with reconciliation, as it encouraged deeper reflection on their own positions within colonial systems. Carmella, Chantelle, and Nichole described seeking out a wide range of resources—books such as Braiding Sweetgrass by Robin Wall Kimmerer or 21 Things You May Not Know About the Indian Act by Bob Joseph; films like Indian Horse; free public offerings such as the University of Alberta's “Indigenous Canada” massive online open course or Cree language classes facilitated by public spaces like the Edmonton Public Library. Carmella noted that engaging with these tools made it “easier to have conversations with friends or family about those deep, heavy issues,” illustrating how personal learning can ripple outward into broader social circles and influence community attitudes.

Importantly, participants framed this learning not as a substitute for direct relationships with Indigenous Peoples but rather a necessary first step in preparing themselves to enter such relationships with greater humility, respect, and cultural awareness. They acknowledged that self-education reduces the burden often placed on Indigenous individuals to explain their histories and experiences—a burden frequently critiqued in reconciliation discourse. As Carmella noted, the increase in publicly available media and educational content reflects a broader societal shift towards amplifying Indigenous voices and creating space for truth-telling. This increased awareness enables more collaborative and reciprocal relationships between occupational therapists and Indigenous communities. In these partnerships, occupational therapists can move beyond performative gestures to engage in shared dialogue, co-learning, and co-creation of programs and interventions that are culturally grounded and community-informed. Such practices, rooted in mutual respect and ongoing critical reflection, are essential to aligning occupational therapy with reconciliation principles and supporting Indigenous self-determination in health-care contexts.

Strengthening Connections Through Collaborative Dialogue

Participants emphasized the importance of building relationships with colleagues to advance reconciliation efforts in occupational therapy. Collaborative connections were seen as crucial for fostering understanding, challenging systemic barriers, and driving positive change. Ellis highlighted the transformative power of collegiate support, sharing that, before finding an ally, she felt isolated in efforts to change occupational therapy practices:

‘I really didn’t have an ally in changing OT practice in the NWT…I was just doing things differently on my own…once [colleague] came, we were better able to…take things together and make decisions…like, this is how we will change things’.

What made these collaborations helpful was not simply shared interest in reconciliation, but the presence of mutual accountability, openness to discomfort, and an intentional focus on reflective dialogue. Several participants described these relationships as spaces where assumptions could be gently challenged and where personal and professional blind spots were surfaced and explored. For example, Carmella credited the University of Alberta's Indigenous Focus certificate program not only for its content, but for its group-based format, which emphasized collective reflection and inquiry: “I was connected to a group that was focused on growing together and learning from each other.”

She noted that hearing others’ interpretations, questions, and uncertainties helped her re-examine her own understandings. This kind of dialogical learning—where peers posed questions, named biases, and offered alternative perspectives—was described as essential for unlearning entrenched ways of thinking. Participants valued colleagues who could name difficult truths without shaming, create space for vulnerability, and model humility in their own learning.

Through respectful and open dialogue, participants reported that, by working alongside colleagues—sharing knowledge, experiences, and perspectives—deepened their understanding of Indigenous history, culture, and contemporary issues. These conversations were most productive when marked by psychological safety, where participants felt able to ask questions and express uncertainty without fear of judgment. In these conditions, learning was not only cognitive but relational, as therapists developed greater self-awareness through connection with others.

However, not all participants had access to such supportive relationships. Nichole, for example, turned to social media to find a sense of collective learning and connection, describing it as “really powerful in terms of connecting, reaching out, and talking to see what other people are working on, what other people are struggling with and what facilitates this.”

Closing Gaps During Foundational Education and Training

All participants reported receiving minimal education about Indigenous Peoples in their occupational therapy programs. One recent graduate mentioned some exposure through a certificate program but felt it was not enough to support meaningful personal or professional growth. Most participants recognized the value of integrating Indigenous perspectives into core curricula, describing the educational gap as contributing to limited understanding of health disparities, colonial history, and intergenerational trauma. Abbie reflected, “I don’t recall receiving any formal education about Indigenous Peoples and healthcare,” while Adrienne expressed surprise at the lack of content: “I expected there to be more…I wanted to learn more, and I wanted to do better, but I felt [the program] fell a little bit short for me.”

Beyond formal education, participants actively sought continuing education and professional development opportunities. Events such as the CAOT Annual Conference were frequently highlighted as particularly valuable. What made these experiences impactful was the opportunity for live, facilitated dialogue and the space to unpack complex ideas in community with others. Sessions were often framed around storytelling, personal experience, and relational learning, which helped foster emotional connection and a deeper understanding of lived realities. These interactive and humanizing elements stood in stark contrast to the impersonal nature of mandatory workplace training.

Several participants expressed concern about perceived ineffectiveness of required training modules, particularly those delivered through pre-recorded videos. Selena stated, “you can’t build a relationship with pre-recorded videos. People try to get through those as fast as possible anyways, so how much benefit is that?” Two other participants admitted to rushing through required Indigenous health training due to workload pressures, describing it as a box-ticking exercise rather than a meaningful learning opportunity. This disconnect revealed a tension between participants’ desire to engage more meaningfully with Indigenous knowledges and the rigid, compliance-oriented nature of many mandated trainings. The absence of interaction, critical dialogue, and emotional connection in these formats diminished their perceived relevance and impact.

Participants’ reflections point to several features that made training useful: facilitation by Indigenous leaders, opportunities for real-time dialogue and reflection, emotional and relational engagement, and the freedom to move beyond surface-level content. These characteristics created more personally resonant and ethically grounded learning experiences—ones that aligned with participants’ values and commitments to reconciliation.

Moving Beyond Words to Meaningful Action

Participants emphasized that reconciliation is not a static goal but a continuous process requiring honest dialogue, verbal commitment, and, most importantly, concrete actions to address historical injustices and rebuild relationships with Indigenous Peoples. Regan voiced concerns that discussions about reconciliation often remain superficial and fail to translate into meaningful change. Similarly, Abbie reflected on the frustration of performative engagement:

‘it's easy to say we should do this and take action…it's better now, but…a lot of times it was just complaining about how it felt. Like, it was just talking about how terrible things are…it felt like we weren’t doing anything about it. We were just reading and talking’.

Desiree was critical of Canadian occupational therapy programs for inadequately enacting change, particularly highlighting the absence of Indigenous professors. She stressed that while events such as recent discoveries of unmarked graves have spared public outcry, these truths were never hidden from Indigenous communities—what was missing was the willingness of settlers to listen and act. She expressed frustration that Indigenous knowledge and experiences have long been dismissed, reinforcing the gap between awareness and action.

Chantelle acknowledged having access to valuable learning materials such as 21 Things You May Not Know About the Indian Act, but described feeling overwhelmed by the breadth of information and unsure of where to begin. She shared feelings of guilt for past harms and a sense of imposter syndrome, admitting that engaging with these materials made her feel like a “fraud.” Her experience reflects a broader emotional complexity with engaging in reconciliation, especially for non-Indigenous therapists who may grapple with shame, discomfort, or fear of “getting it wrong.”

Nora, an Indigenous occupational therapist, pointed to the structural barriers to professional development, particularly the high costs of accessing advanced training in areas like trauma-informed care. Although free resources exist, she noted they often lack depth or specificity. Her experience underscored the broader challenge faced by many therapists: the limited availability of accessible, high-quality training needed to develop truly culturally responsive practices.

Workplace efforts were also criticized for their superficiality. Ellis described reconciliation initiatives in some organizations as tokenistic, highlighting performative gestures such as hanging multilingual signs: “We’re making it culturally relevant by, like, putting signs up in different languages’…really, that's where you’re going with this? It's much more broken than putting up a sign.” Nichole echoed this concern, warning that when reconciliation becomes reduced to surface-level actions, it risks being co-opted and stripped of its connections to justice, accountability, and Indigenous sovereignty.

Across all participants, there was a shared recognition that reconciliation must involve sustained, long-term effort—far beyond symbolic gestures or one-time events. It requires ongoing learning, self-reflection, relationship-building, and a willingness to confront discomfort and make mistakes. Ultimately, participants called for a shift from passive acknowledgement to active responsibility, where occupational therapists engage in reconciliation not as a checklist item but as an ethical and relational commitment embedded in everyday practice.

Transforming Occupational Therapy Practices

Deconstructing Western Paradigms

All participants acknowledged that the occupational therapy profession is rooted in Western cultures and traditions shaped by colonization, assimilation, and systemic oppression. Its normative focus—defining health and function through Western standards—has both excluded and pathologized Indigenous Peoples’ perspectives and worldviews. Nora highlighted how the profession's origins shape the profession's philosophies, tools, approaches, and research, fostering mistrust and reducing Indigenous Peoples’ willingness to engage in services.

Abbie described a disconnect between existing systems and Indigenous Peoples, identifying “two different worlds.” Ellis saw this gap as the catalyst for transitioning from public to private practice, noting public therapists’ limitations in meeting community needs. Her private work focuses on seeking guidance from Indigenous advisors and governments, emphasizing that Indigenous Peoples should have greater say in or power over the services they are provided.

‘I noticed a gap. The government therapists were doing their best but couldn’t serve people the way they needed to be…I wanted to fill some gaps in a private sense. Initially, I always thought, like, why would you go private and make people pay for you? But actually, it's serving people better…[my work] is very centred on seeking direction from Indigenous advisors and Indigenous governments because that's who employs me. I’m going to do what they want because they deserve it’.

Ellis explained that working outside government policies, procedures, and expectations allows for more culturally appropriate practices. For instance, standardized assessments such as the Kettle Test, often fail with Indigenous Elders unfamiliar with items like electric kettles due to their upbringing. Realizing their inappropriateness, Ellis abandoned such assessments in private practice, choosing methods better suited to the cultural context of her clients.

‘A lot of the time we’d be asked to do cognitive assessments, or even any assessment at all, right. And the use of standardized assessments with Indigenous Peoples…all these things just make [the tests]…for example…it uses an electric kettle. These Elders grew up in the bush. Of course they’re gonna do shitty on a Kettle Test. I learned pretty quick…it was not appropriate. Even though I was told this is how you do it…I really don’t use them at all in my private practice’.

Ramona also questioned the reliance on assessments and productivity in occupational therapy, arguing that it can detract from what truly matters—connection. She emphasized focusing on meaningful relationships rather than rigid measures:

‘I would like to get rid of the whole notion that you need to do activities to be useful, that you need to do assessments to be productive. That whole notion of productivity, I feel, really, at times, takes away from the core of what's actually really important’.

Similarly, Nora shared that her approach involves “following [her] heart,” cultural teachings, and guidance from Elders, prioritizing connection over traditional goal-oriented therapy. “What I know is true and what I’ve been taught, what I’ve discussed with family members and Elders from my community [and] in the community I’m in now.” This contrasts with conventional occupational therapy, which emphasizes treatment tied to clear objectives.

Challenging Western Norms of Practice

Traditional occupational therapy methods are often grounded in Western biomedical frameworks that may not align with Indigenous Peoples’ worldviews, healing practices, or relational ways of being. Participants described how institutional norms and time constraints limit their ability to practice in culturally responsive ways. Ellis, for example, reflected on the constraints of brief visits and task-oriented sessions, which she described as superficial “in and out” treatments. Similarly, Abbie recounted referrals that prioritized functional concerns over relational or emotional needs

‘I'll get a referral for a raised toilet seat or something. And then, I'm in a bathroom with someone who's talking about all the abuse they've been through…we sit in the bathroom for two hours talking about their trauma and decide we don't need a raised toilet seat’.

These experiences highlight the disconnect between standardized occupational therapy goals and the lived realities of Indigenous Peoples, particularly when deeper issues—like trauma or social context—are not accounted for in the referral or session design.

Some participants described intentionally resisting institutional norms to meet clients’ needs more meaningfully. Regan, for instance, spoke about deliberately choosing not to follow her health authority's “three-strike rule” (a policy that discontinues services after three missed appointments), recognizing that structural barriers like housing instability, transportation, or trauma often underlie missed sessions. For her, flexibility and compassion were more ethical and culturally aligned approaches.

Rather than framing their actions as explicitly “Indigenous” approaches, participants described them as forms of resistance to rigid, standardized models—making space for more human-centered, relational, and context-aware care. These early efforts to challenge dominant Western norms responded not only to the specific needs of Indigenous communities but also suggest broader possibilities for making care more flexible, relational, and less oppressive for all clients.