Exploring Humour as a Relational Practice in Occupational Therapy with Individuals Post-Stroke: Enacting Collaborative Relationship-Focused Occupational Therapy

Background: Within the Canadian context, collaborative relationship-focused care has been advanced as a key direction for occupational therapy practice. In working with individuals post-stroke, the use of relational practices by occupational therapists needs to be sensitive and responsive to the potential communication, cognitive and physical impairments individuals may be managing within contexts. Literature suggests that relational practices such as humour can foster therapeutic connection and rapport in rehabilitation. However, little is known regarding how occupational therapists enact humour as a relational practice with individuals post-stroke, nor the associated risks and benefits. Methods: This thesis aims to enhance understanding of humour as a relational practice, with a focus on exploring the ways humour is enacted by Canadian occupational therapists when working with individuals post-stroke. First, a scoping review was conducted to understand how the use of humour has been explored in existing literature in several rehabilitation professions across practice areas (audiology, speech-language pathology, physical therapy, and occupational therapy). Then, a sequential explanatory mixed-methods study consisting of a Delphi study (n=30) followed by a qualitative descriptive study (n=12) was conducted to examine humour use by occupational therapists in the specific context of working with individuals post-stroke. Findings: The scoping review identified seven themes, highlighting humour’s therapeutic potential but limited focus on occupational therapy and populations who have sustained a stroke. These insights informed the Delphi study which identified thirty-two distinct benefits and two risks associated with humor use with individuals post-stroke. In interviews, occupational therapists described humour as being shaped by mutual understanding, emotional attunement, and shared power. Humour emerged as a process that was dynamic and co-created, and that helped build relational capital through easing emotional tension, enhancing therapeutic engagement, and fostering therapeutic connection. Conclusion & Significance: This research highlights that humour is not just a therapeutic tool or communication technique—it is a meaningful, dynamic, and context-dependent relational practice. This work expands understanding of how relationship-building happens in occupational therapy practice, especially with individuals post-stroke, who may experience vulnerability, decreased control, or identity disruption. Humour, when used thoughtfully, can contribute to the restoration of occupational identity and foster human connection within care.

Name thesis:degree_name

Ph D

Discipline thesis:degree_discipline

Health and Rehabilitation Sciences

Grantor dc:publisher

The University of Western Ontario

Year dc:date.issued

2025

Author dc:creator

• Kfrerer, Marisa L.

Advisors dc:contributor.advisor

• Marshall, Carrie Anne
• Rudman, Debbie Laliberte

• Occupational therapy
• humour
• humor
• relational practices
• therapy relationship(s)
• collaborative relationship-focused care
• stroke

Language dc:language.iso

en

Handle dc:identifier.uri

https://hdl.handle.net/20.500.14721/39191

OAI identifier oai:identifier

oai:uwo.scholaris.ca:20.500.14721/39191