Abstract
Helen Willard (1894–1980) and Clare Spackman (1909–1992) paved the way for modern and future occupational therapy. This article validates the need for historical research in occupational therapy and presents a historical study on how the personal and professional collaboration of Willard and Spackman influenced occupational therapy. Data were gathered from archival documents, private papers, and 10 oral histories with colleagues, students, family, and friends. We used text analysis with triangulation to develop themes to reconstruct a proximity of the historical story. Two major themes that describe Willard’s and Spackman’s influence on occupational therapy are (1) Enduring Legacies and (2) Sacred Solitude and Chosen Gatherings. Subthemes within Enduring Legacies include Guiding Practice, Leaders in Service, and Educational Leadership. These women strongly influenced practitioners worldwide while maintaining the sacredness of their private lives. Their example can serve as a model for current and future occupational therapy practitioners and leaders.
Current occupational therapy students and practitioners recognize the names “Willard and Spackman” from the commonly used textbooks that bear their names. Helen Willard (1894–1980) and Clare Spackman (1909–1992) published the first edition of Occupational Therapy in 1947 as a comprehensive textbook written by occupational therapists rather than physicians. The editors of the current 12th edition report that it “has become an icon in the field” (Schell, Gillen, & Scaffa, 2014, p. xvi). Willard’s and Spackman’s legacies in occupational therapy endure well beyond the textbook that bears their names. Understanding how these women charted new territories in occupational therapy provides direction for emerging practice areas.
Historical inquiry’s unique contribution to occupational therapy’s foundation is particularly notable at the auspicious milestone of occupational therapy’s centennial anniversary of its 1917 incorporation in the United States. The American Occupational Therapy Association’s (AOTA’s) centennial year provides opportunities for occupational therapy practitioners to appreciate the value of historical research and the ways individuals can change the future. This article has the dual purpose of validating the need for historical research in occupational therapy and discussing the impact of two influential leaders on the profession’s history.
There is a driving need for historical inquiry to ground how today’s practice evolves from earlier roots. With current knowledge changing exponentially, past reflections can be easily lost. As Bing warned in his 1981 Eleanor Clarke Slagle Lecture,
Seemingly, old values are least considered when charting new directions. . . . We have no historical sense. The problem primarily lies in not taking the time to assiduously locate our profession’s diggings, to excavate what is relevant, and, then, to learn from what is unearthed. . . . Lessons can be learned. (pp. 514–515)
Warning against accepting a status quo occupational therapy history, Dunne, Pettigrew, and Robinson (2016) made a case to use “relevant historical evidence, even if it threatens the accepted historical narrative” (p. 382). Yerxa (1995) demonstrated “respecting our history” (p. 295) when she referenced physical medicine’s 1947 attempt to take over occupational therapy in arguing how to deconstruct contemporary issues in occupational therapy. Schwartz (2009) called for “reclaiming our heritage” (p. 681), demonstrating how history connects fundamental professional values and beliefs. Wilcock (2003) reflected, “My journey through history . . . has raised, for me, many contemporary questions about how we make sense of the world and how we raise awareness” (p. 6).
Historical studies enable occupational therapy practitioners to stand on strong footing, adding understanding to the work of the profession’s leaders, scholars, and innovators. This research article describes how the professional and personal collaboration of Helen Willard and Clare Spackman, two such leaders, influenced occupational therapy.
Method
This historical study used a pluralistic school of causation to re-create the time, place, and context of Willard and Spackman (Gottschalk, 1969). Two institutional review boards provided approval to conduct the study before data collection began. We gathered print data and first-person accounts. Primary sources included documents from six archival collections (Table 1), site visits, private collections, and oral histories. Secondary sources included publications about Willard and Spackman and relevant history. Helen Willard (Figure 1) and Clare Spackman (Figure 2) lived and worked in Philadelphia, Pennsylvania, and had a summer residence near Vergennes, Vermont; visits to these locations yielded key data.
Archival Libraries Used in This Study
Helen Willard, ca. 1960.
Clare Spackman, ca. 1960.
We gathered oral histories from 10 people using open-ended questions about their memories of Willard and Spackman. Participants included one Willard family member and one family friend; two Spackman family members and one family friend; two occupational therapy colleagues; and three occupational therapy alumnae from the University of Pennsylvania, one of whom became a colleague at the Curative Workshop. All participants allowed the use of their name and words for this study, which adds to the historical preservation. Consistent with historical tradition, participants often brought pictures, letters, or other artifacts from their personal collections, which aided their recollections of events that had occurred 25 to 70 years previously. Data collection spanned 33 months and was spread across the three authors.
Data analysis was ongoing, with regular discussions among all authors. Interpretation involved comparing data across multiple sources; only key sources are reported in this article. One author (Peters) with expertise in historical inquiry reviewed documents and artifacts for authenticity and historical meaning. Two authors (Mahoney and Martin) independently coded interview transcripts and documents, developed a coding structure, and frequently compared coding to ensure consistency, revising the coding structure as needed. We used NVivo Version 10 (QSR International, Doncaster, Victoria, Australia) to organize data and generate data reports by code. We met virtually or in person at least monthly, depending on the work scope.
Limitations of historical research include the potential for bias and misinterpretation because of missing or lost records and multiple perceptions or memories of past events. Inherent limitations of this study were mitigated by using multiple investigators, reflectively reviewing data through discussion, and journaling after each research phase, all to clarify and limit historical haze.
Results and Discussion
Historical research involves synthesizing results and discussions to present historical interpretations and arguments (Peters, 2013). The findings of this study are integrated with interpretative discussion according to the two major themes, (1) Enduring Legacies and (2) Sacred Solitude and Chosen Gatherings, followed by implications for occupational therapy research, education, and practice. The Enduring Legacies theme focuses on Willard’s and Spackman’s professional impact; they were leaders in occupational therapy who transformed systems and taught subsequent generations of health care reformers, practitioners, and academics who, like their mentors, held strategic positions that promoted policy changes. The theme Sacred Solitude and Chosen Gatherings describes how Willard and Spackman separated their personal lives from their professional lives and the importance of time and space for personal retreat. Enduring Legacies is examined in detail in this article, but both themes are necessary for an understanding of their professional contributions.
Enduring Legacies
Willard’s and Spackman’s Enduring Legacies to occupational therapy include the interconnected subthemes of Guiding Practice, Leaders in Service, and Educational Leadership, each described in subsequent sections. Willard and Spackman used meaningful occupation to change lives, working tirelessly to foster occupational therapy’s sustainability in the United States and throughout the world. They aimed for excellence in teaching, practice, and service, in ways similar to that valued by promotion and tenure committees today.
As educators, they were acutely aware of the need to prepare a qualified workforce for future practice. Willard was an established academic administrator, one of a core of AOTA academic chairpersons, who acted as a motherlike figure to students (Peters, 2013). Spackman, educator and practitioner, focused efforts on clinical education and the opportunity to model interventions that promoted health and wellness for injured workers. Together, these women forged an educational curriculum that tightly integrated classroom learning and clinical education so graduates could work throughout the world in emerging practices within rehabilitation centers, special schools, and community programs. They expected much from their graduates and were rewarded by alumni who became occupational therapy leaders on six continents.
Guiding Practice.
The Enduring Legacies subtheme of Guiding Practice describes how Willard and Spackman influenced occupational therapy practice, developed policy, and shaped emerging practice. Helen Willard began her career as a reconstruction aide after completing a Special War Course in physical therapy (PT) in 1918, the year World War I ended, and several years after earning an Ivy League bachelor’s degree from Wellesley College (Willard, 1975). One year later, already a leader, Willard served as the chief reconstruction aide in PT at a Public Health Service hospital in New York City, rapidly being promoted to assistant superintendent of reconstruction aides of the Office of the Surgeon General in Washington, DC. She qualified as an occupational therapist through the U.S. Civil Service in 1922, joined AOTA, and became director of occupational therapy and chief aide in physical therapy at the U.S. Veterans Hospital in Maywood, Illinois (Willard, 1975). By 1928, Willard adopted an educator’s career path when she joined the Philadelphia School of Occupational Therapy as a lecturer and director of its Curative Workshop. Here she met Clare Spackman.
Spackman graduated with a diploma in occupational therapy from the Philadelphia School of Occupational Therapy in 1930 and immediately began working in a Philadelphia hospital while teaching crafts to children part time (Spackman, 1975). One year after graduation, Spackman accepted the position of assistant director at the Curative Workshop (Spackman, 1975) under Willard (Willard, 1975). Four years later, Spackman was promoted to Curative Workshop director (Spackman, 1975) when Willard was promoted to director of the Philadelphia School of Occupational Therapy (Willard, 1975).
The Curative Workshop was administratively and physically connected to the Philadelphia School of Occupational Therapy as a student-run clinic designed to return injured workers to employment. This clinic provided internships and a supported learning environment for students to learn about occupation’s restorative capacity. One assistant director under Spackman described the Curative Workshop as follows: “We get a lot of woodworking, sawing and hammering. . . . Everything we did was a real occupation that these men could relate to” (C. K. John, oral history with P. Martin & W. Mahoney, March 15, 2016). Students learned to address physical and psychosocial aspects of disability in the interventions they practiced at the Curative Workshop.
Willard and Spackman influenced the positioning of occupational therapy in departments of physical medicine and rehabilitation while ensuring that occupational therapy’s autonomy and place in mental health were not lost. In 1943, Willard served as consultant to the subcommittee on occupational therapy of the Baruch Committee on Physical Medicine, a privately funded committee that explored practices and education in physical medicine, ultimately resulting in the establishment of the American Board of Physical Medicine (Folz, Opitz, Peters, & Gelfman, 1997; Willard, 1975). A few years later, Spackman wrote letters to key U.S. medical directors soliciting feedback about their preferred placement of occupational therapy within medical settings. She wrote to one of the directors,
At the present time the emphasis of Physical Medicine is being placed primarily on the value of Occupational Therapy for physical injuries. This omits entirely the very definite contribution made by Occupational Therapy in other fields, such as psychiatry or tuberculosis. (Spackman, 1947, p. 1)
Of particular interest is the response received from Dr. Frank H. Krusen, who chaired the Baruch Commission from 1943 to 1947. Krusen strongly supported occupational therapy’s position under physical medicine and rehabilitation as a primary placement, yet recognized the possible need for direction by psychiatry, a contested view at the time (Colman, 1992; Krusen, 1947). Willard and Spackman strengthened the presence of occupational therapy as an important profession in the care of people affected by both physical and psychosocial conditions.
Later, Willard and Spackman traveled together to consult with occupational therapy schools and programs in Europe, Africa, Asia, Australia, South America, and Central America (Mendez, 1986; Spackman, 1975; Willard, 1961, 1975). These travels influenced the spread of occupational therapy worldwide.
Leaders in Service.
Leaders in Service, a subtheme of Enduring Legacies, describes Willard’s and Spackman’s impact through volunteerism and professional engagement. Willard and Spackman led through service, each working at local, state, national, and international levels. Willard accepted the position of president of the Physical Therapy and Occupational Therapy Association of the U.S. Veterans Bureau (1923–1925) just 5 years after becoming a reconstruction aide (Willard, 1975). Similarly, she became president of the Illinois Association of Occupational Therapists (1924–1927) soon after becoming an occupational therapist. Willard was a member of AOTA throughout her entire career, serving on the Board of Management (1936–1944), chairing major committees such as the Education (1945–1958) and National Defense committees during World War II (1941–1944), and finally serving as president (1958–1961; Willard, 1975). Willard received the AOTA Award of Merit, the association’s highest honor, in 1954.
Spackman also served multiple professional associations, frequently in leadership positions, beginning 2 years after graduation, when she chaired the Program Committee for the Eastern Pennsylvania Occupational Therapy Association. Soon thereafter, she became president of that association (1936–1938; Spackman, 1975). Her pattern was consistent, moving from being a member to chairing a major committee to filling a position of upper leadership. One colleague remembered Spackman saying, “No matter what you do, never let your registration expire” (C. K. John, oral history with P. Martin & W. Mahoney, March 15, 2016), a reflection on her relationship with AOTA.
When Spackman received the AOTA Award of Merit in 1956, she had filled upper leadership roles in local, national, and international organizations (Spackman, 1975). She served for 5 years as president of the World Federation of Occupational Therapists (WFOT; 1957–1962), a time of great growth for the organization and service for which she may be best known (Spackman, 1975). Yet she exhibited humility in a letter to her niece when responding to questions about her professional achievements: “I got involved in our international association and ended up as president” (letter to A. Marx, January 3, 1976, personal collection of A. Marx).
Willard and Spackman were integrally involved in the founding, development, and expansion of WFOT, both serving in leadership roles in the organization until their retirement (Mendez, 1986; Spackman, 1975; Willard, 1975). Willard chaired the initial preparatory commission in 1952, which set infrastructure and planned initial meetings for this new organization, and chaired its Committee on Education (1952–1960), among other roles (Willard, 1975). Spackman, as the U.S. delegate, served as its assistant secretary/treasurer, chaired the Congress Committee that planned its first conference, and represented WFOT on a United Nations committee that supported the human rights of people with disabilities worldwide (Mendez, 1986; Spackman, 1975).
Simme Cynkin, a South African occupational therapy educator and author who migrated to the United States and became a colleague of Willard and Spackman, reflected as follows in an interview with her protégé Rosalie Miller about their international service and influence:
“Willard and Spackman . . . were a kind of household word all over the world. They were ambassadors for OT. . . . With other professionals . . . they helped to put OT on the map in administrative ways as well. So they did a lot for us, indeed” (interview with R. Miller, November 24, 1996).
Educational Leadership.
The Enduring Legacies subtheme of Educational Leadership describes how Willard and Spackman determined educational quality, met personnel demands, and integrated education and practice. Willard and Spackman prepared a workforce to meet practice needs. Miss Willard and Miss Spackman, as they were known to their students, held major educational leadership roles at the Philadelphia School of Occupational Therapy for many years. The Philadelphia School of Occupational Therapy began in 1918 as one of the first occupational therapy schools, with Eleanor Clarke Slagle among its first faculty members (Willard, 1955).
Willard joined the faculty in 1928, became its director in 1935, and was promoted to professor in 1950. As director, she managed its merger with the University of Pennsylvania in 1950, continuing as director until she retired in 1964 (Willard, 1975). Spackman started teaching in the occupational therapy program in 1937 while continuing her work in the Curative Workshop. She maintained these joint clinical and academic appointments until her retirement in 1970 (Spackman, 1975).
Under their leadership, with Willard as director and Spackman as fieldwork coordinator and director of the Curative Workshop, the Philadelphia School responded to changing societal needs. For example, the program developed an Army emergency training program for occupational therapy volunteer assistants (1942–1945) based on needs during World War II (Willard, ca. 1944, 1945). They also focused on international practice. Occupational therapists who studied under Willard and Spackman started inaugural occupational therapy programs in the Philippines, India, and Israel (Bondoc, 2005; Nimbkar, 1980; Sachs & Sussman, 1995).
Willard and Spackman modeled leadership for subsequent generations of occupational therapy leaders. For example, a 1937 Philadelphia School graduate, Marie Louise Franciscus, became director of the Columbia University Occupational Therapy Program in 1951, making numerous contributions throughout her career (Scullin, 1952). Frances Helmig, a 1941 graduate, assumed the position of assistant director of the Curative Workshop for a year (VanDerhoef, 1950), after which she completed graduate work at the University of Southern California. Ruth Brunyate Wiemer, alumna, former AOTA president, and 1957 Eleanor Clarke Slagle lecturer, described Willard’s and Spackman’s professional commitment and personal balance:
You immerse yourself in your profession, in a sense you marry it, you give your all to it. But you have to live another life as well, and you have to build a comfortable lifestyle. Unless it’s enriched somehow, you won’t be a very good therapist. They knew how to pack it off for the summer, go up to the lake and live their life. They knew how to go off to Europe and have fun. (R. B. Wiemer, oral history with C. Peters, March 18–19, 2003; Peters, 2013, p. 46)
Florence Stattel, alumna and first recipient of the Eleanor Clark Slagle lectureship, reflected on the social class membership of the Philadelphia School faculty, stating, “Helen Willard had just come in when I was entering [the Philadelphia School] in 1936. She was a graduate of Mount Holyoke [sic; actually Wellesley]. . . . So those girls had a level above” (Peters, 2013, p. 44). Like other women of their class, Willard and Spackman combined their personal interest in travel with their professional work.
Sacred Solitude and Chosen Gatherings
The theme Sacred Solitude and Chosen Gatherings emerged from the private lives of Willard and Spackman. They fueled their over 50 years in occupational therapy because they understood the importance of preserving the “sacredness” of private versus professional life. Away from the Philadelphia School, Willard and Spackman led quiet, meaningful lives in which they would “stow away” to the cottage on the shore of Lake Champlain in Vermont, called Stowaway, where they would read, rest, and explore the countryside. They protected their time away, as illustrated in a letter Willard wrote to the governor of Pennsylvania in reply to a request to serve on a committee:
I expect to be on vacation during the month of August, but shall return to the city on September 4. Following that time, I should be glad to be of all possible service in promoting further understanding and increased recruitment in the health fields. (Willard, 1956)
Women of middle- and upper middle-class means in the post–World War I era were raised to understand grace, life balance, and elegance. Willard and Spackman, raised in this culture, knew when to focus on work, giving wholeheartedly to their profession, and when to seek their private, most cherished retreat.
Implications for Occupational Therapy Research
Occupational therapy has many enduring legacies, like those of Willard and Spackman, that could be lost unless historical inquiry is recognized as an important type of occupational therapy research. In this article we have described how two past occupational therapy leaders, through their professional work and personal lives, contributed to the future of the profession. Historical inquiry must be part of occupational therapy research agendas to enable a full understanding of historical discourse, including why and how decisions were made, that may inform future ways of thinking.
Historical research uniquely demonstrates how professional thinking evolves over time. Although evidence-based practice is critical, historical research also justifies the profession’s continued existence. Occupational therapy practitioners and researchers must recognize and discuss the evolution of the profession’s conceptualizations and practices. Many issues currently affecting occupational therapy, including jurisdiction, clinical justification, and professional identity, also existed in the past (Peters, 2013). Historical research provides a mechanism to understand how historical timing and societal trends influence these issues and how they evolved.
Lessons from historical inquiry in occupational therapy lead to the following recommendations for new directions:
Occupational therapy historians should systematically study how occupational therapy pioneers built its practice and knowledge base.
Historical research needs to be elevated in value so that sufficient funding, publication venues, and support for research exists.
Occupational therapy needs to honor and own its historical professional legacy.
Implications for Occupational Therapy Education and Practice
The example of Willard and Spackman challenges today’s educators to seamlessly integrate the classroom and clinic. In their era, all students experienced both the classroom and clinic, at times in nearly equal measure. Learners experienced occupational therapy under the watchful eyes of Curative Workshop directors, also faculty, in a student-run clinic. The Philadelphia School responded to society’s needs by adding a war emergency training program and enrolling international students to seed occupational therapy’s worldwide development. Educators prepared graduates for a changing future while retaining that held most essential to occupational therapy.
Willard and Spackman were experts at forging emerging areas of practice. They created certificate or degree options and developed physical dysfunction and return-to-work programs. They unwaveringly believed in the restorative benefits of occupation, enacting this belief through leadership roles at work and in service. Both believed in the power of professional organizations to influence large-scale change and stepped resolutely into the future, focusing on society’s needs. These same steps occur today when leaders explore emerging roles for occupational therapy practitioners based on populations’ needs.
Willard’s and Spackman’s enduring legacies provide the following lessons for education and practice:
Occupational therapy educators need to prepare a workforce to meet health care needs in changing societies and to collaborate across disciplines and borders to address the complex needs of all people.
Occupational therapy practitioners need to consider new roles for occupational therapy and to use societal needs and historical trends to inform their arguments for these new roles.
Service to the profession and leadership at multiple levels are necessary to create change.
Doing things that one loves and that promote balance between one’s professional and personal lives can help occupational therapy practitioners accomplish great things.
Echoing Bing’s 1981 Slagle lecture, this study elucidated how lessons learned from the past, and from Helen Willard and Clare Spackman in particular, can inform new directions in occupational therapy.
Footnotes
Acknowledgments
The authors gratefully acknowledge financial support from the Frederic W. Sammons Family Foundation; from the University of Minnesota Occupational Therapy Program, for funding one site visit and many virtual researcher meetings; and from Midwestern University, for providing one investigator with research start-up funds. The authors also acknowledge J. Kaspryk, C. Shiffer, K. Holdren, and L. Park of Midwestern University for their assistance in transcribing and organizing research data; the Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy Archive Project for clerical assistance from R. Mak; and assistance from curators and archivists. Results of this study were presented at the 2014 World Federation of Occupational Therapists Congress, the 2015 AOTA Annual Conference & Expo, and the 2016 Congress of the Council of Occupational Therapists for the European Countries and the European Network of Occupational Therapy in Higher Education. The authors thank Laurie “Susie” Willard Fitzgerald and Dixie Willard Wolfe, whose curiosity about their Aunt Helen Willard prompted this study. The authors dedicate this work to the memory of Dixie Willard Wolfe.