Putting occupation into practice

Aged well over time, Julie McLaughlin Gray’s (PhD, OTR/L, FAOTA) paper is as relevant today as when first published 20 years ago.

The Paper
Gray, J. M. (1998). Putting occupation into practice: Occupation as ends, occupation as means. American Journal of Occupational Therapy, 52(5), 354-364

The Problem
Being occupation based is clearly a struggle in today's healthcare environment, and this paper suggests the nature of the problem is that OT has been consumed by the “medical model”.

On one hand, the medical model seems concrete and testable. On the other hand, it causes ‘... a shift away from occupation as the central, unifying focus within theory and treatment (Kielhofner & Burke, 1983)”.

So how can I be occupation-centered in my practice?

What to watch out for
Getting stuck using occupation as an ends.

Occupation as ends is having occupation as the outcome of therapy. This is a very important goal, but this problem is that on it's own it “does not (necessarily) involve the use of occupation or purposeful and meaningful activity...”. It can easily miss using occupation in the therapeutic process. Often this is seen as an over reliance on treating components.

Generally used because they're easy to repeat and do in our workplace, an over reliance on components such as strength, range of motion, perception of cognitive skills etc.. can lead to non-purposeful tasks and activities. Also, improved components don't always transfer to improved occupational performance; patients can finish OT without addressing their occupations (Eg. we must fix your range of motion before you can consider playing golf).

Using occupation as ends also doesn’t differentiate us from other rehab professionals.

Only addressing ADLs

ADLs are important and often the front line of your work. Nonetheless, if we don't view them through the lens of OT, it's easy to disconnect them from their occupational roots.

The Solution

Double-down on an occupation as means!

This refers to the actual use of occupations as the therapeutic process (as opposed to tasks, or functional activities).

It's when you truly use your patient’s occupations as the therapeutic tool to get them to their goal and gain a clear way to practice in an occupation-based way.

ADLs become occupation-centred when we clearly:

  • Identify them as activities of importance and value to the client

  • Incorporate them as personal rituals (as similar to the patients normal context as as possible)

  • Emphasize not only independence, but also active engagement and possibilities for interdependence

  • Structure them as the "just-right challenge"

The Outcome

Providing your patients with occupation-based treatments gives them (and you) ‘the powerful impact of therapeutic occupation on both component and occupational recovery’, and the opportunity to engage in meaningful life activities ‘...purposefulness, meaning, and holism’.

It can be a challenge in today's healthcare environment, but as Julie notes in this review: When you practice like this you provide ‘...a unique contribution to a client's recovery.’ And that's what OT is all about!