Why is it so hard to practise as an occupational therapist?

Occupational therapists around the world are increasingly embracing the idea that occupation is the unique focus and method of our profession. Unlike our colleagues from other professions, who view functional daily life task performance as an ultimate, long-term outcome, we also view occupation — the doing of meaningful and purposeful daily life tasks — as the principal method for achieving the primary goal of people to meaningfully and purposefully seize, take possession of, and occupy the times, spaces, and roles of their lives (Fisher, 1998). In other words, we assert that our unique focus is the ability of our clients to ‘do’, and that we best enable better and more satisfying ‘doing’ through our clients engaging in doings (activities) that are imbued with the power of individual meanings and purposes associated with those doings. When the doings are both the means (interventions) and the ends (outcomes), we have occupational therapy. Occupational therapists also bring our unique expertise in: (i) performance analysis (the observational evaluation of the quality of a person's occupational performance in order to describe what we observe) (Fisher, 1998); (ii) task analysis (the observational evaluation of the impact of body functions, environmental, societal, or other factors on occupational performance in order to understand why we observed what we did) (cf. Hagedorn, 1995, 1997; Watson, 1997); and (iii) activity analysis (the abstract analysis of the demands of a task for purposes of determining how to modify tasks so as to design therapeutic occupations) (cf. Hagedorn, 1995; Trombly, 1995; Watson, 1997) to the occupational therapy intervention process. Why then, with our incredibly important, unique, and powerful expertise, do we sometimes find it so hard to practise as occupational therapists? Consider the following examples that represent occupational therapists from Australia and other areas of the world who struggle with practising occupation-based therapy: A young occupational therapist whom most often uses weights and exercise as the primary therapeutic methods for developing strength of persons with spinal cord injuries. A new graduate occupational therapist, well versed in occupational therapy theory, who frequently uses mat activities as therapeutic methods to develop postural control and balance of persons with neurological disorders. An experienced occupational therapist who spends many of his working hours using psychodynamic principles while talking with persons with psychiatric disorders, attempting to help them resolve their inner conflicts. An occupational therapist working with school students, who, after taking some continuing education courses, increasingly focuses her therapy with these students on evaluating and remediating sensory processing disorders. An occupational therapist whose practice with persons with intellectual disabilities emphasises the assessment of hand functions and fine motor coordination. When I hear from these people, I wonder, ‘What happened to the occupation in occupational therapy?’, for when I pursue the topic more deeply, I learn that: (i) there is little occupation in their evaluations or their interventions; and (ii) enhancing occupational performance remains but a distant, long-term goal. When occupation is present, it is often narrowly focused on some aspect of self-care. Sometimes these therapists enthusiastically defend what they are doing as being ‘real’ occupational therapy, stressing the idea that assessing and remediating underlying impairments will ultimately result in enhanced occupational performance. More often than not, however, such persons readily acknowledge a troubled sense that what they are doing is not what they feel they should be doing, and that they struggle with how to make a change in their practice. At worst, they feel powerless to effect change. Why has this happened? Is it that: (i) they feel compelled to do what others expect or ask them to do; (ii) they have inadequate time or resources; (iii) they favour tradition and the familiar; or (iv) they are not recognised as key members of the team, so therefore their voice is not heard? Perhaps it is because they lack a clear understanding of our unique and powerful role in enabling our clients through occupation. If it is true that we have taught people who we are by what we have been doing, then, if we embrace our core focus on occupation as means as well as ends, then perhaps we can, step by step, bring occupation back into our evaluations and our interventions, change what we do, and teach others who we really are —occupational therapists.