WHAT IS OCCUPATIONAL THERAPY?

What Is Occupational Therapy?

Lou N. Luis

School of Occupational Therapy, Pacific Northwest University of Health Sciences

OTH 510: Introduction to Occupational Therapy

Dr. Brandon Imamshah

October 9, 2023
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What Is Occupational Therapy?

Part 1

Occupational therapy is an expansive field where we, as therapists, can contribute to

various settings and situations. Occupational therapists utilize a client-centered approach that

focuses on someone’s occupation, which allows for unique service opportunities. There is a lot of

confusion with the term occupation when it’s associated with therapy. An occupation is more

than what a person does as a way of making money. Occupations are daily activities that bring

meaning to one’s life, which is subjective to the individual (American Occupational Therapy

Association, 2020b). Each client has their own goals which will dictate what the approach to

their therapy. This idea relates to one of the guiding principles of occupational therapy: providing

occupation-centered practice. This idea is so important to the profession that it’s also established

as one of our cornerstones. Therapeutic use of occupation sets our profession apart from every

other medical profession. Having an occupation center of practice unitizes occupations as part of

the evaluation and intervention. Occupational therapists have a fundamental level of

understanding of what fully encompasses the client by utilizing a holistic approach to medicine.

Another cornerstone of the practice, therapeutic use of self, is establishing rapport with your

client to advocate for their health and wellbeing. We can relate this to a principle of practice of

being culturally relevant by eliminating our bias on how you perceive occupations should be

done and recognizing that there is not one way. Allowing yourself the opportunity to grow and

learn ensures one can practice cultural humility.

An occupation reflects the person. A therapist should understand that it can look different

for people, but their reasoning for participating is also dependent. There are various factors that

can determine why people participate in occupation. A factor could be the client having a
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wonderful support system, which would represent their environmental factors. Another could be

someone’s socioeconomic status which would represent their personal factors. Each factor is a

reflection of their occupational identity. The overarching purpose for occupational therapists is to

advocate for our clients by determining the needs of the community by assessing the social

determinants of health. We want to promote meaningful participation in occupations that bring

value to one’s life because we are all occupational beings. Not being able to participate in

occupations could mean not being able to do everyday activities to sustain your health or being

able to leave the house for meaningful interactions with family. Occupational therapists are

experts in occupations and can evaluate the root of the lack of participation in a particular

occupation of the client so, hopefully, they can return to what’s important to them.

Our domains of practice highlight and focus on what we can do as practitioners,

specifying the different aspects that can influence a person’s health and wellbeing. This includes

occupations, context, client factors, performance skills, and performance patterns. Each domain

has intervening meanings and values that reflect and influence the person. The domain of

occupation are actions that bring meaning and purpose to one’s life. Where a person is at in their

life can change what their occupations entail. For example, health management can look and be

very different for a child with autism compared to an older adult who just experienced a stroke.

The context informs occupational therapists additionally about the environmental and personal

factors that can have an influence on their occupations (American Occupational Therapy

Association, 2020b). Environmental factors span from natural to human-made changes, like a

client living next to a factory that produces heavy CO2 levels or living in a state that doesn’t

provide transgender health services. One way an occupational therapist can then advocate for

their client is by going to their state legislature to promote positive change. Personal factors are
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specific to the individual. In the previous example, the client’s sex may be male and their gender

being a woman, or how they were brought up in the Morman church and left it when they turned

18 are some potential personal factors. Their intervention plan could be connecting them to other

individuals who also left the church. These plans look different for each person. Client factors

encompass the body and mind of the whole person. One aspect of a client factor are their body

functions, their physiology, which is usually a deficit can include sensory, musculoskeletal and

cognitive function just to name a few. Another is body structure, like a client born with an

enlarged heart or scoliosis of the spine. You can’t usually change their body structure so for their

invention plan you would need to restore balance throughout the body for optimal function. The

next domain embodies quality performance that’s goal-oriented, performance skills, which is

determined by motor, process, and social skills. Motor skills are effective performance

movement patterns used in daily life. Process skills are a series of cognitive steps that allow for

effective actions to take place. Then, social interaction skills dictate how we act in social

situations (American Occupational Therapy Association, 2020b). The last of the domains,

performance patterns, is how and why we do things like particular habits, routines, roles, and

rituals (American Occupational Therapy Association, 2020b). They are behaviors that represent

a client’s lifestyle. An example of this could be a parent who just lost their partner and they are

now a single parent. An occupational therapist can help provide resources for financial

management, and child care, and provide guidance for their new role being a single parent.

Disruptions in any of these domains can bring occupational imbalance where one might benefit

from seeing an occupational therapist. During the evaluation stage, we compile all this

information to create the client’s occupational profile to infer what their intervention plan will

be.
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Knowing how expansive the field can be, there are common fields of practice like

outpatient facilities. These can include industrial rehab or non-traditional practices, like

providing refugee resources, which is an upcoming area of practice. The role of occupational

therapists in an industrial rehab is to get workers back to their jobs after experiencing an injury

or illness. An occupational therapist will assess the workplace environment for potential hazards,

psychosocial, and the cognitive factors of the job (American Occupational Therapy Association,

n.d.). Common approaches to intervention in this setting would be to modify/adapt and to

prevent injury. Intervention can require modifying the workplace environment, equipment, or the

client’s behaviors. Within injury prevention, we focus on workers' biomechanical demand in

their scope of occupation. An occupational therapist’s role for providing resources to refugees is

promoting easier acclamations to a new country, culture, people, system, and lifestyle. We do this

by finding meaningful employment opportunities, providing mental health services, establishing

a community, and providing access to additional services (Krishnakumaran et al., 2022). The

difference between these two drastic fields is primarily the population, context, and the

intervention plan. The workers typically experience an injury and require going back to work.

The refugees need assistance to adapt to a new country.

Part 2

Occupational therapy uses a client-centered approach considering every aspect of the

person which includes; physical, mental, cognitive, social, and environmental factors.

Occupational therapists understand important activities or occupations, which can include

hobbies, everyday activities, or work, that are meaningful to the client to achieve their personal

goals. Treatment reflects this. Their occupations can become the treatment or are the end goal.

Part 3
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A key part of occupation is someone participating in that activity. Engagement in

participation is taking part in all of the different life opportunities- both exciting, like becoming a

parent, or not exciting, like washing the dishes. They can be passive or active endeavors,

mindless or thoughtful. We all participate in the occupation of sleeping, but people who have

chronic pain can have insomnia that can influence their ability to participate. This will have a

cascading effect on everything else in that person’s life, like a lack of ability to focus, which can

harm their personal relationships or cause an accident that will harm themself. The damage can

result in further lack of ability to participate in other important occupations. People with

substance abuse history benefit from services by an occupational therapist. From my limited

experience working at a rehabilitation center for substance-abuse disorders, I understood that

most people going to rehab viewed that time as their lowest point in their life. Some people have

lost their right to see their children or been kicked out of their homes, and some have lost support

from their families. For a client who is trying to get their children back, we can be an advocate

for them in court. We can professionally confirm they work hard to be sober and take the steps to

have us justify their readiness to be active parents again. With occupational therapy having a

holistic approach, we recognize every aspect of a person, and use that information to establish

healthy occupations that will enable the client to participate. Finding meaningful occupations to a

person is promoting participation. People are more likely to engage in something if they enjoy it

or find it purposeful, so as practitioners we need to find what would enable them to be active.

Populations with substance-abuse disorders commonly have substances control their life, which

can cause their bodies to not function properly due to the drugs and lack of healthy participation.

Their body structures, for example, their lungs, are being destroyed and they lack healthy social
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interactions (Stoffel, Virginia C. & Moyers, Penelope A., 2004). Health and wellbeing are

determined by their ability to participate in productive and healthy occupations.

Performance and occupational performance both acknowledge the ability to accomplish

what's needed for a task, but occupational performance takes it one step further by understanding

the person's context and their occupations (American Occupational Therapy Association, 2020b).

Establishing context allows for a more active approach, so people have meaning in what they are

doing. Therapists pay attention to the person's performance skill, meaning how they do their

occupation, and their performance patterns, meaning why they do the skill a certain way.

Achieving positive occupational performance allows people to feel confident to continue those

activities, bring a sense of worth and a healthy mindset. People with chronic conditions have

difficulty accomplishing tasks because of the chronic pain they experience, which leads them to

be unmotivated and standoffish with engagement. An appropriate way to get a client with

arthritis engaged in occupational performance would be to modify the environment or establish

and restore functions in their joints (Lambdin-Pattavina, Carol & Pyatak, Elizabeth, 2023.

Showering can be a difficult task when you have arthritis, so working with the client by

modifying the bathroom for accessibility and breaking down movement to regain strength will

support their occupational performance. We want the client to feel independent again, becoming

occupational beings once more. People who lose a sense of independence can have a feeling of

being a burden on their friends and family. In turn, giving back their independence supports

positive mental health outcomes. This intervention supports performance by allowing

accessibility to occupations for the person. Occupational performance looks different and how

the person wants to participate in the occupations relates to the person's client factors.
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Approaching different clients with the same occupation and ailment will still produce a different

approach because of the context needed for occupational performance.

Lastly, it’s important as an occupational therapist to promote health and well-being to

our clients. Another way we can do this is by promoting participation and occupational

performances that are meaningful to the client. Someone considering themselves healthy can be

subjective despite having a positive association with their body, mental state, and social

interaction. Being healthy doesn’t mean having no disease or dysfunction (American

Occupational Therapy Association, 2020b). Wellbeing implies being happy with one’s life,

fulfillment, and satisfaction with their quality of life (American Occupational Therapy

Association, 2020a). Being without occupation means there’s no meaning or purpose in one’s

life, so establishing healthy and productive occupations will allow more opportunities for

enjoyment of life. An example of occupation being used to promote health is a child having

extracurricular activities like sports or art classes. The activities force children to interact with

one another after school. They can form positive relationships with other children their age while

enhancing their own motor and processing skills. Instead of just going to school, then home, and

school again, it gives children an opportunity to have a physical or creative outlet to express

themselves. Not all occupations can prevent diseases but a lot of them can through active

participation in a physical capacity. Swimming is a great example of a way occupation can help

prevent diseases. Swimming builds your physical endurance, strengthens your lung capacity,

strengthens your heart, promotes better breathing techniques, etc. The best time to prevent

diseases is by getting children and young adults to be active as early as possible. It's easier to get

that population to do something by having them engage in occupations that are meaningful to
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them. As we get older we are more prone to diseases so getting children active early will start

healthy habits. Maintaining and continuing active participation in occupations throughout life

will increase their quality of life.

Part 4

When I was writing that entrance essay about “what is occupational therapy," I had very

little understanding of how to answer the question. At the time, I understood what the definition

of occupation was and that the practice was holistic centered. I lacked the terms that best

encompass the practice, such as the profession’s cornerstones, principles of practice, and

approaches to intervention. While I didn’t know the term at the time, I focused on the

client-centered principle of practice, how we value the individual and their occupations.

Retrospectively it is very interesting to look back at and know you can’t mention the therapeutic

use of occupation without it being client-centered.

I truly believed before graduate school that there was little difference between

occupational therapy and physical therapy. While they might look similar in some cases, the

fundamental values and principles of practice are nowhere near the same. If someone asks me

what the difference is, I can with full confidence tell them. My understanding of occupational

therapy was that the intervention process was more geared to the modify and adapt approach. I

remember one of my undergrad professors, who is an occupational therapist, talking about

making a little hook for a client to be able to button up his shirt. I haven't had any clinical

experience with an occupational therapist, so I believe what was the bulk of practice. I

understand now how expansive our field is and we can be used in a multitude of different

professional settings, but I want to be more active in learning all the various specific areas of

practice for occupational therapists. Additionally I want to observe what it looks like and the
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benefit to the grander population. The important aspects of the occupational therapy profession

to me is our holistic approach, practicing therapeutic use of self and being culturally relevant. It

makes complete sense to me that the client has a say in what their main focus for treatment

should be. The client knows the outcome they want and I want to be able to guide them to that

end.

Occupational therapy is the only medical field that doesn't use the medical model because

we value the interrelationship of all the clients' factors. We know that there is value in knowing,

how, why, what, when they are doing their occupations. I value how clearly important it is to

understand the interconnectedness of every aspect of the client. With people it is not just black or

white- we live in a constant state of gray, so having the profession reflect this means we have a

general idea about human beings. Everything depends on the situation at hand and situations

constantly change.

I've enjoyed every surprise and unexpected thing I've learned about our profession. The

one that stands out to me the most is how occupation-focused the profession is. It seems very

obvious now but it wasn't three months ago. While I knew it was important in practice, I didn’t

fully understand the scope of its importance, which made me fall in love with occupational

therapy more. Due to our occupation focused career, we have so many opportunities for practice

where I can still be an occupational therapist but just work in a new setting with new challenges.

There is always opportunity for change while maintaining the role.

I have confidence in myself to be able to produce a general idea of what the value of

occupational therapy has but I also recognize that I have a lot to learn and will be able to enhance

my argument when I get more field experience. I have a pretty good understanding of what

encompasses the profession and am able to explain what we do. There is still a lot of learning
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that needs to happen before I can give specifics to people. I’m really grateful to be going into this

profession that shares a lot of my personal values and to be able to enhance my current strengths

and work on my weaknesses.

References

American Occupational Therapy Association. (n.d.). Work Rehabilitation [Fact sheet].

American Occupational Therapy Association. (2017). Mental Health Promotion, Prevention, and

Intervention in Occupational Therapy Practice. The American Journal of Occupational

Therapy, 71(Supplement_2), 7112410035p1–7112410035p19.

https://doi.org/10.5014/ajot.2017.716S03

American Occupational Therapy Association. (2020a). Occupational Therapy in the Promotion

of Health and Well-Being. The American Journal of Occupational Therapy, 74(3),

7403420010p1–7403420010p14. https://doi.org/10.5014/ajot.2020.743003

American Occupational Therapy Association. (2020b). Occupational Therapy Practice

Framework: Domain and Process—Fourth Edition. The American Journal of

Occupational Therapy, 74(Supplement_2), 7412410010p1–7412410010p87.

https://doi.org/10.5014/ajot.2020.74S2001

Guidelines for Supervision, Roles, and Responsibilities During the Delivery of Occupational

Therapy Services. (2020). The American Journal of Occupational Therapy, 74, Article

7413410020p1–7413410020p6. https://doi.org/10.5014/ajot.2020.74S3004

Krishnakumaran, T., Bhatt, M., Kiriazis, K., & Giddings, C. E. (2022). Exploring the role of

occupational therapy and forced migration in Canada. Canadian Journal of Occupational

Therapy / Revue Canadienne D’Ergothérapie, 89(3), 238–248.

https://doi.org/10.1177/00084174221084463

Stoffel, Virginia C., & Moyers, Penelope A. (2004). An Evidence-Based and Occupational

Perspective of Interventions for Persons With Substance-Use Disorders. The American

Journal of Occupational Therapy, 58(5), 570–586. https://doi.org/10.5014/ajot.58.5.570