O is for Occupation

I feel some pressure having been asked to write the ‘O is for occupation’ blog post for this series. It is a word that carries huge significance for every member of the occupational therapy workforce – occupational therapists, occupational therapy assistants, and student occupational therapist – or at least it should, but more on that later.

More importantly, however, occupation caries great significance for all humans, especially those who have their ability to engage in occupations impacted by illness, disease or social, cultural, or political factors. It is for these people, that we must ensure that occupation is of utmost importance in the minds and work of all members of the occupational therapy community.

In June 2024, I will have been an occupational therapist for 34 years, and I can honestly say that it is a profession that has been exciting, rewarding, challenging, and completely worthwhile. It has also been frustrating and disappointing, but these feelings have not lasted for long on each occasion, thankfully, but they have been a recurring feature of my career.

Living up to the responsibility and promise of the profession

My frustration and disappointment have been because I feel like not all occupational therapists are living up to the responsibility and promise of the profession. Please note that I used the phrase ‘not all occupational therapists’ deliberately. There are excellent examples of occupational therapists, all around the world, engaging in practice that is focused sharply on enabling people – as individuals, groups, or communities – to engage in occupations and thereby enhance or maintain their health. However, not all occupational therapists are doing this and that is a shame for us and the people who could be benefiting from our expertise.

The reasons for why not all occupational therapists are engaging in authentic occupational therapy are numerous and include a wide range of issues such as gender stereotypes, the dominance of the biomedical perspective, our timid professional personality. For the purpose of this blog post I will, however, focus on occupation. Regardless of all the other problems with the profession that occupational therapists proffer, I am certain that the root cause of most, if in fact not all of them, is that not enough occupational therapists know enough about occupation:

Not enough occupational therapists know enough about occupation

I’ve thought for many years now that when it comes to occupation, not enough occupational therapists know enough about occupation. Note again, my use of the word enough to acknowledge that some, perhaps many, occupational therapists know something about occupation. Some or many occupational therapists might know a great deal about occupation. I will stop explaining my word choice, but after being called the antichrist of occupational therapy in the mid 1990s I’ve been careful to ensure my perspective is not misinterpreted.

• “Other people don’t understand what occupation is so it confuses them” – of course they don’t understand it if you can’t and don’t explain it.
• “People don’t understand my assessments and interventions” – of course they don’t if you can’t, and so don’t, explain your work and the complexity of the occupations you are addressing.
• “My clients always confuse me with the physiotherapist/psychologist” – of course they do if what they experience with you in therapy looks and feels like physiotherapy or psychology.

Let’s consider briefly the first common complaint about the term occupation – that nobody else understands occupation. There is a fundamental flaw with that argument that goes some way to prove my point. Assuming the beings you are talking to are human beings and not some other species, they are inherently and by definition, occupational beings. So central to humanity is occupation that Elizabeth Yerxa (2000) in her keynote address at the first UK Occupational Science Symposium, used the term “homo occupacio”. While she was perhaps being playful, the idea that humans are innately occupational beings has a long heritage in our profession.

Occupational beings understand occupation

It stands to reason therefore, that it should not take much to explain to a person, who themselves has an innate occupational nature, the concept of occupation and the relationship between occupation and health. That person is, after all, a living, breathing example of a life full of occupation. I have first-hand experience of this working. After explaining occupation and related concepts to a palliative medicine physician, that physician understood it so readily, that he later referred a patient to occupational therapy because they were “at risk of occupational deprivation.” Occupational beings understand occupation, if we explain it to them.

This exercise of explaining occupation could, however, be difficult if the person providing the explanation does not know enough about occupation. However, that is easily remedied as there is much written about occupation and the relationship between occupation and health – both theories and research evidence. Furthermore, it has been my experience that all occupational therapists have at least some of this knowledge, but it lies dormant, or we assume it is common sense.

After some professional development I delivered on occupation, occupational science, and the theoretical and research evidence – which was a refresher in some areas but also provided some new knowledge – an occupational therapist explained the complexity of completing a kitchen assessment (occupation analysis) to other members of the multidisciplinary team. After the explanation one of the team replied with some surprise: “You know, I never knew you were looking at so much when you made a cup of tea with someone.”

Every occupational therapist has a responsibility to know a great deal about occupation and the relationship between occupation and health. It is our secret weapon. It is what defines us. It is the mechanism by which we can work with people to improve their lives and their health. Let me reassure you that knowledge will increase your confidence in talking about it, and that will mean you can explain it more clearly and more effectively.

We are occupational therapists and we must know deeply about occupation so that we can address the occupational issues of the individuals, groups, and communities we work with and for, by enabling their engagement in occupation.

Reference

Yerxa, E. (2000). Confessions of an occupational therapist who became a detective. British Journal of Occupational Therapy, 63(5), 192-199.

Written by

Matthew Molineux

Professor of Occupational Therapy and Deputy Head of School (Learning and Teaching), School of Health Sciences and Social Work, Griffith University, Australia

Honorary Professor of Occupational Therapy, School of Health and Society, University of Salford, United Kingdom