Why did you choose a career in occupational therapy?
I highly doubt you were enamored by the name. Most likely, you believe in the fundamental nature of occupation and the core concept of "supporting health and participation in life through engagement in occupation" (AOTA, 2008, p. 626).
Personally, I fell in love with OT when first introduced to its key constructs, and my love has only deepened relative to my understanding of its theoretical base.
I write this as I transition from student to practitioner-a journey of excitement tempered with trepidation. In school, I absorbed the value of occupation and its significant role in the founding of our profession. I was extremely fortunate to have exceptional academic and clinical instructors who emphasized occupation-based practice.
But the demarcation between classroom and clinic is real, and when idealism and pragmatism clash, the latter typically prevails. Time constraints, reimbursement, productivity demands and intervention credibility have all been identified as barriers to occupation-based practice (Colaianni & Provident, 2010). With time, will I still utilize occupation and purposeful activity as interventions, or will preparatory activities-such as therapeutic exercise-comprise the bulk of my treatment? Will the attrition of theory occur when practice begins?
Yet, is blending theory with practice actually so vital? If we achieve results and aid those entrusted to our skilled care, do our session particulars really matter?
If we truly believe in occupation's power, we are cheating our clients by merely providing standard exercise. Purposeful activity increases motivation and facilitates therapeutic outcomes by replacing pain-focused rote movement with goal-focused natural activity patterns. The client benefits when occupational competence-not deficit remediation-is considered rehabilitation's ultimate goal (Trombly, 1995) because "occupations are central to a client's. identity" (AOTA, 2008, p. 628).
Occupation-based practice is advantageous for practitioners as well; it infuses novelty and vitality into each treatment encounter. Gathering comprehensive occupational profiles and customizing interventions will immeasurably enhance our therapeutic relationships and preclude monotony and tedium.
Finally, if we minimize occupation in our practice, how are we distinguishable from other rehabilitation professionals? "The profession's use of occupation as both means and end is a unique application of the [rehab] process" (AOTA, 2008, p. 647). In today's healthcare arena, every discipline is vying for recognition and adequate, timely reimbursement. If we don't remain constant to our distinguishing, founding ideals, what remains the source of our viability? Occupation-based practice cannot be overemphasized if we wish to remain a primary healthcare player.
But, how can we reconcile the existing barriers with occupation-based practice's essentiality?
Awareness is the first step. As occupational therapists, we appreciate the difficulty of effecting role shifts in the face of maladaptive performance patterns. Habituation can be dangerous as conscious awareness of one's performance is a necessary prerequisite to change.
Another key is education (Colaianni & Provident, 2010). Exercise is indeed a universal language; but we cannot forget that what we promote possesses universality too. The broad construct of occupation transcends boundaries of geography, time and culture. Our product is not foreign or novel, merely under-acknowledged.
Finally, research is an essential element (Colaianni & Provident, 2010; Trombly, 1995). We may believe and anecdotally know that occupation-based practice works, but to prove it to others, we must have evidence.
There is no contesting our profession's growth since its inception. Our scope of practice has expanded, and practice areas continue to emerge. But this poses a potential danger: If our profession continues to branch out while neglecting its roots, what will ensure that it endures? Occupation-based practice may be our past, but it also guarantees our future. It is our profession.
I challenge myself to blend theory with practice and ensure occupation remains a vital element of my interventions; I challenge you to do the same. Let us share practical ideas on occupation-based practice. Let us generate more research. Let us educate the public; let us educate ourselves on the fundamental, therapeutic nature of occupation as both means and end (Trombly, 1995). Only then can we honestly and proudly identify ourselves as occupational therapists, a title embodying the unique ideals of our profession.
References available at www.advanceweb.com/OT or upon request.
Brocha Stern, OTR/L, a recent graduate from Temple University's MOT program, currently practices at Kessler Rehabilitation Center in NJ.