Purposeful Activity and Active Occupation

When does a purposeful activity become an occupation? And when does an occupation become a purposeful activity? There seems to be a propensity in our profession to make definitive statements about these two categories of action, but in my opinion, there is no such distinction. It is all a matter of perspective. What is purposeful to someone may or may not be purposeful to someone else.

And what one person defines as occupation may not be defined in the same way by another person, even when they are talking about the same activity.

I recently read an interesting article about knitting by Stephanie Pearl-McPhee which compared the following perspectives:

"I find it interesting when people say, 'Oh, I'm not patient enough to knit.' Really, I think it's the other way around. I think it's impatient people who knit, because they can't just sit there."

Clearly, the knitter is one who finds meaning and satisfaction in the job at hand, whereas the person who does not knit sees knitting as onerous and demanding. Pearl-McPhee makes knitting her career as well as her hobby. So is she engaged in purposeful activity or in occupation? I can't make the distinction, and I would venture to say neither does she.

Many of the tasks in which we engage can fall into a variety of categories. How we define them often is colored by social influences. If the activity is valued by society, it is tends to be defined by terms that suggest importance. If the activity is deemed less significant, it might be defined by less-valued terms.

For example, a chef's interest and skill in cooking is marked by the money and fame received for performing the job. A stay-at-home mom or dad who is responsible for daily meals for the family is often not valued for cooking prowess, despite his or her efforts.

Many occupations can be viewed from alternative perspectives. A mason who lays tiles is using many of the same skills that a mosaic crafter is using. Carpenters can be paid workers or hobbyists. Metal artisans produce valued pieces, yet can be considered crafters. Or are they craftsmen?

This discrepancy between crafts that we value and crafts that we feel demeaning permeates our culture and our profession. For many years now some therapists have avoided the use of crafts in therapy, not because they are not therapeutic, but rather because they are considered to be unvalued by the public. They are influenced in that direction by their colleagues in medicine who hold their own skills in high regard because they are grounded in science. It is very difficult to present one's own view of the value of activity as a therapeutic tool when these tools are hard to define and value and have equal grounding in science and philosophy.

These ideas are also influenced by our own profession's insistence on separately defining purposeful activity and occupation. Here, occupation is valued. Is it not the name we call ourselves? Purposeful activity is not valued to the same extent.

There are two problems here. The first is related to education. In order to become a competent therapist who can relate to the occupational life of the patients one encounters, one needs to experience a broad variety of active occupations. One needs also to be able to analyze, adapt and teach these activities. But many schools have limited the experiences of students by eliminating such learning from their curricula, or reduced it to a fragment of its former position.

The second problem is related to clinical practice. When clinical sites have been influenced to remove active occupation from practice, a basic tool of occupational therapy is gone. This poor practice not only impacts patients, it also denies students the opportunity to view how active occupation works in healing.

We must ourselves feel that active occupation is valuable. We can do that by introducing activity into our therapeutic protocols, using our patients' interests to structure their programs. And we can take pride in the special knowledge we bring to healing through our use of activity as a therapeutic tool.

Estelle Breines, PhD, OTR, FAOTA, is nationally known for her study of the creative process in therapy. Her latest book is the 2nd Occupations and Activities from Clay to Computers. She is currently president of the New Jersey Occupational Therapy Association and has a private practice, Geri-Rehab Inc, in Lebanon, NJ. Readers may e-mail Dr. Breines at or go to her new Web site at

Activity Notebook Archives

"...Often have I heard you say, as if speaking in sleep, "He who works in marble, and finds the shape of his own soul in the stone, is nobler than he who ploughs the soil.
And he who seizes the rainbow to lay it on a cloth in the likeness of man, is more than he who makes the sandals for our feet."
But I say, not in sleep but in the over-wakefulness of noontide, that the wind speaks not more sweetly to the giant oaks than to the least of all the blades of grass.
And he alone is great who turns the voice of the wind into a song made sweeter by his own loving..."

Kahil Gibran: "The Prophet"

Geri Church,  OTR,  Watauga County SchoolsNovember 21, 2007
Boone, NC

I've practiced for over 30 years, much in home health. One undeniable truth is that if my treatment plan doesn't bring the client closer to their goals, then my treamtment goes out the door with me, carry over is nil and they don't get better. It's a wonderfully challenging environment.
I usually explain occupational therapy by first asking clients what they think it is. I then attempt to direct their awareness to the word "occupation" and define it relative to occupational therapy as follows. "Occupation refers to anything and everything that you do with your time and energy that has meaning and/or purpose in your life. One's ability to brush their teeth, dress, bathe, feed themself, drive a car, balance a checkbook, carry on a meaningful conversation with another without becoming physically agressive, dusting, doing laundry, shopping for groceries and cooking a planned meal; are all occupations (by this definition). Occupation also entails what we may do to "make a living", problem solving, and the pursuit of leisure activities."
When it comes to therapeutic activities I use (in home health) what's "at hand". Most of the homes I work in could use a thorough cleaning, usually because the client is not up to doing some of the heavier tasks of vacuuming, furniture moving, floor mopping and such.
I often engage the client in a meaningful, purposeful cleaning task WITH ME, so that we are WORKING together. It always makes the therapy session much more effective and worth their while.
Semantics seem less important when you hear them say, "I did that, and I did a good job."

Noel Levan,  OT,  home health agencyNovember 16, 2007
Harrisonburg, VA

I agree with all of the comments in your article. I love your book, and we use it in our curriculum. I currently teach a 3rd year level course on Performance, Adaptation and Media. In the lecture, we cover the typical human development from prenatal through the end of life, and there's a concurrent lab course that goes along with it where we discuss activities/occupations of people in each of the age ranges of life. I try to give the students a good, overall introduction to the therapeutic/purposeful use of occupations within treatment and teach them to analyze any activity imaginable. It's a very fun course, and I hope that it is helpful to them. However, from a clinical background, I know how often this is not infused into everyday practice, as I was not as conscious about it as I should/could have been. Maybe, in hindsight, as I instruct these "soon-to-be" new therapist, their attitudes and actions will be different.

Cathy Dawson

Cathy Dawson,  Asst. Professor,  Tuskegee UniversityNovember 14, 2007
Tuskegee, AL


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