A November 21st letter ("Why Shouldn't Prep Treatment 'Count' as OT?"), written by an OT and fellow CHT, Pamela Karp, about my November 7 column ("What OT Has Is Uniquely Ours") has prompted me to clarify, repeat and possibly streamline my thoughts on the profession, the use of occupation, the notion of client-centered care and the concept of reductionism.

My first point of clarification surrounds the notion that my column of November 7th had a "reductionist" tone. According to several dictionary sources, the term "reductionism" generally means simplifying a complex idea, issue, condition, or the like, especially to the point of minimizing, obscuring, or distorting it. I am assuming that Ms. Karp is of the belief that I have taken the complex notion of what is unique about the profession of OT and simplified it to the point that it has become obscure or distorted.

If this is her position, she may be partially correct. I have taken a stance on the current state of OT practice. The 50-plus articles that I have written are by design intended to make difficult concepts more easily understood. In addition, each is a component of a much larger ongoing narrative.

But simplifying concepts for understanding is much different from the reductionism that we see in some areas of OT practice, where the complexities of the human mind, body and spirit are treated as though they are "parts" of an object, a human being. This manner of reductionism leads to the loss of the essence of humanity and creates the notion that people automatically regain their lives once their gears and levers are back in commission.

In the context of the column, it should be apparent that my mention of a birdhouse building/filling project in a skilled nursing facility was part of a larger activity of caring for birds that was meaningful to the clients and was a permanent engagement that encouraged their participation and created a sense of enjoyment and wonderment of nature for other residents. In addition, this activity (although not mentioned explicitly) could address motor skills of the hand and upper extremities, endurance and functional mobility, and provide stimulation to the cognitive and sensory areas of the brain, decrease isolation and improve social participation.

This type of activity is not the demise of OT in any sense of the word! It is what defines OT. Occupations address underlying factors and attend to psychosocial factors that affect volition and emotional stability. Tune into popular television programming. Occupation and the facilitation of occupational engagement are everywhere in shows like Extreme Home Makeover.

Modern brain science recognizes the importance of the interplay of various areas of the brain and the need for activation of interneuron connections that fire when stimulated through multiple types of input. Authentic OT offers multimodal activities that provide such stimulation. Isolated exercise is PT.

Finally, Ms. Karp states that it is the "client-centeredness" of OT that makes our profession unique. But many professions use client-centered care; it does not provide a unique set of skills and is not a paradigm for OT or any other discipline. Not that long ago, medical-model practice expected therapists and others to assume a paternal or authoritarian stance with clients - to complete evaluations, share our findings with clients and then tell them which goals would be addressed. With good reason, the approach changed.

I look forward to future letters, either through print or private correspondence, to continue this very important dialogue.

Debbie Amini, EdD, OTR/L, CHT, is director of the occupational therapy assistant program at Cape Fear Community College in Wilmington, NC.