Occupational Therapy definition

The word occupation seems like a good place to start, given my position as both practitioner and teacher of Occupational Therapy and given also my background in archaeology and folklore. In doing this I am strongly influenced by the way in which the subject of ‘occupation’ is taught in the department where I work. This will be referred to as the ‘occupation knowledge stream’ and there are papers taught to the students at all stages of their training which focus on the underlying knowledge of occupation and the application to occupational therapy practice.

From the occupation knowledge stream has come the concept of the ‘T’ diagram, which is used to differentiate what is taught in occupation from what is taught in a parallel course which is focussed on rehabilitation/remediation. To recap briefly, the vertical axis represents ‘rehabilitation’/remediation and the focus here a problem or particular deficit. It aims to change the person by focusing on the problem or deficit and it draws heavily on bio/psycho/social academic disciplines to provide a theory base for its practice. The significance of the vertical axis is that it brings people to the point where they are ready to begin to engage in activity. Occupational therapists constantly analyse activities, but the activities are analysed in terms of their bio/psycho/social elements. The expectation within the therapeutic paradigm is that the individual will be changed. Virtually all of the occupational therapy literature which touches on brain injury belongs within this framework and for this reason this literature is not used for the literature review.

The horizontal axis, on the other hand, represents the ongoing involvement that people have in everyday life. The emphasis here is not on changing people, or in identifying their deficits, but in helping them to engage in doing things. The end result will be a satisfactory participation in the activity. The analysis of the activity must therefore be in terms of the activity itself. However, the expectation is that as the world is changed, the consciousness of the individual will reflect the work that they inhabit. As an approach it has the advantage of being firmly grounded in practice, but there has been little work done which draws together a literature which would support it.

The focus on each axis of the ‘T’ diagram is clearly different. In ensuring that the focus is achieved on either axis it may be necessary to take into account a whole range of other factors. The therapist working on the vertical axis may be working on improving sustained attention. The factors which she takes into account may include an idea of what interests the client. The practitioner working on the horizontal axis may help the client to respond to the need to hang a cupboard door for his neighbour. The factors which she takes into account may include an understanding of his difficulty sustaining attention. Even if the therapist and the practitioner end up doing things which look very similar, the difference in focus will mean that the decision about the next step to be taken will be very different.

A frame of reference has begun to appear from the work done by the occupation knowledge stream and Caulton (1998a) identified the concept of occupation as the core of it. In this work she connects the ideas of alienation and community with that of occupation and she makes it clear that occupation is a concept which can begin with a need (alienation) and end up by meeting it (community). Alienation is a manifestation of the need and community is the sense that the need has been met, and both belong to a continuum of occupation. There can be bad and good occupation, the signs of which are a sense of alienation and community respectively. People who are well occupied will have all the benefits of community, they are able to both build and dwell. They will live their lives, enjoy their savings and have a fruitful retirement. Those who are not well occupied will suffer from a sense of alienation. The occupation practitioner is one who can help someone move from a position of alienation to one of community, through the medium of occupation.

The occupation knowledge stream depends on the use of language in its everyday sense and there is a deliberate avoidance of language which has been filtered for use by different disciplines. A dictionary of the English language is therefore the primary reference tool and I do not apologise for starting with a dictionary definition of occupation. The definition in the Oxford English Dictionary (OED 1989) has a strong sense of place coming through.

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Occupation
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