Evolution of the philosophy of occupational therapy

The philosophy of occupational therapy has changed over the history of the profession. The philosophy articulated by the founders owed much to the ideals of romanticism,[7] pragmatism[8] and humanism which are collectively considered the fundamental ideologies of the past century.[9][10][11]

One of the most widely cited early papers about the philosophy of occupational therapy was presented by Adolf Meyer, a psychiatrist who had emigrated to the United States from Switzerland in the late 19th century and who was invited to present his views to a gathering of the new Occupational Therapy Society in 1922. At the time, Dr. Meyer was one of the leading psychiatrists in the United States and head of the new psychiatry department and Phipps Clinic at Johns Hopkins University in Baltimore, Maryland.[12][13]

William Rush Dunton, a supporter of the National Society for the Promotion of Occupational Therapy, now the American Occupational Therapy Association, sought to promote the ideas that occupation is a basic human need, and that occupation is therapeutic. From his statements came some of the basic assumptions of occupational therapy, which include:

Occupation has a positive effect on health and well-being.
Occupation creates structure and organizes time.
Occupation brings meaning to life, culturally and personally.
Occupations are individual. People value different occupations.[14]
These philosophies have been elaborated on over time in order to form the values that underpin the Codes of Ethics issued by each national association. However, the relevance of occupation to health and well-being remains the central theme. Influenced by criticism from medicine and the multitude of physical disabilities resulting from World War II, occupational therapy adopted a more reductionistic philosophy for a time. While this approach led to developments in technical knowledge about occupational performance, clinicians became increasingly disillusioned and re-considered these beliefs.[15][16] As a result, client centeredness and occupation have re-emerged as dominant themes in the profession.[17][18][19] Over the past century, the underlying philosophy of occupational therapy has evolved from being a diversion from illness, to treatment, to enablement through meaningful occupation.[14] This became evident through the development and widespread adoption of the Canadian Model of Occupational Performance.

The two most commonly mentioned values are that occupation is essential for health and the concept of holism. However, there have been some dissenting voices. Mocellin in particular advocated abandoning the notion of health through occupation as obsolete in the modern world and questioned the appropriateness of advocating holism when practice rarely supports it.[20][21][22] The values formulated by the American Occupational Therapy Association have also been critiqued as being therapist centred and not reflecting the modern reality of multicultural practice.[23][24]

Central to the philosophy of occupational therapy is the concept of occupational performance. In considering occupational performance the therapist must consider the many factors that comprise overall performance. This concept is made more tangible using models such as the person-environment-occupation model proposed by Law et al. (1996) and the Person-Environment-Occupation-Performance (PEOP) model developed at the same time by Christiansen and Baum in the United States.[25][26] This approach highlights the importance of satisfactions in one's occupations, broadening the aim of occupational therapy beyond the mere completion of tasks to the holistic achievement of personal well-being.

In recent times occupational therapy practitioners have challenged themselves to think more broadly about the potential scope of the profession, and expanded it to include working with groups experiencing occupational deprivation which stems from sources other than disability.[27] Examples of new and emerging practice areas would include therapists working with refugees,[28] and with people experiencing homelessness.[29]

The expanded version of the Canadian model of occupational performance and engagement (CMOP-E) encourages occupational therapists to think beyond just occupational performance and address other modes of occupational interaction such as occupational deprivation, competence, and justice. The broader notion of occupational engagement encompasses all that we do to become occupied and is congruent with how occupational therapists address issues of occupational enablement today.[14]