Purposefulness and Meaningfulness as Therapeutic Mechanisms

I chose the topic of therapeutic occupation because that was what attracted me to the profession, and it is the concept about which I have thought most. I became an occupational therapist because I liked arts and crafts and “medical things.” When I was about 11 years old, my friend’s sister came home with paintings and jewelry and other things she had made at college. She was enrolled in the occupational therapy program at the University of New Hampshire and told me she was preparing to work in a hospital using arts and crafts to help people get better. I decided then and there that that was the profession for me. So eventually I went to the university and enjoyed learning all those activities. Those were the days when a large proportion of the curriculum was devoted to developing knowledge and skill in crafts. We learned technique from artists and theory in our occupational therapy classes. We learned that activities were therapeutic because they were purposeful, that is, they demanded certain responses that might be deficient in people who had a disease or injury, and that by doing activities, people improved their skills and abilities. We learned how to adapt activities to change the demands as the person changed. We also learned that because the person got to choose from several activities that demanded similar responses, the chosen activity was meaningful and kept the person interested and working. These beliefs were based on anecdotal observations passed down from early occupational therapists. These beliefs are still taught, but have hardly been researched. Current economic and scientific forces in our society require us to provide support for the hypothesis that engagement in purposeful and meaningful occupation improves impaired abilities or produces occupational functioning. It would be to our advantage also to discover how therapeutic occupation brings about those changes so that we can treat more effectively. Because I have always felt the need to know more about what made occupation therapeutic, I took the opportunity of this lecture to attempt to sort out some concepts concerning therapeutic occupation for myself and to pull together evidence for whether and how 1995 Eleanor Clarke Slagle Lecture