The Kawa Model Culturally Relevant Occupational Therapy

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I told him about our innovative community programs and he then decided that he
definitely wanted his students to learn about occupational therapy during their
visit to the medical school. He also asked if he could take away some information
about the Kawa model, which I was very pleased to provide.

We need tools to work with those who need our services and to communicate
our uniqueness to others. I believe the Kawa model can help us focus our work
on individuals in the context of their lives.

Dr Iwama’s book will give us knowledge and it challenges us to think about the
culture of our profession as well as the culture of those with whom we work. It will
also help us gain insight into the cultures of organizations and groups.

This book should form the basis of theory courses for students around the world
– the discussions that will ensue will go a long way to helping us understand that
in fact the world is flat and that occupational therapists all over the world can
learn from each other because we share a culture of occupational therapy. The
book will also help us all honor the cultures of the people we serve as we seek to
improve their everyday lives.

ix
 Foreword
Charles Christiansen

There is a Japanese concept, expressed in the word nyuanshin, which describes

a readiness to learn. This ‘beginner’s mind’, openly receptive to new ideas, is an
excellent state from which to begin exploring this book, particularly if one is a
reader grounded in Western ideas about occupational therapy.

In the parlance of science, sets of ideas about phenomena are variously called
paradigms, models, frameworks or theories. These sets of ideas represent par-
ticular ways of viewing the world and its events. Michael Iwama points out that
these world views, or ways of thinking, are very much influenced by the shared
meanings ascribed to phenomena that have been constructed within a particular
culture. The forming of these views can come from tradition, expert consensus,
empirical research or some combination of these processes. Regardless of how
they evolve, shared meanings and explanations that make the world of practice
comprehensible are so much a part of our everyday interpretations of experience
that we seldom think about them and even less frequently question them. As the
author points out in The Kawa Model, this can be problematic for many reasons.

The late Thomas Kuhn, historian and observer of science, described the
progress of science as something that was far less linear and more social and
political than non-scientists might take comfort in believing1. Practitioners or
technologists who use frameworks as guides for applying knowledge in their
daily work seldom readily embrace new frameworks, however well crafted. This
is because the status quo is comfortable and familiar, and also because those
who established the prevailing ways of looking at the world want them to remain
dominant, regardless of the potential benefits conferred by adopting a new view-
point. Self-interest, cultivated through a career-long process of gaining accept-
ance of a particular point of view, sometimes makes it difficult for the advocates
of a new framework to persuade others of its merits. In short, there are forces
at play besides the intrinsic benefits of a new model that may work against its
xi
 adoption. As a consequence, noted Kuhn, new ideas in the scientific realm have
to be pretty good to get people’s attention, and even better to become adopted
widely enough to replace existing orthodoxies. For these reasons, the emergence
of new world views creates unrest and upheaval. Perhaps this is why Kuhn
described such events as revolutions.

It may be begging the question to assert that the ideas presented in this book
Foreword

constitute the beginning of a revolution. Yet there are many reasons why the
Kawa model can claim to be an important development in the way occupational
therapy is conceptualized. It is true that the model works better for people in
cultures where collectivist rather than individual views of the world predominate;
where interdependence rather than independence are the cornerstones of being;
and where holistic, rather than reductionistic explanations of phenomena are
seen as natural and more fitting.

Yet I believe the Kawa model will have intuitive appeal to many people in the
West, because it is a wonderful and dynamic metaphor for life and the com-
plexities of life’s challenges. Like the flow of life itself, the model is fluid and as
such, lends itself well to the subjective nature of human experience. The popular
US writer, lecturer and student of Eastern religions, Alan Watts, noted that the
world, after all, is not constructed of straight lines. He observed that nature does
very well in creating harmony and beauty with irregular, curved or squiggly lines –
precisely the kind found in drawings of water, or rivers2.

And so it is that the Kawa model, by drawing from nature, does such an effective
job of providing a metaphor for the vicissitudes of life. In so doing it provides a
readily understandable way for both practitioners and clients (be they individuals
or collectives) to understand what occupational therapy is trying to achieve as a
service aimed at engendering participation, health and well-being. More impor-
tantly, this different way of understanding should more readily enable clients and
practitioners alike to become engaged in the process of finding creative, appro-
priate and contextually relevant ways of dealing with those life challenges that
create the need for intervention. This is genuine client-centred therapy at its best,
where therapists empower clients to call upon their ryuboku (or personal charac-
teristics and assets) within the context of their torimaki (physical and social
environment) with an eye toward using sukima (occupations) to contend with the
iwa (circumstances) that impede their life course.

It is not surprising, given the Japanese roots of the Kawa model, that there are
abundant similarities between its concepts and precepts of Zen Buddhism and
Taoism. René Descartes, the 17th-century French mathematician, scientist and
philosopher, is credited with many important ideas that have contributed to
the advancement of civilization3. However, his insistence upon interpreting and
understanding only a world that could be observed and measured helped
xii
contribute to the reductionistic approaches that have dominated so much of
science in the past and present. This obsession with the quantifiable and reduc-
tionistic as the predominate ways of knowing has also been blamed (using Phillip
Shannon’s words) for the historical derailment of occupational therapy4. When
occupational therapists are content with addressing impairments without consid-
eration of their impact on the lives of their clients, they are using a model of inter-
vention that is unrelated to the founding ideas of the field. Sadly, remnants of the
wreckage of occupational therapy’s derailment continue to litter the professional
landscape.

With this book, and its ability to more broadly share the beauty of the Kawa
model with the English-speaking countries of the West, Michael Iwama has
delivered a gift to the profession. At the very least, it will sensitize readers to the
reality of how cultural differences shape ways of knowing. It has the potential,
however, to do much more. It provides a way of understanding occupational
therapy in the context of lives that makes it nearly impossible for one exposed to
its fluidity to ever view therapy in quite the same way again.

There has been a tension in occupational therapy between its qualitative nature
and its existence in a scientific world that values quantitative and positivistic
demonstrations of ‘truth’. This tension is aggravated in the current outcome-
oriented, cost-conscious, evidence-driven milieu of health care in the USA5. As so
many have stated, however, occupational therapy is almost uniquely a profession
where the worlds of applied science and lived experience have been able to
come together. As Tristram Englehardt6 so richly described it, occupational ther-
apists are both technologists and custodians of meaning. Too often, these days,
too much attention is given to the human as body rather than the human as being.
The Kawa model, used alongside Western models of occupational therapy (with
their tendency toward straight-line orientations), will enable a more balanced
understanding of how occupational therapy should be practised. In so doing, it will
add value to the way we think about clients and, thus, enrich the relevance and
outcomes of occupational therapy services provided for them.

REFERENCES
1
Kuhn T. The structure of scientific revolutions. Chicago: University of Chicago Press;
1962
2
Watts AW. Tao: The Watercourse Way. New York: Pantheon; 1975
3
Doney W. Descartes: A Collection of Critical Essays. New York: Doubleday; 1967
4
Shannon PD. The derailment of occupational therapy. American Journal of
Occupational Therapy 1977; 31:229–234
xiii
 5
Mattingly C, Fleming M. Clinical reasoning. Philadelphia: FA Davis; 1993
6
Englehardt HT. Occupational therapists as technologists and custodians of meaning.
In: Kielhofner GW (ed.) Health through Occupation: Theory and Practice in
Occupational Therapy. Philadelphia: FA Davis; 1983
Foreword

xiv
 Preface

The promise of occupational therapy has always been a simple yet potentially
powerful one – to enable people from all walks of life to perform meaningful
activities. Fidler, Reilly, Yerxa, Wilcock, Baum, Townsend and a progression of the
profession’s visionaries have guided us along the most compelling aspect of
occupational therapy’s ideology, despite the enormous pressures that continue to
confine our professional mandate within the modern biomedical paradigm. Their
prophetic declarations about the essentiality of occupation, and the belief that one’s
engagement in meaningful and purposeful doing is profoundly tied to matters of
human health and well-being, remain credible and resonate with a vast number of
people who share the same contexts of experience and meaning; however, the
assumptions about occupation and the relevance of occupational therapy, which
take on universal qualities, remain largely unquestioned and rarely challenged.

While the concept of occupation and ideology of occupational therapy appear to

resonate with many people situated in the normal social boundaries of middle
North America, they may not, in their current constructions, resonate as strongly
and as meaningfully with people abiding in other, differing, social contexts. My
own experience, of acculturating into different ethnically and geographically
located experiences at various points in my life, has stimulated thoughts around
the questions: how are ideas founded in one (‘Western’) perspective of the world
adequate to explain and guide occupational therapy interventions for those
who abide in another very different (cultural) reality? What does it mean for
occupational therapists to mandate independence to collectively oriented,
interdependent-conscious clients?

If we have not already asked it in our ever-increasing diverse practices, these are
questions we will all need to ask eventually as occupational therapy finds its way
across cultural boundaries within and outside of our national contexts of daily life.
Although we frequently construe culture to traverse geographic locations and
xv
 treat it as a static attribute located within the individual, we may need to expand
culture to include spheres of experience (transcending the individual into the
social realm) and consider how these individual markers of distinction are created
and ascribed through a social dynamic. Taking it in this way, we need not cast our
gazes to other nations and geographical locations, but examine the cultural
diversity within the boundaries of our own communities where we live and
practise. A broader regard for culture would take into account and foster an
Preface

appreciation of other common spheres of experience around, for example, socio-

economic groupings, political activity, gender, sexual orientation, religion and
faith, or institutional life. All of these somewhat arbitrary and socially constructed
categories (often reified by expansive products of the scientific academe) speak
to different spheres of shared experience and represent their own developed
values, social norms, rituals, etc.

Our clients in occupational therapy represent a constellation of uniquely lived and

socially constructed spheres of experiences, yet we hold onto universal
narratives of occupation and occupational therapy and even those perspectives
borrowed from the culture of medicine, and proceed to translate these
imperatives onto our unwitting and often vulnerable clients. This is perpetuated
when we rarely question or critically examine the veracity and cultural safety of
our theory, knowledge and methods in this still-fledgling profession, and when we
push forward with our protocols without much regard to whether what we do has
any real relevance with the client’s contexts of daily realities. How client-centred
are we being when we end up taking responses to our own constructed
questions based on a particular construal of occupation and transform the
responses we hear from our clients into the present culturally narrow lanes of
occupational therapy ideology, texts and instruments?

Perhaps that is more of a commentary of where we have come from and where
we are at this present time than it is about where this promising profession is
progressing. Our theoretical materials and epistemology have yet to move
through the post-modern and post-structural bumps and grinds that will take us
from the rational and universal towards the culturally relative and culturally safe.
Occupational therapists will need to figure out what to do with a heavily
biomedical-influenced mandate based on physical evidence and pathology, or a
mandate on Western, existentially situated views embodied in terms like self-
efficacy, personal causation, occupational performance, self-care, productivity
and leisure, for a global diverse clientele.

Occupational therapy has at times been classified as a white middle class

women’s profession. That classification is debatable and troublesome (and
excluding for men of colour like me), but even more so when considered from the
vantage of diverse societies that could benefit from occupational therapy. This
xvi
profession’s hidden power has been in its mandate to be relevant to the functions
of daily life that we (society) often take for granted until we are either denied such
functions or lose the ability to perform them. But our practice, knowledge and
theory have sorely been lost on the needs of a diverse clientele who represent
diverse spheres of experience outside the boundaries of occupational therapy’s
grand narratives. It has also placed occupational therapists like my (male) self,
belonging to non-Western ethnic traditions, out towards the periphery. Perhaps
we can point towards the funding structures, political conditions and institutional
constraints of the world of medicine, to which we have been almost inextricably
tied, that constrain and shape our practice; but perhaps it could also be that
occupational therapists have been theoretically juvenile in not developing our
materials and knowledge in a more culturally inclusive and socially equitable
direction.

Those of us who have experienced a life and spheres of experience different to

those that are reflected in contemporary occupational therapy have at times felt
marginalised or uncomfortable about the processes that we engage in this
profession. It has been challenging to call occupational therapy our own when
much of it fails to resonate on a more profound, cultural level. Those of us who
have not departed for other vocations will have questioned where the voices and
representations of everyday life of our own cultures have been in occupational
therapy. We aren’t quite there yet, in contributing to our literature or to our
leadership.

Yet we hold on to the hope that eventually our profession will move towards a
more inclusive perspective. Occupational therapy has always been about
enabling people to perform meaningful activities in daily life. There is tremendous
power in this simple mandate. This promise is what holds me here and impels me
to exert a view to move my chosen profession closer to this wonderful ideal. At
this present time, the narratives, means and explanations of what this is are
Western-centric and exclude a large majority of occupational therapy’s clients
and practitioners. Just ask anyone on the street what occupational therapy is and
you’ll see what I mean. Ask an occupational therapist in a non-English-language
setting what the occupation in occupational therapy means and you are sure to
get a variety of definitions – some wrong perhaps from your particular vantage.

This book is as much about honouring and respecting different cultural

constructions of occupational therapy as it is about a model that serves as an
example of an alternative view of the meanings of doing. It is a tool to be adapted
and manipulated to suit the language and experience of occupation in varying
cultural situations – not to translate our clients’ experiences into a particular
ethnocentric narrative. By respecting and giving credence to our clients’ diverse
views of reality and the meanings of doing in everyday life, we bring ourselves to
xvii
 a place where we consider reconceptualising occupation. The consequence of
adopting this line of thinking and values shift is the creation of more concepts and
alternate ideals – ideals that resonate meaningfully with the daily life experiences
of all those we endeavour to serve.

A concern for this profession lies in the maintenance of ideals and concepts that
are out of sync with our clients’ real worlds of meaning. A profession that places
Preface

the blinkers on alternative views and constructions of meaning in daily life stands
to trivialise itself into extinction, and thus fall far short of occupational therapy’s
magnificent promise.

Michael K. Iwama
Okayama, Toronto, Brisbane 2006

xviii
 C H A P T E R 1

Situating
Occupational Therapy’s
Knowledge
Why Alternative Conceptualisations and
Models of Occupational Therapy Are Required

Occupational Therapy As Culture 6

Reconceptualising Occupation 8
Does contemporary occupational therapy theory harmonise with and
adequately explain the contexts and shared experiences in the daily lives
of occupational therapists and their clients? In this opening chapter, this
fundamental issue of meaning in our profession is raised. Meaning of the core
concepts of occupational therapy, the principles rationally connecting them,
and the theoretical materials that follow are critically examined. This fun-
damental issue is often overlooked, yet has enormous bearing on whether
occupational therapy is truly relevant, useful, fair and inclusive. In scientific
language, we might say that we are examining matters of construct validity –
whether the constructs and concepts being considered truly represent what
they purport to. In the context of occupational therapy practice we might
conduct such an examination by asking critical questions such as: whose ideas
of occupation are these?; where did these ideas come from?; what influenced
these ideas?; and do these ideas resonate with and agree in meaning with our
clients’ worlds of experiences?
Academicians are challenged to consider the validity of their theory, their
constructs and principles and the veracity with which we regard the
knowledge that informs and translates our theory into occupational therapy
practice. Practitioners are challenged to look beyond the form of occupational
therapy, as they have learned and practised it, towards a more comprehensive
examination of the contexts in which their occupational therapy is applied.
Occupational therapists are encouraged to examine critically whether their
current occupational therapy is meaningful relative to the meanings of their
clients’ day-to-day realities.
We proceed directly, then, to the issue of why we need other conceptual
models, like the Kawa1 model, and why the profession of occupational
therapy, for the sake of our clients, must critically consider the cultural
dimensions2 of its theory, models, knowledge base and patterns of practice. To
deny this need is to overlook culture’s fundamental importance to occupa-
tional therapy and to maintain certain exclusionary qualities of our profession
which, in its current state, appears to favour the maintenance of normal
Western world views and its modal spheres of experience. It is this current
state that draws an inference that competing views of truth and occupation,
which are situated outside its constructed boundaries of normal, require
correction and cultivation. If occupational therapy is to become the relevant,
powerful and useful entity that it can be, then the consideration of culturally
relevant theoretical material and practice approaches is fundamental. A
culturally inclusive occupational therapy is imperative.
What does culture have to do with the knowledge and theory of occupational
therapy? And why do we need yet another conceptual model to describe,
explain and guide our practice? The answers to these fundamental questions
depend on how we define and regard culture, and whether we understand
culture as a static feature of individuals – of occupational therapy clients and of
3
 their therapists – or as something much larger and pervasive, transcending
the individual, to the broader processes that define the profession and practice
of occupational therapy. How we orient ourselves to these fundamental
questions may well determine whether our occupational therapy is truly as
meaningful, relevant and helpful to our clients as we believe it to be.
Few of us are used to regarding occupational therapy as a cultural entity – a
significant oversight in our profession’s demonstrated views of culture – and
Why Alternative Conceptualisations and Models of Occupational Therapy Are Required
S i t u a t i n g O c c u p a t i o n a l T h e r a p y ’s K n o w l e d g e

this has limited our appreciation for its fundamental place in the form, func-
tion and meaning of occupation and occupational therapy. If we are serious
about advancing this profession in a more culturally inclusive direction, and
thereby increasing its meaningfulness and value to our clients and to society,
then we must take a more critical perspective in evaluating the cultural norms
that bind, shape and determine the relevance and meaning of occupational
therapy to the social contexts in which we practise. And, rather than projecting
our culturally bound narratives onto clients who may not abide in our own
situated views of normal, we may need to develop and implement better ways
for our clients’ narratives to form the bases to our theory and knowledge, and
direct the processes of occupational therapy.
Ideas and truth are given power by the social contexts from which they
arise and wherein they reside. The particular world views informed by the
collective experiences we share within groups are evident in our theories
and ideas of occupation and the meanings that are ascribed to doing. These
ideas do not flow from a vacuum nor from heaven but rather, they are thought
up and expressed by human beings who are reflecting on what they believe to
be true, worth knowing and worth doing. And these truths are, arguably,
fundamentally grounded in common social spheres of experience. Whether
we realise it or not, our conceptual models in occupational therapy are
constructed in particular (Western) cultural contexts and reflect the world
views, value patterns and perspectives of truth of their authors. We have not
really made it a priority to recognise and understand the situated-ness of
our knowledge, theory and practice. Subsequently, little heed is paid to the
consequences that occur when the situated grand narratives of occupational
therapy and the situated narratives of the client are out of sync.
When conceptual models are used in the same or similar cultural contexts in
which they have been formed (or constructed), there exists greater probability
for the model’s inner concepts and the principles that bind them, and the
overall structure in which they are organised, to resonate with the clients’ real
world of day-to-day experiences and meanings. Most of our current models of
occupation and occupational therapy have been raised and informed by
people who share common experiences and common views of truth, situated
in the Western world – particularly urban North America. And we are
probably mistaken if we assume that these views of reality are universally
appropriate to explain the realities of occupational therapy’s diverse clientele.
4
Independence fostered by a greater sense of individual determinism, rational
thinking that gives order and a certain confidence in matters of time use and
self-efficacy, and the celebration of the self as rational ‘doer’, are some of the
common social features and value patterns that are evident in the profession’s
current epistemology and theory. What happens to these ideas, theoretical
frameworks and emergent intervention designs when they cross cultural
boundaries of meaning? Do the ideas, value patterns and views of reality
embedded in the models transfer and integrate well with people representing
all walks of life in your own communities? How do the discourses around
occupation – of people as reflective, agent, occupational beings, as rational
occupiers of environments, etc. – relate to people who abide outside of these
culturally situated perspectives? Are the daily life patterns and meanings
ascribed to doing of the elderly, children, of people living in conditions of
poverty and disadvantage, diverse ethnic groups, including the aboriginal
peoples of your nations, truly being appreciated and enabled by our
contemporary theoretical frameworks?
A myriad of consequences surfaces when theory is out of sync and out of touch
with practice and the shared experiences and meanings of our clients. Some of
the more significant of these are explained in greater detail in Chapter 6. And
this is not a simple matter of changing the therapists’ levels of cultural
sensitivity and competence to appreciate the cultures of their clients. The very
ideology, philosophical bases, theory, body of knowledge and practice impera-
tives that speak to matters of culture at a broader level may not be as useful
and enabling as we might want to believe. We may want to proceed deeper
in our musings about client centred-ness, evidence and what constitutes
best practice. Such consequences are the very bases for why new, culturally
relevant knowledge, theory and practice norms are needed in occupational
therapy2.
The Western norm of contemporary occupational therapy – its form, meaning
and functions – become inconceivable and misunderstood when applied in
non-Western social contexts. More than half of the world’s population is
situated outside of the (Western) social contexts that gave rise to occupational
therapy’s raison d’être. Tacit social norms of independence, autonomy, self-
efficacy and unilateral determination brought to bear on a clientele that prefers
collective identity over individual identity, interdependence over autonomy,
and hierarchy over equality, can produce some difficulties or might even be
disastrous to people’s sense of health and well-being. Like a square peg being
forced into a round hole, the resulting incongruence can achieve the opposite
of the enabling and empowering promises of occupational therapy. This can be
reminiscent of certain colonial attitudes from a bygone era in which the
information and assistance being prescribed from the dominant culture to the
other results in superficial compliance to form and procedure, yet deficient in
profound meaning, enabling and empowering.
5
 Occupational Therapy As Culture
The critical examination of fit between occupational therapy’s meanings
and its clients’ world of meanings is treated in this book as a profound
matter of culture. When culture is viewed from such a perspective that
transcends matters of individual attribute and embodiment, then culture is
permitted to take into account the broader social processes, outside of the self
Why Alternative Conceptualisations and Models of Occupational Therapy Are Required
S i t u a t i n g O c c u p a t i o n a l T h e r a p y ’s K n o w l e d g e

in the social realm, that manufacture the categories of distinction into which
such individual attributes become located. Your view from this regard will
necessarily require you to proceed beyond cultural sensitivity at the indi-
vidual level, towards a curiosity for the cultural construction of the profession
and practice of occupational therapy itself. Examine this construal of culture
closely and you may notice that occupational therapy, as a profession,
possesses within it all of the features that would qualify it as a cultural entity.
Occupational therapy has, for example, a shared specialised language3,
common learned values, and certain tacit and expressed rules of conduct,
common social practices, and a developing body of profession-centred
knowledge. A visit to almost any occupational therapy practice settings will
reveal many of its cultural artefacts. By artefacts, we not only include material
objects like splints, orthoses, long-handled reachers, etc., but also what
occupational therapists regard to be worth knowing and doing. Conceptual
models, theory and the assessment tools, new and evolving concepts like
occupational deprivation4 and occupational justice5 represent some of
occupational therapy’s cultural artefacts.

More Than Individuals, Race and Ethnicity

So while the conventional treatment of culture in occupational therapy has
been advanced along the lines of race and ethnicity, discoursed as individual
markers of distinction – of therapists and clients – there is a need to expand its
scope and definition to include social processes, of which the profession of
occupational therapy as we know it qualifies. By recognising professional
systems like occupational therapy or medicine as cultural entities, we are
afforded a more useful framework for making sense of culture as a
fundamental consideration in the construction of and treatment of meaning in
the daily (occupational) lives of the patient-client. To be unaware of the
essential cultural nature of occupation and occupational therapy is to be
ignorant of a large portion of a comprehensive and just understanding of
meaning in the lives of the populations we endeavour to serve. Discoursing
occupational therapy as a cultural system in its own right steers us away from
maintaining a perspective of culture in our profession as one in which the
client is viewed and appreciated as an embodiment of static, stereotypical
attributes.

6
This shift in defining and regarding culture holds important implications for

Occupational Therapy As Culture

this profession. As the emphasis in the culture discourse shifts from individual
to profession, matters of inclusion and equity need to be critically revisited.
Instead of seeing the problems of cultural relativism as existing at the
individual level, the profession and all that it subsumes – its ideology,
philosophy, epistemology, theory and practice forms – are brought into this
spotlight of scrutiny. Congruent with the maxim, we can never be separate
from the things we create and hold to be true, it can now be averred that the
core concepts, ideology, knowledge and practice forms of contemporary
occupational therapy are the manufactures of people who are situated in a
particular sphere of shared experiences and views of ‘normal’. Occupational
therapy is culture-bound.

Culturally Out of Sync With Society?

Occupational therapy is truly powerful when its practice and the ideas
that inform and guide it are congruent in spirit, truth and meaning to the
client’s worlds of the same. Occupational therapy’s processes and benefits
must resonate directly and meaningfully to the client’s real world of home
and community. Until now, we have not really asked the crucial and diffi-
cult questions of relevance of our profession to and with the communities
we serve. We have regarded and maintained our discourse to be universally
true and applicable without having broached the difficult and necessary
questions like: ‘Does occupational therapy actually matter and is it as valuable
and meaningful as we had been taught it to be?’ And yet, despite the
tacit understanding that occupational therapy does matter, occupational
therapists find themselves still having to explain to their clients, to their fellow
health team colleagues, and to the public, what they think occupational
therapy is.
If we take a moment to explore how occupational therapists define and
talk about ‘occupation’ through our own literature, textbooks, educational
programme websites and then ask people – be they relatives, friends and
clients – how they define or explain what the word occupation means, it does
not take long to realise that we may not all be conversing on the same cultural
page. We all hold differing understandings of ‘occupation’ created within
different spheres of experience. When consulting several English language
dictionaries for the definition of occupation, it may be difficult to find
definitions that adequately capture the constellation of meanings occupational
therapists ascribe to ‘occupation’. Comparing and contrasting the varying
definitions of the core concept of the profession of occupational therapy may
reveal a disconnection between what occupational therapists mean by
occupation and what their clients understand it to be.