Occupational therapists have used many media and methods over the years to achieve the therapeutic potential of occupational therapy. Yet the reasons for selecting a specific medium or method frequently have been lost or changed without consideration of the result to the therapeutic situation. When neither therapist nor patient understands fully the rationale for a medium or method, the therapeutic potential of that medium or method may be compromised. The author suggests there are eight factors that influence the selection and discarding of media and methods in the practice of occupational therapy. The effects of the eight factors can be summarized in 14 assumptions. Three examples—arts and crafts, sanding blocks, and work-related programs—are used to illustrate the factors and assumptions. It is suggested that improved analysis of occupations based on values and interests could reduce the separation of meaning and purpose in the selection and discarding of media and methods used in occupational therapy practice.