Ethnographic methods were used to examine how an experienced occupational therapist assesses and treats a pediatric patient within a relatively long-term clinical relationship. Treatment goals for this preverbal child with Hirschsprung disease, who began occupational therapy at 22 months of age, included (a) introduction of oral feeding to reduce dependence on total parenteral nutrition through intravenous feeding and (b) facilitation of exploratory play, which had been developmentally delayed during extensive periods of immobilization during medical care. This article shows how the meaning of therapeutic activities changes for the patient over time, as the occupational therapist builds trust through affect attunement, validates his or her empathic interpretations, and develops common understandings with the patient’s family and others within the social and cultural contexts of chronic care.

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