The purposes of this paper are two. The first purpose is to contribute to cultural competence in occupational therapy practice. The second is to contribute to occupational therapy literature about culture and cultural analysis related to practice. This paper introduces a cultural analysis of stories about the therapeutic process with two Japanese therapists and their Japanese patients. Two therapeutic situations, including therapists’ and their patients’ experiences, are interpreted by the author, a Japanese occupational therapist, as critical incidents for reflection to improve culture general competence. The stories illustrate the patients’ perception of life with illness and, particularly, the emergence of their cultural values within the therapy process. The analyses focus on how an understanding of the patients’ illness experience is integrated into the therapy process and how the therapeutic interventions reflect the culture. In one case, the therapeutic occupation of cooking links to the meaning found in the traditional Japanese woman’s role. In the second case, the therapist–patient relationship, based on local rather than western social relationships, promoted the patient’s engagement in meaningful occupations. Reflection on these stories, which illustrate an alternative cultural view of occupations and therapeutic relationships, may assist occupational therapists in the development of improved level of cultural competence.