OBJECTIVE. The current literature offers no cohesive definition of occupation-based practice. Current definitions emphasize intervention forms and contexts, which do not reflect the complexity of practice. This article demonstrates that the therapeutic relationship and the meanings that are created in the therapy process are central aspects of occupation-based practice. Occupation, as an idea that emerges in the therapeutic process, has aspects of both doing and becoming.

METHOD. The authors conducted observation sessions and interviews with an occupational therapist, Nancy, who used multiple therapeutic strategies with one child, Hannah, as they worked toward Hannah’s goals of going to preschool and becoming a friend.

RESULTS. Strategies include changing therapeutic conditions, using cognitive strategies, bridging the person–task–social context, pushing participation, and engaging in narrative micronegotiations.

CONCLUSION. Occupation emerged in the therapeutic processes as the occupational therapist and client co-created meaning about the client moving toward or away from who she wanted to become.

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