This article reports findings from interviews that explored the meanings occupational therapists attach to independence as a value and a therapeutic goal in interactions with elderly clients. Through a historical review of the literature, we trace the changing use of this term and identify two analytically distinct concepts associated with it: independence as self-reliance in activity and independence as autonomy, self-determination, or choice. We show how the latter has emerged in contemporary service contexts to represent an ideal of client-centered practice for persons with chronic disabilities, such as frail elderly clients. Using a “critical incident” interview approach with 12 Australian occupational therapists, we identified the therapists’ explicit and implicit understandings of independence as a value concept and practice issue. Our findings suggest that a mismatch often exists between idealized and practice-based talk about independence and that therapists narrativize this opposition around what we call “the safety clause.” That is, therapists invoke concerns about safety and duty of care as a caveat to implementing their independence ideals and justifying the retention of professional control. We identify key issues that therapists need to address if the rhetoric of independence-related client-centered practice is to be achieved in reality.

Objective. This study examined occupational therapists’ use of the occupational form of goal setting as therapy and its impact on clients. Method. The study method was qualitative, using participant observation and interviewing as the main source of data. Results. The findings illustrated that therapists work both to give substance to the occupational form and to create the context of an implied narrative that imbues it with particular meanings. Simultaneously, clients’ experience of meaning is influenced by a personal volitional narrative. When the two narratives do not coincide, therapists’ efforts to maintain the occupational form intensify as they encourage clients toward attitudes and performances that do not resonate with the clients’ experience of reality. Conclusion. The findings underscore the importance of recognizing that occupational forms are embedded in social processes and perspectives that inevitably come into play when occupational forms are used as therapy.

Objective. This study examined the roles that play occupies within current occupational therapy practice with preschoolers. Method. Two hundred twenty-four pediatric occupational therapists completed mail questionnaires designed to ascertain how they use play in their practice, their knowledge and use of play assessments, and potential constraints on their use of play. Results. Although respondents indicated that play was important in motivating children and frequently used play as a treatment modality or reinforcer, they Less frequently assessed play behaviors or wrote treatment goals and objectives related to play. Differences were found between school-based and non-school-based respondents regarding the discipline or model that addresses play in the work setting, the use of play assessments, and constraints that Limit the use of play in the work setting. Conclusion. The results suggest a need for increasing the emphasis on play in entry-Level curricula and continuing education, improving clinician access to valid and reliable play assessments, and completing studies designed to examine the use and efficacy of play in occupational therapy intervention.

This article builds on prior work and defines terms basic to the profession of occupational therapy. The prior work defined occupation as the relationship between occupational form and occupational performance and defined related terms, such as meaning, purpose, developmental structure, impact, and adaptation. This article shows how these terms relate to therapeutic occupation, a special type of occupation. Therapeutic occupation through occupational synthesis is the core of occupational therapy. Occupational synthesis is the design of the occupational form by the occupational therapist in collaboration with the recipient of services to advance therapeutic evaluation or achieve a therapeutic goal. Therapeutic occupation, then, is meaningful, purposeful occupational performance leading to assessment, adaptation, and compensation, all in the context of occupational synthesis. Finally, the idea of therapeutic occupation through occupational synthesis is related to frames of reference and models of practice in occupational therapy today.

Objective. In 1993, a replication of a 1983 survey of occupational therapists who used group treatment in practice was administered in order to determine whether economic and demographic changes during the 10-year period altered the use of group treatment in the delivery of occupational therapy services. Method. The survey used in 1983 was updated with new questions regarding reimbursement and payment and was mailed to 307 practicing occupational therapists nationwide. Of the 188 respondents, who represented all areas of practice, 96 used group treatment and provided data on the 233 groups that they led. Results. The two largest groups of occupational therapists who used group treatment worked in non-medical facilities (i.e., schools and community facilities). In general, group occupational therapy was activity oriented and small sized. Therapeutic goals included enhancing patients’ task skills, communication and socialization skills, and physical abilities. Fifty-five percent of the 75 respondents to a reimbursement question indicated that there was no difference in the rate charged for individual versus group treatment. Conclusion. Occupational therapists continue to use group treatment in a variety of facilities and with many different groups. The differences between the 1983 and 1993 studies were largely due to demographics (e.g., the decrease in the number of therapists working in mental health settings.) Recent documentation of the cost-effectiveness of group treatment may promote its use in times of staff member shortages and restricted funds.