Throughout the years, leaders in the profession have challenged us to affirm the value of occupational therapy and to substantiate what we do. Occupational therapy practitioners have always focused on what most matters to clients in what is now called client-centered or patient-centered practice. We have also focused on client function to enable participation in everyday life. In a welcome shift, society’s views about health and meaning-making are becoming more congruent with the long-standing ideals of occupational therapy. Now, more than ever, we have a powerful opportunity to communicate our competence. But how do we assert our competence and the complexity of occupation with confidence? This lecture draws on the conceptual foundations of theories about competence and confidence and provides examples from the research literature, and a practitioner and client narrative to illustrate the factors that enable us to effectively demonstrate the value of occupational therapy.

The author describes personal and professional milestones in becoming an occupational therapist and his early experience in the first behavior disorder program for neurologically based aggression in the world. A real clinical example is used to bring these early lessons into vivid focus. New evidence underlines occupational therapists’ unique role in skill–habit training in clients with severe neurological impairment. For clients with milder impairments, irrespective of diagnosis, strategy training may maximize community independence and reduce hospital recidivism. The concept of functional cognition is described as an important development for the profession. Even in an environment of rapid innovation, occupational therapists need to recognize that it is the commonplace activities that have meaning for the individual that really matter. This is both the art and science of occupational therapy, and it will never be superseded by technological innovation because true creativity and genuine empathy cannot be mechanized.

During the first 100 years of occupational therapy, the profession developed a remarkable practice and theory base. All along, technology was an active and core component of practice, but often technology was mentioned only as an adjunct component of therapy and as if it was a specialty. This lecture proposes a new foundational theory that places technology at the heart of occupational therapy as a fundamental part of human occupation and the human experience. Moreover, this new Metaphysical Physical–Emotive Theory of Occupation pushes the occupational therapy profession and the occupational science discipline to overtly consider occupation on the level of a metaphysical-level reality. The presentation of this theory at the Centennial of the profession charges the field to test and further define the theory over the next 100 years and to leverage technology and its role in optimizing occupational performance into the future.

Every day, in clinics and hospitals around the world, occupational therapists care for patients with serious problems requiring viable solutions. Each patient is unique, and his or her problem does not necessarily correspond to existing practice models. Practitioners must adapt standard approaches to provide effective outcomes, yet problems exist for which few or no beneficial approaches have been identified. Such clinical issues require solutions to be generated de novo from the practitioner’s body of knowledge and past experience. Yet, no single new intervention can be used without prior validation of its efficacy. Only a therapist with a prepared mind can accept such challenges, recognize what is known and not yet known, design studies to acquire that needed knowledge, and translate it into successful clinical treatment strategies. The occupational therapist with a prepared mind is one willing to seize unexpected opportunities and construct new paradigms of practice. Innovation through scientific inquiry requires a prepared mind.

This article, based on the 52nd Eleanor Clarke Slagle lecture given at the 95th American Occupational Therapy Association Annual Conference & Expo, explores the concept of inquiry as the basis for a career and as an activity of daily living. Using the heliocentric theory and the space program at NASA as examples, the broad concept of inquiry is discussed, because it has led to important changes in society over the course of history. The article describes how a career as a clinician–scientist can be grounded in the concept of inquiry and explains how all occupational therapists and occupational therapy assistants can base their own careers in inquiry, using examples from the early history of the profession of occupational therapy and from work by current investigators. Practical suggestions applicable to every clinician are provided.

The pull of education is a powerful engine for societal change. Education is a values-driven product with specific and objective aims that serve society. The values of professional occupational therapy education were laid down at the field’s inception, although they have changed with the passage of time and in response to the profession’s and society’s occupational needs. Learning is different from education and is an individual process that requires facilitators with well-honed pedagogies if it is to fuel the engine pulling the profession forward. Keeping occupation as the central core of the profession serves as a necessary filter that allows more diligent thinking and linking between occupation and other relevant topics. Living life to its fullest—our own lives and the lives of our service recipients—demonstrates progress in the idiosyncratic arrangement of habits and routines that are personally meaningful, socially satisfying, and culturally relevant.

At times on our collective professional journey, occupational therapy practitioners have begun to lose sight of and confidence in our methods, including intervention and assessment approaches; these proverbial “forks in the road” may have led practitioners away from professed and philosophical occupational therapy methods.

Assigning numbers to variations in the behaviors, experiences, or beliefs of individuals and groups is a firmly established tradition in Western culture. In many areas of occupational therapy practice, quantitative measures are required to document need for services and, increasingly, quantitative measures are required to document the value of these services in terms of the outcomes achieved. In order to meet these expectations, occupational therapy frequently has adopted both methods and instruments from other disciplines including psychology, medicine, and education. However, the assumptions and modes of thinking about people that accompany these methods are not always compatible with the values and practice of occupational therapy. This paper explores tensions inherent in the assessment process in a profession that is holistic and humanistic in its orientation. I propose that in order for assessment to serve our goal of supporting health and participation through engagement in occupation we must accept the uncertainty and be vigilant about the biases in thinking that are inherent in our measures.

We live in a time of hyperchange—rapid, dramatic, complex, and unpredictable change occurring in today’s society, which creates unprecedented challenges. High-speed advances in technology and knowledge and changes in society require that we shift our paradigms. We must become innovators of change. This lecture examines how occupational therapy is reacting to hyperchange as a profession. How is hyperchange influencing the roles and responsibilities of practitioners? How is hyperchange affecting education? And, in accepting hyperchange, what can we do as occupational therapy practitioners, educators, and scholars to shape our own future?

Everyday occupation is a primary means by which we organize the worlds in which we live. The phenomenological experiences of day-to-day life build meaning and community in our lives; yet everyday occupation is often “seen but unnoticed.” Cultural tendencies and invisible social forces contribute to the obscurity of the everyday and, in severe situations, to occupational deprivation. The purpose of this Slagle lecture is to raise awareness of the complexity and “delicate layerings” of everyday occupation, its theoretical and conceptual underpinnings, the consequences of severe occupational constraints to health and well-being, and the essential relevance of everyday occupation to occupational therapy and occupational science. Everyday occupation related to food is probed in depth to illustrate the richness of day-to-day living. Occupational therapy personnel are encouraged to gain deeper understandings of the importance and meaning of everyday occupation in the lives of clients and the general public, thereby helping people find value in their everyday practices.

A profession’s ethos is an interlacing of sentiment, value, and thought that describes its character, conveys its genius, and manifests its spirit. The ethos endures over time, serving as touchstone against which individuals may strike their actions to know their worth. As a profession’s inner voice, the ethos inspires individuals and calls them back if they stray too far. This discussion of the occupational therapy profession’s ethos has two discernable parts. The first invites deliberation, given its historical ground. The second is a blend of ideas and images, a clutch of reflections inviting affect and will to join in thought. My hope is to illuminate the ethos of the profession in such a way that a new perspective on current challenges is possible. I set before you this idea: To advance into the future with the ethos that has characterized occupational therapy since its inception is a reclamation of the profession’s heart.

Our daily round of occupations occurs within time and space. Our understanding of occupation has traditionally viewed time and space as part of the external environment. Patterns of the “when?” and “where?” of occupations can be described. But relating time and space to the internal experience of occupation reflects more of the meaning to individuals and more complex patterns arise. Like the varied bits of glass in the object case of an art kaleidoscope, the multiple elements of occupation interact. Reflected in mirrors of our choice, we find always-changing, complex patterns of daily occupation. The elements of occupation most important for maintaining or regaining health and the mirrors and lens through which we view occupation historically have formed shifting patterns in occupational therapy, patterns of how we view ourselves, our practice, and those to whom we provide our services. We must combine the science and the art of occupational therapy as the metaphor of the kaleidoscope combines both, producing awe and wonder at the result.

In the tradition of Mosey’s (1985) Eleanor Clarke Slagle lecture (p. 504) as a road map to where this presentation is going, I will present a short preface and first, talk about herstory and our professional identity; second, use chaos theory as a way to look at occupation; third, introduce you to Charlotte’s Web of Chaos; fourth, make some conclusions about chaos and occupational therapy; fifth, do an ending to this telling, and; sixth, do a summary and closing.

The experience of being human is embedded in sensory events of everyday life. This lecture reviews sensory processing literature, including neuroscience and social science perspectives. Introduced is Dunn’s Model of Sensory Processing, and the evidence supporting this model is summarized. Specifically, using Sensory Profile questionnaires (i.e., items describing responses to sensory events in daily life; persons mark the frequency of each behavior), persons birth to 90 years of age demonstrate four sensory processing patterns: sensory seeking, sensory avoiding, sensory sensitivity, and low registration. These patterns are based on a person’s neurological thresholds and self-regulation strategies. Psychophysiology studies verify these sensory processing patterns; persons with strong preferences in each pattern also have unique patterns of habituation and responsivity in skin conductance. Studies also indicate that persons with disabilities respond differently than peers on these questionnaires, suggesting underlying poor sensory processing in certain disorders, including autism, attention deficit hyperactivity disorder, developmental delays, and schizophrenia. The author proposes relationships between sensory processing and temperament and personality traits. The four categories of temperament share some consistency with the four sensory processing patterns described in Dunn’s model. As with temperament, each person has some level of responsiveness within each sensory processing preference (i.e., a certain amount of seeking, avoiding, etc., not one or the other). The author suggests that one’s sensory processing preferences simultaneously reflect his or her nervous system needs and form the basis for the manifestation of temperament and personality. The final section of this lecture outlines parameters for developing best practice that supports interventions based on this knowledge.

The health care environment of the past quarter century went through numerous evolutionary processes that affected how occupational therapy services were provided. The last iterations of these processes included requests for the evidence that supported what we were doing. This year’s Eleanor Clarke Slagle Lecture (a) examines the strength of the evidence associated with occupational therapy interventions—what we do and how we do it—(b) raises dilemmas we face with our ethical principles when some of our practices are based on limited evidence, and (c) proposes a framework of continued competency to advance the evidence base of occupational therapy practice in the new millennium.

This article presents a view of occupation as the principal means through which people develop and express their personal identities. Based on a review of theory and research, it proposes that identity is instrumental to social life because it provides a context for deriving meaning from daily experiences and interpreting lives over time. The article proposes that identity also provides a framework for goal-setting and motivation. It is asserted that competence in the performance of tasks and occupations contributes to identity-shaping and that the realization of an acceptable identity contributes to coherence and well-being. Within this framework, it is postulated that performance limitations and disfigurement that sometimes result from illness or injury have identity implications that should be recognized by occupational therapy practitioners. By virtue of their expertise in daily living skills, occupational therapy practitioners are well positioned to help address the identity challenges of those whom they serve. In so doing, they make an important contribution to meaning and well-being.