Occupations as means and end was described by Catherine Trombly in 1995.
In the early days of occupational therapy, crafts were used as diversions, as general methods of recovery from disease and injury (Llorens, 1993; Slagle, 1914), and for their utilitarian value because products were produced that could be sold (Haas, 1922).
Occupational therapy is a unique profession that focuses on occupation, engagement and participation in meaningful and purposeful activities.
Occupations should occupy time but also bring meaning and purpose to life. Occupations include things people need to, want to and are expected to do.
Occupation Depends on the Individual
Meaning is individual (Bruner, 1990) and although the occupational therapist can guess what may be meaningful based on a person’s life history, he or she must verify with each patient that the particular occupation is meaningful to that person now and verify that the person sees a value in relearning it.
Occupation is not the same for every individual. Take shopping for example. One person may enjoy shopping in stores (“retail therapy”) while another avoids it at all costs. Having the first person engage in shopping as a therapy intervention may be good, but having the other would be less ideal, especially if it has a negative context (e.g., brings on anxiety). It may be a better idea to find another activity other than shopping for the second person to engage in.
Interventions and Goals
Before we distinguish between Occupations as Means vs End, it helps to understand therapy as intervention and goals. Occupational therapists should collaborate with the client, the client’s team, and anyone who may benefit the client’s recovery – to come up with the client’s goals in therapy. This provides a holistic and client-centered approach to therapy. The client then engages in occupations through interventions with an occupational therapist.
Using the same shopping example- shopping can be an intervention, e.g. practicing shopping in the community with a therapist – perhaps to reach the goal of improving balance.
Shopping can be a goal, e.g., working on scanning a scene in the hospital, improving balancing in the gym so that this skill can translate to shopping in a store.
“In some situations we consider occupation as the goal to be learned and in other situations we consider occupation as the change agent” (Trombly).
Definition – Occupation as Means
Occupation as means, according to Catherine Trombly, “refers to occupation acting as the therapeutic change agent to remediate impaired abilities or capacities”.
- Examples: Various arts, crafts, games, sports, exercise routines, and daily activities that are systematically selected and tailored to each person.
- Occupation as means = a purposeful activity.
I interpret this as: a purposeful activity (“occupation”) is used as the invention to meet some (maybe other, but not necessarily other…) goal.
More recently, Julie Gray expands this definition to refer to the use of “therapeutic occupation as the treatment modality to advance someone toward an occupational outcome”.
Definition – Occupation as End
Catherine Trombly described occupation as ends as situations in which “occupation is the goal to be learned”.
I interpret this as: Occupation is the goal to be achieved using (potentially non-related) interventions.
Is it a Separate, “Versus”?
“There is historical basis for this separation because these two uses of occupation came into occupational therapy practice at different times” (Trombly).
According to Gray, once you apply occupation, occupation as ends and occupation as means begin to merge together in the therapeutic context.
- Meaningful occupation-as-end motivates the person’s participation in life.
Meaningful occupation-as-means seems to motivate the person to persevere in his efforts long enough to achieve a therapeutic benefit.
While the definition aims to define occupation separately as means and end, in my opinion, you can’t tease out and separate occupation as a means and end when you are technically doing occupation and simultaneously engaging in that goal of occupation at the same time.
Of course, this all depends on how you define an occupation and the context of its components and what it means to an individual.
“Both occupation-as-end and occupation-as- means garner their therapeutic impact from the qualities of purposefulness and meaningfulness” (Trombly).
One can define shopping (goal) as a leisurely activity while another may consider it as work (out of necessity). When you do shopping (intervention), you may be “retail therapy” while other person sees it as walking, picking things up, looking around, comparing items and a necessity. This all goes back to how each individual is different and occupation is not the same for everyone.
Also while some individuals may not wish to participate in say, shopping, it may still be a necessity, like our ADLs – and thus still engage in shopping is still “occupation”. This may be why you see basic ADLs being emphasized so much in the occupational therapy profession, because it may be out of necessity in human function to eat and use the toilet. However, OT should not be limited to just ADLs, but also activities that our clients find meaningful and purposeful that they want to and are motivated to do, because they are likely to have better outcomes through
- Active engagement (as opposed to passive just going through the motions)
- Accountability (client, caregivers)
- Goal attainment
- Positive psychological impact, Spiritual
- Develops a routine and promotes re-engagement and therefore success
“Persons without mental illness, who are recently retired, in extreme circumstances such as in prison or lost in the wilderness, or even on extended lazy vacations try to impose organization on their lives by planning and carrying out purposeful occupations of various complexities” (Trombly).
Critical Thinking Question
We all need to sleep (which is defined in the practice framework as an occupation) as humans to function.
- Is sleep an occupational means or an end?
- Can it be Both?
Sleep as an end is easy to conceptualize. A client gets enough hours of sleep and feels rested. Pretty straightforward.
Sleep can also be a means, such as getting enough rest in order to participate in other occupations.
How would an occupational therapist use sleep as a means? Your boss probably won’t be happy seeing you let a client sleep and calling it a therapy session. However, OT’s can prepare and promote engagement in sleep with sleep hygiene, for example, to attain sleep as an end.
Hope that helps.
Julie Gray’s AOTA article, Putting Occupation Into Practice: Occupation as Ends, Occupation as Means.
Trombly: “Occupation: Purposefulness and Meaningfulness as Therpapeutic Mechanisms” article
AOTA’s Occupational Therapy Practice Framework