Do we dare to ask it? Do we dare to mention the basket weavers?

Occupational Therapy emerged as a profession during the early 1900’s and solidified following WW1 where injured service men were prescribed ‘activities’ as a way of promoting both physical, cognitive and emotional rehabilitation. These activities were very often arts and crafts or woodwork type tasks. When you step back and look at the bigger picture, it was actually an ingenious intervention! When you analyse the task of making something, let’s just say crocheting a blanket, it takes an incredible amount of skill; physically, you need postural control to be able to sit, upper limb function, fine motor control and dexterity, adequate sensation, visual acuity; cognitively you need some planning skills, attention, memory, visual perceptual skills, problem solving and then a whole heap of internal self regulation skills such as motivation, awareness and some sort of connection to the task. As you are seeing the product being made, there is a sense of achievement, of progress, creating the internal volition to keep rehabilitating. Phew!! And that’s just for a bit of crocheting!

So, you can see the premise behind giving craft or activities as a means of therapy was actually quite insightful, and as the profession emerged, OT’s moved away from a purely medical model focus towards one that considered a complex combination of social, biological and economic causes for dysfunction. It challenged the purely scientific and physical model of disease and started to use an approach that was based on holism, that occupation is essential for health, and that the environment in which we do everything impacts enormously on us.

Unfortunately, instead of being seen and promoted as a profession that was ahead of the times, was beautifully holistic, functional and integrative in its approach to treating people, we kind of got stuck in the activities of basket weaving and woodwork. Someone in their infinite wisdom thought that during a 4-year university degree which covered anatomy, physiology, neuroanatomy, psychology and social sciences, that we should also turn a bit of wood and weave a few baskets. Yep that’s right; up until very recently, you would find OT students in the ‘labs’ learning woodwork and basket weaving! Mind boggling! No wonder the perception of this top-class profession got lost in the woods.

Now that we understand where the labels and stigmas come from, we can focus on looking at the real value of the profession. As noted, the underpinning philosophy and models of practice focus very heavily on the persons ‘occupational role’ and the factors, both internal and external, cause and effect, both function and dysfunction, as evidenced in the Occupational Performance Model diagram below¹. Furthermore, “the primary goal of Occupational Therapy is to enable people to participate in the activities of everyday life… in the occupations they want to, need to, or are expected to do”².

Being able to analyse a person and a person’s lifestyle to pinpoint areas of dysfunction or disharmony is one of the greatest skills of an OT.