International Journal of Psychosocial Rehabilitation
in occupational therapy: A
core for the Pragmatic Conceptual Model of practice
of Occupational Therapy,
Moses N Ikiugu, Ph.D., OTR/L
University of Scranton
Scranton, Pennsylvania 18510-4501
Phone: (570) 941-4158
Fax: (570) 941-4380
Ikiugu, M.N.(2004) Instrumentalism in occupational
therapy:Atheoretical core for the pragmatic
conceptusl model of practice.
Journal of Psychosocial
In an earlier paper (Ikiugu, 2003), an
argument was made for establishment of a pragmatic conceptual model of
in occupational therapy. It was suggested that in this model, the
construct of instrumentalism be operationalized as a way for therapists
access the client’s mind as a tool for occupational functioning and
to the environment. In this paper, theoretical concepts/constructs used
construct a theoretical core for the model are identified from a review
history of occupational therapy, selected literature of the philosophy
pragmatism, and the dynamical complex adaptive systems theory.
for the above sources of theoretical constructs/concepts was discussed
previous paper (Ikiugu, 2003). Postulations are developed connecting
concepts/constructs to form a comprehensive, internally consistent
In an earlier paper (Ikiugu, 2003) an
argument was made for a proposed conceptual model of practice based on
philosophy of pragmatism, which has been proposed as the philosophy
the maturing of the idea of occupation as therapy in the early 20th
century (Breines, 1986; Hooper & Wood, 2002). It was asserted that
based on such a philosophy would be consistent with the occupational
roots because it would provide interventions that are primarily based
on the concept
of the mind as a means of activating mind-body action through
the proposed model, it was suggested that the pragmatic construct of
instrumentalism (Dewey, 1957; 1996b; 1996c) be operationalized to
practice which centers on the notion of the mind as an instrument which
accessed to facilitate occupational functioning that is geared towards
the client to be more adaptive in his/her environment for the purpose
physical and psychological survival. The
proposed model consists of three phases as illustrated in figure 1.
Following Mosey’s (1996) guidelines on how
to establish sets of guidelines for practice, development of the model
with a definition of the problem, which was identified as diminishing
of occupational therapy as indicated by declining involvement of the
in mental health practice, and lack of use of occupation-based,
client-centered, holistic interventions in practice (Ikiugu, 2003). In
paper, discussion of the theoretical core of the proposed conceptual
be presented. Concepts/constructs will be identified from the
therapy historical literature, the philosophy of pragmatism, and the
complex adaptive systems theory. Postulations will be synthesized
the concepts/constructs into a comprehensive, internally consistent
core. Guidelines for problem identification and intervention will be
in another paper.
Concepts/constructs used to
formulate a theoretical core
from the historical literature of occupational Therapy
From the historical literature of the
profession are derived constructs of the mind, occupation,
and the environment.
The founders of the
occupational therapy intervention as invariably beginning with the
Pinel (1962, p. 108) suggested that in the moral treatment, “… insanity
curable in many instances, by mildness of treatment and attention
to the state of the mind exclusively, …” (italics mine).
He thought that impairment of the ability to use the mind to reason
a person’s humanity, such that, “The figure of the human species is now
that remains to him, ‘and like the ruins of a once magnificent edifice,
serves to remind us of its former dignity and grandeur,’ and to awaken
gloomiest reflections-our tenderest regret for the departure of the
respectable man” (pp. xvi-xvii). He proposed use of occupation to treat
individuals who are mentally ill because occupation is the best way to
the human being at the most intelligent level. The founders of
therapy in the 20th century such as Dunton (1957a; 1957b)
(1980) also aimed at training the mind and body in the appropriate
thinking and acting. The individual patient’s interests and aspirations
carefully considered (Dunton, 1957b; Licht, 1957). The founders of the
profession considered the mind and its functions such as reasoning,
and developing interests to be central to occupational therapy
attributes of the mind that the
founders of the profession emphasized included the ability to learn.
(1980) stated that the purpose of occupation in the hospitals was to
patients so that they can function effectively in their environments.
Similarly, one of the principles advanced by Dunton (1957b) was that a
therapeutic activity should in some way increase the patient’s
ability to pay attention is also a function of the mind that was
these early occupational therapists. One of the purposes of employment
recreation was to facilitate regaining of the habit of attention
and in the process to aid in, “… training emotional control…” (Dunton,
p. 52). In regaining the habit of attention, patients learnt to
themselves and to control and master their disorders (Creek, 2002;
Both Pinel (1962)
and Tuke (1964) used
occupation as an alternative to restraint in the management of the
patients. According to Pinel (1962), a way to secure health, to keep
and well-mannered patients, was through interesting and laborious
In this regard, he stated that, “The fatigues of the day prepare the
for sleep and repose during the night”.
A link between occupation and health has often been postulated
occupational therapy literature. Wilcock (1998) developed a theory to
this link. She postulated that humans have evolved as occupational
because it is through occupation that they adapt and insulate
the environment. Breines (1995) regarded occupations as tools that have
humans to survive and to develop over the ages.
Individualization refers to the idea of
tailoring therapy programs to the specific needs of patients. During
treatment era, Pinel (1962, p. 189) instructed that, “… the
each case must be watched, studied and treated with such assiduity and
as may promote a speedy and permanent cure.” This individualized,
client-centered approach was reiterated at the turn of the 20th
century by Barton (1980) and Dunton (1957b), who considered the
interests as central to the choice of therapeutic occupations for that
In current occupational therapy literature, the construct of
therapy is prevalent with compelling arguments for therapy to be a
collaborative effort between the patient and therapist where the two
and plan interventions together (Law, et al., 1998; Rahman, 2000;
2002; Thesen, 2000; Wressle, Marcussion, & Henrikson, 2002).
During the moral treatment movement, both
Pinel and Tuke postulated that an environment that was conducive to
health for the mentally ill was one that was similar to that of the
(Bing, 1981; Hergenhahn, 1997). Pinel (1962, pp. 206-207) stated that:
word, the general government of the hospital, resembled the
superintendent of a
great family, consisting of turbulent individuals, whose fury it should
the object to repress than to exasperate, to govern by wisdom rather
subdue by terror.” In other words, the therapist (governor) was to be
less like a parent, strict, yet gentle and caring. Similarly, Tuke
described the use of moral treatment at the York
retreat in England
as consisting of kind treatment by the caretakers combined with a
environment consisting of enjoyable social activities and other
the patients enjoyed. It was postulated that patients would be able to
their use of reason if they were engaged in a regimen of daily
the company of other persons of sound mind and a kindly nature
At the turn of the 20th century,
the founders of occupational therapy continued to emphasize the role of
environment, both physical and social, in occupational therapy. Barton
saw occupational therapy as a means of solving economic problems
dependents were reclaimed to be independent producers, and thus to
economically in their environment. In developing his principles of
therapy, Dunton (1957b) stipulated that the best occupations were those
were “…interesting” (p.47) to the patient and should, “… lead to an
the patient’s knowledge” (p. 47). The emphasis on increasing the
knowledge indicates the importance of engagement of the patient with
environment since knowledge comes from synthesis of environmental
(Locke, 1924). Later, Meyer (1977) held that mental illness was a
maladaptive interaction between the person and his or her environment.
proposed that the problem of mental illness is a problem of adaptation.
Occupation was, according to him, a means by which a person maintained
in his/her environment and therefore remained healthy. The theme of a
person as one who interacts effectively with and adapts to the
continued in the professional literature to the current time (Law, et
1998). The context within which the patient lives (community) is
appearing in literature as a major focus of the profession (Gaudet,
from the philosophy of Pragmatism
Some of the concepts/constructs from the
philosophy of pragmatism that are used in the proposed conceptual model
beliefs, activity, contextualization, experience, consequences, and
According to Peirce
(1955b, p. 7) reasoning
helps us to, “… find out, from the consideration of what we already
something else which we do not know.” Good reasoning should lead us to
true conclusions from true premises (Fisch, 1996). The ability to
is dependent on factually grounded premises and ensuing conclusions.
premises from which conclusions are drawn are the beliefs that one
an action based on a belief does not lead to expected consequences
experiential facts, doubt results. Doubt causes irritation and belief
calming of the mind. Belief is therefore the state towards which the
(Hergehahn, 1997). When a belief is established because actions based
result in expected or desired consequences, a habit is established
same action will recur in future.
James (1996, p. 136) defined a belief thus:
“LET US GIVE the name of hypothesis
to anything that may be proposed to our belief; ….” He considered a
be a theory about how things are. Its potency is determined by the
to act on it. If a belief or hypothesis is valid, then a person is
act on it. He reiterated Peirce’s (1955b) position that the test of a
the practical consequences of action arising from that belief (James,
1977b; Mounce, 1997). He saw the truth of a belief as being determined
extent to which the consequences of actions based on it are expected or
desirable. In the pragmatic conceptual model of practice for
therapy, the challenge will be to determine what beliefs motivate a
actions and to help the client examine the consequences of actions
those beliefs to determine if such consequences were expected or
Since according to
both Peirce and James a
belief is a rule for action (James, 1977a; 1977b; Mounce, 1997; Peirce,
it follows that a belief without action/activity is meaningless for
no consequences of holding such a belief. Without consequences, the
cannot be evaluated. This pragmatic valuing of activity is consistent
view in occupational therapy, that a healthy individual is one who is
(Barton, 1980; Bing, 1981; Creek, 2002).
As a rule of action, application of a
belief involves doubt and therefore a thought process whose aim is to
belief and appease the irritation of doubt (Peirce, 1955b). Belief is
the beginning and end of thought. Since thought is the means by which
established, its soundness can also be judged only according to
resulting from it. According to Peirce (1955b, p. 10) the practical
consequences of action resulting from a belief or an idea constitute
sensible meaning of that belief or idea since, “It is certainly best
that our beliefs should be such as may truly guide our actions so as to
our desires; and this reflection will make us reject every belief which
not seem to have been so formed as to insure this result.” In
therapy, consequences are similarly valued since the goal of therapy is
effect change in positive ways (Bruce & Borg, 1993; Creek, 2002).
philosophy was highly
influenced by the British empirical philosophical ideas, especially
John Locke (Buchler, 1955; Fisch, 1996; Hergenhahn, 1997; Whittemore,
Locke’s (1924; 1990) basic premise was that all knowledge arises from
experience. In this regard, he said:
ideas come from sensation or reflection.—Let us then suppose the
be, as we say, white paper, void of all characters, without any ideas;
comes it be furnished? ….. To this I answer, in one word, from
that all our knowledge is founded, and from that it ultimately derives
… (Locke, 1924, p. 42)
(1955b) stated that
experience is not only the source of knowledge but also the compass
humans must navigate life. James (1977b, p. 136), extended this idea in
doctrine of radical empiricism where he asserted that, “… the only
shall be debatable among philosophers shall be things definable in
from experience.” Dewey (1957) argued for reconstruction of philosophy
premise that a philosopher, like a scientist, should adopt the
method of pursuing knowledge rather than introspective rationalization.
adopting the experimental method, the philosopher would draw from
the source of knowledge. The importance attributed to experience by
is consistent with the value of environment in occupational therapy
2002; Law, et al.,1998), since environment is the source of experience.
Instrumentalism refers to the principle drawn
from Darwin’s (1985) theory of evolution which postulates that
humans are not
apart from nature but are part of it (Dewey, 1957; Sibley, n.d.). Dewey
this notion from William James (1996, see also Whittemore, 1964). James
p. 11) argued that the mind, “… seems endowed with a very extraordinary
of plasticity …; so that we may without hesitation lay down as our
proposition the following: that the
phenomena of habit in living beings are due to the plasticity of the
material of which their bodies are composed.” Arguing further about
importance of habit in regulation of human function, James (1977c)
that the brain evolves from interaction between the human being and the
environment, since this interaction is what provides the experiences
result in habit formation. Through this interaction, the environmental
experiences shape the neural system (James, 1977c). He anticipated
that is central to instrumentalism by arguing that the human being
an actor rather than a passive observer of nature. As an actor, he or
mental interests, hypotheses, and postulates, as the basis of action.
faculties of the mind function to transform the world and in so doing,
make true what they declare (James, 1920). Dewey (1931) found in this
postulation by James a method of using philosophy to make the world
argued that intelligence is basically an instrument to effect
social progress (Whittemore, 1964).
to Dewey (1929), intelligence
should be viewed as a tool or an instrument in the same way that other
instruments are made and used with precision to solve the environmental
social problems. Intelligence is employed this way through formulation
appropriate theories to inform action that would improve the situation
world. Any theory then, which is divorced from doing, is useless and
The construct of instrumentalism therefore touches on many themes
occupational therapists, such as doing, agency, and the environment
2002; Dunn, Brown, & McGuigan, 1994; Schwartzberg, 2002).
The whole of Dewey’s philosophical
orientation may be summed up with the construct of meliorism (Fisch,
1964). His goal was meliorism in the sense that he sought a method of
philosophy to serve democracy and solve contemporary social problems
make the world a better place to live. Such a philosophy had to be
the social context (contextualization). Occupational therapists are
with this notion considering that they are primarily interested in how
can make their lives better by interacting and functioning
within the environmental context (Bruce & Borg, 1993; Creek, 2002;
al., 1994; Law, et al., 1998; Schwartzberg, 2002).
Concepts/constructs from the dynamical
According to this theory, living systems
are complex adaptive dynamical systems (Anonymous, 2001; Waldrop,
emerges at the point where matter is beginning to be chaotic but still
order to give it structure (Waldrop, 1992). In other words, the
life (indicated by creative productivity), are order and stagnation on
and chaos on the other (Arndt & Bigelow, 2000). This delicate
what produces creativity, which is one major characteristic of complex
can be conceptualized as complex
adaptive evolving systems. It is postulated in this paper that the
which they maintain balance between chaos and order in their thinking
activities defines the extent to which humans are alive. This view is
to the principle of occupational adaptation advanced in the Occupational
Adaptation Frame of Reference
(Falk-Kessler, Julin, Padilla, & Schultz, 1998; Schkade &
1992; Schultz & Schkade, 1992). In this frame of reference, an
individual is conceptualized as one who blends mobility and stability
occupational performance to produce mature behavior. In the proposed
conceptual model of practice, concepts/constructs derived from the
systems/complexity theory will be: 1) Disproportion between initial
and final outcomes; 2) Emergence; 3) Fractal nature of human
behavior; 4) Strange attractors.
between initial conditions and final outcomes
Complex dynamical systems exhibit a
phenomenon known as non-linearity (Cambel, 1993). This means that the
of such systems cannot be understood in simple linear mathematical
There is no simple cause-effect coupling. Such systems are open (i.e.,
exchange information with their surroundings), are neither completely
deterministic nor completely random, and paradoxes exist within them
1993). There is uncertainty within such systems making precise
outcome difficulty. This property of dynamical systems explains one of
major characteristics, namely, that small differences in initial
cause extensive differences in consequences (Arndt & Bigelow, 2000;
& Atherton, 1999; Cambel, 1993; Whiting, 2001).
theory may be used to explain the
interaction between occupational performance and health. Engagement in
results in varied and unpredictable health outcomes, both physical and
psychological, which may not be easily explained by cause-effect
(Kielhofner, 1997). Occupation organizes behavior generally and does
only the musculoskeletal, neurological, and mental components towards
may be directed. The other use of this concept may be to enable
explain to patients the importance of their actions. A person’s beliefs
subsequent momentary decisions and actions may have significant effects
only on the person’s life but also on other people and the environment.
instance, deciding to stay in bed instead of attending an important
meeting may lead to a loss of job and income, affecting the childrens’
family well-being, and the entire community’s economy in unpredictable
should therefore be emphasized to clients that they should not only
be agents in their environment in order to satisfy their needs, but as
co-agents, they also have a responsibility to their families, entire
communities, and the environment in which they live (Arndt &
One characteristic that distinguishes
dynamical complex adaptive systems from other systems is that they are
(Mendenhall, Macomber, & Curtright, 2000). This means that parts in
system cooperate to produce structures performing totally different
than those performed by the parts (Cambel, 1993). This
what makes evolution possible. In the process of responding to the
in order to reach its goals (Anonymous, 2001), the primary one of which
survive, the organism creates new structures. Cells organize themselves
functionally into tissues that are specialized according to function,
organize themselves into organs, organs into systems and systems into a
functional organism. At each level of organization, properties specific
level and that transcend the sum of individual parts emerge (Bell, Baldwin, &
The property of self-organization and
emergence has significant implications for how occupational functioning
human beings may be viewed. First, the symptoms that a client presents
seen as emergent indicators of a dysfunctional or maladaptive life.
This is the
view adopted by homeopathic practitioners (Bell,
& Schwartz, 2002) and it seems to be a view that may describe the
problems encountered in occupational therapy. This may explain why two
individuals with the same condition, same age, and the same physical
characteristics react differently to the condition (Bruce & Borg,
One person may disregard the discomfort posed by the condition, apply
her/himself, and make progress and recovery. The other person may react
despair, see him/herself as helpless, refuse to do anything, and
deteriorate mentally and/or physically even to the point of death. The
differences between the characteristics of the two individuals may be
indicators of the underlying individual beliefs about themselves. As
therapists, one way to intervene in an attempt to help such
individuals, may be
to help them clarify their underlying beliefs and the resulting
behaviors that produce the consequences that they experience in their
is hypothesized that by clarifying self-defeating beliefs that hinder
achievement of occupational goals, they can substitute such beliefs
supportive of more appropriate occupational functioning, leading to
other application of emergence may be
in the way occupation is conceptualized to work in clients’ lives. In
complex adaptive dynamical systems theory perspective, it could be
that through occupation, therapists apply small inputs at the point
come into contact with patients. Such inputs may, for example, be
habits that are consistent with their goals. For instance, a teenager
to excel in academics may choose to read over engagement in another
until reading becomes a habitual activity. An elderly person who wants
independent may be asked to make small independent decisions such as
wear, and what activities to engage in within a rehabilitation unit on
regular basis. The hypothesis behind this approach would be that such
would eventually lead to emergence of positive characteristics, which
generalize into the patient’s entire life, leading to achievement of
occupational goals such as being an academically astute person, or an
independent person. While the author is aware that there is no
evidence to support such a hypothesis, it can be tested in practice
II applied scientific inquiry (Mosey, 1996) once the model begins to be
fractal nature of human occupational behavior
Fracterity in complex dynamical systems
refers to self-similarity at every level of self-organization (Bell, Baldwin, &
such that at every scale, parts are smaller, exact duplications of the
(Bassingthwaighte, Liebovitch, & West, 1994). This self-similarity
either geometrical or statistical. Geometrical self-similarity is found
nature in symmetrical structures, such as the division of blood vessels
human body (Bassingthwaighte, Liebovitch, & West, 1994). The
vessels is symmetrical, so that any capillary system has the same
system of truncation as that at the level of the veins, or arterioles.
statistical self-similarity, parts are “... ‘kind of like’
the whole.” (P. 13), which means that statistical
properties of the parts are proportional to those of the whole.
self-similarity may be useful
in evaluation and study of human occupation in an attempt to understand
individual client is adaptive or maladaptive in different life
The assumption would be that the general adaptability or maldaptability
manifested in the pattern of individual moment-to-moment choices. For
consider a teenager who wonders why he is not succeeding in school. You
the teenager’s occupational behavior in the occupational therapy clinic
discover that every time you give him a challenging task, he engages in
a few minutes, then loses interest and starts playing video games. You
that this is a pattern in his life. Whenever he is faced with a
has a tendency to escape into games. In this model, it is hypothesized
behavior while engaging in occupation in the occupational therapy
a fractal. This means that each part of the client’s activity lifestyle
similar to the whole pattern of performance in his life.
The field within which dynamical complex
adaptive systems move is known as the phase space (Cambel, 1993).
the system within this space constitutes what is known as a trajectory
(Bassingthwaighte, Liebovich, & West, 1994). A trajectory could,
example, be a person’s occupational life in terms of the various
engaged in over a life-time. When simple systems such as oscillators
displaced from a starting point, they eventually come to rest at that
(Bassingthwaighte, Liebovich, & West, 1994). For example, a
pendulum moves within the phase space until it comes to rest at the
point, which is a point of stable equilibrium. Such fixed points within
the system eventually comes to rest are predictable and are known as
attractors (Bassingthwaighte, Liebovich, & West, 1994; Cambel,
dynamical systems, the region within
which the attractor is situated is called a basin of attraction
The set of initial conditions form the basin of attraction (Alligood,
& Yorke, 1996). In occupational therapy, such conditions could be
self-esteem, beliefs, values, interests, and so forth. Fixed attractors
predictable and irrespective of initial conditions, the system
to rest at them. In dynamical complex adaptive systems, attractors are
Furthermore, two or more points within each attractor may determine the
trajectory for each of the initial conditions. Such attractors are
initial conditions, so that initial differences lead to magnification
differences between points within the attractor. In other words, the
within the attractor diverge from each other (Bassingthwaighte,
& West, 1994). However, the divergence is finite. Consequently, the
trajectories from the nearby initial points on the attractor diverge,
are folded back onto the attractor repeatedly. This creates layers of
trajectory, which are self-same, and therefore, the attractor becomes a
fractal. In such fractal systems there is energy expenditure and they
exchange of energy and information with the environment for survival
(Bassingthwaighte, Liebovich, & West, 1994). Attractors in such
unpredictable and are known as strange or chaotic attractors (Abraham,
& Sheldrake, 1992; Alligood, Sauer, & Yorke, 1996;
Liebovich, & West, 1994; Cambel, 1993).
Kielhofner (1997) explains the phenomenon
of the attractor as a tendency for the system to behave in a certain
the pragmatic conceptual model, it is proposed that the attractor for
occupational functioning is the purpose of occupation. This attractor
more than one point of attraction such as the need for a person to feel
competent in his or her environment as well as the need to earn a
survive. Depending on the initial conditions, the two points may
exponentially. For example, if one has poor self-esteem, pursuing tasks
mostly to earn wages for survival purposes. The need to do things to
feelings of competence becomes secondary. The two points then become
If, however, the initial condition is good self-esteem and therefore a
that one can achieve whatever he or she puts his or her mind into, then
competence and earning a living are perceived as equally achievable
two goals are pursued in tandem and there is no great divergence
two points in the attractor (purpose of engagement in occupation).
statement of the theoretical core
of the pragmatic conceptual model of Practice
Based on the complex dynamical adaptive
systems theory, the human being may be conceptualized as a complex
dynamical system who is engaged in interaction with the environment,
physical and social, through occupational performance, for the purpose
adapting, creating, and therefore surviving. According to the
pragmatism, this adaptive system employs the mind as an instrument to
environment so that it is suitable for human survival (Dewey, 1957;
1996b; Muelder, Sears, & Schlabach, 1990; Sibley, n.d.; Whittemore,
Engagement of the mind as an instrument for
adaptation to the environment involves formation of beliefs as a basis
thought, which directs actions (James, 1977a; 1977b; 1981; 1996;
1955b). Use of the mind also involves awareness of the consequences of
that include knowledge of the gravity of initial conditions. It is
that agency in one’s environment is best achieved if there is awareness
small differences in initial conditions at any point may lead to
differences in outcomes. This is true not only in an individual’s life
in the lives of those close to him or her, and the entire community
As such, the moment-to-moment decisions that one makes as guided by
and the resulting occupational activities make a significant difference
Adaptability or maladaptability depends on
how well a person functions in daily occupations. An adaptive person
continually emerges, so to speak, through action, a phenomenon that may
called self-determination. A maladaptive person is either too rigid or
disorganized, and is unable to accomplish many things in life. If too
the person may not be able to conceptualize alternative ways of doing
when known strategies do not work (Schkade & Schultz, 1992; Schultz
Schkade, 1992). If too disorganized, the person is unable to focus and
flitting from one task to another without any accomplishments, as seen
in a person
suffering from hypomania. Whether a person is too rigid or too
the result is stagnation and inability to have an experience of
with life. Human occupation may be
conceptualized as a fractal (Bassingthwaighte, Liebovich, & West,
therapist is able to assess whether a patient is stagnated
adaptive by examining a part of the patient’s occupational life
the clinic. As a fractal it is assumed that occupational life
self-same properties. Therefore, by examining a part of the trajectory,
therapist is able to judge whether the client exhibits a pattern of
adaptability or maladaptability.
it is determined that a client is
maladaptive, the goal of intervention is to facilitate emergence of
patterns. This would be accomplished by accessing the client’s mind as
to effect functional change. To do this, the therapist would determine
beliefs form the basis of occupational actions for the patient and
beliefs support an adaptive or maladaptive lifestyle. For example,
young man who believes that he is not intelligent enough to accomplish
requiring intellectual acumen such as is required for the bookkeeping
necessary for him to be able to run his own business. He has some good
that may lead to establishment of a successful business, but as long as
believes that he is incapable, he will not be able to act in a manner
actualize his ideas.
In such a case, the therapist may want to
educate the client regarding how his beliefs may be inconsistent with
adaptive lifestyle, in this case being able to achieve his dream of
establishing his own business. The goal would be to help the young man
substitute such beliefs with ones that support an adaptive lifestyle
taking concrete steps towards achieving his dream of starting a
it is determined what negative beliefs the client needs to substitute
to be adaptive, he or she would be asked to make occupational decisions
basis of newly formulated positive beliefs and act on them in the
the hypothetical case of the young man mentioned above, the therapist
to help him substitute the belief that he is not intelligent enough
that he is capable of bookkeeping or any similar task that requires
mathematical aptitude. This may be accomplished in the clinic by asking
be a bookkeeper for a project group in the occupational therapy
therapist can then point out how successful the client is in the task
challenge his belief about lack of aptitude, or encourage him to
access his strengths and, if necessary to the success of his business,
The rationale for the above-described
intervention is that beliefs form a basin of attraction for the client.
purpose of engagement in occupation is a strange attractor (see
‘the basin of attraction’ and ‘strange attractors’ in Alligood, Sauer,
Yorke, 1996; Bassingthwaighte, Liebovich, & West, 1994; Cambel,
the client to be conscious of this attractor, the purpose of
activity must be stated clearly in the form of goals. In the case of
man, the purpose of putting him in charge of bookkeeping for the
would be to demonstrate to him that he is capable of successfully
tasks that require mathematical aptitude or to recognize that he is
successfully complete such tasks and therefore needs to pursue other
Once beliefs are clarified and a purpose in form of goals is stated,
therapist gets a commitment from the client that he or she will act on
newly established beliefs at every instance outside the clinic. For
the young man may be asked to commit to engaging in leisure activities,
playing chess, which require abstraction, planning, forward thinking
(anticipation), pattern recognition, and connecting moves with
which are the same skills required in mathematically oriented tasks, at
once a week in between therapy sessions.
The therapist and client monitor
consequences of the client’s actions and decide whether they are what
expected or desired. If they are what were expected or desired, the
been transformed from a maladaptive to a dynamical adaptive system and
is terminated. If the consequences of the client’s actions both in and
the clinic are not what was expected or desired, the therapist in
with the client re-examines the beliefs upon which the client is acting
adjusts them and therefore the activities they guide accordingly. The
result of intervention is adaptability, conceptualized as emergent
which enables the complex dynamical human system to use the experience
available from the environment to change and recreate itself, and
adapt to the context and to survive both physically and
The purpose of this paper was to present a
theoretical core for a proposed pragmatic conceptual model of practice
occupational therapy which focuses on the mind as an instrument for
adaptation to the environment through occupational functioning. The
core, consisting of constructs/concepts derived from the professional
historical literature, the philosophy of pragmatism, and the dynamical
systems/complexity theory, was discussed. The specific guidelines for
based on the proposed conceptual model of practice and recommendations
II applied scientific inquiry to assess adequacy of the guidelines
1996) will be presented in another paper.
McKenna, T., & Sheldrake, R. (1992). Trialogues
at the edge of the west:
Chaos, creativity, and the
Resacralization of the world. Santa Fe, New Mexico: Bear & Company publishing.
Sauer, T.D., & Yorke, J.A. (1997). Chaos:
An introduction to dynamical systems.
New York: Springer.
Ways of understanding. British Medical
Journal, 323, 700.
Retrieved July 7, 2002, from the Proquest database.
Arndt, M., &
Bigelow, B. (2000). The potential of chaos theory and complexity theory
services management. Health care
management review, 25, 35-41. Retrieved July 7, 2002,
from the Proquest database.
(1980). Teaching the sick. Philadelphia: W.B.
J.B., Liebovich, L.S., & West, B.J. (1994). Fractal
York: Oxford University
Bell, I.R., Baldwin, C.M., & Schwartz,
G.E. (2002). Alternative therapies in health and medicine.
Viejo, 8, 58-66. Retrieved July 7, 2002, from the Proquest
Bing, R.K. (1981).
Occupational therapy revisited: A paraphrasic journey. American
Occupational Therapy, 35, 499-517.
(1971). Occupational therapy--A historical perspective: Legacy of the
treatment--1800s to 1910. American
Journal of Occupational Therapy, 25,223-225.
& Atherton, C.R. (1999). Chaos theory: An alternative approach to
work practice and
research. Families in Society, 80, 367-373.
Retrieved July 7,
2002, from the
(1986). Origins and adaptations: A
philosophy of practice. Lebanon, NJ:
(1995). Occupational therapy activities
from clay to computers: Theory
F.A. Davis: Philadelphia.
Bruce, M.A., &
Borg, B. (1993). Psychosocial
Occupational Therapy: Frames of
Reference for Intervention. Thorofare, NJ: Slack
Bruce, M.A., &
Borg, B. (2002). Psychosocial frames of
reference: Core for occupation-based
practice. Thorofare, NJ: Slack Incorporated.
Buchler, J. (Ed.).
(1955). Philosophical Writings of Peirce.
New York: Dover
(1993). Applied chaos theory: A paradigm
for complexity. New
Inc., Harcourt Brace & Company, Publishers.
(Ed.).(2002). Occupational therapy and
mental health. (3rd Edition).
Darwin, C. (1985).
The origin of species. New York:
Dewey, J. (1929). The quest for
certainty. New York: Minton,
Balch & Co.
Dewey, J. (1931). Philosophy and
Dewey, J. (1957). Reconstruction in
philosophy. Boston: Beacon
Dewey, J. (1996).
The Influence of Darwinism on Philosophy. Classic
(Fisch, M.H., Ed.). New
York: Fordham University
Dewey, J. (1996).
The Supremacy of Method. Classic American
M.H., Ed.). New York:
Dewey, J. (1996).
The Construction of Good. Classic
American Philosophers. (Fisch,
M.H., Ed.). New York:
Dunn, W., Brown,
C., & McGuigan, A. (1994). The ecology of human performance: A
for considering the effect of context. American
Occupational Therapy, 48, 595-607.
(1957. History of Occupational Therapy. Occupational
Principles and Practice. (Dunton, W.R.,
& Licht, S., Eds.). Springfield, Illinois: Charles C. Thomas, Publisher.
(1957). The prescription. Occupational
Therapy: Principles and Practice.
& Licht, S. Eds.). Springfield, Illinois: Charles C. Thomas, Publisher.
Julin, D., Padilla, R., & Schultz, S. (1998). Occupational Therapy
Models. Psychosocial Occupational
Clinical Practice. (Cara, E., & McRae, A., Eds.). New York:
(Ed.).(1996). Classic American
Gaudet, P. (2002).
Measuring the impact of Parkinson’s disease: An occupational
perspective. The Canadian Journal of
Occupational Therapy, 69, 104-116. Retrieved May 14, 2002, from the Proquest database.
(1997). An introduction to the history of
Hooper, B., &
Wood, W. (2002). Pragmatism and structuralism in occupational therapy:
conversation. American Journal of
Occupational Therapy, 56, 40-49.
(2004). Instrumentalism in occupational
therapy: An argument for a
pragmatic conceptual model of practice.
Submitted for publication.
James, W. (1920). Collected essays and
reviews. New York:
Longmans, Green and Co.
James, W. (1977). The writings of
William James: A comprehensive
Ed). Chicago: The University of Chicago Press.
James, W. (1977).
Radical Empiricism. The Writings of
William James. (McDermott,
J.J., Ed.). Chicago:
The University of Chicago Press.
James, W. (1977).
Habit: Its Importance in Psychology. The
Writings of William James.
Ed.). Chicago: The University of Chicago Press.
James, W. (1981). Pragmatism.
(Kuklick, B., Ed.). Indianapolis:
James, W. (1996).
The Will to Believe. Classic American
Philosophers. (Fisch, M.H.,
Ed.). New York:
(1997). Conceptual foundations of
occupational therapy. (2nd Edition).Philadelphia: F.A.
Law, M., Baptiste,
S., Carswell, A., McColl, M.A., Polatajko, H., & Pollock, N.
(1998). Canadian occupational performance measure.
(3rd Edition). Toronto, ON:
CAOT Publications ACE.
Licht, S. (1957).
The Principles of Occupational Therapy. Occupational
Principles and Practice. (Dunton, W.R.,
& Licht, S., Eds.). Springfield, Illinois: Charles C. Thomas, Publisher.
Locke, J. (1924). An Essay concerning
The Clarendon Press.
Locke, J. (1990). Questions Concerning
the Law of Nature.
(Horwitz, R., Clay, J.S., &
Clay, D. Trans.). Ithaca, New York:
Mendenhall, M.E., Macomber,
J.H., & Curtright, M. (2000). Mary Parker Follet: Prophet
of chaos and
complexity. Journal of Management
History, 6, 191-207. Retrieved July 7,
2002, from the Proquest
Meyer, A. (1977).
The philosophy of occupational therapy. American
Journal of Occupational Therapy,
(1997). The two pragmatisms: From Peirce
to Rorty. New York:
(1996). Applied scientific inquiry in
health professions: An epistemological
(2nd edition). Bethesda, MD: The
Occupational Therapy Association, Inc.
Sears, L., & Schlabach, A.V. (Eds.).(1990). The
American philosophy: A book of readings.
USA: Houghton Mifflin Company.
(1955). Philosophical writings of Peirce.
(Buchler, J., Ed.). New
(1955). The Fixation of Belief. Philosophical
Writings of Peirce. (Buchler,
J., Ed.). New York:
(1996). The Fixation of Belief. Classic
American Philosophers. (Fisch, M.H.,
Ed.). New York:
Pinel, P. (1962). A Treatise on Insanity.
Trans.). New York: Hafner
Rahman, H. (2000).
Journey of providing care in hospice: Perspectives of occupational
therapists. Qualitative Health
Research, 10, 806-818.
Sage Publications, Inc.,
Retrieved May 14, 2002, from the Proquest database.
Sibley, J. (n.d.).
Classical ethics for contemporary times:
A heuristic approach.
manuscript. Texas Woman’s University, Denton, Texas.
Schkade, J., &
Schultz, S. (1992). Occupational adaptation: Toward a holistic approach
practice, part 1. American Journal of
Occupational Therapy, 46, 829-837.
Schultz, S., &
Schkade, J. (1992). Occupational adaptation: Toward a holistic approach
practice, part 2. American Journal of
Occupational Therapy, 46, 917-925.
(2002). Interactive reasoning in the
practice of occupational therapy.Upper Sandle River, NJ:
Thesen, J. (2000).
Good intentions overruled: A critique of empowerment in the routine
mental health services (Book Review). Qualitative
Research, 4, 568-569. Sage Publications,
Inc., Retrieved May 14, 2002, from
(1998). Good intentions overruled: A
critique of empowerment in the
Routine organization of mental health
services. Toronto, Canada: University of Toronto Press.
Tuke, S. (1964). Description of the
Retreat: An Institution
near York for Insane persons
of the Society of Friends Containing an
Account of its Origin and
Progress, The mode of Treatment, and a statement of Cases. London, Dawsons of Pall Mall.
(1992). Complexity: The emerging science
at the edge of order and
chaos. New York:
(1964). Makers of the American mind:
Three centuries of American
thought and thinkers. New
Morrow & Company.
(2001). Behavior change for supply chains. Informationweek,
Retrieved July 7, 2002, from the Proquest database.
(1998). A Theory of Occupation and Health. Occupational
(Creek, J., Ed.). London: Whurr.
Marcusson, J., & Henriksson, C. (2002). Clinical utility of the
Performance Measure--Swedish version. The
Canadian Journal of
Occupational Therapy, 69, 40-52.
Retrieved May 14, 2002, from
Copyright © 2004 Hampstead
Ltd - A Subsidiary of Southern Development Group, SA.
All Rights Reserved. A Private
Agency for the good of all, published in the UK & Honduras.