The International Journal of Psychosocial Rehabilitation

Instrumentalism in occupational therapy: A theoretical core for the Pragmatic Conceptual Model of practice

Moses N Ikiugu, Ph.D., OTR/L
Assistant Professor

Department of Occupational Therapy,
University of Scranton

800 Linden Street,
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
.   International Journal of Psychosocial Rehabilitation. 8, 151-163.

In an earlier paper (Ikiugu, 2003), an argument was made for establishment of a pragmatic conceptual model of practice in occupational therapy. It was suggested that in this model, the pragmatic construct of instrumentalism be operationalized as a way for therapists to access the client’s mind as a tool for occupational functioning and adaptation to the environment. In this paper, theoretical concepts/constructs used to construct a theoretical core for the model are identified from a review of the history of occupational therapy, selected literature of the philosophy of pragmatism, and the dynamical complex adaptive systems theory. Justification for the above sources of theoretical constructs/concepts was discussed in the previous paper (Ikiugu, 2003). Postulations are developed connecting the concepts/constructs to form a comprehensive, internally consistent theoretical core.

In an earlier paper (Ikiugu, 2003) an argument was made for a proposed conceptual model of practice based on the philosophy of pragmatism, which has been proposed as the philosophy that guided the maturing of the idea of occupation as therapy in the early 20th century (Breines, 1986; Hooper & Wood, 2002). It was asserted that practice based on such a philosophy would be consistent with the occupational therapy 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 occupation. In the proposed model, it was suggested that the pragmatic construct of instrumentalism (Dewey, 1957; 1996b; 1996c) be operationalized to inform practice which centers on the notion of the mind as an instrument which can be accessed to facilitate occupational functioning that is geared towards helping the client to be more adaptive in his/her environment for the purpose of both 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 began with a definition of the problem, which was identified as diminishing identity of occupational therapy as indicated by declining involvement of the profession in mental health practice, and lack of use of occupation-based, client-centered, holistic interventions in practice (Ikiugu, 2003). In this paper, discussion of the theoretical core of the proposed conceptual model will be presented. Concepts/constructs will be identified from the occupational therapy historical literature, the philosophy of pragmatism, and the dynamical complex adaptive systems theory. Postulations will be synthesized connecting the concepts/constructs into a comprehensive, internally consistent theoretical core. Guidelines for problem identification and intervention will be outlined in another paper.
Concepts/constructs used to formulate a theoretical core

Concepts/constructs from the historical literature of occupational Therapy

From the historical literature of the profession are derived constructs of the mind, occupation, individualization, and the environment.

The Mind
The founders of the profession viewed occupational therapy intervention as invariably beginning with the human mind. Pinel (1962, p. 108) suggested that in the moral treatment, “… insanity was 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 diminished a person’s humanity, such that, “The figure of the human species is now all that remains to him, ‘and like the ruins of a once magnificent edifice, it only serves to remind us of its former dignity and grandeur,’ and to awaken our gloomiest reflections-our tenderest regret for the departure of the real and respectable man” (pp. xvi-xvii). He proposed use of occupation to treat individuals who are mentally ill because occupation is the best way to reach the human being at the most intelligent level. The founders of occupational therapy in the 20th century such as Dunton (1957a; 1957b) and Barton (1980) also aimed at training the mind and body in the appropriate habits of thinking and acting. The individual patient’s interests and aspirations were carefully considered (Dunton, 1957b; Licht, 1957). The founders of the profession considered the mind and its functions such as reasoning, thinking, and developing interests to be central to occupational therapy intervention.

Other attributes of the mind that the founders of the profession emphasized included the ability to learn. Barton (1980) stated that the purpose of occupation in the hospitals was to re-educate 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 knowledge. The ability to pay attention is also a function of the mind that was important for these early occupational therapists. One of the purposes of employment and recreation was to facilitate regaining of the habit of attention (Licht, 1957) and in the process to aid in, “… training emotional control…” (Dunton, 1957b, p. 52). In regaining the habit of attention, patients learnt to discipline themselves and to control and master their disorders (Creek, 2002; Tuke, 1964).
Both Pinel (1962) and Tuke (1964) used occupation as an alternative to restraint in the management of the mentally ill patients. According to Pinel (1962), a way to secure health, to keep good order and well-mannered patients, was through interesting and laborious employment. In this regard, he stated that, “The fatigues of the day prepare the labourers for sleep and repose during the night”.  A link between occupation and health has often been postulated in occupational therapy literature. Wilcock (1998) developed a theory to explain this link. She postulated that humans have evolved as occupational beings because it is through occupation that they adapt and insulate themselves from the environment. Breines (1995) regarded occupations as tools that have enabled 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 the moral treatment era, Pinel (1962, p. 189) instructed that, “… the peculiarities of each case must be watched, studied and treated with such assiduity and address 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 patient’s interests as central to the choice of therapeutic occupations for that patient. In current occupational therapy literature, the construct of individualized therapy is prevalent with compelling arguments for therapy to be a collaborative effort between the patient and therapist where the two set goals and plan interventions together (Law, et al., 1998; Rahman, 2000; Schwartzberg, 2002; Thesen, 2000; Wressle, Marcussion, & Henrikson, 2002).
During the moral treatment movement, both Pinel and Tuke postulated that an environment that was conducive to regaining health for the mentally ill was one that was similar to that of the family (Bing, 1981; Hergenhahn, 1997). Pinel (1962, pp. 206-207) stated that: “In a word, the general government of the hospital, resembled the superintendent of a great family, consisting of turbulent individuals, whose fury it should be more the object to repress than to exasperate, to govern by wisdom rather than to subdue by terror.” In other words, the therapist (governor) was to be more or less like a parent, strict, yet gentle and caring. Similarly, Tuke (1964) described the use of moral treatment at the York retreat in England as consisting of kind treatment by the caretakers combined with a comfortable environment consisting of enjoyable social activities and other amusements that the patients enjoyed. It was postulated that patients would be able to recover their use of reason if they were engaged in a regimen of daily activities in the company of other persons of sound mind and a kindly nature (Bockoven, 1971). 
At the turn of the 20th century, the founders of occupational therapy continued to emphasize the role of the environment, both physical and social, in occupational therapy. Barton (1980) saw occupational therapy as a means of solving economic problems whereby dependents were reclaimed to be independent producers, and thus to contribute economically in their environment. In developing his principles of occupational therapy, Dunton (1957b) stipulated that the best occupations were those that were “…interesting” (p.47) to the patient and should, “… lead to an increase in the patient’s knowledge” (p. 47). The emphasis on increasing the patient’s knowledge indicates the importance of engagement of the patient with the environment since knowledge comes from synthesis of environmental experiences (Locke, 1924). Later, Meyer (1977) held that mental illness was a result of maladaptive interaction between the person and his or her environment. He proposed that the problem of mental illness is a problem of adaptation. Occupation was, according to him, a means by which a person maintained balance in his/her environment and therefore remained healthy. The theme of a healthy person as one who interacts effectively with and adapts to the environment has continued in the professional literature to the current time (Law, et al., 1998). The context within which the patient lives (community) is increasingly appearing in literature as a major focus of the profession (Gaudet, 2002; Townsend, 1998).
Concepts/constructs from the philosophy of Pragmatism
Some of the concepts/constructs from the philosophy of pragmatism that are used in the proposed conceptual model include beliefs, activity, contextualization, experience, consequences, and instrumentalism.
According to Peirce (1955b, p. 7) reasoning helps us to, “… find out, from the consideration of what we already know, something else which we do not know.” Good reasoning should lead us to draw true conclusions from true premises (Fisch, 1996). The ability to reason well is dependent on factually grounded premises and ensuing conclusions. The premises from which conclusions are drawn are the beliefs that one holds. When an action based on a belief does not lead to expected consequences according to experiential facts, doubt results. Doubt causes irritation and belief causes a calming of the mind. Belief is therefore the state towards which the mind tends (Hergehahn, 1997). When a belief is established because actions based on it result in expected or desired consequences, a habit is established because the 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 belief to be a theory about how things are. Its potency is determined by the willingness to act on it. If a belief or hypothesis is valid, then a person is willing to act on it. He reiterated Peirce’s (1955b) position that the test of a belief is the practical consequences of action arising from that belief (James, 1996; 1977b; Mounce, 1997). He saw the truth of a belief as being determined by the extent to which the consequences of actions based on it are expected or desirable. In the pragmatic conceptual model of practice for occupational therapy, the challenge will be to determine what beliefs motivate a client’s actions and to help the client examine the consequences of actions arising from those beliefs to determine if such consequences were expected or desirable.
Since according to both Peirce and James a belief is a rule for action (James, 1977a; 1977b; Mounce, 1997; Peirce, 1996a), it follows that a belief without action/activity is meaningless for there are no consequences of holding such a belief. Without consequences, the belief cannot be evaluated. This pragmatic valuing of activity is consistent with the view in occupational therapy, that a healthy individual is one who is active (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 establish belief and appease the irritation of doubt (Peirce, 1955b). Belief is therefore the beginning and end of thought. Since thought is the means by which belief is established, its soundness can also be judged only according to action(s) resulting from it. According to Peirce (1955b, p. 10) the practical consequences of action resulting from a belief or an idea constitute the only sensible meaning of that belief or idea since, “It is certainly best for us that our beliefs should be such as may truly guide our actions so as to satisfy our desires; and this reflection will make us reject every belief which does not seem to have been so formed as to insure this result.” In occupational therapy, consequences are similarly valued since the goal of therapy is to effect change in positive ways (Bruce & Borg, 1993; Creek, 2002).
The pragmatists’ philosophy was highly influenced by the British empirical philosophical ideas, especially those of John Locke (Buchler, 1955; Fisch, 1996; Hergenhahn, 1997; Whittemore, 1964). Locke’s (1924; 1990) basic premise was that all knowledge arises from experience. In this regard, he said:
2. All ideas come from sensation or reflection.—Let us then suppose the mind to be, as we say, white paper, void of all characters, without any ideas; How comes it be furnished? ….. To this I answer, in one word, from EXPERIENCE. In that all our knowledge is founded, and from that it ultimately derives itself. … (Locke, 1924, p. 42)
 Similarly, Peirce (1955b) stated that experience is not only the source of knowledge but also the compass with which humans must navigate life. James (1977b, p. 136), extended this idea in his doctrine of radical empiricism where he asserted that, “… the only things that shall be debatable among philosophers shall be things definable in terms drawn from experience.” Dewey (1957) argued for reconstruction of philosophy on the premise that a philosopher, like a scientist, should adopt the experimental method of pursuing knowledge rather than introspective rationalization. In adopting the experimental method, the philosopher would draw from experience as the source of knowledge. The importance attributed to experience by pragmatists is consistent with the value of environment in occupational therapy (Creek, 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 derived this notion from William James (1996, see also Whittemore, 1964). James (1977c, p. 11) argued that the mind, “… seems endowed with a very extraordinary degree of plasticity …; so that we may without hesitation lay down as our first proposition the following: that the phenomena of habit in living beings are due to the plasticity of the organic material of which their bodies are composed.” Arguing further about the importance of habit in regulation of human function, James (1977c) suggested that the brain evolves from interaction between the human being and the environment, since this interaction is what provides the experiences that result in habit formation. Through this interaction, the environmental experiences shape the neural system (James, 1977c). He anticipated human agency that is central to instrumentalism by arguing that the human being (knower) is an actor rather than a passive observer of nature. As an actor, he or she uses mental interests, hypotheses, and postulates, as the basis of action. These faculties of the mind function to transform the world and in so doing, help make true what they declare (James, 1920). Dewey (1931) found in this postulation by James a method of using philosophy to make the world better. He argued that intelligence is basically an instrument to effect individual and social progress (Whittemore, 1964).
According to Dewey (1929), intelligence should be viewed as a tool or an instrument in the same way that other tools or instruments are made and used with precision to solve the environmental and social problems. Intelligence is employed this way through formulation of appropriate theories to inform action that would improve the situation in the world. Any theory then, which is divorced from doing, is useless and futile. The construct of instrumentalism therefore touches on many themes embraced by occupational therapists, such as doing, agency, and the environment (see Creek, 2002; Dunn, Brown, & McGuigan, 1994; Schwartzberg, 2002).
The whole of Dewey’s philosophical orientation may be summed up with the construct of meliorism (Fisch, 1996; Whittemore, 1964). His goal was meliorism in the sense that he sought a method of doing philosophy to serve democracy and solve contemporary social problems and thus make the world a better place to live. Such a philosophy had to be placed in the social context (contextualization). Occupational therapists are familiar with this notion considering that they are primarily interested in how humans can make their lives better by interacting and functioning occupationally within the environmental context (Bruce & Borg, 1993; Creek, 2002; Dunn, et al., 1994; Law, et al., 1998; Schwartzberg, 2002).
Concepts/constructs from the dynamical systems/complexity theory
According to this theory, living systems are complex adaptive dynamical systems (Anonymous, 2001; Waldrop, 1992). Life emerges at the point where matter is beginning to be chaotic but still has some order to give it structure (Waldrop, 1992). In other words, the boundaries of life (indicated by creative productivity), are order and stagnation on one end and chaos on the other (Arndt & Bigelow, 2000). This delicate balance is what produces creativity, which is one major characteristic of complex adaptive evolving systems.      

Humans can be conceptualized as complex adaptive evolving systems. It is postulated in this paper that the extent to which they maintain balance between chaos and order in their thinking and activities defines the extent to which humans are alive. This view is similar to the principle of occupational adaptation advanced in the Occupational Adaptation Frame of Reference (Falk-Kessler, Julin, Padilla, & Schultz, 1998; Schkade & Schultz, 1992; Schultz & Schkade, 1992). In this frame of reference, an adaptive individual is conceptualized as one who blends mobility and stability through occupational performance to produce mature behavior. In the proposed pragmatic conceptual model of practice, concepts/constructs derived from the dynamical systems/complexity theory will be: 1) Disproportion between initial conditions and final outcomes; 2) Emergence; 3) Fractal nature of human occupational behavior; 4) Strange attractors.
Disproportion between initial conditions and final outcomes
Complex dynamical systems exhibit a phenomenon known as non-linearity (Cambel, 1993). This means that the behavior of such systems cannot be understood in simple linear mathematical equations. There is no simple cause-effect coupling. Such systems are open (i.e., they exchange information with their surroundings), are neither completely deterministic nor completely random, and paradoxes exist within them (Cambel, 1993). There is uncertainty within such systems making precise prediction of outcome difficulty. This property of dynamical systems explains one of their major characteristics, namely, that small differences in initial conditions can cause extensive differences in consequences (Arndt & Bigelow, 2000; Bolland & Atherton, 1999; Cambel, 1993; Whiting, 2001).
This theory may be used to explain the interaction between occupational performance and health. Engagement in occupation results in varied and unpredictable health outcomes, both physical and psychological, which may not be easily explained by cause-effect coupling (Kielhofner, 1997). Occupation organizes behavior generally and does not affect only the musculoskeletal, neurological, and mental components towards which it may be directed. The other use of this concept may be to enable therapists to explain to patients the importance of their actions. A person’s beliefs and subsequent momentary decisions and actions may have significant effects not only on the person’s life but also on other people and the environment. For instance, deciding to stay in bed instead of attending an important business meeting may lead to a loss of job and income, affecting the childrens’ education, family well-being, and the entire community’s economy in unpredictable ways. It should therefore be emphasized to clients that they should not only strive to 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 & Bigelow, 2000).  

One characteristic that distinguishes dynamical complex adaptive systems from other systems is that they are self-organizing (Mendenhall, Macomber, & Curtright, 2000). This means that parts in the system cooperate to produce structures performing totally different functions than those performed by the parts (Cambel, 1993). This self-organization is what makes evolution possible. In the process of responding to the environment in order to reach its goals (Anonymous, 2001), the primary one of which is to survive, the organism creates new structures. Cells organize themselves functionally into tissues that are specialized according to function, tissues organize themselves into organs, organs into systems and systems into a functional organism. At each level of organization, properties specific to that level and that transcend the sum of individual parts emerge (Bell, Baldwin, & Schwartz, 2002).
The property of self-organization and emergence has significant implications for how occupational functioning of human beings may be viewed. First, the symptoms that a client presents may be seen as emergent indicators of a dysfunctional or maladaptive life. This is the view adopted by homeopathic practitioners (Bell, Baldwin, & Schwartz, 2002) and it seems to be a view that may describe the kinds of 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, 2002). One person may disregard the discomfort posed by the condition, apply her/himself, and make progress and recovery. The other person may react with despair, see him/herself as helpless, refuse to do anything, and gradually deteriorate mentally and/or physically even to the point of death. The differences between the characteristics of the two individuals may be emergent 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 occupational behaviors that produce the consequences that they experience in their lives. It is hypothesized that by clarifying self-defeating beliefs that hinder achievement of occupational goals, they can substitute such beliefs with ones supportive of more appropriate occupational functioning, leading to desired consequences.
The other application of emergence may be in the way occupation is conceptualized to work in clients’ lives. In the complex adaptive dynamical systems theory perspective, it could be postulated that through occupation, therapists apply small inputs at the point when they come into contact with patients. Such inputs may, for example, be inculcating habits that are consistent with their goals. For instance, a teenager who wants to excel in academics may choose to read over engagement in another activity until reading becomes a habitual activity. An elderly person who wants to be independent may be asked to make small independent decisions such as what to wear, and what activities to engage in within a rehabilitation unit on a regular basis. The hypothesis behind this approach would be that such behaviors would eventually lead to emergence of positive characteristics, which may generalize into the patient’s entire life, leading to achievement of desired occupational goals such as being an academically astute person, or an independent person. While the author is aware that there is no empirical evidence to support such a hypothesis, it can be tested in practice using type II applied scientific inquiry (Mosey, 1996) once the model begins to be applied in practice.
The fractal nature of human occupational behavior
Fracterity in complex dynamical systems refers to self-similarity at every level of self-organization (Bell, Baldwin, & Schwartz, 2002) such that at every scale, parts are smaller, exact duplications of the whole (Bassingthwaighte, Liebovitch, & West, 1994). This self-similarity may be either geometrical or statistical. Geometrical self-similarity is found in nature in symmetrical structures, such as the division of blood vessels in the human body (Bassingthwaighte, Liebovitch, & West, 1994). The truncation of vessels is symmetrical, so that any capillary system has the same number and system of truncation as that at the level of the veins, or arterioles. In 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.

Statistical self-similarity may be useful in evaluation and study of human occupation in an attempt to understand why an individual client is adaptive or maladaptive in different life circumstances. The assumption would be that the general adaptability or maldaptability is manifested in the pattern of individual moment-to-moment choices. For instance, consider a teenager who wonders why he is not succeeding in school. You analyze the teenager’s occupational behavior in the occupational therapy clinic and discover that every time you give him a challenging task, he engages in it for a few minutes, then loses interest and starts playing video games. You realize that this is a pattern in his life. Whenever he is faced with a challenge, he has a tendency to escape into games. In this model, it is hypothesized that his behavior while engaging in occupation in the occupational therapy department is a fractal. This means that each part of the client’s activity lifestyle is similar to the whole pattern of performance in his life.
Strange attractors
The field within which dynamical complex adaptive systems move is known as the phase space (Cambel, 1993). Movement by the system within this space constitutes what is known as a trajectory (Bassingthwaighte, Liebovich, & West, 1994). A trajectory could, for example, be a person’s occupational life in terms of the various activities engaged in over a life-time. When simple systems such as oscillators are displaced from a starting point, they eventually come to rest at that point (Bassingthwaighte, Liebovich, & West, 1994). For example, a displaced pendulum moves within the phase space until it comes to rest at the starting point, which is a point of stable equilibrium. Such fixed points within which the system eventually comes to rest are predictable and are known as fixed attractors (Bassingthwaighte, Liebovich, & West, 1994; Cambel, 1993).
In dynamical systems, the region within which the attractor is situated is called a basin of attraction (Cambel, 1993). The set of initial conditions form the basin of attraction (Alligood, Sauer, & Yorke, 1996). In occupational therapy, such conditions could be self-esteem, beliefs, values, interests, and so forth. Fixed attractors are predictable and irrespective of initial conditions, the system eventually comes to rest at them. In dynamical complex adaptive systems, attractors are not fixed. Furthermore, two or more points within each attractor may determine the trajectory for each of the initial conditions. Such attractors are sensitive to initial conditions, so that initial differences lead to magnification of the differences between points within the attractor. In other words, the points within the attractor diverge from each other (Bassingthwaighte, Liebovich, & West, 1994). However, the divergence is finite. Consequently, the trajectories from the nearby initial points on the attractor diverge, and then are folded back onto the attractor repeatedly. This creates layers of the trajectory, which are self-same, and therefore, the attractor becomes a fractal. In such fractal systems there is energy expenditure and they rely on exchange of energy and information with the environment for survival (Bassingthwaighte, Liebovich, & West, 1994). Attractors in such systems are unpredictable and are known as strange or chaotic attractors (Abraham, McKenna, & Sheldrake, 1992; Alligood, Sauer, & Yorke, 1996; Bassingthwaighte, Liebovich, & West, 1994; Cambel, 1993).

Kielhofner (1997) explains the phenomenon of the attractor as a tendency for the system to behave in a certain way. In the pragmatic conceptual model, it is proposed that the attractor for human occupational functioning is the purpose of occupation. This attractor may have 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 living and survive. Depending on the initial conditions, the two points may diverge exponentially. For example, if one has poor self-esteem, pursuing tasks may be mostly to earn wages for survival purposes. The need to do things to enhance feelings of competence becomes secondary. The two points then become polarized. If, however, the initial condition is good self-esteem and therefore a feeling 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 goals. The two goals are pursued in tandem and there is no great divergence between the two points in the attractor (purpose of engagement in occupation). 

A concise 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 adaptive dynamical system who is engaged in interaction with the environment, both physical and social, through occupational performance, for the purpose of changing, adapting, creating, and therefore surviving. According to the philosophy of pragmatism, this adaptive system employs the mind as an instrument to shape the environment so that it is suitable for human survival (Dewey, 1957; 1996a; 1996b; Muelder, Sears, & Schlabach, 1990; Sibley, n.d.; Whittemore, 1964).

Engagement of the mind as an instrument for adaptation to the environment involves formation of beliefs as a basis for thought, which directs actions (James, 1977a; 1977b; 1981; 1996; Peirce, 1955a; 1955b). Use of the mind also involves awareness of the consequences of actions that include knowledge of the gravity of initial conditions. It is postulated that agency in one’s environment is best achieved if there is awareness that small differences in initial conditions at any point may lead to extensive differences in outcomes. This is true not only in an individual’s life but also in the lives of those close to him or her, and the entire community (context). As such, the moment-to-moment decisions that one makes as guided by beliefs, and the resulting occupational activities make a significant difference in the world.
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 be called self-determination. A maladaptive person is either too rigid or too disorganized, and is unable to accomplish many things in life. If too rigid, the person may not be able to conceptualize alternative ways of doing things when known strategies do not work (Schkade & Schultz, 1992; Schultz & Schkade, 1992). If too disorganized, the person is unable to focus and keeps 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 disorganized, the result is stagnation and inability to have an experience of satisfaction with life.  Human occupation may be conceptualized as a fractal (Bassingthwaighte, Liebovich, & West, 1994). A therapist is able to assess whether a patient is stagnated (maladaptive) or adaptive by examining a part of the patient’s occupational life trajectory in the clinic. As a fractal it is assumed that occupational life trajectory has self-same properties. Therefore, by examining a part of the trajectory, the therapist is able to judge whether the client exhibits a pattern of adaptability or maladaptability. 

Once it is determined that a client is maladaptive, the goal of intervention is to facilitate emergence of adaptive patterns. This would be accomplished by accessing the client’s mind as a tool to effect functional change. To do this, the therapist would determine what beliefs form the basis of occupational actions for the patient and whether such beliefs support an adaptive or maladaptive lifestyle. For example, consider a young man who believes that he is not intelligent enough to accomplish tasks requiring intellectual acumen such as is required for the bookkeeping that is necessary for him to be able to run his own business. He has some good ideas that may lead to establishment of a successful business, but as long as he believes that he is incapable, he will not be able to act in a manner to actualize his ideas.
In such a case, the therapist may want to educate the client regarding how his beliefs may be inconsistent with an 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 to substitute such beliefs with ones that support an adaptive lifestyle leading to taking concrete steps towards achieving his dream of starting a business. Once it is determined what negative beliefs the client needs to substitute in order to be adaptive, he or she would be asked to make occupational decisions on the basis of newly formulated positive beliefs and act on them in the clinic. In the hypothetical case of the young man mentioned above, the therapist may want to help him substitute the belief that he is not intelligent enough with one that he is capable of bookkeeping or any similar task that requires some mathematical aptitude. This may be accomplished in the clinic by asking him to be a bookkeeper for a project group in the occupational therapy department. The therapist can then point out how successful the client is in the task and thus challenge his belief about lack of aptitude, or encourage him to accurately access his strengths and, if necessary to the success of his business, hire a bookkeeper.
The rationale for the above-described intervention is that beliefs form a basin of attraction for the client. The purpose of engagement in occupation is a strange attractor (see discussion on ‘the basin of attraction’ and ‘strange attractors’ in Alligood, Sauer, & Yorke, 1996; Bassingthwaighte, Liebovich, & West, 1994; Cambel, 1993). For the client to be conscious of this attractor, the purpose of occupational activity must be stated clearly in the form of goals. In the case of the young man, the purpose of putting him in charge of bookkeeping for the project group would be to demonstrate to him that he is capable of successfully completing tasks that require mathematical aptitude or to recognize that he is unable to successfully complete such tasks and therefore needs to pursue other options. Once beliefs are clarified and a purpose in form of goals is stated, the therapist gets a commitment from the client that he or she will act on the newly established beliefs at every instance outside the clinic. For example, the young man may be asked to commit to engaging in leisure activities, such as playing chess, which require abstraction, planning, forward thinking (anticipation), pattern recognition, and connecting moves with consequences, which are the same skills required in mathematically oriented tasks, at least once a week in between therapy sessions.
The therapist and client monitor consequences of the client’s actions and decide whether they are what is expected or desired. If they are what were expected or desired, the client has been transformed from a maladaptive to a dynamical adaptive system and therapy is terminated. If the consequences of the client’s actions both in and outside the clinic are not what was expected or desired, the therapist in collaboration with the client re-examines the beliefs upon which the client is acting and adjusts them and therefore the activities they guide accordingly. The expected result of intervention is adaptability, conceptualized as emergent behavior, which enables the complex dynamical human system to use the experience available from the environment to change and recreate itself, and therefore to adapt to the context and to survive both physically and psychologically. 

The purpose of this paper was to present a theoretical core for a proposed pragmatic conceptual model of practice in occupational therapy which focuses on the mind as an instrument for human adaptation to the environment through occupational functioning. The theoretical 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 practice based on the proposed conceptual model of practice and recommendations for type II applied scientific inquiry to assess adequacy of the guidelines (Mosey, 1996) will be presented in another paper.

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