WFOT’s New Definition and an Old Tension in OT
“Occupational therapy promotes health and wellbeing by supporting participation in meaningful occupations that people want, need, or are expected to do.”
Some commenters online have already begun objecting to the phrase “expected to do,” criticizing it as normative, colonial, or culturally prescriptive. What many don’t seem to realize is that the phrase isn’t new. It’s been in the WFOT definition since at least 2010. The 2025 revision didn’t add this language; it chose not to delete it.
That’s significant.
A Bit of History
Occupational therapy once had role theory as an anchor point. That orientation helped the profession identify what people should be doing, based on their life stage, culture, and social context. In the 1960s through the 1980s, OT was often described as facilitating participation in the roles of self-care, productivity, and leisure. These weren’t rigid categories; they were broad, interpretable, and grounded in shared life structures.
Critics rightly pointed out that role theory often reflected white, middle-class, Western ideals. Rather than adapt or expand it, much of the profession abandoned it altogether. What replaced it was the concept of “occupation” that was generically defined, personally constructed, and unbounded - and we can thank the discipline of occupational science for that. This was the beginning of a professional identity crisis. Without social roles or shared expectations, anything could become an “occupation,” and in many circles, everything did.
That drift has not served us well.
In 1972, Phil Shannon warned that OT was veering off track in his famous 'The Derailment of Occupational Therapy' article. He noted how the field had decoupled from its foundational premise that was articulated by Reilly of needing to address not only biomedical function (second paradigm values), but also meaningful social participation (first paradigm values). Shannon argued that OT had lost its connection to the intentions of the rehabilitation movement which was a movement fundamentally about restoring people to valued social roles.
The occupational behavior model and the Model of Human Occupation (Kielhofner's work) briefly pulled us back. Kielhofner was also a student of Mary Reilly. MOHO re-engaged OT with role performance, habituation, and meaningful action in context. But then came occupational science, and with it, the postmodern turn. We studied Foucault, decolonization, and came to a wholesale rejection of anything that smelled of Western normativity. In the name of inclusivity, we threw away structure. “Doing, being, becoming” became a mantra. That was poetic, I guess, but I believe that it unmoored the profession from Reilly’s occupational behavior model that Shannon said we so desperately needed to reclaim.
That was probably intentional.
Add to that the rise of the Internet which globalized discourse and flattened distinctions between frameworks, and supercharged the profession’s tendency toward abstraction and theoretical maximalism. The result was a field where the boundaries were porous, the definitions were vague, and the center was hard to hold.
We argued internally - what will happen if basic occupational science takes us off track of applied occupational therapy. And it did.
Why “Expected to Do” Still Matters
That’s why the persistence of “expected to do” in WFOT’s 2025 definition is so fascinating.
It certainly is not a return to role theory but it is a quiet nod to the idea that people live in systems, and those systems make demands. Expectations can be oppressive but they can also be identity-forming, developmental, and socially meaningful. Ignoring them doesn’t liberate patients; it erases the context they have to navigate.
I don’t know why WFOT chose to keep that language but I’m glad they did. I don’t share the view that the term "expected to do" is inherently problematic. In fact, I see it as one of the only remaining anchors in a definition that could have otherwise floated off entirely.
OT Is Not Everything
Occupational therapy cannot be everything. A profession that claims all activity (occupation) as its domain ceases to be a profession. If we are to regain our footing, we need to deliberately reengage with structure. Reilly's vision of occupational behavior, Shannon’s critique of biomedical reductionism, and MOHO’s scaffolding of volition and habituation are not relics. They’re tools we’ve neglected and it has hurt American practice that we have lost them (to a degree).
That may still cause problems internationally - I get it. But we don't have to destroy American occupational therapy because the profession is trying to expand into international contexts. I think the opposite needs to happen - theoreticians and practitioners in those other contexts have to decide whether or not occupational therapy fits their cultural context, and make adjustments as needed.
So before we call to purge “expected to do” from the definition, maybe we should ask what’s really driving the discomfort. Is it a principled objection to normativity? Or is it a deeper anxiety that we’ve lost our bearings and that the idea of socially anchored occupation reminds us of what we left behind?
Occupational therapy was developed in a Western context. If its theoretical tenets don't translate into every culture, then perhaps occupational therapy is not a global construct, and that is okay.
We have to come to a realization that something built in one cultural context doesn't need to be dismantled simply because it doesn't fit all others.
No other profession has ever done so. Why does occupational therapy?
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