A Living Archive: Twenty Years of Blogging Occupational Therapy
The blog has received more than 1.7 million pageviews since 2006, with an estimated 200,000 to 250,000 of those representing real human engagements. That is a remarkable footprint in a small profession where many peer-reviewed articles are read only a few hundred times. Spikes in readership came during inflection points such as the doctoral mandate debate, showing that the blog became a gathering point when the profession was most unsettled. Even in quieter years, thousands still returned, treating the archive as a touchstone for reflection and critique.
Publishing this reflection here is the only logical choice. It keeps the analysis connected to its source, ensures the record remains open and accessible, and resists the impulse to smooth it into something more 'acceptable.' This blog has always been a place for dialogue in a profession that too often avoids it. It now stands as part of occupational therapy’s history, a living archive that future students, practitioners, and scholars can return to when they want to understand not just what the profession said about itself, but what it wrestled with in real time.
An autoethnography can never reproduce the full archive. That’s what the archive itself is for. What follows is my attempt to make sense of it.
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Introduction and Narrative Framing
Occupational therapy has not been immune to the societal,
cultural, and ideological shifts of the past two decades. From healthcare
reform and expanding academic expectations to the growing influence of social
justice paradigms and rapid technological change, transformative forces have
reshaped the profession. While considerable scholarship has examined these
developments individually, little research has addressed how they have been
experienced and interpreted longitudinally by practitioners working in the
field. This gap warrants attention. As the profession struggles to balance
advancement, adaptation, and coherence, perspectives grounded in lived
experience remain underexplored and essential.
Since 2005, I have maintained a publicly accessible blog
that began as a platform to explore clinical reasoning and private practice
realities. Over time, it evolved into a forum for broader engagement with
issues of professional identity, education, ethics, and governance. This
archive now constitutes a longitudinal record — charting my own development
alongside shifts in the profession’s ideological and pedagogical landscape.
This paper employs autoethnography (Denzin, 2014) to analyze
this corpus, treating the blog as both narrative and data. The blog and its
entries are framed as a form of dialogic practice, serving as a public and
evolving space where professional tensions are explored in conversation with
readers, colleagues, critics, and the broader disciplinary discourse. These
dialogues unfolded through comment threads, private correspondence,
professional responses, and the evolving settings of clinical and academic practice.
Through thematic analysis of selected entries, three patterns emerged: grounded
clinical pragmatism, the rise of ideological frameworks, and a turn toward
future-oriented systems thinking.
While applying scholarly methods to interpret these entries,
it is important to recognize their origin. These were written
contemporaneously, amid uncertainty and concern. They do not reflect detached
retrospective analysis, but rather immediate and candid responses to unfolding
challenges, including governance decisions, ideological shifts, and perceived
missteps in leadership. Although many of these developments were driven by
well-intentioned ideals, this analysis foregrounds how they were experienced at
the practice level. Maintaining this practitioner perspective is critical to
understanding the profession’s trajectory and preserving the authenticity of
engagement with contested change.
The uniqueness of this archive, which spans two decades, presents
both opportunity and methodological challenge. Occupational therapy lacks
comparable longitudinal narratives that trace professional and cultural
evolution across such an extended period. In this sense, the archive functions
as a singularity: a site where conventional empirical methods reliant on
comparison and replication do not serve as effective analytic tools.
This metaphor is intentional. As I noted in a 2005 blog post,
I observed that "relativity breaks down at the point of singularities —
where space-time has zero volume and maximum density." This was initially framed
as a casual reflection on cognition, but now aptly describes the corpus of blog
entries. Spanning upheavals, ideological shifts, and evolving sensibilities,
this record resists reduction and demands interpretive methods that can be attuned
to emergence and contradiction.
Autoethnography is a fitting methodological tool and it is
also necessary. It allows examination of lived experience where traditional
research paradigms falter, enabling meaning to emerge organically from
narrative. This approach also advocates for narrative-informed scholarship as a
counter to fragmentation, offering a means to sustain intellectual diversity
and professional integrity during periods of accelerated change (Denshire &
Lee, 2013).
Narrative inquiry reinforces this frame. As Creswell and
Poth (2023) observe, stories help individuals construct meaning and coherence.
Occupational therapy scholars have similarly validated narrative approaches.
Clark, Carlson, and Polkinghorne (1997) positioned life history and narrative
inquiry as essential to understanding human occupation, while Frank (1996)
emphasized how life stories shape identity and coherence. Recent work has
extended these insights, highlighting persistent tensions in how occupational
therapy practitioners conceptualize their professional identity (Walder et al.,
2021).
Hooper and Wood (2002) illuminated how the profession has
historically wrestled with competing frameworks for conceptualizing practice.
Although my inquiry arises from a different historical moment, this dynamic
remains familiar. Structuralist models have largely given way to new discursive
forces, particularly ideological frameworks centered on social justice and
identity (Kronenberg, Pollard, & Sakellariou, 2005), that similarly
challenge pragmatist commitments. The profession has debated how best to address
social justice and equity within its practices, both theoretically and
practically (Braveman & Suarez-Balcazar, 2009). My own professional
trajectory reflects these tensions.
For example, I have navigated the growing emphasis on
doctoral education, which has sparked debates about its implications for
professional identity and pedagogical coherence (Lane, 2023). In earlier work,
I also explored narrative methods pedagogically, using online narratives to
help students make sense of occupation through qualitative analysis (Winstead
& Alterio, 2021). That project affirmed narrative not only as a research
method but as an essential tool for teaching occupational reasoning.
This project continues that trajectory. Over time,
systems-oriented thinking became an integral part of my writing, shaped by the
profession’s increasing complexity and evolving challenges. These ideas align
with calls to integrate systems theory within occupational therapy education
and practice to better address professional and societal challenges (Schell
& Gillen, 2019). Drawing from my extensive public archive, this study
engages in dialogic examination to explore how professional identity and
pragmatist sensibilities have evolved across two decades shaped by shifting
discourses.
Methods
Study Design
This study employs autoethnography to examine a longitudinal
archive of blog posts authored between 2005 and 2025. By integrating
autobiographical narrative with cultural analysis, this approach enables
exploration of how personal experience intersects with evolving professional
landscapes. Here, the method supports examination of how public, narrative
engagement with occupational therapy discourse unfolded over time.
Data Source and Selection
The data corpus consists of publicly accessible blog posts
composed contemporaneously across a 20-year span. For this analysis, posts were
curated to focus on entries addressing clinical practice, education, ethics,
policy, and professional trends. Posts reflecting purely personal matters
without professional relevance were excluded. The original entries were not
edited or revised for this analysis the writing is presented as originally
published, preserving any textual inconsistencies, rhetorical tone, or logical
shifts that may be apparent in hindsight.
Analytical Approach
Because I wrote the blog posts contemporaneously, they reflect
the immediacy of practitioner experience, including moments of frustration and
critique. This analysis deliberately preserves their original tone and
perspective as part of the data. I attend to the thematic content and to the
affective and dialogic qualities of the entries, which offer insight into how
professional tensions were experienced and expressed in real time.
I conducted a thematic analysis to identify and organize
recurring patterns within the corpus. I reviewed entries iteratively and used
inductive coding to allow themes to emerge organically from the material. This
process resulted in three dominant themes, which provide the primary structure
for the analysis presented in this article.
Ethical Considerations
All analyzed material was self-authored and publicly
available. No identifying information about patients, students, or colleagues
appears in the selected posts. Given the nature of the data and the focus on
personal narrative, ethical concerns were minimal. Nonetheless, I took care to
maintain transparency and interpretive rigor throughout the analysis.
Findings
The thematic analysis yielded three interpretive categories
that illuminate the profession’s evolution and my own engagement with it over
two decades. These themes capture ongoing dialogues between pragmatic clinical
concerns, ideological pressures, and the emergence of integrative systems
thinking.
Thematic Framework
The themes identified In this analysis are best understood
as Interpretive categories rather than strictly chronological phases. While
certain ideas emerged more strongly at particular points in time, they are
interwoven throughout the 20-year narrative and reflect ongoing tensions and
developments in the profession.
The first theme, Grounded Clinical Pragmatism,
centers on the enduring importance of practical, experience-based reasoning in
everyday occupational therapy. These reflections emphasize how real-world
clinical dilemmas, often encountered under time constraints, shape ethical
decision-making, professional identity, and perspectives on systemic
challenges. This dynamic prompts practitioners to act pragmatically rather than
adhere rigidly to theoretical models.
The second theme, From Drift to Dominance: Ideology in
Occupational Therapy, explores how social justice language and
identity-based frameworks became increasingly embedded in education, ethics,
and governance. This shift raised critical questions about alignment with the
profession’s historical values, as well as concerns about marginalizing
dissenting perspectives.
The third theme, Beyond Ideology: Reintegrating
Pragmatism through Systems Thinking, reflects more recent efforts to move
past polarized discourse and apply integrative, interdisciplinary approaches.
Posts in this category highlight a renewed focus on aligning occupational
therapy with complex practice realities, while retaining its foundational
commitments to autonomy and client-centered care.
Rather than marking clear transitions, these themes
represent overlapping and evolving patterns of thought. They capture how the
profession, like this narrative, continues to negotiate between ideals and
realities, trends and traditions, and competing visions for its future.
Theme 1: Grounded Clinical Pragmatism
Pragmatist perspectives have long shaped occupational
therapy’s understanding of clinical reasoning and professional identity. Dewey
(1938) emphasized how knowledge emerges through action and interaction with the
environment, while Schön (1983) advanced this view through the concept of
reflective practice, framing professionals as engaged in iterative cycles of
reflection-in-action and reflection-on-action. Narrative inquiry, likewise, has
established itself as a central mode of understanding human occupation. Clark,
Carlson, and Polkinghorne (1997) and Frank (1996) demonstrated how life stories
provide essential insight into meaning and coherence within therapeutic
contexts. Yet much of this narrative scholarship has focused on retrospective
accounts where narratives constructed after the fact are used to interpret past
experiences. In contrast, the blog entries explored in this theme offer
contemporaneous reflections, produced amid clinical uncertainty, ethical
dilemmas, and systemic constraints. They illustrate not only retrospective
reflection but also real-time narrative sense-making, documenting how
pragmatic reasoning unfolds during moments of professional tension. In this
way, the data presented here both affirms and extends narrative traditions
within occupational therapy, offering a window into how therapists actively
negotiate complexity as it arises.
The earliest blog entries reflect a practitioner deeply engaged in the
day-to-day realities of clinical care, particularly within the context of private
practice and early intervention. These posts capture not only the operational
challenges of the period, including reimbursement structures, regulatory
demands, and the ethical dilemmas of balancing business viability with
patient-centered care, but also a parallel, more personal narrative reflecting
the author’s evolving intellectual engagement with practice itself.
At the time, I was completing my doctorate, and this process
shaped how I approached my clinical experiences. My posts reveal not only
frustration with systemic obstacles, but also the gradual development of a more
deliberate and systems-aware perspective. I was learning to step back from
immediate challenges to identify underlying patterns and consider how
organizational structures, policies, and external pressures shaped the
experiences of both therapists and patients.
In one early post, I reflected candidly on this dynamic through the story of a
home visit to a child in early intervention. The post (That Overwhelmed
Feeling, 2005) describes the dissonance between clinical ideals and lived
realities. Confronted with poverty, isolation, and the limits of what early
intervention services could address, I wrote:
“My eyes focused on that torn
and crumpled page in the mom’s hand, and all I could think was that Amber’s
world had just gotten a little smaller.”
The post captured a moment of ethical and emotional
tension—between the desire to intervene beyond professional boundaries and the
recognition that such actions were constrained by policy, scope, and the
realities of parental autonomy within service systems.
Other posts from this formative period reinforce similar
themes. In More Than a Little Rain (2006), I reflected on a difficult
session in which a child shut down emotionally and soiled herself in response
to parental criticism. Confronted with the rawness of this moment, I wrote:
“I wasn’t sure what to say, or
do. Then I thought of the way Samantha’s mother spoke to her, and the way her
words must have stung as they fell from the mother’s mouth and toward
Samantha’s ears, forming puddles around her feet.”
Here, I was grappling not only with therapeutic strategy but
also with broader questions about family dynamics, parental roles, and the
limits of my professional scope.
These realities became even more stark in Occupational
Therapy Street Reality: Early Intervention (2008), where I described
working in a trailer home saturated with kerosene fumes and visited by child
protective services. Despite the evident risk and disrepair, I noted:
“The early intervention program
accepts the determination of CPS. That means that I can either resume the case
or they will assign another provider. Ethics dictates that I will remain on
this case until they remove me.”
The post concludes more broadly:
“Our systems are very broken. I
can not fix these problems, but I can point them out.”
In sum, these reflections mark the beginning of a deeper
intellectual project: making sense of the profession through immediate clinical
practice and a deep analysis of its ecosystem. The emerging ethos was pragmatic
yet probing. Posts from this period wrestle with the frustrations of insurance
denials, regulatory burdens, and ethical grey zones, while increasingly
questioning the structural forces that shaped these challenges.
This evolution became particularly visible by 2009 in a post
titled The Equivocal Value of (Some) School-Based Occupational Therapy. I
openly questioned not only the immediate practices I observed but also the
underlying validity of certain service delivery models. I wrote critically
about inconsistencies in school-based therapy, the practice of removing
children from meaningful classroom activities for isolated skill-building, and
the profession’s complacency with vague or unexamined approaches. These concerns
reflected more than frustration with day-to-day obstacles; they signaled the
emergence of a broader critique directed toward systemic and ecological
questions.
By this point, my narrative had begun to transcend
individual clinical encounters. I increasingly questioned how policies,
professional standards, and governance frameworks shaped occupational therapy
at large. In retrospect, this period of grounded clinical pragmatism and
growing professional perspective served as the foundation for later critiques
of ideological and governance trends in the profession. Having spent formative
years grappling with the real-world complexities of patient care and systemic
navigation, I carried forward a skepticism toward abstract or ideologically
driven frameworks that did not seem responsive to lived clinical realities.
This tension between pragmatic clinical reasoning and emerging ideological
frames would become a defining through-line in the blog’s later evolution.
These representative experiences, selected from numerous
similar entries, establish the pragmatic, clinically grounded perspective that
formed the basis of my later critiques and evolving analyses. While this early
period was defined by grounded pragmatism and close attention to practice
realities, the next phase of writing reflected a growing need to address how
ideological frameworks, often introduced through accreditation standards,
curricular mandates, and professional position statements, were reshaping the
profession itself. Building upon this foundation of clinical pragmatism,
subsequent analysis increasingly grappled with how ideological frameworks
reshaped occupational therapy’s professional identity.
Theme 2: From Drift to Dominance: Ideology in
Occupational Therapy
Across the health professions, critical and sociocultural
scholars have noted the growing influence of ideological frameworks on
education, ethics, and governance. From Giroux’s (1988) analysis of ideology in
curriculum design to Apple’s (2004) critique of educational stratification,
these perspectives highlight how professions can become arenas of competing
values and priorities. Occupational therapy reflects similar dynamics. Scholars
such as Kronenberg, Pollard, and Sakellariou (2005) and Braveman and Suarez-Balcazar
(2009) emphasized social justice paradigms and identity-based narratives within
occupational therapy discourse. However, while these ideological shifts are
well-documented at conceptual and aspirational levels, less is known about
their practical impact on practitioners navigating dynamic educational and
regulatory landscapes. This theme addresses that gap. Drawing from blog entries
written contemporaneously amid changes in ethics codes, curricular language,
and governance debates, the analysis explores how ideological narratives have
interacted with traditional frameworks, such as pragmatist and
autonomy-centered ethics rooted in classical principles like those of Beauchamp
and Childress (2019). These reflections reveal real-world tensions, including
those between efforts to promote inclusion and the need to maintain a coherent
professional identity, and between lofty goals and the practical demands of
regulation. By showing how practitioners navigate these shifts as they happen,
this work offers a grounded view of what these changes mean in practice, especially
where ethical demands often conflict.
As occupational therapy entered the second decade of the 21st
century, tensions that were once peripheral or philosophical began moving closer
to the profession’s center. My early concerns, which echoed sentiments
expressed by some other practitioners, centered on discomfort with aspirational
discourse and perceived misalignment between education and the realities of
practice. That discomfort later expanded to concerns about how ideological
frameworks were becoming embedded within ethics, education, and governance
structures.
It is worth noting that the tone of the blog posts analyzed in this study
varied widely across the decades. While many early entries were grounded in
clinical pragmatism and descriptive narrative, later posts—particularly during
periods of rapid professional change—sometimes reflected frustration, urgency,
and rhetorical intensity. Rather than obscuring or editing out these emotional
dimensions, this analysis treats them as part of the narrative record,
capturing not only evolving intellectual positions but also the affective
responses that often accompany professional dissonance and contested change. These
responses were sometimes amplified by interactions with readers, including
comments and private correspondence, though many readers expressed hesitation
about engaging publicly. Over time, this reluctance became a pattern,
suggesting that fear of professional pushback or reputational risk may limit
open dialogue within the profession, even in informal spaces like blogs.
Early Signs of Drift
The shift began subtly, embedded in what appeared to be
well-meaning and socially conscious revisions to foundational documents. The
2010 revision of the AOTA Code of Ethics inserted “social justice” as a formal
value, repositioning responsibilities traditionally categorized under
beneficence.
At the time, I raised concerns in the blog about how this
ideological shift, while seemingly aligned with societal goals, introduced
ambiguity and regulatory risk. In a 2011 post titled 2011 Social Justice
Debates in Occupational Therapy, I wrote:
“...AOTA ethics documents are
included in some state license laws. That means that failure to abide by
generic aspirational and potentially vague language about social justice in
ethics documents might cause someone to be in jeopardy with their state license.”
Beyond governance, the implications for education and
practice also became evident. In the same post, I expressed unease that lofty
ideals were displacing pragmatic guidance critical to frontline clinicians:
“Lofty ideals are fun, but the
atmosphere is pretty thin — and sometimes it is nice to get your feet planted
back on the ground again.”
I further noted:
“I don’t think that the OT
profession needs to avoid issues that are politically charged, but it does not
seem unreasonable to have a core value of inclusiveness so that we are not
disenfranchising our membership...”
Viewed together, these entries marked the beginning of a
growing tension: between occupational therapy’s expanding ideological
aspirations and the practical realities and risks faced by clinicians operating
under regulatory oversight.
These concerns intensified in 2013. In a blog post titled Social
Justice: What Would Dr. Kielhofner Say? (2013), I openly questioned how
abstract justice concepts could be meaningfully operationalized in clinical
settings:
“Social justice itself is not a
practice model. It is so poorly described and so frequently misunderstood that
at best we can describe it as a concept that academicians are trying to infuse
into practice models.”
By the end of this period, I issued a stark warning in the
same post that the profession was straying from its pragmatic and
autonomy-respecting roots:
“I think we have taken a wrong
turn, and we need to turn back.”
In a blog post titled Recurring Philosophical Questions
(2009), I posed foundational concerns about the trajectory of occupational
science and its growing distance from clinical reasoning and patient-centered
practice:
“This kind of philosophizing
about the meaning of living kind of works for me, but when I try to think
fairly about others—for example, the man with developmental disabilities
scraping together bus tokens to escape domestic violence—it becomes difficult to
imagine his lived experience in terms of the word ‘flourish.’ I think that
there is something more germane to OT than a highfalutin preoccupation with I.
I think it may have something to do with the basic dignity of human experience,
and perhaps meeting needs across a broad spectrum of perspective—especially and
particularly when that perspective has to do with finding ways to duck from
flying pots.”
These reflections illustrate an emerging anxiety about
whether occupational therapy’s conceptual frameworks were becoming too
theoretical, too removed from lived experience, and potentially vulnerable to
ideological colonization. These early signals of anxiety, while initially
focused on ethics documents and conceptual clarity, became magnified as the
profession increasingly embraced global and aspirational frameworks.
Intensification and Globalization
By the mid-2010s, the profession’s aspirational turn
accelerated. Internationalization and the growing prominence of occupational
science as an academic discipline contributed to further abstraction. While
intended to address global concerns and elevate marginalized voices, these
frameworks increasingly clashed with occupational therapy’s foundational
commitments to autonomy and human agency.
In a blog post titled A Fourth of July Message for
Occupational Therapists (2013), I captured this tension:
“Public health, just like social
justice, is based on the notion of egalitarianism. Application and respect of
autonomy is often very challenging within the public health context.
Globalization generated a new
wave of occupational therapy academic thinking that has since provided us with
a vision of occupational therapy practice that is very unlike and often at
direct odds with our philosophical core that respects autonomy and human
agency.”
The implications, I argued, were becoming profound:
“We have failed to prove Mary
Reilly’s hypothesis. What could have been the greatest idea in 20th
century medicine is currently being sold out to a global model of paternalism
and egalitarian justice.”
As ideological narratives gained strength in academic and regulatory
spaces, practice-oriented and pluralistic voices began to face increasing
marginalization.
Manifestation in Educational Priorities and Governance
By the late 2010s, subtle ideological drift became
increasingly embedded in institutional structures. A key consequence of this
shift was the misalignment between educational trends and clinical realities.
While academic discourse increasingly focused on emerging niches and global
justice narratives, real-world practice settings faced more immediate
challenges including reimbursement pressures, regulatory burdens, and patient-centered
dilemmas.
In a blog post titled Degree Escalation and Doctoral
Education Are Sinking the Occupational Therapy Profession (2019), I
described this growing tension:
“Occupational therapy started on
a simple premise — that man, through the use of his hands as they are energized
by mind and will, can influence the state of his own health... It is a simple
concept, borne out of a core philosophy of pragmatism and infused with a dose
of all the good intentions of the moral treatment movement.”
Reflecting on the profession’s historical grounding, I
questioned how degree escalation and pedagogical drift were eroding that
philosophical foundation:
“The answer to the problem of
therapists abandoning their philosophical beliefs is not to escalate the degree
level. The correct answer lies in a re-examination of core values and a
re-commitment to curriculum development that properly orients and educates new
therapists to the ‘magnificent purpose’ that Reilly extolled.”
The consequences, I argued, extended beyond individual
programs to the very coherence of the profession itself:
“This is in part facilitated by
academia and the endless fascination with the philosophical drift that has OT
students imagining roles for themselves in all kinds of ‘emerging areas’ that
don’t even reflect occupational therapy practice.”
By this period, ideological narratives had become firmly
embedded in ethics, education, and curricular design — eclipsing pragmatic
preparation for clinical roles and setting the stage for further tensions.
As I noted in a 2013 blog post titled When the Fishing is Good but the
Catching is Bad:
“You see, without that element
of pragmatism, we run headfirst into misalignment between priorities and the
external environment.
Outcomes are not measured by the
integrity of our intentions. Outcomes are measured by what actually happens.
If educators fail to talk about
what is real then all we will accomplish is promoting a bunch of disconnected
graduate and doctoral projects on childhood obesity or bullying that have no
traction beyond the demonstration project level.”
By this stage, the risk was no longer merely ideological
overreach. Rather, it was the very coherence of occupational therapy as a
clinical and educational enterprise that was at stake.
Conclusion: Entrenchment and the Erosion of Pluralism
Viewed across this 15-year span, the profession’s
aspirational turn evolved from subtle drift to a more established and dominant
narrative. Governance structures, academic discourse, and professional
narratives increasingly centered on identity frameworks and ideological
formulations, leaving diminishing space for pragmatism, autonomy-respecting
principles, and heterodox viewpoints.
This phase in occupational therapy’s evolution, as traced
through my blog, marks the culmination of educational tensions and ideological
drift — a period that demands both reflection and recalibration as the
profession looks ahead.
This entrenchment of ideological narratives, while profoundly shaping
occupational therapy’s educational and governance structures, also set in
motion a countervailing imperative regarding the need to rediscover frameworks
capable of navigating complexity, honoring autonomy, and restoring coherence in
an increasingly fragmented professional landscape. As ideological pressures
intensified, the narrative began exploring more comprehensive frameworks, particularly
systems thinking, as a necessary corrective.
Theme 3: Beyond Ideology — The Emergence of Systems
Thinking in Response to Professional Complexity
As polarized debates and ideological frameworks increasingly shaped
occupational therapy discourse, traditional modes of reasoning proved
insufficient to address the profession’s growing complexity, including the
expanding scope of practice, the interplay between clinical care and
sociopolitical agendas, and the pressures introduced by shifting educational,
ethical, and regulatory expectations. Systems thinking, established in
organizational studies and education as a way to interpret dynamic and
interdependent phenomena (Meadows, 2008; Senge, 2006), has long been recognized
within occupational therapy itself as a valuable lens for conceptualizing the
interconnectedness of human systems (Kielhofner, 1978), and has gained renewed
relevance in contemporary scholarship on reasoning, coherence, and complexity
in practice (Alterio, 2019; Coppola, Gillen, & Schell, 2024; Schell &
Gillen, 2019). The systems orientation emphasizes interconnection, contextual
responsiveness, and the recognition of emergent patterns. This theme explores
how systems-oriented perspectives emerged within my narrative not as an
abstract intellectual pursuit, but as a necessary and pragmatic response to
evolving challenges in clinical practice, education, and governance. The
entries analyzed here demonstrate how adopting a systems lens reshaped my
approach to interpreting complexity and reaffirmed the need for flexibility,
pluralism, and grounded reasoning within a fragmented professional landscape.
Early Signals: Grappling with Complexity
In the blog’s early years, systems-oriented ideas appeared
sporadically, often triggered by challenges in clinical reasoning and service delivery.
These explorations reflected a growing recognition that traditional models were
inadequate for capturing the multifaceted realities of practice.
A post titled Rantings of a Crazed Dynamic Systems
Theorist (2005) considered how adaptive use of technology and network
thinking might support more responsive service delivery. Although speculative,
this marked the beginning of an effort to seek broader conceptual tools.
This orientation deepened in On Piano Tops and
Proprioception (2012), where the limitations of sensory integration models
came under scrutiny:
“In occupational therapy we have
this tendency to want to solve the problem by constricting our interpretation
of observed behavior so that it fits neatly in with our preconceived notions
and existing models.”
This marked an important shift toward resisting rigid
constructs and embracing a more context-sensitive and systems-informed view of
clinical problems.
From Clinical Insight to Strategic Skepticism
As professional discourse became more contested, systems
thinking proved indispensable beyond clinical reasoning. It evolved into a tool
for questioning trends and strategic decisions that increasingly seemed driven
by ideology and speculation.
In Can Occupational Therapists Predict the Future?
(2015), concerns about trend-chasing and utopian visions came to the forefront:
“I am concerned that we are
asking members to plan for the future. Leaders don’t seem to have good ability
to plan for the future... OTs are skilled in chasing trends but not so much in
leading change themselves.”
Similarly, Occupational Therapists Want the General
Systems Funk (2016) raised a critique of policy incoherence driven by
siloed interests:
“Have the operators within
systems found ways to pull the strings of the professional associations...
promoting methods that maximize billing opportunities?”
At this stage, systems thinking offered a useful
methodological tool for understanding the messages and actions of the
professional associations that were perceived as confusing.
Confronting False Polarities in Professional Theory
As debates within occupational therapy grew more
ideologically charged, systems thinking became an important counterweight to
rigid framing that threatened intellectual diversity.
In The Problems with Polarity Frames in Occupational
Therapy Theory (2022), polarized academic narratives—particularly those
challenging American pragmatism and autonomy—were interrogated:
“Is it possible that there is no
paradigm crisis, at least from the perspective of American occupational therapy
practitioners?”
Drawing from Reilly’s Not Only, But Also philosophy
and Kielhofner’s contextual models, the argument rejected simplistic either/or
framings:
“Truth and Knowledge should not
be set in a zero-sum polarity — that is against American occupational therapy
philosophy at its core.”
In this example, systems thinking preserved space for
nuance, contextual reasoning, and pluralistic professional sense-making.
Diagnosing Self-Reinforcing Loops in Professional
Discourse
As professional orthodoxy tightened, systems thinking became
critical for recognizing and diagnosing closed-loop patterns that limited
discourse and innovation.
In The Ant Mill of Occupational Therapy (2025), a
vivid metaphor captured the dangers of reflexive ideological alignment:
“The ant mill is not driven by
malice or ignorance... The tragedy emerges when this once-reliable rule is
followed reflexively, without re-evaluation.”
Where once professional ethics emphasized dignity and
respect, they now demanded ideological conformity:
“Practitioners were no longer
simply expected to treat patients with dignity and respect but to adopt
specific sociopolitical interpretations of justice, equity, and power.”
Systems thinking became a means of proposing constructive
disruption:
“We are no longer curious ants
exploring terrain. We are circling each other, each convinced that the ant in
front knows the way.”
The critique called for re-centering professional discourse
on flexibility, context, and curiosity.
Interrogating Ideological Drift and Historical
Revisionism
Systems thinking also offered a way to interrogate how
professional history was being reframed through contemporary ideological
lenses.
In Emmanuelism provided the Core Values (2014),
retrospective reinterpretations of occupational therapy’s humanitarian origins
were critically examined:
“Attempting to frame the
humanitarian motivations into some re-configured social justice narrative is
factually incorrect... They were founded because of the severe problems that
tuberculosis caused to society... and the humanitarian desire to help other people.”
Here, systems analysis became a safeguard against historical
distortion by preserving accuracy and honoring the profession’s pragmatic and
philanthropic roots.
Evolving Toward a Strategic Systems Orientation
In more recent writing, systems thinking expanded beyond
epistemological critique to strategic analysis, particularly in response to
challenges in occupational therapy education.
In Occupational Therapy Education: How to Navigate in a
Perfect Storm (2024), systems analysis was applied to interconnected issues
threatening the profession’s infrastructure:
“Oversaturation of programs...
Faculty shortages... Market failures exacerbated by poor information and
regulatory gaps.”
Systems thinking helped to identify these factors as being interdependent
problems. Additionally, this mode of thinking helped to frame proposals for
recalibration, including market rationalization, clarified standards, and
alignment with actual demand.
At this stage, systems thinking became a sharpened and
effective tool for critique that helped to address ideological rigidity,
institutional contradictions, and existential pressures.
Systems Thinking as an Adaptive Lens During Crisis
Systems thinking became particularly salient during moments
of acute disruption, where traditional assumptions proved inadequate. This was
evident in the early days of the COVID-19 pandemic, as educators scrambled to
transition courses online. Many, seeking continuity, gravitated toward
synchronous instruction as a substitute for in-person learning. Yet in a March
2020 blog post, Synchronous vs. Asynchronous Content Delivery in Context of
COVID-19, I questioned this reflexive response:
“Maybe some do want that
structure, but now they are in home or other environments that are familiar but
unfamiliar... Multiply this complexity by 20, 50, or 100 students.”
Recognizing these cascading contextual factors, I reframed
the problem. Rather than imposing rigid schedules, asynchronous delivery
offered a systems-informed alternative that could be responsive to diverse
environments and needs. As I urged at the time:
“Take some time to watch the
stream, sliding away, so much more complex than our impulses would have us
normally consider.”
This moment exemplified a shift away from linear
problem-solving toward adaptive reasoning, a pattern that became increasingly
central as I confronted other complex dilemmas in practice, education, and
governance.
Systems Thinking as Survival and Sense-Making in
Entrenched Systems
Not every application of systems thinking resolved into
clarity or resolution. In many professional contexts, particularly in
navigating bureaucratic and policy environments, it became a lens for survival
and sense-making rather than transformation. My experience sustaining a private
practice in pediatric occupational therapy exemplified this shift. Over years
marked by pandemic disruptions, reimbursement challenges, and shifting delivery
models, adaptation became constant — but the system itself remained resistant
to substantive change. Reflecting on this in a 2024 blog post, Sniff and
Scurry Navigate the Red Queen’s Race: Occupational Therapy Private Practice in
2024, I wrote:
"I have been trying to pump
figurative bullets into our private practice for a couple years now and it just
won’t die... We must look like Sniff and Scurry with adaptability these last
few years but I assure you I am actually a secret double agent doing my best to
sabotage everything. And I am failing in my covert mission."
In this reflection, systems thinking emerged not as a
pathway to ideal solutions, but as a framework for navigating complex,
self-reinforcing systems. The private practice persisted not through heroic
intervention, but because of dynamic adaptation in response to evolving
constraints such as cash models, municipal contracts, and shifts in service
delivery modes. At the same time, broader systemic dysfunction remained
entrenched, particularly in public systems such as early intervention. I
observed:
"Therapists must
strategically adapt and engage in gamesmanship... Competent and caring
therapists do this as naturally as breathing... This often results in total
burnout, and can drive people out of the system — except for those who are
somehow adaptive and caring enough — the Sniffs and Scurrys who are so
competent that they can’t manage to be killed off by the game."
This narrative captured an essential and often overlooked
dimension of systems thinking: its capacity to explain and endure, not simply
to solve. Within entrenched and morally ambiguous systems, systems thinking
offered a means to recognize competing logics, anticipate counter-moves, and
sustain ethical commitments without illusion. It did not offer liberation from
the system, but allowed for professional coherence amid intractable complexity.
Together, these narratives reflect the growing centrality of
systems thinking across my professional landscape. Whether responding
adaptively in moments of disruption, engaging collaboratively in efforts to
modernize practice education, or enduring within entrenched and morally complex
systems, systems thinking proved essential. No longer an occasional
perspective, it became a durable and versatile orientation that allowed me to
remain responsive, constructive, and ethically engaged in navigating occupational
therapy's shifting terrain.
Summary Reflection
As occupational therapy confronted escalating complexity,
polarized discourse, and institutional fragmentation, I used systems thinking to
make sense of increasingly incoherent professional realities.
Where traditional frameworks faltered, systems-oriented
analysis allowed for deeper questioning of clinical assumptions, governance
structures, and ideological drift. It illuminated contradictions, preserved
space for intellectual diversity, and offered pathways toward more grounded and
contextually responsive approaches to education, ethics, and practice.
By the mid-2020s, this perspective evolved beyond a mode of
analysis. Systems thinking offered the practitioner a path forward: a means to
reclaim coherence, re-center pragmatic values, and sustain pluralism within a
profession navigating the challenges of disruption and ideological
entrenchment. Equally important, this perspective provided emotional relief and
clarity, tempering earlier urgency and frustration, and enabling a more
measured approach to professional complexity.
Discussion and Synthesis
The findings presented in this autoethnography invite
broader reflection on how occupational therapy can meaningfully process
ideological shifts and professional volatility through sustained dialogic
practice. The analysis of 20 years of blogging offers insight into how
occupational therapists navigate personal, professional, and ideological
transitions in periods of rapid and unpredictable change. This reflects what
Hinojosa (2007) aptly called hyperchange and defined as an era marked by
accelerating complexity and uncertainty that requires professions to adapt
rapidly while striving to maintain intellectual and ethical coherence.
The trajectory from grounded clinical pragmatism to
systems-oriented thinking reflects not only individual growth but also shifting
demands within occupational therapy. Tensions between academic expectations,
clinical realities, ideological movements, and foundational principles remain
pressing. Revisiting and critically analyzing contemporaneous reflections helps
capture this living memory, offering a mid-term synthesis before narratives
become simplified or lost to institutional forgetting.
This analysis highlights a deeper challenge: how professions
process change in real time through the experiences of its practitioners. When
disruptive events or ideological shifts are absorbed uncritically, professions
risk reinforcing self-sealing narratives and inviting forms of institutional
capture (Carpenter & Moss, 2013), a process in which organizations become
dominated by particular interests or ideologies, constraining debate and
limiting adaptive responsiveness. Without contextualization and debate, future
practitioners may inherit rigid frameworks divorced from lived experience. Hinojosa
(2007) argued that professional innovation depends on rejecting singular
paradigms and fostering pluralism. This narrative echoes that view,
illustrating the risks of intellectual closure and the value of maintaining
diverse and contextually grounded perspectives.
Practitioner-generated knowledge plays a vital role in this context.
While regulatory bodies and academic institutions offer necessary and even
helpful guidance, they may be distant from rapidly shifting experiences of
working practitioners. Dialogic narratives capture subtle dissonances,
contextual complexities, and early signs of drift that formal discourses often
miss. They help anchor the profession in authentic practitioner experiences and
provide early warnings against reactive or performative trends.
As hyperchange accelerates, pressures toward enforced
consensus and ideological simplification grow. Yet, this inquiry demonstrates
the importance of principled disagreement and pluralistic reasoning. Later
phases of this narrative reveal how systems thinking offered tools for
reconciling grounded clinical pragmatism with emergent complexity. Crucially,
this evolution did not abandon occupational therapy’s person-centered or
autonomy-respecting roots. Rather, it expanded the conceptual repertoire while remaining
ethically grounded.
Looking ahead, sustaining coherence and integrity in
occupational therapy will demand more than reactive adaptation. It will require
intentional reflection on what is retained, contested, and reimagined. As
Hinojosa (2007, p.635) noted, “relationships are essential to being
innovative,” underscoring the value of inclusive dialogue and professional
solidarity. Practitioner narratives, such as those reflected here, offer vital
counterpoints to official accounts. By reaffirming intellectual pluralism and
elevating practitioner voices, the profession may remain adaptable, responsive,
and true to its foundational commitments.
Conclusion
This inquiry demonstrates the unique value of
practitioner-generated, longitudinal narrative as a vital form of professional
knowledge. In tracing two decades of occupational therapy discourse through
contemporaneous blog entries, this analysis reveals how tensions between
pragmatism, ideology, and systems thinking were experienced and negotiated at
the ground level. While formalized discourses often lag behind or obscure such
shifts, dialogic narrative offers timely insight into professional change as it
unfolds.
Moving forward, sustaining coherence and integrity in
occupational therapy will require critical examination of emerging paradigms
and very intentional preservation of pluralism and practitioner voice. In a
profession increasingly shaped by ideological currents and reactive governance,
dialogic narratives offer a necessary corrective. They provide early warnings
of drift, capture contextual nuance often lost in policy and accreditation
frameworks, and offer alternative ways of seeing that are grounded in the
realities of practice.
Systems-oriented thinking emerged in this narrative not
simply as critique, but as a pragmatic strategy for navigating complexity,
diagnosing self-reinforcing professional patterns, and resisting reductive
binaries. As occupational therapy continues to face interconnected challenges
of ideological polarization, regulatory pressures, and educational misalignment,
systems thinking offers valuable tools for restoring flexibility and coherence.
However, adopting systems thinking at scale will require deliberate effort to
integrate these perspectives into curricula, professional development, and
governance processes.
Equally critical is the need to reaffirm intellectual
pluralism within occupational therapy’s collective dialogue. Healthy
professions are marked not by enforced consensus, but by space for principled
disagreement and ongoing negotiation of meaning and purpose.
Practitioner-generated narratives, such as those presented here, serve as
reminders that professional identity is lived as much as it is theorized.
Ultimately, the future of occupational therapy depends on its ability to balance tradition and innovation, hold space for divergent viewpoints, and embrace complexity without losing sight of foundational commitments to autonomy, dignity, and person-centered care. Through dialogic engagement and systems-informed reflection, the profession may chart a path forward that honors its pragmatic roots while remaining responsive to emerging complexities and evolving societal expectations.
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Post script
If occupational therapy forgets how to argue with itself, it forgets how to grow. This archive stands as a reminder. -cja
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