ABC Therapeutics Occupational Therapy Weblog

Subtitled: Pornography, professional scope, and the missing clinical threshold. Last month I wrote about an article examining drag as an occupation . My objection was not that drag could not be studied as an occupation. Occupational science can study almost anything people do, including activities that are unfamiliar, controversial, highly personal, culturally specific, or socially contested. That descriptive work can help us understand meaning, identity, habits, routines, context, and participation. That is not occupational therapy, per se, but it might sometimes be additive. The additional leap into occupational therapy practice remains my persistent concern. Once an occupation has been described, authors sometimes attach a few sentences explaining its supposed clinical relevance. The occupational therapist is then asked to acknowledge it, assess it, support it, or incorporate it into practice, even when no particular patient population, health condition, intervention, competency, or...

  Apparently, the definition of critical is critical. A recent mixed-methods study in the Australian Occupational Therapy Journal examines how occupational therapy educators across different countries think about and define critical thinking. The authors found something I have long suspected and have previously documented: occupational therapy educators do not all mean the same thing when they use the term 'critical.' Some define critical thinking in concrete, clinical, pragmatic terms: reasoning, evidence appraisal, decision-making, and reflective practice. Others define it in broader sociopolitical terms: questioning knowledge production, identifying oppressive structures, pursuing social transformation, and taking “critical action.” There is a wide chasm between these definitions. It matters because “critical thinking” is not a minor curricular phrase. The term 'critical' appears everywhere in higher education, accreditation language, learning outcomes, rubrics,...

Thirteen years ago, on the Fourth of July, I wrote about autonomy. At the time, I was trying to understand what I believed was a subtle but important shift occurring within occupational therapy. I argued that our profession was moving away from one of its deepest philosophical commitments: respect for the autonomy and agency of individual human beings. Looking back, I think I was observing a real phenomenon. But I don't think I had yet identified the central issue. Over the past decade I have come to believe that the debate was less about public health or occupational science than I originally thought. Those are manifestations of something deeper. Today I am framing the question differently and in a more fundamental way: Who, exactly, is the recipient of occupational therapy? For most of our history, the answer was obvious. It was the human being sitting in front of us. Everything else flowed from that simple proposition. Perhaps that is why this question seems appropriate for Inde...

A recent article in The Open Journal of Occupational Therapy caught my attention: “ Doing Drag: Exploring the Experiences of Drag as an Occupation for Performers in California. ” I want to start with a point of clarity: I do not object to anyone studying drag. It can definitely be studied as an occupation. It involves preparation, performance, costume, makeup, role construction, social interaction, community participation, identity expression, skill, and meaning. There is no serious argument that drag is not something people do, or that it cannot be examined through an occupational lens. But I still scratch my head a little at the topics that seem to get elevated for study. There is no reliable national estimate of drag performers, in part because drag often occurs outside formal occupational categories. But by any reasonable comparison, drag is a niche performance occupation, while ordinary occupations involve hundreds of thousands or millions of people. That raises a question: wh...

I read the recent AJOT article, “ Occupational Therapy in Crisis, ” with interest and some frustration. Interest, because I agree with the basic premise. Occupational therapy is in a period of identity instability. The profession is struggling with questions about its theoretical base, its view of humans, its scope of practice, and its methods of creating change. Those are not small questions - they are the questions that define a profession. Frustration, because this crisis did not suddenly appear in 2026. I have been writing and presenting about these same tensions for years, often in less formal spaces and often without the kind of protective language that makes professional journals comfortable. So, welcome to the crisis conversation. I actually mean that sincerely. I am glad the issue is being named in AJOT. I am glad the word “crisis” is being used. I am glad there is some recognition that occupational therapy may not have a shared understanding of what it is, what it does, or ho...

NBCOT recently released a crosswalk analysis comparing the OTR examination content outline with the ACOTE educational standards . Most of the document tells us what we would expect: the entry-level practice tasks described in the certification exam outline are broadly represented in the ACOTE didactic standards. That is useful, and it is reassuring, but it is not the most interesting part of the document. The more interesting part is Table B, which identifies the ACOTE standards that are not reflected in the NBCOT examination task statements. Some of those differences make immediate sense. Professional history, philosophy, the distinct nature of occupation, policy, advocacy, and systems-level thinking are not always going to map cleanly onto a certification exam content outline. Certification exams are task-oriented by design. Educational standards should be broader than test preparation because occupational therapy education is not simply about preparing people to pass an examination...