Kimberly Breeden, MS, OTR/L Founding Partner

A Closer Look at WHY Occupational Therapy is Underrecognized

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In my last blog, I examined just how underrecognized the profession of occupational therapy actually is as well as the impact that it can have on our clients.  I also shared my feelings of frustration, which I suspect many of you experience, in regards to this reality.   It is my hope that my last blog did not discourage you, instead I hope it motivated you to join me in working toward a solution. 

I think the next logical step in the process is to identify what factors are contributing to the problem.  Again, there is not a lot of data on this subject, but what I did find may surprise you.   


The very concept of occupation has posed a significant challenge regarding the uncertainty of OT, according to Dr Ellen Cohn in her 2019 Eleanor Clarke Slagle Lecture.   She suggests that occupation “is simultaneously incredibly complex and elegantly simple”(Cohn, 2019, p1).  As most of us are aware, the term occupation is frequently associated with a job or work. OT practitioners, however,  understand that occupations are “everyday personalized activities that people do as individuals, in families, and with communities to occupy time and bring meaning and purpose to life.” (AOTA, 2020).  OTs, OTAs, and students recognize that occupations have different meanings and significance for each individual and can change over time and across contexts.  The problem can be that many outside of the profession may view occupations as simple and ordinary while OT practitioners view occupations as an incredibly complex activity that goes beyond the body movements required to complete a task.  OTs, OTAs, and students understand that occupational engagement involves a complex interaction among  body functions and structures, motor skills, process skills, social interaction skills, but also one’s values, beliefs, spirituality, habits, roles, routines, rituals, personal factors such as gender, sexual orientation, race, ethnicity and lastly environmental factors which include more than the physical environment but also the cultural, social and political environments.  

 It is this difference in understanding of the word occupation that can contribute to a lack of recognition of OT. In contrast other disciplines such as physical therapy, speech therapy, and respiratory therapy tend to lend themselves to less confusion as their names seem to clearly indicate what type of services they provide.  

It was also identified that OT practitioners tended to avoid using the word occupation and substituted it for function.   I would like to add my thoughts on this.  Early in my career I described OT as “working on function”.  I no longer describe OT this way.  As I have thought about this, I think every healthcare professional is working to increase function.  Physical therapy doesn’t address ambulation just so someone can walk for the sake of walking; they address ambulation so that individuals can be more functional in their daily lives. Speech therapy addresses speech and communication to allow clients to be functional with communication. Many reimbursement and policy guidelines require physicians and other healthcare professionals to address function and report on outcomes related to function.   It is my thought that utilizing the word function will further add to the lack of understanding to the true value of occupational therapy services.   

Medical Model

The medical model has been the dominant model for western healthcare throughout the the last 2 centuries. Typically the medical model views health as the absence of disease.  It views the body as functioning like a machine and is based on the premise that illness and injury can be cured with medication and surgery.  Medical models typically utilize a bottom-up approach to treating disease, meaning foundational components of function and disease are identified and treatment protocols are provided based on these findings.  

Occupational therapy is different.  Since it’s inception, OT has always recognized the mind-body-spirit connection to health and wellness as well as recognizing that each individual experiences health and disease differently. Most occupational therapy models and frameworks are based on a top-down approach, which focuses on participation in occupations, despite the presence of disease. OT interventions are typically focused on addressing occupational engagement to achieve health and wellness.  

A majority of OT practitioners work in healthcare settings in which the medical model is the predominant approach. Wilding and Whiteford attribute the differences of OT approaches and medical model approaches to OT practitioners often“ feeling significantly misunderstood and ignored” (2006, p 190).  The good news is that there is growing evidence to the benefits of utilizing biomedical and biopsychosocial models for treating illness and disease and these models are more consistent with occupational therapy approaches.   

OT Practitioners

What? Yes, it’s true.  Behaviors of occupational therapy practitioners actually contribute to the uncertainty regarding our profession.  I was able to find specific behaviors in the literature that you may not have expected. 

Difficulty describing occupational therapy:   

OT practitioners have reported difficulty explaining what occupational therapy is within their practice settings.  Some of the reasons include the difference of OT approaches compared to the medical model and OT practitioners feeling as if OT uses jargon that is different and not well understood by other healthcare professionals (Wilding, 2011).  OT practitioners reported that they felt that their descriptions of OT were over-inclusive, too lengthy and detailed, and did not clearly convey what they wanted to (Wilding & Whiteford, 2006).  The OT practitioners attributed these detailed descriptions to feeling that a straightforward explanation would appear too simple and they reported feeling devalued by their colleagues because OT “looked too easy” (p 189).  On the other hand, Cohn asserts that OT practitioners become become passive because of self-limiting attitudes such as “occupational therapy is too complex to explain” (2019, p 6).  

Self-limiting and overly conforming behavior: I

In another study, Wilding discovered that OT practitioners show a tendency of self-limiting and overly conforming behavior (2011). The OT practitioners in the study shared a perception that they should act in a conformist way.  OT practitioners reported that their practice was often constrained within their settings, but they did not speak up because they did not want to be seen as troublemakers.  In the same study, OT practitioners reported that there were instances when they had concerns regarding other disciplines encroaching on their practice but they seldom confronted the individuals. The study also found that OT practitioners demonstrated a tendency to not advocate for OT services for clients if other disciplines did not also see a need for rehabilitative services, despite feeling that the client would benefit from occupational therapy.  

Underground practice:

Cohn reports that OT practitioners encounter professional dilemmas in regards to promoting their clients’ engagement in meaningful occupations because interventions may appear to be “difficult to measure in objective and reimbursable terms” (2019).  This dilemma results in OT practitioners overemphasizing the objective and documenting in reimbursable medical terms (underground practice) resulting in OT practitioners not having confidence in proclaiming the full scope of OT practice.      

When you review the information as a whole you can definitely see the relationship among the factors.  The term occupation can create some confusion as to what exactly occupational therapy consists of and is more difficult to understand in the context of the medical model.  If occupational therapy practitioners lack the ability to clearly explain OT services and are hesitant to advocate for the profession, it further contributes to the misunderstandings regarding the value we bring to the organizations in which we serve. 

I am sure that there are other factors that contribute to the underrecognition of OT but these are the factors that I was able to find in the literature.  This information has definitely changed my perspective.  Until recently I had only focused on my frustration of OT being undervalued, I had not really focused my attention on the factors that actually impact the lack of recognition of OT.   Believe it or not, I am actually encouraged by this information because I feel that these factors are all within our control to address.   I hope this blog has given you a lot to think about and I hope you continue to join us on this journey.   
Written by: Kimberly Breeden, MS, OTR/L
Founding Partner of Aspire OT

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