Instrumentalism in Occupational Therapy model

This model aims to facilitate occupational therapists in accessing clients’ mind as an instrumental tool for occupational functioning and adaptation to the environment. It consists of three phases across 10 steps.

Phase 1, belief establishment. This is to clarify beliefs that guide actions and includes the step 1 to 5. Step 1 is the introduction where the client is introduced to the concept of mind as an instrument for adaptation and is described as a tool to achieve his/her desired goals. The purpose of the therapy is to explore how to use the mind to live adaptively in the environment. Step 2 is to assist the client in clarifying perceived purpose in life. A personal mission statement serves as a systemic attractor. Step 3 is to select activities that are consistent with the personal mission statement. By using the Assessment and Intervention Instrument for Instrumentalism in Occupational Therapy (AIIIOT), therapists individualize therapeutic activities in a structured manner, and the client is asked to list required activities in achieving the mission statement. Step 4 is to clarify beliefs that guide performance of chosen activities. This includes clarifying the extent to which the beliefs hinder performance and identifying the origins of the beliefs. Step 5 is to challenge these beliefs. This involves challenging through the provision of the questions that give the client insight and require he/her to formulate new beliefs that energize tasks that are consistent with the personal mission.

Phase 2, action. This is to design activities that strengthen appropriate beliefs and to commit to complete the activities. This phase includes the step 6 to 9. Step 6 is to set consistent and concrete goals. The therapist uses activity analysis to assist the client to set goals that are functional, observable, measurable, and achievable within a reasonable time frame. Step 7 is to perform activities in daily lives to strengthen the newly chosen beliefs. This enables the client to engage in occupations that lead to a purposeful and meaningful lifestyle. Step 8 is the evaluation of the cognitive and physical capabilities to perform the chosen activities. Step 9 is the commitment, and these activities must be performed regularly, achieved by establishing a contract.

Phase 3, appraisal of consequences. This is to evaluate if the consequences are expected or desired. Step 10 is the evaluation of progress towards the personal mission. Then a feedback loop back to phase 1, to use the consequences to adjust beliefs. In short term, scores in the AIIIOT may be used to assess progress (performance and satisfaction). In long term, the therapist and client examine the consequences of the client’s activities carefully to determine if the activities are what were expected, therapy continues until the client is confident that s/he can accomplish the mission.