You know that moment at the end of the eval when you ask the patient what their goal in therapy is and your heart stops with anticipation that they will say something documentable like "My goal in occupational therapy is to increase my ADL independence to return to my PLOF." But instead, you are disappointed when their response looks like this: "I want to walk again" (NOooooo, that's PT!); "I want to get the hell out of here" (Is that OK to document as a therapy goal?); "Get back to my life" (Maybe I can work with that?).
I would argue that moments like this are indicators that we have lost ourselves in the wording of insurance reimbursement. We have begun to believe that engagement in occupation is actually people's end goal. We've begun to believe that the purpose of occupational therapy is to increase independence as quickly as possible to get people out of hospitals or alleviate their need for services. The theory of occupation has become watered down.
I recently saw Silver Linings Playbook. Florence Nightengale would have loved this movie. The premise is that the two main characters have both weathered significant life events that have triggered/exacerbated mental health issues. They are in need of healing. In addition to medication, talk-based therapy sessions, family support, regular exercise, a key ingredient to their healing journey is the engagement in a purposeful activity, the preparation for a dance competition. The movie makes this a linchpin of their healing journey, to score a 5/10 at the dance competition becomes the primary stated goal that motivates their compliance with other treatments. However, while engagement in this occupational goal is crucial, the actual underlying goals are obvious... to be loved and to have someone to love.
In the movie it is clear that the medication compliance, the engagement in meaningful occupation, etc. are only avenues, they are not the end goal in themselves. The true underlying forces are relational.
We should never be surprised when patients are not able to articulate goals. Their goals are much deeper and more personal than insurance lingo accounts for. We should see through the "I want to get the hell out of here" comments and assume that personal/relational/spiritual goals are driving our clients. AND we need to believe that engagement in occupation can help people to accomplish these deep goals, even if it is not captured in our documentation. We must understand that participation in ordinary activity can impact the extraordiary. If we cheapen our view of occupation, our interest in our clients stops when the results of the dance competition come in, and we miss the true resolution of the story.
Let us hope that we have not become so wrapped up in quantifiable occupational goals that Hollywood has come to have a better understanding than the OT community of the levels on which occupation can bring healing.