Holism in occupational therapy: elusive fiction and ambivalent struggle

The profession of occupational therapy is said to have underpinnings of holistic, humanistic, and client-centered values. How does this claim translate into practice? This article reports on a qualitative study in which the practice experiences of 12 occupational therapists in the United Kingdom were explored. Through phenomenological analysis of interviews and participant observation data, the findings revealed that although holism is indeed valued, considerable uncertainty exists about what it actually means. The therapists studied seemed to understand holism and enact it in different, sometimes contradictory, ways. Further, each therapist's practice could be simultaneously reductionistic and holistic, depending on the perceived needs of the situation. Therapists struggled to negotiate the tensions between beliefs and practices and to cope with their uncomfortable feelings when they did not achieve their ideals. Although the occupational therapists in this study strove to be person-centered, the demands of their work context pushed them to be pragmatic and strategic.