Persson D, Erlandsson L-K, Eklund M, Iwarsson S. Value dimensions, meaning, and complexity in human occupation -a tentati×e structure for analysis. Scand J Occup Ther 2001; 8: 7-18. In occupational therapy and occupational science, it is important to clarify the perspective from which the analysis of occupation is addressed. The purpose of this paper is to present a tentative structure for describing occupation, allowing for analysis in a lifelong panorama as well as for the immediate experience a person acquires from performing a single occupation. The concept of occupational value is introduced as a prerequisite for meaning, de ning three different dimensions: concrete, symbolic, and self-reward value. A dynamic categorisation of single occupations is presented, considering each unique occupational performance viewed from a macro, meso, and a micro perspective, inspired by dynamic systems theory. It is proposed that all occupations are meaningful if they are integrated parts of a person's occupational continuity, and that it is the interaction between the mentioned three perspectives that determines their meaningfulness. With an explicit focus on value and meaning as perceived by the unique person, occupational therapists will become more skilled in designing meaningful occupational therapy interventions. This paper is a contribution to the development of occupational science as well as to occupational therapy, but the theoretical framework presented must be empirically tested in order to demonstrate its validity.

The present study investigates patients' opinion on what constitutes good psychiatric care. It was a qualitative study using an open-ended in-depth interview centering on the patient's experiences of receiving psychiatric care. The subjects were selected to ensure maximum variation and heterogeneity. A model of deliberate sampling for heterogeneity and a modified, stratified sampling method were used. One outpatient and one inpatient sample were selected. The description and analysis of data were based on a variable-oriented, cross-case technique. The analysis was made separately for the two sub-samples. The main result for both samples was the emergence of one main category: the quality of the helping encounter. The quality of the relationship between patient and therapist/staff, and being understood by the therapist/staff, formed the most central aspects of good care. For the inpatient group the analyses also pointed to stability and structure and relief of pressure as main categories. Though the focus of the study was on satisfaction with general psychiatric care, the results revealed a construct initially identified within the field of psychotherapy, namely the 'helping alliance', as the most crucial factor. The results also gave some further indications of what bring about a good therapeutic relationship; and prominent in this study, and not very often reported in the context of helping alliance, was that ambivalence, time and meaning were important constituents of the relationship. The findings emphasize the importance and quality of the therapeutic relationship and point to the incorporation of psychotherapeutic principles in all provider-patient relationships in general psychiatric care.

This study investigated the importance of competitive work as compared to participating in community-based activities and having no regular daily activity for people with long-term mental illness. One hundred and three persons visiting an outpatient unit and representing the three targeted occupational conditions were randomized to the study and assessed on satisfaction with daily occupations, health, and wellbeing. Persons with work were more satisfied with their daily occupations and were interviewer-rated as better functioning than the other groups, but the groups did not differ on self-ratings of health and wellbeing. Unexpectedly, people participating in community-based activities did not show better satisfaction or functioning than those without regular daily activity. It was concluded that competitive work should be an urgent end goal for services designed for occupational or vocational support.

Previous research suggests that having schizophrenia involves not being fully equipped to engage in daily occupations. This study was aimed at exploring relationships between occupational engagement and the issues of self-related variables, psychiatric symptoms, and quality of life. Seventy-four outpatients with schizophrenia entered the study. Instruments used in this study were Profile of Occupational Engagement in People with Schizophrenia, Locus of Control, Mastery, Sense of Coherence, Brief Psychiatric Rating Scale, and Lancashire Quality of Life Profile. The results showed that a high level of occupational engagement was related to higher ratings of self-related variables, fewer psychiatric symptoms, and better ratings of quality of life, and vice versa. A significant difference and a linear trend were found among the three subgroups of different levels of occupational engagement and the estimated variables. In the regression model, negative symptoms and internal locus of control together explained 47% of the variance in occupational engagement. The results add a new dimension to understanding mental health and suggest the importance of assessing the level of occupational engagement.

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