OBJECTIVE. The current literature offers no cohesive definition of occupation-based practice. Current definitions emphasize intervention forms and contexts, which do not reflect the complexity of practice. This article demonstrates that the therapeutic relationship and the meanings that are created in the therapy process are central aspects of occupation-based practice. Occupation, as an idea that emerges in the therapeutic process, has aspects of both doing and becoming. METHOD. The authors conducted observation sessions and interviews with an occupational therapist, Nancy, who used multiple therapeutic strategies with one child, Hannah, as they worked toward Hannah’s goals of going to preschool and becoming a friend. RESULTS. Strategies include changing therapeutic conditions, using cognitive strategies, bridging the person–task–social context, pushing participation, and engaging in narrative micronegotiations. CONCLUSION. Occupation emerged in the therapeutic processes as the occupational therapist and client co-created meaning about the client moving toward or away from who she wanted to become.

For occupational therapists working in neonatal intensive care units, the tenuousness of life is part of ordinary daily experience. However, for parents, having a premature infant must feel like a break from their expectations of having a healthy infant and an ordinary family life. Occupational therapists provide opportunities for co-occupation that promote the development of the family and support parents by providing the knowledge that family life is still possible even if the infant has severe disabilities. This article will illustrate how one occupational therapist facilitated extraordinarily ordinary moments of becoming a family for a mother and premature infant through negotiating the meaning of parenting and parenting co-occupations and providing opportunities for parenting co-occupations, which are both important aspects of occupation-based practice implemented in the neonatal intensive care unit.

Female Sprague-Dawley pups were separated from mothers every other day for 8 hr (long-term separation/LTS), 4 hr (short-term separation/STS), or 0 hr (no separation/NS) from postnatal day 2-20. In adulthood, they were mated and tested for maternal behaviors during two lactations. It was expected that females separated from mothers as pups would show deficits in maternal behavior as adults. Contrary to expectations, LTS showed better nest building and grouped young faster during both lactations. LTS were first to display aggression and displayed more aggression during the second lactation. Notably, while some measures decreased from first to second lactation in NS and STS, LTS maintained levels of maternal care. These results suggest that extended periods of maternal separation may exaggerate some aspects of maternal behavior.

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Occupation-centered practices with infants and children necessarily involve parents. Although the importance of parent-therapist collaboration is recognized, there is little research demonstrating how collaboration is enacted. This article describes the therapy process between Erin, a NICU therapist, and Carmen and her infant, Mikala. These findings demonstrate how Erin, through the therapeutic strategies of scaffolding and narrative reinterpretation was able to facilitate the development of Carmen's competence and confidence in feeding Mikala, ultimately fostering their attachment and progress toward becoming a family. This article not only illustrates what was done-the procedural techniques-but how it was done through therapeutic use of self, a central aspect of occupation-based practice. These data strongly support understanding family patterns and perspectives through treating the infant as a developing occupational being within the context of co-occupations with the parents. The findings suggest that therapists must see parents as clients who must learn to nurture and manage their infant's ongoing medical and social needs as a member of the nuclear and human family. These findings provide therapists with an example on which to reflect on their own practices with infants and families and evidence-based theory through which to articulate and practice from an occupation-based approach.