Abstract
Purpose in life is increasingly understood to be important to health and well-being. Despite occupational therapy’s long history of using occupations to advance health and the linkage between a subclass of occupations and purpose in life, the term is nearly absent from the American Occupational Therapy Association’s documents and the profession’s empirical literature. We propose that the profession explicitly name purpose in life as among our intervention outcomes and address disruptions of purpose in life in practice. This can be accomplished by first investing in purpose in our own lives, discussing the topic with colleagues and students, identifying possible purpose disruptions in our clients, and using direct or indirect intervention approaches to help clients reconnect to purpose in their lives. By explicitly naming purpose in life as part of the domain of occupational therapy, we become poised to leverage human occupation to address both a broad societal gap and our clients’ needs for a renewal of purpose in life.
The authors of this column propose that the profession of occupational therapy name “purpose in life” as an explicit intervention outcome and address disruptions of purpose in life in practice.
A robust body of evidence suggests that having a sense of purpose in life—a set of life aims that motivate a person’s daily pursuits, decisions, and resource use and that provide a sense of directedness (McKnight & Kashdan, 2009)—contributes to health and psychological well-being (Ryff, 2014; Willroth et al., 2021). Longitudinal and cross-sectional studies have found that purpose in life predicts longevity, functioning, and cognition as people age (Mota et al., 2016; Wingo et al., 2020) and mediates depression and anxiety (Kashdan & McKnight, 2013 ; Mens et al., 2016). Purpose in life is believed to advance health by contributing to people’s receptivity to health-related suggestions (Kang et al., 2019) and willingness to engage in healthy behaviors (Kim et al., 2014). Although purpose in life is increasingly viewed as a modifiable health risk factor (Alimujiang et al., 2019), the scientific literature offers little guidance about what to do when purpose in life is disrupted.
We propose that the occupational therapy profession must address this gap by explicitly naming purpose in life as one of the profession’s domains of concern in practice and research and by advancing occupational therapy interventions in which purpose in life is specified as a primary or secondary outcome. To support these recommendations, we describe the linkage between purpose in life and occupational therapy and offer steps to address purpose in life in occupational therapy practice.
Background
The importance of advancing purpose in life was implied in the occupational therapy profession’s beginnings and remains so in its contemporary professional literature. The profession’s founders believed that people’s productive and satisfying use of time contributes to their sense of competence, self-pride, and productivity (Meyer, 1922; Ryon, 1925; Slagle, 1934); they did not specifically link these benefits to purpose in life. Today, the phrase “purpose in life” is nearly absent from occupational therapy’s empirical and theoretical literatures. To illustrate, a CINAHL search of “purpose in life” in the 2012–2022 issues of the American Journal of Occupational Therapy yielded only two articles that referenced this phrase in the title or abstract (Cheraghifard et al., 2022; Chippendale & Boltz, 2015). The sole reference to purpose in life in both the American Occupational Therapy Association’s (AOTA; 2020a) statement on Occupational Therapy in the Promotion of Health and Well-Being and the Occupational Therapy Practice Framework, Fourth Edition (OTPF–4; AOTA, 2020b) occurs in the definition of occupation: “everyday personalized activities that people do as individuals, in families, and with communities to occupy time and bring meaning and purpose to life” (AOTA, 2020b, p. 79). Thus, much like the profession’s beginnings, contemporary occupational therapy does not explicitly state that improving purpose in life is within the profession’s purview.
We have a professional responsibility to formally name purpose in life as an outcome of occupational therapy intervention because engagement in a subclass of occupations appears to be the remedy for purpose disruption. To be specific, occupations that advance a sense of purpose in life (1) support a desired life direction or overarching goal (Hill et al., 2022); (2) align with one’s deepest values and strengths (Kashdan & McKnight, 2009); (3) reflect the true self, authentic and separate from societal expectations (Sutton, 2020); (4) are chosen and intentional (Martela & Steger, 2016; Ryff, 2014); and (5) are avenues for achieving something, savoring experiences, or choosing one’s attitudes (Frankl, 1984).
Moreover, explicitly addressing purpose in life in occupational therapy interventions is important because many people served by occupational therapy practitioners are at risk for disruptions in purpose in life. Purpose-related distress is often catalyzed by experiences that jolt people out of a distracted, business-as-usual way of living and inspire a desire for authenticity and reframed purpose in life (Yalom, 1980). This awakening can be provoked by changes associated with illness (e.g., cancer; Lagerdahl et al., 2014), the life cycle (Bridges, 2004), and aging (Springer et al., 2011). Addressing purpose disruption matters because having a sense of purpose is associated with psychosocial well-being and adaptation for a wide range of disabling conditions, such as spinal cord injury (deRoon-Cassini et al., 2009), rheumatoid arthritis (Verduin et al., 2008), orthopedic difficulties (Smith & Zautra, 2004), and depression (Błażek et al., 2015).
Steps to Promote Positive Change
Beyond specifically mentioning purpose in life in documents developed by AOTA, occupational therapy practitioners can take immediate steps to address it in practice.
Learn About and Invest in Purpose in Your Own Life
By exploring what purpose means in their own lives, occupational therapy educators, students, and practitioners develop relevant knowledge and experiences that inform their efforts to address the purpose-related needs of their clients (Radomski, 2023).
Discuss Purpose in Life With Colleagues and Students
After or during personal exploration of the construct, occupational therapy educators and practitioners may organize a professional discussion regarding how purpose in life supports or extends existing theories, practice models, and frameworks. For example, educators, students, and occupational therapy practitioners might discuss whether and how purpose in life is relevant to various domains and processes of the OTPF–4 (e.g., client factors, performance patterns, outcomes, occupational profile, evaluation, intervention; AOTA, 2020b).
Identify Clients Who Are Experiencing Concerns Related to Purpose in Life
To identify clients with purpose- related issues, occupational therapy practitioners can cultivate therapeutic relationships that allow clients to disclose concerns that go beyond disrupted activities and impairments and yield information about values and meaning, life aspirations, and priorities (Martin et al., 2020). Occupational therapy practitioners should be alert for possible disruptions to purpose in life among clients who have experienced a number of recent stressful life changes (Radomski et al., 2022). A simple screener question can be folded into routine assessment practices. For example, the Purpose Status Question (“Related to living with purpose in life, right now I am: moving backwards; stalled; figuring it out; moving forward on a path”) was found to differentiate between cancer survivors who lacked purpose direction and those who endorsed it (Radomski et al., 2022). Standardized self-report measures of purpose and meaning in life (e.g., the Meaning in Life Questionnaire [Steger et al., 2006] and the Purpose in Life Test [Crumbaugh & Maholick, 1981]) are important when purpose-in-life renewal is a primary outcome of intervention.
Advance Purpose in Life in Occupational Therapy Intervention
Interventions to improve purpose in life involve helping clients intentionally engage in endeavors that align with their authentic self and advance life aims that they deem important. This can be accomplished through direct and indirect intervention approaches (Scheier & Carver, 2001); both require conversations with clients about what they value, what they see as their strengths, and what they hope for in a good life. This information enables occupational therapy practitioners to help their clients decide how to use their time in ways that buoy their sense of purpose. Doing so emphasizes engagement in occupations over purposeful activities. Latham (2021) proposed that occupations are central to one’s identity, time use, and decision making, whereas purposeful activities are important to functioning and skill development but lack the deep connection to a sense of self that is necessary to advancing purpose in life. Note that purpose-oriented occupations have little to do with the specific type of activity or performance area and everything to do with how the person perceives their alignment with their true self and life aims.
In an indirect intervention approach, occupational therapy practitioners intentionally fold in strategies to renew or support clients’ sense of purpose in life while they are primarily addressing engagement in occupations and interventions that target impairments and performance skills. This is exemplified in the following scenario. A client was referred to outpatient occupational therapy after a mild stroke to address resulting cognitive impairments. During the initial interview, the therapist noticed a discrepancy between the client’s current struggles with activities of daily living, including sleep, nutrition, and daily exercise, and his enthusiasm for premorbid routines that he now missed (work, regular exercise, hiking). He made statements such as “I feel lost” and “I don’t know what to do with myself,” which suggested purpose disruption. In response, the therapist provided information to normalize the client’s transition- related feelings, highlighting that he was currently facing two transitions (recovery from his stroke and retirement). The therapist reflected back to the client the character strengths and values that were evident in his earlier comments (e.g., self-discipline, positive relationships, zest for life), which he endorsed as true. These and other values and strengths informed how he framed his current life aims, which were to improve his stamina so that he could enjoy treasured relationships with his wife, family, and friends and to use his talents and experiences to help others. He and the occupational therapist established intervention goals that supported these life aims, learning cognitive compensatory strategies and new routines to manage his health and functioning and reconnect with his friends and the community. He practiced using a day planner and scheduling routines to enhance his cognitive performance and help him manage his energy to expand his purpose-relevant choices, such as walks in nature with his wife and taking on small service projects as part of a community men’s group.
In direct intervention approaches, purpose in life is the primary outcome, as exemplified by two occupational therapy interventions. First, Chippendale and Boltz (2015) compared meaning and purpose-in-life outcomes of the Living Legends program (a life review workshop plus an intergenerational exchange program) versus a life review workshop alone for community-dwelling older adults. During eight weekly sessions, participants wrote about their lives and received positive feedback in a life review workshop. Participants who were randomized to the Living Legends condition continued with weekly sessions during which they shared their knowledge and experiences with students. Participants in the Living Legends condition had statistically significant pre–post increases in purpose and meaning in life; those who attended only the writing workshop did not. Second, Radomski et al. (2020) examined the effects of the Compass Course, an eight-session group designed to help people reconnect with their inner compass (e.g., strengths, values, sources of personal meaning), and then implement a Purpose Plan composed of everyday endeavors that advance their desired life aims. The intervention was found to be implementable and acceptable to participants with breast cancer when delivered in person or via Zoom (Radomski et al., 2020, 2023). Breast cancer survivors made statistically significant baseline–posttest improvements on two of four purpose-in-life measures and on all four measures between baseline and a follow-up (Radomski et al., 2022). More research is needed regarding the relationship between purpose in life and engagement in occupations and the efficacy of other direct occupation-based interventions in which purpose in life is the primary outcome.
Conclusion
Given the profession’s historical and contemporary emphasis on engagement in meaningful activities and occupations, we may well have been advancing purpose in life all along without saying so. It is time to change that by explicitly stating that purpose in life is an outcome of occupational therapy interventions. The societal need for evidence-based purpose- renewal interventions constitutes both an imperative and opportunity for the profession to demonstrate how occupation can advance purpose in life for those we serve.
Footnotes
*Indicates an excellent preliminary resource.
Acknowledgments
The authors developed and copyrighted the Compass Course Guidebook. Two of the authors, Ginger Carroll and Joette Zola, have each received less than $5,000 from the guidebook over the 12 months before the publication of this column and will not receive any income for participants’ use of the guidebook in studies conducted on the Compass Course.