The CMOP-E proposes that occupational therapy practice requires both enablement and client-centred practice. While the concept of occupational performance remains implicit in the model during its development from the Canadian Model of Occupational Performance (CMOP) (CAOT, 1997) to the CMOP-E (Polatajko et al., 2007), the authors also emphasized that the newer version of this model is not restricted to a focus on occupational performance but also encompasses the concept of occupational engagement. In explaining this difference, Polatajko et al. (2007) provided a story about a father and son who participated in marathons together. Their first run together occurred because one of the son’s classmates became paralyzed and the school organized a charity run to raise money. The son expressed a strong desire to participate. This event was the start of an occupation that father and son shared for more than four decades. The father ran, pushing his son, severely disabled from birth and only able to communicate using assistive technology operated by his head, in a wheelchair. Over the years they completed a number of marathons, 212 triathlons (in which the son sat in a dinghy and was pulled by the father while he swam) and four ironman events together. These activities had meaning for both of them. After the initial charity run, the son had commented to the father how much he had enjoyed the event because he “didn’t feel disabled” (Polatajko et al., 2007, p. 25).This, in turn, motivated the father to pursue subsequent opportunities to participate in the activity together. The “awesome feeling” he gets seeing his son smile is the reason the father does these events (p. 25). The authors used this story to illustrate that occupational performance is a more limited concept than occupational engagement, in that the son did not perform the occupation but engaged in it fully.
This story also illustrates the importance of the second major proposition in Enabling Occupation II; that enablement through occupation is the current core of occupational therapy. The authors proposed that this focus contrasted with the initial concern of the profession of “the provision of diversional activity” and with the following period in which attention centred on “the use of therapeutic activity” (Polatajko et al., 2007, p. 15). Townsend et al. (2007) reminded readers that enabling occupation had been defined in 1997 as “enabling people to choose, organize, and perform those occupations they find useful and meaningful in their environment” (p. 89). At the time this definition was originally published, choosing and organizing would probably have been considered tasks required to prepare for occupational performance. The newer definition of occupational therapy is based on the assertion that occupational therapists enable through occupation (Townsend et al., 2007). It reads:
Occupational therapy is the art and science of enabling engagement in everyday living, though occupation; of enabling people to perform the occupations that foster health and well-being; and of enabling a just and inclusive society so that all people may participate to their potential in the daily occupations of life. (p. 89)
The dictionary definition provided by Townsend et al. (2007) for the word enable refers to concepts of giving power, strengthening, providing with the ability or means to do something and with the means to do or be something, and making something possible. The definition of occupational therapy provided by the authors emphasizes three types of undertaking that are enabled: (a) people’s engagement in everyday life; (b) their performance of occupation; and (c) the development of a just society in which people can participate. For an occupational therapist to enable all three of these outcomes, their practice would need to be aimed at both personal and societal levels.
In recognition of the need to target both personal and societal levels, Townsend et al. (2007) identified six “categories of client” (p. 96) – individuals, families, groups, communities, organizations (including e.g. agencies, clubs and associations, and other government, corporate or non-government organizations) and populations. The authors stated that these categories evolved from four categories presented in the 1997 edition and this expanded view represents a practice that goes beyond working with individuals and might focus on the environment at the levels of client communities, organizations and populations. Detailed definitions of each of these client groups are provided on page 97 of Enabling Occupation II.
Client-centred practice is also fundamental to CMOP-E. Townsend et al. (2007) commented that client-centred practice means “focusing on client goals and projected outcomes” (p. 98) and pointed out that the following definition, provided in the 1997 edition of Enabling Occupation, had concepts of client-centred practice embedded within it. “Enabling is the basis of occupational therapy’s client-centred practice and a foundation for client empowerment and justice” (cited in 2007, p. 99). The assumption at the core of both enablement and client-centred practice is that occupational therapy involves “collaborating with people – rather than doing things to or for them” (p. 98). This statement needs to be understood in contrast to a biomedical approach in which ‘patients’ were primarily expected to be passive recipients of care or curative methods, rather than active participants in the process. Therefore, there might be things that client-centred and enabling occupational therapists do for people, such as advocate on their behalf for certain outcomes. However, these do not conjure the image of the passive patient.
Townsend et al. (2007) also noted that there has been a burgeoning of occupational therapy research around the notion of client-centred practice, which has not always “specifi[ed] the connection to enablement” (p. 99). However, the CMOP-E appears to assume a mutual relationship between the two concepts. This is evidenced in the statement, “In occupational therapy, client-centred practice delimits the definition of enablement; conversely enablement delimits the definition of client-centred practice” (Townsend et al., 2007, p. 99). The authors also stated that the challenges to client-centred practice are similar to those of enablement in that they can be encountered at the levels of the client and/or therapist and the broader systems surrounding them. Examples include the client’s culture and level of education, the therapist’s capacity to share power and recognize client expertise, and the management philosophies and resource distribution of the broader system.
