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learning while reading and reflecting, and Chapter 4,
“Establishing Readiness for Practice,” invites learning
by doing—whether individually, in pairs, or in groups.
Chapter 1 The Mindfulness That Empowers Crafts
The rationale chapter. Discussion within this chapter
touches first on lessons drawn from instances of mind-
less practice. In contrast, mindfulness in occupational
therapy emerges as an attentive and careful engagement
in understanding, activity analysis, and synthesis. The
understanding needs to be deep, the analysis logical,
and the synthesis imaginative so that these functions
can together help practitioners humanize daily prac-
tice, set a scope and direction for sound therapy, and
show clients that they care. Throughout the chapter,
interactive features, historical highlights, and practice
stories elaborate the mindfulness of these functions.
Best practice reaches past the hands of clients—the
purpose of therapy—to engage their hearts—the mean-
ingfulness that clients seek. Basic to such practice is
a process of “really getting” the profession’s guiding
beliefs and then enacting principles from holistic and
client-centered models. The PEO model, with its call for
goodness of fit, and the recovery model, with its press
for empowerment, inform the logic of our analysis and
fuel the imagination in our synthesis, turning crafts
into best practice occupational therapy.
This chapter’s discussion culminates in a step-by-
step analysis of one craft within a well-considered
intervention. To assure deep understanding, readers
engage in a parallel analysis of a second craft interven-
tion, attending to the 12 points of consideration that
structure the guidelines in this book. The authors’ views
of both analyses yield helpful feedback. Following the
analyses, readers engage in an introduction to imagina-
tive synthesis, with author feedback.
Chapter 2 Making Craftwork Therapeutic
The intervention chapter. Discussion within this
chapter turns to how imaginative synthesis “works,”
how practitioners connect with the client and make
modifications to fit each person uniquely. Elaboration of
therapeutic measures occurs within practice scenarios
that illustrate (1) therapeutic use of self; (2) goodness
of fit among clients, environments, and crafts; and (3)
positive shifts toward health. Concrete examples, inter-
active features, and helpful hints move discussion of the
PEO and recovery models from theoretical principles
to practical applications.
A practitioner’s use of self can reflect many therapeu-
tic intentions. Resources in this chapter apply constructs
from the Intentional Relationship Model to show how
using the self can “work” during crafts. When making
Preface vii
a good PEO fit among client, craft environment, and
craftwork, practitioners make modifications related
to the physical environment, social environment, and
contextual influences surrounding a client’s views.
Numerous examples, whether related to lighting, guests
in the treatment room, or gender differences, illustrate
these adjustments.
Modifications also occur because of client challenges
in motor, process, or social interactional skills, as well
as to emotional and sensory functions. Practitioners
modify or grade craft demands to make them more
challenging for skill development or less difficult to
enable performance. Casework, practice examples,
and appendices featuring physical and mental health
conditions elaborate purposeful grading and its effects
on outcomes.
When engaged in individualized craft interventions,
clients make positive shifts in health, becoming craft-
ers with choice while occupied in productive work.
Mindful crafts can enhance such outcomes in most
group types through a process of therapeutic framing,
crafting, and meaning making, which are well detailed
in this chapter. A comprehensive checklist for leading
mindful craft sessions concludes this discussion.
Chapter 3 Making Craftwork Feasible
The pragmatics chapter. Discussion within this chapter
targets practical matters associated with using crafts to
include opposing attitudes, administrative challenges,
and constraints in resources such as supplies, space,
and time. Practitioners successful in implementing
craftwork adopt and promote mindsets that foster
openness and creativity. They engage in cognitive,
interpersonal, and marketing strategies that support
craft programs. Numerous examples of these strategies
appear in this chapter.
Practitioners of crafts gain administrative support.
They enact mindful approaches to honoring the institu-
tion’s culture, sharing evidence about crafts, securing
reimbursement, and respecting financial constraints.
For each approach discussed, readers will find examples:
a strategy for writing proposals aligned with mission
statements, a craft-based documentation process for
writing goals and recording progress, an excerpt from
a letter of appeal, a sample of a budget for supplies,
a listing of low-cost materials and free discards, and
ideas for organizing and improvising work spaces and
storage. Management of time constraints includes a
process for minimizing or dividing mindful crafts to
accommodate 15- to 20-minute sessions. A starter kit
of crafts that use only coloring or collage may appeal
to those starting from scratch. Because of this chapter’s
viii Preface
aims, all points of discussion or interaction help make
crafts do-able.
Chapter 4 Establishing Readiness for Practice
The application chapter. This chapter offers in three
parts opportunities to practice logical activity analysis
and imaginative synthesis that includes therapeutic
modifications. This chapter shows how purpose and
meaning can come together. Part 1 offers resources that
make mindful crafts replicable. Each of 10 application
tables is followed by an interactive exercise that pro-
motes its use. The interactive exercises consider imple-
mentations of mindful crafts among a woman combat
veteran, a man with bipolar disorder, an older woman
with arthritis, a group in an assisted living facility, a
middle-aged man with traumatic brain injury, a young
mother on bed rest, a group of individuals with spinal
cord injury, and an older man with left cerebrovascular
accident. Author feedback follows the exercises. Part
2 presents photos of 14 therapeutic modifications in
action, with a request that readers identify client chal-
lenges to skills or functions that might warrant these
adjustments.
Part 3 consists of realistic practice challenges that
promote integrative thought. The seven challenges,
with the client noted parenthetically, are these: Analyze
three crafts and select the best (bipolar disorder in a
young man), record observations and suggest modifi-
cations (developmental delay and low vision in a young
woman), grade tasks and give environmental supports
(deconditioned status in an older man), identify client
interests and therapeutic crafts (outpatient group for
a variety of conditions), consider safe practice in a
restricted environment (conduct disorder in a teenaged
boy), resubmit a SOAP note for reimbursement (post-
surgical hand and posttraumatic stress syndrome in a
middle-aged man), and lead or co-lead a mindful craft
group using guidelines in this book (peers in student
groups or clients in fieldwork settings). Again, author
perspectives on each challenge offer helpful feedback.
Chapter 5 The Evidence That Supports Crafts
The research chapter. This chapter consists of a review
of published research on handcrafts used therapeuti-
cally. The chapter models a professional literature review
while interspersing salient historical and anecdotal nar-
ratives as special features. Research on mindful crafts
used among clients and students leads the discussion.
Informative tables clarify research results on mental
and physical health outcomes and will be helpful to
readers.
Highlights from the review include the following.
Despite challenges associated with their use, randomized
control trials (RCTs) and other quantitative inquiries
have occurred in highly diverse contexts, from clinical
settings to research think tanks. Studies of handcrafts
used therapeutically among individuals with diverse
conditions have used a broad range of designs; RCTs
are the least represented, qualitative methods the most.
Research findings about the benefits of craftwork
support most assumptions made in early chapters of
this book. The assumption that crafts benefit social
interactional skills is borne out, but effects on process
and motor skills need more investigation. The following
earned support: Handcrafts meet diverse preferences,
unique needs, and wide-ranging goals; are engaging,
from mildly absorbing to causing flow; divert attention
from anxiety, sorrow, and other disruptive challenges;
transform a client into an active and productive doer;
invite expression of the self; are purposeful and mean-
ingful in their process and outcomes; and affirm an
individual as a maker. The preponderance of evidence
related to handcrafts in health care to date supports
its positive effects on health of the mind regardless of
primary presenting condition.
The Craft Sections
Sections II, III, and IV each include two craft chapters.
Together these chapters offer 80+ craft guidelines
organized according to the PEO model.
Section II: Craft Interventions With the Person
in Mind
Chapter 6 Crafts With Interwoven Reflections on
Personal Themes
Chapter 7 Crafts With Preparatory Reflections on
Personal Themes
Section III: Craft Interventions With the Person’s
Environments in Mind
Chapter 8 Crafts With Interwoven Reflections on
Environmental Themes
Chapter 9 Crafts With Preparatory Reflections on
Environmental Themes
Section IV: Craft Interventions With the Person’s
Occupations in Mind
Chapter 10 Crafts With Interwoven Occupational
Reflections
Chapter 11 Crafts With Preparatory Reflections on
Occupational Themes
Each craft chapter offers an introductory overview, an
index of 12 to 15 crafts with a difficulty rating, pho-
tographs that showcase crafts and clarify instructions,

and detailed guidelines for conducting interventions,
grounded in the PEO and recovery models and reflect-
ing these points of consideration:
♦ PEO focus for the intervention
♦ Mindful theme that names and frames the session
♦ Required actions within the craft that point to an
appendix of related skills and functions
♦ A cue to formulate client-specific skill-building
goals
♦ Mindful goals for the intervention
♦ Introduction that sets the stage for a mindful
session
♦ Questions or exercises that prompt person-
centered reflection on the mindful theme
♦ Identification of tools and supplies (and patterns
if needed)
♦ Sequential instructions directed at the participant
♦ Troubleshooting tips that alert practitioners to
potential challenges
♦ Comments to foster reflection during quiet
moments
♦ Suggestions for an interactive conclusion
♦ Variations possible when planning the session
The learning-by-doing craft chapters. All six craft
chapters are designed to be used by readers, whether
students or practitioners. Distinctions between the two
complementary craft chapter types within each section
are these:
Chapters 6, 8, and 10 with
interwoven reflections
♦ The typical time for conducting each session is 60
minutes. Some interventions may require more
than one session.
♦ In these sessions, most didactics and client-
centered reflections are informal and woven into
the intervention. This format accommodates
clients for whom formal written work and
discussion might be overly challenging or
distancing. For clients preferring more formal
learning strategies, practitioners may formalize
this interwoven work into written exercises and
discussion periods, as seen in Chapters 7, 9,
and 11.
Chapters 7, 9, and 11 with
preparatory reflections
♦ The ideal time for conducting the full session is 90
minutes. All interventions take one session.
♦ During the first 30 minutes of these sessions,
clients complete a written didactic or reflective
exercise and engage in a brief discussion. This
Preface ix
format appeals to those seeking educational
content in occupational therapy. If practitioners
prefer 60-minute sessions, they may invite clients
to complete the written exercise before the session.
Additionally, both the exercise and discussion may
be transformed into interwoven work, as seen in
Chapters 6, 8, and 10.
The Appendices
Expedite key functions. The appendices can prompt
a swift implementation of the mindful crafts in this
book while helping practitioners to easily generalize a
process that will make many other crafts mindful.
Appendix A: Broad Required Actions With
Performance Skills and Body Functions
Analyze potential. This appendix is the outcome of an
analysis of all of the actions required during completion
of the crafts in this book. Forty required actions, such as
cut with scissors and stir liquid, were then further ana-
lyzed to specify their demands on performance skills
and bodily functions. Practitioners can use this resource
to consider and tap the therapeutic potential of crafts.
Appendix B: Modifications to Address Challenges
With Required Actions
Meet client needs. Alongside the actions required by
the crafts in this book, this appendix notes various
modifications that enable client performance. This
logical and imaginative resource can guide practi-
tioners in making adjustments to accommodate client
difficulties with process, motor, and social interactional
skills and sensory as well as emotional functions.
Appendix C: Analysis of Distribution of Required
Actions for Crafts in This Book Organized by
PEO Themes
Capture purpose and meaning. This index identifies at
a glance some 5 to 20 actions required by each mindful
craft, depending on its complexity. The organization of
the index highlights themes from the PEO model that
imbue crafts with meaning: person (self-concept and
self-determination), environment (physical, social, and
societal and cultural), and occupation (self-maintenance,
self-fulfillment, and self-expression). Using this resource,
practitioners can readily choose interventions with
purposeful actions and meaningful themes.
Appendix D: Actions and Skills Tapped by Craft-
Related Housekeeping Tasks
Enable adjunct occupations. Part 1 of this resource
examines the demands of several daily living tasks such
as wipe surfaces clean and deposit trash in receptacle that
x Preface
surround and support craft use. Part 2 offers modifica-
tions that make these tasks do-able despite performance
challenges with process, motor, and social interactional
skills or sensory and emotional functions. Practitioners
can use this integrative work to plan sessions that
enhance participation and affirm occupation.
Appendix E: Group Facilitation and Leadership
Rating Version A
Get or give feedback. This rubric allows an individual
to acquire or give feedback on performance in leading
a mindful craft session. The form allows the rating of
some 60 practitioner functions clustered into 6 catego-
ries. The Likert scale (5 = performed exceptionally well
to 2.5 = performed fairly well) is skewed in a positive
direction. Instructions specify a method of noting
functions well done or in need of improvement.
Appendix F: Group Facilitation and Leadership
Rating Version B
Give or get feedback. This rubric also allows an indi-
vidual to give or acquire feedback on performance in
leading a mindful craft session. Performance of some
45 practitioner functions clustered into 5 categories can
be rated using a clear checklist format. Points allotted
to each category and totaling 100 translate readily to
an academic grade.
The Book’s Special Features
Your Turn and Our View
In Chapters 1 through 4, Your Turn features offer
pauses in the reading that focus and provoke thought.
These features mimic exchanges that many educators
use at 15-minute intervals during interactive lectures.
Your Turns invite critical thinking to fuel discussion or
reflection that leads to awareness.
Working in tandem with the Your Turns are the
Our View features. These follow discrete sections of the
chapter and share author feedback related to clusters
of Your Turns. Not to be construed as rigid “answers,”
Our Views are just that—views of two seasoned practi-
tioners on the Your Turn prompts. Although typical of
how many practitioners might respond, Our Views are
not beyond question and invite discussion.
At the end of Chapter 1 and throughout Chapter 4,
the Your Turns become more complex opportunities
for the kinds of application that deepen knowledge and
understanding. In these instances, Our Views continue
to offer practitioner perspectives as opposed to fixed
solutions.
Drawing our Past Forward
In Chapters 1, 2, 3, and 5, boxes titled Drawing our Past
Forward showcase historical narratives linked to the
discussion. Here, founders, professional leaders, and
practitioners from different decades describe perspec-
tives or practices from earlier times. These highlights
draw forward into the present a still-keen insight.
A Story
In Chapters 1, 2, and 5, boxes titled A Story feature
sometimes inspiring but always interesting anecdotes
about clients engaged in crafts or practitioners involved
in research. A few stories are ours, but most are contri-
butions that have come from colleagues eager to share
a story.
Ancillaries
For the Instructor
Assets housed on DavisPlus and available through
your instructor’s login include an Instructor’s Guide,
PowerPoint slides for Chapters 1 to 5, additional Prac-
tice Challenges similar to those in Chapter 4, an Image
Bank that includes all photographs in the book in their
original full color, and test questions.
 REVIEWERS

Alma R. Abdel-Moty, PhD, Hector Huerta, MS, OTD,

MS, OTR/L OTR/L
Clinical Associate Professor Occupational Therapy Department
Occupational Therapy Florida International University
Florida International University Miami, Florida
Miami, Florida
Joanne T. Jeffcoat, OTR/L,
Susan Baptiste, MHSc OT[C] MEd
Reg., FCAOT Professor
Professor Occupational Therapy Assistant Program
Rehabilitation Science Community College of Allegheny County/Boyce
McMaster University Campus
Hamilton, Ontario, Canada Monroeville, Pennsylvania

Susan Lee Cheng, MS, OTR/L Stephanie Johnston, MA, OTR

Assistant Dean, Allied Health; Program Director, Professor and Fieldwork Coordinator
OTA Occupational Therapy Assistant Program
Health Technologies Lone Star College-Tomball
Durham Technical Community College Tomball, Texas
Durham, North Carolina
Linda Kelly, PhD, LOTR,
Tina Sue Fletcher, EdD, MFA, OTA
OTR Occupational Therapy Assistant Program Director
Assistant Professor Allied Health
Occupational Therapy Delgado Community College
Texas Woman’s University New Orleans, Louisiana
Dallas, Texas
Carol Marcus, MS, OTR/L
Jennifer L. Geitner, COTA/L, Clinical Coordinator and Instructor
BS, AFWC Occupational Therapy Assistant Program
Academic Fieldwork Coordinator/Faculty Durham Technical Community College
Occupational Therapy Assistant Durham, North Carolina
Pueblo Community College
Pueblo, Colorado
Nancy Ranft, OTD, OTR/L
Assistant Professor of Occupational Therapy
Nancy Schneidenbach Green, Occupational Therapy
MHA, OTR/L The Sage Colleges
Program Chair Troy, New York
Occupational Therapy Assistant Connie Rooks, MAT, COTA/L
Cabarrus College of Health Sciences Program Director, Assistant Professor
Concord, North Carolina Allied Health, OTA Program
Western New Mexico University
Silver City, New Mexico

xi
xii Reviewers

Janeene Sibla, OTD, OTR/L Callie Schwartzkopf, OTD,

Occupational Therapy Program Director and OT/L
Professor Associate Professor
Occupational Therapy Occupational Therapy
University of Mary College of Saint Mary
Bismarck, North Dakota Omaha, Nebraska
Barbara Ellen Thompson, JoAnne Wright, PhD, OTR/L,
OTD, LCSW, OTR/L, CAGS CLVT
Professor Professor (Clinical)
Department of Occupational Therapy Division of Occupational Therapy
The Sage Colleges University of Utah
Troy, New York Salt Lake City, Utah

We should certainly count our blessings, but we should also make
our blessings count.
—Neal A. Maxwell
The act of acknowledgment turns on gratitude. To
acknowledge others is to recognize them, declare a
receipt of gifts from them, disclose positive truths about
them, and express to them deep thanks. In the spirit
of being mindful, we acknowledge others in the full
sense of the word. We recognize, declare, and disclose
the generosity of many, and we express to them our
deepest thanks.
We first acknowledge the power that an occupation
can have in bringing people together. We discussed
writing a book once during casual conversation at a
state conference. We had never before worked together,
but we had both come to a similar understanding of
how adding deeper meaning to crafts enhanced their
worth. Our two years spent in the making of this book
have forged a friendship for which we are grateful.
We acknowledge our photographer, Ann Nikirk,
who captured so well the images of our crafts and our
grasp of mindfulness. Ann’s developing belief in the
power of occupation and mindful crafts was a resound-
ing endorsement that moved us toward completing our
work. We asked Ann to share an image of herself while
at work and in flow, and that photo appears in Figure
1-4 in Chapter 1.
We acknowledge the influence of those individuals
who led each of us to the idea of infusing meaning into
crafts—whether intellectual or emotional. For Cynthia,
that idea germinated while working among able team
members who forged an ever-increasing clarity about
the benefits of using metaphor to add meaning to
craftwork. These individuals include Martha Diskin,
MA, OTR; Anna Olson, MOT, MBA, OTR, CLT; Susan
Ennist Dobbs, MOT, OTR; and Claudette Fette, PhD,
OTR, RCC. For Suzanne, preparing to work with a new
population was the prompt. The prospect of making
crafts meaningful for what might be a tough and
mixed audience—women recovering from addictions,
ACKNOWLEDGMENTS
whether immersed in careers, living on the streets, or
newly released from prison. Adding symbolism to each
project seemed a good way to forestall complaints about
the irrelevance, condescending nature, or childishness
of crafts. The idea worked beautifully!
We acknowledge those who guided us in the making
of this book. We launched and finished the work with
the help of able editors. F.A. Davis senior acquisitions
editor Christa Fratantoro saw promise in our proposal,
shepherded it to acceptance, and helped us set a path.
Jill Rembetski, our developmental editor, organized
and led the review process, anticipated and answered
endless questions, and guided our steps with gentle
insight. We thank Margaret Biblis and George Lang
for their leadership and direction. We thank design
editor Carolyn O’Brien and art editor Kate Margeson
for enhancing the visual appeal of our work and Sharon
Lee and Lisa Thompson for moving our work toward
production. We also acknowledge F.A. Davis staff Alisa
Hathaway and Nichole Liccio who helped us to make
necessary connections without which the book would
not have emerged.
We acknowledge individuals who met our need for
expertise in practice areas that complement our own.
These clinicians and educators include Beatriz C. Abreu,
OTR, PhD, FAOTA; Kira Beal, OTD, OTR; Debbie
Buckingham, OTR, MS, CVE, CCM, CRC; April C.
Cowan, OTR, OTD, CHT; Barbara M. Doucet, OTR,
PhD; Tina Patel Gunaldo, PhD, PT, DPT, MHS; and
Shama Lawji, MOT, OTR. We hope that these experts
see that we used their suggestions to good advantage.
We acknowledge the generosity of others to whom
we turned for help. We thank practitioners who
shared experiences with crafts that became Our Story
features. The clinical stories of Beatriz Abreu, OTR,
PhD, FAOTA; Whitney-Reigh Asao, PhD, OTR; and
Paula McComb, OTR added to the deep understanding
xiii
xiv Acknowledgments
that we sought. Another group deserving our thanks
is a circle of friends in Northern Texas who willingly
engaged in many of our crafts, helping to tweak our
instructions and make samples that let us capture crafts
“in progress” with photos. These individuals include
Vivienne Pitts; Carol Griffith; Shann Shubert; and
Madeleine, Julianne, and John Nikirk.
We acknowledge the work of graduate occupational
therapy student assistants Megan Gay Crisson, Emily
Miller, and Dora Alcacio. Their devotion to this book
was clear in their search and review of literature, format-
ting and reformatting of documents, data management
from student surveys, and feedback on the clarity of
craft instructions. When this book comes to print, all
will have moved on to practice where we hope that they
use mindful crafts.
We acknowledge with deep thanks the support of
friends and family who encouraged us and understood
our need to spend time in “book mode.” We acknowledge
our mothers in a special way. Cynthia thanks Darlene
Biondi Evetts, whose longtime engagement in crafts,
whether in making home life festive or making con-
tributions within the community, taught her children
the worth of crafting. When in rehabilitation during
the last months of our writing, Mrs. Evetts used crafts
suggested by Cynthia and then taught them to others
in the setting. Suzanne is grateful to Loretta Bernier
Peloquin, whose able hands as hair stylist and gardener
turned to satisfying artwork in her brief retirement. Her
giving nature and gentle soul are well-remembered by
all who knew her. The nurturing spirits of these two
strong women course through our book as we aim to
gently persuade and imaginatively lead.
We hope that we have made count of the bless-
ings that we have received. The greatest blessing that
might come from this book is a widespread embrace
of mindful crafts, in which case our gratitude will turn
to readers like you.
 TABLE OF CONTENTS
SECTION 1: Mindful Principles and Modifications to the Craftwork 53
Processes 1 Attend to Personal Relevance 53
Consider the Suitability of Tools 54
Chapter 1: The Mindfulness That Empowers Consider Objects and Their Properties 54
Crafts 3
Think About Sequence and Timing 55
Mindfulness and Mindlessness 4
Mindfulness Defined, Described, Attend to Safety Issues 55
and Illustrated 4 Grade Crafts With Two Directions
Mindlessness in Health Care 6 in Mind 56
Mindlessness in Occupational Therapy 8 Make a Fit That Leads to Performance:
A Case 60
The Understanding That Empowers
Occupational Therapy 9 Modifications Within the Person:
Understanding Persons and Their Positive Shifts Toward Health 62
Occupational Natures 10 A Healthy Shift in Role 63
Understanding Our Guiding Beliefs 11 A Healthy Shift in Participation 64
Insights From Holistic Person- Group Approaches to Craftwork 67
Centered Models: Person- Formal Population-Centered Groups 68
Environment-Occupation and Informal Population-Centered Craft
Recovery 12 Groups 71
Understanding Ourselves 14 Formal Setting-Specific Therapy
The Logical Analysis and Imaginative Groups 71
Synthesis That Empower Informal Setting-Specific Groups 72
Occupational Therapy 16
Informal Social Gatherings 72
Logical Assumptions About the
Therapeutic Potential of Craftwork 16 The Process of Mindful Craft Groups 73
Framing 73
Analysis of Each Craft 22
Crafting 75
Analysis of Each Craft Intervention 28
Meaning Making 77
Imaginative Activity Synthesis 29
Establishing Client-Centered Purpose 34 Summary 84
Discerning Meaning as Part of
Synthesis 35
Chapter 3: Making Craftwork Feasible 87
Personal Mindsets That Make Crafts
Summary 38 Do-Able 88
Create New Categories 88
Chapter 2: Making Craftwork Therapeutic 41 Be Open Minded 90
The Therapeutic Process Within Crafts 42 Take Control Over Context 92
Therapeutic Use of Self 42
Be Process Oriented 92
Creating a Good Fit 43
See Oneself as Savvy: Enhance
Modifications to the Craft Environment 47 Personal Skill 93
The Physical Environment 48
Mental Locks That Put Crafts at Risk 96
The Social Environment 49 Pathways to Administrative Support 98
Influential Contexts 50 Honor Institutional Culture 98

xv
xvi Table of Contents

Heed Administrative Directives: Perceptions Among

Evidence, Documentation, and Students 197
Finances 99 Research on the Therapeutic Use of
Pathways to Abundant Resources 115 Handcrafts 200
Secure Supplies: Starter Kits, Dual Focus 200
Discards, and Bright Ideas 115 Search Process 201
Secure Places and Spaces: Challenges in Securing Evidence 201
Organization and Improvisation 119
Contexts Within Which Evidence
Summary 124 on Handcrafts Has Mattered 203
Additional Research Findings
Chapter 4: Establishing Readiness for Organized Within a Recovery
Practice 127
Framework 214
PART 1: Resources That Lead to
Readiness 128 Discussion and Future Directions 224
Resources: The Purposeful Core Summary 226
of Crafts 128
SECTION 2: Craft Interventions With
Resources: The Meaningful Core the Person in Mind 231
of Interventions 142
PART 2: Photographs of Modifications 157 Chapter 6: Crafts With Interwoven
PART 3: Practice Challenges That Reflections on Personal
Develop Readiness 160 Themes 233
4-1 Analyze Three Crafts and Select Crafts With the Person in Mind:
the Best One—Bipolar Disorder 160 Self-Concept 235
4-2 Record Observations and 6-1 Cracked Pot—Reframing Flaws 235
Suggest Modifications— 6-2 Purple Hearts—Acknowledging
Developmental Delay and Low Pain and Suffering 237
Vision in a Young Woman 169 6-3 Mixed Emotions—Identifying
4-3 Grade Task and Environmental Internal Conflict 239
Supports—Deconditioned Status 171 6-4 Knock, Knock. Who’s There?
4-4 Identify Client Interests and Inside/Outside Emotions 242
Therapeutic Crafts—Outpatient 6-5 Treasure Boxes—Value
Group for a Variety of Conditions 175 Clarification 246
4-5 Consider Safe Practice in a 6-6 What’s Your Superpower?
Restricted Environment—Conduct Adventures in Life 248
Disorder in a Teenaged Boy 177
Crafts With the Person in Mind:
4-6 Resubmit a SOAP Note for Self-Determination 250
Reimbursement—Postsurgical 6-7 Layers—Reflecting on Personal
Hand and Posttraumatic Stress Development 250
Disorder 179
6-8 Get Real—Telling My Story 255
4-7 Lead or Co-Lead a Mindful Craft
6-9 Review, Appraise, Plan—Past,
Group 181
Present, Future 259
Perspectives on the Challenges 182
6-10 Totem Fetishes—Character
Summary 192
Strengths and Aspirations 261
Chapter 5: The Evidence That Supports 6-11 What’s in Your Wallet?
Crafts 195 Identity 264
Research to Date on Mindful Crafts 196 6-12 Refocusing, Letting Go,
Perceptions of Satisfaction and Moving On—Recycling
Engagement 196 Unpleasant Memories 267
 Table of Contents xvii

Chapter 7: Crafts With Preparatory 8-5 Interpersonal Relations—Inside/

Reflections on Personal Outside Box 367
Themes 271 8-6 Blast From the Past—
Crafts With the Person in Mind: Environmental Impact 369
Self-Concept 272
8-7 Social Ties—Strengthening
7-1 Having a Positive Sense of Self 273
Relationships 371
7-2 Scratching Past the Surface 277
8-8 Friendly Bouquet—Individuals
7-3 Amazing Grace 282 in Community 374
7-4 Windows Into the Soul 286 Crafts With the Environment in Mind:
7-5 Taking a Lighthearted Perspective 290 Cultural and Societal Environment 378
7-6 Taking Pride in Being or 8-9 Best-Laid Plans—Coping With
Honoring a Real Woman 294 Change 378

7-7 Taking Pride in Being or 8-10 Not So Trivial Trivets—

Honoring a Real Man 299 Adaptation to Change 380

7-8 Spring Holiday Reflections 8-11 What’s Bugging You? Problem

About Recovery 303 Solving 383

7-9 Winter Holiday—Joy 309 8-12 Who Am I? Communication

and Interaction Skills 384
Crafts With the Person in Mind:
Self-Determination 313
7-10 Reinventing the Self 313 Chapter 9: Crafts With Preparatory
7-11 Having Purpose and Motivation 317 Reflections on Environmental
7-12 Transformations in Life 322
Themes 389
Crafts With the Environment in Mind:
7-13 Pieces to Peace 327 Physical Environment 390
7-14 Spring Holiday—What Are 9-1 Being in a Safe and Accessible
You Hatching? 331 Place 391
7-15 Holding on to Friendship 338 9-2 Seeds of Recovery 397
9-3 It’s in the Bag 401
SECTION 3: Craft Interventions 9-4 We Fly and Crawl 406
With the Person’s 9-5 Winter Holiday—The Little
Environments in Mind 347 Things 410
Crafts With the Environment in Mind:
Chapter 8: Crafts With Interwoven Social Environment 415
Reflections on Environmental 9-6 Being Among Supportive Others 415
Themes 349
Crafts With the Environment in Mind: 9-7 What Are You Banking On? 419
Physical Environment 351 9-8 Being Real 423
8-1 Welcome/Keep Out—Protecting 9-9 Being in a Nurturing Place 428
Well-Being 351
9-10 Halloween—Web of Support 435
8-2 Doors—Interpersonal
Crafts With the Environment in Mind:
Boundaries 356
Cultural and Societal Environment 440
8-3 Boxes to Baskets— 9-11 Respecting Boundaries 440
Repurposing—Accepting
9-12 Square One 444
and Embracing Change 360
9-13 Halloween—Healthy Tricks or
Crafts With the Environment in Mind:
Treats 448
Social Environment 364
8-4 Parts of a Whole— 9-14 Catching the Sun in Your Life 453
Acknowledging Influential Others 364 9-15 Weaving a Balanced View 457
xviii Table of Contents

SECTION 4: Craft Interventions 11-4 Coping With Courage and

With the Person’s Heart 516
Occupations in Mind 461 11-5 Holding On, Letting Go 519
Crafts With the Occupation in Mind:
Chapter 10: Crafts
With Interwoven Self-Fulfillment 523
Occupational Reflections 463
11-6 Bucket List 523
Crafts With the Occupation in Mind:
Self-Maintenance 464 11-7 From Broken to Whole 527
10-1 Framed—First Impressions 465 11-8 Valentine’s Day—Life’s Patterns 531
10-2 Guardian Angels—Risky 11-9 Tearing Apart, Rebuilding 534
Behaviors 467 11-10 Swimming Strong 538
10-3 Getting It Together—Problem- Crafts With the Occupation in Mind:
Solving Process 470 Self-Expression 543
10-4 Keep On Keeping On—Routine 11-11 Developing Healthy Habits 543
Building 472 11-12 Essential Tools for Growth 547
Crafts With the Occupation in Mind: 11-13 Winter Holiday—Giving Real
Self-Fulfillment 475 Gifts 551
10-5 Holding it Together—
11-14 Giving Thanks 557
Catch-All Can 475
11-15 Mother’s or Father’s Day—
10-6 To-Do List Accountability—
Making Parental Connections 563
Seven-Day Log 477
10-7 Symbolic Reminders—Visual
Appendix A: Broad
Required Actions With
Cues 480
Performance Skills and Body
10-8 An Extra Pocket—Taking Time Functions 571
for Self 482
Crafts With the Occupation in Mind: Appendix B: Modifications
to Address
Self-Expression 486 Challenges With Required
10-9 Spiritual Expressions—Prayer Actions 591
Beads 486
10-10 Magic Wands—Expressing Appendix C: Analysis
of Distribution of
Yourself With Style 490 Required Actions for Crafts
in This Book Organized by
10-11 Personal Business: Profiling
PEO Themes 613
Strengths 494
10-12 DIY (Do-It-Yourself) Book— Appendix D: Actions
and Skills Tapped by
Explain Yourself 498 Craft-Related Housekeeping
Tasks 623
Chapter 11: CraftsWith Preparatory
Reflections on Occupational Appendix E: Group
Facilitation and
Themes 503 Leadership Rating Version A 635
Crafts With the Occupation in Mind:
Self-Maintenance 504 Appendix F: Group
Facilitation and
11-1 Eating With a Design in Mind 505 Leadership Rating Version B 637
11-2 Carrying Responsibilities 509
Index 639
11-3 Thinking Little 513
SECTION ONE

Mindful Principles
and Processes
 CHAP TE R

1
The Mindfulness That
Empowers Crafts
Guided by the belief that occupational therapy is a personal
engagement, we enable occupations that heal.

LE A R NING O U TC O MES
1. Distinguish between mindful and mindless health-care practices.
2. Identify longstanding aspects of mindfulness in occupational therapy practice.
3. Elaborate a deep understanding of persons and their occupational natures.
4. Identify the guiding beliefs and person-centered models that shape best practice.
5. Describe the relationship between conscious and therapeutic use of self.
6. Offer logical assumptions to support the therapeutic use of crafts.
7. Apply logical activity analysis to a given craft.
8. Describe the principles of imaginative activity synthesis.
9. Elaborate the manner in which crafts can be made mindful.

When it comes to making interventions work, practi-
tioners must be mindful. To be true to the meaning of
the term, they must be attentive and aware. They must
be careful. They must heed the mindful functions of
practice. More specifically, occupational therapy prac-
titioners must honor three dimensions of mindfulness:
(1) a deep understanding of persons and therapy, (2)
logical activity analysis, and (3) imaginative activity
synthesis. In this chapter, we elaborate the meaning of
each after sharing this overview.
Consider first the need to understand or “really get”
some things. As occupational therapy practitioners, we
must understand persons, their occupational natures,
and the unsettling disruptions that occupational chal-
lenges cause in a life. This aspect of mindfulness human-
izes therapy. We must next understand the guiding
beliefs of occupational therapy and the action-oriented
principles drawn from person-centered models. This
understanding sets the depth, scope, and direction
of therapy. And we must also turn inward so as to
understand ourselves and how we work with others.
This aspect of mindfulness helps us become caring.
Beyond this threefold understanding, our mindful-
ness extends to logical analysis and imaginative synthe-
sis. We must use logic to analyze the demands of an
occupation, activity, or task and identify the skills and
functions needed to meet those demands. This aspect
of mindfulness gives purpose to our therapy. We must
then turn to those who seek our care. Clients bring
to therapy unique needs and strengths. Clients tell us
what has meaning. We must work imaginatively with
them to synthesize our knowledge of therapy and their
grasp of their situations. This aspect of mindfulness
individualizes therapy and makes it engaging. The
ensuing goodness of fit—best practice—has healing
power.
Can practitioners use craft interventions mindfully?
This book is our “Yes!” In this chapter, we make our
3
4 SECTION ONE ✍ Mindful Principles and Processes
approach transparent. We share a practice of deep
understanding, logical analysis, and imaginative syn-
thesis. We showcase mindful crafts. Our bottom line is
this: You can make crafts work.
Your Turn 1-1
Look at Figure 1-1. Before reading any further,
write within each loop in the figure a number
from 1 to 5 (with 5 indicating very familiar
and 1 not so familiar) to answer this question:
What number would you use to rate your
familiarity with each of the three dimensions
of mindfulness named in the figure? If, for
example, you think that you are somewhat
familiar with logical activity analysis, you
might write the number 3 within that loop.
Deep
understanding
of persons and
therapy
Logical
activity
analysis
Imaginative
activity
synthesis
MINDFUL
CRAFTWORK
FIGURE 1-1 The mindfulness that empowers crafts.
Mindfulness and Mindlessness
We turn to a discussion of mindfulness because we
believe that framing occupational therapy interventions
in terms of mindfulness awakens us to vital functions of
practice. We believe that we are at risk of being pulled
or lulled into mindlessness in today’s health systems.
Our aim is not to flaunt a trendy term but to deeply
consider the grounding in mindfulness that the best of
occupational therapy has always been.
Mindfulness Defined, Described,
and Illustrated
Definitions of mindfulness and its opposite are impor-
tant preludes to a discussion of mindlessness in health
care. The term mindful is defined as “attentive, aware,
and careful.” Synonyms include “heedful,” “thoughtful,”
and “regardful.” When we hear the term mindless, we
rightly deduce that inattentive, unaware, and careless
apply. The dictionary notes that heedless, thoughtless,
and disregardful also fit.
Mindfulness, then, means being attentive to, aware
of, and careful about something—some idea, function,
or person. Mindfulness helps us to do safely and well
the things that we choose to do. See Figure 1-2 for one
of those things.
We all claim to be dutifully mindful. We likewise
admit that mindlessness “happens.” Consider driving.
Complex enough to warrant a license and dangerous
enough that criminal charges attach to recklessness,
driving can occur mindlessly. Long stretches of highway
can pull us from active driving. Suddenly “brought
back” from musing about other things, we fear we’ve
passed our exit. So skilled are most of us at steadying
the wheel and checking the mirrors that we drive a
two-ton vehicle on autopilot.
FIGURE 1-2 Mindful threading of a needle.
 CHAPTER 1
FIGURE 1-3 Mindless application of toothpaste.
Your Turn 1-2
Identify an activity other than driving during
which you find yourself acting on autopilot.
Which, if any, adverse consequences can
follow?
Most are less attentive during basic self-care. The
precise steps and motions in applying deodorant or
tying shoes all move to the background until some
occupational challenge thwarts their attempt. As occu-
pational therapy practitioners, we stay mindful of daily
activities, aware of their demands and dimensions.
Others turn to us for help because we heed the realm
of daily performance, staying mindful on their behalf.
See in Figure 1-3 the result of a mindless moment.
Mindfulness, then, is the adaptive state of being
attentive and aware. It allows us to do carefully whatever
we need to do. Fables and fairy tales portray mindful-
ness in ways that move past its value in daily activities
into matters of life and death. Little Red Riding Hood
(Lang, 1891) and a later rendition called The Little Girl
and the Wolf (Thurber, 1939) offer contrasting views.
Little Red Riding Hood features a young girl setting
out with a basket of goodies to take to her sick grand-
mother. Along the way, she meets and chats with a wolf,
mindlessly disclosing to him her destination. This Big
Bad Wolf takes his leave of the girl and lopes ahead to
make a satisfying if hurried meal of the grandmother.
Astute wolf that he is, he sees in the approach of
the child a chance for a second meal. He dresses in
granny’s bedclothes, slips into her bed, and greets the
girl. She exclaims over oddities in the wolf ’s voice and
features, heedless of their meaning. Her last comment,
✍ The Mindfulness That Empowers Crafts 5
“Grandmother, what big teeth you have,” elicits a deadly
response. Mindlessness can be deadly.
James Thurber’s fable, The Little Girl and the Wolf
(1939), introduces a young girl of a different ilk.
Thurber takes liberties with Lang’s tale:
She had approached no nearer than twenty-five
feet from the bed when she saw that it was not
her grandmother but the wolf, for even in a
nightcap a wolf does not look any more like
your grandmother than the Metro-Goldwyn
lion looks like Calvin Coolidge. So the girl took
an automatic out of her basket and shot the
wolf dead. (p. 5)
The moral of Thurber’s story is this: “It is not so easy
to fool little girls nowadays as it used to be” (Thurber,
1939, p. 5). Mindfulness can save us.
Most of us can point to bodily nicks and scars,
evidence of mindless moments turned unsafe. Mind-
lessness can hurt feelings, too. Read what author May
Sarton (1988) had to say about her experience at a
hairdresser’s:
While Donna was securing my hair into curlers,
an old lady who was waiting to be picked up
came and stood beside us and talked cheerfully
about herself and her daughters and Donna
responded. It was as though I did not exist, was
an animal being groomed. (p. 235)
Sarton felt disregard when her hairdresser attended to
another. In similar circumstances, some of us might feel
the same. Others of us might feel no dismay and take
our thoughts elsewhere. Perceptions of mindlessness
as rude can differ.
Your Turn 1-3
Would the behavior described by May Sarton
bother you if you were at the hairdresser’s or
barber shop? Explain.
We’ve established our familiarity with mindfulness
and its opposite. Two more points of discussion seem
salient: the absorbed state that mindfulness can cause
and the mindfulness revolution.
Absorption
First, consider the deep absorption that mindfulness
can produce. Psychologist Mihaly Csikszentmihalyi
(1990) named this positively energized state flow. He
described flow as an intense mental state when one
6 SECTION ONE ✍ Mindful Principles and Processes
FIGURE 1-4 Engagement in flow during photography.
engages in a just-right challenge. Some ignore food
or drink when in flow. Flow can occur with artwork,
sports, or playing an instrument (Fig. 1-4). The sense
of being swept away on water led to the naming of
flow. Passive activities cannot elicit flow; they evoke
boredom or anxiety (Csikszentmihalyi, 1975). Many of
our clients can name activities that absorb them, and
we should stay mindful of these. If we strive to occupy
our clients, we should be skeptical of methods that are
downright boring.
What can we say about an activity that, although
still absorbing, tends to calm us? Such engagement
is mindful in that we stay present to the activity, but
the mental state is not intense. We often switch from
intense tasks to those that tax us less. Some call these
“mind-flushers.” Benefits can follow an easy mindful-
ness that diverts us from stress and pain. We bristle
when others call occupational therapy diversional.
Our work, we say, is therapeutic. But diversion can be
therapeutic. Removal from anxiety about the future or
sorrow over the past offers a healthy reprieve. Individu-
als find reprieve in different tasks, from tidying shelves
to grooming pets (Figure 1-5).
FIGURE 1-5 Absorption in pet grooming.
Time spent in simple stitching or sanding can be
restful steps in craftwork. We note this calmly absorbed
state alongside that of flow because they both affect our
well-being in time. If Csikszentmihalyi’s flow is like
being swept away in time, restful absorption is like a
gentle floating. Bays (2011) described the floating well:
“The mind needs rest, too. Where it finds rest is in the
present moment, where it can lie down and relax into
the flow of events” (p. 6).
The mindfulness revolution
A second point about mindfulness seems important
to our discussion: the mindfulness revolution. Strate-
gies for achieving mindfulness fill the psychological
literature as part of healing and living well (Boyce,
2011). The practice of mindfulness derives from
Eastern philosophies and from cognitive behavioral
therapy (Boyce, 2011). Prompts from this practice, such
as staying in the moment and living life to its fullest,
align well with occupational therapy. All of this merit
aside, our focus is neither on the mindfulness revolu-
tion nor in trying to prompt a meditative state. Rather,
our view of mindfulness targets the common view of
attentiveness, awareness, and care in using occupations
that has characterized best practice since our incep-
tion. We target the construct because the challenges to
stay mindful nowadays are on the rise, particularly in
health care.
Mindlessness in Health Care
We see mindfulness as the force behind best practice.
We especially note the need to be mindful of the persons
who seek our care. Currents in care systems shape an
 CHAPTER 1
undertow that can pull us from such regard. Stories
shared by those seeking care suggest that caregivers can
be mindless. We hear such stories at family gatherings,
on elevators, and in waiting rooms. In stories thought
uncaring, concern for the person’s experiences, feelings,
and needs is not primary, preempted by matters thought
more pressing (Biro, 2000; Casillas, 2006; Cole, 2004;
Gazella, 2004; Hill, 2006; Ivančić, 2006; Martensen,
2008; Sonkë, Rollins, Brandman, & Graham-Pole, 2009;
Srivastana, 2011). Surely no caregiver intends harm,
but many engage in hurtful behaviors. In a hallmark
statement, physician Seymour Sarason (1985) wrote:
In a vague, inchoate way, people feel and
know that the clinical endeavor has become
problematic, that those who are in helping roles
are both cause and victim, that something is
wrong somewhere, and that far from getting
better, it seems to be getting worse. (pp. 203–204)
During the 1980s and 1990s, many individuals went
public with health care narratives that clarified the
problem and shed light on its nature and causes. Those
stories decried actions thought uncaring: (1) failure to
see injury, illness, and chronic conditions as having
deeply personal consequences; (2) failure to attend to
that which patients want to share; (3) establishment of a
distance that feels cold and dismissive; (4) withholding
of information that patients deem important; (5) use
of brusque manners; and (6) misuse of professional
power (Peloquin, 1993a). More recent stories affirm the
same complaints (Biro, 2000; Casillas, 2006; Cole, 2004;
Gazella, 2004; Hill, 2006; Ivančić, 2006; Martensen,
2008; Sonkë et al., 2009; Srivastana, 2011). Each com-
plaint targets a form of being inattentive to or unaware
of something, of being careless toward someone.
A narrative seems apt, and Arnold Beisser’s (1989) is
a classic. A physician and former tennis champion who
contracted polio just months before the vaccine hit the
market, Beisser thought his hospital time quite grim:
I would call the nurse and ask for another
blanket to cover me. The room seemed
comfortable to her, so she would doubt my
judgment. In order to check, she would usually
reach down to feel my leg. Then she would say
something like, “Oh, it’s all right, you’re not
cold.” (pp. 18–19)
His perceptions of feeling cold were dismissed. His
bodily experience was ignored. The nurse’s attention to
his room and skin temperature preempted his discom-
fort. Professional coldness prevailed. How differently
might Beisser have felt with the gift of a blanket!
✍ The Mindfulness That Empowers Crafts 7
Thankfully, instances of caring occurred, even during
difficult times. This one affirms a hasty handcraft:
As I slept, a nurse took the cloth wrapping
off a sterile instrument. He smoothed out the
material. He painted with a blue flow pen a
moon face with wide eyes and an enormous
crescent smile. He climbed over my bed. He
climbed over my plants and hung this banner
down from my window, using the extra-wide
masking tape. It was the first thing I saw in the
morning. (Lee, 1987, p. 111)
In most cases of uncaring, a regard for something other
than the patient’s concerns prevails. Note Sarason’s take:
Helpers are both cause and victim (1985). Caregivers
struggle. They name societal and institutional forces
that pull them from caring. Three seem dominant:
(1) an emphasis on logical fixing; (2) an overreliance
on methods and protocols; and (3) a health-care system
driven by business, efficiency, and profit (Buckly, 2011;
Crossen & Tollen, 2010; Frampton, 2009; Gazella, 2004;
Muñoz, 2006; Peloquin, 1993b; Sonkë et al., 2009;
Srivastana, 2011).
Each of these three dominant forces carries a concern
vital to best practice. Health-care problems must be
solved; sound methods must shape treatment; institu-
tions must have business sense. But when logical fixing,
scientific methods, or profit-first ideas stand at the
center, patients feel displaced. Even when unintended,
the mindlessness hurts. Often client and caregiver feel
pain, as in this more recent example:
Five months of clerkships had shown me that
the ideal patient-doctor relationship ... crumbles
under the demands of ward work. I had already
begun to place my efficiency, interests, and
performance ahead of the patient’s feelings and
questions. ... I felt ashamed that we had neither
listened, nor made her feel comfortable, nor
prepared her in the slightest for a diagnosis that
we knew she wouldn’t understand. (Muñoz,
2006)
Reform has accelerated since the “unraveling of health
care” in the mid-1990s when the “miracle of the managed
care marketplace did not deliver” (Morrison, 2000).
Changes have included a proliferation of satisfaction
surveys, accountability proposals, “customer training
workshops,” and recognition and reward programs for
caring behaviors. We have a long way to go, with Press
Ganey Associates’ (2013) special reports affirming the
need for a deeper understanding of client sentiment
than that offered by satisfaction measures.
8 SECTION ONE ✍ Mindful Principles and Processes
In the context of this discussion, Planetree, a non-
profit facilitator of patient-centered care in settings
worldwide, is worth noting (Frampton, 2009). In an
effort to transform hospital stays into healing events,
developers envisioned Planetree hospital designs, both
architectural and programmatic, as venues for patient-
centered care. Seeing hospital wards as prison-like,
designers reimagined them as healing spas. Planetree
centers offer massages, greenery, and airy spaces filled
with stunning artwork. In many sites, arts and crafts—
from scrapbook making to using craft kits—reflect the
belief that art enhances outcomes. Relationship-centered
care is a dominant theme in Planetree philosophy, and
deeply human connections are encouraged (Frampton,
2009; Harvey Picker Center, 2013; Ulrich, 2009).
Your Turn 1-4
Call to mind any instance during a health-care
event when you experienced or saw real
caring. What was it about the behavior that
seemed caring to you?
Mindlessness in
Occupational Therapy
Occupational therapy practitioners have shared angst
similar to that faced among medical caregivers. Some
have asked:
Are occupational therapists today meeting the
needs of the rehabilitation population ...? Or
are we compartmentalizing our services on the
basis of our own need for neat tidy treatment
plans that fit our expertise and selective mission
of our institution? (Boyle, 1990, p. 941)
Because we argue that crafts can be mindful, we first
share three cases of craftwork run amuck. Later, we’ll
explore the manner in which each case might have
been mindful. The first case concerns a writer with
Guillain-Barré syndrome, the second a bright woman
in a nursing home, and the third a professional leader
with cerebral palsy. In each case, therapy missed its
mark.
Heller and Vogel (1986) described Heller’s experi-
ence with occupational therapy for Guillain-Barré
syndrome. As soon as he could complete seven steady
repetitions of sanding on a block of wood, the therapist
replaced the sandpaper with a coarser grade, increas-
ing the difficulty of his work. Heller wrote of those
repetitions, “It was just as punishing for me to have
to execute them as it had been in the beginning” (p.
167). He had hoped to savor gains, but the protocol for
strength discouraged him.
A patient’s poem, “Occupational Therapy” (McClay,
1977), featured an elderly woman’s case and her reflec-
tion about her therapist. Consider this excerpt:
Preserve me from the occupational therapist,
God ...
“Please open your eyes,” the therapist says,
“You don’t want to sleep the day away.”
As I say, she means well ...
She wants to know what I used to do,
Knit? Crochet?
Yes, I did all those things,
And cooked and cleaned
And raised five children,
And had things happen to me.
Beautiful things, terrible things,
I need to think about them. ...
Arrange them on the shelves of my mind.
The therapist is showing me glittery beads,
She asks if I might like to make jewelry. ...
She’s a dear child and she means well,
So I tell her I might
Some other day. (pp. 107–108)
Because the therapist never heard this woman’s needs,
attending to them was impossible.
Your Turn 1-5
What suggestion do you have about
something that this young therapist might
have said or done differently?
A case described by Diane Parham (1987), rounds out
this triad. Parham spoke of June Kailes, director of
an independent living center, as a “talented and intel-
ligent woman who happened to have cerebral palsy”
(p. 556). Parham reflected on Kailes’ time in occupa-
tional therapy.
Her recollection of therapy is that she was
asked repeatedly to drill on tasks like putting
beads into jars, presumably for coordination:
“Anybody could see that wasn’t going to be my
thing!” Why had no one attempted to help her
channel her considerable intellectual abilities
toward more satisfying goals? (Parham, 1987,
p. 556)
 CHAPTER 1
Occupational therapy was meaningless rote, Kailes’
grasp of its purpose notwithstanding.
In the face of such stories, we must ask: Have occu-
pational therapy interventions become like mindless
driving on familiar highways? Are we so skilled in
routine methods that we intervene on autopilot? Do
we ask the same questions and use the same methods
without seeing diverse preferences, unique needs,
and wide-ranging goals? Or have we been swept into
mindless currents in health care? Do we narrow the
depth and scope of our practice when pressed to first
and foremost fix problems, honor protocols, and rack
up productivity? Do our expertise and institutional
bottom lines trump patients’ needs? Does our daily
practice pull us from caring?
Thankfully, mindful occupational therapy has always
occurred and sometimes using a craft. Therapist Betty
Baer (2003) introduced us to J., a Vietnam veteran with
a high-level spinal cord injury (SCI). J. lived in a remote
part of Texas and called himself a “Mountain Man.”
Self-conscious about a tracheotomy scar, he wanted a
beaded choker. Unable to bead because of paralysis,
he and his therapist made this plan: Because J. had to
direct his caregivers well, Baer proposed that he design
a necklace and tell her how to bead it, step by step. She
later wrote:
Our View 1-1 Feedback on Your Turn Responses to Mindfulness and Mindlessness
1-1: The numbers that you wrote on this
figure will vary depending on your
experiences, whether in school or in
practice. Our hope is that after reading
this chapter, any low numbers will
increase. Come back to check these
numbers when you finish the chapter!
1-2: Most responses to the question of
when you become mindless will mention
familiar activities or ones that are simple
or repetitive. You may have mentioned
basic activities of daily living or leisure
tasks, but it’s not unusual to go into
autopilot during instrumental activities of
daily living (such as driving) or educational
and work activities (such as sitting in long
lectures).
1-3: Whether you might feel offended by
this hairdresser or a barber will vary
depending on your expectations, your
✍ The Mindfulness That Empowers Crafts 9
This was a big challenge to both of us. ... To
our mutual amazement, the choker ... looked
great. J. wore it with pride and received many
compliments. This activity not only transformed
a handful of beads into a necklace, but it also
transformed J.’s role from a passive patient
to an active teacher. It was a truly wonderful
experience ... one I will never forget. (p. 5)
The Understanding
That Empowers
Occupational Therapy
Earlier we laid out the mindfulness that makes inter-
ventions “work.” We noted that we must start with deep
understanding. Here we explore the dimensions of the
understanding that we must have. Understanding is a
full appreciation; it is a hard-earned familiarity. When
we understand, we comprehend or grasp things com-
prehensively. Understanding moves us past knowing
to really getting.
Recall the three dimensions of understanding that
occupational therapy practitioners need:
1. We must understand persons, their occupational
natures, and the unsettling disruptions that
personality, and your comfort with
receding quietly into the background.
May Sarton felt that she should
have been acknowledged. A simple
introduction might have pleased her.
1-4: We hope that you can recall many caring
experiences in health care. Usually,
descriptions of caring experiences
include caregiver attitudes and behaviors
that convey respect, consideration, and
understanding. Having been heard makes
a large impression.
1-5: We’re pleased if you thought of
a suggestion to foster this young
therapist’s mindfulness of her patient’s
needs. For our view of how this
conversation might have gone, read
our reframing of the exchange in the
section on Understanding Ourselves
(p. 14).
10 SECTION ONE ✍ Mindful Principles and Processes
occupational challenges can cause in a life so as to
humanize therapy.
2. We must understand our guiding beliefs and
action-oriented principles from person-centered
models in order to set the depth, scope, and
direction of our therapy.
3. We must understand ourselves. We must know
how to use our unique selves so as to become
caring. These three aspects of understanding
support our science and our art.
Your Turn 1-6
Which of the three dimensions of
understanding noted is the one that you feel
you possess and demonstrate the most? To
what do you attribute your capacity?
Understanding Persons and Their
Occupational Natures
To intervene well, occupational therapy practitioners
must understand persons, their occupational natures,
and the unsettling disruptions that occupational chal-
lenges can cause in a life. The strong link between the
human spirit and occupation is well stated by Janet
Petersen (1976) in this snippet from her poem.
There is a shouting SPIRIT
deep inside me:
TAKE CLAY, it cries,
TAKE PEN AND INK
TAKE FLOUR AND WATER,
TAKE A SCRUB BRUSH
TAKE A YELLOW CRAYON
TAKE ANOTHER’S HAND—
AND WITH ALL THESE SAY YOU,
SAY LOVING
So much of who I am
Is subtly spoken in my making (p. 61)
Our grasp of human making lets us see past the sim-
plicity of daily occupations to their deeper meaning.
Philosopher Elaine Scarry (1985) saw in occupation a
world-making function:
As one maneuvers each day through the realm
of tablecloths, dishes, potted plants, ideological
structure, automobiles, newspapers, ideas about
families, streetlights, language, city parks, one
does not at each moment actively perceive the
objects as humanly made; but if one for any
reason stops and thinks about their origins, one
can with varying degrees of ease recover the
fact that they all have human makers. (p. 312)
Occupational challenges force individuals to stop and
think about the making in their lives. Individuals in
our care grasp anew the meaning of the daily doing
that gives them purpose and helps them belong. A
grandmother may grieve because making a family meal
is impossible. A recent graduate may despair over her
lost chance to make a mark at work. A preteen may be
embarrassed that he can’t make himself presentable. We
must stay mindful of such sorrows.
Your Turn 1-7
Name a world-making function that you
would be devastated to lose if injury, illness,
or a chronic condition were to compromise
your capacities.
A practitioner’s understanding of the meaning of
being well occupied can foster an empathy that lessens
sorrow. While thinking of practical ways to help, we can
imagine what it is like to need help with the simplest
or most private of tasks. Such empathy prompts our
hallmark brand of care. Characterized as doing with
another, it stands in high contrast against interventions
that are a doing to (Peloquin, 1995). When we support
the spirit of those who hope to resume their occupa-
tions, we help them remake their lives.
Heller’s occupational therapist, who upped the
grade of sandpaper with the regularity of a machine,
lost touch with our hallmark doing with. Heller found
occupational therapy punishing, and empathy got
lost. Heller was a famous writer, caught in the bind of
Guillain-Barré. Mindless therapy worsened his state:
As soon as he began to sand with rhythm, his task was
made harder. He had hoped to feel success but was
stymied instead. In an ironic twist, his occupational
therapy was a power-down doing to. With the wisdom
of hindsight, we think of things more helpful to Heller.
Sanding sections of a bookend or paper tray might
have given him strength; products related to his writing
might have sparked energetic work and conveyed real
hope. A more recent story of similarly mindless therapy
appears in A Story 1-1.
No practitioner described the enactment of empathy
in occupational therapy better than did Ora Ruggles,
a Reconstruction Aide and pioneer occupational
therapist. We find a legacy in one of her stories. As she
 CHAPTER 1
A STORY 1-1: A Story of Mindless Therapy
as Punishment
From the Life of Cynthia Evetts
The two boys, Mitchell and Marshall, joined their
mother in a visit to their paternal grandmother
in a rehabilitation facility after she had fallen and
injured her hip. The boys were 18 and 12 years
old. When they arrived, their grandmother was
not in her room, so the family went to see her
as she worked on her rehabilitation program
among several others in the same large gym.
The boys saw their grandmother astride a sta-
tionary bicycle, that in itself a rare sight. They also
saw other patients doing therapy: One patient
placed clothespins on a wire. When they were
all placed, the therapist instructed the patient
to remove them all and repeat the process.
Another patient placed geometric shapes into
a box with matching holes. Yet another tossed
beanbags through holes. A fourth placed pegs
into a board. The boys saw that as each patient
finished, the task was either to undo and repeat
or trade tasks with someone nearby. Over and
over, the tasks recurred.
entered the barracks at Fort McPherson, her friends
noted her silence. Ruggles said that her quiet came from
a simple yet huge discovery. She said: “It is not enough
to give a patient something to do with his hands. You
must reach for the heart as well as the hands. It’s the
heart that really does the healing” (Carlova & Ruggles,
1961, p. 59). We hope to enact her vision.
Understanding Our Guiding Beliefs
The second dimension of understanding that makes
therapy work relates to our really getting occupational
therapy. Our essential character lies within the profes-
sion’s ethos. Each guiding belief sets the depth of our
therapy. Each is deeply mindful:
1. We believe that time, place, and circumstance open
paths to occupation. Acting on this belief and
doing the best of what we do, we are pathfinders.
2. We believe that occupation fosters dignity,
competence, and health. Acting on this belief
and doing the best of what we do, we enable
occupations that heal.
✍ The Mindfulness That Empowers Crafts 11
As the boys left the facility, one, earnestly
supported by affirmations from the other, but
not prompted by his occupational therapist
mother, said, “Did you see that? That was awful!
It’s like they were all in purgatory!”
The comment about purgatory begs elabora-
tion. Purgatory, in some belief systems, is a
place where those who have led a life of grace
but are still possessed of sin upon dying expiate
their sins through suffering. Redemption will be
theirs to claim after a period of suffering com-
mensurate with their sins. The term has come
to mean any place of temporary punishment.
Applied to this scenario, rehab practitioners
inflict torment.
Mindless therapy can feel punishing. Although
some therapeutic procedures can cause physi-
cal pain that we may regret, it seems reasonable
that we do our best to change boring approaches
that punish the spirit.
3. We believe that occupational therapy is a personal
engagement. Acting on this belief and doing the
best of what we do, we co-create daily lives.
4. We believe that caring and helping are vital to our
work. Acting on this belief and doing the best of
what we do, we reach for hearts as well as hands.
5. We believe that effective practice is artistry and
science. Acting on this belief and doing the best
of what we do, we are artists and scientists at once
(Peloquin, 2005).
When mindful and doing our best, we enact the
profession’s genius. The contours of our genius are
clearly stated in our guiding beliefs. If we examine the
contours of our daily interventions and hold these up
against those of our genius, we can see whether we are
doing what we profess to do (Fig. 1-6).
Long ago, craftwork was thought to honor nine
curative principles that psychiatrist and founder
William Rush Dunton, Jr. (1921) thought essential
to occupational therapy. Note in Drawing Our Past
Forward 1-1 the early contours of our genius. As we
12 SECTION ONE ✍ Mindful Principles and Processes
FIGURE 1-6 Questionable application of the
occupational therapy genius.
Drawing Our Past Forward 1-1
The Curative Principles of
Occupational Work
William Rush Dunton, Jr., was one of the founders of
the National Society for the Promotion of Occupational
Therapy (NSPOT) who became its president at its Second
Annual Meeting in 1918. A psychiatrist by profession,
Dunton was prolific in writing about his new profession.
He identified nine principles that he thought essential to
occupational work, whether to restore physical or mental
functioning (Dunton, 1919). The principles were these:
1. The work should be carried on with cure
as the main object.
2. The work must be interesting.
3. The patient should be carefully studied.
4. One form of occupation should not be
carried to the point of fatigue.
5. It should have some useful end.
6. It preferably should lead to an increase in
the patient’s knowledge.
7. It should be carried on with others.
8. All possible encouragement should be
given the worker.
9. Work resulting in a poor or useless
product is better than idleness. (p. 320)
We find it notable that the use of mindful crafts almost
a century later still honors these principles to a great
extent.
Dunton, W. R. (1919). Reconstruction therapy. Philadelphia: Saunders.
enact that genius in our time, we reclaim our heart
(Peloquin, 2005).
Insights From Holistic
Person-Centered Models:
Person-Environment-Occupation
and Recovery
Our understanding of occupational therapy must press
further than “getting” our guiding beliefs. If we seek
to implement those beliefs in ways that work well, we
must act on them. We must understand action-oriented
principles drawn from holistic and person-centered
models. Such principles set the scope and direction for
best practice. Holistic models set our scope of concern
wide, capturing the richness of persons as occupational
beings. And person-centered models direct us to see our
clients as experts in framing their needs. We discuss
two models: The Person-Environment-Occupation
(PEO) model (Law, Cooper, Strong, Stewart, Rigby, &
Letts, 1996) and the recovery model (Deegan, 2001;
Onken, Craig, Ridgway, Ralph, & Cook, 2007). Both
embrace holism; both center on clients as primary
agents.
Understanding the
person-environment-occupation model
The PEO model captures the fullness of persons as
“composites of mind, body, and spiritual qualities”
(Law et al., 1996). The model further considers the
influences outside of persons that shape everyday
doing—the occupation itself as well as the environment
within which performance is expected. Because the
model includes the richness and complexity of personal
performance, it is holistic.
When in an analytical frame of mind within this
model, we can tease the discrete ways in which the
person (P), environment (E), and occupation (O)
shape any performance. We might call each of the three
components, whether P, E, or O, an agent—a person
or thing that brings about a result. In this case, the
result is performance of an occupation. The PEO model
proposes that person, environment, and occupation
have a relationship that is transactive, meaning built
on mutual agency. Any performance is “the outcome
of the transaction of the person, environment, and
occupation” (Law, et al., 1996, p. 16).
Let’s consider the PEO transaction further. Consider
P and E and O as influential agents, each with potential
for hindering or supporting occupational performance.
One observable performance—successful hammering
of a nail—seen in its complexity, might be this: Chuck
 CHAPTER 1
Cawshun, a 30-something man, stands poised to
hammer a 2.5″ nail into a 12″ × 12″ pine beam in his
dimly lit garage. He has carpal tunnel syndrome. He
wears two wrist cock-up splints that hold his wrist in
a neutral position. He holds between his knees an 8″ ×
8″ decorative metal sign reading Man Cave. An open
can of blue paint, the lid, a can opener, and a wooden
paint stirrer lie on newspaper 6 inches behind Chuck’s
right foot. A tabby cat sits about 2 feet to Chuck’s right,
licking its paw.
The person (P) in this case is Chuck Cawshun, a
30-something man. He holds a hammer in his right
hand and a nail in his left while wearing carpal tunnel
splints. Pressed together, his knees hold a Man Cave
sign. According to the PEO model, Chuck, as P, is “a
unique being who assumes a variety of roles ... brings
a set of attributes and life experiences to bear on
the transaction ... including self-concept, personality
style, cultural background, and personal competen-
cies” (p. 16). Chuck’s parents used quirky humor
when naming him; he takes well any plays on “Chuck
Caution.”
The environment (E) in this case is the dimly lit
garage and everything in it. But the environment can
be described much more broadly to include social,
cultural, and socioeconomic considerations (Law et
al., 1996). We might benefit from knowing that Chuck
owns his home and garage and gathers there with
coworkers in a computer-programming firm to play
poker every Friday night. He and his wife agree that
the garage is his domain.
Within this model, persons pursue occupations for
the sake of self-maintenance, self-expression, or fulfill-
ment. Chuck’s Friday night games fulfill his need for
male bonding. By the model’s standards, Chuck’s occu-
pation in this moment has hierarchical distinctions.
The broad occupation (O), the decoration of Chuck’s
garage, is “a cluster of activities and tasks in which a
person engages in order to meet his intrinsic needs
for self-maintenance, expression, and fulfillment”
(p. 16). The narrower task is hanging a Man Cave sign
on an upright beam, one of a “set of purposeful activi-
ties in which a person engages” (p. 16). And the specific
activity is narrower still—hammering the nail, or “the
basic unit of any task” (p. 16).
We can predict possible outcomes for this transac-
tion. Wrist pain (P) might distract Chuck. Hitting the
mark with the hammer (O) might be awkward with
splints. The open can behind Chuck in this dimly lit
space (E) might lead to spillage. The cat (E) might bolt
at the crack of the hammer. We’d hope that Chuck’s
humor and coping style (P) would support him.
✍ The Mindfulness That Empowers Crafts 13
Your Turn 1-8
Consider one daily task or activity in which
you engage. Using our example of Chuck,
analytically tease out the PEO agents and
describe the transaction that occurs during
your performance.
The PEO model holds as central that occupational
therapy aims to maximize the fit among the three
transacting components—person, environment, and
occupation—so that optimal performance will occur
(Law et al., 1996). Practitioners work with clients
to structure interventions—PEO transactions—that
enhance performance. For a good fit to occur, interven-
tions often enable changes within the person, the envi-
ronment, or the occupation that support performance.
If Chuck Cawshun were to seek input on his approach
to hammering a nail, an occupational therapist would
explore with him possible changes—whether related to
the use of his wrist (P), the state of his garage (E), or the
way in which hammering might occur (O)—in order to
enhance goodness of fit and his success.
Two other principles from the PEO model are
key to our discussion of mindful crafts and to their
manner of effecting change: (1) “Consider interven-
tions that target the person, environment, and occupa-
tion in different ways,” and (2) “Consider the option of
using multiple avenues for eliciting change” (Law et al.,
1996, p. 18). These considerations prompt us to plan
interventions creatively. They direct us to a variety of
enabling methods that can include crafts.
If used with June Kailes, these principles from
the PEO model would have taken her past drills in
bead sorting. June’s coordination would have stayed
important, but the intervention would have honored
June’s intelligence (P) as well as her leadership in the
Independent Living Center (O and E). A mindful
occupational therapist would have collaborated with
June to find a meaningful way to tap coordination. A
practitioner’s craft suggestions might have been (1) a
motivational office poster using stencils and markers,
(2) a collage on freedom decorating a manila folder
or bookmark, or (3) any craft requiring coordinated
assembly that June considered useful. A practitioner
who really gets the PEO model chooses interventions
that honor the richness and complexity of persons. If
the focus of an intervention must at a given time be on a
person’s strength or coordination, the scope of the PEO
14 SECTION ONE ✍ Mindful Principles and Processes
model can hold that focus while also capturing the big
picture of all else that matters to that person.
Understanding the recovery model
In the past 15 years, a recovery approach to mental
health has emerged in the United Kingdom, North
America, Australia, and New Zealand (Ralph, 2000;
Spandler, Secker, Kent, Hacking, & Shelton, 2007). The
Substance Abuse and Mental Health Services Admin-
istration (SAMHSA, n.d.) describes recovery as a
“journey of healing and transformation.” Occupational
therapist Patricia Deegan (2001) first used the journey
metaphor while characterizing helpers in this model
as facilitators who support self-direction and skill in
managing illness. The idea of “fixing” chronic illness
is not a central aim. Rather, the aim is living life well
when illness is present.
Onken et al. (2007) characterized this idea of
recovery as an integrative paradigm or model. Note
how their analysis of the recovery model recalls the
PEO model and several guiding beliefs in occupational
therapy:
Recovery is a product of dynamic interaction
among characteristics of the individual (the
self/hope/sense of meaning and purpose),
characteristics of the environment (basic
material resources, social relationships,
meaningful activities, peer support, formal
services, formal service staff ), and the
characteristics of the exchange (hope, choice/
empowerment, independence/interdependence).
(p. vii)
In a review of the literature, Davidson et al. (2005)
clarified this dynamic interaction, offering guiding
principles for those engaged in recovery: (1) renew
hope and commitment, (2) redefine the self, (3)
incorporate illness as but one aspect of the self, (4)
be involved in meaningful activities, (5) overcome
stigma, (6) assume control and become empowered,
(7) manage symptoms, and (8) be supported by others.
In a professional fact sheet, the American Occupational
Therapy Association (AOTA) has endorsed the model’s
congruence with practice in mental health (2016). We
propose that the model works for most occupational
therapy practice when one considers the components
thought to characterize the journey.
Ten fundamental components of recovery appear
in the national consensus statement published by
SAMHSA (n.d.). The components remind practitioners
and clients to support actions that align with these
perspectives: (1) self-direction, (2) individualized and
person centered, (3) empowerment, (4) holistic, (5)
nonlinear, (6) strengths based, (7) peer support, (8)
respect, (9) responsibility, and (10) hope. We illustrate
in Box 1-1 each recovery component as enacted in
Baer’s intervention with J., “The Mountain Man.”
The person-centered influences of the recovery
model can shape best practice in occupational therapy.
That claim seems clear in Box 1-2, where we showcase
the potential of the recovery components in shaping
daily interventions.
Well-elaborated recovery components reflect a
definition of recovery that resonates with occupational
therapy: “It is a way of living a satisfying, hopeful, and
contributing life, with or without limitations caused by
the illness. Recovery involves the development of new
meaning and purpose in one’s life” (Anthony, Cohen,
Farkas, & Gagne, 2002).
Your Turn 1-9
Of the 10 components drawn from the
recovery model, which do you think might
be the easiest for you to enact in practice
and why?
Understanding Ourselves
The third dimension of understanding vital to occu-
pational therapy comes from our turning inward to
understand ourselves and how we can work with
others. This aspect of mindfulness helps us become as
caring as we are skilled. Mindful practice first requires
a conscious use of self. This passage explains:
The fact is that wherever one goes, one’s “self ”
goes there too. To know that self, to cultivate
the best of one’s abilities in order to help, is part
of therapy. Some practitioners are especially
good listeners, some are witty, some can charm
a crowd. Some have deep patience, some sing
well, and others love sports. When practitioners
consciously use themselves and their talents
to meet needs that arise in therapy, that action
becomes a tool. Likewise when one knows and
monitors one’s less helpful responses, that, too,
is a conscious use of self. Some practitioners are
moody; some are sensitive to criticism, some
tend to be impulsive. When practitioners note
these tendencies, when they apologize if they
surface unexpectedly, their actions are tools in
therapy. (Peloquin, 2000)
 CHAPTER 1
Box 1-1 | Recovery Components in the Case of
J. the Mountain Man
Self-direction: J. identified his need for a beaded
choker.
Individualized and person centered: The necklace
would cover J.’s tracheotomy scar, eliminating
his embarrassment.
Empowerment: J. directed the therapist as he
would need to direct his caregivers.
Holistic: J.’s necklace was familiar to those in his
age group in Texas (E). He had the intellect
and communication skills to direct another
(P). Beading was a familiar task (O).
Nonlinear (meaning nonsequential in process
with a mix of growth and setbacks): The
occupational therapist called the process
challenging. We imagine back-and-forth
exchanges to get the directions clear and the
beading right. Craftwork here is a metaphor
for recovery.
Box 1-2 | Recovery Components Possible in Occupational
Therapy Practice
We can support the self-direction of our clients.
We can affirm their capacity to make choices
and to find unique pathways to self-determined
lives.
We can assure that our interventions are
individualized and person centered. We can find
the unique strengths of clients as we help them
to meet their needs.
We can attend to the empowerment of our
clients. We can assure that they collaborate in
therapeutic decisions and find a renewed sense
of personal control.
We can be holistic in our perception of client
needs. We can focus on discrete problems while
also respecting an individual’s whole life, to
include mind, body, spirit, and community.
We can remind clients that progress can
be nonlinear. We can help them accept that
✍ The Mindfulness That Empowers Crafts 15
Strengths-based: Paralyzed from the neck down,
J. lacked hand function but used his other
skills and experiences.
Peer support: J. and Baer functioned as peers,
at once giving and getting support.
Respect: Baer respected J.’s capacity to
“transform himself from a passive patient to
an active teacher.” J. took pride in the piece
and heard many compliments.
Responsibility: J. and Baer collaborated, each
responsible for discrete aspects of the work.
J. took on the design and directions. Betty
lent J. her hands.
Hope: Baer’s idea that they make a choker
together was a strong affirmation of hope.
J.’s acceptance was equally hopeful.
although setbacks may occur, overall growth is
part of the journey.
We can hold a strengths-based mindset. We
can prompt our clients to focus on capacities
while developing relationships built on trust.
We can foster peer support among our
clients. We can encourage them to engage in
mutually supportive exchanges that yield a
sense of belonging.
We can uphold mutual respect as our central
norm. We can foster dignity and promote
inclusion and participation.
We can shape responsibility. We can
encourage clients to set personal goals and to
embrace the actions that achieve them.
We can foster hope. We can convey the belief
that individuals can meet most challenges when
they stay positive and focus on possibilities.
16 SECTION ONE ✍ Mindful Principles and Processes
Conscious use of self comes first. When awareness of
self turns helpful, therapeutic use of self emerges.
To be therapeutic in the sense of the word, we must
learn how to use the “self ” in a way that promotes
health and well-being. Renée Taylor’s (2008) discussion
of the intentional relationship helps enormously with
that learning. We note high points of her work here
and elaborate them in subsequent chapters. We recom-
mend her book for the sake of deep understanding.
Taylor, although not an occupational therapist, knows
our practice well. She brings from her psychological
practice keen insights into ours.
Taylor (2008) interviewed and videotaped occu-
pational therapists at work, choosing individuals
thought by peers to be skilled in use of self. She then
elaborated the modes of interaction most common in
occupational therapy: advocating, collaborating, empa-
thizing, encouraging, instructing, and problem solving.
She described each mode to include its applications,
strengths, and weaknesses. She identified client disposi-
tions that invite or discourage one mode over another.
She suggested ways to handle “inevitable interpersonal
events” and “empathic breaks (rifts in understanding
between client and therapist)” lest they thwart our
practice (Taylor, 2008, p. 51).
A core principle of Taylor’s intentional relationship
model (2008) is that we heed the therapeutic relation-
ship. Her model leads us to seek a good fit not just
in our interventions but also in our interactions. She
proposed that, both in advance of and in the moment,
we align our intentions well among those with diverse
preferences, unique needs, and wide-ranging goals. We
must also respond flexibly, as in a partnered dance. It
would be mindless, for example, to choose one mode
and use it exclusively because it “felt natural.” To get
stuck in a problem-solving mode, for example, risks
turning us into caregivers thought to fix more than care
(Peloquin, 1993b). The challenge to learn and use the
modes well is large. But if we really “get” therapeutic
use of self, client perceptions of our caring will grow.
The poem that starts, “Preserve me from the occu-
pational therapist, God,” speaks to the use of self. The
patient calls the therapist a “dear child who means
well,” noting her good intentions. But empathic breaks
occur. The therapist sees closed eyes and perceives a
dozing woman. She chides, “You don’t want to sleep
the day away.” This woman is not dozing. Her thoughts
reveal her need: “Yes, I did those things, and cooked
and cleaned, and raised five children and had things
happen to me ... I need to think about them, rearrange
them on the shelves of my mind.” This need escaped her
young OT.
What if the therapist had used herself differ-
ently? The exchange in Box 1-3 might have occurred
instead:
There is comfort in knowing that the best of caregiv-
ers have empathic breaks. Ruggles (Carlova & Ruggles,
1961) shared hers: “He hadn’t done very well when I
first started with him, but he’s doing fine now. I asked
myself why, and the answer suddenly came to me—the
patient had improved because I had. I had become truly
concerned about him” (p. 69).
The Logical Analysis
and Imaginative Synthesis
That Empower
Occupational Therapy
In the previous section, we noted that practitioners
must use deep understanding if interventions are to
“work.” This section explores the logical analysis and
imaginative synthesis that we must also use. Let’s start
with logic, otherwise known as sound reasoning and
good judgment. Throughout our discussion of under-
standing, we appealed to your logic while making key
points about practice turned mindless. On the edges of
our discussion has been the assumption that craftwork
is a viable intervention. Before we move into logical
activity analysis, we will target the logic of the assump-
tion that crafts have therapeutic worth.
Logical Assumptions About the
Therapeutic Potential of Craftwork
When considering craftwork as mindful therapy in the
light of logic, we might ask: (1) Can craftwork reflect an
understanding of persons, their occupational natures,
and the disruptive effects of occupational challenges?
(2) Can craftwork reflect the guiding beliefs of occupa-
tional therapy and the action-oriented principles drawn
from the PEO and recovery models? (3) Can craftwork
invite practitioners to use themselves both consciously
and therapeutically? We believe so. In our discussion,
we showcased craftwork run amuck and then done
right. We made logical assumptions about how and why
crafts might work therapeutically. Those assumptions
are featured in Box 1-4. We offer two more reasons to
propose craftwork as therapeutic. These reasons, also
grounded in logic, relate to (1) the nature of craftwork
and (2) the profession’s longstanding use of occupations
favored within the culture.
Occupational therapist Beth Velde (1999) examined
the nature of craftwork extensively in her review of
the literature on crafts. She reminded us that many
occupations include a crafting process, from camping
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Title: Psyche's task

A discourse concerning the influence of superstition on the
growth of institutions

Author: James George Frazer

Release date: October 30, 2023 [eBook #71985]

Language: English

Original publication: London: Macmillan and Co., Limited, 1913

Credits: an anonymous Project Gutenberg volunteer

*** START OF THE PROJECT GUTENBERG EBOOK PSYCHE'S

TASK ***
 PSYCHE’S TASK
A DISCOURSE CONCERNING
THE INFLUENCE OF SUPERSTITION ON
THE GROWTH OF INSTITUTIONS

SECOND EDITION, REVISED AND ENLARGED

TO WHICH IS ADDED
THE SCOPE OF SOCIAL ANTHROPOLOGY
AN INAUGURAL LECTURE

BY
J. G. FRAZER, D.C.L., LL.D., Litt.D.
FELLOW OF TRINITY COLLEGE, CAMBRIDGE
PROFESSOR OF SOCIAL ANTHROPOLOGY IN THE UNIVERSITY OF
LIVERPOOL

MACMILLAN AND CO., LIMITED

ST. MARTIN’S STREET, LONDON
1913
 [EPIGRAPHS]
Good and evil we know in the field of this world grow up together
almost inseparably; and the knowledge of good is so involved and
interwoven with the knowledge of evil and in so many cunning
resemblances hardly to be discerned, that those confused seeds,
which were imposed on Psyche as an incessant labour to cull out
and sort asunder, were not more intermixt.
Milton, Areopagitica.

Il ne faut pas croire cependant qu’un mauvais principe vicie

radicalement une institution, ni même qu’il y fasse tout le mal qu’il
porte dans son sein. Rien ne fausse plus l’histoire que la logique:
quand l’esprit humain s’est arrêté sur une idée, il en tire toutes les
conséquences possibles, lui fait produire tout ce qu’en effet elle
pourrait produire, et puis se la représente dans l’histoire avec tout ce
cortège. Il n’en arrive point ainsi; les événements ne sont pas aussi
prompts dans leur déductions que l’esprit humain. Il y a dans toutes
choses un mélange de bien et de mal si profond, si invincible que,
quelque part que vous pénétriez, quand vous descendrez dans les
derniers éléments de la société ou de l’âme, vous y trouverez ces
deux ordres de faits coexistant, se développant l’un à côté de l’autre
et se combattant, mais sans s’exterminer. La nature humaine ne va
jamais jusqu’aux dernières limites, ni du mal ni du bien; elle passe
sans cesse de l’un à l’autre, se redressant au moment où elle
semble le plus près de la chute, faiblissant au moment où elle
semble marcher le plus droit.
Guizot, Histoire de la civilisation dans l’Europe, Cinquième
Leçon.
 [DEDICATION]
TO
ALL WHO ARE ENGAGED
IN PSYCHE’S TASK
OF SORTING OUT THE SEEDS OF GOOD
FROM THE SEEDS OF EVIL
I DEDICATE THIS DISCOURSE
 PREFACE
The substance of the following discourse was lately read at an
evening meeting of the Royal Institution in London, and most of it
was afterwards delivered in the form of lectures to my class at
Liverpool. It is now published in the hope that it may call attention to
a neglected side of superstition and stimulate enquiry into the early
history of those great institutions which still form the framework of
modern society. If it should turn out that these institutions have
sometimes been built on rotten foundations, it would be rash to
conclude that they must all come down. Man is a very curious
animal, and the more we know of his habits the more curious does
he appear. He may be the most rational of the beasts, but certainly
he is the most absurd. Even the saturnine wit of Swift, unaided by a
knowledge of savages, fell far short of the reality in his attempt to set
human folly in a strong light. Yet the odd thing is that in spite, or
perhaps by virtue, of his absurdities man moves steadily upwards;
the more we learn of his past history the more groundless does the
old theory of his degeneracy prove to be. From false premises he
often arrives at sound conclusions: from a chimerical theory he
deduces a salutary practice. This discourse will have served a useful
purpose if it illustrates a few of the ways in which folly mysteriously
deviates into wisdom, and good comes out of evil. It is a mere sketch
of a vast subject. Whether I shall ever fill in these bald outlines with
finer strokes and deeper shadows must be left to the future to
determine. The materials for such a picture exist in abundance; and
if the colours are dark, they are yet illuminated, as I have tried in this
essay to point out, by a ray of consolation and hope.
J. G. FRAZER.

Cambridge, February 1909.

 NOTE TO THE SECOND EDITION
In this edition Psyche’s Task has been enlarged by fresh illustrative
examples and by the discussion of a curious point of savage
etiquette, but the substance and the form of the discourse remain
unchanged. I have added The Scope of Social Anthropology, an
inaugural lecture intended to mark out roughly the boundaries of the
general study of which Psyche’s Task aims at setting forth some
particular results. There is therefore a certain appropriateness in
presenting the two discourses together to the reader.
J. G. F.

Cambridge, 6th June 1913.

 CONTENTS
Preface

PSYCHE’S TASK

I. Introduction

The dark and the bright side of Superstition: a plea for the accused:
four propositions to be proved by the defence 3-5

II. Government

Superstition has been a prop of Government by inculcating a deep

veneration for governors: evidence of this veneration collected
from Melanesia, Polynesia, Africa, the Malay region, and
America: evidence of similar veneration among Aryan peoples
from India to Scotland 6-19

III. Private Property

Superstition has been a prop of Private Property by inculcating a

deep fear of its violation: evidence of this fear collected from
Polynesia, Melanesia, the Malay Archipelago, Europe, Asia,
Africa, and America 20-43

IV. Marriage

Superstition has been a prop of Marriage by inculcating a deep fear

of disregarding the traditionary rules of sexual morality:
evidence of this fear collected from South-Eastern Asia, the
Malay Archipelago, Africa, the Hebrews, the Greeks, the
Romans, and the Irish: extreme severity with which breaches of
 the sexual code have been punished in India, Babylon,
Palestine, Africa, the East Indies, Australia, America, and
Europe: the avoidance of the wife’s mother and of a man’s own
mother, sisters, daughters, and female cousins, based on the
fear of incest: the origin of the fear of incest unknown: belief that
adultery and fornication inflict physical injury not only on the
culprits but on their innocent relations: evidence of the belief
collected from Africa, America, Sumatra, and New Britain 44-
110

V. Respect for Human Life

Superstition has been a prop for the Security of Human Life by

inculcating a deep fear of the ghosts of the murdered dead:
evidence of the fear collected from ancient Greece, modern
Africa, America, India, New Guinea, Celebes, the Bismarck
Archipelago, and Fiji: deep fear of ghosts in general: evidence
collected from America, Africa, India, Burma, the Indian
Archipelago, Australia, New Guinea, and China: influence of the
fear in restraining men from murder 111-153

VI. Conclusion

Summing up for the defence: by serving as a prop for government,

private property, marriage, and human life, Superstition has
rendered a great service to humanity: Superstition at the bar:
sentence of death 154-156

THE SCOPE OF SOCIAL ANTHROPOLOGY

Anthropology, or the Science of Man, a new study: Social

Anthropology restricted to the rudimentary phases of human
society: not concerned with the practical application of its
results: all forms of human society either savage or evolved out
of savagery: hence Social Anthropology deals primarily with
savagery and secondarily with those survivals of savagery in
civilization which are commonly known as folklore: importance
of the study of savagery for an understanding of the evolution of
 the human mind: existing savages primitive only in a relative
sense by comparison with civilized peoples: in reality the
savages of the present day probably stand at a high level of
culture compared with their remote predecessors: for example,
the present systems of marriage and consanguinity among
savages appear to have been preceded by a period, not
necessarily primitive, of sexual communism: survivals of
savagery in civilization due to the natural and ineradicable
inequality of men: mankind ultimately led by an intellectual
aristocracy: superstition the creed of the laggards in the march
of intellect: the wide prevalence of superstition under the surface
of society a standing menace to civilization: the lowest forms of
superstition the most tenacious of life: function of the
Comparative Method in reconstructing the early history of
human thought and institutions: its legitimacy based on the
ascertained similarity of the human mind in all races: the need of
studying savages only of late years understood: urgent
importance of the study in consequence of the rapid
disappearance of savagery: the duty of our generation to
preserve a record of it for posterity: the duty of the Universities
and of the State 157-176

INDEX 177-186

ENDNOTES
PSYCHE’S TASK
 I.
INTRODUCTION

We are apt to think of superstition as an

The dark side of unmitigated evil, false in itself and pernicious in its
superstition.
consequences. That it has done much harm in the
world, cannot be denied. It has sacrificed countless lives, wasted
untold treasures, embroiled nations, severed friends, parted
husbands and wives, parents and children, putting swords, and
worse than swords between them: it has filled gaols and madhouses
with its innocent or deluded victims: it has broken many hearts,
embittered the whole of many a life, and not content with persecuting
the living it has pursued the dead into the grave and beyond it,
gloating over the horrors which its foul imagination has conjured up
to appal and torture the survivors. It has done all this and more. Yet
the case of superstition, like that of Mr. Pickwick
The brighter side of after the revelations of poor Mr. Winkle in the
superstition.
witness-box, can perhaps afford to be placed in a
rather better light; and without posing as the Devil’s Advocate or
appearing before you in a blue flame and sulphureous fumes, I do
profess to make out what the charitable might call a plausible plea
for a very dubious client. For I propose to prove, or at least make
probable, by examples that among certain races and at certain
stages of evolution some social institutions which we all, or most of
us, believe to be beneficial have partially rested on a basis of
superstition. The institutions to which I refer are purely secular or
civil. Of religious or ecclesiastical institutions I shall say nothing. It
might perhaps be possible to shew that even religion has not wholly
escaped the taint or dispensed with the support of superstition; but I
prefer for to-night to confine myself to those civil institutions which
people commonly imagine to be bottomed on nothing but hard
common sense and the nature of things. While the institutions with
which I shall deal have all survived into civilized society and can no
doubt be defended by solid and weighty arguments, it is practically
certain that among savages, and even among peoples who have
risen above the level of savagery, these very same institutions have
derived much of their strength from beliefs which nowadays we
should condemn unreservedly as superstitious and absurd. The
institutions in regard to which I shall attempt to prove this are four,
namely, government, private property, marriage, and the respect for
human life. And what I have to say may be
Four propositions to summed up in four propositions as follows:—
be proved.
I. Among certain races and at certain times
superstition has strengthened the respect for government, especially
monarchical government, and has thereby contributed to the
establishment and maintenance of civil order.
II. Among certain races and at certain times superstition has
strengthened the respect for private property and has thereby
contributed to the security of its enjoyment.
III. Among certain races and at certain times superstition has
strengthened the respect for marriage and has thereby contributed to
a stricter observance of the rules of sexual morality both among the
married and the unmarried.
IV. Among certain races and at certain times superstition has
strengthened the respect for human life and has thereby contributed
to the security of its enjoyment.
Before proceeding to deal with these four
Preliminary propositions separately, I wish to make two
remarks.
remarks, which I beg you will bear in mind. First, in
what I have to say I shall confine myself to certain races of men and
to certain ages of history, because neither my time nor my
knowledge permits me to speak of all races of men and all ages of
history. How far the limited conclusions which I shall draw for some
races and for some ages are applicable to others must be left to
future enquiries to determine. That is my first remark. My second is
this. If it can be proved that in certain races and at certain times the
institutions in question have been based partly on superstition, it by
no means follows that even among these races they have never
been based on anything else. On the contrary, as all the institutions
which I shall consider have proved themselves stable and
permanent, there is a strong presumption that they rest mainly on
something much more solid than superstition. No institution founded
wholly on superstition, that is on falsehood, can be permanent. If it
does not answer to some real human need, if its foundations are not
laid broad and deep in the nature of things, it must perish, and the
sooner the better. That is my second remark.
 II.
GOVERNMENT

With these two cautions I address myself to my

Superstition as a first proposition, which is, that among certain races
prop of government.
and at certain times superstition has strengthened
the respect for government, especially monarchical government, and
has thereby contributed to the establishment and maintenance of
civil order.
Among many peoples the task of government
Superstitious has been greatly facilitated by a superstition that
respect for chiefs in
Melanesia. the governors belong to a superior order of beings
and possess certain supernatural or magical
powers to which the governed can make no claim and can offer no
resistance. Thus Dr. Codrington tells us that among the Melanesians
“the power of chiefs has hitherto rested upon the belief in their
supernatural power derived from the spirits or ghosts with which they
had intercourse. As this belief has failed, in the Banks’ Islands for
example some time ago, the position of a chief has tended to
become obscure; and as this belief is now being generally
undermined a new kind of chief must needs arise, unless a time of
anarchy is to begin.”6.1 According to a native Melanesian account,
the authority of chiefs rests entirely on the belief that they hold
communication with mighty ghosts and possess that supernatural
power or mana, as it is called, whereby they are able to bring the
influence of the ghosts to bear on human life. If a chief imposed a
fine, it was paid because the people firmly believed that he could
inflict calamity and sickness upon such as resisted him. As soon as
any considerable number of his subjects began to disbelieve in his
influence with the ghosts, his power to levy fines was shaken.7.1 It is
thus that in Melanesia religious scepticism tends to undermine the
foundations of civil society.
Similarly Mr. Basil Thomson tells us that “the key to the
Melanesian system of government is Ancestor-worship. Just as
 every act in a Fijian’s life was controlled by his fear
Superstitious of Unseen Powers, so was his conception of
respect for chiefs in
Fiji. human authority based upon religion.” The dead
chief was supposed still to watch jealously over his
people and to punish them with dearth, storms, and floods, if they
failed to bring their offerings to his tomb and to propitiate his spirit.
And the person of his descendant, the living chief, was sacred; it was
hedged in by a magic circle of taboo and might not even be touched
without incurring the wrath of the Unseen. “The first blow at the
power of the chiefs was struck unconsciously by the missionaries.
Neither they nor the chiefs themselves realized how closely the
government of the Fijians was bound up with their religion. No
sooner had a missionary gained a foothold in a chief village than the
tabu was doomed, and on the tabu depended half the people’s
reverence for rank. The tabu died hard, as such institutions should
do. The first-fruits were still presented to the chief, but they were no
longer carried from him to the temple, since their excuse—as an
offering to persuade the ancestors to grant abundant increase—had
passed away. No longer supported by the priests, the Sacred Chief
fell upon evil days”; for in Fiji, as in other places, the priest and the
chief, when they were not one and the same person, had played into
each other’s hands, both knowing that neither could stand firm
without the aid of the other.7.2
In Polynesia the state of things was similar.
Superstitious There, too, the power of chiefs depended largely
respect for chiefs in
Polynesia generally on a belief in their supernatural powers, in their
and in New Zealand relation to ancestral spirits, and in the magical
particularly. virtue of taboo, which pervaded their persons and
interposed between them and common folk an
invisible but formidable barrier, to pass which was death. In New
Zealand the Maori chiefs were deemed to be living atuas or gods.
Thus the Rev. Richard Taylor, who was for more than thirty years a
missionary in New Zealand, tells us that in speaking a Maori chief
“assumed a tone not natural to him, as a kind of court language; he
kept himself distinct from his inferiors, eating separately; his person
was sacred, he had the power of holding converse with the gods, in
fact laid claim to being one himself, making the tapu a powerful
adjunct to obtain control over his people and their goods. Every
means were used to acquire this dignity; a large person was thought
to be of the highest importance; to acquire this extra size, the child of
a chief was generally provided with many nurses, each contributing
to his support by robbing their own offspring of their natural
sustenance; thus, whilst they were half-starved, miserable-looking
little creatures, the chief’s child was the contrary, and early became
remarkable by its good appearance. Nor was this feeling confined to
the body; the chief was an atua, but there were powerful and
powerless gods; each naturally sought to make himself one of the
former; the plan therefore adopted, was to incorporate the spirits of
others with their own; thus, when a warrior slew a chief, he
immediately gouged out his eyes and swallowed them, the atua
tonga, or divinity, being supposed to reside in that organ; thus he not
only killed the body, but also possessed himself of the soul of his
enemy, and consequently the more chiefs he slew, the greater did
his divinity become.… Another great sign of a chief was oratory—a
good orator was compared to the korimako, the sweetest singing
bird in New Zealand; to enable the young chief to become one, he
was fed upon that bird, so that he might the better acquire its
qualities, and the successful orator was termed a korimako.”8.1
Again, another writer informs us that the opinions of Maori chiefs
“were held in more estimation than those of others, simply because
they were believed to give utterance to the thoughts of deified men.
No dazzling pageantry hedged them round, but their persons were
sacred.… Many of them believed themselves inspired; thus Te Heu
Heu, the great Taupo chief and priest, shortly before he was
swallowed up by a landslip, said to a European missionary: ‘Think
not that I am a man, that my origin is of the earth. I come from the
heavens; my ancestors are all there; they are gods, and I shall return
to them.’ ”9.1 So sacred was the person of a Maori chief that it was
not lawful to touch him, even to save his life. A chief has been seen
at the point of suffocation and in great agony with a fish bone
sticking in his throat, and yet not one of his people, who were
lamenting around him, dared to touch or even approach him, for it
would have been as much as their own life was worth to do so. A
missionary, who was passing, came to the rescue and saved the
chief’s life by extracting the bone. As soon as the rescued man
recovered the power of speech, which he did not do for half an hour,
the first use he made of it was to demand that the surgical
instruments with which the bone had been extracted should be given
to him as compensation for the injury done him by drawing his
sacred blood and touching his sacred head.9.2
Not only the person of a Maori chief but
Superstitious fear of everything that had come into contact with it was
contact with Maori
chiefs. sacred and would kill, so the Maoris thought, any
sacrilegious person who dared to meddle with it.
Cases have been known of Maoris dying of sheer fright on learning
that they had unwittingly eaten the remains of a chief’s dinner or
handled something that belonged to him. For example, a woman,
having partaken of some fine peaches from a basket, was told that
they had come from a tabooed place. Immediately the basket
dropped from her hands and she cried out in agony that the atua or
godhead of the chief, whose divinity had been thus profaned, would
kill her. That happened in the afternoon, and next day by twelve
o’clock she was dead.9.3 Similarly a chief’s tinder-box has proved
fatal to several men; for having found it and lighted their pipes with it
they actually expired of terror on learning to whom it belonged.10.1
Hence a considerate chief would throw away where it could not be
found any garment or mat for which he had no further use, lest one
of his subjects should find it and be struck dead by the shock of its
inherent divinity. For the same reason he would never blow a fire
with his mouth; for his sacred breath would communicate its sanctity
to the fire, and the fire would pass it on to the meat that might be
cooked on it, and the meat would carry it into the stomach of the
eater, and he would die.10.2 Thus the divinity which hedged a Maori
chief was a devouring flame which shrivelled up and consumed
whatever it touched. No wonder that such men were implicitly
obeyed.
In the rest of Polynesia the state of things was
Superstitious similar. For example, the natives of Tonga in like
respect for chiefs
and kings in Tonga manner believed that if any one fed himself with
and Tahiti. his own hands after touching the sacred person of
a superior chief, he would swell up and die; the