Running Head: OCCUPATIONAL PROFILE AND ANALYSIS

Occupational Profile and Analysis

Elisa Dick
Touro University, Nevada

OCCUPATIONAL PROFILE AND ANALYSIS

Occupational Profile
Lilly (not her real name) is a 28-year-old mother who is receiving services at Community
Counseling of Nevada. She suffers from a comorbid diagnosis of substance abuse and bipolar
disorder. Due to an unknown offence, Lilly is under the jurisdiction of the mental health court
system. She must continue to meet the requirements of her treatment, including residing in a
group home, attending therapy sessions at Community Counseling five times a week, and testing
negative for drugs, or she will face incarceration. Lilly has been sober approximately five months
and reports a strong desire for continued sobriety.
Lillys history with substance abuse began at age 12. Within a few years, she had tried
alcohol, marijuana, cocaine, and heroin. All her peer interactions centered around getting high.
After dropping out of high school, her drug of choice became methamphetamine. This habit was
supported at first by her boyfriend, and then, she implies, through theft. Much of the details of
Lillys life remain unknown to me. Due to the circumstances of the setting I was only able to
piece together her story from what she shared in group therapy sessions.
Lilly frequently talks about her two young children. Child Protective Services has been
involved with her family and they currently reside with their father, also a recovering addict. He
has been sober for approximately six months longer than Lilly, which causes her envy and
resentment of his success. Lilly has strained relationships with several of her family members,
including her mother, aunt, and stepmother, who either currently use drugs or have used them in
the past. Because her relationships with her family always centered around drug use, she has
trouble interacting with them now that she is sober. She would like to strengthen these
relationships, but is unsure how to proceed.

OCCUPATIONAL PROFILE AND ANALYSIS

Lilly is seeking disability status for the Social Security Administration. I am unaware of
the cause and status of her disability. She is the most highly functioning member of the group,
and appears sound in her cognition and physical state. I am unaware of any employment history,
it is possible that she has not held a regular job.
Lillys daily routine is highly structured, as required by her residential facility. She wakes
up at 6:00 AM and dresses, makes her bed, performs chores, and has breakfast. A shared van
drives clients to their various counseling facilities. Her group session is from 9 AM-12 PM
Monday through Friday. After this, she returns home for lunch. In the afternoon she may attend
Narcotics Anonymous (NA) meetings, participate in mandatory group activities, go to
appointments, or do chores. After dinner, clients have free time, and can go to the gym or pool at
the facility.
From my observation, Lilly is doing well in her recovery. She has some conflicts with
other clients in the facility, but seems to find the environment conducive to recovery. She is not
allowed to leave the facility without permission during the week. The highly structured
environment seems to agree with her. I have noticed other members of the group have anger
management issues, and the structure of the environment and staff are a source of constant
conflict. Lilly reports that she enjoys her home and daily routines.
Lilly looks forward to the weekends with great anticipation, but this is also a source of
anxiety in her life. Saturday and Sunday are much less structured at the facility, and she can
attend community events and be away for extended periods of time. Lilly has earned the
privilege to visit her daughters most weekends. She enjoys this immensely, but it adds strain that
is not present on her highly structured weekdays. Lilly enjoys playing with her daughters, but is
still adjusting to having these interactions in a sober state. She states that she previously used

OCCUPATIONAL PROFILE AND ANALYSIS

meth to keep up with the energetic girls, and to cook and clean quickly without getting tired. She
would also use alcohol and opiates in the evening to relax and deal with the stresses of parenting.
Lilly feels guilty when she is with her children because of her past drug abuse, and this guilt is a
trigger for her to want to use.
On the weekends, Lilly sometimes visits other family members. One weekend she was
visiting her dad, and when she walked into the kitchen she was shocked to find her stepmother
smoking meth. She was able to immediately remove herself from the situation and did not use
the drug. She talked frequently about this incident the following week. She was having dreams
about using and constantly replayed the scene in her mind. While this is a more blatant example
of family drug use, she reports witnessing her mother taking pills on several occasions. While
Lilly wishes to have relationships with these family members, she recognizes that exposure to
drugs is a trigger for her.
Lilly is on several medications for bipolar disorder. One side effect is that she has gained
a significant amount of weight. She is self-conscious about her body and suffers from low selfesteem. She feels sluggish and is unmotivated to exercise, and frequently thinks of using meth
for weight loss. With meth, she says she has endless energy and she knows she could lose the
weight in a few weeks. Because traditional weight loss is slow and difficult, she is unmotivated
to try.
Sobriety is the main focus of Lillys life. She knows that only through sobriety can she
avoid incarceration and hope to regain custody of her children. She has very little idea of how
she will transition to living independently; it seems this is a far-off goal that to her feels
unobtainable. Lilly would like to maintain relationships with the members of her family, but she
knows this is problematic.

OCCUPATIONAL PROFILE AND ANALYSIS

Occupational Analysis
I observed Lilly participating in group therapy sessions, which falls under the educational
domain of occupational engagement. This is not a traditional educational setting, but shares
characteristics with formal education. Lilly is required to attend group for the specified time and
hours, and is required to report on her status and participate. The goal of group is to help clients
transition to a life free from drugs and alcohol, including providing resources and suggestions for
living and work situations. Clients share their personal experiences with coping with sobriety, so
that others may learn and find similar success.
As this is a discussion-based activity, many of the client factors fall under the category of
mental function. Lilly has the global mental functions necessary to meet the demands of
engaging in group. She is generally at a comfortable level of arousal and motivated to
participate. Her temperament is fairly level, and she has good emotional stability. Because of the
intense and personal nature of discussions, some emotional fluctuation will occur. At one point
she was discussing the death of her cousin by overdose, and had written a letter to him. She read
the letter aloud then became emotionally distraught. Her ability to cope brought her back to a
calm level where she was again able to participate in discussion. Many of the other clients do not
possess these skills and have outbursts inappropriate to the group setting. Lilly is able to control
her own reactions and not lash out at these clients, although she did mention to me after group
that this can be hard, because she is trying so hard and sees other clients lacking in dedication. In
terms of other body structures and functions, Lilly has not indicated any difficulties.
The activity demands of group therapy center largely around cognition and social
participation, although other factors can also be considered. The physical environment is a 30 by
30 foot room with a closing door. The room contains two large tables surrounded by chairs.

OCCUPATIONAL PROFILE AND ANALYSIS

Efforts have been made to make the room comfortable, although it is lacking in upkeep. The fact
that the room is enclosed makes it feel private and encourages clients to be candid. There is a
constant stream of air conditioning in the room, which makes me cold but the clients love. The
therapist sets up the room with a pitcher or water and disposable cups prior to each session, and
wants the environment to be as welcoming as possible.
The physical environment sets the tone for the social environment. Clients are
encouraged to speak their mind, but do so in a respectful and productive manner. There are
ground rules for group participation. All clients much share their check-in information at the
start of group. This includes their desire to use, suicidal or homicidal ideations, and a goal for the
day. Clients must express their feelings using I fell rather than you fell or other terms that
separate the experience from themselves. Discussions are encouraged, but interrupting and
rudeness is not allowed and will be moderated by the therapist.
The sequencing of therapy sessions will vary, but each will begin with the check-in
described above. Some days the therapist will have a set topic for discussion, other days the
conversation follows an organic progression through topics chosen by clients. One break is given
during the session so that clients may go outside for a smoke, stretch, and generally have a break
from the intensity of group.
Performance skills to participate in group are largely cognitive. Clients must behave in a
manner acceptable in this context. Clients are encouraged to express themselves as they feel,
using course language and displaying emotions such as anger is permitted. Because this group
has a large mental health component, some group members have trouble with social boundaries.
Physically, clients need to be able to produce speech and listen. This requires the physical
mechanisms for speech and hearing as well as the neurological pathways and cognition to

OCCUPATIONAL PROFILE AND ANALYSIS

process language. All the clients in this group are able-bodied, but a client in a wheelchair or
with motor impairments could easily be accommodated.
There are performance patterns for both the individual client and the group during
sessions. Aside from participating in check-in, Lilly does not have any particular habits or
routines during group. She is usually attentive to the discussion, but her participation will depend
on the topic and her mood. Unlike some group members, she does not exhibit behaviors that are
attention seeking. The whole routine of her structured life is very regular, and attending group is
her regular weekday morning activity. She fits the role of an individual in recovery well and
seems to have adapted to this persona, to the extent that her life lacks individuality. She may find
following her routines easier than facing life with free volition. As an organization, the group
members have typical behaviors that can be considered roles. There is the woman who needs
attention and will behave dramatically with her body language as she describes her physical
ailments or the wrongs committed against her. There is the young man who wants to change the
subject and hijack the conversation. The newest member when I left seemed quite unstable and
would have frequent outbursts that were completely off-topic. Lilly is more contemplative before
she speaks, and is nurturing in her responses to other members, filling somewhat of a mothering
role. Together, the combination of these individuals make up the group dynamic.
The performance skills necessary to participate in group therapy include the physical
ability to come to group and sustain a seated position for three hours. Participants must have the
physical structures of the ear, neurological pathways to convey sensory information, and
processing centers of the brain to comprehend speech. To produce speech, the person much have
the cortical centers to produce speech, the neurological pathways to send motor signals, and the
muscular abilities in the larynx to produce speech. Emotional regulation, social skills, and

OCCUPATIONAL PROFILE AND ANALYSIS

communication skills are crucial in this environment. Many clients are lacking in one or more of
these categories, and the act of attending group and receiving feedback can in itself help improve
these skills.
In analyzing the body functions and body structures influenced by this task, the answer is
more abstract. The act of participating in group therapy is through verbal communication, and
very little physical movement is involved. The changes that come about from participation are
psychosocial. Clients are here to learn how to cope with their addiction, and the cognitive, social,
and emotional regulation skills that develop are the desired outcome.
The contexts of group therapy can be viewed on many different levels. All clients have
their own personal experience with life and with their addiction, but there are many cultural
similarities. Even between clients that differ in age by several decades, their stories of the
progression of their drug use have many similarities. Many of these clients also live together in
group homes, and a culture develops as they all share the same goal: staying clean. This shared
culture also stems from the temporal contexts shared by clients. They all come to group at the
same time, and those residing in the same facility will share the same schedule throughout the
say. The physical environment for group is the room at Community Counseling, and within this
context the social context for group is created. All clients are here for the same reason, substance
abuse, and for the most part they support each other in their shared goal. There will always be
conflicts within the group, just as there will always be benefits. The members of the group
change almost daily, as clients complete their term or drop out, and are replaced with new faces,
struggling with the same problem.
Problem List

OCCUPATIONAL PROFILE AND ANALYSIS

1. Due to Lillys history of substance abuse, she does not engage in meaningful occupations
2.
3.
4.
5.

or leisure activities.
Lilly lacks parenting skills to care for her young children because of her past drug use.
Lilly puts herself in situations that may trigger her to use drugs due to poor judgment.
Lilly suffers low self-esteem due to weight gain from medications.
Lilly lacks a support system on non-drug users due to her longstanding involvement with
drugs.
I consider problem 1 to be the highest priority because it does encompass goals 2-5 as

well. Lilly has been abusing drugs and alcohol since she was 12, and missed many
developmental milestones of adolescence and young adulthood. She did not develop her
sense of self through exploration of hobbies and career interests, instead all activities
revolved around procuring and using drugs. While Lilly is doing well in the highly structured
environment of recovery, she has little idea what to do with herself otherwise. If Lilly finds
occupations that are meaningful, it will give her purpose in life beyond using drugs. Through
activities she will meet friends who share the same interests, therefore developing a support
system. If she finds a physical activity she enjoys, this will help her to maintain a healthy
weight, and improve her self-esteem.
As Lilly starts exploring activities she can do sober, this can improve her engagement
with her children. She needs to learn how to interact with them and deal with the stress of
parenting without using drugs. Lilly loves her children very much, and being an active and
effective parent will give her a role and purpose in life.

OCCUPATIONAL PROFILE AND ANALYSIS

References
American Occupational Therapy Association. (2008). Occupational therapy practice
framework: Domain and process (2nd ed.). American Journal of Occupational Therapy,
62, 625683.

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