The Elizabeth Casson Memorial Lecture is one of the most prestigious lectures in the occupational therapy profession, delivered each year by someone recognised for their significant contribution to occupational therapy practice, leadership, education, or research. This year’s lecture was delivered by Sue Parkinson,
I think I first met Sue as a fairly newly qualified occupational therapist at the then College of Occupational Therapists’ head office during MOHOST training. What I remember most was her passion, and one moment has always stayed with me.
Sue showed us a video of somebody putting on make-up very chaotically, and we had to score the assessment based on what we observed. Sue helped us think about scoring what we had seen using the FAIR scale — Facilitates, Allows, Inhibits, and Restricts — and consider motivation, routines, environment, performance, identity, and participation, all through one everyday occupation.
It was also lovely to hear that Sue is a second-generation occupational therapist. Sue spoke about her Quaker upbringing, her mother being an occupational therapist, and how ideas around simplicity, environment and participation influenced her thinking.
What came through most strongly in the lecture was Sue’s focus on managing complexity and sustaining occupation-centred practice through clear models, assessments, narratives and interventions.
One part of the lecture I particularly loved was Sue’s reflection on her own lived experience of occupation changing during maternity leave. Sue spoke about how changes to her environment, routines, roles, capacity and volition helped her truly understand the interaction between the different elements of MOHO. That reflection really spoke to me because it grounded the theory in real human experience and reminded us that occupational therapy models are not just things we apply to other people, but ideas that help explain all of our occupational lives.
I also really appreciated the care Sue took with language throughout the lecture. Every time she referred to somebody whose work had influenced her thinking, she used their full name. And when acronyms or shortened terms came up, she said them out loud in full before moving on. That might sound like a small thing, but I noticed it straight away. In a profession where we can so easily slip into abbreviations and shorthand, it felt thoughtful and inclusive. It made the lecture easier to follow and modelled something really important about accessible communication.
Sue reflected on how occupations that appear simple on the surface are often far more complex than people realise. She spoke about how occupational therapists hold complex professional reasoning that often remains invisible to others. What may look like an everyday task can involve layers of observation, adaptation, environmental consideration and therapeutic reasoning.
As I listened, I reflected on my own experiences of receiving occupational therapy during my long hospital admission after intensive care. To someone else, the tasks I was doing may have looked simple. Brushing my teeth. Holding a toothbrush. Sitting in a shower.
But after months in hospital and time in intensive care, none of those things were simple.
I remember how exhausting it felt simply to hold the toothbrush in my hand. The effort it took to lift my arm. The fatigue that followed. I remember finally managing a shower with my occupational therapist supporting me throughout. She got absolutely soaked in the process, but what looked to others like “just having a shower” was actually an incredibly complex occupational achievement at that point in my recovery.
There was weakness, pain, fatigue, planning difficulties, balance difficulties, and fear all wrapped into what appeared to others to be an ordinary, everyday task.
And perhaps that is exactly what Sue was describing throughout her lecture.
Another important part of the lecture was Sue’s discussion around the Model of Human Occupation (MOHO) and how models of practice can help occupational therapists manage complexity rather than become overwhelmed by it. She spoke about the importance of making professional reasoning more visible and giving occupational therapists tools and language that help make occupation-centred practice clearer, more consistent and easier to sustain.
If I am honest, MOHO was not a model I immediately got on board with when I first came across it at university. I really struggled with the language and the concepts at the time, and I remember finding parts of it hard to connect with. Looking back now, almost twenty-five years later, I can see how much that has changed. It has become a model I often return to when thinking through occupational formulation. It provides a really helpful structure for making sense of someone’s occupational story and understanding the interaction among what matters to them, the environment around them, and how they participate in daily life. Hearing Sue speak reminded me that sometimes these models take time. We grow into them, and they grow with us through practice.
I also really valued Sue’s reflections on occupational formulation and narrative. She described formulation as taking complex professional reasoning and turning it into a meaningful story that helps make sense of somebody’s occupational life, needs and goals. That felt particularly important at a time when occupational therapists often work within systems that value standardisation, outcomes and efficiency.
I also now really want to go away and learn more about Sue’s TICKS goal-setting framework. The way she broke goals down into Timeframe, Individual, Change expected, Key goal, and Supports felt both practical and very occupational therapy-focused.
Towards the end of the lecture, Sue reflected that occupational therapists should not feel embarrassed when what they do appears simple.
I think she is right.
Sometimes the occupations that appear the most ordinary on the surface can hold the greatest complexity, effort and meaning for the person doing them.
I would highly recommend watching Sue’s lecture, now available on the Royal College of Occupational Therapists’ YouTube channel.
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