The Natural Approach to Meaningful Occupation

Sam Eperson's picture

The Natural Approach to Meaningful Occupation (NAMO) is a model I have designed to aid occupational therapy interventions, considering features of outdoor natural environments. NAMO allows occupational therapists to work in collaboration with individuals, taking a sustainable and therapeutic approach.

The theory reflects on the core occupational therapy principles: Leisure, Self Care and Productivity, as well as additional paradigms including Cognitive Capacity and Identity. It aims to focus on meaningful goals as well as incorporating additional features such as Culture and Life-Development (based on Erikson’s Developmental theory; including purpose, love, competence and wisdom). NAMO intends to synthesise occupation, activity and skill in a creative yet uncomplicated design; making it unique, dynamic and contemporary. Occupational therapists can use this model within any area of practice to address needs, plan interventions, measure performance and evaluate goals. Where possible, clients are encouraged to participate in NAMO to allow them to explore their needs and monitor their life-development; offering choice, empowerment and client-centred practice.

NAMO is designed around the concept of a tree and consists of four parts, which illustrates the occupational individual; the Roots, the Trunk, the Branches and the Atmosphere. Extensive research has shown that the natural environment offers positive physical and psychological benefits on an individual’s health and well-being2. Thus, it is important that occupational therapists use this evidence-based sustainable approach to facilitate interventions.


Life begins when a seed is planted and starts germinating. It relies purely on the soil for nutrients, warmth and water in order to grow healthily and successfully. Like an unborn baby, he depends on his mother to provide the nutrients and support to enable healthy development. Within a few weeks, the seed liberates tiny shoots and begins to take personal control on life and surviving.

In NAMO, these Roots would reflect as ‘Goals’ ‘Culture’ and ‘Life-Development’ and would be the first factors to consider in therapeutic intervention. The reason being, after learning basic survival skills, the next milestone is to establish where we come from, what is important and what is expected. In therapeutic intervention, it is important these three intrinsic factors are explored extensively before proceeding onto present occupations of Self Care, Leisure and Productivity. There is little value providing treatment plans for individuals, without understanding a person’s background, ambitions, cultures and values.

The Trunk

Once the roots have established a strong foundation, the stem or skeleton of the tree starts developing. In NAMO, the Trunk resembles the Core Spirit of the tree combining the chemistry of heart and soul of the person. As the Trunk grows, it becomes bigger and stronger, producing a new ‘layered-shell’ each year. With age, the physical appearances change, looking completely different to a young sapling.

Like a person, as they grow older their physical appearances change; however they have the same Spiritual Core, values and beliefs. It is paramount to understand that the 80 year old lady being treated in hospital is still the same individual, with the same heart and soul as when she was 8 years old. With respect, it is understandable that her roles, routines and even interests have altered with age, although her Core Spirit remains unchanged.


As the tree develops, new branches, leaves and seeds are created. In NAMO, these occupational Branches represent the core occupational therapy principles including Self Care, Leisure, Productivity, Cognitive Capacity and Identity. For the tree Branches to cultivate successfully, they require the support of healthy Roots and a resilient Trunk.  In therapy terms, for an individual to develop and carry out occupations independently, they require support from their Social, Physical and Emotional Environment, as well as having motivation from their Goals, Culture and Life-Development.

Every tree is unique in shape and size, with Branches developing in different places and like every human, we have differences meaningful occupations and values. Our occupations have developed through our Goals, Culture and Life Development and are nurtured through the Environment. Smaller branches stem off from the main Branch; e.g. Productivity to Employment.


The Atmosphere plays a key role in nurturing the tree, helping it develop into something healthy and prominent. Without the support of the Atmosphere, it is unlikely the tree will thrive and even survive. The vital atmospheric ingredients for having a healthy tree include water, sunlight, carbon dioxide and efficient roots. The key external factors humans require to enable development include supportive social relationships, emotional well-being and a physically stimulated environment.

Our surroundings offer energising opportunities and motivating challenges, to enable us to flourish and develop productively. Within NAMO, the Atmosphere symbolises the persons’ environment. When using NAMO during assessments, occupational therapists must consider the individuals’ ‘Atmosphere’, including the Physical Environment, Emotional Well-being and Social Status. This consideration will ensure individuals’ are given best opportunity for developing and flourishing.

The Traumatised Tree

As occupational therapists, we know that one, medical conditions can affect our ability to carry out occupations and two, being deprived from occupations can influence our health and well being. NAMO aims to identify these issues specifically by using the tree to symbolise medical conditions. By addressing and appreciating how illnesses would affect one’s ability to carry out occupations, occupational therapists can devise accurate, measureable treatment plans.

Most medical conditions can be grouped into 3 categories: Terminal or Long Term Conditions, Mental Health and Acute Physical Trauma. In NAMO, the Ivy resembles Terminal or Long Term Conditions, such as Dementia or MS. Naturally, ivy can be slow or fast growing and usually spreads across other living plants, competing for nutrients and survival. As a result, the ivy can consequently severely damage or kill the tree, if left unmanaged or untreated.

Mental Health illnesses affect 1 in 4 people in the UK and is an umbrella covering many conditions from Anxiety to Anorexia. In NAMO, a Woodpecker is used to illustrate these psychological conditions, as they are renowned for the continuous erosion and damage to trees. Although Woodpeckers are known for wearing down woodlands, they are occasionally absent from the tree. A lot of Mental Health Conditions compromise from having ‘good’ and ‘bad’ episodes and this is where the Woodpecker in NAMO would demonstrate these periods. When the Woodpecker is absent, it is not damaging the tree, which could be seen as a ‘good’ period. However when the Woodpecker has returned and constantly eroding the tree, it could be seen as a ‘bad’ episode. NAMO aims to focus on keeping the Woodpecker occupied, so he doesn’t return to erode the tree for long periods of time.

Acute Physical Traumas can be the result of unexpected incidents such as Amputations, Strokes or Heart Attacks. In NAMO, these Acute Physical Traumas are symbolised by a Lightning Bolt. Lightning is associated with a destructive charge of high voltage, which could instantly damage or kill. Like some medical conditions, the purpose of lightening is not always known and its reactions are very unpredictable. In relation to NAMO, Physical Traumas (Lightning Bolts) are often unexpected and tend to strike our daily occupations directly.

The Rehabilitated Tree

Meaningful occupational therapy interventions can be used to nurture and rehabilitate a tree/individual. Treatment would predominately target the occupational Branches, with support of the clients’ Life Development from the Roots, Atmosphere and Trunk.

Interventions would aim to repair and form new flourished occupational Branches and ensuring the soil is nutritious, to enable healthy Roots. This will encourage the ‘spark’ of energy and values into our branches, to enable us to be motivated to accomplish our occupations.

I would appreciate feedback on the NAMO model or thoughts and suggestions about how I could develop it further.  My aim is to eventually pursue it with evidence base through research. I then hope to standardise it, so it can be used in occupational therapy practice.  

You can click here to see Figure 1 and 2 in detail.

Register or log in to join our networks!