Personal causation is reflected in our awareness of present and potential abilities (Harter, 1983 and Harter and Connel, 1984) and our sense of how able we are to do what we want to do (Rotter, 1960 and Lefcourt, 1981). Our own culture and social environment tell us what capacities we should have and why they matter. For example, a performer on stage, a taxi driver in a large city, a secondary school teacher, and a farmer in the countryside will each be concerned about very different kinds of ability. Also, developmental level will affect the experience of personal causation. A young child typically will be concerned with developing such skills as walking and playing with toys. An older child may be mostly concerned with school performance and ability to get along with peers and perform in sports. Adolescents usually begin to think about capacity for further education and entry into a line of work. Adults will focus on such things as the capacity for work performance and management of other adult responsibilities such as parenting. Older adults will often be concerned with loss of capacity associated with ageing and how to maintain abilities for personally important things.

Consequently, personal causation is never static, but rather a dynamic unfolding set of thoughts and feelings about our capacities and our efficacy in doing what we want to do. Our unique personal causation influences how we anticipate, choose, experience and interpret what we do. Consequently, the thoughts and feelings that make up personal causation are powerful motivational influences and they also guide how we experience what we do and how we look forward to the future.

Choices of occupations are also influenced by our values. Values are beliefs and commitments that define what we see as good, right and important; they shape our sense of what is worth doing, how we ought to act, and what is the right way of doing things (Lee 1971). The child who plays nicely with other children because he has learned that playing in this way is important is expressing values. The worker who feels she needs to excel, the father who believes it is important to spend time with his children, and the old person who feels compelled to volunteer his services to his church are all examples of people whose values shape what they do. When we cannot live up to our values, we may feel guilty or inadequate and we experience a lack of meaning (Bruner 1990). The worker who has a stroke and subsequently loses his job, the mother whose mental illness interferes with parenting her child, the child whose learning disability makes it difficult to do as well in school as he thinks he should, and the elderly person whose fear of falling interferes with being able to engage in meaningful occupations are all examples of persons who are unable to enact their values.

Being interested in an occupation means that one feels an attraction based on anticipation of a positive experience in doing that occupation. The experience of pleasure and/or satisfaction in doing something may come from positive feelings associated with either the exercise of capacity, intellectual or physical challenge, fellowship with others, aesthetic stimulation, or other factors. We are more likely to enjoy what we can perform with some level of proficiency when skill is involved in the performance. Csikszentmihalyi (1990) describes flow, a form of ultimate enjoyment in occupations that occurs when a person’s capacities are optimally challenged. Often, this preference is manifested as a pattern of related interests such as athletic interest or cultural interests, including theatre and art. Preferring certain occupations over others influences what we are motivated to choose to do.

Illness or impairment can interfere with doing what one is interested in. For instance, a person might lose the capacity to do something he previously enjoyed, or an individual may find that engaging in an interest is no longer pleasurable because it evokes too much pain or fatigue. Persons with depression may find that they no longer enjoy doing what was previously pleasurable. Being able to engage in occupations that interest us and provide us with enjoyment and satisfaction is essential to well-being, and when illness or impairment interferes with this engagement, quality of life is reduced.

Our interests, values and personal causation affect what everyday activity we are motivated to do, what activities we choose to engage in and how we experience doing them. Illness and disability can interfere with volition in many ways. When this is the case, occupational therapists need to be able to assess and address volitional problems.

Additionally, volition is critical to the occupational therapy process. In order to provide therapy, occupational therapists must enable clients to engage in meaningful activity. Choosing a therapeutic activity and experiencing it as meaningful is a function of volition. Therapy cannot be meaningful unless occupational therapists attend to their client’s volition.

The outcomes of therapy also depend on volition. It is not enough to improve a client’s capacity. If the client leaves therapy and has no volitional motivation to use that capacity by engaging in activities of value and interest, then the client will not use what he or she has gained in therapy. Thus, therapy should always support the client’s volition. Good therapy outcomes require that clients will choose to use their capacity, to develop new capacities, or make adjustments for their limitations because they can see these efforts as providing a life with value and satisfaction over which they can exercise reasonable control.

Habits involve learned ways of doing occupations that unfold automatically. The way we bathe and dress ourselves each morning, and how we drive, take a bus or ride a bike to work or school are examples of habits. We learn these habits through repeated experience. When we learn a habit, we acquire a way of appreciating and behaving in our familiar environments. So, for instance, we recognize the ring of the alarm clock as an indication that it is time to rise and bathe and dress; we know where to find the toothbrush and reach for it without thinking. We know how to turn on the shower and do it unreflectively. Because we do not have think about these things as we go about our morning routine, our routines take less effort and concentration. Our habits always involve cooperation with our environment (Dewey 1922). When our environment changes, our habits may no longer work automatically. For instance, when we find ourselves in an unfamiliar environment such as a hotel room, we may suddenly find that we have consciously to think about and figure out how to do a routine task such as turning on the shower. As the example illustrates, when habits cannot guide our behaviour automatically, it takes more concentration and effort to complete our routines. Consequently, habits give us our bearings throughout daily life and allow us to do routine things with relative ease.

Habits also organize our underlying capacities. When we reach for the toothbrush or turn on the shower, we are using our vision, our cognition and our motor capacity. If we were to experience a loss of any of these capacities, our habits would disintegrate. For example, if the power is out and one has to feel one’s way about the bathroom at night without the benefit of sight, habits go out of the window. If one has a broken arm and one’s dominant hand is in a cast, simple things like turning on the shower, brushing one’s teeth or putting on clothes take a lot more thinking and effort or may be impossible. When clients develop impairments, their habits become disrupted and their everyday routines take additional effort and thought or cannot be done without help. When one suddenly must use a wheelchair, the environment is changed and familiar habits no longer work. Getting into the shower and reaching to the medicine cabinet for the toothbrush are suddenly no longer habitual or possible. All the familiarity and ease of everyday life is disrupted. An important function of occupational therapy is to help clients develop new habits of everyday life in order to restore some of the ease and familiarity of daily life.

People see themselves as students, workers and parents, and recognize that they should behave in certain ways to enact these roles. Much of what we do is done as a spouse, parent, worker, student and so on (Mancuso & Sarbin 1983). The presence of these and other roles helps assure that what we do is regular (e.g. we go to school or work according to a schedule). Roles also give us a sense of identity and belatedly a sense of what we are obligated to do. When we tell someone we are a parent, a student, a worker or a member of some group, we are telling them who we are. Moreover, we know what is expected of us in those roles. Parents take care of children. Students attend lectures, study and take exams. Members of a bicycling club plan and go on bicycle trips together.

The roles that we have internalized serve as a kind of framework for looking out on the world and for engaging in occupation. When one is engaging in an occupation within a given role, it may be reflected in how one dresses, one’s demeanour, the content of one’s actions and so on. For instance, one would dress differently for work from when engaging in a leisure role. We do quite different things when we are in the role of student from when we are in the role of a friend.

Having an impairment can compromise one’s ability to engage in meaningful life roles. If the impairment is severe, it can prevent or alter the way a person engages in all of their life roles. People with chronic disabilities often inhabit many fewer roles than those who do not have impairments. As a consequence, they have fewer opportunities to develop a sense of identity and to fill their lives with meaningful activities. In order to understand fully how a disability has influenced a client, the occupational therapist must understand its impact on their roles. Moreover, the aim of occupational therapy should be to support clients to enable them to engage in those roles that are most important or necessary for them.

Habituation regulates the patterned, familiar and routine features of what we do. Habits and roles give regularity, character and order to what we do and how we do it. They make our everyday lives familiar and they give us a sense of who we are. Disability can invalidate established habits and roles. Having a disability may require one to develop new habits for managing everyday routines and it may interfere with being able to engage in a role or alter how one can do that role. Understanding how a disability affects any person requires that the occupational therapist pays careful attention to the client’s habituation.

Moreover, it is not sufficient that a client develops skills for doing everyday routines; it is also critical that the client develops the habits to integrate these skills into effective ways of doing everyday life tasks. Similarly, having abilities does little good, if clients are not able to access and identify with roles that call upon them to use those abilities. Therapy that focuses only on augmenting capacity without considering how the client will go about organizing everyday life is incomplete. Moreover, knowing what roles and habits are part of a client’s life will also provide important information to enable us to prioritize the kinds of skill development on which to focus. Clients do not simply do things; they do them in order to enact daily routines and discharge their roles.

The things we do reflect a complex interplay of our motives, habits and roles, and performance capacity. Volition, habituation and the subjective experience of performance always operate in concert with each other. We cannot fully understand a client’s occupation without considering all these contributing factors. For example, a person with low personal causation will tend to feel anxious when attempting to perform. This anxiety in turn can negatively affect performance. Another example is that if a person does not have interests and values that lead him to use his capacities, those capacities will diminish through disuse. For this reason, it is important that occupational therapists gather information about all the aspects of a client (performance capacity, values, interests, personal causation, roles and habits) in order truly to understand that client and provide the best services.