The PEARL Framework
A reflective framework and visual tool that helps OTs articulate the complexity of a client’s occupational self.
An occupational lens for understanding people, not just problems.
Occupational therapy has always worked at the intersection of doing, being, belonging, and becoming. It takes place in spaces that are layered, relational, and uncertain.
Yet many OTs describe a familiar tension:
You know the conversation matters.
You can feel when something shifts for a person.
But you haven’t always had the language, structure, or confidence to name what you’re doing or why it works.
People arrive shaped by their environments, relationships, histories, roles, and expectations. Their difficulties rarely sit neatly within a single domain, and their strengths are often spread across contexts rather than contained within tasks.
The PEARL Framework offers occupational therapists a way to hold this complexity with clarity and coherence.
PEARL is an occupational formulation approach that supports therapists to think integratively, remain grounded in occupation, and work with meaning without reducing people to parts.
A way of thinking, not a checklist
PEARL does not operate as a protocol or prescriptive model.
It supports a form of clinical reasoning that allows multiple influences on occupational engagement to remain visible at the same time. Rather than narrowing focus to what is easiest to measure or name, PEARL helps therapists maintain a coherent view of the person within the realities of their life.
This includes:
- The conditions that shape participation
- The patterns that sustain or restrict engagement
- The relationships that influence capacity and choice
- The meanings attached to everyday doing
PEARL supports understanding without fragmentation.
Specifically, PEARL helps occupational therapists:
- Formulate complexity while staying grounded in occupation
- Make sense of patterns across a person’s life, not just presenting issues
- Work relationally and psychologically as an OT, not as an add-on
- Use conversation, reflection, and meaning-making as legitimate clinical work
- Articulate professional reasoning with clarity to clients, teams, and systems
A framework built on interaction, not parts.
At the heart of PEARL is the understanding that people are not experienced in fragments.
Lives are shaped by the interaction between inner experience, external context, relationships, roles, rhythms, and meaning over time.
PEARL offers a structured way to hold those interactions in mind, acknowledging their impact on occupation even when they are not the stated focus of the referral or service.
This is where PEARL differs from many familiar approaches.
It is not the individual domains that matter most.
It is how they move together.
This approach supports occupational therapists to stay oriented to the whole picture while making thoughtful, clinically grounded decisions about where and how to work.
Grounded in Occupational Therapy practice
PEARL sits comfortably alongside established occupational therapy models and ways of working. It does not replace them or compete with them.
Instead, it supports therapists to:
- Integrate relational, environmental, and experiential understanding into everyday practice
- Use conversation and reflection as legitimate occupational tools
- Articulate clinical reasoning with confidence across settings
- Remain occupation-centred while engaging with psychological and social complexity
PEARL reflects the work many occupational therapists already do and gives it structure, language, and coherence.
Who this approach supports
PEARL is used by occupational therapists working across a range of contexts, particularly where work involves:
- Complexity rather than linear change
- Ongoing adaptation rather than short-term intervention
- Identity, meaning, or role disruption
- Emotional, relational, or systemic influences on occupation
It is especially relevant in settings where understanding the person matters as much as addressing the task.
Who PEARL is for
PEARL is designed for occupational therapists who:
- Feel constrained or disconnected from ‘occupation’ with existing work
- Want to strengthen their formulation and reasoning skills
- Value relational depth and reflective practice
- Are ready to deepen their relational and occupational focus practice
PEARL was developed to support depth, coherence, and integrity in occupational therapy practice.
It offers a way to remain with complexity without becoming overwhelmed by it, and to work with meaning without losing professional clarity.
For occupational therapists seeking an approach that honours the richness of practice while strengthening reasoning and confidence, PEARL provides a grounded place to work from.
Learning and developing with PEARL
PEARL is taught through structured training and applied learning. The focus is on developing clinical reasoning, reflective capacity, and confidence in working with complexity as an occupational therapist.
Learning PEARL involves exploration, practice, and integration over time, rather than the application of fixed techniques.