Lifespan development embraces an evolutionary perspective on individuals in context, incorporating both growth and decline in function. Health and social welfare programs influence an individual's capacity to accommodate for functional changes. Specifically, occupational therapy's role in facilitating adaptation to and compensation for trauma, illness, and the aging process has a major impact on lifespan development. The impetus toward evidence-based practice challenges occupational therapy to show direct relationships between intervention and outcomes. However, it has been difficult to operationalize and measure process variables in routine intervention and to connect process with the outcome of engagement in occupation to support social participation.

The purpose of this non-experimental, qualitative study was to describe the long-term evolution of insights about occupational therapy process and to identify how therapeutic goals, socially co-constructed by an occupational therapist and a client, contributed to transformative self-regulation in a mature man with bipolar disorder who had expertise in computer technology. The therapeutic process was examined from two perspectives, the client's and the occupational therapist's, through analysis of archival data containing the client's guided debriefing interviews following each of 10 occupational therapy sessions.

Content and descriptive analyses revealed insights about occupational therapy process and endorsed client reflection in learning. Some process components set the foundation for learning (goals, transformative self-regulation, and reflection) and others were instrumental (activity demands, occupational performance, and participation). Competence was distinguished by activity goals and therapeutic goals; sessions addressed computer-related activities and communication skills.

This study demonstrated the reorganization of self-concept congruent with performance changes. Testing of possible selves eventually led to a revised ideal self, one competent to participate in valued social roles despite functional limitations. Reflecting on therapeutic activities, this client described his adjustment to fluctuating abilities imposed by bipolar disorder. The client's evolution was guided by the occupational therapist's social co-construction of the client's self-knowledge. Guiding reflection to develop transformative self-regulation led to the client's capacity for goal-directed adaptation, compensation, and self-development. Transformative self-regulation emerged as both process and outcome of occupational therapy.