Abstract The adaptive functions of occupation during the phylogenetic history of the human species and the ontogenetic development of individual primates are examined through a review of relevant research of wild and captive nonhuman primates. This review suggests that the effectiveness of occupation as a therapeutic medium throughout life span development is fundamentally lied to humankind’s phylogenetic history. It is accordingly argued that there is considerable justification to maintain occupational therapy’s historical commitment to therapeutic occupation as the profession’s primary treatment modality. To support this commitment, questions to guide practice and research are identified that emanate from the primate literature and that are highly germane to the therapeutic process in occupational therapy. These questions address: (a) the relationship between the press of the various environments in which occupational therapists practice and subsequent opportunities availed to patients for engagement in occupation: (b) the relationship between the extent to which patients are or are not empowered to exert real control over their use of time their eventual development of disabling conditions; and (c) the therapeutic efficacy of occupation as compared with other treatment approaches that are not comparably holistic.