Ellen S. Cohn and Wendy J. Coster Chapter 37 Unpacking our Theoretical Reasoning: Theory and Practice in Occupational Therapy Ellen S. Cohn and Wendy J. Coster

“In theory there is no difference between theory and practice “In theory there is no difference between theory and practice. In practice there is.” Yogi Berra

Learning Objectives After reading this chapter you will be able to: Explain the distinction between personal and formal theories. Explain the distinction between tacit and explicit knowledge. Identify assumptions and propositions guiding practice. Critically examine theory to identify assumptions and propositions of theory.

Theories Guide Our Professional Reasoning They help practitioners reason about: what to assess; how to understand occupational performance problems; how to intervene; and what to expect from the intervention

The Vocabulary of Theory Propositions: formal statements about causes and effects or the nature of relationships among features of the world Distinguishing feature: it is possible to test them and to prove them false Assumptions: beliefs that are accepted without question Distinguishing feature: they cannot be proven definitively true or false

Theories Vary in Specificity Broad theories provide an overarching model or framework Serve to organize the elements of the phenomena being observed, to help focus observations and determine what is relevant Do not provide precise information on how to intervene to enable change

Theories Vary in Specificity (Continued) Discrete theories describe specific causal relationships Propose the specific causes of a problem or how a specific feature of intervention leads to a specific therapeutic change Guide specific actions during intervention

The Critical Core of Theory Specification of the “mechanisms of action” (or “mechanisms of change”) is a vital feature of clinical theories The mechanisms of action explain in detail how specific intervention features lead to particular outcomes What specific conditions must be present for an intervention to achieve the desired results? What types of clients might benefit from the intervention? How is the intervention best delivered? What outcomes should be seen?

Example: Identifying Specific Outcomes Predicted by Theoretical Propositions Theory proposition (Movement science): If a movement is directed toward a goal, then that movement will be organized uniquely in relation to that goal Outcome: Increased quality of performance and effectiveness of skill learning Theory proposition (Meichenbaum): If the person is engaged in setting a goal, then his or her problem-solving process in relation to that goal will be facilitated Outcome: More effective problem-solving Theory proposition (Bandura): If the person is engaged in setting a goal, then he or she will experience an increased feeling of self-efficacy Theory proposition (Bandura): If the person’s feeling of self-efficacy is increased, then his or her motivation and commitment to the goal will be enhanced Outcome: Sustained engagement in intervention activities

Example: Translating Theory into an Intervention Feature: Goal-Setting Theoretical predictions: If the person is engaged in setting the goals of an intervention based on his or her own values and preferences, he/she will engage in more effective problem-solving and will be more motivated to stay engaged in the intervention activities Intervention decision: The therapist asks the child to identify 3 activities that he or she needs or wants to do that they could work on together

Key Points Whenever you make a decision in practice you are acting on theory, although that theory may be implicit rather than explicit. In order to examine whether the evidence supports the validity of your theory, you need to make the key assumptions and propositions explicit. As evidence accumulates, theory should evolve. If key propositions of the theory are not supported by current evidence, the theory needs to be discarded.