1. 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

2. “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

3. 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.

4. 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

5. 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

6. 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

7. 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

8. 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?

9. 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

10. 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

11. 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.