1. Chapter 53 Overview of Theory Guided Intervention
Barbara A. Boyt Schell, Glen Gillen

2. Learning Objectives After reading this chapter, you will be able to:
Discuss the importance of client subjective experiences in considering therapy approaches.
Explore the limitations of deficit-oriented theories in light of the strength-based models.
Critically examine both the benefits and limitations of restorative approaches in improving client participation.
Examine opportunities for improving participation by attending to client preferences, occupational needs, and the timing and duration of theoretical approaches focused on client impairments.

3. Overview
OTs seeking to use occupation in a way that restores bodily impairments or promote improved bodily function, rely on:
extensive scientific knowledge from medical, educational, social, and psychological domains

4. Overview (Continued)
OT researchers and expert practitioners blend knowledge from these fields with OT theories, resulting in …
evaluation and intervention methods that are informed by interdisciplinary perspectives

5. Discussion
It is important to gain a sense of perspective about how these theories “fit” within effective OT practice.
The vast array of important information about each aspect of performance can threaten to overshadow the focus on each person and the uniqueness of each person as an occupational being.

6. Discussion: “Infinite Distance Between the I and the It” (Yerxa, 2009 p. 409)
“Traditional science and medical practice in the 21st century often separates the I of consciousness, the person who experiences daily life, from the it of an object that can be probed, tested, and fixed. This separation may also influence the development of occupational science and the practice of occupational therapy to the detriment of the profession.”

7. Discussion: “Infinite Distance Between the I and the It” (Yerxa, 2009 p. 409) (Continued)
Attention to theories focused on restoring bodily functions run the risk of creating therapy situations in which practitioners lose track of their clients as individuals who have unique desires and needs

8. Discussion: Strength-Based Approaches (Dunn, 2011, p. 7)
“There is certainly a place for finding out what is interfering with participation However, what has happened is that, in doing the detective work to identify needs, professional have gotten caught up in the empty places and have forgotten to consider what is working!”

9. Discussion: Strength-Based Approaches (Dunn, 2011, p. 7) (Continued)
Adaptive approaches, strategy training approaches, and/ or environmental modifications are examples of effective interventions that indeed tap into our client’s strength to overcome performance deficits.

10. Discussion: Assumptions about Learning Transfer and Skills
There appears to be a durable assumption that one must have certain skills or abilities in order to engage in higher level activities. Does one to crawl in order to walk?
Be wary of potential pitfalls when we “can’t see the forest through the trees.”

11. Discussion: Is Restoration the Best Choice? Considerations for Practice
Questions to Consider:
What is the client interested in being able to do? If the client is focused on a bodily impairment, why does it matter? How does it affect the client’s ability to live life?
Why restore impairments versus choosing to work directly on the occupational areas the client wants to improve?
Can the bodily impairment be used to enhance performance?

13. Final Points
Perhaps the best way for practitioners to use the focused theories designed to manage impairments is to blend them with theories that provide a broader understanding of human learning and motivation as it occurs within the context of occupation.

14. Final Points (Continued)
Focused theories can be used in the context of assisting the client to perform actual occupations.

15. Final Points (Continued)
There is promising evidence to suggest that by directly working on the occupational tasks that the client wants or needs to do, occupational participation is enhanced.