What are theory and practice and why do they matter?

In occupational therapy, theory has been defined as a set of connected ideas or concepts that can be used to guide or form the basis for action (Crepeau et al., 2009; Melton et al., 2009). If a given theory is good, it can be used to explain phenomena as well as predict the likely outcomes of changes to those phenomena. Because they are made explicit, theories can be scrutinized and tested (Melton et al., 2009).

Theories form part of a profession’s body of knowledge. Higgs et al. (2001) explained that, without a theoretical base, practice would be akin to guesswork. While experienced occupational therapists often have difficulty explaining the theoretical bases for their practice, the fact that they make well-reasoned and effective decisions after gaining very little information (Mattingly & Fleming, 1994) suggests that they are not engaged in ‘guesswork’ but are combining the information obtained with their body of knowledge. As Melton et al. (2009) explained, disciplines develop “a specialized knowledge base, important concepts, models and theories to help busy practitioners make rapid but well-informed decisions about their practice” (p. 12). In occupational therapy, Crepeau et al. (2009) stated that its theoretical knowledge base “concerns occupation, how occupation influences health and well-being, and how occupation can be used therapeutically to enable people to engage in those occupations they value most” (p. 429).

Melton et al. (2009) proposed that providing a “framework of conceptual ideas” serves purposes such as the following:

Practice is more than theory

While theory appears to be essential for practice, it is rarely considered to be sufficient for practice. The practice of occupational therapy refers to what occupational therapists do in their professional roles. It is a process that requires decision-making about action and can be thought of as reasoned action (Carr, 1995). Sometimes practice is conceptualized as the application of theory, but Mattingly and Fleming (1994) proposed that practice is much more than this because it requires a different type of reasoning.

Both theory and practice are important for the work of professionals. However, they are not the same. Higgs et al. (2001) distinguished between knowing that and knowing how. Theory can be thought of as knowing that. By making explicit what a particular profession knows about, theory is essential to both the organization and sharing of the profession’s knowledge base in its area of concern. On the other hand, practice is more aligned with knowing how. It requires both skills, in particular aspects of the profession’s work and the ability to choose action (or non-action) wisely.

Different types of knowledge

In discussing the difference between theory and practice, some authors (e.g. Higgs et al. 2001; Mattingly & Fleming, 1994) refer back to the ancient philosophies of Plato and Aristotle. While both philosophers agreed that there are different types of knowledge, Plato argued for the superiority of the type of knowledge associated with mathematics. This kind of knowledge was called episteme and gives rise to the term epistemology. This type of knowledge is: (a) propositional, that is, it comprises a set of assertions or propositions that can be explained, studied and transmitted in words and often includes assertions of truth; (b) generalized, aiming to state universal principles; and (c) purely intellectual (rather than emotional). It is generally associated with a scientific way of thinking and is the type of knowledge that the word theory usually conjures.

The type of knowledge that is often associated with practice is phronesis or practical wisdom. As Kessels and Korthagen (1996) explained, “this is an essentially different type of knowledge, not concerned with scientific theories, but with the understanding of specific concrete cases and complex or ambiguous situations” (p. 19). This type of knowledge is situated in and relevant to particular times and places. As Aristotle stated, while phronesis can involve general principles, “It must take into account particular facts as well, since it is concerned with practical activities, which always deal with particular things” (Aristotle, 1975, p. 1141). Practice requires more than just knowing information and is often distinguished by the need to act in a particular situation (even if it is only to make decisions, a form of action). Understanding a situation is dependent on experience, which allows the practitioner to see patterns and similarities (upon which to base practice ‘rules’) in a series of particular instances. As Kessels and Korthagen explained, “particulars only become familiar with experience, with a long process of perceiving, assessing situations, judging, choosing courses of action, and being confronted with their consequences” (p. 20).

Often, theories are conceptualized as being ‘applied’ to practice, the implication being that theory somehow precedes (and is possibly superior to) practice. Certainly, most occupational therapy courses in Western countries are structured with theoretical concepts taught first and more extensive professional practice experiences occurring later. An extensive knowledge of theory – generally conceptualized as generalized, propositional knowledge – is consistent with society’s expectation of professionals as ‘experts’. Mattingly and Fleming (1994) explained that, in the health professions, the reasoning required has generally been conceptualized as “applied natural science” in which “reasoning is presumed to involve recognizing particular instances of behaviour in terms of general laws that regulate the relationship between cause and a resultant state of affairs” and that “practice is considered the application of empirically tested abstract knowledge (theories) and generalizable factual knowledge” (p. 317).

Higgs et al. (2001) identified three forms of knowledge that professionals use. The first of these, propositional knowledge, is the type of knowledge that is most associated with professions and aligns most closely with the concept of episteme. It is also known as theory or scientific knowledge. As Higgs et al. explained:

Propositional knowledge is the type of knowledge that underpins the concept of the ‘expert’. It forms an important part of the professional knowledge base, which is often associated with broad principles that can be generalized to a range of different settings. The particularity of various knowledge bases helps to distinguish one profession from another.

The second type of knowledge identified was professional craft knowledge. This type of knowledge is based on experience in practice and relates to knowing how to do something. It includes the skills required to practice; knowing from experience about particular client groups, the types of problems that they might face and the kinds of interventions that are often useful to them; and knowledge about the particular client with whom the professional is working at the time. As Higgs et al. stated, “Professional craft knowledge can be expressed in propositional statements, but here no attempt is made to generalize beyond the individual’s or a group of colleagues’ own practice” (p. 5). Thus, professional craft knowledge is often highly context-specific, rather than generalized (or necessarily generalizable) like propositional knowledge. As a practical form of knowledge, it aligns most closely with phronesis.

The third type of knowledge is personal knowledge. This includes the professional’s knowledge of him- or herself as a person and in relation to others. It is built up over the course of a person’s life and can relate to the social mores that the individual professional has experienced (and internalized or rejected), his or her world view, and any knowledge of him- or herself as a person that may have been developed through reflection and experience.

While theoretical knowledge can be conceptualized as propositional knowledge, the other two types of knowledge are primarily examples of ‘non-propositional’ knowledge (Higgs et al., 2001, p. 5). The distinction between propositional and non-propositional knowledge relates, respectively, to the difference between knowing that and knowing how (Polanyi, 1958; Ryle, 1949) mentioned earlier. It also aligns with the distinction Mattingly and Fleming (1994) made between theoretical and practical reasoning. In contrast to propositional knowledge, which exists in the public sphere through wide dissemination, non-propositional knowledge is often “tacit and embedded” (Higgs et al., p. 5), that is, not necessarily put into words or easy to explain but embedded in the action of practice.

Aligning with the concept of propositional and non-propositional knowledge being important aspects of practice, Crepeau et al. (2009) distinguished between formal and personal theories. Formal theories are those that are “publicly articulated, published and validated to varying degrees by scientific study” (p. 429). Personal theories are those beliefs held by individuals. They are formed through the individual’s experiences and perspectives formed from observations and exposure to ideas and beliefs. They are not made widely available and, therefore, are less likely to have been publicly scrutinized and debated.

Implications of different types of knowledge

The distinction between personal and formal theories is important to consider in relation to the current emphasis in health on evidence-based practice (EBP). The desire to provide quality and cost-effective services that have a positive impact of outcomes for clients and patients is widely shared by a range of stakeholder groups including clients, health professionals, managers of services and funding bodies (Turpin & Higgs, 2010). However, there is a lack of consensus as to how to achieve these outcomes. In its approach to achieving these outcomes, the EBP movement generally values formal theories over personal theories. It promotes the use of knowledge that has been generated and tested using rigorous research methods such as randomized controlled trials and their systematic reviews. The emphasis on research findings that are generalizable to situations other than those in which the results were generated aims to overcome the limitations in reasoning that have been noted in professionals. As Duncan (2006) explained, “it is known that professionals’ individual perspectives are highly vulnerable to a range of biases and heuristics when making clinical judgements” (p. 60).

A problem facing practitioners is that, if they only rely on their own experiences of phenomena in the local context, they are likely to make their decisions based on a reasonably narrow range of choices. These are often influenced by factors other than effectiveness of interventions (the focus of EBP). An example includes the difference between a practitioner’s extensive knowledge of the services they can provide and their relative lack of knowledge of the interventions that another professional or service could provide (and the research outlining the effectiveness or otherwise of these interventions).

On the other hand, the advantage of personal theories is that they are based on experience within the particular practice context and knowledge of, and the capacity to respond to, individual variations in client preferences and needs. Sackett (2000) defined evidence-based medicine (upon which EBP in occupational therapy is based) as “the integration of best research evidence with clinical expertise and patient values” (p. 1). This definition suggests that both formal and personal theories may be constitutive of EBP.

There is much discussion about theory and practice in professional disciplines. In these discussions, frequent reference is made to a ‘gap’ between theory and practice. Examples from a range of disciplines include education (Kessels & Korthagen, 1996), nursing (Rolfe, 1998), physiotherapy (Rothstein, 2004), and occupational therapy (Melton et al., 2009). The concept of the theory–practice gap provides a way of articulating the problem inherent within professional practice of having to integrate different types of knowledge from different sources when making decisions about professional action. While definitions of evidence-based practice, such as the one by Sackett (2000) quoted before, refer to the integration of different types of information, little has been done to investigate the process of integration.

Valuing, and therefore having to combine, different types of knowledge in practice is particularly powerful within occupational therapy. The equal valuing of both propositional and non-propositional knowledge has been expressed in occupational therapy through concepts such as art and science and the ‘two-body practice’ (Mattingly & Fleming, 1994). In addition, through its focus on occupation as both a means to facilitate occupational performance and participation and an end in itself, the practice of occupational therapy requires both theory about occupation and practical guidance on how to use occupation to achieve these aims (theory and practice or episteme and phronesis).

Terminology

In this section, a range of different terminology is reviewed in relation to the occupational therapy discourse about theory and practice. A historical approach to understanding this terminology has been taken, as the way occupational therapy has used terminology relating to theory and practice appears to have changed over time. The ways that a variety of authors have categorized theory are discussed.

There are historical differences in the way terms have been used to describe the various levels of theory referred to in occupational therapy. Mosey, an important writer about occupational therapy theory in the 1970s, 80s and early 90s, distinguished between a profession’s “fundamental body of knowledge” (p. 49) and its “applied body of knowledge” (p. 69). She stated that, “a profession’s fundamental body of knowledge is a compilation of all the information a profession recognises as basic to, and supportive of, its applied body of knowledge and practice. The information is typically a combination of philosophical and scientific knowledge drawn from a variety of sources. It may also include some practical knowledge” (p. 49). Mosey identified five categories of knowledge within a profession’s fundamental body of knowledge. These were philosophical assumptions (basic beliefs), an ethical code, theoretical foundations (“theories and empirical data that serve as a scientific basis for practice” [p. 63]), a domain of concern and legitimate tools.

Mosey (1992) explained that a profession also requires an applied body of knowledge, which is compatible with the fundamental body of knowledge, because the latter “is not meant to be used directly” (p. 69). She defined an applied body of knowledge as “a collection of information formulated so that it serves as the basis for day-to-day problem identification and resolution with clients” and proposed that it included a profession’s “sets of guidelines for practice” (p. 69). She commented that, while a range of different terms might be used for these guidelines, including terms like practice theory, model of practice and ground rules, all of these terms refer to “the transformation of theoretical knowledge into a form that allow[s] it to be used in practice” (p. 73).

Mosey (1992) provided examples of two sets of guidelines for practice; diagnostic categories in medicine and frames of reference in occupational therapy. She explained that a frame of reference includes: (a) its theoretical base that “defines and describes the nature of the area of human experience to which the frame of reference is addressed” (p. 85); (b) the relevant function–dysfunction continua which define the way that problem areas are understood and how they are resolved; (c) the behaviours and physical signs that indicate function and dysfunction; and (d) the postulates (statements or precepts) outlining the actions that are expected to lead to change (usually to enhance function – in whatever way that is conceptualized in the frame of reference).

Mosey (1992) saw frames of reference as relevant to a particular profession. For example, she stated, “it should be remembered that a frame of reference is only one type of sets of guidelines for practice. Frames of reference are not suitable for medicine, just as diagnostic categories are not suitable for occupational therapy. Each profession, then, has a type of sets of guidelines to meet its own particular practice needs” (p. 87).

In contrast to Mosey’s definition, some current authors use the term frame of reference to refer to bodies of knowledge that occupational therapists use that are not specific to occupational therapy. Crepeau et al. (2009) stated that “frames of reference guide practice by delineating the beliefs, assumptions, definitions, and concepts within a specific area of practice”. An example of this categorization includes theoretical frameworks such as developmental, cognitive-behavioural, psychodynamic and biomechanical theoretical frameworks (Duncan, 2006; Reel & Feaver, 2006). Categorizing frames of reference as those approaches that guide practice in a specific area means that specific perspectives can be included regardless of whether they are specific to occupational therapy or not. Consequently, the examples of frames of reference provided by a number of authors include approaches that are broader than occupational therapy such as motor control, self-advocacy and rehabilitation as well as frameworks that are specific to occupational therapy practice, such as the AOTA Practice Guidelines.

Writing to a broader interdisciplinary audience, Reel and Feaver (2006) listed eight terms that are often used to discuss theory and practice in rehabilitation. These were frames of reference, domains, treatment approaches, paradigms, perspectives, models, philosophies and techniques. In organizing this list they first considered philosophy to be a broader concept and cited Craig’s (1983 in Reel & Feaver, 2006) definition as follows: “A philosophy is a creed, a set of beliefs to live by; it provides a purpose encompassing and overriding the minor and trivial concerns of the everyday, or if not, it communicates a state of mind from within which the ultimate purposelessness of life becomes bearable” (p. 53). They proposed that the various disciplines working in rehabilitation have their own philosophies but also have shared philosophies. Examples of the latter were healthcare ethics, client-centred practice and a developmental/lifelong context. They defined professional philosophy as “the system of beliefs and values unique to each profession, which provides its members with a sense of identity and exerts control over theory and practice. It helps locate the domains of concern for that profession – irrespective of the particular practice context” (p. 53). They defined frames of reference as “clusters of theories selected or developed by different professionals out of the need to support the philosophical beliefs that are the core of the profession” and stated that “Frames of reference give principles on which to base specific intervention. Frames of reference are aimed at specific problems and professionals choose from a number of appropriate frames of reference.” (p. 55). In comparing philosophy and frames of reference, they suggested that philosophies (and paradigms) represented a ‘softer’ type of knowledge and that frames of reference are based on the ‘harder’ sciences (p. 56).

The way terms are used in occupational therapy varies widely and is dependent on the system each author uses for classifying different levels of theory. Generally, the term Frame of Reference is favoured for theoretical systems that are not specifically limited to the profession of occupational therapy. This term often appears to be used interchangeably with terms such as treatment or intervention approaches because they often provide a level of detail that enables their direct use in practice. Theoretical frameworks that deal with occupation are considered to be specific to the profession of occupational therapy and are generally referred to as conceptual models of practice.

In occupational therapy, Cole and Tufano (2008) identified three levels of theory. These were paradigm, occupation-based models and frames of reference. They used the term paradigm to “incorporate some of what Mosey called our fundamental body of knowledge” (p. 57), and included the philosophical basis for occupational therapy, its values and ethics, and “three concepts most basic to practice in the OT profession: occupation, purposeful activity, and function” (p. 57). They drew upon the AOTA Occupational Therapy Practice Framework, proposing that it creates a classification system “for OT knowledge that is consistent with our paradigm” (p. 59). Their second level was occupation-based models. They explained that these have also been referred to as overarching frames of reference, conceptual models and occupation-based frameworks. They stated that, “in OT, occupation-based models help explain the relationships among the person, the environment, and occupational performance, forming the foundation for the profession’s focus on occupation” (p. 57). Included in this level are Occupational Behaviour, Model of Human Occupation, Occupational Adaptation, Ecology of Human Performance, and Person-Environment-Occupational-Performance Model. Their third level, called frames of reference, referred to practice guidelines in specific domains. This level included frameworks such as Applied Behavioural Frames, Cognitive Behavioural Frames, Biomechanical and Rehabilitative Frames, Allen’s Cognitive Levels Frame and a range of other ‘frames’.

Kielhofner (2009) presented knowledge relevant to occupational therapy as three concentric circles with paradigm in the middle of the circle, conceptual practice models as the next layer and related knowledge as the outer layer. Paradigm refers to the shared or common vision of the discipline and includes core constructs, a focal viewpoint and values. Kielhofner proposed that the paradigm helps to unify the profession and define its nature and purpose. Conceptual practice models provide the details that guide occupational therapists in their practice and he contended that they consist of theory, practice resources and a research and evidence base. In contrast to the previous two layers, related knowledge comprises knowledge and skills that are not unique to occupational therapy. He provided examples such as knowledge of medical diagnoses and disease processes and cognitive and behavioural concepts and skills from psychology.

Duncan’s (2006) categorization of levels of theory is consistent with that of Kielhofner (1997, 2009). He used three theoretical categories to structure his presentation of occupational therapy frameworks. These were: (a) paradigm, which was defined as “the shared consensus regarding the most fundamental beliefs of the profession”; (b) frame of reference, which he conceptualized as a theoretical framework that was developed outside of the profession but can be applicable to occupational therapy (similar to Kielhofner’s related knowledge); and (c) conceptual models of practice, which are occupation-based and were developed specifically to explain occupational therapy practice and processes. Examples of conceptual models of practice provided were MOHO, CMOP, the Functional Information-processing model, Activities Therapy: a recapitulation of ontogenesis and the Kawa model. The frames of reference provided were the client-centred frame of reference, the cognitive-behavioural frame of reference, the psychodynamic frame of reference, the biomechanical frame of reference, and approaches to motor control and cognitive-perceptual function.

In this book, we use the term models of practice (often abbreviated to models) to refer to occupational therapy frameworks that relate to practice. We have not included theoretical or philosophical frameworks or specific frames of reference that exist to guide practice in a specific area.

Practice as a starting point: models serving occupational therapy practice

In this book, we draw upon the idea that different ways of knowing are required for practice. Rather than taking the perspective that theory precedes and is applied to practice, we use practice as our starting point and ask how theory can serve practice. Emphasizing the difference between ‘serving’ and ‘applying to’ allows us to address the taken-for-granted assumption in Western society that theoretical knowledge has a higher intrinsic value than practical wisdom. As this book is about practice, and aims to provide a useful resource for practitioners, we centre our attention firmly on practice and how theory can be used in practice. As Kielhofner (1995) stated, “Theory can never tell therapists, in advance, exactly what should be done in the context of therapy. But, if therapists understand a theory, it will help them figure out what to do at the time. Practice requires therapists to imagine how persons might find their ways out of states of dysfunction and achieve better lives. Theory which supports such therapeutic imagining cannot offer a simple plan or recipe. Rather, it must sharpen and deepen the quality of a therapist’s thinking.” (p. 1).

As the purpose of this book is to provide resources to assist occupational therapists in practice, only those conceptual frameworks that are specific to occupational therapy are included. As discussed earlier, these are often referred to as conceptual models of practice as their purpose is to present a system of ideas that can be used to guide practice. Thus, they are developed to link theory and practice together.

Occupational therapy appears to be a practice in which the development of models of practice has been important. The nature of occupational therapy theory and practice may have contributed to the proliferation of models of practice in two ways. First, occupational therapy focuses on occupational engagement and participation in everyday life. Therefore, the practice of occupational therapy can appear from outside the profession like ‘common sense’ because it centres on ordinary doing. However, occupational therapy practice could better be described as uncommon sense because occupational therapists provide unique ways of looking at various aspects of ordinary doing. They use this unique perspective to enable people who face barriers to occupational performance to participate fully in their daily lives and societies. However, this uncommon sense needs to be articulated clearly to others who might only be able to see the outcomes that relate to people doing ordinary things. It is likely that making explicit occupational therapy’s unique perspective serves to assist people to see the value of the contribution that occupational therapy can make to people’s lives and to see that it is not simply common sense. Without such explicitness, the value of occupational therapy could go unnoticed because engagement in occupation and participation in society are taken for granted and, therefore, often invisible until disrupted. Occupational therapy models of practice are one way that the practice makes its uniqueness overt and explicit.

The second reason why models of practice could have become prolific in occupational therapy is because of its basis in pragmatism, a discipline of philosophy. Pragmatism emphasizes the connection between theory and practice (Encarta, 2009), that is, between thought and action. This connection appears to operate at two levels within occupational therapy. First, occupational therapists are concerned about both what people do and how they think about those actions. This concern is usually articulated through the concept of meaningful occupation. That is, occupational therapists attend to what people think about the things they do, as well as about what and how they do them. The second way that the connection between thought and action is evident in occupational therapy is in the way that occupational therapists work. Mattingly and Fleming (1994) emphasized that thinking in action is central to occupational therapists’ reasoning. Thus, the distinction that is often made between theory and practice might not be relevant to the way occupational therapists work. While it is accepted that they need to have a firm base of knowledge upon which to base their practice, occupational therapists quickly turn their knowledge (whether pre-existing generalized knowledge or specific knowledge about clients and their particular circumstances) into action. They also acquire new knowledge through action. Models of practice aim to assist therapists by providing a conceptual framework for thinking about, planning and interpreting action (both theirs and that of their clients). While other levels of theory might aim to address issues such as philosophy, models of practice aim to link theory and practice together.

Ways models of practice serve practice

Models of practice aim to guide practice by providing a basis for decision-making. They are specific to occupational therapy and encapsulate the values and beliefs of the profession. Because occupation is the core of occupational therapy, they all deal with occupation in a central way. Models of practice serve practice in a variety of ways.

First, models of practice make the profession’s assumptions about humans and occupation explicit. In explaining the relevant concepts and their relationships, each model makes explicit the assumptions upon which it is based. For the model to be accepted as appropriate to occupational therapy, it has to be based on the assumptions of the profession. While occupational therapists will have to initially put time and energy into understanding a particular model, once they are familiar with it, the structure of the model can usually be used to guide practice. That is, the assumptions underpinning the model become internalized and the person using it does not need to constantly refer to its assumptions each time they use it. Therefore, models of practice essentially provide a ‘short-cut’ for guiding professional reasoning. By using the model properly, professionals can have confidence they are being faithful to the assumptions of the profession.

Second, models of practice help to define the scope of practice. They have embedded within them assumptions about the domain of concern of occupational therapy. They shape the way that professionals ‘see’ their practice and they provide guidance about what falls within the scope of practice and what does not. They provide a focus for the occupational therapist and define the parameters of factors and information that should be included in the planning of assessment and intervention. Some models provide specific guidance through the development of assessments that deal specifically with the model’s concepts. Occupational therapists are guided to pay particular attention to those things that are within the scope of their practice and to know when other professionals or services might be best dealing with other things.

Third, models of practice can enhance professionalism and accountability. Three criteria form the basis for claims of professional status. These are: (1) an independent body of knowledge and expertise, with a university degree as a minimum standard of education; (2) recognition of professional status at a state (government) level; and (3) self-regulation (autonomy) through ethical decision-making guided by a code of ethics (Williams, 2005). In making explicit the theoretical assumptions of the profession upon which they are based, models of practice contribute to this demonstration of an independent body of knowledge.

Higgs et al. (2001) stressed the importance of professional accountability and of reviewing critically their professional knowledge base and making it publically available. Models of practice are a way that the profession makes explicit its knowledge base and can contribute to the critical review of that knowledge base. The historical approach that we have taken in this book emphasizes this function of models by discussing the reasons for the model’s development and any perceived gap in the profession’s discourse or emphasis that the model aimed to fill.

Fourth, models of practice assist occupational therapists to be systematic and comprehensive in their collection of information. In general, models aim to guide occupational therapists to develop a holistic understanding of their clients. Each aims to set out a holistic theoretical framework (as the authors see it at the time of the model’s development or revision), which can be used to assist occupational therapists to avoid some of the problems inherent in human reasoning. For example, it is acknowledged that clinical/professional reasoning is affected by a number of factors, including the order in which information is obtained. Humans tend to favour the hypotheses they have developed and can tend to overemphasize information that supports a favoured hypothesis and disregard information that does not support or refutes it. By using a model of practice, therapists can be guided to overcome a tendency to collect information according to routines and habits that are not comprehensive (or have ‘blind spots’) and to be more systematic in the sources and type of information they collect. Models of practice can also help them to identify gaps in their knowledge and actively seek out information they might not have, rather than being overly influenced by the information they have already acquired.

Finally, models of practice provide guidance about what could ideally be done. As stated, they are comprehensive and holistic. However, they also aim to guide practice beyond one particular practice (and organizational) setting. Because it is not possible for them to be context specific, they can be very useful in guiding occupational therapists to work out more ‘ideal’ solutions. However, they cannot possibly take into account the specific context in which any individual therapist finds him- or herself. Therefore, it requires professional reasoning on the part of the occupational therapist to determine what can be done in that particular practice setting, given the constraints of factors such as time, resources, role expectations and the skills of the therapist.

Conclusion

Professionals draw upon complex and extensive knowledge bases for their practice. As professionals are expected to be able to think and act in practice, these knowledge bases cover different types of knowledge that support different aspects of professional practice. Two of these types of knowledge are theory (episteme) and practical knowledge (phronesis). Professionals also have to use their knowledge of themselves and their skills and abilities.

A range of different terminology is used to categorize theory in occupational therapy. The use of these terms depends on the way that different levels of theory are categorized by the author. Some of the major ways that terminology is used to refer to theory and its relationship to practice were reviewed in this chapter. In this book, we focus on those levels of theory that aim primarily to guide practice. We refer to this level of theory as models of practice. Models of practice aim to guide occupational therapists to put into action the profession’s unique understanding of occupation and its relationship to everyday life.

Being able to put occupational therapy into action not only requires knowledge of the profession’s unique perspective, but also an understanding of the context within which that action must take place and the ability to identify and choose from a range of potential actions. In this chapter, we highlighted that occupational therapists work with particular people in specific contexts. We also emphasized that, while models of practice aim to guide practice, occupational therapists are required to use their professional reasoning skills to make decisions in practice. As Kielhofner (1995) stated, “Theory can never tell therapists, in advance, exactly what should be done in the context of therapy” (p. 1). Models of practice provide a framework within which to reason, but occupational therapists also require the ability to reason and make decisions about action.

In Chapter 2 we present a model of context-specific professional reasoning. Both occupational therapists and their clients exist within specific contexts. For occupational therapists, these contexts shape their roles and purposes and include the social, political and organizational contexts in which they work. They also exist as members of their professional communities of practice. Models of practice are artefacts of this community and help occupational therapists to determine their role as an occupational therapist within a particular organization and with particular clients. Because they are based in the philosophical perspectives of the profession, models of practice combine with professional reasoning to guide practitioners in determining how to be an occupational therapist in a particular context with particular clients and in combining thinking and action.