Occupational performance: a case for self‐determination

Abstract

The term, 'self-determination', implies that individuals have choice and control over aspects of their lives. Individual/family preferences and choices are now core aspects of Australia's National Disability Insurance Scheme, underpinning the importance attributed to these concepts in relation to the fostering of wellbeing. As occupational therapists, in collaboration with our clients, we facilitate and enable occupational performance goals which are personally meaningful and self-endorsed. As such, our professional practice provides us with a powerful motivational tool by which we can harness individuals' energies in the pursuit of their goals - occupation. Self-Determination Theory (SDT) is an influential theory of human motivation and is presented as a way of understanding the elements of our occupational therapy transactions, and the way in which we enact them so as to enhance client outcomes. In SDT, it is proposed that individuals engage in, pursue and persist with certain behaviours when three psychological needs are being met. These needs are for autonomy (engaging in behaviour that is self-endorsed), relatedness (feeling cared for and connected to others) and competence (feeling effective in one's environment). A focus on supporting satisfaction of these basic psychological needs, it will be argued, engenders therapeutic alliance and internalisation of goal pursuits, thus optimising therapy engagement and outcomes. Examples of practice approaches that attend to the psychological needs for autonomy, relatedness and competence will be presented. A case will be made for embedding SDT into our models of practice as a sound way of articulating how we practise.

Canine‐assisted occupational therapy for children on the autism spectrum: Parents’ perspectives

“…Incorporating a therapy dog into occupational therapy sessions was thought to enhance a sense of emotional security and relatedness for the children involved. Within therapy, a sense of relatedness can provide children with the confidence to take risks and try new things within the learning process (Junkers & Kennedy‐Behr, 2017; Poulsen, Rodger, & Ziviani, 2006; Ziviani, 2015). Although individuals on the autism spectrum are known to experience difficulty developing and maintaining relationships with human social partners, there is increasing evidence to suggest that they are able to develop a secure relationship with animals (Grandin et al, 2015).…”

“…When a child feels competent that they have the skills and external supports required to master a task, they will demonstrate increased willingness to persist (Poulsen et al, 2006; Ziviani, 2015). Parents identified that the incorporation of the therapy dog into the goal‐directed interventions appeared to enhance their child's belief that they could master the skill.…”

“…They noted that frequently their child didn't realise it was therapy, possibly reducing the fear that they would fail. The skill of the therapist in providing a ‘just right challenge’ (the optimal state where the level of challenge is balanced with the individual's perceived skill) (Poulsen et al, 2006; Ziviani, 2015) was also noted when parents identified the therapist's ability to be flexible in response to the child's emotional state and perceived level of competence on any particular day, grading activities accordingly.…”

“…D'Arrigo et al (2017) proposed that the motivational framework of self-determination theory (SDT) in the hands of a skilled practitioner might be the mechanism by which child engagement in therapy is facilitated. Attending to children's psychological needs for relatedness (experiencing a secure attachment and connection to another being), competence (the belief that one can achieve success) and autonomy (a sense of meaning and choice), as proposed in SDT, is thought to optimise therapeutic engagement (Biddiss, Chan-Viquez, Cheung, & King, 2019;D'Arrigo et al, 2017;Ziviani, 2015). Specific techniques which attend to these psychological needs in therapy can include the use of visual supports such as activity schedules to facilitate the individual's sense of control (Bryan & Gast, 2000;Dearden, Emerson, Lewis, & Papp, 2016;Massey & Wheeler, 2000;Palmen & Didden, 2012).…”

Strategies occupational therapists use to engage children and parents in therapy sessions

“…Strategies included those that were autonomy-supportive: providing choice, novelty, fun and variability in the upper limb intervention. The findings of this research adds to the growing evidence that autonomy-supportive strategies help child engagement in therapy in a range of practice contexts (Gilmore et al, 2010;Levac, 2016;Meyns et al, 2018;Miller et al, 2016;Ziviani, 2015).…”