What makes one an occupational therapist, beyond the earned credentials, certification and licensure?

What are the shared features and beliefs that bind us together as a tribe?

One component of OT DNA is our philosophy, as reflected by our founders’ and leaders’ inspiring essays and lectures. Another is the OT Practice Framework: Domain and Process, which gives us a common language and structure regarding what, how and why we perform our trade.

Yet another aspect of our genetic code is our complex theoretical heritage.

During the years I taught OT theory, I saw the emergence of wonderful OT meta-theories that provided a scaffolding and large pattern for OT practitioners’ clinical reasoning, such as the Model of Human Occupation and the Canadian Occupational Performance Model.

Using a meta-theory can structure and guide clinical reasoning to ensure a thorough approach to OT evaluation and intervention. It gives us language that clearly reflects OTs’ domain and process, and encourages us to be logical and consistent in our actions.

In some regards, we could look at the OT meta-theories as large toolboxes.

Both the MOHO and Canadian Model offer assessment tools, most of which focus on determining the client’s perspectives and goals related to their occupational needs and priorities. The MOHO also offers standardized tools for assessing environments. These are essential pieces of an OT evaluation. Usually, we also need to obtain objective assessment of clients’ task skills, physical and cognitive abilities, environmental supports and obstacles, activity demands and information about habits and routines. With so many variables that may be relevant to occupational performance and an intervention plan, it’s no wonder that we need to have access to a number of approaches.

For example, a child may be disruptive in school because of sensory processing disorder, inadequate social skills, motor planning problems, and/or difficulty with his teachers’ expectations and under-use of meaningful rewards. If the school OT operates from a single frame of reference, effective intervention may never be achieved.

To be a master clinician, an OT needs to be proficient in understanding and applying a collection of assessment and intervention methods that apply to specific clinical populations and problems. These tested, evidence-supported approaches include behaviorism, social learning, motor learning, sensory integration, biomechanics, humanism, etc.

I consider these more specific approaches to be drawers in the large toolbox that is theory-driven occupational therapy. The more tools OTs know how to use proficiently, the better they are at customizing the best possible interventions for clients (and the more creative we can be).

Master OTs clearly can explain what they are doing and why, based on a coherent theoretical approach or combination of approaches. They can read their clinical settings to determine what frames of reference will be best received in each context. They know when and how to blend approaches, which frames of reference are not compatible, and when to shift approaches as therapy progresses.

Performing at this level does not emerge from an entry-level theory course. It requires continuing to revisit theory and its application by discussing, reading and continuing professional education throughout your career.

It’s a moving target. Theories and their application develop, change, grow and sometimes even die off over the years. But take heart, because it’s usually a lot more fun to learn about theoretical stuff after you’ve practiced for a while. You become a much different learner with each year that you practice OT.

You may even find that what seemed dry and indecipherable makes a lot more sense after you have clients on whom you apply the ideas. Besides, wouldn’t it be great to feel confident when your fieldwork students ask the dreaded question, “What frame of reference do you use?”