Frames of Reference
Asst. Prof. Kim Gerald G. Medallon, MHPEd, OTRP
Internship Supervisor
Department of Occupational Therapy
Cognitive Behavioral FOR
• A person’s cognitive function is believed
to mediate or influence one’s affect and
behavior
• Seeks to change the thoughts believed to
result in or cause specific behaviors
• Develop a knowledge base for problem-
solving
Cognitive Behavioral Therapies
• Rational Psychotherapy
• Coping Skills Therapy
• Problem Solving Therapy
Cognitive Behavioral Theories
• Social Learning Theory
• Plasticity
• Vicarious learning
• Self-efficacy
• Triadic reciprocal causation (environment,
behavior, person)
Cognitive Behavioral Theories
Cognitive Behavioral Modification
• Self-instruction protocol (self-talk)
• Think aloud protocol for problem-solving
• What is my problem?
• What is my plan?
• Am I using my plan?
• How did I do?
Function-Dysfunction Continuum
• Function: Optimum function (flexible thinking, adequate
knowledge, emotional health, belief that one can meet life’s
challenges, ability to problem solve)
• Dysfunction: Insufficient, inflexible, or distorted knowledge;
cognitive function does not meet developmental expectations;
distorted self-knowledge
Evaluation
• Ongoing process
• Observations, testing, interview
• Cognitive structures (remember, perceive,
attend, interpret behavior, knowledge base,
strategies)
• Match between the individual and the
environment
Evaluation
• Task Checklist
• Beck Depression Inventory
• Stress Management Questionnaire
• Rotter’s Internal-External Scale
• Locus of Control for Children
• Dysfunctional Attitude Scale
Intervention
• Facilitate cognitive growth and
improve cognitive function (broaden
knowledge base, skills to function in
the environment, knowledge of self,
others, and environment, problem
solving)
• Home works, readings, film
showings, modeling, role play,
educational groups
Cognitive Disability FOR
• Cognitive processing impairments that
compromise the ability for normal
function and task performance
• Identifying adaptations based on analysis
of activity demands
• Looking over the role of habits and
routines
Theoretical Base
• Piaget’s Stages of Cognitive Development
• Sensorimotor
• Pre-operational
• Concrete operational
• Formal operational
• Allen’s Cognitive Levels
Allen’s Cognitive Levels
• Level 1
• Level 2
• Level 3
• Level 4
• Level 5
• Level 6
Function-Dysfunction Continuum
• Function: Ability to do cognitive processing at Level 6
• Dysfunction: Physiological abnormality resulting in impairment
Evaluation
• Chart review, interview
• Allen Cognitive Level Screen
• Large Allen Cognitive Level Screen
• Lower Cognitive Level Test
• Routine Task Inventory
• Cognitive Performance Test
• Work Performance Inventory
• Allen Diagnostic Modules
Intervention
• Identify activities at which the client can
succeed
• Advise other professionals and caregivers
• Make environmental recommendations
compatible with the client’s functional level
• 3 (arm’s reach), 4 (visual field), 5 (immediate
task environment), 6 (potential task
environment)
Object Relations FOR
• Theoretical approach that views persons,
media, and activities as objects with
invested psychic energy
• Interaction with these objects is necessary
to satisfy personal needs
• Activities are designed to lead to an
understanding of client’s needs, conflicts,
feelings, and behaviors; expression of
feelings; establish a sense of self and control
Theoretical Base
• Sigmund Freud’s Psychoanalytic Theory
• Levels of mental life
• Provinces of the mind
• Psychosexual stages of development
• Defense mechanism
• Jung’s Analytical Psychology
• Collective unconscious
• Psychological types
Function-Dysfunction Continuum
• Function: Balanced expression of drives in ways that are self-
gratifying and acceptable within his/her social environment
• Dysfunction: Presence of neurotic anxiety, fixations, usage of
immature defense mechanisms
Evaluation
• Clarify thoughts, feelings, and experiences that
are influencing behavior
• Projective tests
• Azima Battery
• Shoemyen Battery
• Goodman Battery
• BH Battery
• Lerner Magazine Picture Collage
• Person Symbol Test
• Draw a Person Test
Intervention
• Use of projective activities to develop object
relations, ego function, and defenses; increase
conscious awareness of the dynamic reason for
behavioral problems
• Creative therapy / psychotherapy
• Psychodrama
• Creative writing
• Body work
• Pottery
• Music therapy
Lifespan Developmental FOR
• Assisting clients with transitional tasks
• Establishing or restoring client-chosen, age-
appropriate occupations within continued
life roles
• Helping clients adapt to the changes
brought on by health conditions within and
across the lifespan developmental
continuum
Lifespan Developmental FOR
• Life stages
• Developmental tasks
• Marker events
• Enabling skills
Theoretical Base
• Kohlberg’s Theory of Moral Development
• Erikson’s Psychosocial Theory
• Epigenetic principle
• Basic strength
• Maladaptation
• Malignancy
• Levinson’s Life Transition Theory
• Havighurst’s Stages of Development
Function-Dysfunction Continuum
• Function: Presence of adaptation, ability to accomplish
developmental tasks, has stage-specific enabling skills
• Dysfunction: Stage-specific enabling skills were never learned or
can no longer be used effectively, difficulty with transitions,
inflexibility
Evaluation
• Brief history with emphasis on current status
• Identify the client’s characteristic lifestyle
• Determine which enabling skills are deficient or weak and barriers
• Lifestyle Performance Profile
• Adolescent Role Assessment
• Role Checklist
• Occupational Performance History Interview
Intervention
• Remediation or prevention
• Provision of a growth stimulating environment
• Selects activities that bridge the gap between the client’s present
skill level and the skills needed to learn and master
• Mastery of skills and success experiences
• Remember why you started.
• Thank you for listening!
