Occupational performance: a case for self‐determination

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.     

Certification in internal medicine: 1989–1992

Objective: To determine whether changes in the demographic/educational mix of those entering internal medicine from 1986 to 1989 were associated with differences among them at the time of certification. Participants: Included in the study were all candidates for the 1989 to 1992 American Board of Internal Medicine certifying examinations in internal medicine. Measurements: Demographic information and medical school, residency training, and examination experience were available for each candidate. Data defining quality, size, and number of subspecialties were available for internal medicine training programs. Results: From 1990 to 1992, the total number of men and women candidates increased as did the numbers of foreign-citizen non-U.S. medical school graduates and osteopathic medical school graduates; the number of U.S. medical school graduates remained nearly constant and the number of U.S.-citizen graduates of non-U.S. medical schools declined. The pass rates for all groups of first-time examination takers decreased, while the ratings of program directors remained relatively constant. Program quality, size, and number of subspecialty programs had modest positive relationships with examination performance. Conclusions: Changes in the characteristics of those entering internal medicine from 1986 to 1989 were associated with declines in performance at the time of certification. These declines occurred in all content areas of the test and were apparent regardless of program quality. These data identify some of the challenges internal medicine faces in the years ahead. Received from the American Board of Internal Medicine, Philadelphia, Pennsylvania. This research was supported by the American Board of Internal Medicine but does not necessarily reflect its opinions or policies.     

A picture is worth a thousand words: Children's representations of family as indicators of early attachment

To ascertain whether attachment representations at age 7 are related to early attachment behaviour, family drawings of 123 7-year-olds of known infant attachment status (25 avoidant, 80 secure, 18 resistant) were scored in four ways. Three of these were based in previous attachment research and one was based on a clinical method. The attachment-based coding schemes included specific markers for each attachment pattern (Kaplan & Main, 1985), global ratings (Fury, Carlson, & Sroufe, 1997) and efforts to classify each drawing as belonging to one of the three primary infant attachment groups (secure, avoidant, resistant). In the clinical scheme, children who had been resistant infants were distinguished from the others by use of overlapping and encapsulated figures. For the attachment based schemes, although individual markers were not successful in discriminating attachment groups, the more global approaches (aggregation of markers, global rating scales and judgments of attachment classification) succeeded in this task. In regression analyses controlling for concurrent child and parent measures, infant attachment did not make a significant contribution to predicting insecurity markers in drawings, although child current emotional functioning did. These findings linking attachment relationships with later representations of family relationships were in accord with the conception that avoidant attachment strategies de-emphasize intimate relationships, while resistant attachment strategies are preoccupied with close relationships. These links are most evident in global interpretive strategies rather than those that rely on specific markers.