CHAPTER 11 Interactive Reasoning


The occupational therapist in Case Study 11-1 is describing interactive reasoning in action. This term was coined by Fleming (1991) in the seminal clinical reasoning study in occupational therapy at the Boston Hospital. Using the analogy of “the three-track mind,” she stated that occupational therapists worked with patients on three levels, thinking about: (a) the procedures they could use to intervene with the physical ailment, labeled procedural reasoning; (b) how they could get to know the patient as a person, to understand their subjective experience, and to engage them, labeled interactive reasoning; and (c) developing a vision of how things could change in the future, considering the whole situation and being dependent on the patient’s participation, labeled conditional reasoning. They switched between these three tracks rapidly, appearing to use them simultaneously. Kristensen et al. (2012) described interactive reasoning as being “concerned with the patient’s illness expe riences and developing partnership with the patient” (p. 120). Considering these definitions, interactive reasoning has two important aspects: understanding clients as people who experience illness and disability and devel oping partnerships with them. These two aspects of interactive reasoning are in tertwined and reciprocal, in that an understanding of the person develops through the process of relationship building and a deeper mutual understanding tightens relationship bonds. Schell (2019) described occupational therapy as “inherently a communicative process” (p. 490). Occupational therapists support their clients to imagine realis tic and preferred futures and assist them to establish goals that provide stepping stones to those futures. They communicate what they can offer to this venture, including expertise in interventions and knowledge gained from experiences with other clients. Although they must employ their technical expertise (e.g., in splint ing, environmental modification, rehabilitation, occupational analysis), that alone is insufficient. Their role involves guiding clients to make decisions or engage in specific therapeutic endeavors, both of which require a substantial investment of time and energy by clients. For this, occupational therapists need to use skilled and sensitive interaction. Metaphorically, this interaction could be seen as a dance. Initially, clients are often in a vulnerable position, so occupational therapists are tasked with leading the dance, providing a strong and stable base for guidance through the process of overcoming challenges that are often overwhelming. How ever, as the therapy progresses, both partners contribute equally, and the dance becomes a shared endeavor.


“The difference between listening and pretending to listen, I discovered, is enormous . . . . Real listening is a willingness to let the other person change you. When I’m willing to let them change me, something happens between us that’s more interesting than dueling monologues. Like so much of what I learned in the theatre, this turned out to be how life works, too.” —(Alan Alda, 2005, p. 160)

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In this chapter, we explore the interactive nature of occupational therapy. We present occupational therapy as a two-way (or more) venture that involves thera pists and clients working together from a shared vision. However, this shared vision

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