During the 20th century, many new theories were developed to explain how individuals learn and develop. Theoretical perspectives are crucial to the process of occupational therapy, since they inform the therapist what, when, and how the individual should be guided and scaffolded to achieve. For example, Jean Piaget was a developmental psychologist who devised a trajectory of typical cognitive development. Piaget’s work suggests how children’s cognition should be assessed as well as how they should be scaffolded to the next level (Lourenco, 2012). Albert Bandura is a psychologist who developed social learning theory and principles of self-efficacy. His work emphasizes the importance of modeling as well as the role of individuals as active learners.
Piaget created his developmental theory from information he gathered about how children think. Before Piaget, psychologists believed that children merely lacked certain adult skills. This was a quantitative perspective. However, Piaget discovered that children thought in qualitatively different ways (Lourenco, 2012). His theory has been called constructivist because he believed that children construct knowledge based on what they already know, using the processes of equilibration and assimilation. Equilibration occurs when a child is confronted by a new problem. When he or she successfully discovers a solution to the problem, accommodation and assimilation take the child’s thought processes to a slightly higher level, and the cycle is repeated (Lourenco, 2012). Piaget also identified stages of cognitive development associated with approximate ages; when a child transitions from one stage to another, his or her cognitive processes are literally rearranged to create a new way of thinking. The stages are sensorimotor, preoperational, concrete operational, and formal operational.

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In the sensorimotor stage, which begins at birth and lasts until approximately two years of age, the child does not have full understanding of him- or herself as separate from the rest of the world. He or she uses trial and error to acquire information about the world, which is assimilated into available cognitive processes. This changes future behavior, so that the child gradually accommodates to the world. The essential knowledge in this stage is object permanence, or the understanding that objects and people exist even when the child cannot perceive them with his or her senses (Houdé & Borst, 2015).

From about two to seven years old, children are in the preoperational stage. Piaget’s research indicated that preoperational children are not able to understand the perspectives of others; they are largely egocentric. They also do not focus on more than one attribute of an object or problem at a time. This is called conservation (Houdé & Borst, 2015). For example, if a preoperational child is shown two equal cups of water, then one cup is poured into a taller but narrower cup, the child believes there is more water in the taller cup. A similar difficulty is one-to-one correspondence. Children can learn to count long before they understand the meaning of counting, i.e. that when they are counting objects, each object gets only one number and vice versa (Lourenco, 2012).

In the concrete operational stage (ages seven to eleven), children can think logically, but only when they are dealing with concrete objects. They do not have the ability to think logically about abstract ideas (Lourenco, 2012). Concrete operations include classifying objects by more than one attribute, conservation, and placing items in a series. The final stage is the formal operational stage, which begins around age eleven. Children are able to work with abstract ideas, such as inferring the answer to a hypothetical question in his or her head. They can also understand the concept of the scientific method and the importance of changing only one factor at a time (Houdé & Borst, 2015).

Bandura’s Social Learning Theory was based, in part, on the behaviorism of B.F. Skinner, but Bandura extended Skinner’s work to vicarious experiential learning in addition to direct experiential learning. His theory stated that individuals learn by watching others (models), and that this type of learning can produce new behaviors, reduce fears, encourage self-regulation, and change behavior in groups as well as individuals. Bandura’s most famous experiment examined how children treated a “Bobo doll” after seeing adults treat it aggressively or gently. Children who saw adults being aggressive were more likely to treat the doll aggressively themselves (Bethards, 2014).

However, Bandura did not believe that children are passive learners who just reproduce everything they see. Instead, he identified all human beings as active learners, who select what behaviors to imitate based on he or she already knows and does (Huitt & Monetti, 2015). Acquisition of new behaviors follows a four-step process: attention, retention, reproduction, and motivation (Bethards, 2014). The attention simply refers to whether the individual is paying attention at the time of observation. The observations must then be retained (possibly via cognitive rehearsal) until a time when they might be useful, then the observed behavior is reproduced. Finally, the motivation step occurs when the behavior is reinforced either positively or negatively (Hoover & Giambatista, 2009).

In his later work, Bandura focused on human needs for self-efficacy, self-regulation, and control over their own lives. His concept of “reciprocal determinism” involved the 3-way relationship of person, behavior, environment. A person’s behavior influences and is influenced by personal characteristics (psychological) and the outside world (environmental). This is a much more complex model than the original behaviorism of Skinner (Huitt & Monetti, 2015).

Piaget and Bandura both sought to characterize how people learn. While Piaget focused on the cognitive development of children (which may include older individuals with cognitive disabilities), Bandura’s social learning theory can be applied to any human being learning any subject at any age. They also differed in their focus — mental processes versus behaviors — and

Piaget’s theory considered mental processes to be the most important aspect of development. Behaviors, such as his tests for conservation and object permanence, were primarily useful to determine how the child was thinking. Bandura, however, emphasized the behaviors themselves. Although his “active learning” components, as well as the four processes involved in social learning theory, are cognitive in nature, they were still intended to point towards crucial changes in behavior. In this respect, Piaget and Bandura can be considered complementary, illuminating both behavioral outcomes and mental processes.

Another difference between Piaget and Bandura is the way each viewed the psychobiological characteristics of the individual. Piaget generalized his stages to all children, regardless of culture, language, or other factors. He focused on hard-wired, genetics-based features, while Bandura viewed individual characteristics as simply one aspect in the process of learning. He also stressed the importance of the environment, which Piaget did not.

The principles set forth by both theorists can be applied to the practice of occupational therapy. Piaget’s stages were intended to describe normal child development, but they may be useful in therapy with older children and adults. One example is sensory integration with an older autistic child who has not achieved the preoperational level. To improve discrimination and modulation of sensory input, activities such as finding objects in a ball pit, swinging by a rope, or climbing a rock wall should coincide with the abilities seen in the sensorimotor stage, while at the same time facilitating movement to a higher level (Askins et al., 2013). In another example, the occupational therapist working with a preoperational child should have back-up activities planned for each session since children at this stage are egocentric and have difficulty understanding another’s viewpoint. Modeling is crucial to occupational therapy since it is frequently used to introduce and develop new skills. For example, an OT helping an older person learn to get in and out of the bathtub will begin by modeling the procedure step by step. Another example uses Bandura’s theory of self-efficacy. Based on this theory, group therapy that instructs people with chronic medical problems on how to manage their conditions will empower patients and motivate self-care. Clients will feel more self-efficacious as they learn to do more activities of daily living by themselves (Landa-Gonzalez & Molnar, 2012).

  • Askins, L., Diasio, B., Szewerniak, D., & Cahill, S. M. (2013). Children with Developmental Disabilities and their Motivation to Play. The Open Journal of Occupational Therapy, 1(4), 4.
  • Bethards, M. L. (2014). Applying social learning theory to the observer role in simulation. Clinical Simulation in Nursing, 10(2), e65-e69.
  • Garvey, J., Connolly, D., Boland, F., & Smith, S. M. (2015). OPTIMAL, an occupational therapy led self-management support programme for people with multimorbidity in primary care: a randomized controlled trial. BMC family practice, 16(1), 59.
  • Houdé, O., & Borst, G. (2015). Evidence for an inhibitory-control theory of the reasoning brain. Frontiers in human neuroscience, 9.
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  • Landa-Gonzalez, B., & Molnar, D. (2012). Occupational therapy intervention: Effects on self-care, performance, satisfaction, self-esteem/self-efficacy, and role functioning of older Hispanic females with arthritis. Occupational therapy in health care, 26(2-3), 109-119.
  • Lourenço, O. (2012). Piaget and Vygotsky: Many resemblances, and a crucial difference. New Ideas in Psychology, 30(3), 281-295.