Our personal causation or, sense of competence and effectiveness is with us from even our earliest days and grows and develops with us. It is an important factor to consider when working with our patients/service users as, personal causation heavily influences our participation in occupation and what we seek to achieve. As, more often than not, we want to be competent at the things we value and we tend to find enjoyable the things that we do well and, dislike doing the things that we are not so good at. Personal causation does not need to be articulated into words, it can be expressed in a person’s actions but, for the sake of this bog I will try to put the concept into the written form and give you examples.
One of our very first discoveries as a child is that there is an interaction between personal intention, action and consequences. As we grow, learn and experience this so too does our understanding. What happens along the way, as a result of these interactions ultimately, forms how we think and feel about what we do which, in turn becomes a powerful motivational influence; have a positive experience and our sense of competence and effectiveness grows, thus encouraging us to try more/do new things, utilise the feedback available to us to correct our performance and preserve to achieve our goals. While, if we have a negative experience, we will feel incapable and lack a sense of efficacy, which will lead to us shying away from opportunities, avoiding feedback and make it more likely that we will not persist with achieving our goals (Burke, 1977; De Charms, 1968 and Goodman, 1960). Consequently, our personal causation is never static, but grows with us as we learn more about our capacities and efficacy.
There are two dimensions to personal causation:
Sense of personal capacity
Self efficacy
Our sense of personal capacity is a self assessment of one's physical, intellectual and social abilities (Harter, 1983, 1985; Harter and Connel, 1984). It is an active awareness of ones capabilities for doing the things that we want and need to do. This knowledge is built up over time through our own observations of how we perform and the achievements we experience. As we travel through our life and our capabilities change, so too does our sense of capacity. For example, a young child may measure their personal capacity by learning to walk or play with a new toy, while an older child maybe mostly focused on their ability to perform academically, socialise with their peers and/or participate in their hobbies. Our measure of our capacity will again shift as we move into our teenage years and we start to think about what next after school, our potential career choices and further education. As an adult, we tend to derive our sense of capacity from our ability to perform at work and/or manage our responsibilities (running the household, childcare, caring for family members) and therefore, measure ourselves against our idea of what level we should be performing at, which is influenced by our culture/society, the expectations of others and ourselves.
When our sense of capacity is challenged by pain, fatigue and/or limitations of sensation, cognition or movement we can feel trapped within our body (Sienkiewicz-Mercer and Kaplan, 1989) and/or feel a sense of failure and shame. When shame or fear governs our sense of capacity, we are discouraged and will avoid taking risks or, learning new tasks due to a fear of failure. Therefore, a negative view of our capacity can be as limiting as the impairment itself. Additionally, reduced tolerance levels and high levels of frustration, poor concentration and an expectation of failure can lead to disengagement or, even avoidance in participation and also, impact on one's willingness and ability to set occupational related goals, and/or enable follow through.
Our self efficacy describes how we use our capacity to impact what happens in our life. It encompasses the perception of self-control and being able to achieve what we desire. Through our experiences, we form a picture of how effective we are at using our capabilities, the impact we have and the ability of ourselves to cause what we want. If we believe that we can make change and use our capacities, we are more likely to be be motivated to do so. To be successful we need self efficacy, as well as the capacity to achieve the change and the self control to do so. To utilise our self efficacy, we must be able to shape or contain our emotions and thoughts and exercise control over our decisions and actions.
The loss of ability associated with physical disability and/or mental health conditions significantly impacts self efficacy and in turn, can create a dependency on others, which further exacerbates feelings of inefficacy. Therefore, disabled people have to achieve a fine balance between necessary hope for the future and unrealistic expectations. The search for efficacy involves knowing disappointment, realising what we cannot control and finding what we can influence and emphasising this (Burish and Bradley, 1983).
So, why is how we judge our own capacity and efficacy so important? Thoughts and feelings about personal capacity evoke strong emotions which in turn, influences how accurately we assess ourselves. Additionally, many factors (cognition, denial, avoidance and projection, secondary gains related to disability etc) influence our ability to self appraise and can bias a person's perceptions. If we over estimate our abilities, we may take unnecessary risks by seeking challenges that are higher than our performance capacity. This will result in poor occupational performance, danger, stress, damage and/or injury. We may also fail to seek assistance appropriately or make use of needed environmental adaptations. While those, who underestimate their abilities may avoid participating in occupations and/or become reliant on support, which will negatively influence participation in daily occupations and/or therapy input.
So, what can we do as occupational therapists when we need to initiate change in a person's personal causation and/or, enhance occupational engagement? We can...
Enable better understanding of occupational capacities (strengths and limitations).
Encourage a more accurate interpretation of how strengths and limitations impact on performance.
Encourage/support emotional acceptance of limitations and facilitate pride in occupational abilities.
Work towards reducing unnecessary feelings of dependance, resentment or guilt associated with the loss of participation.
Increase opportunities for occupational participation that match performance capacity.
Build confidence.
Encourage acceptance of using adaptive aids / environmental modifications to increase capacity via education for need.
Encourage willingness to ask for help when needed.
Reduce anxiety and fear of failure.
Seek ways to improve the person's ability to sustain participation and therefore, enable attainment of goals and/or completing occupational performance.
Widen expectation of success.
Extend readiness to take on occupational challenges and responsibilities.
Increase sense of efficacy in occupational life circumstances.
How can we promoting optimal engagement?
Commit to over coming fear in occupational performance.
Explore alternative ways of doing an occupational form that compensates for performance capacity limitations.
Re-exmine previously held beliefs about effectiveness in achieving occupational outcomes.
Re-examine anxieties and fears in the light of new performance experiences.
Identify occupational forms within/beyond performance capacity.
Negotiate an appropriate level of risk within occupational performance.
When planning interventions, choose relevant and meaningful activities that are within the person's performance capacity.
Support and encourage participation in occupational forms that challenge the person is a safe and constructive manner.
Seek ways to facilitate sustained performance in occupational forms despite anxiety.
Practise asking for and using help appropriately.
Practise performance to reinforce sense of efficacy.
How do we achieve this in our intervention plans?
Structure the environment to allow clients to take risks safely.
Validate client's thoughts and feeling about their performance capacities.
Validate how difficult it can be to do things that provoke anxiety.
Identify the person's strengths and weaknesses in occupational performance.
Give tangible feedback about the match/mismatch between choice of occupational forms and performance capacity.
Give feedback to support a positive reinterpretation of their experience of engaging in an occupation.
Enable choice and provide opportunity to engage in occupations that are relevant, meaningful and that match performance capacity
Enable success by encouraging participation in occupational forms within the person's performance capacity.
Encourage sustained effort in different occupational circumstances.
Encourage the use of performance capacities in the face if anxiety.
Physically support when necessary to ensure success.
Coach when appropriate to ensure success.
Case study:
Aiya is an 18 year old female with Down syndrome who is currently experiencing high levels of anxiety; she is becoming withdrawn and socially isolated. Aiya is in her final year of main steam school and with one to one support in class, Aiya has managed to gain certification in English, Maths and Drama. Aiya finds the structure of the school day reassuring, she likes the routine and has a close friendship group. All of Aiya's friends have either secured places in further education or, will be entering full time employment at the end of the school year. Aiya would like to get a part time job but, is worried about other's perceptions of her due to her Downs syndrome and believes that she will not be able to manage without the support of her teaching assistant and friends.
Aiya is able to communicate well, she has some budgeting skills and can fill out simple forms independently. She is also able to sustain the effort required to complete her occupational goals but lacks confidence to face occupational demands. Aiya does require support with her executive functioning however, can be over reliant on this and tends to under estimate her abilities, lacking confidence in her ability to participate in her chosen occupations and consequently, avoids challenging situations due to fear of failure. When asked about her strengths, Aiya finds it hard to name any and focuses purely on her limitations which is not a fair representation of her abilities. Aiya attributes her academic success to her teaching assistant rather, then down to the hard work and dedication to her studies that Aiya has consistently shown. Therefore, Aiya believes that she will not be able to continue with further studies as she is more than likely to fail.
Now consider and put your answers in the comments section below:
What is Aiya's view of her personal capacity and effectiveness? How does this affect the choices, experience, interpretation and anticipation of doing things?
Is her sense of capacity accurate?
Does Aiya expect to achieve her goals?
Does Aiya have confidence, anxiety or other feelings in the face of performance?
References:
Burish, T. G. and Bradley, L. A. (1983) Coping with chronic disease: Research and applications. New York: Academic Press
Burke, J. P. (1977) A clinical perspective on motivation: Pawn versus origin. American Journal of Occupational Therapy 31 254-258
De Charms, R. E. (1968) Personal causation: The internal affective determinants of behaviours. New York: Harper and Row
Goodman, P. (1960) Growing up absurd. New York: Vintage Books
Harter, S. (1983) The development of the self-system. In M, Hetherington (Ed.) Handbook of child psychology: Social and personality development (Vol. 4). New York: John Wiley and Sons
Harter, S. (1985) Competence as a dimension of self-evaluation: Toward a comprehensive model of self-worth. In R. L. Leahy (Ed) The development of the self. Orlando, Fl: Academic Press
Harter, S. and Connel, J. P. (1984) A model of relationships among children's academic achievement and self-perceptions of competence, control and motivation. In J. Nicholls (Ed.) The development of achievement motivation Greenwhich, CT: JAI
Sienkiewicz-Mercer, R. and Kaplan, S. B. (1989) I raise my eyes to say yes New York: Avon Books
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