Therapists and Parents Learn Together, New Grounded Theory Reveals

For decades, occupational therapists have been cast in a familiar role: the expert who teaches, and the client who learns. A new study published in the Scandinavian Journal of Occupational Therapy upends that one-way picture. Drawing on interviews, filmed therapy sessions and photographs of instructional materials, researcher Cait Harvey of Otago Polytechnic and the Child Development Centre at Health New Zealand, together with Clare Hocking and Margaret Jones of Auckland University of Technology, constructed a grounded theory showing that learning between therapists and clients is deeply relational, bidirectional and continuously responsive. The theory, named Responsive learning: Learning from and with each other, describes how parents and therapists move through an ongoing cycle of connecting, partnering and integrating what they learn into everyday life.

The research was motivated by a gap the authors identified in the occupational therapy literature. Although teaching and learning have long been recognised as core components of practice, learning is typically framed as hierarchical and unidirectional, with the expert therapist educating the learner client. Where theory does underpin practice, it is usually borrowed from other disciplines. Bandura’s social cognitive theory has informed health education programmes for older adults and motivation-driven stroke rehabilitation interventions, while the Four-quadrant Model of Facilitated Learning, an occupational therapy specific paediatric teaching process, draws on Vygotsky’s social development theory. Prochaska’s transtheoretical model of behaviour change has underpinned coaching approaches, and adult and transformative learning theories have been invoked in studies of client education. What was missing, the researchers argue, was a discipline-specific theory of how learning actually unfolds between therapists and clients in naturalistic practice.

To build that theory, the team used constructivist grounded theory methodology, informed primarily by Charmaz’s approach and supplemented by Birks and Mills’ coding framework and Bryant’s pragmatist-constructivist perspective. The study was conducted in the context of therapy provision to pre-school children requiring long-term intervention. Participants were recruited from two large regional paediatric services and a community service offering home and clinic-based therapy in two New Zealand cities. Eleven parents of children aged up to six years took part, alongside eight female occupational therapists with an average of 20.5 years of practice experience. Parents had been working with a therapist for an average of eleven months, most receiving weekly to monthly home visits. Three parents identified as Māori and eight as New Zealand European.

Data generation was deliberately multi-source. Twenty-three intensive semi-structured interviews were conducted, averaging 65 minutes, with two parents and two therapists returning for second interviews to check that the emerging theory resonated with their experiences. Five routine therapy sessions were filmed, capturing not only dialogue but gestures, body movements, use of objects and the environment, and the responses of those involved. Nine photographs of learning resources, such as tailored written instructions given to parents, were taken during interviews and analysed as documents. The observational data proved invaluable: analysis revealed multiple layers of learning happening simultaneously, with rapid shifts between learning and tending the relationship, and therapists and parents continually responding to each other’s needs and to what was happening in the moment.

Analysis followed the constant comparative method, in which data generation, coding and analysis proceed simultaneously from the first interview until the theory is fully integrated. Three stages of coding were used: initial line-by-line coding, including in vivo codes that preserved participants’ own words such as ‘hooking’; intermediate focused coding and categorising; and advanced coding using storyline and theoretical coding to integrate the theory at a high conceptual level. Reflexivity strategies, including a presuppositions interview, a reflective journal, memoing and regular research meetings, were used to keep the theory grounded in the data rather than in researchers’ assumptions. The study received ethical approval from the Auckland University of Technology Ethics Committee and cultural endorsement from the locality District Health Board, with cultural guidance sought throughout to ensure the research was acceptable and safe for Māori participants.

The resulting theory comprises three main categories that can also be viewed as phases. The first, Establishing relationship, involves connecting and crossing what the authors call the relational threshold. Both parents and therapists invested time in showing friendly interest and learning about each other. Parents often gauged trust through how their child responded to the therapist, and both parties used ‘hooking’ strategies to draw each other into a therapeutic partnership, from both a relating perspective of feeling comfortable and a doing perspective of projecting and instilling confidence. One therapist explained that modelling a technique that works well is like a hook: you have to make sure you get the right one. Crossing the threshold was experienced as feeling more comfortable, losing a defensive wall, and trusting the therapist unreservedly. Notably, parents were unanimously reluctant to connect with a new therapist afterwards, with some describing a forced restart as feeling like abandonment or a setback, and on rare occasions a failure to connect became a make-or-break situation in which therapy did not proceed at all.

The second phase, Partnering in learning, is where doing therapy together happens, through a responsive recursive cycle of getting on the same page, tailoring learning, and getting on the same page again. Getting on the same page involves finding common ground and building mutual working knowledge: parents learn what to expect from therapy and how to navigate the health system, while therapists learn how each family functions, what they already know and what they want to know. One therapist framed it plainly: we are learning together; you know your child, I know some things, let’s put it together. Tailoring learning involves working side by side, often mirroring each other’s body movements, using strategies such as explaining, demonstrating, observing, embodied experience and practising. Some parents initially found hands-on participation daunting, even invoking performance anxiety, but confidence grew with shared experience. Written home programmes and session summaries reinforced learning between visits and allowed it to be shared with other family members.

Getting on the same page again is described as the crux of the theory, revealing its recursive, responsive nature. Parents and therapists oscillate between a relating focus, reconnecting and tending the relationship through encouragement, positive feedback and small acts of welcome such as vacuuming before a home visit, and a doing focus, responding to each other’s needs, questions and cues by clarifying understanding, reframing instructions or using analogies when understanding faltered. At times both parties moderated what they revealed, with therapists gently preparing parents for difficult information and parents sometimes biting their tongue to preserve the relationship. The third phase, Integrating learning, marks the crossing of an independence threshold, where knowledge or skills are mastered and woven into everyday life. Parents began adapting what they had learned to suit their child and taking the lead in setting therapy goals, while therapists integrated lessons from families into their own practice, building what one described as a book of knowledge to help the next family. Moving on often meant re-entering the partnering cycle to address new issues, or ending well through gradual withdrawal or joint visits to ease transitions.

The authors situate their theory within a broader literature on therapeutic relationships, tipping points and co-learning, noting that while individual components align with prior work, no existing account captures the entire process. They acknowledge limitations: the doctoral research spanned seven years, participants came from four services in two New Zealand cities, only three Māori parents and no Māori therapists took part, and the study examined the parent-therapist dyad within what is actually a parent-child-therapist triad. Future research on the triad and with different client groups would test the theory’s generalisability. The practical implications, however, are immediate. Although therapists often feel pressure to work quickly toward therapy goals, the theory supports prioritising time to establish and sustain collaborative relationships, and it urges clinicians to become knowing, intentional co-learners rather than unknowing ones, since most therapists in the study struggled to articulate what they had learned from parents. Incorporating responsive learning into clinician training and professional education, the authors suggest, could support more efficient, equitable and effective engagement with service users across a range of health settings.

Subject of Research: The process of learning between occupational therapists and parents of children receiving long-term therapy

Article Title: Responsive learning in practice: A grounded theory

Article References: Harvey, C., Hocking, C., & Jones, M. (2025). Responsive learning in practice: A grounded theory. Scandinavian Journal of Occupational Therapy, 32(1), Article 2578329. https://doi.org/10.1080/11038128.2025.2578329

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2578329

Keywords: occupational therapy, grounded theory, responsive learning, therapeutic relationship, parent education, paediatric therapy, constructivist methodology, co-learning, family-centred care, therapist-client collaboration, New Zealand, qualitative research