what is the model of creative ability?

The Model of Creative Ability is an occupational therapy practice model originating from South Africa.  The model as presented by de Witt (2005), is founded upon the theory of creative ability developed by Vona du Toit in the 1960s and early 1970s.  The term ‘creative’ does not refer to artistic flair but to one’s ability to grow or change – the creation of oneself.

Vona du Toit

Du Toit’s conceptualisation of the theory of creative ability was influenced by work carried out in Israel by an occupational therapist and a psychiatrist, Weinstein and Schossberger. This work hypothesised that there are identifiable stages that a person can go through in order to establish or re-establish effective occupational performance. Drive or motivation is central to this understanding.  Inspired by this work, du Toit observed children and adults with a variety of conditions and over several years presented and refined a theory of creative ability.

Since du Toit’s untimely death in 1974, many occupational therapists have continued to develop the theory and it is taught on the majority of undergraduate programmes in South Africa. The theory is commonly referred to as a model and is one of only two occupational therapy practice models to explicitly explain and incorporate theory of motivation.

The model has a developmental frame of reference combined with existentialism, phenomenology and motivation theory.  The central belief is that motivation governs action and action is the manifestation or expression of motivation. Motivation and action are inextricably linked, and therefore one can identify an individual's motivation by observing the person’s action.

The model describes stages or levels of creative ability – that is, levels of motivation and corresponding action (behaviours and skills – occupational performance).  These levels are sequential and there can be progression and regression through the levels (table 1). Vona du Toit believed that human beings progress through developmental levels of behaviour and skill development and are motivated to develop these in a sequential sequence. That is, we are motivated to develop a variety of skills as environmental/social/relationship/occupational demands change and influence us throughout the lifespan.  In the event of illness, trauma, injury or in response to changing life demands, we can regress to a lower level of ability.  This is recognisable in clients that prior to developing a mental illness were ‘high functioning’ or living effective daily lives.  However, with the onset of a psychotic or other illness, appear to be functioning at a lower level than previously.  For people with dementia, a continuing regression through the levels is evident.  Creative ability develops in relation to four occupational performance areas: social ability, personal management, work ability and use of free time.

The model states a belief in recovery.  Du Toit was far ahead of her time in realising that the concept of recovery is extremely important to clients and to psychosocial practice. The theory therefore, can be used with clients across a very broad range of diagnoses and severity of illness or trauma: if there is any residual ability, there is the potential for recovery.  The model is also ability focused – it seeks to identify ability rather than identifying dysfunction or deficit.

Levels of Creative Ability

Table 1.  The levels of creative ability

Levels: there is a term to describe what the person is motivated for (motivation level) and a term to describe the corresponding action observed (action level).  The levels are described in a lot of detail by de Witt (2005) (chapter on the model in R Crouch, V Alers 2005 – see the list of literature provided on the CPD page). Levels 1-6 are most commonly seen in healthcare services (see ‘the model in context’)

De Witt (2005) categorised the levels into three groups, indicating the similarities in the overall purpose of grouped levels.  This grouping has been expanded upon here with additional notes ( table 2).

Table 2. Grouping of Levels

The task of the occupational therapist is to identify the client’s current level of creative ability.  This enables the therapist (and the team/carers) to understand what the client is motivated for and the extent of his/her corresponding skills / occupational performance.  With this understanding, intervention can be offered to elicit motivation and participation in order to facilitate growth towards the next (higher) level of ability.  In the case of a client with dementia, intervention is provided to maintain level of ability and prevent deterioration for as long as possible. Within each level there are three phases.  First there is the therapist-directed phase when the therapist is required to provide a great deal of in-put to enable the client to participate and explore his/her abilities and occupational performance.  This is followed by the patient-directed phase when the client has gained a degree of competence in occupational performance at the level and requires less input from therapists.  Finally there is the transition stage when occupational performance at the level has been achieved and there are signs of motivation and skills characteristic of the next level.  Being able to identify these phases enables therapists to finely tune therapy to small changes in clients, and to provide a graded approach to enabling clients to grow or move through the levels.

The model provides a means of performing an assessment to identify the level of creative ability and the phase of the level.  In addition, the model uniquely provides a detailed guide to treatment/intervention - the selection and use of activity, the environment and the therapeutic use of self in order to provide the ‘just right challenge’ for growth.  This guide brings together the core occupational therapy skills of activity analysis, grading, use of purposeful activity and activity groups, therapeutic use of self and use of the non-human environment.  Essentially, it enables therapists to do occupational therapy and to use activity as a powerful therapeutic tool. Du Toit (1974) states that the advantages of the model are:

1. Characteristics of motivation and action at each stage of growth and recovery can be analysed
2. The direction and content of treatment aimed at restoring motivation by means of action can be clearly defined
3. Demands made on the patient interpersonally, socially and in respect of material handling and activity handling can be systemised
4. Criteria for selecting, presenting and grading activities at each stage of motivational recovery may be extracted
5. The stage of motivational growth and action attained may be stabilised and the next stage stimulated by application of the criteria and graded demands
6. The stage of 'work readiness' is detectable
7. A total treatment programme based on the growth of motivation and action enables the OT to systemise an approach to a patient from the earliest stage of illness and motivational deficit to the stage of work readiness and reintegration into work.

Creative ability terms

Creative ability:
Your current state in relation to occupational performance in the environment  
Your physical self + your psychological self + your drive in the environment:
Body + mind + drive
= creative ability

Creative ability develops during a lifetime. At birth, our creative ability is extremely limited because the drive is instinctual: for survival and our physical and psychological development is in infancy. We go through the stage of developing in neurological terms for posture, movement etc., and become aware that we exist and exist in an environment in which there are things that are different to us; materials, objects and people. As we are presented with this environment, we decide to participate – reaching, grabbing etc. This action is evidence of a drive – a drive to interact with the environment. At this stage, creative ability is limited by the physical abilities in terms of grip, crawling, perception etc., plus the limited psychological development in terms of cognition, understanding, emotional development etc. The total of the physical ability plus the psychological ability plus the drive to interact with the environment, is this infant’s current creative ability. Ones development of creative ability is influenced by the environment (opportunities, culture), including the people within it.

Creative ability is developmental and consists of stages (levels). The levels are sequential: you cannot skip a level. Although we all go through the same stages, each individual is unique in terms of their creative ability. For us all, there is a ‘ceiling’ that we would reach in terms of creative ability – there is a limit to what we could achieve even in the optimum circumstances. This is our creative capacity or potential.  One’s creative ability can be understood as part fulfilment of one’s capacity or potential (diagram 1).  The occupational therapist’s task is to facilitate the client’s growth in creative ability towards meeting his/her potential.

Diagram 1: Creative ability as part fulfilment of creative capacity

Creative response and maximum effort:
The creative response relates to our receptiveness to the demands presented to us and the decision that we make.

In occupational therapy, we are concerned with engaging clients in therapy. We hope that the client will have a positive response – a willingness to try – to participate. People are more likely to have a positive response if what is presented to them is meaningful/purposeful and there is an expectation or anticipation of success/fulfilment. It is the decision to participate which fully brings together the body, mind and drive: the drive vitalises the body and mind. It is therefore, important that occupational therapists have an understanding of what the client’s drive is (the level)– what he/she is motivated for, in order to present activities for intervention that will stimulate a positive response and participation. The theory of creative ability suggests that growth through the levels occurs when the individual participates and exerts maximum effort.

Creative participation:
Active engagement in ‘doing’ - the process of being involved in activities / challenges presented.

Creative act:
The creative act is the result of the creative response and creative participation. The result is a tangible or intangible end product. Tangible products are easy to identify such as, a meal or a clay pot. Intangible products include knowledge, understanding, change to self-esteem, an interaction with another person.  Creativity is about the creation of something that was not there before and is not limited to the creation of tangible products, but relates to everything to do with the process of ‘becoming’ – ones development as occupational beings. 

To grow or extend ones creative ability requires:
• a positive response towards an opportunity / activity
• active engagement in the activity (creative participation)
• effort exerted in producing an end product (tangible or intangible)