There are nine levels of creative ability, consisting of a level of motivation and a coinciding level of action. The levels follow a developmental sequencial pattern, therefore, levels cannot be omitted. Individual's develop and consolidate skills and abilities on each level, as building blocks in prepardness for the next level of creative ability. Individuals can progess or regress through the levels depending upon their mental, physical and spiritual well-being, their current circumstances and/or situation. Therefore, the levels are fluid, not static, demanding the therapist be receptive and responsive to any change (Van der Reyden et al, 2019). Table 1 illustrates the levels of creative ability with level 1, Tone being the lowest. 

NB: If you wish to use colours, in your clincial practise to represent the levels of creative ability, you must follow the colours as illustrated in table 1. 

Table 1.  The levels of creative ability 

9 Competitive contribution Society-centred participation 
8 Contribution Situation-centred participation
7 Competitive Competitive-centred participation 
6 Active participation Norm transcendence, individualistic and attentive action 
5 Imitative Participation Imitative norm compliant action
4 Passive Participation Norm awareness experimental action 
3 Self-presentation Constructive explorative action  
2 Self-differentiation Destructive action, Incidentally constructive action 
1 Tone Purposeless, unplanned action

(Van der Reyden et al, 2019, p.62)

The lowest level, tone can be observed in severe dementia, a comatose state or severe psychosis. In contrast the highest level, competative contribution is considered the highest level of human capability, where the need for self is subliminated for the  needs of others. Therefore the levels of creative ability move through illness in to wellness. The first five levels are most commonly seen in mental healthcare services. 

The task of the occupational therapist is to identify the individual’s current level of creative ability.  This enables the therapist, team, client and/or carers to understand what the client is motivated for and the extent of his/her skills for doing things that s/he finds meaningful and is motivated towards.  With this understanding, intervention can be offered to elicit motivation and participation in order to facilitate growth towards the next level of creative ability. 

Within each level there are three phases.  The sequence of the phases within each level begins with the therapist-directed phase, then progresses to the patient-directed phase, followed by the transitional phase in which signs of the next level emerge. Being able to identify these phases enables therapists to  provide a very graded approach to enabling individual's to grow and change. This also makes the model extremely sensitive to small changes in individuals (Van der Reyden, 2019). 

As the VdTMoCA follows a sequencial pattern of development and identifies small changes as an individual develops, outcomes of intervention can be mapped and clearly indicated. 

Further information on the levels of creative ability and assessment procedures can be found in the references below and in the books sold in our shop. 


Van der Reyden, D, Casteleijn, D, Sherwood, W and de Witt, P. (2019) The Vona du Toit Model of Creative Ability: Origins, Constructs, Principles and Application in Occupational Therapy. Pretoria: The Marie and Vona du Toit Foundation.