Effective communication between parents and occupational therapists (OTs) is central to family-centered care in Filipino pediatric practice; unclear expectations, power differentials, and unaddressed cultural dynamics often hinder collaboration. This paper aims to develop a culturally grounded conceptual framework that identifies and illustrates the dynamics of parent–OT communication supporting reflective, strengths-based, and context-sensitive collaboration in Filipino pediatric OT. It was developed through an iterative process that included clinical reflection, extensive literature review, and iterative consultation with mentors and reviewers. The framework integrates the ideas of the Kawa model, Two-Way Communication model, Sikolohiyang Filipino concepts of loob–labas–kapwa, the Double Empathy Problem, and the Strengths-Based approach. Communication elements (sender–receiver roles, message, feedback, medium, and noise) are situated within three cultural–relational spheres (inner self, shared understanding, and sociocultural context) to explain how messages are produced, interpreted, and sustained over time. The framework offers a culturally grounded lens and reflective tool for OTs seeking to strengthen therapeutic partnerships with Filipino families, while highlighting the need for empirical validation, multi-caregiver applications, and co-designed refinements with parents and neurodivergent adults.