Therapeutic use of self

• Therapeutic use of self

  Conscious act whereby the occupational therapist uses his or her own personal characteristics in a professional way
• Therapeutic use of self (other definitions)

  Thoughtful and deliberate use of one's personality, opinions, and judgments as a component of the therapeutic process<|>Planned use of his or her personality, insights, perceptions, and judgments as part of the therapeutic process

  
• Therapeutic use of self is generally about OT being aware of verbal language, body language, choosing which personal information to share when interacting with a client, and using own personality & interpersonal skills in order to build rapport and ultimately make the client feel at ease, motivated, and that they can give trust
• In a study in the US (N=568), more than 80% of OTs rated therapeutic use of self as the most important determinant of the outcome of therapy
• Client–therapist relationship is a crucial determinant of whether occupational therapy has been successful

  
• Positive therapeutic relationship is the single variable consistently associated with successful psychotherapy outcomes
• Therapeutic use of self included as one of the major categories of intervention in the Occupational Therapy Practice Framework 1st & 2nd edition or OTPF

  
• In OTPF 3rd ed, Therapeutic use of self has been moved to the process overview to ensure the understanding that use of the self as a therapeutic agent is integral to the practice of occupational therapy and is used in all interactions with all clients

  
• Occupational paradigm


  • The occupational therapy approach was based on the assumption that occupation is essential to life and influences health, and as such can be used to improve function
  • Although this paradigm was thought to be holistic by focusing on personal motivation and the impact of the environment on performance, the approach and justification for occupational therapy services were very subjective
  • OT roles: expert, or guide, in the performance of therapeutic activities, role model for occupational engagement, emulator of the joy of occupation, instiller of confidence, creator of a positive physical and social 'scene'

  
• Mechanistic paradigm


  • The pressure from medical profession that sought objectivity to explain the practice is increasing emphasis on eliminating pathology, borrowed from the medical model
  • During the mechanistic paradigm, OT occupational therapy was also heavily influenced by psychoanalytic (i.e., Freudian and Neo-Freudian) concepts
  • Emotional, psychiatric, and interpersonal difficulties were considered aspects of internal pathology that needed to be treated using approaches that focused heavily on the relationship that existed between the therapist and the client
  • The term "therapeutic relationship" first emerged during this era
  • Given this new emphasis, the occupation or activity lost its unitary importance (Kielhofner, 2004). Instead, the central focus was on the relationship between therapist and client
• Contemporary paradigm


  • Beginning during the 1960s, Reilly (1962) was the first to notice that the field of occupational therapy was drifting away from a focus on occupation and away from its original values
  • The view that the therapeutic relationship was the key dynamic of therapy was rejected in favor of occupational engagement as the true dynamic
  • Once again, the therapist was viewed as a proponent of occupational engagement who must use a variety of strategies to make occupations appealing and to support the therapy process
• "Man, through the use of his hands, as they are energized by mind and will, can influence the state of his own health." (Mary Reilly 1961)
• Cornerstone of occupational therapy practice (OTPF 4th ed.)

  • Provide a fundamental foundation for OT from which to view clients and their occupations and facilitate the occupational therapy process
  • Cornerstones include: core values and beliefs rooted in occupation, knowledge of and expertise in the therapeutic use of occupation, professional behaviors and dispositions, therapeutic use of self

  
• Therapeutic use of self

  Occurs when occupational therapy practitioners develop and manage their therapeutic relationship with clients by using professional reasoning, empathy, and a client-centered, collaborative approach to service delivery

  
• Professional reasoning


  • To help clients make sense of the information they are receiving in the intervention process, discover meaning, and build hope
• Empathy


  • The emotional exchange between occupational therapy practitioners and clients that allows more open communication, ensuring that practitioners connect with clients at an emotional level to assist them with their current life situation
• Client-centred, & collaborative approach to service delivery

  • To understand client experiences and desires for experience
  • Honour the contributions of clients along with practitioners
  • OT shifts the power of the relationship to allow clients more control in decision making and problem solving, which is essential to effective intervention
• Model of intentional relationship

  A model that conceptualizes the processes involved in therapeutic use of self<|>Explains how components of the client–therapist relationship interact and can be enhanced in the face of everyday challenges to that relationship

  
• Purpose of the model

  • To explain the therapeutic use of self in occupational therapy and how that relationship can facilitate or hinder a client's occupational engagement
  • To guide interpersonal reasoning for addressing dilemmas and challenges to the therapeutic relationship that arise in everyday practice
  • To illustrate how best to develop relationships that embrace the fundamental values and ethics of occupational therapy practice

  
• The intentional relationship model (IRM) views the therapeutic relationship as being comprised of four central elements: the client, the interpersonal events that occur during therapy, the therapist, and the occupation

  
• The client


  • The client is the focal point
  • OT responsibilities: to develop a positive relationship with the client and to respond appropriately when interpersonal events occur
  • It is important to know the client's situational characteristics (acute emotional reaction to a specific situation) and enduring characteristics (more stable and consistent aspects of the client's interpersonal behavior)
• Interpersonal events of therapy


  • The interpersonal event can be defined as the naturally occurring communication, reaction, process, task, or general circumstance that occurs during therapy and that has the potential to weaken or strengthen the therapeutic relationship
  • Examples: client resistance, therapist behavior, client displaying strong emotions, difficult circumstances in therapy, rift or conflict between client and therapist, differences concerning the aim of therapy, client request that test boundaries or limits of the therapeutic relationships

  
• The therapist


  • The OT is responsible for making every reasonable effort to make the relationship work
  • Three main interpersonal capacities: an interpersonal skill base, therapeutic modes (or interpersonal styles), capacity for interpersonal reasoning

  
• Interpersonal skill base


  • Comprised of a continuum of skills that are judiciously applied by the therapist to build a functional working relationship with the client: therapeutic communication, interviewing skills and strategic questioning, establishing relationships with clients, working with families, social systems, and groups, working with supervisors, employers, and other professionals, understanding and managing difficult interpersonal behavior, empathic breaks and conflicts, professional behavior, values, and ethics, therapist self-care and professional development

  
• Therapeutic modes (interpersonal styles)


  • Define therapist's interpersonal style when interacting with client: advocating, collaborating, empathizing, encouraging, instructing, problem solving
  • Multimodal interpersonal style - able to match all the modes with the client
  • Mode shift - conscious change in one's way of relating to a client

  
• Interpersonal reasoning


  • The capacity to engage in an interpersonal reasoning process when an interpersonal dilemma presents itself in therapy
  • Process by which a therapist decides what to say, do, or express in reaction to the occurrence of an interpersonal dilemma in therapy: anticipate, identify & cope, determine if a mode shift is required, choose a response mode or mode sequence, draw upon interpersonal skills associated with the mode, gather feedback

  
• Desired occupation


  The task or activity the therapist and client have selected for therapy<|>Selection of the occupation and support for occupational engagement is primarily informed by other Occupational therapy conceptual practice models