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Documenti di Professioni
Documenti di Cultura
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Therapeutic Use Of Self
and The Intentional Relationship
Case example of an interaction gone wrong
After viewing the video, identify an example of an
undisciplined response….a reaction
Then identify an example of a disciplined response
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Therapeutic Use Of Self
and The Intentional Relationship
Occupational Therapy Practice Framework III (AOTA,
2014) now known as the Framework
Defines occupational therapy as it applies to both
occupational therapists and occupational therapy assistants
Defines the domain of occupational therapy
What we do, to whom, to what extent
“Areas in which we have a body of knowledge and expertise” (AOTA,
2014)
Describes the process of occupational therapy”
Actions practitioners take when providing services, which are client-
centered and focused on engagement in occupation (AOTA, 2014)
AOTA, 2014
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Therapeutic Use Of Self
and The Intentional Relationship
OTPF II (2008)
Therapeutic use of self considered an intervention
OTPF III (2014), now referred to as the Framework
Therapeutic use of self considered “an essential part of
the process of occupational therapy”
While interventions may be selected and used at the
discretion of the practitioner
As an essential part of the process of OT, therapists are
expected to apply the therapeutic use of self in all their client
interactions
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Therapeutic Use Of Self:
Definitions
In Occupational Therapy, therapeutic use of self has been
defined in various ways.
Punwar & Peloquin’s (2000)definition became part of the
OTPF in 2002 (as cited in Taylor, 2008, p5)
A practitioner’s planned use of his or
her personality, insights, perceptions
and judgments as part of the therapeutic
process
(Taylor, 2008)
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Therapeutic Use Of Self:
Definitions
Mosey (1981) “The deliberate use of one’s responses as part
of the therapy “(as cited in Taylor, 2008, p 5)
Denton (1987)“…a way of communicating an attitude of
respect and acceptance to clients” (as cited in Taylor, 2008,
p 5)
Hagedorn (1995)“The artful, selective, or intuitive use of
personal attributes to enhance therapy” (as cited in Taylor,
2008, p 5)
Cara & MacRae (1998) “Therapeutic use of self is
developing an individual style that promotes change and
growth in clients and helps furnish them with a corrective
emotional experience” (as cited in Taylor, 2008, p 5)
(Taylor, 2008, p 5)
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Therapeutic Use Of Self
and The Intentional Relationship
The Framework (2014) identifies therapeutic use of self as
part of the process of occupational therapy and further
defines it as…
An integral part of the occupational therapy
process …which allows occupational therapy
practitioners to develop and manage their
therapeutic relationships with their clients
by using narrative, clinical reasoning; empathy;
and a client-centered, collaborative approach to
service delivery
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Therapeutic Use Of Self
and The Intentional Relationship
What the research evidence indicates
Respondents to a national study of occupational therapists
(N=568) (Taylor, Lee, Kielhofner, & Ketkar, 2007)
80% = most important determinant of the outcomes of therapy
50% = not prepared in professional program on TUS
Participants felt insufficiently prepared to manage difficult
interactions
< 33 % felt there was enough knowledge in OT about the TUS
4% of participants had course dedicated to TUS
Participants identified insufficient information in the OT literature
on TUS
(Taylor, 2008, p 3)
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Therapeutic Use Of Self
and The Intentional Relationship
What the research evidence indicates (Cont.)
OT studies by Ayres- Rosa & Hasselkus (1996), Cole and
McLean (2003), identified the client-therapist relationship as
key determinant of the outcomes of therapy (as cited in
Taylor, 2008, p 3)
Studies in psychology by Bergin & Garfield (1994), and
Orlinsky (1994) (as cited in Taylor, 2008, p 3)found the
variable most consistently associated with successful
outcomes across different perspectives in psychotherapy was
the therapeutic relationship
(Taylor, 2008, p 3)
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Therapeutic Use Of Self
and The Intentional Relationship
Therapeutic use of self, eras, and paradigms
Era of moral treatment (Europe, 1700’s)
Humanitarian
Promoted self-determination through engagement in
occupations of daily life
Early occupational era (early 1900’s)
Emphasis on crafts and activities
Therapist as expert, role model for engagement in occupation
Intent to inspire joy and confidence
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Therapeutic Use Of Self
and The Intentional Relationship
Therapeutic use of self, eras, and paradigms (Cont)
Era of inner mechanisms (1940’s)
Focus on medical model, “cure”
Emphasis on pathology
Focus on expertise
Good judgment
(Taylor, 2008, p 6)
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Therapeutic Use Of Self
and The Intentional Relationship
Therapeutic use of self, eras, and paradigms (Cont)
Activities used as mechanism to understand “inner motives” (client
selection of activity; his/her performance; selection of materials, color,
etc; degree of dependence on therapist were all ways to understand the
client’s inner drives
Most important was the relationship between the client and the
therapist to help client achieve change, i.e. resolution of inner conflicts
Competence and professional attitude toward clients, favoring skills
such as
Tact, self-control, objectivity
Good judgment
Capacity to identify with client
(Taylor, 2008, p 6)
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Therapeutic Use Of Self
and The Intentional Relationship
Re-emergence of occupation (1960’s)
Reilly and others note the profession has moved away
from its roots
Therapeutic relationship falls out of favor
Move is toward engagement in occupation as the central
focus of occupational therapy
(Taylor, 2008, p 7)
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Therapeutic Use Of Self
and The Intentional Relationship
Re-Emergence of the therapeutic relationship
Current discussions acknowledge the importance of
The client’s narrative
Client-centered
(Taylor, 2008, p 7)
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Therapeutic Use Of Self
and The Intentional Relationship
Current views on the therapeutic relationship
Important attributes and skills of the therapist
Self-awareness
Respond vs. react
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Therapeutic Use Of Self
and The Intentional Relationship
Current views on the therapeutic relationship (Cont.)
A successful and positive therapeutic relationship is:
Client-centered and collaborative
Addresses power dynamics of the relationship
Creates a level-playing field (no power-differential)
Client is agent in his own process of therapy
A successful and positive therapeutic relationship is based
on:
Caring and empathy
Address affective aspects of the relationship
Connects at emotional level
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Therapeutic Use Of Self
and The Intentional Relationship
Current views on the therapeutic relationship (Cont.)
A successful and positive therapeutic relationship
utilizes:
Clinical reasoning
The client’s narrative
To assist the therapist
Reflect on aspects of the therapeutic encounter, including the
client-therapist relationship, to understand assessment
findings and engage in intervention planning
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The Relationship In OT
(Taylor, 2008, p 46)
The Client
Treatment approaches,
activities, and strategies
selected to improve
performance The
The Occupational
Occupation Therapy
Practitioner
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A Model of the Intentional Relationship in
Occupational Therapy (Taylor, 2008, p 48)
Client:
The client brings
intrinsic factors into
the relationship
which include his/her This Intentional Relationship Model inhabits the space where the therapist
enduring engages in Interpersonal Relating with the client
characteristics.
Situational
characteristics will
show up in response
to specific situations The client will have his or her own
interpretation of and reaction to the
event
(Taylor, 20008)
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Therapeutic Use Of Self
and The Intentional Relationship
Client interpersonal characteristics
Enduring interpersonal characteristics
Emotions, reactions, or behaviors that are lifelong patterns
Reflect the client’s temperament and personality
Will likely also reflect the client’s cultural characteristics
Situational interpersonal characteristics
Emotions, reactions, or behaviors that are situation-specific
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Inevitable Interpersonal Events
Power dilemmas
Triggered by anything that reminds client of loss of power and control
over aspects of his/her life
Nonverbal cues
Triggered by:
Facial expressions
Body language
Change from informal to formal communication
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Inevitable Interpersonal Events
Crisis points
Unexpected events
Events external to therapy
Temporarily derail client from engagement in therapy
Resistance and reluctance
Resistance
Active or passive
Refusal to participate in any or all therapy
There is a connection to the therapeutic relationship, or
aspects of therapy
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Inevitable Interpersonal Events
Reluctance
The precipitating event in the lack of participation is
external to the therapy
Boundary testing
“Pushing the limits” of the relationship
Empathic breaks
Therapist fails to notice or respond to client’s verbal or
behavioral communication
Consequently, client perceives therapist as insensitive
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Inevitable Interpersonal Events
Emotionally charged therapy tasks and situations
Activities or tasks precipitate emotional reactions,
shame, or cause client to feel humiliated
Limitations of therapy
Any restriction in therapy, available services, time, etc
Contextual inconsistencies
Can range from minimal changes in the of therapy, to
inconsistencies (schedules, changes in treatment venue,
etc.
Clifford-O’Brien & Solomon, 2013, p 40)
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Therapeutic Use Of Self
and The Intentional Relationship
Instructions to group:
Break into work groups
What was the inevitable interpersonal event?
What client enduring characteristics can you identify?
What situational characteristics did you observe?
What modes did the nurse/therapist use?
What was the outcome of this exchange?
What mode might have worked better? How so?
What might be the possible outcome if that/those modes were
utilized?
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Six Steps to Successful Interpersonal
Reasoning
Anticipate potential inevitable interpersonal events
Observe
Get information from others about their experiences
interacting with the client
Draw on your own previous experiences with the client
Identify and cope
Don’t use judgmental language, use the language from
the Intentional Relationship Model to objectively
manage the situation
Pull yourself together
Keep your “buttons” out of the reach of the client
(Clifford-O’brien & Solomon, 2013)
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Six Steps to Successful Interpersonal
Reasoning
Decide if you need to shift modes in this situation
Be aware of the mode you’re currently using
Determine if this current mode is producing desired effects
Determine how you could best meet your client’s needs at the
moment
Determine what mode or sequence of modes is indicated
Think of the mode or modes that tend to be more effective
with your client
Client responses are like a moving target; do you need to
think in terms of a sequence of modes to respond to changing
needs?
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References
American Occupational Therapy Association. (2002) Occupational
Therapy Practice Framework: Domain and Process. American Journal
of Occupational Therapy, 56, 609-639.
American Occupational Therapy Association. (2014). Occupational
Therapy Practice Framework: Domain and Process (3rd ed.).
American Journal of Occupational Therapy, 68(Supp.1), S1-S48.
http://dx.doi.org/10.5014/ajot.2014.682006.
Clifford-O’Brien, J., & Solomon, J. (2013). Occupational Analysis and
Group Process. MO: Elsevier Mosby.
Taylor, R. (2008). The Intentional Relationship: Occupational Therapy
and Use of Self. PA: F.A. Davis.
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