Therapeutic Use of Self

OT Intervention 1
Therapeutic Use of Self

◉ Use of one’s personality and traits as a therapeutic tool

◉ A practitioner’s planned use of his or her personality,
insights, perceptions and judgments as part of the therapeutic
process
○ Not accidental
○ TUS starts even in evaluation
○ Different from establishing rapport. Rapport Is part of the
therapeutic relationship
Therapeutic Use of Self

◉ Being aware of oneself and of the patient and

being able to control what one communicates
◉ If you don’t know yourself, you cant help your
client as well
◉ Includes proper use of attitudes and
communication
Therapeutic Relationship vs
Friendship

◉ Both require respect and communication

◉ Therapeutic Relationship: more formal
◉ Friendship: more casual
Stages in Therapeutic Relationship
1. Establish Rapport
2. Working relationship
3. On-going Working Relationship
1. Establish Rapport
◉ Gather information
◉ Engaging with the patient
◉ Learning how to share info with the patient
◉ Done from the first time you see client during
evaluation
◉ How will you gain the trust of difficult patients?
◉ For persuasive patients, give vague answers that
will at least satisfy the patients for a while
2. Working Relationship
◉ Collaborate goals with patient
◉ Important that the client understands what OT is
◉ Responding to success and failure
◉ Customizing the working relationship
3. On-going Working Relationship
◉ Consists of hard work
◉ Longest period
◉ Monitor progress
◉ Clients will invite OT to birthdays and other
personal events
◉ Becomes easy especially when OT is genuine with
helping the client
◉ Important to establish TUS well
 Therapeutic Relationships (Roles)
- Instructor
- Coach
- Supervisor
- Role Model
- Problem Solver
- Environmental Manager
- Group Member
 Therapeutic Relationships
Instructor
◉ Therapist analyzes what the clients should learn, and
how they learn best (e.g. demonstration, oral direction)
◉ Educator, teaching client to be competent and capable
◉ Creating activities that will help client experience what
they need to learn
◉ Provision of activities that has just-right challenge
 Therapeutic Relationships
Coach
◉ Supports the effort of the patient
◉ Urges patient to do even better
 Therapeutic Relationships
Supervisor
◉OT oversees their efforts
◉Checks the quality of their work
◉Monitoring progress
◉Supplies new tasks and challenges
 Therapeutic Relationships
Role Model
◉ Therapist must not only identify what is to be
learned but also explain why
◉ Demonstrate the appropriate skill or behavior and
help client imitate it
 Therapeutic Relationships
Problem Solver
◉ Helping someone identify problems and set goals
for treatment
◉ Helps the client understand the result of the
evaluation
◉ Involving the client in the process of solving
problems
 Therapeutic Relationships
Problem Solver
◉ Don’t give solution to the problem directly but
your process it and give options
◉ Explore the problem of the patients
◉ Communication to find out the problem
◉ Helps the client understand the result of
evaluation
 Therapeutic Relationships
Environmental Manager
◉ Manages the environment and change the nature
of the task, the tools and materials involved or the
social or physical context in which the activity occurs
◉ Tries to show how the environment affects the
client and how the client changes it
◉ Process the reason for the changes with patients
 Therapeutic Relationships
Group Member
◉ Modeling the appropriate behavior of being a
member and should follow the guidelines for serving
as a role model
◉ If client is high function, OT can just give
instructions at the start then T can sit and do activity
with the client
◉ OT acts as a member of the group
 Therapeutic Qualities of the Therapist
1. Empathy 7. Specificity
2. Sensitivity 8. Immediacy
3. Respect
4. Warmth
5. Genuineness
6. Self-disclosure
 Empathy
◉ Ability to understand what the other person feels
- Becomes hard if you haven’t experienced what the client is going through

◉ Listening to what the patient says and encouraging him to

say more about it
◉ If client cries, talk and distance self slightly
◉ OT must be genuine; must fully enter the world of the
patient
◉ “Experiential bonding”: being with the patient
 Sensitivity
◉ Alertness to patient’s needs and awareness of
your effect on him/her
◉ Includes facial expressions and nonverbal behavior
◉ “Zen of therapy” – the experience of powerful
moments that are mysterious and magical and not
easily analyzed; “being in the moment”
 Respect
◉ Recognition as a unique individual with personal
interest and values that may be quite different from
those of the therapist
◉ Different cultures have different expectations for
what should happen between patient practitioner
◉ Respect other people’s culture
◉ Can be felt by the patients during group therapy
 Warmth
◉ Sense of friendliness, interest, enthusiasm the
therapist conveys
◉ Shown by smiling, eye-contact, leaning forward,
touching and non-verbal behaviors
○ But be cautious because client might misinterpret especially if
sexually preoccupied
◉ The way the therapist displays warmth must vary
with the situation
 Genuiness
◉ Ability of oneself to be open and real
◉ No need to distance oneself from consumers with
an artificially professional role
◉ Therapists must first be aware of themselves and
be comfortable with who they are
 Self-Disclosure
◉ Practice of revealing things about oneself
◉ Always for the patient’s benefit
◉ Knowing what not to disclose
◉ Revealing only as much as is needed to make the
person more comfortable
◉ Most helpful when the patient has asked for it
◉ Timing is very important
 Specificity
◉ Art of stating things simple directly and concretely
focusing only on what is relevant
◉ Effective therapist points out what is happening
without labeling it
◉ Be specific and straight to the point
 Immediacy
◉ Practice of giving feedback right after the event to
which it relates
◉ Idea of focusing the patient’s attention on the
here and now
 Techniques for Relating to Patients
◉ Try making the first contact brief
◉ Don’t be feeling close
◉ Use language that conveys what you mean and
that will accomplish your purpose
◉ Be comfortable with occasional silences
◉ Use minimal responses such as “uh-huh” or “go
on” to show that you have been listening
 Techniques for Relating to Patients
◉ Actively listen to what the patient is
communicating
◉ Try to get the patient to focus at one thing at a
time
◉ Ask for clarification when you do not understand
something the patient has said or done
◉ Promise only what you can deliver
 3 Elements
1. Understanding (communicate very well)
2. Empathy
3. Caring (warmth, sensitivity to client)
 Demands of the Therapist
1. Develop self-awareness
2. Have a habit of reflective analysis (work hard,
practice)
3. Competence (know what you are doing, doing it
well, continuous grow, update ourselves)
Attitude
◉“an attitude is a relatively enduring organization of beliefs
around an object or situation, predisposing one to response
in some preferential manner”- Rokeach, 1968
◉“an attitude refers to certain regularities of an individual’s
feelings, thought, and predispositions to act toward some
aspect of his environment” - Secord and Bachman, 1964
◉What attitudes the OT should show to improve the
relationship
Components of Attitudes
◉ Cognitive – beliefs and thoughts that could
influence the behavior
◉ Affective – values, feelings, emotions
◉ Behavioral – conduit through which the first 2
factors are expressed
 Types of Attitudes
1. Active Friendliness 6. Watchfulness
2. Passive Friendliness
3. Kind Firmness
4. No
demand/Indulgence
5. Matter of Fact
Active Friendliness
◉ OT takes initiative in doing friendly gestures,
usually the default attitude
◉ Subtypes:
○ Solicitousness: anticipative needs of client, adapt (material)
○ Extra attention: mention client’s name, make kulit
○ Praise for acceptable behavior
○ Companionship: staying with the client
Active Friendliness
◉ For clients who has low motivation
◉ If you want to encourage them and participate in
tasks
◉ For depressed clients
Passive Friendliness
◉ OT is available but does not force/impose self on
others
◉ For new and paranoid clients
Kind Firmness
◉ OT insists on request to be followed but on a
friendly manner
No demand/Indulgence
◉ No insistence, but we don’t exclude them from
activities
◉ For medicated clients
Matter of Fact
◉ Makes no emotional response to patient’s pleas;
firm, no friendliness
◉ For clients who are fearful, aggressive, hostile and
sometimes even paranoid patients
◉ Stating fact (“You have 5 minutes left”)
Watchfulness
◉ For suicidal tendencies, homicidal and escape
patients
◉ Count materials
Issues in Therapeutic Relationship
◉ Negative attitude, fear and hostility
◉ Communication difficulties
- Language barriers
◉Transference and countertransference
◉ Dependence
◉ Stigma
◉ Helplessness, anger, and depression
◉ Sexual Feelings
◉ Fear and Revulsion
Issues in Therapeutic Relationship
◉ Transference – occurs when one person usually
the patient unconsciously relates to the other usually
the therapist as if that person were someone else,
usually an important person in the patient’s life
○ Client to therapist
Issues in Therapeutic Relationship
Transference
○ The patient thinks that you are someone else other
than the OT
○ Set distance if already apparent
◉ Transference can manifest in erotic attraction,
rage, hatred, mistrust, parentification, extreme
dependence on the therapist
Issues in Therapeutic Relationship
○ Countertransference – occurs when the other
person usually the therapist unconsciously falls into
that role
○ Therapist to client
○ The OT thinks that the patient is someone else
other than a client (ex. OT thinks patient is her sibling
so she gives her too much attention and care)
Issues: Dependence
◉ Detrimental – excessive dependence by the
patient on the health professional even if they can do
it
◉ Constructive – patient relies on the health
professional to provide something that the patient
cannot manage because they cannot do it
◉ Self-dependence – ability to depend on oneself, to
identify and solve one’s own problems; synonymous
with independence
 Ethics
1. Patient-centered focus 6. Continuing Education
2. Goal-oriented 7. Standard of Care
Treatment
3. Patient’s Rights
4. Confidentiality
5. Patient Welfare
Ending the Relationship
◉Discharge
◉Successful accomplishment of goals
◉Change of job/living situation
◉Recognize the client cannot benefit
Intentional Relationship Model
IRM
Intended as a conceptual practice model
◉ To explain TUS in OT
◉ Guide interpersonal reasoning for addressing
dilemmas and challenges to the therapeutic
relationship
◉ Illustrates how to best develop relationships that
embrace the fundamental values and ethics of OT
practice
Elements
◉ Client
◉ The interpersonal events that occur during
therapy
◉ The therapist
◉ The occupation
Client
◉ Focal point
◉ Therapist’s responsibility to:
○ Develop a positive relationship with the client
○ Respond appropriately when interpersonal events occur
◉ Therapist should work to understand the client
from an interpersonal perspective
Dimensions of Interpersonal
Characteristics

◉ Situational characteristics
◉ Enduring characteristics
Interpersonal Events of Therapy
◉ A naturally occurring communication, reaction,
process, task, or general circumstance that occurs
during therapy and that has the potential to detract
from or strengthen the therapeutic relationship
May be precipitated by:
◉ Client resistance
◉ Therapist behavior
◉ Client display of strong emotions during therapy
◉ A difficult circumstance of therapy
◉ A rift or conflict between client and therapist
◉ Differences concerning aim of therapy
◉ Client requests that test the limits of the
therapeutic relationship
Interpersonal Events
◉ Inevitable during the course of therapy
◉ Ripe with both threat and opportunity
9 Categories of Interpersonal Skills
1. Therapeutic communication
2. Interviewing skills and strategic questioning
3. Establishing relationship with clients
4. Families, social systems, and groups
5. Working effectively with supervisors, employers
and other professionals
9 Categories of Interpersonal Skills
6. Understanding and managing difficult
interpersonal behavior
7. Empathic breaks and conflicts
8. Professional behavior, values, and ethics
9. Therapist self-care and professional development
Therapeutic Mode
◉ Specific way of relating to a client
◉ Therapeutic modes consistent with the therapist’s
fundamental personality characteristics are used
◉ Interpersonal style
◉ Multimodal interpersonal style
◉ Mode shift
Interpersonal Reasoning
◉ Includes developing a mental vigilance toward the
interpersonal aspects of therapy in anticipation that
a dilemma might occur and a means of reviewing and
evaluating options for responding
Desired Occupation
◉ The task or activity that the client and therapist
have selected for therapy
◉ Function of therapeutic relationship:
○A support to occupational engagement
○A place where emotions and coping process associated with
the client’s impairment and its implications for occupational
participation can be addressed
The Therapeutic Modes
Advocating Mode
◉ Ensuring that client’s rights are enforced and
resources are secured.
◉ May require the therapist to serve as mediator,
facilitator, negotiator, enforcer, or other type of
advocate with external persons and agencies
Collaborating Mode
◉ Expecting the client to be an active and equal
participant in therapy
◉ Ensuring choice, freedom, and autonomy to the
greatest extent possible
Empathizing Mode
◉ Ongoing striving to understand the client’s
thoughts, feelings, and behaviors while suspending
any judgments
◉ Ensuring that client verifies and experiences the
therapist’s understanding as truthful and validating
Encouraging Mode
◉ Seizing the opportunity to instill hope in a client
◉ Celebrating a client’s thinking through + rf
◉ Conveying an attitude of joyfulness, playfulness
and confidence
Instructing Mode
◉ Carefully structuring therapy activities and being
explicit with the clients about the plan, sequence,
and events of therapy
◉ Providing clear instruction and feedback about
performance
◉ Setting limits on a client’s requests or behavior
Problem Solving Mode
◉ Facilitating pragmatic thinking and solving
dilemmas by outlining choices, posing strategic
questions, and providing opportunities for
comparative or analytical thinking
References
◉Early, M.B. Mental Health Concepts and
Techniques for the OTA 4th ed.
◉Taylor, R. The Intentional Relationship:
Occupational Therapy and Use of Self
Thank you for listening!