The Therapeutic Use of Self and Intentional Relationship

The Therapeutic Use of Self and Intentional Relationship.

Learning Objectives. Describe the concept of therapeutic use of self Describe the Intentional Relationship Model and the various components of the model Describe the various aspects of therapeutic communication? Describe how to establish intentional relationships Be able to apply strategies to address sadness, anger, and anxiety Describe how to conduct an intentional interview.

What is the therapeutic use of self. Application of empathy and intentionality to an interpersonal knowledge base and skill set that can be applied to resolve evocative interpersonal events in practice. Fundamental understanding of our clients as human beings at an interpersonal level. A personal and subjective investment in the client How to initiate and respond to the client’s reactions to therapy..

Empathy - Psychotherapy. Empathy - Psychotherapy.

Empathy- OT. Suzanne Peloquin – first to emphasize the role of empathy in OT Emphasized the role of art, literature, imagination, and self-reflection Providing OTs with stories and poems that illustrated empathy and the depersonalizing consequences of neglectful attitudes and failed communications. (Peloquin, 1989, 1990, 1993, 1996, 2003).

Intentional Relationship Model (IRM). Empathy is the deliberate effort to understand the client’s inner experience as a separate and independent ideological, psychological, visceral, cognitive, or emotional perspective as reflected in the person’s expressed thoughts, feelings, or behaviors. Empathy includes the actual act of showing empathy toward one’s client. Used to achieve an open, reliable, and trusting communication with clients so that one may apply other OT models and methods to achieve OT goals. Done so in the absence of any projected personal experience by the therapist. FOCUS is on occupational engagement as the central mechanism of change.

Historical definitions of Therapeutic Use of Self.

Intentionality and the IRM. Maintaining emotional integrity Physical impulse control Behavioral impulse control Emotional impulse control Psychological impulse control.

Client-Centered. “[O]bligated to respond in a custom-tailored way to the interpersonal characteristics and events of a given client because that client is situated in the moment within his or her unique clinical situation” (Taylor, 2020, p. 17). What does this statement mean?.

Intentional Relationship Model. A Model of the Intentional Relationship in Occupational Therapy.

Model of the Intentional Relationship. Client’s interpersonal characteristics: situational and enduring The interpersonal events that occur during therapy The therapist’s use of self: interpersonal knowledge base, therapeutic modes, and interpersonal reasoning Occupational engagement, which is the mechanism of change.

Therapeutic Communication. Therapeutic Communication.

Therapeutic Communication. How communication influences treatment outcomes.

Therapeutic Communication. Verbal communication Nonverbal communication Unidirectional vs. bidirectional communication Therapeutic listening Seeking and responding to client feedback Providing clients with structure, direction, and feedback.

Verbal communication. [image] The Lack of Non Verbal Communication in a Digital World MelibeeGlobal com.

Nonverbal communication. Sounds Tone of voice Facial expressions Body postures Movements Gestures Orienting your body toward the client and making eye contact.

Unidirectional vs. bidirectional. Unidirectional – communication that does not feel reciprocal initiated and sustained by therapist without response from client Sometimes occurs early in therapy with clients who have communication challenges Bidirectional – communication that feels reciprocal Some indication that the client has received communication and involves give and take during which both client and therapist may initiate and maintain a sharing of body language, thoughts, or feelings..

Therapeutic Listening. Therapist’s efforts to gather information from a client that promotes a greater understanding of the client’s experiences. Provide client with as much validation and support for the client’s perspective as possible Empathetic listening Guided listening Verbal prompts and sounds Enrichment questions.

Therapeutic Listening Empathetic Listening. [image] Communication Skills Empathetic Listening Inside Out 2015 YouTube.

Therapeutic Listening Guided Listening. Summary statements to help organize or clarify what the client is saying Assist a client in limiting, structuring, or organizing what is being said. Helpful for clients who seek guidance when timed correctly.

Therapeutic Listening Verbal Prompts and Sounds. Expressions such as Ah, Uh-huh, or Umm. Reminds client that therapist is listening Careful not to overuse.

Therapeutic Listening Enrichment Questions. Would you feel comfortable telling me more about it? Would you give me some more details about it? When did this happen? When did this idea first occur to you?.

Seeking and Responding to Client Feedback. Seek feedback about the client’s experience in therapy Focus on aspects of process that therapist can alter or correct Examples Ask about how they felt while performing a task Ask what difficulties they encountered when following through on a recommendation Ask if they noticed any problems with an assistive device or environmental modification Ask if they find your style to be supportive enough Respond to feedback (thanks, apologize, repeat main points of feedback, offer to offer, ask their preferences, educate about rationale).

Providing clients with Structure, Direction and Feedback.

Providing clients with Structure, Direction and Feedback.

Establishing Intentional Relationships. Rapport building Impression management Emotional climate.

Establishing Intentional Relationships. Mode Matching Mode Versatility Convey to the client that therapist is willing to orient their interpersonal style so that the client is not worried about interpersonal issues and can get the most out of therapy.

Establishing Intentional Relationships. When a mode matches a client’s interpersonal needs, you may observe: Relaxation of facial muscles and other body muscles Signs of increased interest or engagement Increased ability to attend to and concentrate on the activities and tasks of therapy Signs of appreciation, respect, or endearment toward you.

Establishing Intentional Relationships. Managing emotional intensity Sadness, anger, anxiety are the most common Witnessing the client’s expression Showing emotional resonance (feeling same type of emotion and allowing your feelings to show it through your affect or what you say) Labeling the client’s affect or emotional expression Intervening.

Sadness: Witnessing. [image] Sadness Pixar Wiki Fandom.

Sadness: Labeling. [image] Sadness Pixar Wiki Fandom.

Sadness: emotional resonance. [image] Sadness Pixar Wiki Fandom.

Anger: Witnessing. Challenging because anger has the potential to evoke fear when it carries implicit threats of physical or emotional harm. Most cases of anger do not manifest into aggressive behavior but this is unpredictable. Adaptive anger: Client discloses feeling angry, frustrated, irritable Irritability in tone of voice Slightly raised voice Use of strong words or angry vocalizations Nonviolent nonverbal behaviors and gestures that convey irritation or frustration (throwing hands up in air, putting head in hands) SUPPORT AND VALIDATE feelings if no known risk that anger will escalate..

Anger: Witnessing. Maladaptive anger: Verbal hostility Verbal threats to act aggressively Subtle insinuations or jokes that are sexually provocative, offensive, disrespectful Deriding you in presence of others Nonverbal behaviors or gestures that are menacing or threatening (hand signs, raising hand as if to hit, etc) Physical acts of aggression toward objects (throwing objects) Physical acts of aggression toward people (hitting, pushing, biting).

Anger: Why? Perceived loss. Loss of control of bodily functions (no longer to use arm) Loss of control concerning other aspects of life (divorce, employment) Loss of a skill An unfulfilled expectation of performance Loss of control concerning decisions and activities of therapy Loss of the therapist’s affection, approval, or praise.

Anger: emotional resonance. Validate feelings (labeling) Restore control and de-escalate anger: stay calm, firm with neutral tone Set limits on verbal hostility – if continue, consequences (ask to leave, end session early, escorted to ED by security, expelled from program Rise when client rises Urge client to sit back down to talk Instruct client to describe feelings rather than act on them Remind client that they have a choice in how to communicate anger Remind client of consequences for physical aggression and that behavior is not permitted. Remind client to leave room if they feel they may act on their feelings Maintain a safe distance or remove yourself from the physical proximity of client altogether if needed..

Anger – intervention. Use instruction mode to gain respect and establish yourself as authority figure Remove nonstationary objects from room Memorize phone number of security Sit or stand by door Leave door open Ask security to stand outside room Behavior modification with children Self defense strategies Safe room for clients Make and post policies that describe how anger can and cannot be expressed in setting Emphasize that clients have choices in how they wish to express their anger and remind them of consequences of maladaptive choices.

Anxiety- Witnessing. Elevated or heightened pitch of voice More talkative or rapid speech Wringing or clenching hands Dry mouth Scrunching shoulders Raised eyebrows or widened eyes Approval seeking or frequently questioning you about performance Hesitating or resisting activity High level of need for reassurance Self-doubt about performance Medically unexplained increase in fatigue, pain, or physical or cognitive symptoms Slower than usual performance or underperformance on an activity or task.

Anxiety - labeling. Stating what is observed: “I can see that you are worried about….” Validating what is observed: “It makes sense you would be feeling worried about….” “This is a big step you are taking.” Giving client permission to be anxious “You look a little uncertain about this.” Nomalizing the worry: “A lot of people are reluctant to try this the first time.” Validation: Are you having any questions or concerns today Are you feeling worried or nervous today Does this task or activity worry you Is there something on your mind?.

Anxiety -caution. Avoid prolonged validation of anxiety Silently witnessing, showing emotional resonance, or labeling may heighten anxiety.

Anxiety - intervention. Use instructing mode – increase structure, repetition, guidance and leadership may comfort client Encouraging mode – offer incentives, reassurance, promote self-confidence and instill hope Collaborating mode – deliberate effort to increase client’s perceived control Slow pace of therapy and grade activities more careful to allow for mastery Reserve time out or break to discuss client’s worries and problem solve Strategic questioning – begin to examine the validity of their worries and analyze the utility of the anxious thinking..

Judicious use of Touch. [image] Beyond Touch Tomorrow 39 s Devices Will Use MEMS Ultrasound to Hear Your Gestures IEEE Spectrum.

Cultural Competencies. Cultural Competencies. Responsible for possessing the cultural competence necessary to be able to adjust your practices to better understand and accommodate the ways in which you differ from your clients. Step outside our comfort zones and learn to relate. With and be guided by unique ideologies and behavioral practice of our diverse clients..

Intentional Interview. Assume differences exist Create a confidential and protective environment Conveying a take charge attitude (semi-structured interviews) Assessing vulnerabilities and sensitivities Orienting client to the process and requesting consent Rephrasing, reordering, or asking questions creatively Detecting and respecting client’s boundaries Listening well.

Intentional interview. Responding to a response Responding therapeutically (summary statements, validating, judicious about showing emotions, etc) Never apologize for interview length or the questions Checking in and acting as an emotional buoy (highlighting shifts in topics) Knowing when to stop Redirecting hyperverbal or tangential clients Spotting and clarifying ambiguities, doorknob comments, contradictions (admit you do not understand, ask for clarification).

Intentional interview. Summarizing, seeking feedback, and establishing closure Strategic questioning: influence their perspectives, convey a certain message, or cause client to reflect and evaluate thinking on a topic To assist in problem solving To assist clients in evaluating different options To address a client’s apprehension about engaging in a new activity To raise client’s awareness that their thinking is unnecessarily pessimistic To assist clients in achieving realistic idea of their performance To help clients see distinctions between aspects of lives they can and cannot control To help alleviate worries about uncontrollable events To help plan how to address worrisome aspects of their lives that they can control To help client synthesize information so they can develop new ways of thinking or reacting to a given situation.

References. Taylor, R. (2020). The intentional relationship: Occupational therapy and use of self (2nd ed). Philadelphia, PA: FA Davis..