Last year, Bob Collins hosted an #OTalk called ‘Interpersonal Skills: Intangible or Teachable‘ (click the link to read more – opens in a new window). Building on this discussion, Hazel Clerkin (@hazelclerkin) will be hosting this week’s #OTalk about the therapeutic modes from Taylor’s Intentional Relationship Model. Hazel was the first person to introduce me to the model – something I now regularly use to reflect on my practice – so I’m pleased she’s agreed to host this chat.
– Clarissa (@geekyOT)
Therapeutic Use of Self
Taylor (2008, p.14) identifies the aim of therapeutic use of self (TUS) in practice is to facilitate the therapeutic relationship and in turn facilitate a clients occupational engagement, thus increasing therapy outcomes. Davison (2011) highlights that “the values concepts and skills required for therapeutic use of self are fundamental to entry level practice and should be taught in a student-centred, active manor”, however extensive education in TUS is not typical in most occupational therapy programmes (Bailey & Cohn, 2001; Ledet, Esparza & Peloquin, 2005; Peloquin & Davidson, 1993; Sands, 1995).
Taylor (2008) developed the Intentional Relationship Model to deliver TUS and how it can be utilized to promote occupational engagement and promote positive therapy outcomes. This model offers a set of concrete tools and interpersonal skills in TUS. “Therapeutic Modes” which are advocating, collaborating, empathising, encouraging, instructing, problem solving can be used by the occupational therapist to facilitate TUS. The modes should be adopted and vary, according to client characteristics, therapeutic responding and interpersonal reasoning. The modes promote the therapist’s ability to establish and maintain relationships with clients and manage possible difficult behaviour to achieve optimum therapy outcomes
Clarissa and I designed a role play workshop using six modes of TUS, advocating, encouraging, instructing, problem-solving, empathising and encouraging as outlined by (Taylor, 2008). We delivered the workshop to occupational therapy students, and assisted them to integrate each of the modes through a role play case study. The results of the workshop indicate that students perceived skill level in TUS increased after participating in the role play workshop.
It should be noted that this increase was statistically significant for problem solving, collaborating, instructing and advocating modes and not significant for empathising and encouraging modes. This study indicates a need for further research into effective deliverance of skills to occupational therapy students such as empathising and encouraging within the therapeutic relationship.
Therapeutic Modes (Taylor, 2008, page reference to follow)
Advocating Mode
- Facilitate and consult
- Ensure opportunities for participation and access
- Legal rights, barriers, obstacles to independence
- Approach interpersonal difficulties by adjusting and accommodating the needs of the client.
Collaborating Mode
- Therapist to make decisions jointly with clients, involve clients in reasoning about therapy, and expect clients to participate actively in therapy.
- Facilitate the clients active participation in therapy
- Encourage the client to make more decisions in therapy
- Inform the client they are responsible for the outcomes of therapy
- Define the therapeutic relationship as a shared effort to explore and pilot test new goals or skills
- Insist that the client provide direct and honest feedback about his or her experience in therapy
- This mode works well with client who are excessively dependent, symptom focussing, resistant, denial, difficulty with rapport and trust.
Empathising Mode
- Therapist to strive to understand the client’s interpersonal needs and perspectives as accurately as possible. Paying particular attention to client’s emotional experiences.
- Articulate the clients need or perspective, so the client feels heard
- Strive to understand the behaviour from the clients perspective
- Validate the need of the client.
- This mode works well with clients who are manipulative, excessively dependent, symptom focussing, resistant, and denial, difficulty with rapport and trust, hostility towards the therapist.
Encouraging Mode
- Therapist to compliment, applaud, and cheer. Rejoice and celebrate when clients are successful.
- Instils clients with hope, courage, will, participation and perform
- Examine the extent to which a client values and are interested in a given activity.
- Focus on selecting and altering activities to make them more appealing, pleasurable and attractive
- Frequent use of positive reinforcement, positive feedback, humour, entertaining antics, cheering, coaxing, compliments, applause, motivational words.
Instructing Mode
- Therapists to emphasise education in clients.
- Label and define the negative behaviour for the client so they are aware of it and they are aware you are aware of it
- Set a limit on the behaviour
- Highlight the negative consequences of the behaviour for the therapeutic relationship and the outcome of therapy
- Teach alternative more adaptive ways the client can get their needs met within the relationship.
- This mode works well with emotional disengagement, passivity, isolative, difficulty with rapport and trust, hostility
Problem Solving Mode
- Ask the client strategic questions
- Discuss the advantages as well as the negative consequences of the clients behaviour
- Negotiate with the client to find an alternative way of obtaining gratification of his or her needs.
- This works well with resistance, emotional disengagement, isolation, passivity.
Questions
Q1. Have you come across the Intentional Relationship Model before? What are your thoughts on it? How might this theory be useful?
Q2. Thinking about the various therapeutic modes, are there any that you are more comfortable with? How do you think you developed skills in these modes?
Q3. Do you believe therapeutic use of self can be taught? How can we support students to develop skills/confidence in this area? What do you think of the idea of using role play?
References
Bailey, D.M. & Cohn, E. (2001) ’Understanding others: a course to learn interactive clinical reasoning’, Occupational Therapy in Health Care, 15, pp.31-46.
Davidson, D.A. (2011) ’Therapeutic use of self in academic education: a mixed methods study’ , Occupational Therapy in Mental Health, 27, pp.87-102.
Ledet, L., Esparza, C.K. & Peloquin, S.M. (2005)’The conceptualization, formative evaluation, and design of a process for student professional development’, American Journal of Occupational Therapy, 59, pp. 457-466.
Peloquin, S.M. & Davidson, D.A. (1993) ’Interpersonal skills for practice: an elective course’, American Journal of Occupational Therapy, 47 (3), pp.260-264.
Sands, M. (1995) ‘Readying occupational therapy assistant students for level II fieldwork : beyond academics to personal behaviours and attitudes’, American Journal of Occupational Therapy, 49 (2), pp.150-152.
Taylor, R.R. (2008). The Intentional relationship: occupational therapy and use of self. Philadelphia: F.A.Davis Company
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PDF of Transcript. #OTalk – 17 Mar 2015
