Therapeutic Relationships and Person-Centered Collaboration

Chapter 28 - 14th edition of Williard and Spackman's OT

Collaboration

Collaboration

is a process of mutual participation between the person and the practitioner and is a critical element in person-centered care.

This process often includes providing choice, involving individuals in decision-making, and encouraging them to actively contribute and to set their own goals for therapy.

Intentional Relationship Model

is both a person- and practitioner-centered and an evidence-based conceptual model of practice that is applied across OT with all people in diverse settings and fields.

This model has been developed for OT practitioners and students to discover, validate, and improve their natural interpersonal skills and styles the use (or will use) in practice.

Enduring characteristics

are those which come from an individual’s personality and reflect their natural interpersonal styles.

Situational characteristics

are emotional and behavioral reactions to immediate stressful personal circumstances or events experienced within the contexts of participation (i.e., problems found in health system’s organization or social and physical restrictions to their participation).

Communication style

Interpersonal Characteristics

A person’s ability to communicate in a clear, well-paced, and detailed yet succint manner that is appropriate to his or her developmental level and cognitive ability.

Tone of voice

Interpersonal Characteristics

A person’s voice volume (e.g., low, loud, soft, or shrill) used while speaking, which could indicate emotional states, reactions during interaction, or enduring personal characteristics related to his or her interpersonal style, or physical or sensory conditions.

Body language

Interpersonal Characteristics

A person’s nonverbal cues while he or she interacts with others can be exhibited through mannerisms such as posture, eye contact, facial expression, or position of extremities and can be related to a person’s interpersonal characteristics.

Level of trust

Interpersonal Characteristics

A person’s ability to trust that the practitioner has his or her best interests in mind and that every effort will be made to ensure his or her physical safety and emotional well-being.

Need for control

Interpersonal Characteristics

The degree to which a person takes an active versus passive role within the relationship and in determining the course of therapy.

Approach to asserting needs

Interpersonal Characteristics

A person’s approach to expressing his or her wishes and needs for support, information, resources, or other requests within the therapeutic relationship.

Response to change and challenge

Interpersonal Characteristics

A person’s ability to adapt to changes in the therapy plan or environment and his or her approach to occupational therapy tasks and situations that are new or challenging.

Affect (facial expression)

Interpersonal Characteristics

A person’s outward expression of emotion, usually through facial expression, which varies in terms of frequency, intensity, consistency, and fluency.

Predisposition to giving feedback

Interpersonal Characteristics

A person’s ability to provide the therapist with appropriate negative or positive comments about his or her reactions to the therapist and experience of therapy as either helpful or unhelpful.

Response to feedback

Interpersonal Characteristics

A person’s ability to maintain perspective when receiving praise from the practitioner or when receiving correction during performance, limits on behavior, or information about his or her strengths and weaknesses.

Response to human diversity

Interpersonal Characteristics

A person’s reaction to ways in which he or she may be the same or different from the practitioner in terms of perceived worldview or interpretations of observable characteristics (race, age, ethnicity, gender, and clothing).

Orientation toward relating

Interpersonal Characteristics

A person’s need for interpersonal closeness versus professional distance within the therapeutic relationship.

Preference for touch

Interpersonal Characteristics

A person’s observed comfort or discomfort with or expressed reaction to any type of physical touch, whether it be a necessary part of treatment or an expression of caring.

Interpersonal reciprocity

Interpersonal Characteristics

A person’s ability to engage fully in the therapy process and or show appreciation toward the therapist as a separate but connected partner within the therapy process.

Interpersonal event

is a naturally occuring communication, reaction, process, task, or general circumstance that occurs during therapy and that has the potential to detract from or strengthen the therapeutic relationship.

Expression of strong emotion

Interpersonal Events

Observable manifestations of internal feelings that occur with a higher-than- usual level of intensity given a person’s cultural context and norms; can be positive or negative expressions.

Intimate self-disclosures

Interpersonal Events

Statements or stories that reveal something personal or sensitive about the person making a disclosure; can be related to oneself or to close others.

Power dilemmas

Interpersonal Events

Feelings of stress or conflict that emerge when the person and the practitioner disagree about something.

Can manifest overtly or covertly during therapy. They are more likely to occur when people feel a lack or loss of control over their lives.

Nonverbal cues

Interpersonal Events

Communications that do not involve the use of formal language. Some examples are movement patterns, body posture, and eye contact.

Crisis points

Interpersonal Events

Unanticipated, stressful events that cause persons to become absent or distracted from therapy. Examples include natural disasters, a change in the person’s health status, or an emergency involving a person’s significant others.

Resistance and reluctance

Interpersonal Events

is a person’s passive or active refusal to participate in some or all aspects of therapy for reasons linked to the therapeutic relationship (e.g., unexpressed anger toward the practitioner or situation).

is disinclination toward some aspect of therapy for reasons outside the therapeutic relationship, such as a person’s anxiety about task difficulty or other concerns about performance.

Boundary testing

Interpersonal Events

A person’s behavior that violates or asks the therapist to disclose something or act in ways that the therapist is not comfortable with or that are outside the definition of a professional relationship.

Empathetic breaks

Interpersonal Events

Any action initiated by the practitioner, or something a practitioner fails to notice or acknowledge, that results in a person feeling dissapointed, disillusioned, insignificant, or emotionally injured.

Emotionally charged therapy tasks and situations

Interpersonal Events

Activities or circumstances that a person feels strongly about because of a past experience, a high level of value for the activity, or because of something embarassing about the activity.

Limitations of therapy

Interpersonal Events

Restrictions on the available or possible sevices, time, resources, or nature of the desired relationship with the practitioner.

Contextual inconsistencies

Interpersonal Events

Any aspect of a person’s interpersonal or physical environment that changes during the course of therapy.

Verbal innuendos

Interpersonal Events

The person says something illusive or oblique that it is meant to serve as a hint about a more direct communication.

Therapeutic mode

is a specific way of relating to the client

Advocating

Collaborating

Empathizing

Encouraging

Instructing

Problem-Solving

Enumerate the six therapeutic modes

Advocating

Therapeutic modes

Ensuring that the person’s rights are enforced and resources are secured; may require the practitioner to serve as a mediator, facilitator, negotiator, enforcer, or other type of advocate with external persons and agencies.

Collaborating

Therapeutic modes

Expecting the person to be an active and equal participant in therapy; ensuring choice, freedom, and autonomy to the greatest extent possible.

Emphatizing

Therapeutic modes

Ongoing striving to understand the person’s thoughts, feelings, and behaviors while suspending any judgement; ensuring the person verifies and experiences the practitioners understanding as truthful and validating.

Encouraging

Therapeutic modes

Seizing the opportunity to instill hope in a person. Celebrating a person’s thinking or behavior through positive comments; conveying an attitude of joyfulness, playfulness, and confidence.

Instructing

Therapeutic modes

Carefully structuring therapy activities and being explicit with people about the plan, sequence, and events of therapy. Providing clear instruction and feedback about performance; setting limits on a person’s request or behavior as needed.

Problem-solving

Therapeutic modes

Facilitating pragmatic thinking and solving dilemmas by outlining choices, posing strategic questions, and providing opportunities for comperative or analytical thinking.

CAM

is a valid and reliable tool that comes in different version.

CAM-T

is the practitioner version that helps to identify their modes used.

CAM-C

is a version to elicit from the person in therapy perceptions about their practitioner’s mode use.

CAM-O

is used by a third person to rate a practitioner’s modes through observation.

Client Mode Preference Questionnaire

measure the extent and type of therapeutic communication that a person would prefer from their practitioner and is most commonly used before therapy begins.

Interpersonal reasoning

is a dynamic and ongoing six-step process in which practitioners intentionally evaluate and make decisions of the best ways to relate with people under different cicumstances, taking into consideration their historic narrative, interpersonal characteristics, occupational needs, and contextual realities.