OTD 520 Exam #3

Why is the client-therapist relationship important, and how does it affect OT outcomes?

The relationship between therapist and client is central to successful occupational therapy. A strong therapeutic relationship fosters trust, collaboration, and motivation, allowing clients to fully engage in treatment. When communication and empathy are present, clients are more likely to participate meaningfully and achieve therapeutic goals. Conversely, misunderstandings or poor rapport can hinder progress and limit positive outcomes.

What is the central objective of the Intentional Relationship Model?

The IRM’s central objective is to help occupational therapists use their therapeutic relationships intentionally and effectively to support clients’ occupational engagement and participation. It provides a framework for understanding how interpersonal dynamics influence therapy and how therapists can adjust their communication and behavior to meet each client’s needs.

What are the central components of the IRM?

1. The Client – their interpersonal characteristics and reactions.

2. The Therapist – their interpersonal skill base, modes, and personal characteristics.

3. The Interpersonal Events – naturally occurring challenges or emotional triggers that arise during therapy.

4. The Occupation – the actual activity or task being used as therapy.

What does intentionality mean in the IRM?

Intentionality refers to the therapist’s conscious awareness and deliberate use of their words, tone, actions, and reactions to benefit the client. It is about being purposeful in communication and behavior rather than acting on impulse or emotion. Therapists are encouraged to pause, reflect, and choose responses that best support the client’s needs and the therapeutic goals. Key phrase: “Thinking before responding”—acting with purpose, not by accident.

How is empathy defined within the IRM?

Empathy in the IRM is the therapist’s emotional resonance and understanding of the client’s experiences, combined with the ability to communicate that understanding effectively. It’s not just “feeling for” the client but “feeling with” them in a way that strengthens trust and connection. Example: The therapist listens deeply, acknowledges emotions, and conveys understanding without judgment.

How does the OTPF-4 define the term client?

The term client broadly refers to persons, groups, or populations who receive occupational therapy services.

- Persons include individuals and those involved in their care.

- Groups are collections of people with shared purposes or characteristics (e.g., families, students, workers).

- Populations are larger aggregates with common attributes such as contexts, concerns, or health risks.

The OTPF uses “client” inclusively for all these categories unless otherwise specified

What is the vision of the OTPF-4th Edition?

The vision of the OTPF-4 is to articulate a modern version of the profession’s founding values—that occupational therapy is:

- Occupation-based

- Client-centered

- Contextual

- Evidence-based

It emphasizes the belief that therapeutic occupations help remediate illness and promote participation and well-being through engagement in meaningful life activities

What is occupational science according to the OTPF-4th Edition?

Occupational science provides a foundation for understanding humans as occupational beings. It studies:

- The relationship between occupation, health, and well-being

- How time use, identity, satisfaction, and engagement shape lifeIt offers a way of thinking that deepens understanding of how occupations influence quality of life and participation

What are the two main sections of the OTPF-4th Edition?

1. The Domain – outlines the areas of knowledge and expertise that define occupational therapy (what we know).

2. The Process – describes the actions practitioners take when providing services (what we do).

These sections are interconnected, guiding OTs to support health, well-being, and participation through meaningful occupation

What are the cornerstones of occupational therapy practice?

1. Core values and beliefs rooted in the occupation

2. Knowledge of and expertise in the therapeutic use of occupation

3. Professional behaviors and dispositions

4. Therapeutic use of self

These interact dynamically and distinguish OT from other health professions. They evolve through education, mentorship, and experience

Give one example of each type of client.

- Person: A child learning social rules during recess.

- Group: Travelers in an airport following cues and staff directions.

- Population: Individuals affected by environmental factors such as noise or temperature controls in a sensory-friendly museum

What are the five aspects of the OT Domain?

1. Occupations – Everyday activities people want, need, or are expected to do.

2. Client Factors – Values, beliefs, body functions, and body structures influencing performance.

3. Performance Skills – Observable actions (motor, process, social interaction).

4. Performance Patterns – Habits, routines, roles, and rituals.

5. Contexts – Environmental and personal factors influencing engagement.

What are the three main phases of the OT process?

1. Evaluation: Developing the occupational profile and analyzing occupational performance.

2. Intervention: Planning, implementing, and reviewing intervention strategies collaboratively with the client.

3. Outcomes: Determining success through achievement, improvement, prevention, and satisfaction measures

What are the main intervention approaches?

- Create/Promote: Enhance performance for all individuals.

- Establish/Restore: Develop or regain skills and abilities.

- Maintain: Preserve performance capabilities.

- Modify (Compensate): Adapt environment or activity to support participation.

- Prevent: Reduce potential barriers or disability.

Types of interventions include:

- Therapeutic use of occupations and activities

- Interventions to support occupations

- Education and training

- Advocacy and self-advocacy

- Group and virtual interventions

What are examples of OT outcomes?

- Occupational performance

- Prevention

- Health and wellness

- Quality of life

- Participation

- Role competence

- Well-being

- Occupational justice

What are co-occupations?

- Co-occupations are shared activities that require mutual participation, such as caregiving, playing a game, or mealtime routines. They involve interactive and interdependent actions between two or more people (e.g., parent and child during dressing or feeding).

- Parallel: (different occupations in close proximity to others; e.g., reading while others listen to music when relaxing at home)

- Shared: (same occupation but different activities; e.g., preparing different dishes for a meal)

What's the difference between direct and indirect services?

- Direct Services: Occur when the therapist works directly with the client in person or through telehealth.

- Indirect Services: Provided through consultation, advocacy, or collaboration with others (e.g., teachers, caregivers, organizations) on behalf of the client

Why are occupational and activity analyses important?

They allow OTs to understand the demands of an activity, the skills required, and how performance can be adapted or graded. These analyses help practitioners tailor interventions to improve participation, safety, and independence across contexts.

Why is the information gathered during the occupational profile important to the OT process?

The occupational profile provides the foundation for understanding who the client is, their values, interests, routines, and goals, and what occupations are meaningful to them. This information allows the therapist to connect chosen activities to real-life participation and to tailor interventions. It also helps the OT identify barriers, supports, and priorities, which guide the analysis of performance and outcome goals.

Key idea: The occupational profile is the starting point of the OT process—it ensures treatment is client-centered and occupation-based.

How do a client's environmental and personal factors influence performance in occupations and activities?

- Environmental factors include the physical, social, and cultural surroundings. Examples: lighting, noise, accessibility, family expectations, and community norms.

- Personal factors include internal influences such as age, gender identity, motivation, education, and coping style.

Together, these factors can support or hinder participation—for instance, poor lighting might limit success in reading, or strong family support might enhance independence.

OT Application: Therapists evaluate and modify environmental and personal barriers to improve participation and engagement.

How do performance patterns influence participation in occupations and activities?

Performance patterns—habits, routines, roles, and rituals—create structure and meaning in daily life.

- Habits: automatic behaviors (e.g., brushing teeth before bed).

- Routines: established sequences (e.g., morning self-care).

- Roles: expected behaviors (e.g., parent, student).

- Rituals: symbolic actions that convey identity or values (e.g., family dinners).

When disrupted (e.g., after injury or life transition), participation suffers. Reestablishing positive patterns supports consistency, identity, and engagement.

How do objects, space, and social demands affect participation, and how can OTs grade or modify to improve it?

- Object demands: characteristics like size, shape, weight, texture, or number of tools needed.

- Space demands: physical environment—lighting, temperature, noise, room size, layout.

- Social demands: expectations or norms involved (e.g., turn-taking, communication, eye contact).

Grading or Modifying:

- Grade up: make tasks more challenging to build skill (e.g., add resistance, reduce assistance).

- Grade down: simplify the task or environment (e.g., larger handles, seated position).

The goal is to reach the “just-right challenge” to encourage progress and success.

How do body functions relate to client factors?

Body functions are the physiological and psychological processes that support performance, such as:

- Mental functions (attention, memory, emotion)

- Sensory functions (vision, hearing, touch)

- Neuromusculoskeletal and movement functions (strength, range of motion, coordination)

- Cardiovascular, respiratory, and other systems that sustain activity

Client factors encompass both body functions and body structures, influencing how effectively a person performs tasks

What are the categories of performance skills?

1. Motor Skills: Moving and interacting with the environment (e.g., stabilizes, grips, coordinates).

2. Process Skills: Organizing, sequencing, and adapting actions (e.g., chooses, initiates, adjusts).

3. Social Interaction Skills: Engaging with others appropriately (e.g., turns toward, clarifies, thanks).

Identification Tip:

If it involves movement or physical effort → Motor

If it involves thinking or problem-solving → Process

If it involves communication or social behavior → Social

What are examples of interpersonal characteristics seen in group therapy?

- Communication style: e.g., client reluctant to speak due to low confidence

- Tone of voice: soft vs. loud reveals comfort or anxiety.

- Body language: closed posture = low self-confidence.

- Level of trust: interaction and openness show trust levels.

- Need for control: client insists on own choices.

- Affect & feedback capacity: positive or negative emotional response to input.

- Interpersonal reciprocity: how clients relate mutually with others or the therapist.

OT Insight: Recognizing these traits helps choose appropriate IRM modes (e.g., Collaborating, Empathizing).

What inevitable interpersonal events occur in group therapy?

Events are normal and unavoidable parts of therapy, such as:

- Expression of strong emotion – anger, frustration, sadness.

- Intimate self-disclosures – sharing personal stories.

- Power dilemmas – issues of control between client and therapist.

- Nonverbal cues & verbal innuendos.

- Crisis points & resistance.

- Boundary testing or empathic breaks.

- Emotionally charged situations or limitations of therapy.

OT Insight: Recognizing and responding with intentional use of self prevents ruptures in trust and keeps therapy productive.

What is the difference between adaptive and maladaptive group dynamics?

- Adaptive (production): trusting, collaborative, goal-directed interactions that support growth (e.g., mutual problem solving).

- Maladaptive: patterns that create tension or limit progress (e.g., competition for leader approval or avoidance of tasks).

OT Insight: Intentional therapists identify dynamics early and manage them through interpersonal reasoning—balancing empathy with objectivity.

What tools do OTs use when teaching?

- Objects that stimulate learning (novel & fun)

- Visual aids (handouts, models)

- Meaningful repetition

- Plain language

- “Just-right” challenge

- Active engagement and activity analysis

- Measurable goals in a natural context

Example: Having clients cook pasta to practice sequencing, gripping, and attention skills.

Why do occupational therapists use Universal Design for Learning (UDL)?

UDL promotes access and flexibility by reducing learning barriers and allowing multiple ways to represent, express, and engage with information. It helps clients with different abilities learn through visual, auditory, or tactile pathways.

OT Insight: Applying UDL principles ensures that interventions are inclusive and adaptable for diverse learners.

What are examples of perceptual pathways for learning?

Pathway

Print = Reading a recipe for a cooking group

Aural = Listening to verbal directions

Interactive = Participating in a discussion

Visual = Drawing a circle while watching a demo

Haptic = Assembling a puzzle

Kinesthetic = Engaging in movement (e.g., posture training)

Olfactory = Using scents like peppermint in an activity

What are the main steps in the teaching and learning process?

1. Preparation: Plan space, materials, time, and client goals.

2. Activity: Introduce task, demonstrate, monitor, and adjust as needed.

3. Follow-up: Reflect, give feedback, evaluate learning, and plan next steps.

Effective OT traits: knowledgeable, fair, flexible, open to feedback, uses multiple teaching modes, and empowers learners.