therapeutic relationship and client collaboration

What does client-centered care require?

Collaboration (the process of mutual participation of the client and therapist)

How/Where does client-centered care occur?

Within the context of a therapeutic relationship (which requires therapeutic use of self).

The therapeutic relationship is complex and ever-changing

What is therapeutic use of self?

"Occupational therapy practitioners develop and manage their therapeutic relationship with clients by using professional reasoning, empathy, and a client-centered, collaborative approach to service delivery” - OTPF-4 (AOTA, 2020)

Intentional Relationship Model

includes

• client personal characteristics

• inevitable interpersonal events of therapy

• therapist interpersonal modes

• desired occupational outcome

• interpersonal reasoning at the CENTER

what is between client interpersonal characteristics and inevitable interpersonal events of therapy?

client’s interpretation and reaction to the event

what is between inevitable interpersonal events of therapy and therapist interpersonal modes?

therapeutic responding to the event, given the client’s characteristics

what is between client interpersonal characteristics and desired occupational outcome?

occupational engagement

IRM: Client Interpersonal Characteristics

• Communication style

• Capacity for trust

• Need for control

• Capacity to assert needs

• Response to change and challenge

• Affect

• Predisposition to giving feedback

• Capacity to receive feedback

• Response to human diversity

• Orientation toward relating

• Preference to touch

• Capacity for reciprocity

IRM: Inevitable Interpersonal Events of Therapy

• Expression of strong emotion

• Intimate self-disclosures

• Power dilemmas

• Nonverbal cues

• Crisis points

• Resistance and reluctance

• Boundary testing

• Empathic breaks

• Emotionally charged situation

• Limitations of therapy

• Contextual inconsistencies

IRM: Therapist Interpersonal Modes

• Advocating: Ensuring the client’s rights are honored and resources are secured

• Collaborating: Ensuring client choice, freedom, and autonomy to the greatest extent possible

• Empathizing: Striving to understand the client’s thoughts, feelings, and behaviors while suspending judgment

• Encouraging: Conveying an attitude of hope, confidence, and joyfulness; positive reinforcement

• Instructing: Providing education and training, as well as feedback on performance

• Problem Solving: Facilitating pragmatic thinking and solving dilemmas

IRM: Interpersonal Reasoning

Steps

1) Anticipate: What are likely interpersonal events, what modes might work best

2) Identify and cope: Name and frame interpersonal events and client characteristics, maintain own perspective

3) Determine if a mode shift is required

4) Choose a response mode or mode sequence

5) Draw upon any relevant interpersonal skills associated with the modes

6) Gather feedback: Verbal and nonverbal from client about process/incident