therapeutic modes

advocating

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

advocating example

lobbying to secure adequate resources for the provision of ongoing support and environmental adaptation. this enabled a man with learning disabilities to participate safely in self-care and domestic activities in his own home environment

collaborating

expecting the client to be an active and equal participant in therapy. ensuring choice, freedom, and autonomy to the greatest extent possible

collaborating example

facilitating a man to set his own recovery-oriented occupational goals after undergoing an inpatient detoxification program for alcohol misuse

emphasizing

ongoing striving to understand client’s thoughts, feelings, and behaviors while suspending any judgement. ensuring that the client verifies and experiences the therapist’s understanding as truthful and validating

emphasizing example

taking care to summarize and acknowledge the occupational requests and sensitivities of a woman experiencing psychotic symptoms. this approach enabled her to reclaim her values of being a vegan and being very environmentally conscious throughout her therapeutic recovery experience

encouraging

seizing the opportunity to instill hope in a client. celebrating a client’s thinking or behavior through positive reinforcement. conveying an attitude of joyfulness, playfulness, and confidence

encouraging example

spontaneously responding to a women attending an OT group therapy session who, inspired by some background music, started to dance. therapeutic connection was enhanced by this small gesture to join with her joy of the activity

instructing

carefully structuring therapy activities and being explicit with clients about the plan, sequence, and events of therapy. providing clear instruction and feedback about performance. setting limits on a client’s request or behavior

instructing example

enabling a withdrawn woman with little belief in her own abilities to undertake self-care activities. this was achieved by talking the woman through the task, all the while verbally reinforcing the correct approach to the task

problem solving

facilitating pragmatic thinking and solving dilemmas by outlining choices, posing strategic questions, and providing opportunities for comparative or analytical thinking

problem solving example

analyzing options for a young man with Asperger syndrome to undertake the activities of value to him that also supported his well-being. this involved analyzing pros and cons of different activities and negotiating with his family, who were concerned about his extraordinary choices of some occupations and his neglect of others

empathising mode

mode most effective for empathic breaks

problem-solving application

• phrases: “What makes you think that you won’t be good at gardening?” Let’s make a list of the strenghts and weaknesses of this approach.”

• questions: “What advice would you give to a firend?” “Are there any other possible explainations for that?” “What’s the best or worst that could happen?”

• continuity: facial expression should be neutral to serious and body position should be businesslike and match the topic of discussion

• application: ask the client questions that will help clarify/challenge their thinking; make lists of options with client

instructing application

• phrases: “Here’s what I’d like you to do.” “The rules are as follows.” “I’m going to do ___.”

• questions: “Why do you think I’m asking about this?” “What’s the next step?” “What do we do during ___?”

• continuity: facial expressions should be serious, authoritative, or businesslike; body position should convey a sense of confidence and leadership

• application: provide your opinion, advise, or give a recommendation; assign homework; describe what’s happening to act as a guide; provide information or education

encouraging application

• phrases: “your ROM has improved.” “You can do it! I know you can!” “ You were able to walk twice as far this week compared to last week.”

• questions: not used a lot with this mode

• continuity: body language/facial expressions should be relaxed and more casual and should match what you’re communicating

• application: use humor; tell client they’re doing well; label strengths; reassure; express confidence

emphasizing application

• phrases: “Let me stop and summarize what you just told me to make sure I understand.” “My only goal right now is to listen.” “You have a right to feel that way.”

• questions: “Are you able to tell me why you feel that way?” “Can you tell me more about that?” “What were you thinking at the time?”

• continuity: facial expressions should be neutral or naturally match client’s; maintain eye contact; minimize physical presence so client feels like center of attention; maintain open body position

• application: summary statements; emotional resonance; strive to understand; listen silently

collaborating application

• phrases: “You may choose anything you want.” “Please provide me ongoing feedback.” “How can I serve you today?”

• questions: “Tell me what you’d like to get out of therapy.” “What goals do you have for yourself?” “In your opinion, what would be the best use of our time in therapy?”

• continuity: facial expression should be neutral, curious, and unassuming; maintain less assertive and more deferential posture

• application: ask what client wants out of therapy; solicit feedback; encourage client to make decisions; verify choices with client

advocating application

• phrases: “I would like to recommend this organization/information.” “Under this act, these are your rights.” “I think you should get in contact with these people that share similar experiences.”

• questions: “Do you know about the services you’re entitled to?” “Are you interested in talking to others with similar experiences?” “Are you aware of your rights?”

• application: encourage client to be assertive with others about their needs and rights; offer opportunities; normalize illness/impairment experience; utilize professional capacity to fight on client’s behalf