501 Unit 2 Exam

therapeutic use of self

therapist’s planned use of his or her personality, insights, perceptions, and judgment as a part of the therapeutic process

four elements of IRM

• the client

• Inevitable interpersonal events

• the therapist

• the occupation

• results in the therapeutic relationship

IRM 6-Step Reasoning Process

1) Anticipate potential for event

2) Identify & Cope (name it; initial healthy response)

3) Determine need for mode shift

4) Choose response mode/sequence

5) Use interpersonal skills (paraphrase, reflect, probe)

6) Gather feedback

principle 1 of the IRM

critical self-awareness is key to the intentional use of self

principle 2 of the IRM

interpersonal self-discipline is fundamental to effective use of self

principle 3 of the IRM

it is necessary to keep head before heart

principle 4 of the IRM

mindful empathy is required to know your client

principle 5 of the IRM

grow your interpersonal knowledge base

principle 6 of the IRM

provided that they are purely and flexibly applied, a wide range of therapeutic modes can work and be utilized interchangeably in OT

principle 7 of the IRM

the client defines a successful relationship

principle 8 of the IRM

activity focusing must be balanced with interpersonal focusing

principle 9 of the IRM

application of model must be informed by core values and ethics

principle 10 of the IRM

cultural competence is central to practice

therapeutic mode

a specific way of relating to a client; there are six therapeutic modes

how are the interpersonal behaviors of therapists reflected?

• their fundamental motivation to serve others

• their preferred approach to serving

• the values they hold while serving

a mode can have a negative effect if used:

too frequently or inflexibly

when the timing is not right for the client

when the mode is not consistent with the client’s interpersonal needs in the moment

when the mode is not changed so as to be more consistent with the client’s interpersonal needs of the moment

therapeutic style

defined by the primary mode or set of modes that you tend to utilize most often during interactions with clients

advocating mode

providing clients with knowledge about and access to resources, awareness of laws or rights, consciousness-raising, normalization of experience, tends toward roles of facilitator or consultant

collaborating mode

relinquishing all therapeutic power and control, facilitating the client’s independence in thought and behavior, expecting clients to drive your therapeutic reasoning by following their preferences and participation choices, following the client’s lead in every way (even if you do not agree with what the client is saying or doing)

empathizing mode

summary statements, mirroring affect, validating negativity, deepening questions that reflect an effort to understand, not rushing to alter or fix a client’s problem, putting a significant amount of time and effort into listening and communicating in ways that increase your understanding of the client’s experience, showing discretion when deciding whether to reveal your spontaneous reactions versus putting your own reactions aside to allow full space for the client’s reactions and experience.

encouraging mode

Instilling hope, courage, and the will to participate, explore, or perform; praising accomplishments; using positive reinforcement to encourage continued behavior; using cheering, applause, high-fives, compliments, motivational words, humor, and engaging in play or other types of joyful expression.

instructing mode

directing, informing, guiding, educating, explaining, justifying, providing structure, correcting, redirecting, showing an active and directive style, assuming a teaching stance, making recommendations unapologetically, using gentle or finessed confrontation.

problem-solving mode

facilitating the client’s ability to reason through obstacles, asking Socratic or agenda-driven questions to uncover faulty assumptions or analyze decisions, comparing options for action.

mode shifting

shifting from one mode to another. desirable, a central part of the interpersonal reasoning process

suboptimal mode use

includes a mode mismatch, mixed mode use, and incongruent mode use

emotional incongruence

when a person is communicating one statement verbally and the person’s emotional expression, facial expression, or body language contradicts or does not support what the person is saying

mode incongruence

when a therapist delivers a mode verbally but their facial expression or body language is inconsistent with the mode or with the overall interpersonal context of the communication

interpersonal characteristics

client emotions, behaviors, and reactions that occur during interactions between the client and therapist and that emanate from the client’s immediate circumstances and the client’s underlying personality traits

situational characteristics

emotions, behaviors, and reactions that are context-specific and inconsistent with how the client typically interacts

enduring characteristics

emotions, behaviors, and reactions that are consistent across time and circumstance and that emanate primarily from the client’s underlying personality.

communication style

approaches to a formally spoke or signed language; includes, preferred amount, nature, and pacing of the interaction

affect

extent to which emotion is expressed

interpersonal events

naturally occuring communications, reactions, processes, tasks, or general circumstances that take place within the context of the client-therapist interaction

pro of advocating mode

• Going out of your way for your clients to provide access to resources

• Most often used when OT’s recognize the advantages of raising awareness of an injustice or when clients are unable to overcome barriers without additional resources/support

con of advocating mode

• Occurs when the mode is overused or misapplied

• Ideological orientation can cause therapists to overestimate clients’ desire, ability, resources, and socioeconomic, political, or cultural context

• for some clients awareness-raising may be too soon or overbearing

pro of collaborating mode

• reflects core values of OT (autonomy)

• usually instills confidence in the client since it conveys the view that therapist sees them as competent

  • allows control for client

con of collaborating mode

• Overreliance on the mode or nonjudiciously using it across clients

• may not be received well by those who view practitioners as authority figures

• clients who do not understand the therapy process or health care may not be well informed enough to know what is best for themselves

• Some clients don’t value independence as much, which can lead to disengagement and passivity

• can also result in diffusion of responsibility

pros to emphasizing mode

• Vital to the therapeutic relationship

• facilitates emotional healing; enables client independence and understanding

• more effective with interpersonally challenging clients (conflict resolution)

cons to empathizing mode

• Can place too much emphasis on emotion as the foreground of therapy

• Some clients will feel more comfortable with activities as the focus of the session

• Can cause fundamental therapy tasks to become delayed

• Can cause projection of therapist’s needs

• May lead to an inappropriate level of dependence (boundary blurring)

pros of encouraging mode

• Projects positive energy

• can be particularly effective with children or those with developmental/cognitive impairments

• skilled at using incentives to elicit participation

cons of empathsizing mode

• clients may become desensitized if used too frequently

• can delay clients’ ability to develop intrinsic motivation independent of the therapist

• can be misinterpreted if used with the wrong client

pros of instructing mode

• Required for competent conduct of OT; leads to excellent teachers and clear communication

• tend to be highly organized and systematic therapists

• empowers and inspires clients

cons of instructing mode

• Can lead to overinvestment in outcomes, causing disappointment when clients don’t fulfill their role

• can undermine clients’ confidence, choice, and autonomy

• can appear parental, authoritarian, dominant, controlling, or demanding

• may lead to arguments/power struggles with more sensitive clients

pros of problem-solving mode

• allows OTs to interact with clients at a more cognitive/intellectual level

  • most appropriate for clients who are able to verbally engage also fits well with clients who are uncomfortable with an emotion-focused approach

cons of the problem-solving mode

• Can lead to overuse of agenda-focused questioning and ignorance of the client’s interpersonal needs

• can appear too strategic or manipulative

categories of interpersonal characteristics

• communication style

• tone of voice

• body language

• facial expression

• response to change or challenge

• level of trust

• need for control

• approach to asserting needs

• predisposition to giving feedback

• response to feedback

• response to human diversity

• orientation toward relating

• preference for touch

  • interpersonal reciprocity

interpersonal events

inevitable, naturally occurring communications, reactions, processes, tasks, or general circumstances that take place within the context of the therapist-client interaction (emotionally charged and ripe with threat/opportunity)

expression of strong emotion

external displays of internal feelings that are shown with a level of intensity beyond usual cultural norms for interaction

intimate self-disclosures

statements or stories that reveal something unobservable, private, or sensitive about the persons making disclosures

power dilemmas

tensions that arise in the therapeutic relationship because of clients’ innate feelings about issues of power, the inherent situation of therapy, the therapist’s behavior, or other circumstances that underscore the clients’ lack or loss of power regarding aspects of their lives

nonverbal cues

communications that do not involve the use of formal language

verbal innuendos

communications in which the client says something elusive or oblique that is meant to serve as a hint about a more direct communication

crisis points

unanticipated, stressful events that cause clients to become distracted or that temporarily interfere with clients’ ability for occupational engagement

resistance

clients passive or active refusal to participate in some or all aspects of therapy for reasons linked to the therapeutic relationship

reluctance

disinclination toward some aspect of therapy for reasons outside the therapeutic relationship; easy to understand and therapist is able to see how it serves the client’s best interest

boundary testing

A client behavior that violates or asks the therapist to act in ways that are outside the defined therapeutic relationship.

empathic breaks

occurs when a therapist fails to notice or understand a communication from a client or initiates a communication or behavior that is perceived by the client as hurtful or insensitive

emotionally charged therapy tasks and situations

activities or circumstances that can lead clients to become overwhelmed or experience uncomfortable emotional reactions such as embarrassment, humiliation, or shame

limitations of therapy

restrictions on the available or possible services, time, resources, or therapist actions

contextual inconsistencies

any aspects of a client’s interpersonal or physical environment that change during the course of therapy; check in with the client to determine its impact

interpersonal event cascades

when more than one interpersonal event occurs during a single interaction and those events appear to be connected by a single theme and a predominant emotion. may occur in response to the therapists’ actions, statements, or absence thereof

therapeutic responding

encourages therapists to by systematic and self-disciplined when deciding what to say, do, and express to clients when facing a sensitive or negative situation

interpersonal reasoning

the process by which a therapist monitors the interpersonal events of therapy, the client’s unique interpersonal characteristics, and her or his own communication in a reflective way

6 Steps of Interpersonal Reasoning

1) Anticipate

2) Identify and Cope

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 mode(s)

6) Gather feedback and, if necessary, strive toward mutual understanding of the response

1) Anticipate

upholding the expectation that an interpersonal event or behavior on the part of the client is likely to occur that will test, challenge, or threaten the therapeutic relationship. occurs based on the understanding of the clients’ interpersonal characteristics

2) Identify and Cope

accurately identifying the interpersonal event or events that have occurred; best accomplished by labelling the event & searching for a reaction in the client. then having self-awareness and coping strategies to move on

3) Determine if a mode shift is required

when considering whether a mode shift is necessary, you should consider the exact nature of the interpersonal event and the unique constellation of client interpersonal characteristics

4) Choose a Response Mode or Mode Sequence

For each of the six modes, there is a corresponding set of actions or communications that reflect the therapist's use, aka response modes. When shifted rapidly to address a single interpersonal event or sequence of interpersonal events, it is known as a response mode sequence.

5) Draw on any relevant interpersonal skills associated with the mode

knowledge base comprises a continuum of skills that therapists are expected to develop early in their careers and continue to maintain and develop in more sophisticated ways as their careers continue`

6) Gather feedback, and if necessary, strive toward mutual understanding of the response

The client defines a successful relationship; therefore OT’s must check in with clients and gather feedback after an interpersonal event. If the client feels that the event has not been resolved, the OT should strive for mutual understanding.

scientific reasoning

involving the use of applied logical and scientific methods, such as hypothesis testing, pattern recognition, theory-based decision making, and statistical evidence. impersonal focused on the diagnosis, condition, guiding theory, evidence from research, or what “typically” happens with clients like the one being considered

examples of scientific reasoning

what is the nature of the illness, injury, or development problem?

What are the common impairments or disabilities resulting from this condition?

what theories and research are available to guide assessment and intervention?

diagnostic reasoning

investigative reasoning and analysis of the cause or nature of conditions requiring OT intervention can be considered one component of scientific reasoning. uses both personal and impersonal information. Therapists attempt to explain why client is experiencing problems using a blend of science & client based information.

examples of diagnostic reasoning

what are the occupational performance problems this client has or may have in the future?

what are the factors contributing to this problem (impairment, performance context)?

how will these problems manifest (skills, habits, routines, occupational roles)?

procedural reasoning

Therapists consider and use intervention routines for identified conditions; they may be science-based or may reflect the habits and culture of the intervention setting. Characterized by the OT using regimes or routines thought to be effective for the identified problems and that are typically used with clients in that setting.

examples of procedural reasoning

what evaluation and intervention protocols are applicable to this person’s situation?

how are clients like this usually handled in my setting?

narrative reasoning

reasoning process used to make sense of people’s particular circumstances, prospectively imagine the effect of illness, disability, or occupational performance problems on their daily lives; and create a collaborative story that is enacted with clients and families through intervention.

examples of narrative reasoning

what is this person’s life story?

what is the nature of this person as occupational being?

how has the health condition affected the person’s life story or ability to continue their life story?

pragmatic reasoning

practical reasoning that is used to fit therapy possibilities into the current realities of service delivery, such as scheduling options, payment for services, equipment availability, therapists skills, management directives, and the personal situation of the therapist.

examples of pragmatic reasoning

Who referred this person, and why?

how much time do I have to see this person?

what are my practice competencies?

who is paying for services, and what are their rules?

ethical reasoning

directed toward analyzing an ethical dilemma, generating alternative solutions, and determining actions to be taken; systematic approach to moral conflict.

examples of ethical reasoning

are the benefits of therapy worth the cost?

how should I prioritize my caseload?

what are the limits of how I change my documentation to maximize payment?

interactive reasoning

directed toward building positive interpersonal relationships with clients, permitting collaborative problem identification and problem-solving

examples of interactive reasoning

how can I best relate to this person?

what cultural factors do I need to consider as I engage with the person?

how can I put this person at ease?

conditional reasoning

blending of all forms of reasoning for the purposes of flexibly responding to changing conditions or predicting possible client futures. typically found with more experienced therapists

examples of conditional reasoning

where is this person going?

how will the various therapy options play out, given the person’s health condition, social situation, economic status, and culture?

given these future possible trajectories, what is the best action I can take now?