IRM Model

Resistance

Refusal linked to the therapeutic relationship

• anger towards therapist

Reluctance

hesitation for reasons outside that relationship

• fear of making mistakes during dressing

Empathetic break

pause the task to address feelings

Boundary testing

respond respectfully and maintain professional limits

Six IRM therapeutic modes

• advocating

• collaborating

• empathizing

• encouraging

• instructing

• problem solving

Advocating

• speak up for services and resources

• support access to care, equipment or resources

ex. justify a wheelchair to an insurance provider

Collaborating

• share decisions and respect autonomy

• make decisions WITH the client

ex. set treatment goals together

Empathizing

validate feelings without judgement

acknowledging distress and validate emotions

ex. “ i can see this has been frustrating”

Encouraging

build hope and celebrate progress

ex. “you completed that step independently today!!”

Instructing

teach, cue and give feedback

provide directions, demonstration, and cues

ex. teaching the sequence for transfer

Problem solving

help identify and address barriers

explore practical solutions to barriers

ex. identify ways to manage a home accessibility challenge

Clinical situations: choose the mode

client feels hopeless

empathize

Clinical situations: choose the mode

client wants to choose goals

collaborating

Clinical situations: choose the mode

client wants to clear a task sequence

instructing

client needs equipment approval

advocating

client succeeds at a difficult step

encouraging

client faces a new participation barrier

problem solving

Final review: identify the purpose
restore a physical impairment

biomechanical

adapt how a person completes an occupation

rehabilitative

facilitate movement/ normalize tone

motor control

choose an interpersonal response

IRM