OT Reasoning & Therapeutic Modes: Principles, IRM, and Client Interaction

Reasoning in Practice:

-whole body process

-underlying cognitive processes of therapist

-cue acquisition

-pattern recognition

-limiting the problem space

-problem formulation

-problem solution

Scientific reasoning

involving the use of applied logic and scientific methods such as hypothesis, testing, pattern recognition, and theory based decision making

ex: focused on the diagnosis, what is the nature of the illness, injury, or developmental problem?

Diagnostic reasoning

-Can be considered one component of scientific reasoning

-Investigative reasoning and analysis of cause or nature of conditions requiring OT intervention.

ex: What are the occupational problems this client has or may have in the future?

Procedural reasoning

-the therapist considers and uses intervention routines for identified conditions; may be science based or reflect the habits or culture of the intervention.

ex: What evaluation and intervention protocols are applicable to this person's situation, and how are clients usually handled in this setting?

Narrative reasoning

-used to make sense of people particular circumstances, creates a collaborative story that is enacted with clients and families through intervention

ex: what is this person's life story, and what is their nature as an occupational being?

Pragmatic reasoning

uses to fit therapy possibilities into the current realities of service such as scheduling options, payment options, equipment availability, and the personal situation of the therapist. focused on things that surrounds the therapy encounter

ex: who referred this person and why? 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, approach to moral conflict

ex: are the benefits of therapy worth the cost, are risks worth the benefits? What the right thing to do is

Interactive reasoning

directed towards building positive interpersonal relationships with clients, collaboration and problem solving.

Takes into consideration what the client likes or does not like

ex: how can I best relate to this person, how can I put them at ease?

Conditional reasoning

a blending of all forms of reasoning for the purpose of flexibly responding to changing conditions or predicting possible client futures.

-Typically found with more experienced therapists who can "see" multiple views based on experience.

ex: where is this person going, what can I do to best impact their future?

The 6 therapeutic modes

advocating

collaborating

empathizing

encouraging

instructing

problem-solving

advocating

providing clients with knowledge about and access to resources, awareness, laws and rights.

collaborating

relinquishing all power and control, facilitating the clients independence, following preference of the client, follow the client's lead

Empathizing

summary statements, mirroring affect, deepening questions that reflect understanding, empathetic listening

Encouraging

instilling hope and will to participate, explore, perform, praising accomplishments and positive reinforcement

Instructing

directing, informing, guiding, educating, explaining, providing structure.

Problem-solving

The client's ability to reason through obstacles, ask questions, comparing options for action

4 elements of IRM

The client (interpersonal characteristics) inevitable interpersonal events, the therapist (use of self), Occupation (engagement)

The client (interpersonal characteristics)

communication style, tone of voice, body language, level of trust, etc.

Situational characteristics

typically inconsistent with how the client usually behaves, related to the situation

Enduring characteristics

stable and consistent aspects of client's interpersonal behavior, not related to the situation

Interpersonal events

expression of strong emotion, power dilemmas, nonverbal cues, verbal innuendos, crisis point, boundary testing, empathic breaks, etc.

Therapeutic use of self

interpersonal skill base, therapeutic modes, capacity for interpersonal reasoning

Mode shift

A conscious change in one's way of relating to a client

Occupation (engagement, the desired occupation)

The task or activity the therapist and client have selected for therapy

Therapist

Interpersonal skill base, therapeutic modes, interpersonal reasoning

The IRM 6-step Reasoning process

Anticipate, identify and cope, determine need for mode shift, choose response mode/sequence, use interpersonal skills, gather feedback

1. Anticipate

synthesize all info about the client to assist how they might feel or react to situation

2. identify and cope

identify interpersonal events that may have occurred, don't avoid, name the event

3. determine if mode shift is required

what mode am I currently using, is there a better mode that would fit?

4. choose a response mode or mode sequence

use the mode that is thought to be best, and think of a sequence that works best. aka feelings focused or activity focused

5. use interpersonal skills

skills that an OT has developed that can be useful with modes, conflict resolution skills, cognitive strategies, motivational interviewing, etc.

6. Gather feedback

observe the situation, ask questions, pre and post assessment

Responsibilities of the therapist

modes and rapport, positive interpersonal, appropriate boundaries

responsibilities of client

collaborate, engage,

Macro levels in therapeutic relationship

Overall, large picture

Micro levels in therapeutic relationship

small, inside specific therapy

Underlying principles of IRM

10 principals, they underline the concepts of this model

Principal 1

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

principal 2

interpersonal self discipline is fundamental to effective use of self

principal 3

it is necessary to keep head before heart

principal 4

mindful empathy is required to know your client

principal 5

grow your interpersonal knowledge base

principle 6

a wide range of therapeutic modes can work and be utilized in OT

principal 7

the client defines a successful relationship

principal 8

activity focusing must be balanced with interpersonal focusing

principle 9

application of model must be informed by core values and ethics

principal 10

cultural competence is CENTRAL to practice