PP: Chapter 3: Client-Centered Groups

1 Complexity Theory

  • Also termed “chaos theory”

  • Attempts to explain systems that are too complex to predict the future, but display underlying patterns that help us cope in an increasingly complex world

2 Modern vs Postmodern

  • Modern: linear science, objective truth, orderly

  • Postmodern: dynamic science, subjective, complex, individual, disorderly

  • Complexity theory attempts to bridge the gap between the extremes

3 Clinical Reasoning in OT Groups Overview
4 OT Practice with Complexity Theory

  • Multiple changing realities impacting how OT intervention is delivered

  • Cannot be easily “predicted”

  • Challenging for students because you must “know how to”

  • HOW do you “know”?

5 Answer

  • Through Use of Clinical Reasoning Skills

6 Types of Clinical Reasoning

  • Procedural: evidence-based evaluation & intervention techniques

  • Interactive: therapeutic relationship w/client

  • Conditional: social and temporal context; understanding implications of Dx

  • Narrative: storytelling; sharing of therapist’s experience to gain knowledge

7 Schell and Schell in 2008 Added 2 New Elements & Reclassified Old

  • Pragmatic reasoning: the business aspects of practice

  • Ethical reasoning: based on the “right thing to do”

  • Rephrased older model to “scientific” (AKA- procedural)

  • “Narrative” also includes client storytelling to understand disability & tell a new story

  • Interactive and conditional: intertwines these two w/focus on client relationship, unique, personal

8 Canadian Model of Occupational Performance & Engagement

  • Person-centered

  • People influence

  • Adaptation

  • People of all races, genders, levels of abilities, etc. are equally valued (humanistic theory)

  • The physical and mental well-being and social and physical environment are shaped through purposeful activities (Ax)

  • A change in function that promotes survival and self-actualization

  • OT’s goal is “enablement” (empowering the client to function at highest, most meaningful level)

9 Foundations of Enablement

  • Choice, risk, responsibility (autonomy and accountability)

  • Client participation (partnership not dictatorship)

  • Vision of possibilities (what are the goals?)

  • Change (how will goals be reached?)

  • Justice (advocacy, inclusion)

  • Power-sharing (what will you learn from each other? Not a power struggle)

10 Existential & Humanistic Concepts

  • Existential:

  • Freedom & responsibility

  • Aloneness & relatedness

  • Existential anxiety & search for meaning

  • (Know pgs 66-69)

  • Humanistic:

  • Respect

  • Genuineness

  • Nonjudgmental acceptance (unconditional positive regard)

  • Deep understanding (of self = behavioral change)

  • Self-actualization (inherent to all)

  • Occupational competence/Motivation

  • Spirituality

  • Cultural competence (acceptance of diversity)

11 Intentional Relationship Model

  • Advocating

  • Collaborating

  • Empathizing

  • Encouraging

  • Instructing

  • Problem-solving

  • Therapeutic use of self at the forefront!

12 Stages of Therapeutic Communication & Skills Required

  • Orientation: communication skills needed = attending, being concrete, using primary (1*) accurate empathy

  • Conflict: skills needed = immediacy, advanced accurate empathy (gets beneath surface), confrontation, self-disclosure

  • Cohesive maturity: skills needed = supportive tone for behavior changes

  • Use pgs 84-86 when planning your own group sessions!