Relationship Focused Practice/therapeutic use of self - sept 4

Collaborative Relationship Focused Practice

• OT approach that centers on the relational aspects between the therapist and the individuals, families, groups, and communities served.

• The collaborative relationship is the vehicle for achieving occupational participation and goals; effectiveness depends on the quality of the relationship.

• Flower framework (relationship-focused practice) with four key characteristics.

Four Key Characteristics of relationship-focused practice

• Contextually relevant relationships

  • Reflect on personal values, beliefs, social location, and explicit/implicit biases.

  • Bring a contextually aware lens; respect client choices and dignity of risk in decision-making.

  • Examples illustrate biases and how they influenced care; importance of recognizing and managing biases in the moment.

• Nuanced relationships

  • Not all relationships are the same; adapt approach to fit each person and situation.

  • Some clients want direct expertise; others want collaborative engagement.

  • Relationship protocols may need to be negotiated or iterated over time (e.g., directness vs. open-ended questions, communication styles).

  • Household/community dynamics influence interaction styles.

• Safety (emotional, cultural, and professional)

  • Strive for safety through humility, curiosity, and cultural safety.

  • Do no harm, do not judge, and ensure personal beliefs do not unduly influence care.

  • Preparedness and context awareness (e.g., understanding diverse backgrounds, trauma history).

  • Boundaries and reciprocity; consider sharing aspects of self only as they support the therapeutic alliance.

• Rights-based self-determination

  • Center clients’ and groups’ right to make their own choices and control their lives.

  • Refusal to treatment is an expression of autonomy; not a problem to fix or equate with noncompliance.

  • Advocate for self-determination within the team and systems; address capacity assumptions and ensure informed, voluntary choices.

Context and Ethics in Practice

• Value conflicts may arise; aim to do no harm, avoid judgment, and ensure personal beliefs don’t dictate services.

• Moral and ethical responsibility to navigate differences in values and maintain client-centered care.

• Documentation and communication around refusals and decisions should capture context and rationale.

Therapeutic Use of Self

• Definition: artful, selective, and planned use of one’s personality, attributes, and interactions to enhance therapy.

• It is intentional and context-dependent; not simply self-disclosure for personal rapport.

• Two primary features

  • Planned use: deliberate choice of how to engage, based on client needs (how do your actions influence outcome?)

  • Therapeutic in itself: should strengthen the therapeutic relationship and support change.

• Learning and using therapeutic use of self

  • Role modeling: observe and imitate effective exemplars; adapt to fit one’s own style.

  • Reflective practice: assess what works, what doesn’t, and adjust accordingly.

• Personal attributes (examples from practice)

  • Strengths: creativity, humor, empathy, curiosity, honesty, directness when appropriate.

  • Considerations: impatience, potential biases (e.g., cultural or demographic), need to adapt style to client needs.

• Practical application

  • Use curiosity to build rapport (e.g., asking about meaningful aspects of a client’s life) when it supports engagement.

  • Set boundaries and know when to be more directive or more collaborative.

  • Recognize power dynamics and consciously distribute leadership in the relationship.

• Why it matters

  • The quality of the therapeutic relationship strongly influences outcomes and client motivation.

  • Builds clinician confidence and aligns care with core OT values.

• How to learn it

  • Lots of practice in class, fieldwork, and observing mentors.

  • Use a flexible, adaptive approach; there is no single “right way.”

Applying the Four Characteristics (Practical Focus)

• Develop emotional intelligence, collaboration, and empowerment in client interactions.

• Expect relationships to evolve: may start therapist-led and gradually shift toward coaching/partnered decision-making.

• Prepare and tailor approach to context; be culturally and trauma-informed; check emotions that arise in clinician and client.

• Be ready to adjust plans if safety or self-determination concerns emerge.

Activity and Reflection Prompts (Last-Minute Review)

• Think about times you were a client or in a caregiving role: what worked well in therapeutic use of self?

• Consider experiences with less effective care: what could have been done differently to support the relationship and participation?

• List essential qualities for effective therapeutic use of self beyond those discussed (e.g., specific communication skills, boundaries, respect, empathy).

• In small groups, discuss concrete examples of how to apply the four characteristics in real scenarios and identify potential challenges.