Therapeutic Interactions: Final

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

When a client and therapist realize they need more sessions to accomplish a therapy goal but the facility and insurance will not pay for the additional sessions, it is defined as: a. An interpersonal event known as a crisis point b. A client interpersonal characteristic known as capacity for trust c. An interpersonal event known as a power dilemma d. An interpersonal event known as limitations of therapy

An interpersonal event known as limitations of therapy

interpersonal events

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

Which of the following is not one of the skill areas necessary for establishing effective client relationships in occupational therapy? a. Rapport building, impression management, and setting an emotional climate b. Mode matching and versatility c. Managing emotional intensity d. Intentional use of therapeutic touch e. Cultural competence

Intentional use of therapeutic touch

Ms. Beatle, an anxious client receiving occupational therapy to recover fine motor functioning following a bite on her finger by a brown recluse spider, harshly criticizes the therapist for suggesting a compensatory strategy that did not work for her in the kitchen. The occupational therapist responds by making a summary statement in an attempt to recount and affirm the client's experience. What therapeutic listening skill did the occupational therapist employ? a. Empathic listening c. Verbal prompts and sounds b. Guided listening d. Enrichment questions

a. Empathic listening

Which of the following is not a step in the Intentional Relationship Model (IRM)'s interpersonal reasoning process for managing difficult behaviors? a. Evaluate client's interpersonal characteristics and behavior. b. Identify, cope, and strive for understanding. c. Determine if a mode shift is required. d. Choose a response mode. e. Draw on any relevant interpersonal skills associated with that mode. f. Gather feedback.

a. Evaluate client's interpersonal characteristics and behavior.

Ms. Gourami is a frail elderly woman who poses no threat to anyone's safety. The occupational therapist did not expect to need the treatment room, but has realized after the fact that she needs to conduct an interview with Ms. Gourami. The occupational therapy treatment room is now being used by the speech therapist. In the interest of confidentiality, which of the following is the least optimal environment for the interview to take place? a. In the waiting room of the outpatient center during normal business hours b. In an empty gym typically used for sensory integration treatment c. In the physician's empty examination room d. In a well-lit and well-organized storage space containing occupational therapy and physical therapy equipment

a. In the waiting room of the outpatient center during normal business hours

According to the Intentional Relationship Model (IRM), what mode is least effective when managing a resistant client? a. Instructing mode c. Empathic mode b. Advocating mode d. Problem-solving mode

a. Instructing mode

Which of the following is true in regard to judicious use of touch? a. Knowing how to use touch in a way that respects clients' boundaries and meets their interpersonal needs—whether they be for closeness or for distance b. Knowing how to use touch in a way that respects clients' boundaries and meets their interpersonal needs for closeness and support c. Knowing how to use touch in a way that respects clients' boundaries and meets their interpersonal needs for distance and intolerance for touch d. Knowing how to use your clinical skill base in order to limit the frequency of touch or refrain from it entirely

a. Knowing how to use touch in a way that respects clients' boundaries and meets their interpersonal needs—whether they be for closeness or for distance

When a client asks a therapist if she is married, which of the following possibilities should the therapist consider? a. Responding to the fact that an interpersonal event just occurred b. Recognizing the situation as boundary testing c. Entertaining the possibility that sexual harassment may have occurred d.All of the above

a. Responding to the fact that an interpersonal event just occurred

Which of the following may be taken as a sign that the mode selected by you does match the client's interpersonal needs? a. Signs of decreased tension in the facial muscles and a relaxed posture b. Signs of decreased interest or engagement in therapy c. Decreased ability to attend to and concentrate on the activities and tasks of therapy d. All of the above

a. Signs of decreased tension in the facial muscles and a relaxed posture

Response modes

advocating collaborating empathizing encouraging instructing problem-solving

A 6-year-old client tells his occupational therapist that he is his only friend in the world. What kind of an interpersonal event would this be considered? a. A limitation of therapy c. An empathic break b. A power dilemma d. An intimate self-disclosure

an intimate self-disclosure

Which of the following challenging interpersonal behaviors encompasses allowing or encouraging the therapist to do things that one is capable of attempting or doing on his or her own or striving to please the therapist and relying on the therapist's approval to determine one's self-worth? a. Manipulative behavior c. Symptom focusing b. Excessive dependence d. Resistance

b. Excessive dependence

Which of the following does not describe what it means to assume a take-charge attitude during an interview? a. Have interview questions memorized and well-rehearsed before beginning. b. Focus on making the client feel at ease. c. Set limits in order to maintain the structure and timing of the interview. d. If a client refuses to answer a question and appears emotionally overwhelmed by the interview, explain the rationale behind why you need the information and try again.

b. Focus on making the client feel at ease.

Lately, Joanne has been finding herself feeling at odds with one of her clients. Whenever she introduces a more challenging sequence of range of motion exercises, he begins to complain of pain and accuses her of ignoring his limitations. At first, he did this in a joking manner, but now it seems he is serious about it. In addition to downgrading the task itself, from an interpersonal perspective Joanne has tried strategic questioning, problem-solving, reassurance, and becoming stronger and clearer with respect to her instructions and expectations. None of these has worked to stop the complaining. When it comes to use of self with difficult or resistant clients, which aspect of communication does Joanne most need to work on? a. Self-confidence b. Gentle inquiry and further developing her ability to use summary statements c. Self-care d. Giving directives

b. Gentle inquiry and further developing her ability to use summary statements

You are working in an inpatient rehabilitation hospital. You have just received a referral for a 19-year-old male client who suffered a severe spinal cord injury from a skiing accident. You have overheard the nurses describing the client as angry, aggressive, and reluctant to begin therapy. As you review his chart and plan for treatment, you anticipate that he will be resistant in therapy. When you approach his bedside, the client begins to yell, "Leave me alone, I'm not doing anything today!" At this point you begin to take a deep breath and remind yourself that this is a typical response in newly disabled clients. You are currently using what interpersonal reasoning step? a. Anticipate c. Determine if a mode shift is required b. Identify and cope d. Gather feedback

b. Identify and cope

According to the Intentional Relationship Model (IRM), which of the following is not an example of rapport building? a. Making eye contact and greeting the client in an earnest, professional, and friendly manner b. Informing the client of your clinical training, approach to treatment, and your anticipated goals for the client's rehabilitation stay c. Asking the client how he or she wants to be addressed, even if the client is a child d. Asking the client how he or she is feeling today or how his or her day is going

b. Informing the client of your clinical training, approach to treatment, and your anticipated goals for the client's rehabilitation stay

Mrs. Filosoof, an adult client with complications in her shoulder from a stroke, appears disengaged from therapy. She makes a "door-knob comment" that she cannot wait to be discharged from the hospital because she finds the environment rather oppressive. When you ask her more about it, she discloses that she doesn't see the point in doing the exercises that you and her other therapist have been recommending. She reports that she feels particularly irritated when the other therapist asks her if she has been "doing her homework" in-between sessions. What mode is not working and what other mode might be the best one to try next? a. Empathizing mode is not working; try instructing. b. Instructing mode is not working; try empathizing. c. Problem-solving mode is not working; try advocating. d. Collaborating mode is not working; try encouraging.

b. Instructing mode is not working; try empathizing.

While conducting an interview, Jane noticed that her client was becoming increasingly distressed, reluctant to answer the questions, and defensive in her responses. At this point of the interview, which interpersonal guideline should Jane be most aware of? a. Establishing a take-charge attitude by setting limits and establishing structure b. Knowing when to stop and assessing the client's ability to regroup c. Orienting the client to the process by reminding the client of the shared purpose d. Responding therapeutically by highlighting the client's strengths

b. Knowing when to stop and assessing the client's ability to regroup

Which of the following is not a major component of therapeutic communication? a. Providing structure, direction, and feedback b. Multidirectional communication c. Verbal and nonverbal communication d. Seeking and responding to client feedback e. Therapeutic listening

b. Multidirectional communication

Bruce prefers to structure his intake interviews and frequently uses the Occupational Performance History Interview as part of the intake process. What type of interview type does Bruce use? a. Structured interview c. Unstructured interview b. Semi-structured interview d. Open-structured interview

b. Semi-structured interview

Which of the following statements is not correct? a. Reluctance may be explained by a task being perceived as too difficult or demanding. b. The inevitable interpersonal events of therapy usually weaken the therapeutic relationship. c. Therapists should be prepared to adapt when crisis points occur. d. Clients may naturally test the limits of their relationship with you.

b. The inevitable interpersonal events of therapy usually weaken the therapeutic relationship.

Which of the following is most consistent with the recommended approach for introducing parents (or caregivers) to intentional and flexible mode use? a. Offering the parents a handout that defines the six modes and outlines the pros and cons of each mode for different interpersonal characteristics b. Weighing the pros and cons of introducing the new mode(s) into the family system with the parents c. Identifying and educating the parents on the mode(s) that the parent is least comfortable using d. Discussing the common cautions of the six modes and instructing the parents on the modes that should not be used in their everyday interactions

b. Weighing the pros and cons of introducing the new mode(s) into the family system with the parents

An occupational therapist is administering an assessment to Ms. Danio. When the occupational therapist asks a question about Ms. Danio's relationship with her boss during her most recent job as a waitress, Ms. Danio begins to cry before she can even respond to the question. Which of the following represents the least optimal way for the occupational therapist to respond? a. Pause a moment, perhaps offer a Kleenex, and watch silently to see where Ms. Danio takes the interview. c. Apologize for asking and try to rephrase the question to make it sound less direct. b. Tell Ms. Danio that she has the option of not responding to the question if she feels it is too sensitive of a topic area. d. Ask Ms. Danio what about the question prompted her to cry.

c. Apologize for asking and try to rephrase the question to make it sound less direct.

Which of the following offer effective ways in which one can integrate self-care into the daily routine? a. Setting aside regular and specific times in your schedule for self-care b. Seizing in-the-moment opportunities for self-care c. Both answers A and B

c. Both answers A and B

According to the Intentional Relationship Model (IRM), which of the following is not an example of therapeutic communication? a. Capacity to act assertively and the ability to provide clients with feedback that is positive as well as feedback that is honest and constructive b. Capacity to receive feedback from clients gracefully, regardless of whether it is positive or negative c. Capacity to assert an expert stance even when you know the client is not ready and will not respond well to the information shared d. Capacity to ask the right questions at optimal times and in ways that facilitate information-sharing and client self-refection

c. Capacity to assert an expert stance even when you know the client is not ready and will not respond well to the information shared

When a client has something unexpected happen in his/her life that interrupts the normal process and flow of therapy, how would you categorize this in terms of an interpersonal event? a. Boundary testing c. Crisis point b. Limitations of therapy d. A conundrum

c. Crisis point

Which of the following is not a step in interpersonal reasoning? a. Anticipate b. Identify and cope c. Determine if a different conceptual practice model should be applied d. Determine if a mode shift is required

c. Determine if a different conceptual practice model should be applied

You are working with an adolescent who has previously demonstrated high frequency of self-harm as well as physical and emotional hostility toward her siblings. As time goes on, you notice that her family members have grown increasingly disengaged from your client and the therapeutic process. Which of the following modes is likely to be least effective in this scenario? a. Advocating b. Empathizing c. Encouraging d. Instructing e. Problem-solving

c. Encouraging

Mr. Bean, an adult client with an intellectual and developmental impairment that affects his speech, is having a stressful day in therapy. You have tried coaxing him into speaking using your favorite football game and by playfully singing his favorite phrase, "Get ready, get set, GO!" Usually this works and he completes the phrase by responding "GO!" but today it is not working. Instead, he says the game is "stupid." What mode is not working and what other mode might be the best one to try next? a. Instructing mode is not working; try empathizing. b. Problem-solving mode is not working; try instructing. c. Encouraging mode is not working; try collaborating. d. Advocating mode is not working; try problem-solving.

c. Encouraging mode is not working; try collaborating.

Which of the following offers an example of a question that probes about the client's viewpoint? a. What are the likely short-term consequences of not cooking at home? b. Do you think someone else would make this same assumption? c. How might you explain the car accident to another person? d. Are there any alternative explanations for you feeling more tired today?

c. How might you explain the car accident to another person?

Tom was working with a client, Bill, who had recently injured his hand in a work accident. The therapist has become frustrated with Bill because he often complains that the activities are too hard and too painful. After a long day of clients, Tom responded to Bill's comments by saying, "Come on, it's not that hard!" Which potentially nontherapeutic response did Tom use? a. Parental response c. Minimizing response b. Defensive response d. Confused response

c. Minimizing response

When might it be useful to utilize Strategic/Socratic questioning with a client? a. When a client is unmotivated to engage in a recommended compensatory strategy and is refusing to speak b. When a client approaches you with a dilemma and needs help problem-solving c. When a client is joking around in therapy d. When a client attempts to break a professional boundary

c. When a client is joking around in therapy

Mr. Pesty, who experienced a brain injury when hit by a steel pole at work, is being seen on an inpatient neurology unit. You arrive on the unit to hear that, today, he has been refusing to take medications. You also learn that, today, the speech and physical therapists describe him as difficult to work with. You have been ordered by the referring neurologist to assess Mr. Pesty's functional independence. Before you enter this client's room, what aspects of the Intentional Relationship Model (IRM) would be important to keep in mind? a. It is possible that the other therapists lacked an understanding of brain science and so it would be important to characterize Mr. Pesty's behavior in terms of which areas of his brain were affected by the injury to better refine your biomechanical treatment goals. b. It would be important to adhere strictly to what the physician ordered, and to begin the session with a brief assessment of Mr. Pesty's functional independence. c. When introducing yourself, it would be important to anticipate that an interpersonal event might occur, to make mental note of some of Mr. Pesty's client characteristics, and to show Mr. Pesty that you are willing to try different modes of communicating and responding. d. All of the above

c. When introducing yourself, it would be important to anticipate that an interpersonal event might occur, to make mental note of some of Mr. Pesty's client characteristics, and to show Mr. Pesty that you are willing to try different modes of communicating and responding.

Which of the following is at least one interpersonal event that characterizes the following situation? Mike, an intelligent and high-achieving 15-year-old client, has relocated to your area and you are now assigned as his new occupational therapist. His mother requests that you work with him on becoming more independent in his self-care and hygiene. When you meet Mike, it is very evident in his appearance and odor that he does not practice adequate hygiene. You are faced with a situation in which you must discuss these issues with Mike, who seems disinterested and angry about others' concerns about his hygiene. a. boundary violation b. Crisis Point c. emotionally charged therapy situation d. contextual inconsistency

c. emotionally charged therapy situation

Which of the following does not represent an interpersonal event in therapy? a. A court reporter attempts to type on a keyboard for the first time since the stroke that affected her left upper extremity. b. A therapist must tell a young client, who tends to be very attached to her in therapy, of her plans to take maternity leave. c. A therapist forgets to order the scooter in time for the client's field-trip to Washington, DC. d. A therapist consults with her supervisor about a client.

d. A therapist consults with her supervisor about a client.

According to the Intentional Relationship Model (IRM), which of the following are encompassed in nonverbal communication? a. Noticing any changes in the client's facial expression, eyes, posture, tone of voice, or other body language interpreted the client's nonverbal communication accurately b. Remaining self-aware and intentional about one's own facial expression, eyes, posture, tone of voice, or other body language c. Maintaining eye or body orientation to the client while multitasking d. All of the above

d. All of the above

Cultivating intentionality in our use of self during therapy requires: a. Recognizing and cultivating our strengths b. Knowing and accepting our weaknesses and limitations c. Striving for critical self-awareness and reflection d. All of the above

d. All of the above

Which of the following is a function served by empathic listening in occupational therapy? Please choose the best answer. a. Empathic listening provides a means by which to summarize and clarify the content of what a client is communicating. b. Empathic listening shows a client that a therapist is continually striving to understand his or her thoughts, feelings, or behavior. c. Empathic listening can be used effectively to repair rifts and resolve conflicts. d. All of the above

d. All of the above

Which of the following represent(s) a responsibility on the part of a therapist in establishing and maintaining a relationship with a client? a. Ensure that the relationship is socially defined as being an occupational therapy relationship and that professional boundaries are upheld. b. Work to earn a client's trust through an intentional and effortful process of trying. c. Recognize and respond, when appropriate, to interpersonal events. d. All of the above

d. All of the above

Occupational therapy interviews often require clients to disclose personal details that may make a client feel uncomfortable or pressured to influence the interviewer's opinion in a certain direction. To avoid misunderstanding, the interviewer must be careful to: a. Convey the importance of accuracy in reporting and understanding b. Demonstrate acceptance and evenly hovering attention c. Rely on previous knowledge and experience of working with similar clients d. Both answers A and B e. Both answers A and C

d. Both answers A and B

Ms. Fallible is a client who has just injured her wrist while competing in a sport that means the world to her, judo. As the clinician is in the process of making a splint for her, Ms. Fallible laughs nervously and confides that she feels as if she has really failed because she not only lost the match but she also injured herself. According to the Intentional Relationship Model (IRM), what, if any, of the following are true? a. This is an interpersonal event that should not be ignored. b. It would be important to ignore the comment so she does not feel worse about it. c. This is an intimate self-disclosure. d. Both answers A and C

d. Both answers A and C

Which of the following are important approaches toward self-care? a. Capitalizing on interpersonal strengths c. Building self-confidence b. Attending continuing education courses d. Both answers A and C

d. Both answers A and C

Which of the following challenging interpersonal behaviors encompasses a failure to communicate authentically with the therapist and provide feedback about personal experience of therapy? a. Emotional disengagement b. Denial c. Difficulty with rapport d. Difficulty with trust e. Hostility

d. Difficulty with trust

According to the Intentional Relationship Model (IRM), which of the following is not included in the interpersonal reasoning process? a. Drawing upon relevant interpersonal skills b. Determining if a mode shift is required c. Gathering feedback d. Doing what is most comfortable or habitual

d. Doing what is most comfortable or habitual

When a therapist fails to notice or understand a communication from a client or unintentionally initiates a communication or behavior that the client feels is hurtful or insensitive, he/she is engaging in which interpersonal event? a. Expression of strong emotion b. Boundary testing c. Emotionally charged therapy tasks and situations d. Empathic break

d. Empathic break

Which of the contemporary approaches explains the mechanisms underlying difficult interpersonal behaviors as a manifestation of a maladaptive dynamic within the larger social system of which the client is a part? a. Behavioral c. Humanistic b. Cognitive-behavioral d. Systems

d. Systems

What potential risk does the response in question 1 have on the client? a. The client may feel confused by the therapist. b. The client may experience it as invalidating or judgmental. c. The response may cause the client to become overreliant. d. The client may perceive it as the therapist not listening to his concerns.

d. The client may perceive it as the therapist not listening to his concerns.

Which of the following describes potential maladaptive dynamics within a therapeutic relationship? a. When an individual establishes a pattern of asking for assistance and then explains why it would not work b. Individuals have close ongoing contact and are expected to share information readily, even if it is highly intimate or personal c. When an individual establishes a pattern of recruiting assistance when it is not necessary d. When individuals permit, facilitate, or support the behavior of another individual even though it is negative or potentially harmful e. All of the above

e. All of the above

Which of the following definitions of communication is (are) correct? a. Unidirectional communication is communication that does not feel reciprocal to the therapist because it is initiated and sustained by the therapist without any apparent response from the client. b. Bidirectional communication is communication that feels reciprocal to the therapist because at minimum it involves some indication that the client has received the communication. c. Unidirectional communication is communication that does not feel reciprocal to the therapist because it is initiated and sustained by the therapist with active dismissal or rejection by the client. d. Bidirectional communication is communication that feels reciprocal to the therapist because at minimum it involves active engagement and response (verbal or nonverbal) from the client. e. Both answers A and B f. Both answers C and D

e. Both answers A and B

According to the Intentional Relationship Model (IRM), which of the following is not a strategy for providing clients with structure, direction, and feedback within the context of occupational therapy? a. Educating the client about the purpose and potential utility of therapy b. Using goal setting to track progress and assess outcomes c. Informing the client about openness to change based on feedback d. Making expectations for client's role in therapy clear e. None of the above

e. None of the above

While helping a client problem-solve through a dilemma, which of the following strategies would adhere to strategic questioning derived from the Socratic approach? a. Questions about the origin or source b. Questions that probe evidence c. Questions that probe assumptions d. Questions about the viewpoint e. Both answers B and C f. All of the above

f. All of the above

establishing relationships

rapport building, impression management, and emotional climate mode matching and versatility managing emotional intensity judicious use of touch cultural competence