Chapter 16 Therapeutic Relationships
The Intentional Relationship Model defines 6 primary interpersonal modes (or styles) used in therapeutic relationships. What are they?
(A PIECE) Advocating Problem-solving Instructing Empathizing Collaborating Encouraging
What are some examples of self-awareness exercises?
-Keep a journal -participate in group activities -give feedback to others
Why must the health care professional first develop trust with the client?
-Once the client trusts the practitioner, he or she will feel comfortable sharing personal information that may shape the intervention process. -This develops an honest and open relationship
What grade level should practitioners use when communicating with others?
6th grade level of language. This allows a person hearing the information to process the questions or responses.
What is active listening?
A critical skill for maintaining an effective therapeutic relationship. The practitioner actively listens to the client w/o making judgements, jumping in with advice, or providing defensive replies. The receiver paraphrases the speaker's words to ensure that he or she understands the intended meaning
How does the practitioner develop trust?
By being sincere, following through with plans, and listening to the client.The practitioner develops trust to learn from the client and direct intervention
What can practitioners develop using verbal communication?
Can be used to develop an intervention plan
How should the OT practitioner use body language?
Carefully, and should match it to the particular needs of the client. Obviously, it is not appropriate to smile when the individual is sharing feelings of how life has changed for the worse.
What is the client's thoughts and feelings summarized or simplified?
Clarification
client-"When my doctor referred me to OT, I thought you would be the person who would help me get the use of my arm back. I've been coming for weeks and i still dont have full functioning of my arm." Practitioner-" When u came to OT, you expected to immediately get function back in your arm. Now you realize that the return of you r arm and hand function is going to take longer than expected." This is an example of ?
Clarification
What type of Therapeutic mode from the Intentional Relationship Model(IRM): Develops goals and strategies with the client and modifies the intervention plan based upon the client's input?
Collaborating
Overall, what traits should the group leader convey?
Confidence and clarity in the goals and structure of the activity.
What are some examples of group activities?
Cooking, Arts and crafts, exercise, ADLs, leisure participations, and reality orientation.
What are the Universal Stages of Loss?
Denial Anger Bargaining Depression Acceptance
What can a lack of self-awareness result in?
Distorted self-perceptions that are destructive to "real" relationships.
Why is it important for the OT practitioner to not judge the client's progression through the universal stages of loss?
Each person and family deals with experiences differently. Ot's who are sensitive to the emotional impact of loss are more effective in developing therapeutic relationships and helping clients progress
Who defined the universal stages of loss?
Elisabeth Kubler-Ross
What type of therapeutic mode from the IRM: Actively listens to the client's story or adjusts the intervention session to meet the client's needs?
Empathizing
What is the ability to place oneself in another person's position and understand the other's experience?
Empathy
What type of therapeutic mode from the IRM: Provides positive reinforcement or suggests that the client "do one more repetition"?
Encouraging
Clients receiving OT may lost function, health, occupations, or time. They may realize they have a chronic illness that will require their attention.This can result in many patients feeling a __?__
Loss
People who are busy defending the ideal self and denying the perceived self do not allow the real self to emerge and consequently have?
Superficial or misunderstood relationships, whereas a self-aware person is able to realistically acknowledge his or her own strengths and limitations and adapt and modify behaviors to help others or engage in healthy relationships
Leadership may shift in a group, but who is ultimately responsible for the structure and form of the group?
The OT practitioner
What does the OT practitioner use to select courses of action for the client?
The OT practitioner is aware of the client's needs and uses technical and interaction skills to select responses or courses of action that benefit the client
What is the most obvious form of communication and what can this type of communication form?
Verbal communication. Can form therapeutic relationships
What is the definition of our ideal self?
What an individual would like to be if free of the demands of mundane reality. Our "perfect self" with only desirable qualities and with all wants and wished fullfilled.
When does the Intentional Relationship Model work best?
When therapists are aware of their modes of interacting and are able to shift modes as needed. Taylor provides techniques and exercises to develop skill and awareness in therapeutic use of self.
What often makes the difference between a successful and an unsuccessful therapy experience?
The therapeutic relationship
What does the effective OT practitioner apply to address the clients needs?
The therapeutic us of self *See page 162-163 for examples of application of therapeutic use of self to OT*
What does a consultation and supervision group involve?
The use of group format for peer support, consultation, and supervision of OTA's, aides, and caregivers -Seen as an increasing need as large OT departments diminish and more practitioners work independently in private and community-based practices
What is the process of using one's interactions for the benefit of another and is referred to as "the art of relating"?
Therapeutic Use of Self
What is the interaction between an occupational therapy practitioner and a client?
Therapeutic relationship
How do therapeutic relationships differ from everyday relationships?
Therapeutic relationships are key for facilitating the healing and rehabilitation process
What does the OT practitioner watch for regarding nonverbal communication?
They are sensitive to and watchful for nonverbal forms of communication from clients.The nature of the client's disability may make it difficult for him or her to verbally communicate or understand verbal communication. In these situations, the OT and client must rely on nonverbal forms of communication
How can OT's better serve their clients?
They can learn to be aware of their own strengths and weaknesses. This allows the practitioner to focus on the other person and adapt one's behavior and interactions w/ others
How should practitioners speak to clients?
They should be clear, concise, and speak in "plain language".
What tools can be used to help group members reach their goals?
This can be accomplished by adapting and changing tasks, delegating responsibility, and intervening when needed. Ex: A practitioner may help a member who is working to improve right hand use by placing objects closer to the member. OT may suggest another member help with supplies.
How do we become aware of "one's self"?
This requires introspection in terms of the ideal self, the perceived self, and the real self.
Why do OT's create therapeutic relationships?
To help clients achieve their desired goals.
What is the primary purpose of peer support groups?
To provide support for individuals who have a diagnosis, medically related problem or disability in common -group may also involve the partners, families, and caregivers -group size can be large or small depending on the format
Is the ideal self unrealistic?
Yes, it is unrealistic and includes all intention, feeling, and desires. It is not known well to others, although people frequently feel the need to defend the ideal self (perhaps subsconsciously) when others do not acknowledge it.
What does the OT practitioner use reflection for?
To verbalize both the content and the feelings that are implied by the client EX: client-"I've been trying for weeks now. I just can't do it" practitioner-"you're frustrated and feeling defeated because you cant dress yourself?" -this demonstrates that the OT is hearing the emotion behind the words, not just the words
True or False: The perceived self is not the true self.
True: Many times the perceived self is different from the ideal self's perceptions
Practitioners who speak confidently and clearly help clients __?__ them as opposed to practitioners who speak timidly and mumble.
Trust
What skills do OT practitioners use in developing a therapeutic relationship?
Trust Empathy Nonverbal communication Verbal communication Active listening Group leadership skills
What are some techniques to develop trust with a patient?
-Follow through w/ plans -Be on time to appointments with clients -Be honest with clients -Do not overpromise things you can't deliver -Be cautious when disclosing personal information -Discuss clients' progress and intervention plans in private -Always involve the client in decisions -Be direct upon decisions -Use clear language so the client understands -Address any issues or problems that develop in the therapeutic relationship -Remember to put the client first
What is important for the practitioner to remember when leading a group session?
-It involves using therapeutic use of self and awareness of group dynamics -OT must be continuously aware of how group members are working together -OT must be aware of all members' individual goals and help each member meet those goals.
Whys is communication an essential component of the therapeutic relationship?
-Practitioners use both verbal and nonverbal communication to express themselves to clients. -It is key to gathering information, developing the intervention plan, and following up with plans.
What are some techniques to develop empathy?
-Read stories about others who have undergone significant life events -participate in activities of other cultures -interview others and try to understand their life views -reflect upon the stories of clients or peers -try to imagine conditions, disability, or trauma from the family and client's point of view (see page 160 for more)
How may a practitioner intervene when the dynamics of a group are detrimental to the progress of its members?
-This may involve setting limitations on certain individuals who may take over the group. -OT may decide to meet individually with members who are disrupting the group -Collaborate with clients on group goals that improve group dynamics -may allow the group to address the work of the group in certain settings
What is an example of positive nonverbal communication?
-a practitioner may smile and nod to provide positive support for a client's progress. The practitioner may decide to gently touch the client on the shoulder to show how he or she understands how difficult therapy may be.Sometimes eye contact alone is enough to show understanding
What are some exercises to develop nonverbal communication?
-observe an intervention session and identify nonverbal communication used -observe how others use nonverbal communication in a variety of settings -communicate with a peer without talking -practice expressing your emotions without talking -observe how you use nonverbal communication by having someone videotape you interviewing another person
What are some techniques to develop verbal communication skills?
-practice interacting with a variety of people in a variety of circumstances -reflect upon your communication skills -seek and listen to feedback from others -review videotaped sessions to observe strengths and weaknesses -practice using different techniques -identify communication skills in others that you may use -become familiar with your own style of communications
What are some techniques to improve active listening?
-practice using restatement, reflection, and clarification -role-play a variety of interviews -interview others and ask for feedback. Try to summarize what they told you -receive feedback from peers -record conversations to hear how you listened -identify strengths and weaknesses -develop techniques to improve listening skills by setting goals -observe others and identify active listening techniques they used
What are the 3 processes of active listening?
1-Restatement 2-Reflection 3-Clarification
What are some ways to take charge of a group?
1. Plan and practice or rehearse the activity to know what is needed 2. Anticipate! Think how people might interpret instructions 3. Carry a written list of all the points to remember 4. Stand to address the group 5. Get everyone's attention before talking 6. Regulate voice appropriately 7. Tell in sequence. Keep words to a minimum 8. Tell group what to do when the task is complete 9. Indicate the end of instructions and the beginning of the activity
What principles are basic to therapeutic use of self?
1st- Practitioners must possess a level of self-awareness so that they can mindfully examine their role in the intervention process 2nd- Practitioners learn to develop trust, provide support, actively listen, and empathize. They use genuineness, respect, self-disclosure, trust, and warmth when interacting with clients.
What is identification?
A term to describe the event of the OT practitioner feeling at one with a client and, as a result, losing sight of the differences. The practitioner may become confused with those of the client in such a way that they become less important to the therapy process
What is the key to working in groups?
Addressing group and individual group goals through a common task
What type of Therapeutic Mode from the Intentional Relationship Model(IRM): Justifies the need for OT services in the school system to help the child complete schoolwork?
Advocating
What type of therapeutic mode from the IRM: Consults with an employer on workplace accommodations that would allow a client to return to work?
Advocating
Practitioners with self-awareness are able to help clients who?
Are struggling with new identities and crises.
What does therapeutic use of self involve?
Awareness of oneself, including such things as how one communicates, presents, and relates with others.
What does treating a client holistically mean?
It involves understanding the client and his or her motivations, desires, and needs. To do this, OT's create a therapeutic relationship with each client
Practitioners must also consider the quality of verbal communication they provide. Why is this important?
For example, talking too fast, loudly, or in a rushed fashion suggests that the practitioner is too hurried or consumed with something else to listen and may make the client feel unimportant.
What refers to "the interacting forces within a small human group; the sociological study of these forces."
Group Dynamics
What does the practitioner do after determining the group goals?
He or she organizes the activity by analyzing the steps involved. The practitioner decides how many participants will be involved in the activity, the setting, the timing, and materials needed. After preparing the group, the OT uses skills to lead the members in the activity
Why is empathy important?
Important to the development of trust in the therapeutic relationship and helps clients communicate and participate in treatment
How do therapeutic relationships differ from friendship?
In friendship, each person contributes to and receives from the relationship, whereas, the goal of the therapeutic relationship is for one person (the client) to benefit.
What does nonverbal communication include?
Includes facial expressions, eye contact, tone of voice, touch, and body language. -Practitioners are aware of their own nonverbal communication expression
What is the primary aim of a therapeutic group?
Individual change -OT uses therapeutic tasks that are designed to restore and develop functioning in occupational performance areas and client factors -group size is typically 6-10 individuals
What type of therapeutic mode from the IRM: Teaches the client to dress using one hand, reviews precautions for the condition, or demonstrates the use of adaptive equipment or technology?
Instructing
What systematically describes therapeutic use of self and the development of modes of interacting with clients for their benefit?
Intentional Relationship Model
Will all clients experience every stage of loss?
No, clients may go through some or all of these stages during the intervention process.
Is it appropriate for a practitioner to give a client their address or phone number?
No, the practitioner should not give out his or her address or phone number
Crossing one's arms during an interview may make a client feel like the practitioner is not listening or is angry. What is this a form of?
Nonverbal communication that can be taken negatively (also sighing, or avoiding eye contact)
What are task groups?
OT practitioners generally lead task groups which can be categorized as therapeutic, peer support, focus, and consultation and supervision.
What is the objective of focus groups?
Objective is to find out about the attitudes and opinions of the members
Who addresses both the physical and emotional needs of clients?
Occupational Therapists
What is the definition of pity?
Pity is demeaning to the individual and conveys the attitude that the practitioner is better than the client.
Empathy is not to be confused with ?
Pity or indentification
What is one way that nonverbal communication can be helpful in a clinical setting?
Practitioner may be doing ROM exercises with a patient after an injury. OT moves arm and asks patient if it hurts and the patient says "no", but he is wincing as he responds(nonverbal communication). The OT feels he is really experiencing pain and would stop the movement and document the pain Reason for patients response: Patient may be impatient about getting better and works very hard in therapy. May be in danger of pushing too hard
How can we use communication to have a better therapeutic relationship?
Practitioners who listen or watch carefully for communication from clients are more effective in developing therapeutic relationships
What type of therapeutic mode from the IRM: Figures out with the client how to perform daily living skills, examines with the client how to access resources, or modifies equipment to meet the client's needs?
Problem-solving
Practitioners should consider that the information is new to the client and not use __?__
Professional "jargon" because it can be confusing
What is a blending of the internal and external worlds involving intention and action plus environmental awareness?
Real Self
What is "plain language"?
Refers to language that is understood by "laypeople" (those not familiar with the health care environment
What is a response in which the purpose is to "express in words the feelings and attitudes sensed behind the words of the sender"?
Reflection
What refers to knowing one's own true nature? It is the ability to recognize one's own behavior, emotional response, and effect on others.
Self-awareness
What does the ability to develop an effective therapeutic relationship require?
Self-awareness and a variety of skills (ability to develop trust, demonstrate empathy, understand verbal and nonverbal communication, and use active listening)
What types of factors does the practitioner consider when developing group activities?
Size and composition of group members, client population, frame of reference, setting, duration, and frequency of group meetings.
What is our perceived self?
The aspect of self that others see without the benefit of knowing a person's intentions, motivations, and limitations.
What is important for a practitioner to remember about the therapeutic relationship regarding trust?
The client may divulge personal information. While this may be beneficial to the intervention process, practitioners must be careful to remember that the relationship is about the client, not the practitioner. Self-disclosure should never be offered when the client is in the middle of a crisis or expressing thoughts
What does the real self include?
The feelings, strengths, and limitations of the person, as well as the reality in which the person exists(his or her environment)
Who is typically called upon in group settings to convey knowledge to the members, structure and carry out organizational tasks, and guide members' performance?
The group leader -informs members of their assignments, reinforces active listening, and facilitates the group process.
In a group setting, what happens in the case of an emergency?
The group leader follows emergency procedures as outlined by the facility.
Prior to leading a group, the practitioner must determine?
The individual goals of the members. The next step is to determine the group goal and decide how to meet individual needs within a group task. While all members are working on the same task, each member is addressing his or her goal
Why might the client revisit an earlier stage of the universal stages of loss? What can the OT do to help?
The intervention process is dynamic. The OT practitioner recognizes these stages and provides support and opportunities to help clients work through the stages.
What does the receiver do when using the Restatement process of active listening?
The practitioner repeats the words of the speaker (the client) as they are heard.
What is the primary purpose of restatement?
used in only the initial phases of active listening. Its primary purpose is to encourage the person to continue talking