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OT IN PSY DYS
THERAPEUTIC USE OF SELF
| Term | Definition | Definition 2 |
|---|---|---|
| THERAPEUTIC USE OF SELF | ● Refers to therapists' conscious efforts to optimize their interactions with clients ● A practitioner's planned use of his or her personality, insights, perceptions and judgments as part of the therapeutic process | |
| Early occupational therapists viewed the therapeutic use of self as | a means for encouraging clients to engage in occupation | |
| TUS PURPOSE | ● Provide reassurance and/or information ● Alleviate anxiety/fear ● Obtain needed information to them ● Improve and maintain function ● Promote growth and development ● Increasing coping skills | |
| THERAPEUTIC RELATIONSHIP | ● A trusting connection and rapport established between Tx and Cx through collaboration, communication, therapist empathy, and mutual respect ● Tx is responsible for developing and maintaining a good relationship with the patient | |
| BUILDING THERAPEUTIC RELATIONSHIP | ● The therapeutic relationship is the central aspect of the therapeutic process of occupational therapy and one catalyst for change | |
| “art of practice" | ■ it is the relationship you build with your client | |
| "emphatic competence" | ■ Emotional ability of the Tx to respond to the Cx ■ Response of therapist: responding calmly, redirecting attention | |
| STAGES IN THERAPEUTIC RELATIONSHIP | 1. RAPPORT-BUILDING 2. WORKING RELATIONSHIP 3. ON-GOING WORKING RELATIONSHIP | |
| RAPPORT-BUILDING | ● Gather information ● Engage with the patient patient ● Learning how to share information with the | |
| WORKING RELATIONSHIP | ● Collaborative goal-setting ● Responding to success and failure ● Customizing the working relationship | |
| ON-GOING WORKING RELATIONSHIP | ● Consists of hard work ● Longest period ● Monitor progress | ● This is where therapist and client comes to understand each other, know how to deal feelings, adapt goals, create strategies to new realities or how it can be applied to different scenarios |
| ROLES IN THE THERAPEUTIC RELATIONSHIP ● Instructor: | improving a skill and what Cx has to learn | |
| ROLES IN THE THERAPEUTIC RELATIONSHIP ● Coach: | motivating client: modulating the client | |
| ROLES IN THE THERAPEUTIC RELATIONSHIP ● Supervisor: | ensuring safety: ensuring safety, checking the task, monitor, supervise task completion and implementation | |
| ROLES IN THE THERAPEUTIC RELATIONSHIP ● Role Model: | professional behavior | |
| ROLES IN THE THERAPEUTIC RELATIONSHIP ● Problem solver: | when barriers arise | |
| ROLES IN THE THERAPEUTIC RELATIONSHIP ● Environmental manager: | adapting, modifying spaces or adding to environment | |
| ROLES IN THE THERAPEUTIC RELATIONSHIP ● Group member: | modeling behaviour as a member | |
| ROLES IN THE THERAPEUTIC RELATIONSHIP | ● Be flexible to whatever the client currently needs | |
| THERAPEUTIC QUALITIES OF A THERAPIST; SENSITIVITY | ● Alertness/being sensitive to the patient’s needs and awareness of your effect on him or her ● Includes facial expressions and nonverbal behavior | |
| THERAPEUTIC QUALITIES OF A THERAPIST; SENSITIVITY ● Non verbal behaviors: | open body language, nodding head, eye contact, neutral facial expression, appropriate distance from the client (do not invade personal space) | |
| THERAPEUTIC QUALITIES OF A THERAPIST; RESPECT | ● Recognition as a unique individual with personal interests and values that may be quite different from those of the therapist ● Diff cultures have different expectations for what should happen between a patient and a mental health work | |
| OT has to learn what the culture expects (in terms of communication, personal space, authority, etc.) = | cultural competence | |
| THERAPEUTIC QUALITIES OF A THERAPIST; WARMTH | ● Sense of friendliness, interest, and enthusiasm the therapist conveys ● Shown by smiling, eye-contact, leaning forward, touching and other nonverbal behaviors ● The way the therapist displays warmth must vary with the situation | |
| THERAPEUTIC QUALITIES OF A THERAPIST; GENUINENESS | ● Ability of oneself to be open and real ● Therapists must first be aware of themselves and be comfortable with who they are ● What you say is the same as what you’re doing! | |
| THERAPEUTIC QUALITIES OF A THERAPIST; SELF-DISCLOSURE | ● Practice of revealing things about oneself ● Revealing only as much as is needed to make the person more comfortable ● Most helpful when the patient has asked for it (verbally or nonverbally) | ● Timing is very important ● Important to know what not to disclose ● Cultural competence is still pertinent in self disclosure as certain cultures might misinterpret how you shared your personal information |
| what not to disclose: | ○ Details about one’s personal life (address, phone number) ○ Certain times are appropriate in the therapeutic relationship to help them feel more open ■ Ex: Leisure exploration - share what you also like to try or have tried like reading | ■ Part of self-disclosure is telling the patient that you can help/motivate them, especially if there is apprehension, “Ako rin po mahilig magbasa, I can recommend books din po sa inyo” ■ Don’t invent false information |
| THERAPEUTIC QUALITIES OF A THERAPIST; SPECIFICITY | ● Art of stating things simply, directly, and concretely ○ We point out what we actually observe ● Focusing only on what is important | ● Effective therapist points out what is happening without labeling it or turning it into an abstract principle or a value judgment ○ Be concrete |
| THERAPEUTIC QUALITIES OF A THERAPIST; IMMEDIACY | ● Practice of giving feedback right after the event to which it relates ● Idea of focusing the Cx’s attention on the here and now ● Don’t delay the feedback, both you and the client will get confused | |
| COMMUNICATION TECHNIQUES | ● Make initial contacts brief ● Choose words carefully ● Be comfortable with silence ● Encourage using minimal responses ● Listen and observe ● Summarize and focus ● Ask for clarification ● Follow through on promises ● Make initial contacts | |
| ATTITUDE | ● An attitude is a relatively enduring organization of beliefs around an object or situation, predisposing one to respond in some preferential manner | ● An attitude refers to certain regularities of an individual’s feelings, thought, and predispositions to act toward some aspect of his environment |
| COMPONENTS OF ATTITUDES | ● All three shape how we respond to our client ● Cognitive ● Affective ● Behavioral | |
| Cognitive | ○ Beliefs ○ Thoughts | |
| Affective | ○ Values ○ Feelings ○ Emotions | |
| Behavioral | ○ Two internal factors are expressed | |
| TYPES OF ATTITUDE | see pdf | |
| ACTIVE FRIENDLINESS | ● OT Takes the Initiative in Making Friendly Gestures | |
| ACTIVE FRIENDLINESS ● Key Elements | ○ Extra attention ○ Reassurance ○ Praise for acceptable behavior ○ Companionship | |
| ACTIVE FRIENDLINESS ● Clinical Scenario | ○ A client with major depressive disorder sits apart during a group cooking session and avoids eye contact. | |
| ACTIVE FRIENDLINESS ● OT Example | ○ The OT walks over, smiles, and says: “I'm really glad you came today. Would you like to stand next to me and help stir? You did a great job with this last time.” ■ Acknowledge presence, encouraging Cx, giving her a role to participate in session | |
| ACTIVE FRIENDLINESS ● Why This Attitude Fits | ○ Extra attention helps counter social withdrawal. ○ Reassurance and praise support low self-esteem and fear of failure. ○ Companionship reduces isolation and increases the client’s willingness to participate. | |
| ACTIVE FRIENDLINESS ● Clinical Purpose | ○ Builds rapport, increases motivation, and supports re-engagement in meaningful occupation. | |
| ACTIVE FRIENDLINESS ● Best Used When | ○ Client is withdrawn or socially isolated ○ Client has low confidence or motivation ○ Client is unsure but not suspicious or escalated | |
| ACTIVE FRIENDLINESS ● IRM Link: | Encouraging/Collaborating | |
| ACTIVE FRIENDLINESS | ● Active friendliness reduces emotional distance and invites engagement. It is most effective when the client’s main barrier is avoidance or low self-efficacy rather than safety or boundary issues. | |
| ACTIVE FRIENDLINESS ● Inappropriate when: | ○ Heightened emotions, crisis, suicidal, paranoid, highly suspicious, hostile ○ Active Friendliness could be seen as access to manipulations and a sign of weakness for Tx | |
| PASSIVE FRIENDLINESS | ● Warm, Accepting Presence—Client Leads the Interaction | |
| PASSIVE FRIENDLINESS ● Key Elements | ○ Calm, supportive tone ○ OT does not push or direct ○ Emotional availability without pressure | |
| PASSIVE FRIENDLINESS ● What It Looks Like in Practice | ○ OT remains physically present but non-intrusive ○ Uses soft voice and minimal prompting ○ Allows silence without rushing to fill it ○ Mirrors the client’s pace and emotional intensity | |
| PASSIVE FRIENDLINESS ● Clinical Scenario | ○ A client with PTSD sits quietly during an art-based coping session and avoids sharing. | |
| PASSIVE FRIENDLINESS ● OT Example | ○ The OT sits nearby and says softly: “I’m here if you’d like to talk about what you’re working on. If not, that’s okay too.” ■ Provides options (to share or not to share) ■ Tells the cx that they are in control of the pace | |
| PASSIVE FRIENDLINESS ● Why This Attitude Fits | ○ Respects emotional boundaries. ○ Avoids pressuring the client to disclose. ○ Supports a sense of control, which is crucial in trauma-informed care. | |
| PASSIVE FRIENDLINESS ● Clinical Purpose: | ○ Promotes emotional safety and trust while allowing self-directed engagement. | |
| PASSIVE FRIENDLINESS ● Best Used When | ○ Client is fearful, anxious, or emotionally vulnerable ○ Client needs control and predictability ○ Disclosure or participation cannot be forced | |
| PASSIVE FRIENDLINESS ● IRM Link: | Empathizing / Collaborating ○ Because we are validating our client’s feelings and providing them choices in this scenario. | |
| PASSIVE FRIENDLINESS | ● Passive friendliness supports trauma-informed care by prioritizing emotional safety and autonomy. It communicates presence without demand. | |
| PASSIVE FRIENDLINESS ● Inappropriate when: | ○ Safety concerns | |
| KIND FIRMNESS | ● Supportive with Clear Limits and Expectations | |
| KIND FIRMNESS ● Key Elements | ○ Emotional validation ○ Clear, consistent boundaries ○ Calm, steady tone ■ But non negotiable, they still need to follow | |
| KIND FIRMNESS ● What It Looks Like in Practice | ○ OT names the client’s emotion (“I can see you’re frustrated.”) ○ States expectations clearly (“We need to stay in the group for five more minutes.”) ○ Offers limited, structured choices ○ Follows through consistently on limits | |
| KIND FIRMNESS ● Clinical Scenario | ○ A client with schizophrenia becomes agitated and starts pacing near the door, insisting on leaving during a group session. | |
| KIND FIRMNESS ● OT Example | ○ The OT says calmly: “I can see you’re uncomfortable. For everyone’s safety, we need to stay in the room right now. Let’s sit together and take a few slow breaths.” | |
| KIND FIRMNESS ● Why This Attitude Fits | ○ Kindness maintains rapport and reduces defensiveness. ○ Firmness ensures safety and structure. ○ Sets clear boundaries without being punitive. | |
| KIND FIRMNESS ● Clinical Purpose: | ○ Maintains a therapeutic environment while modeling respectful limit-setting. | |
| KIND FIRMNESS ● Best Used When | ○ Client is impulsive, manipulative, or boundary-testing ○ Emotional escalation is beginning ○ Safety or structure is required ○ When aggressiveness is starting | |
| KIND FIRMNESS ● IRM Link: | Instructing / Advocating | |
| KIND FIRMNESS | ● Kind firmness contains behavior while preserving dignity. It is essential for maintaining safety and predictability in emotionally charged situations. | |
| MATTER OF FACT | ● Neutral, Calm, Task-Focused ○ Removes emotional tone ○ Use when the behavior is not yet escalated | |
| MATTER OF FACT ○ Neutral, Calm, Task-Focused KEY: | Redirection rather than processing, Cx should still be regulated even if they are frustrated | |
| MATTER OF FACT ● Key Elements | ○ Minimal emotional language ○ Focus on steps, choices, and solutions ○ Predictable and consistent tone | |
| MATTER OF FACT ● What It Looks Like in Practice | ○ OT uses short, clear instructions ○ Avoids emotional debate or validation language ○ Provides checklists, timers, or written steps ○ Redirects to the task with simple choices | |
| MATTER OF FACT ● Clinical Scenario | ○ A client with generalized anxiety disorder feels overwhelmed by planning their daily routine. ○ Cx wants to do something na, complaining but still doing the activity | |
| MATTER OF FACT ● OT Example | ○ The OT says: “Let’s list what you do in the morning. Then we’ll choose one step to simplify.” ○ The OT says: “5 more minutes na lang po, tapusin lang natin itong activity” | |
| MATTER OF FACT ● Why This Attitude Fits | ○ Reduces emotional intensity. ○ Helps the client focus on practical steps instead of anxious thoughts. ○ Keeps the session structured and goal-oriented. | |
| MATTER OF FACT ● Clinical Purpose: | ○ Supports problem-solving and functional skill development without escalating emotional distress. | |
| MATTER OF FACT ● Best Used When | ○ Client is frustrated but regulated ○ Client seeks emotional reaction or debates ○ Task completion and problem-solving are needed | |
| MATTER OF FACT ● IRM Link: | Problem-Solving / Instructing | |
| MATTER OF FACT | ● Matter-of-fact responses help shift the client from emotional reactivity to cognitive | |
| NO DEMAND ● Removes Pressure to Perform or Respond | ○ Prioritizing relationship over performance | |
| NO DEMAND ● Key Elements | ○ No expectations for productivity ○ Emphasis on presence and connection ○ Low stimulation, low pressure | |
| NO DEMAND ● What It Looks Like in Practice | ○ OT reassures client that participation is optional ○ Allows quiet presence without tasks ○ Avoids goal-setting or performance language ○ Maintains calm, supportive body language | |
| NO DEMAND ● Clinical Scenario | ○ A client with severe depression refuses to participate in a vocational readiness activity and stares at the floor | |
| NO DEMAND ● OT Example | ○ The OT says: “That’s okay. You don’t have to work on the task today. Would you like to just sit and talk, or can we stay quiet for a bit?” | |
| NO DEMAND ● Why This Attitude Fits | ○ Reduces shame and performance pressure. ○ Prevents power struggles. ○ Keeps the therapeutic relationship intact even when the client cannot engage in tasks. | |
| NO DEMAND ● Clinical Purpose: | ○ Maintains connection and trust during periods of low motivation or emotional exhaustion. | |
| NO DEMAND ● Best Used When | ○ Client is emotionally exhausted or shut down ○ Performance pressure increases distress ○ Goal is maintaining connection, not task completion | |
| NO DEMAND ● IRM Link: | mpathizing / Collaborating | |
| NO DEMAND | ● No demand preserves the therapeutic relationship when the client’s capacity for engagement is temporarily limited. | |
| WATCHFULNESS ● Alert, Observant, Safety-Focused | ○ Looking at the behavior before it escalates, and removing the cx from the situation | |
| WATCHFULNESS ● Key Elements | ○ Close monitoring of behavior and environment ○ Early intervention ○ Calm but ready stance | |
| WATCHFULNESS ● What It Looks Like in Practice | ○ OT scans the room for exits, objects, and client positioning ○ Notices change in tone, pacing, or body language ○ Positions self near the client for quick support ○ Prepares to modify the environment or call for assistance | |
| WATCHFULNESS ● Clinical Scenario | ○ A client with bipolar disorder in a group session starts speaking rapidly, interrupting others, and pacing. | |
| WATCHFULNESS ● OT Example | ○ The OT gently intervenes: “Let’s take a short break and step into the hallway together. I want to check in with you.” (Advocating mode - for the safety of the Cx and the group members) – because that is escalating to a manic episode | |
| WATCHFULNESS ● Why This Attitude Fits | ○ Allows early detection of emotional escalation. ○ Protects the client and the group. ○ Supports timely regulation strategies. | |
| WATCHFULNESS ● Best Used When | ○ Early signs of escalation or dysregulation ○ Group or environmental safety concerns ○ History of aggression or impulsivity | |
| WATCHFULNESS ● IRM Link: | Advocating / Problem-Solving | |
| WATCHFULNESS | ● Watchfulness is preventive. It allows early calm intervention before a situation becomes unsafe. | |
| CLINICAL SCENARIOS PRACTICE ● During a vocational skills group, a client stands up abruptly, raises their voice, and says, "If you don't let me leave right now, I'm done with this program." | ○ Attitude: Kind firmness ○ Mode: Instructing/Collaborating | |
| CLINICAL SCENARIOS PRACTICE ● A client repeatedly says, "This schedule won't work," while continuing to erase and rewrite the same line on a planning worksheet. | ○ Attitude: Matter of fact | |
| CLINICAL SCENARIOS PRACTICE ● A client with severe depression arrives to a one-on-one session and says, "I don't have the energy to do anything today," and turns away from the activity materials. | ○ Attitude: No demand | |
| CLINICAL SCENARIOS PRACTICE ● In a group session, a client begins pacing, speaking rapidly, and interrupting others. She is not aggressive yet, but her behavior is picking up. | ○ Attitude: Watchfulness | |
| ISSUES IN THERAPEUTIC RELATIONSHIP | ● Transference and Countertransference ● Dependence ● Stigma ● Helplessness, anger & depression ● Sexual feelings ● Fear and revulsion | |
| Transference: | Cx is unconsciously redirecting his feelings to another person | |
| Countertransference: | You naman. Because you are seeing the person, you have the same experience, you are transferring it to the Client | |
| INTENTIONAL RELATIONSHIP MODEL (IRM) | ● Designed to fill a gap in our practical knowledge about how to manage the interpersonal aspects of therapy, particularly the more challenging ones ● Complement (not replace) existing OT conceptual practice models rather than any single models | ● Explains the relationship between client and therapist that is part of the overall process of OT ● It guides OT in making intentional choices on how they relate to the client; there’s always a modal shift. ● TUS is an intentional reasoning process |
| Therapeutic Relationship Process | is in the center because every activity/interaction is happening within a human relationship that can support/hinder Cx’s engagement in occupations | |
| THE CLIENT | ● Focal point● Our responsibility is to observe behavioral patterns over time. | |
| THE CLIENT ● Therapist responsibility: | ○ Develop a positive relationship with the client ○ Respond appropriately to interpersonal events | ○ Understand the client from an interpersonal perspective not just a clinical one (not only symptoms but how they relate to other people) ○ Know the client's interpersonal characteristics |
| Situational characteristics: | temporary behaviors or emotional responses ● Something triggers the behavior ● Ex: may pinagawa kang mahirap na axs kay Cx, sinabi niya “Nubayan ang hirap.” ● Here there is a situation kaya nasabi ni Cx yon | |
| Enduring characteristics: | stable and consistent interpersonal behavior across time and situation ● How cx usually/typically responds to any type of situation ● Personality-based ● Everything is approached in a heightened manner | |
| THE CLIENT ● OT Example: | Imagine a client in a psychiatric unit who refuses to participate in a group session on their first day. Over time, you notice that the same client consistently avoids asking for help and prefers to work alone in many situations. | |
| THE INTERPERSONAL EVENT | ● Naturally occurring communication, reaction, process, task, or general circumstance that occurs during therapy ● Has the potential to detract from or strengthen the therapeutic relationship | ● Inevitable during the course of therapy ● Can be a threat and an opportunity |
| THE INTERPERSONAL EVENT ● As therapists, our task is not to avoid interpersonal events, but to recognize them when they occur. We pause and ask ourselves: | ○ What is the client feeling right now? ○ What am I feeling in response? ○ How is this moment affecting our working relationship? | |
| THE INTERPERSONAL EVENT ● Ex: "A client working on return-to-work skills suddenly says, 'You don't understand what it's like to fail every day? | ○ Cx is trying to express his vulnerability. Cx feels that every time he tries, he doesn’t succeed. ○ If you empathize first and guide them back to task, you can encourage them ○ Mode: Empathizing/Encouraging then Collaborating | |
| THE INTERPERSONAL EVENT ● What makes a moment and interpersonal event: | ○ If there is a change/strong emotion/change in trust | |
| THE INTERPERSONAL EVENT ● What is one way to turn a difficult moment into a therapeutic opportunity | ○ You can first empathize, then encourage, then collaborate, ○ As a therapist you should reflect on the situation (Ano ba talaga sinasabi non?) | |
| THE THERAPIST | ● Responsible for making every reasonable effort to make the relationship work ● Specifically, therapist is responsible for bringing 3 main interpersonal capacities into the relationship | |
| 3 main interpersonal capacities into the relationship: | ○ A. Interpersonal Skill base ○ B. Therapeutic Modes ( or interpersonal styles) ○ C. Capacity for interpersonal reasoning | |
| THE THERAPIST ● Scenario: | Imagine working with a client who frequently arrives late and shows little interest in therapy. | |
| THE THERAPIST ● OT's Response; Inappropriate response: | "You're late again and clearly not taking this seriously. If you keep showing up like this, there's no point in continuing therapy." | |
| THE THERAPIST ● OT's Response; Appropriate response: | "I've noticed it's been hard to get here on time, and I'm wondering what's been getting in the way for you (empathizing). Your participation matters to me, and I'd like to understand how we can make these sessions work better for you (collaborating)." | |
| INTERPERSONAL SKILL BASE | ● Comprise of a continuum of skills that are judiciously applied by the therapist to build a functional working relationship with the client | |
| INTERPERSONAL SKILL BASE ● Nine Categories: | ○ Therapeutic communication ○ Interviewing skills and strategic questioning ○ Establishing relationship with clients Families, social system, and groups ○ Working effectively with supervisors, employers, and other professionals | ○ Understanding and managing difficult interpersonal behaviors ○ Empathic breaks and conflicts ○ Professional behavior, values, and ethics ○ Therapist self-care and professional development |
| INTERPERSONAL SKILL BASE ● Scenario: | During a discharge planning meeting, a client and their family disagree about whether the client is ready to go home | |
| INTERPERSONAL SKILL BASE ● OT's Response: | "You're confident managing at home, and concerned about safety and support. Our goal is to help you return home safely and independently (safety). Let's review the specific supports and steps that would make home a safe option for you (collaborating)." | ○ Attitude: Matter of fact ■ No emotional tone and more task-focused ■ Therapist remains calm, neutral, and clarifying the issue ○ Mode: Collaborating / Advocating |
| THERAPEUTIC MODES | ● Specific way of relating to a client | |
| Therapeutic style | - a skill set that incorporates therapeutic modes they view as being maximally therapeutic for their clients | |
| Six Therapeutic Modes | ○ Empathizing ○ Encouraging ○ Collaborating ○ Instructing ○ Problem-solving ○ Advocating - the barrier is external | |
| If a client becomes tearful during a task which mode would you use first? | - empathizing → validate before giving solutions | |
| When is advocating more appropriate than problem solving? | - When the barrier is systemic and not personal - When policies/institutions limit Cx’s access - When Cx lacks the power to negotiate themselves | - It is a problem, but not an internal problem - When the problem is external that is where you will use an advocating mode |
| INTERPERSONAL REASONING | ● Process by which therapist monitors ● His or her own behavior in a reflective way ● Process by which therapists decide what to do, say, or express in reaction to their clients | ● Instead of therapist reacting automatically, we can pause and intentionally choose appropriate node and attitude |
| CLINICAL SCENARIOS ● A client with a recent stroke begins to cry during a grooming task and says, "I used to do all of this myself. I feel useless now." | ○ Empathizing and Passive Friendliness: Approach in a calm, supportive manner that allows the patient to control the task. Provide them options. You are trying to process the emotions | ○ Kaya hindi siya No demand kasi hindi mo pwedeng sabihin na “okay lang kahit di mo gawin yan…” You should process their emotions first ○ Then Encouraging and Kind Firmness after processing their feelings |
| CLINICAL SCENARIOS ● A client frequently misses sessions and says, "I want to come, but my ride keeps falling through and my work schedule changes every week." | ○ Problem-solving or Collaborating: identify the barriers and work around it ○ Active friendliness: Show warmth and encourage them to do problem -solving | |
| CLINICAL SCENARIOS A client with cognitive impairment looks at a medication management worksheet and says, "I don't know where to start." | ○ Cx is feeling overwhelmed but still regulated ○ Attitude: Matter of fact ○ Mode: Instructing (you tell them what to do) → problem-solving (how will they do it, how will they solve 1 problem at a time) | |
| ultimate goal | is to them to feel respected, empowered in their everyday lives |
Created by:
avemaria