This document discusses the therapeutic use of self in occupational therapy. It defines therapeutic rapport as the qualities between client and therapist that involve concentration, communication and enjoyment, affecting client performance and involvement in therapy. Developing a therapeutic relationship requires using empathy, narrative, clinical reasoning and a collaborative approach. Elements of an effective therapeutic relationship include unconditional acceptance, genuineness, empathy, active listening, open-ended questioning, and appropriate use of silence. Establishing rapport provides scaffolding for skill development and improves clients' physiological and emotional health.

1. THERAPEUTIC USE OF
SELF
Shamima Akter
B. Sc (Honors) in Occupational Therapy
& M. Sc in Rehabilitation Science
Assistant Professor,
Department of Occupational Therapy
Bangladesh Health Professions Institute (BHPI)
Centre for the Rehabilitation of the Paralysed (CRP)
Chapain, Savar

2. Brainstorming
• What is the first legitimate tools in
Occupational Therapy that we learn in
therapeutic skills subject?
• How that legitimate tools can be used in
occupational therapy practice?/ What are the
components of that legitimate tools?
• Do you know the core values of BHPI and
CRP?
TS1_Shamima_2018

3. Core values of BHPI Core values of CRP
Sensitivity Sensitivity
Flexibility Respect
Honesty Dignity
Respect Compassion
Dignity Collaboration
Empathy Commitment to
excellence
Collaboration
Commitment to excellence
TS1_Shamima_2018

4. Core value & Therapeutic relationship
• Core value is aligned to build therapeutic
relationship with clients.
• It is an internal process, inherited and can be
shaped.
TS1_Shamima_2018

5. Therapeutic rapport/ Therapeutic use of self/Rapport
Building
Therapeutic rapport or therapeutic relationship is the
qualities of optimal interpersonal experience and
behavior between client and therapist that involve
concentration, masterful communication and
enjoyment and that affect the client’s performance and
involvement in therapy (Trombly 2008).
CONTINUE…
TS1_Shamima_2018

6. Continue...
• An integral part of the occupational therapy
process is therapeutic use of self, which allows
occupational therapy practitioners to develop
and manage their therapeutic relationship
with clients by using narrative and clinical
reasoning; empathy; and a client-centered,
collaborative approach to service delivery
(Taylor & Van Puymbroeck, 2013).
TS1_Shamima_2018

7. Continue...
• Occupational therapy practitioners use
narrative and clinical reasoning to help clients
make sense of the information they are
receiving in the intervention process, to
discover meaning, and to build hope.
(AOTA, 2016)
TS1_Shamima_2018

8. Continue...
• Occupational therapy practitioners develop a
collaborative relationship with clients to
understand their experiences and desires for
intervention.
• The collaborative approach used throughout
the process honors the contributions of clients
along with practitioners.
(AOTA, 2016)
TS1_Shamima_2018

9. Continue...
• Through the use of interpersonal
communication skills, occupational therapy
practitioners shift the power of the
relationship to allow clients more control in
decision making and problem solving, which is
essential to effective intervention.
(AOTA, 2016)
TS1_Shamima_2018

10. Continue...
• Occupational therapy practitioners bring their
knowledge about how engagement in
occupation affects health, well-being, and
participation; they use this information,
coupled with theoretical perspectives and
clinical reasoning, to critically observe,
analyze, describe, and interpret human
performance.
(AOTA, 2016)
TS1_Shamima_2018

11. Continue...
• Practitioners and clients, together with
caregivers, family members, community
members, and other stakeholders (as
appropriate), identify and prioritize the focus
of the intervention plan.
(AOTA, 2016)
TS1_Shamima_2018

12. Continue...
Therapeutic relationship can be defined as that
conveys empathy and a consistent willingness to
both “be there” and “do with” clients through a
process that clients did not bargain for and might not
be able to work through alone (Price 2009).
The therapeutic relationship is the central aspects of
the therapeutic process in occupational therapy and
one catalyst for change (Price 2009).
TS1_Shamima_2018
CONTINUE…

13. Continue...
It also means involving the interpersonal influences
arising between client and therapist that can support
the client’s desire to try occupational therapy, to
maintain continued involvement in therapy despite
the need for considerable effort and courage, and to
participate with the therapist in constructing a new
version of life possibilities that project into the
client’s occupational functioning (Trombly 2008).
TS1_Shamima_2018
CONTINUE…

14. Continue...
It is one mechanism, or means, by which a client
achieves positive therapeutic outcomes, or in the
case of occupational therapy, confident and
competent occupational functioning (Trombly
2008).
TS1_Shamima_2018
…….

15. BENEFICIAL EFFECTS OF ESTABLISHING
THERAPEUTIC RELATIONSHIP
TS1_Shamima_2018

16. Beneficial effects of establishing therapeutic relationship
The interaction provides the external scaffolding
necessary for skill development by directing attention
to important aspects of a task problem by
communicating the information necessary to solve
problem and by giving motivational support for
pursuing problem solution.
The interaction improves physiological and
emotional health, thus enabling individuals to focus
energy and effort on occupation.
CONTINUE…TS1_Shamima_2018

17. • Through verbal and non-verbal
communication, a therapist conveys his or
her expectations or the progress of a client,
with the effect that the client’s actual
performance conforms to those expectations.
• The interaction creates a self-fulfilling
prophecy of improved performance.
CONTINUE…
TS1_Shamima_2018

18. CONTINUE…
Informative, warm and respectful behavior may
affirm to the client that he or she is capable and
valued human being, which mobilizes the client’s
psychological and physical resources toward
fulfillment of those qualities.
Occupational therapists who enter individuals’ lives at
some critical time of significant transition, requiring
more intimate exchanges of empathy and willingness
to know about clients history of illness and loss of
occupation performance capacity.
TS1_Shamima_2018

19. STORY BREAK
TS1_Shamima_2018

20. TS1_Shamima_2018

21. TS1_Shamima_2018

22. TS1_Shamima_2018

23. Continue...
In Greek myths, Chiron was the wisest of the
Centaurs. He was accidentally wounded by an arrow
that had been dipped in the blood of the Hydra. In his
search for his own cure, he discovered how to heal
others. The Wounded Healer understands what the
patient feels because he has gone through the same
pain. The suffering patient can be cared for by the
Healer and be instrumental in the Healers own
healing. Each encounter between Healer and patient
can be transforming for both.
TS1_Shamima_2018

24. Lesson learned
• The lesson of Chiron teaches us is that we can
overcome pain and transcend into knowledge. That
each of us can become a Wounded Healer.
TS1_Shamima_2018

25. Quote
Our sorrows and wounds are healed only when we
touch them with compassions.
~Buddha
The doctor is effective only when he himself is
affected, only the wounded physician heals.
~Carl Jung
TS1_Shamima_2018

26. ELEMENTS OF THERAPEUTIC
RELATIONSHIP
TS1_Shamima_2018

27. Elements of therapeutic relationship
• Unconditional acceptance
• Genuineness
• Empathy
• Attending and listening
• Open ended question
• Silence
TS1_Shamima_2018

28. Unconditional Acceptance
• The practitioner must be able to accept every
patient who comes to see him, regardless of
their background, social standing, ethnicity,
race and presenting illness.
• This acceptance must be unconditional and
the patient must not be made to feel that it
has to be earned and they have to fight
against preconceptions.
TS1_Shamima_2018

29. TS1_Shamima_2018

30. Empathy
Empathy is the ability to perceive accurately
the feelings of another person and to
communicate this understanding to him.
For example: I understand you must be feeling
worried because you could not take enough
preparation for examination.
TS1_Shamima_2018

31. TS1_Shamima_2018

32. Continue...
• Empathy is the emotional exchange between
occupational therapy practitioners and
clients that allows more open communication,
ensuring that practitioners connect with
clients at an emotional level to assist them
with their current life situation.
TS1_Shamima_2018

33. TS1_Shamima_2018

34. TS1_Shamima_2018

35. TS1_Shamima_2018

36. A Lack Of Empathy = A Lot Of Problems
TS1_Shamima_2018

37. Continue...
• Empathy is not sympathy. It’s not feeling for
someone, but feeling with someone, allowing
yourself to be a conduit for a river of emotion.
Even when not required to, empaths feel from
the inside out:
TS1_Shamima_2018

38. Being Genuine
• Genuineness is another facet of the
practitioner’s personality that cannot really
be learned the practitioner really must have a
genuine desire to help if a therapeutic
relationship is to ever develop.
• If other factors motivate the practitioner, i.e.
money or personal gain, then this will always
act as a barrier between himself and the
patient.
TS1_Shamima_2018

39. • How to practice attending and active
listening
–Physical environment
–Attending posture: SOLER
–Listening skills
–Questioning skills
Attending & ListeningAttending & Listening
TS1_Shamima_2018

40. Attending
Physical environment
Ensure privacy
Minimize interruption
Eliminate barrier
Attending Posture (SOLER))
Sit Squarely
Open posture
Lean forward
Eye contact
Relax posture
TS1_Shamima_2018

41. Listening
Active Listening = Hearing + Understanding
Listening refers to more than simply hearing
what the patient says.
The practitioner must be aware of three
aspects;
- linguistic,
- paralinguistic &
- non-verbal aspect of communication.
TS1_Shamima_2018

42. Listening continue…
The linguistic aspect refers to what the
patient says and the ways in which they choose
to express it.
Paralinguistic refers to the aspects of speech
such as timing, volume and fluency.
Non-verbal aspects mainly refer to the
patient’s body language and facial expressions
that occur during the dialogue.
TS1_Shamima_2018

43. • Evaluative – making judgments of good/bad,
right/wrong, should/should not, fair/unfair,
just/unjust, etc.
• Interpretative-trying to infer a meaning behind
a problem/statement by Paraphrasing or
reflection of content.
Listening continue…Listening continue…
TS1_Shamima_2018

44. • Supportive-being reassuring, calming
• Probing- clarification, seeking further
information
• Understanding – confirming with the speaker
that the listener has understood the message
correctly
Listening continue…Listening continue…
TS1_Shamima_2018

45. Open-Ended Questioning
• The practitioner must avoid ‘over-talking’ and
asking too many questions.
• Instead open-ended questions should be
used. This may have the benefit of revealing
a deeper understanding of the patient.
TS1_Shamima_2018

46. Open-Ended Questioning
• Reflection can also be used to this end. This is
when the practitioner picks up on the last
few words spoken by the patient in order to
encourage them to expand on the point.
• However, closed questions are sometimes
necessary when looking into specific
manifestations of illness but in general open-
ended questions will go further to
empowering the patient.
TS1_Shamima_2018

47. Silence
• Silence can also be an important tool to the
practitioner and they should not feel that
there must always be someone talking.
• Silence can give the patient time to think
about what they want to say and the best way
to express them.
TS1_Shamima_2018

48. Silence
• At the same time it gives the practitioner time
to collect his thoughts and assimilate what the
patient has been expressing.
• It must be remembered not to allow the
silence to last too long, as it may become
uncomfortable and if silences occurs too
often, it could cause the patient to question
the practitioner’s ability.
TS1_Shamima_2018

49. Reference
• Owen A 2004, The Therapeutic Relationship, retrieved on 03
October, 2010 from
<http://www.holisticlocal.co.uk/articles/view/293/The+Thera
peutic+Relationship>
• Trombly CA 1996, Occupational Therapy for Physical
Dysfunction, 5th
ed, Mosby Company, Philadelphia
• Radomski and Trombly-Latham 2008, Occupational Therapy
for Physical Dysfunction (6th
Ed). Philadelphia: Lippincott,
Williams and Wilkins.
• Radomski and Trombly-Latham 2014, Occupational Therapy
for Physical Dysfunction (7th
Ed). Philadelphia: Lippincott,
Williams and Wilkins.
TS1_Shamima_2018