You may have come across the term before, you may not, but if you’re an OT you’ve probably utilised it without realising already. Therapeutic use of self is a useful technique employed by occupational therapists in order to engage clients and therefore illicit a better outcome during the OT process. Essentially it’s being aware of yourself (your verbal language, body language, which personal information you choose to share…) when you’re interacting with a client, and using your own personality & interpersonal skills in order to build rapport and ultimately make the client feel at ease, motivated, and that they can trust you.
In order to use yourself therapeutically, you must first be aware of your interactions with a client to then be able to adapt them to suit the style of the client. It can be useful to consider some models in order to structure your thoughts, and provide guidance for an occupational therapy student who is just beginning to reflect on their own therapeutic style.
Taylor (2008) has recently proposed the Intentional Relationship model, which categorises the six therapeutic modes -or types of client-therapist interactions- into six categories.
The modes in the Intentional Relationship model (IRM) are:
- advocating mode– therapist makes sure client gains access to resources needed to participate in occupations
- collaborating mode– therapist sticks to client’s principles & involves them in all decisions (client-centred practice)
- empathising mode-therapist makes every effort to fully understand client’s experience
- encouraging mode– therapist applauds the client’s performance, with the hope they will proceed with their current occupation
- instructing mode– therapist takes a teacher-like role, educating the client about issues considered to be important
- problem-solving mode – therapist relies on logical reasoning in their approach to clients.
Recent research (Bonsaksen 2013) has showed that OT students are most likely to use problem-solving mode, and that students who preferred this mode were less likely to use collaboration mode. They proposed a broad split between students: those who were problem-solvers (task focused) and those who were collaborators (relationship focused). This sort of situation has been described in group dynamics literature as well. Reflecting on my own style I think I tend towards being a collaborator first, although at this stage of my experience I’m not sure what strengths and limitations this will bring to me as a practising OT! Taylor et al (2011) found that qualified OTs use encouraging mode most often, except when challenging emotions/behaviours are encountered then all modes are used more evenly, especially instructing and problem-solving modes. I found this interesting because it reflected my own experience while on my first clinical placement.
Transactional Analysis theory (Berne 1961) can be useful when considering how to respond to clients especially when they appear to challenging you or the intervention in some way. It describes the conversational interactions (‘transactions’) people have as either falling into the role of a;
- Parent – either mothering, or controlling/critical;
- Child – either unaware of self/playful, questioning /creative, or fearful/guilty/adapts behaviour to comply with others’ wishes; or
- Adult – rational, confident with self: the ideal response.
Transaction theory can also be helpful to remember if you feel a bit anxious during supervision discussions, since it reminds you to respond in an ‘adult’ way and not in a less appropriate knee-jerk way (such as whiny child or superior parent), because you feel threatened in some way…
Berne E (1961) Transactional analysis in psychotherapy. New York: Grove Press
Bonsaksen T (2013) Self-reported therapeutic style in occupational therapy students. British Journal of Occupational Therapy 76(11), 496–502
Solman B and Clouston T (2016) Occupational therapy and the therapeutic use of self. British Journal of Occupational Therapy
Taylor R (2008) The Intentional Relationship: Occupational Therapy and Use of Self. Philadelphia: F.A. Davis Co
Taylor RR, Lee SW, Kielhofner G (2011) Practitioners’ use of interpersonal modes within the therapeutic relationship: results from a nationwide study. OTJR: Occupation, Participation and Health 31(1), 6–14