Midterm Flashcards
Empathy defined by the IRM
Empathy is defined as the deliberate effort to understand the client’s inner experience as a separate and independent ideological, psychological, visceral, cognitive, or emotional perspective, as it is reflected in that person’s thoughts, feelings, or behaviors. This effort is made in the present moment as the occupational therapy session is unfolding.
The client’s expressed thoughts, feelings, and behaviors are not examined or questioned for their validity or accuracy.
Elements of the Intentional Relationship Model
- The client’s interpersonal characteristics
- The inevitable interpersonal events that occur during therapy
- The therapist’s use of self (I.e. mode use, interpersonal skill base, and ability to apply interpersonal reasoning)
- Occupational engagement, which is viewed as the mechanism of change
10 Underlying IRM Principles
- Critical self-awareness is key to the intentional use of self.
- Interpersonal self-discipline is fundamental to effective use of self
- It is necessary to keep head before heart.
- Mindful empathy is required to know your client.
- Therapists are responsible for expanding their interpersonal knowledge base.
- Provided that they are purely and flexibly applied, a wide range of therapeutic modes can work and be utilized interchangeably in occupational therapy.
- The client defines a successful relationship.
- Activity focusing must be balanced with interpersonal focusing.
- Application of the model must be informed by core values and ethics.
- Application of the model requires cultural sensitivity.
6 Therapeutic Modes: Collaborating Mode
Expecting the client to be an active and equal participant in therapy (ensuring choice, freedom, and autonomy to the greatest extent possible.)
6 Therapeutic Modes: Empathizing Mode
Ongoing striving to understand the client’s thoughts, feelings, and behaviors while suspending any judgment as well as making sure that the client experiences the therapist’s understanding as genuine.
6 Therapeutic Modes: Encouraging Mode
Seizing the opportunity to instill hope in a client hope in a client by celebrating a client’s thinking or behavior through positive reinforcement demonstrating an attitude of joyfulness, playfulness, and confidence.
6 Therapeutic Modes: Instructing Mode
Carefully structuring therapy activities, being transparent with clients about the plan, sequence, and events related to therapy, providing clear instruction, and feedback, as well as, setting limits on client requests or behavior.
6 Therapeutic Modes: Problem-Solving Mode
Facilitating pragmatic thinking and solving dilemmas through outlining choices, posing strategic questions, and providing opportunities for comparative or analytical thinking.
6 Therapeutic Modes: Advocating Mode
Ensuring that the client’s rights are enforced, and resources are secured.
Mode shifting
identifying and using modes in real time, and shifting between them, using interpersonal reasoning.
Mode match
applying the appropriate mode for the client’s interpersonal characteristics and/or occurring interpersonal event.
Mode mismatch
applying a mode that is inappropriate for the client’s interpersonal characteristics and/or occurring interpersonal event.
Mixed mode
usage of two modes at the same time within a communication, causing confusion about what the therapist actually means.
Emotional congruence
when the therapist’s facial expression and body language are consistent with the mode or interpersonal context.
Emotional incongruence
when the therapist’s facial expression and body language are inconsistent with the mode or interpersonal context.
Enduring Interpersonal Characteristics
-Emotions, behaviors, and reactions that mostly emanate from underlying traits of the client are referred to as enduring interpersonal characteristics.
-When clients’ interpersonal behaviors are largely linked to the experience of their impairments or some other external stressful circumstance, they are referred to as situational.
-They reflect the client’s baseline interpersonal style that is relatively constant across time, people, and contexts.
Situational Interpersonal Characteristics
-Knowing the client when the client is under stress
-Identifying the interpersonal characteristics that appear when the client is experiencing discomfort, fatigue, pain, nausea, loss, psychosocial distress, and other common feelings and symptoms experienced by individuals in treatment settings
-The stress may be linked to the treatment situation, something outside of treatment, or to the illness or impairment and its associated losses
Interpersonal Client Characteristics: Communication Style
quantity, quality, and pace with which clients express themselves verbally or using gestures or sign language
Interpersonal Client Characteristics: Tone of Voice
may provide a window into his or her emotional state – loud vs soft, shaky vs still
Interpersonal Client Characteristics: Body Language
Desired: an open, relaxed, or neutral posture
Closed-off: Closed body position (arms or legs crossed)
Stiff/quick moving – anxious
Interpersonal Client Characteristics: Facial Expression
-reveals a person’s affect
*Affect – outward expression of emotion usually through facial expression – reveals thoughts and feelings of client
-emotional regulation difficulties may make this hard (exhibiting a wide range of intense emotions over a short period of time, exhibiting behavioral impulsivity or poor judgment, difficulty controlling emotions)
Interpersonal Client Characteristics: Response to Change & Challenge
May include…
-expressing worry/anxiety/fear
-becoming easily demoralized
-withdrawing
-giving up before or when the activity just started
-avoiding therapy
-underestimating performance
-challenging the therapist
IInterpersonal Client Characteristics: Level of Trust
Required for…
-Dressing
-Bathing
-Toileting
-Grooming
-Asking questions
-Teaching
-Providing feedback
Interpersonal Client Characteristics: Need for Control
therapists want to give clients as much choice/control as possible
Interpersonal Client Characteristics: Approach to Asserting Needs
– some may want full control, others may relinquish all control
*High control – refusing the therapist, ignoring the therapist, excessive demands, unusually high expectations, attempting to dominate sessions, requesting a change in therapy style.
*Relinquish control – seeking lots of structure, failing to have ideas, approval seeking, being passive.
Interpersonal Client Characteristics: Predisposition to Giving Feedback
– therapists rely on feedback to adjust strategies to maximize the likelihood of positive outcomes
-Make patients comfortable enough to give feedback
Interpersonal Client Characteristics: Response to Feedback
Client feedback is important for improving but can be hurtful is a client exhibits…
-Dismissing behavior
-Self-criticism
-Irritability
-Passive aggressiveness
-Defensiveness
Interpersonal Client Characteristics: Response to Human Diversity Orientation Toward Relating
– wide range of differences that distinguish individuals from one another
*sex, race, culture, parental status, marital status, disabilities, religion, political views & more
Interpersonal Client Characteristics: Preference for Touch
very important to consider in therapy
-Positive vs negative reactions to touch
-Signs of comfort or discomfort
-Bodily pain
-History of neglect
-Sexual attraction toward therapist
-Person’s upbringing
Interpersonal Client Characteristics: Interpersonal Reciprocity
giving and sharing between client and therapist
Interpersonal Events, what they are, and what they look like.
-An interpersonal event is a naturally occurring communication, reaction, process, task, or general circumstance that has the potential to strengthen or detract from the therapeutic relationship.
Interpersonal Event Cascade
when more than one interpersonal event occurs during a single interaction and those events appear to be connected by a single theme and a predominant emotion
Interpersonal events: Expression of Strong Emotion
External displays of internal feelings that are shown with a level of intensity beyond usual cultural norms for interaction.
Interpersonal events: Intimate Self-Disclosures
Statements or stories that reveal something unobservable, private, or sensitive about the person making the disclosure.
Interpersonal events: Power dilemma
Tensions that arise in therapeutic relationships because of clients’ innate feelings about issues of power, the inherent situation of therapy, the therapist’s behaviors, or other circumstances that underscore client’s lack or loss of power regarding aspects of their lives
Interpersonal events: Nonverbal Cues
Communications that do not involve the use of formal language.
Interpersonal events: Verbal Innuendos
Communications in which the client says something illusive or oblique that is meant to serve as a hint about a more direct communication.
Interpersonal events: Crisis point
Unanticipated, stressful events that cause clients to become distracted or that temporarily interfere with the client’s ability for occupational engagement
Interpersonal events: Resistance
A client’s passive or active refusal to participate in some or all aspects of therapy for reasons linked to a therapeutic relationship (direct refusal, challenging the therapist, disagreeing, refusal)
Interpersonal events: Reluctance
disinclination toward some aspect of therapy for reasons outside the therapeutic relationship.
Interpersonal events: Boundary Testing
A client’s behavior that violates or that asks the therapist to act in ways that are outside the defined therapeutic relationship.
Interpersonal events: Empathic Breaks
Occurs when a therapist fails to notice or understand a communication from a client or initiates a communication or behavior that is perceived by the client as hurtful or insensitive.
Interpersonal events: Emotionally Charged Therapy Tasks and Situations
Activities or circumstances that can lead clients to become overwhelmed or experience uncomfortable emotional reactions such as embarrassment, humiliation, or shame.
Interpersonal events: Limitations of Therapy
Refer to restrictions on the available or possible service, time, resources, or therapist actions.
Interpersonal events: Contextual Inconsistencies
Any aspects of a client’s interpersonal or physical environment that change during the course of therapy.
Who assumes full responsibility for communicating intentionally with the client?
It is the responsibility of the therapist to develop working and predictable communication as well as maintain a relationship with the client no matter what is occurring.
The only responsibility the client has is to confirm whether this communication is effective, based on their preference.
