Midterm

Question 1

Empathy defined by the IRM

Answer 1

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.

Question 2

Elements of the Intentional Relationship Model

Answer 2

1. The client’s interpersonal characteristics
2. The inevitable interpersonal events that occur during therapy
3. The therapist’s use of self (I.e. mode use, interpersonal skill base, and ability to apply interpersonal reasoning)
4. Occupational engagement, which is viewed as the mechanism of change

Question 3

10 Underlying IRM Principles

Answer 3

1. Critical self-awareness is key to the intentional use of self.
2. Interpersonal self-discipline is fundamental to effective use of self
3. It is necessary to keep head before heart.
4. Mindful empathy is required to know your client.
5. Therapists are responsible for expanding their interpersonal knowledge base.
6. Provided that they are purely and flexibly applied, a wide range of therapeutic modes can work and be utilized interchangeably in occupational therapy.
7. The client defines a successful relationship.
8. Activity focusing must be balanced with interpersonal focusing.
9. Application of the model must be informed by core values and ethics.
10. Application of the model requires cultural sensitivity.

Question 4

6 Therapeutic Modes: Collaborating Mode

Answer 4

Expecting the client to be an active and equal participant in therapy (ensuring choice, freedom, and autonomy to the greatest extent possible.)

Question 5

6 Therapeutic Modes: Empathizing Mode

Answer 5

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.

Question 6

6 Therapeutic Modes: Encouraging Mode

Answer 6

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.

Question 7

6 Therapeutic Modes: Instructing Mode

Answer 7

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.

Question 8

6 Therapeutic Modes: Problem-Solving Mode

Answer 8

Facilitating pragmatic thinking and solving dilemmas through outlining choices, posing strategic questions, and providing opportunities for comparative or analytical thinking.

Question 9

6 Therapeutic Modes: Advocating Mode

Answer 9

Ensuring that the client’s rights are enforced, and resources are secured.

Question 10

Mode shifting

Answer 10

identifying and using modes in real time, and shifting between them, using interpersonal reasoning.

Question 11

Mode match

Answer 11

applying the appropriate mode for the client’s interpersonal characteristics and/or occurring interpersonal event.

Question 12

Mode mismatch

Answer 12

applying a mode that is inappropriate for the client’s interpersonal characteristics and/or occurring interpersonal event.

Question 13

Mixed mode

Answer 13

usage of two modes at the same time within a communication, causing confusion about what the therapist actually means.

Question 14

Emotional congruence

Answer 14

when the therapist’s facial expression and body language are consistent with the mode or interpersonal context.

Question 15

Emotional incongruence

Answer 15

when the therapist’s facial expression and body language are inconsistent with the mode or interpersonal context.

Question 16

Enduring Interpersonal Characteristics

Answer 16

-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.

Question 17

Situational Interpersonal Characteristics

Answer 17

-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

Question 18

Interpersonal Client Characteristics: Communication Style

Answer 18

quantity, quality, and pace with which clients express themselves verbally or using gestures or sign language

Question 19

Interpersonal Client Characteristics: Tone of Voice

Answer 19

may provide a window into his or her emotional state – loud vs soft, shaky vs still

Question 20

Interpersonal Client Characteristics: Body Language

Answer 20

Desired: an open, relaxed, or neutral posture

Closed-off: Closed body position (arms or legs crossed)
Stiff/quick moving – anxious

Question 21

Interpersonal Client Characteristics: Facial Expression

Answer 21

-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)

Question 22

Interpersonal Client Characteristics: Response to Change & Challenge

Answer 22

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

Question 23

IInterpersonal Client Characteristics: Level of Trust

Answer 23

Required for…
-Dressing
-Bathing
-Toileting
-Grooming
-Asking questions
-Teaching
-Providing feedback

Question 24

Interpersonal Client Characteristics: Need for Control

Answer 24

therapists want to give clients as much choice/control as possible

Question 25

Interpersonal Client Characteristics: Approach to Asserting Needs

Answer 25

– 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.

Question 26

Interpersonal Client Characteristics: Predisposition to Giving Feedback

Answer 26

– therapists rely on feedback to adjust strategies to maximize the likelihood of positive outcomes
-Make patients comfortable enough to give feedback

Question 27

Interpersonal Client Characteristics: Response to Feedback

Answer 27

Client feedback is important for improving but can be hurtful is a client exhibits…
-Dismissing behavior
-Self-criticism
-Irritability
-Passive aggressiveness
-Defensiveness

Question 28

Interpersonal Client Characteristics: Response to Human Diversity Orientation Toward Relating

Answer 28

– wide range of differences that distinguish individuals from one another
*sex, race, culture, parental status, marital status, disabilities, religion, political views & more

Question 29

Interpersonal Client Characteristics: Preference for Touch

Answer 29

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

Question 30

Interpersonal Client Characteristics: Interpersonal Reciprocity

Answer 30

giving and sharing between client and therapist

Question 31

Interpersonal Events, what they are, and what they look like.

Answer 31

-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.

Question 32

Interpersonal Event Cascade

Answer 32

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

Question 33

Interpersonal events: Expression of Strong Emotion

Answer 33

External displays of internal feelings that are shown with a level of intensity beyond usual cultural norms for interaction.

Question 34

Interpersonal events: Intimate Self-Disclosures

Answer 34

Statements or stories that reveal something unobservable, private, or sensitive about the person making the disclosure.

Question 35

Interpersonal events: Power dilemma

Answer 35

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

Question 36

Interpersonal events: Nonverbal Cues

Answer 36

Communications that do not involve the use of formal language.

Question 37

Interpersonal events: Verbal Innuendos

Answer 37

Communications in which the client says something illusive or oblique that is meant to serve as a hint about a more direct communication.

Question 38

Interpersonal events: Crisis point

Answer 38

Unanticipated, stressful events that cause clients to become distracted or that temporarily interfere with the client’s ability for occupational engagement

Question 39

Interpersonal events: Resistance

Answer 39

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)

Question 40

Interpersonal events: Reluctance

Answer 40

disinclination toward some aspect of therapy for reasons outside the therapeutic relationship.

Question 41

Interpersonal events: Boundary Testing

Answer 41

A client’s behavior that violates or that asks the therapist to act in ways that are outside the defined therapeutic relationship.

Question 42

Interpersonal events: Empathic Breaks

Answer 42

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.

Question 43

Interpersonal events: Emotionally Charged Therapy Tasks and Situations

Answer 43

Activities or circumstances that can lead clients to become overwhelmed or experience uncomfortable emotional reactions such as embarrassment, humiliation, or shame.

Question 44

Interpersonal events: Limitations of Therapy

Answer 44

Refer to restrictions on the available or possible service, time, resources, or therapist actions.

Question 45

Interpersonal events: Contextual Inconsistencies

Answer 45

Any aspects of a client’s interpersonal or physical environment that change during the course of therapy.

Question 46

Who assumes full responsibility for communicating intentionally with the client?

Answer 46

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.