OTA 100 - Ch. 17-18 Ther Relationships and Reasoning

Question 1

Ideal Self vs Perceived Self vs Real Self

Answer 1

Ideal Self = what an individual would like to be if free of demands of mundane reality; unrealistic and often defended

Perceived Self = aspect of self that others see without benefit of knowing person’s intentions, motivations and limitations; not the true self and often different from ideal self

Real Self = blending of internal and external worlds involving intention and action, plus environmental awareness; includes feelings, strengths and limitations of person plus the reality they exist in

Question 2

Task Groups

Answer 2

Groups with common needs lead by OTs around shared concerns or tasks; OT skillfully sets up environment to address each member’s goal and delegates responsibilities based on therapeutic needs. Groups can be categorized as:
• Therapeutic
• Peer Support
• Focus
• Consultation and Supervision

Question 3

Therapeutic Relationship

Answer 3

Interaction between OTP and client. Designed to benefit the client (one-sided). Key for facilitating healing and rehab process. Helps clients achieve goals. Includes tools such as: therapeutic use of self, self-awareness and trust. Skills developed are trust, empathy, nonverbal and verbal communication, active listening and group leadership skills.

Question 4

Universal Stages of Loss

Answer 4

Denial, Anger, Bargaining, Depression, Acceptance

Sense of loss can cause loss of function, health, occupations or time. Dynamic process; may go through some or all stages; may return to some. OTP recognizes these stages and helps work thru them.

Question 5

Intentional Relationship Model (IRM)

Answer 5

Describes therapeutic use of self and development of “modes” (styles) used in therapeutic relationships, which can be shifted and used by OTP as needed. There are 6 primary modes:
• Advocating
• Collaborating
• Empathizing
• Problem Solving
• Instructing
• Encouraging

“ACE PIE”

Question 6

Principles of Therapeutic Use of Self

Answer 6

Qualities useful in establishing and sustaining Therapeutic Relationships:
• Possess self-awareness
• Develop trust
• Provide support
• Actively listen
• Empathize
• Use genuineness, respect, self-disclosure, trust and warmth

Question 7

Skills for Effective Therapeutic Relationships

Answer 7

1) Develop trust
2) Develop empathy
3) Develop verbal and nonverbal communication skills
4) Improve active listening

Question 8

Active Listening

Answer 8

Listening without interruption, judgment, etc. Receiver must paraphrase speaker’s words back to them to show understanding. Uses:
• Restatement: receiver repeats words back to speaker.
• Reflection: receiver expresses in words the feelings/attitudes sensed behind words of speaker.
• Clarification: speaker’s thoughts and feelings are summarized or simplified.

Question 9

Therapeutic (or Clinical) Reasoning

Answer 9

Thought process therapists use to evaluate clients and design and carry out intervention. Also referred to as Clinical Reasoning, but OTPs use therapeutic as a more inclusive term. Involves both thinking and feeling; used to make decisions. Includes scientific, ethical and artistic elements.

Question 10

Conditional Reasoning

Answer 10

Consideration of client’s condition as a whole, what it means to client, and how it may change depending on participation level.

Question 11

Interactive Reasoning

Answer 11

Goal is to understand client as a person; face-to-face interaction with client.

Question 12

Narrative Reasoning

Answer 12

OTP shares “stories” about clients to each other; may create stories about future envisioned for client as a guide for intervention.

Question 13

Pragmatic Reasoning

Answer 13

Taking into account how the context of practice setting and personal context affect intervention. (ie: availability of resources, or client’s motivation)

Question 14

Procedural Reasoning

Answer 14

Focus is on client’s disease/disability to determine appropriate modalities to improve functional performance. (Similar to scientific element.)

Question 15

Artistic vs Ethical vs Scientific Elements

Answer 15

Elements used in therapeutic reasoning.
Artistic = Using creativity to skillfully design intervention specific to a client; requires OTP to modify activities, use humor/coaching and read client cues when interacting.

Ethical = Using the client’s perspective to develop an intervention plan that preserves client’s values; requires consultation and inclusion of client in decisions. What should be done? What is the fair path?

Scientific = Determining strengths/weaknesses of client through careful evaluation and assessment to make a plan for most successful occupational performance out-comes. Good starting point as it is based on the medical (physiological) model.

Question 16

Thought Process of Therapeutic Reasoning (steps):

Answer 16

1) Formation of preassessment image (basic facts)
2) Cue acquisition (gather data on function/roles)
3) Hypothesis generation (assumptions based on data as basis of therapeutic action)
4) Cue interpretation (is further data gathered relevant to hypothesis?)
5) Hypothesis evaluation (Weighs diagnostic hypotheses; chooses one with most supporting evidence for intervention plan)

Question 17

Development Levels of Therapeutic Reasoning Skills

Answer 17

1) Novice: using procedural/scientific reasoning and coursework
2) Advanced Beginner: using cues, begins to see client as individual
3) Competent: using more facts, understands client’s problems, individualized treatment; may lack creativity
4) Proficient: viewing situation as whole; develops vision of client’s goals; able to modify
5) Expert: knows rules of practice; uses intuition as guide; uses conditional reasoning

Question 18

Promotion vs Compensation vs Adaptation vs Prevention

Answer 18

Approaches to intervention:

Promotion: To provide enriched contextual/activity experiences that enhance performance for all people (parenting class; fall prevention).

Compensation: Modifying task/environment to make up for a deficit/disability.

Adaptation: Modifying a task, method of accomplish-ing task, and environment to promote engagement in occupation.

Prevention: Address needs of client at risk of performance problems. Prevent occurrence or evolution of barriers (anti-drug strategies; ergonomics).

Question 19

Body Language

Answer 19

Read others’ body language, but also be aware of your own! Consider what you are projecting before you react to a negative response. Posture, stance, gestures, eye contact, personal space, facial expression and energy level send messages you may not intend.

Question 20

Vocal Cues

Answer 20

How you speak often gives a perception:

Monotone=boredom
Slow speed/pitch=depression
High voice/emphatic pitch=enthusiasm
Ascending tone=astonishment
Abrupt speech=defensiveness
Terse/loud=anger
High pitch/drawn out=disbelief

Question 21

Tips to Improve Listening:

Answer 21

1) Do not fake understanding. Ask to repeat if needed.
2) Do not tell speaker you “know how they feel”. Reflect you understand but not that “you are with them”
3) Vary your responses.
4) Focus on the feelings (when reflecting back, use accurate feeling word)

Question 22

Questions to ask yourself about the effectiveness of your people skills:

Answer 22

1) Are you truly listening and hearing what is being said?

2) How can you slow down your rx and respond successfully to behavior you do not like or expect?