Define therapeutic use of self
An integral part of the occupational therapy process which allows occupational therapy practitioners to develop and manage their therapeutic relationship with clients by using narrative and clinical reasoning; empathy; and a client-centred, collaborative approach to service delivery
Define the therapeutic relationship
A partnership between the therapist and the individual (a patient) which evolves when that individual seeks the assistance of a therapist to promote a joint exploration of action on some problem affecting daily life
Define a client centred approach
A client centred approach prioritises the clients interests goals preferences values and roles. It makes use of the activities that the client may undertake daily and enjoy. It includes the client in their own treatment and allows them to have a sense of control over the process. It makes them a collaborator
6 assumptions for the client centred approach
1) valuing their personal experience
2) consider an individual as a whole
3) an individual has the right to personal choice
4) the goal of an individual is to function as a free self-directing, honest person whose life is meaningful and satisfying
5) an individual is capable of directing their own life, therefor direct their therapy as far as possible
6) an individual is innately capable of positive development
Different aspects of clinical reasoning
1) scientific
2) narrative
3) pragmatic
4) ethical
5) conditional
Guidelines in OT documentation
- date and time
- document missed sessions
- facts: reflects the nature of services provided and the clinical reasoning
- don’t point blame
- don’t change without clarifying the nature of change
- no correction fluid
Purpose of documentation
Communication, continuity between staff, justification to medical aids, complying with the law, ensure clients rights and advocacy, interpreting Rx to patient, evaluating effectiveness, ensuring accreditation of service, research, facilitating training and student education
Define clinical reasoning
The thinking process therapists use to plan, direct, perform and reflect on client care which happens after the assessment when the occupational therapist decides on what the goals for the client are
Main components of clinical reasoning
1) understand the client
2) analyse performance
3) develop a treatment plan
4) monitor progress
The OT process describes
The actions practitioners take when providing services that are client centred and focused on engagement in occupations
Define the OT process
A client centred delivery of occupational therapy services. It is a structure used to ensure the use of therapeutic professional reasoning, which is evidence-based, in order to address the clients health-related concern. An occupational therapist customises the process by supporting the clients health and participation through occupational engagement as the end goal.
The unique application of the process within OT is the
Use of occupation as an end bias snd as a means to achieve the goal
Interactive reasoning
Simultaneous interaction and monitoring the situation and responding spontaneously to events and reactions of the client
Characteristics of interactive reasoning (9)
1) engage
2) know
3) understand
4) individualise
5) communicate
6) humour
7) shared language
8) show interest
9) determine if treatment is going well
You need to consider 3) things in a therapeutic relationship
1) professional self
2) social self
3) private self
Professional self includes
- being skilled efficient and competent
- oath of “do good and do no harm”
- honourably
- ethically
- honestly
- confidentiality
Social self includes
- good social skills
- good manners and politeness
- set boundaries in context of your purpose
- use or suppress of yourself in order to be therapeutic
Private self includes
- insight
- empathy
- NB deeply personal experiences
- aware when your private self can become a problem or disadvantage a client
- be aware of your own stress or burnout
- patients, humour, energy, honesty, valuing the individual, caring, being one self
Documentation should
Always record the practitioners activity in the areas of screening, evaluation, intervention, and outcomes
What is the goal of clinical reasoning
To decide on the best intervention for a client (individual/group/community)
Scientific reasoning questions
- what is the nature of the condition?
- what are disabilities that result from this condition?
- theories and research to guide Ax and Rx?
- what intervention protocols are applicable?
Narrative reasoning questions
- what impact has this disease had on your life story?
- what occupational activities are important to the client?
- what activities are meaningful to the client?
- what activities are useful in meeting therapy goals?
Pragmatic reasoning questions
- who referred this client and why?
- what resources are available?
- what are expectations of OT and workplace?
- How much time is there to see the client?
- what are OT’s competencies?
Reflect in action
Adapt to meet the demands of the situation
