therapeutic modes - my part

Therapeutic ModesGregorio, L.M.Maximo, B.K.

USTH-CC Interns, 2013

OUTLINE

INTRODUCTION6 THERAPEUTIC MODES

◦advocating,◦collaborating,◦empathizing,◦encouraging◦instructing◦problem solving

SUMMARY

INTRODUCTION

Personalities are comprised of a unique set of emotional experiences, a distinct pattern of interpersonal behavior, and a stable psychobiological profile (Kagan, 2000).

product of genetics, biology and experiences interacting within one’s family and in the broader social community

Genetics,+

Biology+

Experiences

TEMPERAMENT

personality and temperament do not change significantly over the life span (Kagan, 2000)

how we relate to others daily varyinterpersonal strategies

Therapeutic Modes

a specific way of relating to a client

Therapist’s Personality

reflected in (a) her fundamental motivation to serve others, (b) her preferred approach to serving, and (c) the values she hold while serving

reflected through her ways in specific ways in which she behaves and interacts with clients.

Optimal therapy = flexibility of OT◦develop an awareness of her natural modes ◦develop the self-discipline to using the modes ◦be aware of the limits of the modes

THERAPEUTIC MODES

◦advocating,◦collaborating,◦empathizing,◦encouraging◦instructing◦problem solving

Negative effects◦Too frequently or inflexibly,◦When the timing is not right for the client,◦When the mode is not consistent with the

client’s personality as a whole, and◦When the mode is not changed so as to be

more consistent with the client’s interpersonal needs of the moment

Advocating Mode

Physical

Optimally Functional

Social Occupational

OT as an advocate

Provide clients with vital resources

Approach interpersonal difficulties by adjusting and accommodating to the needs of the client

OT becomes a facilitator or defender of justice

Become involved in civil rights or legal activities in behalf of their client

Consciousness-raising about their legal rights , barriers to access and obstacles to independence

Testify on behalf of a client in a legal situation

Strength of Advocating Mode

If therapists do not advocate for their clients, they would be on their own to battle insurance companies, agencies that provide public or private aid, landlords, educational systems, employers, and other powerful organizations.

Cautions of Advocating Mode

Underestimating the capabilities of the client, making them feel powerless but who is actually capable of becoming empowered

Overestimate a client’s desire, ability and/ resources for autonomy and independence

Collaborating Mode

OT as a collaborator

Makes decisions jointly with the client

Involve clients in reasoning

Solicit ongoing feedback from clients

Empowering the client to use his or her own judgement

Encourage autonomy and independence

Strengths of Collaborating Mode

This mode reflects many of the core values of occupational therapy.

These values are enabled by having clients choose activities, have opinions, and participate actively in evaluating the process of therapy and reflecting on their own performance

Strength of Collaborating Mode

This mode is likely to instill confidence in clients ◦because it conveys the idea that therapists view them as competent in their ability to direct their treatment, choose occupations, and gain greater control in determining the course of their own lives

Cautions for Collaborating mode

Overreliance on this style or using it non-judiciously across all types of clients

May not be received well by clients who are prefer or are accustomed to view service providers are expert

Client inclined to participate in social or cultural networks with hierarchical role structures may not value collaboration in therapy

Caution for Collaborating Mode

Clients may be looking for a structured instruction, advice, resources and ongoing direction

Therapists who value the collaborating mode may misperceive or misunderstand less-engaging clients as passive or even apathetic, when clients are merely behaving in their own comfort zone and may become disappointed


Unrestrained or unstructured collaboration may result in diffusion of responsibility or uncertainty regarding who is responsible for which part of the therapy process

Overestimating the client’s strengths and capacities. Sometimes client’s need a more directive therapy


Clients may become lost, insecure, and/or anxious about the therapy process when they are asked to participate in a collaborative therapy session when they are not yet ready

Empathizing Mode

OT as an empathizer

Bearing witness and to fully understand a client’s physical, psychological, interpersonal, and emotional experience

Put a significant amount of time and effort into striving to understand a client’s interpersonal needs and perspective

Able to notice and respond to the client’s behavior

OT as an empathizer

OTs listen carefully are watchful of what their client’s communicate and adjust their approach accordingly

Use intermissions from “doing” for processing and communicating with clients

Using a understanding as a means for resolving rifts, obstacles and conflicts

Strengths of Empathizing Mode

Provides a model for the clients to learn to empathize with themselves and to self-reflect and gain insight into their emotional reactions and behaviors

Empathy is fundamental to the resolution of conflicts, rifts and misunderstanding that occur during therapy

Strengths of Empathizing Mode

Empathizing tends to disarm clients who are reluctant, resistant, critical or otherwise negativistic about therapy.

Clients feel responded to, cared about and respected.

More likely to achieve open, honest communication with clients which increases trust and a more stable relationship

Caution for Empathizing Mode

Slow pace of this mode may be beneficial to clients not yet ready to engage in OT

Overemphasis can place too much emotions in the foreground of therapy


Some clients may not be ready to see or hear emotions reflected back to them. Instead feel more comfortable focusing on the activity.

Pacing of treatment is slow and functional tasks of the therapy may be delayed or left unaccomplished


Therapists who show too much emotion or probe too much for emotional expression from client may be perceived as over-involved or psychologically instructive and may recoil because of too much intimacy or emotional intensity

Overprotection of clients, inappropriate level of dependence in more vulnerable or isolated clients


Clients may perceive the therapist as a friend, and become disappointed and rejected when the therapist does not behave accordingly to their domains

For the therapists, emotional over-involvement may result to guilt over the limitations of what at therapist can actually do and result to a burn out

Encouraging Mode

Encouraging Mode

therapist works to instill clients with hope, courage, and the will to explore or perform a given activity

“cheerleaders”Help to generate or help sustain a client’s

interests in occupational engagement

Strengths of Encouraging Mode

open and generous in their emotional expression, project a great deal of positive energy, skilled at conveying optimism and hope, and are willing to celebrate and be joyful with their clients

Playful = children

Strengths of Encouraging Mode

anxious, demoralized or reluctant participants

convey their belief in a client’s potential for success

Cautions of Encouraging Mode

Clients may be desensitized to its use overtime

Clients may develop have difficulty in developing a sense of intrinsic motivation independently

Risk of being misinterpreted

Instructing Mode

Instructing Mode

Therapists emphasize educationassume a teaching styleproviding detailed descriptions of

the objectives and tasks of therapyproviding feedback to clients about

the therapy process

Instructing Mode

provide their clients with information, direction, recommendations, and in some circumstances, advice

Instructional statements and mini-lectures, role modeling and demonstrations

Q and A

Strengths of Instructing Mode

excellent teachers and clear communicators

empower and inspire their clients by◦sharing information◦noting accomplishments◦providing contructive feedback◦training to utilize tools required for adaptation and participation

Cautions of Instructing Mode

Therapist may overinvest = react more negatively when they cannot get clients to do what they would like them to do

Therapist may tend to bolster, overprotect, or overinstruct their clients to prevent them from experiencing failure in therapy


Clients may misunderstand therapist’s behavior as being parental, authoritarian, dominant, controlling, or demanding

Therapists may feel obligated to help all clients address their difficulties and may miss the point at which client want them to simply listen and validate them

Problem-Solving Mode

Therapists rely heavily on using reason and logic in their relationships with clients

have excellent technical abiltiesgenerally approach the interpersonal

aspects of therapy by reasoning or by using other logical approaches

Strengths of Problem-Solving Mode

Therapists are self-sufficient, self-disciplined, and straightforward in their communications, and solution-oriented

clients who are uncomfortable with a more emotion-focused approach


Therapists may be vulnerable to assuming an expert stance or a more challenging approach without paying enough attention to other interpersonal needs of the client

Clients may misinterpret therapist’s behavior as too strategic or even intimidating


unwitting use of technical terms and language in inappropriate settings

Therapist as aloof, judgmental or distant by clients who are sensitive, vulnerable or are otherwise interpersonally demanding

Modes in Perspective

No single “typical” manner in which a therapist might enact a mode or set of modes

Modes may be used interchangeably provided that they do not blend into one another during a single communication

Modes in Perspective

In shifting modes make sure that the two modes are easily distinguished

“I understand why you want to use alcohol, but I need to educate you on why

you shouldn’t”

Suggestions to ensure that modes are used purely

1. Think about what message you believe the client needs to hear at that moment

2. Occasionally remind yourself why it is therapeutic for the client to hear the given message

3. Take responsibility for what you say

Therapeutic Style

is a skill set that incorporates the therapeutic modes they view as being maximally therapeutic for their clients

No therapist is perfect!

THANK YOU!

therapeutic modes - my part

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