From the Roots of Psychosocial Practice-Therapeutic Use of Self in the Classroom: Practical Applications for Occupational Therapy Faculty

The roots of occupational therapy stem from psychosocial practice and embrace concepts of humanism, client-centered practice and therapeutic use of self. These concepts are integral to both clinical and academic settings. As the profession has moved toward graduate level education, increased numbers of non-traditional students are entering the field. Models of teaching that incorporate principles of active learning and therapeutic use of self within the classroom provide a consumer-learner-based model of education that is uniquely suited to students of diverse backgrounds, lifestyles, and educational needs. This article presents a brief overview of andragogical principles and the development of the student-faculty relationship. Mosey's concepts of conscious use of self are introduced as a means by which positive faculty-student relationships can be formed in order to enhance student learning and educational outcomes.     

Emotional Intelligence: An Opportunity for Occupational Therapy

Emotional intelligence theory developed within the psychology and business fields and is described as an ability to monitor emotions and to use the information to guide thinking and problem solving. Emotional intelligence skills are needed by occupational therapy practitioners to support therapeutic use of self, promote client-centered care, and foster communication skills within the workplace. A scenario illustrates how emotional intelligence supports the therapeutic use of self during a clinical interaction. The Mayer Salovey Caruso Emotional Intelligence Test is introduced as a resource for occupational therapy practitioners to measure and develop therapeutic relationship skills based upon emotional intelligence research.     

Occupational Therapy Students' Development of Therapeutic Communication Skills During a Service-Learning Experience

This qualitative study examined the effect community-based service-learning experiences had upon occupational therapy students' therapeutic communication skills and their application of theoretical concepts. After their semester-long course was completed, six students de-identified and voluntarily submitted their weekly reflective journals for retrospective analysis in accordance with Giorgi's strategies (1985 Giorgi , A. ( 1985 ). Phenomenology and psychological research . Pittsburgh , PA : Duquesne University Press . [Google Scholar], 1997 Giorgi , A. ( 1997 ). The theory, practice, and evaluation of the phenomenological method as a qualitative research procedure . Journal of Phenomenological Psychology , 28 , 235 – 261 .[Crossref] , [Google Scholar]). Two analysts identified eight themes: developing trust, establishing boundaries, communication, client-centered care, breakdown of preconceptions, increased self-awareness, power of pride, and power of occupation. Educators are urged to use service-learning experiences to facilitate student interpersonal skill development and integration of theoretical knowledge.     

Conscious and Unconscious Use of Self: The Evolution of a Process

Recent emphasis has been placed on the central role of the therapeutic relationship in successful treatment. One aspect of the development of an effective relationship is the clinical social worker's use of self. We argue that the use of self happens both consciously and unconsciously and is a dynamic and evolving process in psychotherapy. This evolution can result in the clinical social worker shifting from a stance of doing to being. Drawing from a Japanese tradition of learning, three stages of learning provide a framework for understanding how therapists may transition from a state of doing to being in the therapy. Through this process, the conscious use of self may develop into unconscious use of self. Two case examples demonstrate how expanding and using one's self-awareness and the new knowledge through meaningful learning experiences can shift a clinical social worker's ability to develop and enhance his or her use of self, inviting therapeutic presence and depth.     

Three Aspects of the Therapeutic Conversation in Couples Therapy

Abstract

Feminist scholars have revealed the importance of examining the influence of gender on the therapeutic process. Gender differences in the treatment of clients may reveal inequitable or traditionally Stereotypie treatment of clients by therapists. This study examined gender differences in three conversational strategies widely used by therapists: expressions of empathy or understanding, compliments or praise, and challenges or requests for change. Fourteen tapes of live therapy sessions conducted by “master” therapists were examined using an exploratory, qualitative methodology based on Conversation Analysis. Results of this exploration revealed that therapists who are not self identified as “feminist challenged female clients more than male clients, and complimented male clients more than female clients. Feminist therapists challenged male clients more than female clients, and complimented female clients more than male clients. Feminist therapists used more challenges designed to facilitate non-stereo-typic gender behavior in both male and female clients. Only male therapists used disrespectful challenges of female clients, and were more often disrespectful to female clients than to male clients. Implications for the therapist-client relationship and the feminist critique are provided.     

孔子与泰德·本顿的生态观之比较

20世纪后半期,人类面临的最突出的问题就是全球性的生态危机和环境问题。摆脱人类生存的困境,走向具有生态持续性的文明社会是中国现代化实践面临的严峻挑战。本文试将孔子和泰德·本顿的生态观加以比较,求同存异,发掘其中蕴含的积极因素。两者在对自然的解读上,强调自然的客观实在性,重视自然的内在价值和对自然规律的遵循;在人与自然的关系上,阐发人与自然的息息相关性和密不可分性,强调二者相互作用。相互影响;在对自然资源的利用上,强调合理地支配和有限地利用自然,承认自然的极限。这些思想为我国生态文明建设提供了有益的借鉴。     

Personhood of the Therapist in Couples Therapy

SUMMARY

Integrity Therapy (Lander, 1986; Lander & Nahon, 1992a, 1995a; Mowrer, 1961b, 1964a) views the personhood of the therapist as the very essence of therapy. By meeting the deepest part of the therapist with the deepest self of individuals in therapy, a healing process unfolds which opens up the healing potential of both the individuals and the couple. This article offers couple therapists and other mental health professionals an Integrity Therapy perspective of the personhood of the therapist and its therapeutic potential for helping couples in distress to reclaim their personhood. Two aspects of the Integrity Therapy approach which play a critical role in enhancing therapists' use of their personhood in the therapeutic process are explored: (a) the use of therapist self-disclosure, and (b) therapists' awareness and therapeutic use of counter-transference issues.     

Factors Associated with Therapeutic Approaches Among Norwegian Occupational Therapists: An Exploratory Study

According to the Intentional Relationship Model, the use of therapeutic approaches tailored to individual clients’ needs is essential for building therapeutic relationships. This study investigated factors associated with occupational therapists’ preferred therapeutic approaches. One hundred eight occupational therapists were recruited as a convenience sample, and the data were analyzed with linear regressions. Mental health as the field of practice was associated with a stronger preference for use of empathy. More job satisfaction was associated with stronger preference for the instructing mode. Empathy appears to be more commonly used in mental health practice, whereas instructing may be linked with job satisfaction.     

Commentary on Three Articles on Self‐practice/Self‐reflection in Cognitive‐Behavioural Therapy

The commentary embraces three valuable contributions to the development of professional practice: (a) engagement with self‐practice/self‐reflection as a professional self‐development: the role of therapist beliefs; (b) spontaneous self‐practice of cognitive‐behavioural therapy (CBT) by aboriginal counsellors during and following CBT training: a retrospective analysis of the facilitating conditions and impact; (c) developing metacompetence in low intensity CBT interventions: evaluating a self‐practice/self‐reflection programme for experienced low intensity CBT practitioners. Each article provides different perspectives of the self‐practice and self‐reflection benefits for efficient therapy and their use as powerful resources in therapeutic training skills in general and CBT in particular. Conclusions of their contributions close the commentary.     

Three modes of psychotherapy and their requisite core skills

The field of psychotherapy suffers from the lack of an integrative meta‐perspective on the large variety of existing psychotherapies and on the therapeutic skills involved. In the present paper, it is suggested that the development of a more comprehensive view of this field may be facilitated if we differentiate between three modes of psychotherapy, which require different therapeutic core skills: (a) an educational mode, which requires teaching skills; (b) a reparative mode, which requires analytic‐conceptualising skills to identify some kind of disordered functioning, in combination with specific relational‐technical skills to repair this dysfunction; and (c) a developmental mode, which involves engaging in a therapeutic relationship with patients to facilitate their personal growth, and which requires non‐directivity skills. In addition, some therapeutic skills (e.g., awareness and communication skills) may be more or less important in all modes of treatment. Concrete manifestations of the three different modes of psychotherapy are discussed in terms of five different theoretical perspectives on psychotherapy: the common factors, the humanistic‐experiential mindfulness cognitive‐behavioural (CBT) and psychodynamic perspective. The common factors model is criticised as being insufficient in several respects. Finally, it is argued that if personal therapeutic skills are essential to the effects of psychotherapy, then empirical research on psychotherapy needs to be re‐oriented towards a person‐oriented study of therapist skills in action, in the context of a study of the interaction between therapist and patient.     

The New Occupational Therapy Paradigm: Implications for Integration of the Psychosocial Core of Occupational Therapy in All Clinical Specialties

In this paper, it is argued that the new occupational therapy paradigm includes a core of psychosocial skills, consistent with the profession's historical roots in mental health. It is proposed that contrary to the declining presence of occupational therapy in mental health, psychosocial interventions should be explicitly integrated in all professional practice, such that occupational therapy will become the profession of choice in addressing psychosocial issues of all clients irrespective of clinical specialty. A case study is presented as an example to demonstrate how this explicit integration may be achieved in physical rehabilitation.     

Evidence‐based practice: Accounting for the importance of the therapeutic relationship in UK National Health Service therapy provision

It is argued that different models of therapy result in broadly similar outcomes and that the therapeutic relationship is the most important factor in relation to outcome. This paper presents some of the main findings from over 30 years of psychotherapy research. We discuss these findings in relation to current provision of therapy within the UK National Health Service (NHS) and express our fears that despite a culture of evidence‐based practice, this evidence is in danger of being ignored. We conclude by discussing some of the implications and challenges that this evidence presents to therapy researchers, policy makers, trainers and practitioners.     

胃部恶性肿瘤临床实践中的医疗艺术

医学是一门讲求艺术性的科学.随着社会的发展,医疗艺术在整个医学临床实践中的重要性越来越突出.医疗艺术体现了医生对生命的尊重和伦理的理解.讲求医疗艺术对于建立和谐的医患关系具有重要意义.因此,如何在过硬的现代医学技术基础上提高临床医疗的艺术性,是医学教育和临床实践领域都应该思考的问题.本文以胃部恶性肿瘤的临床实践为例,从态度、语言、表情以及医患互动等细节方面入手,探讨在初诊、术前、康复以及面对晚期临终患者的不同情况中应该如何提高医疗艺术.     

Developing the Working Alliance in Marital Therapy; A Psychodynamic Perspective

A good working alliance in marital therapy is one in which the partners are actively collaborating with their therapist to work through conflicts. The therapist begins to develop the alliance by setting the frame of therapy and helping the couple understand the guidelines of treatment. The partners gradually identify with and emulate the therapist's working style and use of self as a reflective instrument. The working alliance can be weakened by empathic failures and strengthened by increased feelings of trust in the therapist and the process of treatment This paper looks at the development of the working alliance in marital therapy from a psychodynamic perspective. A clinical illustration is included.     

Spontaneous Self‐Practice of Cognitive Behavioural Therapy (CBT) by Aboriginal Counsellors During and Following CBT Training: A Retrospective Analysis of Facilitating Conditions and Impact

Previous cognitive behavioural therapy (CBT) training studies have suggested that therapists who practice CBT strategies on themselves during training may experience professional and personal benefits. However, it has also been reported that some CBT trainees are reluctant to engage in self‐practice. The present study reports an incidental finding from a CBT training study with Aboriginal counsellors: all five counsellors reported that they practiced CBT techniques on themselves without specific encouragement by the trainers to do so. This paper therefore posed three questions: (a) Why—in contrast to some other trainees—did this group choose to apply CBT to themselves? (b) How did they apply it—with what purpose, in what contexts, and which skills? (c) What was the impact of CBT self‐practice? Data from the group's reflections were qualitatively analysed by two of the researchers, and “member checked” by the remainder. Results indicated that the counsellors were motivated to practice CBT on themselves for two principal reasons: the value they placed on CBT, and their personal need resulting from the high number of crises experienced while living and working in their communities. The counsellors reported practicing CBT in a wide variety of contexts as part of their learning. As in previous studies, the impact of CBT self‐practice was that it increased their confidence and competence as therapists. It also appeared to be a valuable burnout prevention strategy. If the results are generalisable, they suggest that self‐experiential training in CBT may be a culturally responsive and adaptive way for Aboriginal counsellors to enhance their learning of CBT skills.     

Occupational Therapy Shared Decision Making in Adolescent Mental Health

Shared decision making (SDM) shares values of client-centered practice; however, a few studies exist that explore experiences of occupational therapists (OTs) working in adolescent mental health. This study aims to better understand SDM in adolescent mental health using the Canadian Model of Client-Centered Enablement. A qualitative study included interviews (n = 6) and analysis using an inductive approach. The role of the OT, client factors, therapeutic relationship, and nature of the decision were identified as influencing the process and outcome of SDM. The study helps better understand SDM in practice, the need for specialized education for OTs and has identified future research areas.     

Perceptions of Spirituality and Spiritual Care in Occupational Therapy Practice

Occupational therapists view human occupation as active engagement in that which brings meaning to the life of the patient. Spirituality is understood to be one important construct in the creation of meaning in the lives of human beings. This study examined the attitudes toward the use of spiritual care in occupational therapy. The study sample consisted of 310 occupational therapists. Data were collected through the use of a secure web-based survey tool. Analysis was conducted to determine the significance of relationships between several important constructs (e.g., education, theory base, definition of spirituality) and perceptions regarding the use of spiritual care.     

Enhancing Cognitive‐Behavioural Therapy (CBT) Skill Acquisition Through Experiential and Reflective Learning: A Commentary on Studies Examining the Impact of Self‐Practice and Self‐Reflection in CBT

Self‐practice and self‐reflection (SP/SR) is a targeted training tool that is intended to increase CBT competency in therapists. The four articles reviewed in this commentary examine the benefits of SP/SR with various types of therapists, and survey the significant obstacles faced in implementing this tool with clinicians. Collectively, these articles conclude that SP/SR is a valuable tool in improving CBT skill acquisition and preventing burnout, particularly with difficult patients, but that most therapists elect not to use it largely because of the time involved in engaging in it. In this commentary, I suggest that empirical studies with larger samples and controlled designs are needed to build on the wealth of qualitative data collected to date in order to assess the value added by SP/SR compared with other training methods, and in order to determine its impact on a range of therapeutic outcomes. I also suggest that future studies should examine the efficacy of required SP/SR engagement, isolate its critical ingredients, and assess if there are clients and therapists for whom SP/SR is comparably more effective.