Therapeutic Use of Self

Grapes BannockburnTherapeutic use of self or conscious use of self is often recognized as an important therapeutic tool or by some as a core skill of occupational therapy. Two events have recently renewed my interest in therapuetic use of self. Completing a thesis on the supervision of occupational therapists in New Zealand – where one of the important functions of supervision was seen as looking at ‘me as a therapist’ and then running into an ‘ex’ occupational therapist at an occupational therapy awareness week activity who stated that the skill she continues to use and values most from her training is that of therapeutic/conscious use of self. So what is it? Mosey states that conscious use of self is “the use of oneself in such a way that one becomes an effective tool in the evaluation and intervention process” (Mosey, 1986, p. 199). And sees that it “involves a planned interaction with another person in order to alleviate fear or anxiety, provide reassurance, obtain necessary information, provide information, give advice, and assist the other individual to gain more appreciation of, more expression of, and more functional use of his or her latent inner resources” (p.199).

“conscious use of self includes but is greater than rapport and the art of practice” (Mosey, 1986, p. 199). It is not spontaneous, or unconscious but requires forethought – what the message will be and how you will get it across.

What does it involve?

Understanding Neutrality/empathy Caring Trust

How do you do it ? with rapport, insight, patience, humour, energy, honesty, voice and body language Is it “the exploitation of personal characteristics which are of benefit to the therapeutic relationship” (Hagedorn, 2000, p. 61) …umh?

So what do you think? …how about posting on any or all of the following

What do you see as the key elements of therapeutic use of self?

Keilhofner and Forsyth indicate that the therapeutic relationship is synonymous with therapeutic use of self – is it ?

and …….. Is this skill any better developed in occupational therapist than in others – if so how?

References:

Hagedorn, R. (2000). Tools of practice in occupational therapy: A structured approach to core skills and processes.
Edinburgh: Churchill Livingstone.

Kielhofner, G. & Forsyth, K. (2002). A model of human occupation: Theory and Application (3rd. ed.). Baltimore: Lippincott Williams & Wilkins.

Mosey, A. (1986). Psychosocial components of occupational therapy. New Psychosocial components of occupational therapy.
New York: Raven Press.

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33 responses to “Therapeutic Use of Self

  1. People have a lot to fear, they fear ridicule because some of the language is unscientific. Empathy is not measurable. They fear they could be seen as bad practioners if they ‘dont get it’. So they resist it. Mostly i think they fear that this approach may challenge them, most people have never learned how to make challenges opportunities. They refuse to expose themselves to risk but then they never get the reward.

  2. What a great topic. I am searching for OT articles about this as i find it really fascinating and agree that this is the most important thing. The therapeutic relationship is the vehicle through which we work and so influences the result hugely.
    There doesn’t seem to be much out there on it, but i have just started my search so wish me luck!

  3. Great concept for a website. I have recently reviewed the text by Renee Taylor, 2008, The Intentional Relationship: Occupational Therapy and Use of Self. I hope to incorporate many of the activities into my courses here at Saginaw Valley State U. You may find it to be useful for your endeavor as well. Tim Blasius, EdD, MOT, OTR, LMSW

    • Therapeutic Use of Self, though difficult to define, is all of the other characteristics people have posted on this blog, but to me also includes a genuine sense of caring about someone else, and accepting them as a worthy human being, regardless of their past or present status. Being an OT for over 30 years, I still find it very tough to explain it or even teach it, so any ideas are welcome.

  4. The publisher for the book is F.A. Davis and is available at http://www.fadavis .com.

  5. occupationaltherapyotago

    Hi Tim
    Thanks for your comments, I’ll see if I can get hold of the book. I always mean to add to this posting as interestingly enough it is the post that most people look at (so my blog statistics say) …. but they tend to look and not comment !!. So it’s great to hear from you.
    Jackie

  6. Hi guys,
    This is a topic that im interested in and when researching it more i havn’t really come across and critiques of it!! Does anyone have any idea of where to look?

  7. occupationaltherapyotago

    Hi Amy,
    Your post has me thinking and likewise I am not sure that I have seen any critiques or recent research( into the concept).
    I was at a presentation today and the person was talking about emotional intelligence and you could see the links between the concept of emotional intelligence and therapeutic use of self.
    I always think that I need to follow up my supervision research – perhaps one day.

    I’ll keep an eye out but perhaps someone else can help.

    Jackie

  8. leigh-ann gilchrist

    i absolutely love your site, i’m a 2nd year OT student from Scotland and i think that communication is the most important aspect of OT the ability to give something of yourself to enable others is skill that i often feel is imbred rather than learned, as in nursing university can give you the skills but i feel that you either have the ability to CARE or not. As many of us know through life we encounter many people who are in a profession that cares but dont do so themselves. Thankyou for sharing some of yourself with me it has been so very useful.

  9. In response to Mr. Blasius’ comment on Renee Taylor,

    I am currently in a MOT program and my professor is using this very book you mentioned in your post. As a student, I highly recommend the book. I found the early chapters which cover the various types of responding to be very helpful. I am always looking for more literature applicable to OT, and any references would be greatly appreciated.

  10. Hi, I’m an OT student in Canada. I’m currently doing a placement at a rehab hospital. I found the information you have put here are very useful. My supervisor always suggest me in order to build a therapeutic relationship with patients, I have to ask question in regards to the therapeutic use of self. Could you suggest me any questions or topics that you would ask or talk to a patient to develop therapeutic relationship?

  11. Hi Jackie, I thought I would comment because you mentioned above that people look but don’t comment on this post. I’m an OT student in Scotland doing my dissertation on the therapeutic relationship in OT in forensic settings and am shocked by the lack of literature for something that is so important to OT. In my opinion, the therapeutic use of self is necessary in the development of a therapeutic relationship although there are other factors that come into play and this is what I’m trying to get information on for my dissertation. I think the use of self in a forensic setting can be very challenging for therapists yet is so vital for patients in forensic settings, perhaps even more so than in other settings…what are your thoughts on this? Rachel

  12. Hi Jackie,
    I am an OT student in the United States of America, New York more specifically. Through my education I have learned about therapeutic use of self and its benefits on the relationship between patient and therapist. Included in those courses were topics such as religion and faith, culture and empathy. I think all three are vital to using therapeutic use of self effectively. Many patients are not going to open up to a therapist who is very guarded and “cold.” What do others think about the relationship between religion and faith and therapeutic use of self?

  13. Hi there. I realise I’m responding to an old entry but I’ve just become really interested in this topic. I’m an OT working in Social Services in England, with previous experience in acute and community psychiatry. I’m more and more intrigued by the nature of the therapeutic relationship, from an experiential / felt perspective. My question would be: what is the relationship between self and personality? For myself, I feel that as my experience has deepened I’ve come to rely less and less on personality in making relationships with clients, and more on something that is deeper, underlying, perhaps less intrusive… whatever is there when I sit with a very still awareness of the situation and hold a space without necessarily occupying too much of it myself… Does that make any sense? I’d be very glad to get into dialogue with anyone in whom this strikes a chord!

    • Hi Mark. I am just discovering this site and your remarks. They do strike a chord. I am a COTA and have always worked in community mental health for in the US. The “self” feel I am bringing into the relationship is absent of ego/personalty/judgement/storytelling. I am open and listening with a keen awareness that the person in front of me is doing the best that they can, and while that is true, they can do better (because they are, after all back in the hospital). The same is true for me at any given moment. I am doing the best that I can, but I can always do better. Does that make any sense to you?
      Sally in Houston Texas

      • Hi Sally. What a surprise to get a reply to this old comment! But very good to hear from you. I’ll try to find you on Facebook and maybe we can start corresponding about this?

        Mark

      • Hi Sally. I think I’ve managed to send you an email on facebook. If you haven’t got it leave me a message here and we’ll get in touch somehow.
        Mark

      • Yes, Sally, that does make a lot of sense to me. Though I think it’s impossible, and probably not desirable, to suspend ego/personality completely, I agree that letting them take a back seat brings very fruitful results. And letting go of judgement is so important – as soon as we judge, we stop being open to all the many possibilities in a situation. Storytelling? I suppose it depends on what you mean by that. I have a deep love of story as a way of structuring experience; but maybe you meant something about not trying to fit people into preconceived narratives / characterisations?
        I think most people do their best most of the time, though that is shaped and limited by so many factors, so it may sometimes be hard to appreciate that that’s what they’re doing.
        Please reply and let’s keep the dialogue going!
        Mark in the North of England

  14. Love the discussion on here. Trying to find ways to measure therapeutic use of self in FW students in order to write objectives. Any ideas?

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  22. I am a 2nd year OT student and currently in the process of writing an essay on therapeutic use of self and therapeutic communication. I too am all to frustrated at the lack of peer reviewed research on a topic that to me is paramount to the rapport and trust building relationship between self and patient. As an old boss once told me in the world of insurance “people buy into YOU NOT the product – we could have the best policy in the world but if the client doesn’t like you there’s no way on earth he’s gonna buy it!!” So many a true word spoken and a one I’ve very much discovered is true. If a person just doesn’t like the cut of your jib then I can’t see how the therapeutic relationship will work.
    What I would love to see is more research on this topic and outcome measures to demonstrate that a therapeutic relationship does improve patient motivation and enthusiasm in occupational participation.
    I would love to hear back from anyone who has any further feedback on this topic. It’s so very interesting.
    Thanks
    Louise

  23. This is a topic that is close to my heart… Best
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  24. Much thanks! It a astonishing website.

  25. I’m finishing my fist year as a COTA student in the US. Our instructors have been dancing around the topic of “therapeutic use of self” for months but never tackled it head on. They keep assuring us that we will get it eventually when students have questions.

    Like much of Occupational Therapy jargon, the words are familiar but clearly the sum as a phrase is so much more than the sum of the individual words – and the meaning is NOT obvious to those outside the field.

    I was appalled to find that we were graded on our skills in this area on our first fieldwork. I’m going to follow the links and do some more reading. I may also turn to one of my favorite resources: YouTube. I tend to remember concepts better when I’ve seen them in action. I hope learning more about this will explain why two different OTs at my fieldwork site had two very different opinions on me sharing a 15 second story about my children during an activity on time management – one child is oblivious to the concept of time and claims he is allergic to watches but the other child has a stomach that must be fed precisely on time or the world might end and both influenced family dynamics at my house. One OT said this example was a great lead-in to my next question about what value group members place on time management. The other said it was completely inappropriate and stealing the focus from patients.

    But to tell you the truth, I’m still so vague on the concept of “therapeutic use of self” that I don’t even know if this example is in the right ballpark!! Can those of you who get it post some concrete examples? Please!?

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