Occupational therapy (OT) is a client-centered health profession focused on enabling people to participate in daily life activities, or occupations. Practitioners help clients achieve health and well-being through engagement in meaningful activities. This process requires a sophisticated approach to the client-therapist relationship, formalized as the Therapeutic Use of Self (TUS). TUS is a foundational skill that acknowledges the therapist’s personal attributes and communication style significantly influence client outcomes and engagement.
Defining Therapeutic Use of Self
Therapeutic Use of Self (TUS) is the thoughtful and deliberate application of a therapist’s personality, insights, perceptions, and clinical judgment within the therapeutic process. It is a conscious, planned professional skill, not merely an innate ability to be friendly. The purpose is to foster a positive, goal-oriented relationship supporting the client’s progression toward their occupational goals. Successful TUS requires the therapist to consistently choose specific interaction strategies based on the client’s needs and the current situation.
Core Components of the Therapist’s Self
To practice TUS effectively, a therapist must cultivate internal characteristics and interpersonal skills. High self-awareness is necessary, requiring the therapist to understand their own biases, reactions, and emotional triggers. This internal discipline allows the practitioner to maintain objectivity and focus responses on the client’s needs. Genuine empathy involves making every effort to fully understand the client’s physical, emotional, and psychological experience without judgment.
The therapist must also utilize effective communication skills, including active listening and attunement. Active listening involves attending to the client’s verbal and non-verbal communication to gauge their discomfort or engagement. Non-verbal cues, such as body language and tone, are used purposefully to convey positive regard and validate the client’s experience. Collaborative goal setting ensures the client is an active partner in all stages of therapeutic planning and decision-making.
The Intentional Relationship Model
The Intentional Relationship Model (IRM) is the primary framework occupational therapists use to structure and operationalize the Therapeutic Use of Self. IRM posits that the therapeutic relationship involves four parts: the client, the therapist, the occupation itself, and the inevitable interpersonal events that occur. The model helps practitioners manage these challenging communications or reactions, known as interpersonal events, which can strain the client-therapist relationship.
IRM guides the therapist in selecting the most effective interpersonal style, referred to as a therapeutic mode, to respond to these events. The model identifies six therapeutic modes:
- Advocating
- Collaborating
- Empathizing
- Encouraging
- Instructing
- Problem-Solving
This flexible use of modes is enabled by interpersonal reasoning. Interpersonal reasoning is the internal dialogue where the therapist continually assesses the client’s characteristics and decides how to respond to promote occupational engagement.
Maintaining Professional Boundaries
Utilizing personality and insights in TUS requires clear, ethical professional boundaries to ensure the relationship remains therapeutic and client-centered. The therapeutic relationship inherently contains a power differential, placing the client in a vulnerable position of trust due to the therapist’s authority. Boundaries define the demarcation separating a professional relationship from a personal one, protecting both the client and the practitioner.
The therapist must practice interpersonal self-discipline to prevent boundary crossings or outright boundary violations. This requires careful management of personal disclosure, which should only occur if it benefits the client’s therapeutic goals. Ongoing self-monitoring and critical reflection are essential tools for recognizing and managing feelings that could lead to blurred lines, ensuring professional objectivity is maintained.