Occupational Therapy (OT) is a health profession focused on helping people across the lifespan participate in the activities they want and need to do through the therapeutic use of everyday activities. While activity analysis and technical skills are important aspects of practice, the primary tool an Occupational Therapist uses to facilitate change is the Therapeutic Use of Self (TUS). This concept describes the conscious and planned interaction between the therapist and the client, positioning the therapist’s own being as a deliberate instrument for healing and goal achievement. The practitioner’s personal qualities and professional insights are purposefully engaged to build a working relationship that supports the client’s occupational engagement.
Defining the Core Concept
The Therapeutic Use of Self is formally defined as the practitioner’s planned use of their personality, insights, perceptions, and judgments as an intentional part of the therapeutic process. This systematic approach leverages the therapist’s unique attributes to foster a collaborative environment and promote positive client outcomes. The conscious deployment of self elevates the interaction beyond a general social exchange, making it a professional, goal-oriented intervention.
TUS ensures that the relationship is purposefully managed and reflective to meet the client’s needs at any given moment. For example, a therapist uses TUS to decide when to offer encouragement versus when to offer instruction, based on the client’s response and behavior. As a core skill, TUS is officially recognized by professional bodies like the American Occupational Therapy Association (AOTA) as a foundational competency for practitioners.
The purpose of TUS is to maximize the client’s engagement in meaningful occupations by creating a supportive and non-judgmental space. It helps the therapist better understand the client’s unique life experiences, challenges, and perspectives, which directly informs the selection and adaptation of therapeutic activities.
Foundational Skills of the Therapist
To successfully execute the Therapeutic Use of Self, the occupational therapist must possess and consistently utilize a specific set of interpersonal skills. Active listening and reflection are foundational to this process, requiring the therapist to fully concentrate on the client’s verbal and non-verbal communication.
Active listening involves not only hearing the words but also understanding the underlying message. This allows the therapist to reflect the client’s feelings or thoughts back to them for validation, creating a space where clients feel genuinely heard and valued. This technique is a powerful motivator for participation in therapy.
Empathy and compassion form another crucial skill set. Empathy is the ability to understand and share the feelings of another person, allowing the therapist to step into the client’s experience without losing their professional perspective. TUS requires mindful empathy, which involves acknowledging and validating the client’s emotional experience while remaining focused on the therapeutic goals.
The therapist establishes rapport and trust by maintaining authenticity and using self-awareness to recognize and manage their own biases or emotional triggers. This self-management ensures the relationship remains professional and centered entirely on the client’s needs, creating a non-judgmental environment necessary for the client to feel safe taking risks in therapy.
Applying TUS Through Interaction Models
The application of TUS is systematically guided by conceptual frameworks such as the Intentional Relationship Model (IRM). The IRM provides practitioners with a structure for managing the inevitable interpersonal challenges of therapy by identifying four main components: the client, the therapist, the occupation, and interpersonal events. Interpersonal events are the naturally occurring communication, reaction, process, task, or circumstance that has the potential to challenge the relationship, such as a client expressing resistance or experiencing an emotional outburst.
The IRM helps the therapist recognize these events and respond using an intentional approach, rather than a purely reactive one. The therapist must use critical self-awareness to monitor their own behavior and engage in interpersonal reasoning to select the most effective response. This deliberate choice is made by drawing upon the six therapeutic modes, which are distinct styles of relating to a client:
- Advocating
- Collaborating
- Empathizing
- Encouraging
- Instructing
- Problem-Solving
For example, if a client is struggling to access necessary community resources, the therapist might select the Advocating mode to ensure environmental supports are in place. Conversely, if a client lacks confidence in their ability to perform a new task, the therapist would intentionally switch to the Encouraging mode, offering positive reinforcement to build self-efficacy.
The therapist must maintain a flexible repertoire, selecting the mode that best supports the client at that moment. The Collaborating mode involves making joint decisions with the client, ensuring active involvement in all stages of the therapeutic process. In contrast, the Instructing mode is a more teacher-like approach, providing structured guidance and clear expectations for a specific task. By strategically applying these modes, the therapist uses the IRM to ensure the relationship remains productive and supports functional improvement.