11/5/07 1:45 PM Page i The Intentional Relationship Occupational Therapy and Use of Self Renée R. Taylor, PhD Professor Department of Occupational Therapy University of Illinois at Chicago Chicago, Illinois
11/5/07 1:45 PM Page ii F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright © 2008 by F. A. Davis Company Copyright © 2008 by F. A. Davis Company. All rights reserved. This product is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Acquisitions Editor: Christa Fratantoro Developmental Editor: Denise LeMelledo Manager of Content Development: Deborah Thorp Art and Design Manager: Carolyn O’Brien As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. All identifying information pertaining to the client cases presented in this book has been altered to protect clients’ identity and confidentiality. Additionally, certain case content has been fictionalized or merged with examples of other cases so that no individual client can be identified. Some of the photographs representing clients in this book are photos of models or actors serving in the roles of clients. Library of Congress Cataloging-in-Publication Data Taylor, Renée R., 1970The intentional relationship : occupational therapy and use of self / Renée R. Taylor. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-0-8036-1365-2 ISBN-10: 0-8036-1365-2 1. Occupational therapy. 2. Allied health personnel and patient. 3. Self. I. Title. [DNLM: 1. Occupational Therapy—methods. 2. Professional-Patient Relations. 3. Self Concept. WB 555 T245i 2008] RM735.T326 2008 615.8′515—dc22 2007040663 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.10 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 8036-1365/08 0 ϩ $.10.
11/5/07 1:45 PM Page iii This book is dedicated to the exceptional therapists whose work was featured in this book. Generously, they contributed their time, personal reflections, and revealing stories of practice to serve the interest of education and knowledge development in this under-recognized area of occupational therapy.
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11/5/07 1:45 PM Page v Preface This book emerged from an ongoing curiosity and a fair amount of frustration in trying to locate a detailed, comprehensive, and integrated textbook on therapeutic use of self specific to the field of occupational therapy. As a professor teaching in this area, my interactions with students and practicing occupational therapists inspired me to learn more about the interpersonal aspects of practice. As a practicing psychotherapist, I was also interested in learning how I might blend knowledge from the field of psychology with existing occupational therapy knowledge as it pertains to the therapeutic relationship. I began this inquiry by conducting a nationwide survey of 568 practicing occupational therapists randomly selected from a membership database provided by the American Occupational Therapy Association (Taylor, Lee, Kielhofner, & Ketkar, 2007). The objectives of this study were to determine the degree to which occupational therapists value the client-therapist relationship, to identify variables that challenge the clienttherapist relationship, and to summarize the interpersonal strategies that are currently being used to respond to such challenges. Results from this survey revealed that, across practice settings and client populations, practicing occupational therapists are frequently encountering clients who are demonstrating a wide range of emotional, behavioral, and interpersonal difficulties. Most experienced occupational therapists place a high priority on their interactions with clients but at the same time feel that their training in this area could have been more sophisticated and comprehensive. The findings from this study confirmed the need for a text addressing these issues for use by educators, students, and practitioners of occupational therapy at various levels of development. In preparing to write this book, I first reviewed the occupational therapy literature in order to get an idea of the historical terrain of thinking about therapeutic use of self in the field. There is a rich history of thought as well as changing ideals regarding what constituted effective therapeutic use of self at various times in history. As an educator and a practitioner, I am fully aware that there often exists a gap between the ideals expressed in literature on a topic and what actually occurs in everyday therapeutic encounters. Consequently, I sought to shape the contents of this book around practitioners’ expressions of the dilemmas and challenges they face in therapeutic use of self as well as their descriptions of the way they attempt to manage these circumstances. Additionally, I decided to look for instances of excellence in therapeutic use of self in occupational therapy that could be shared with practicing occupational therapists, occupational therapy assistants, educators, fieldwork supervisors, and students of occupational therapy. This quest took me across the globe where I extensively interviewed and observed occupational therapists who were nominated by their peers as being uniquely talented in terms of their ability to relate to a wide range of clients. This journey taught me volumes about therapeutic use of self in occupational therapy, and my goal is to share what I have learned with you in this book. Renée R. Taylor v
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11/5/07 1:45 PM Page vii Acknowledgments This book would not have been possible without the ongoing support of Gary Kielhofner, who not only believed in the ideas behind the book but also provided some of the international linkages necessary to include the work of therapists from diverse nationalities and cultures. Also critical to the energy behind the production of this book were its acquisition editors, Christa Fratantoro and Margaret Biblis of F.A. Davis who inspired me to think expansively about use of self. Special thanks goes to Christa, an editor whose enduring support, creative suggestions and feedback, and ongoing belief in a novel approach kept me going. I would also like to thank Denise LeMelledo, Deborah Thorp, Carolyn O’Brien, and Berta Steiner for their time and care in producing this book. Finally, special thanks to the following occupational therapy students whose intelligent in-class questions and critical editorial feedback helped to refine the presentation of the contents of this book. In particular, I’d like to thank Emily Ashpole, Robin Black, Joel Bové, Kim Daniello, Kelly Doderman, Barbara Flood, Mark Kovic, Anne Plosjac, Abigail Tamm-Seitz, Rachel Trost, Jennifer Utz, Angie Vassiliou, and Debbie Victor. vii
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