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Introduction to Relationship- and Capacity-building Practices

Evguenia S. Popova, PhD, OTR/L (she/her)

Name Pronunciation Resource

Assistant Professor

Rush University, Department of Occupational Therapy

Rush University

1. Evaluate the role of communication in family and child engagement
2. Apply social learning theory to family and child engagement
3. Evaluate the role of empathy in family and child engagement
4. Identify four components of the intentional relationship model
5. Examine six therapeutic communication modes
6. Describe three barriers to therapeutic communication

Objectives

• Getting Started
• Family and Child Engagement
• Principles of Learning
• Mindful Empathy
• Intentional Relationship Model
• Q&A

Agenda

Everything you need for our workshop can be found here: https://sites.google.com/view/intentional-relationship-model/

• Assistant Professor at Rush University
• Department of Occupational Therapy
• College of Health Sciences
• President at GiGi’s Playhouse Chicago
• Education
• PhD, University of Illinois at Chicago
• MS, University of Illinois at Chicago
• BA, University of California, Berkeley
• Research Areas
• Pediatrics, early intervention, and community-based practice
• Family- and client-centered care, occupational engagement and participation
• Model of Human Occupation and Intentional Relationship Model
• Social and transformative learning in health care and professional education

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Zhenya

• Background
• 2nd Year OTD Student at Rush University
• Interested in OT in Pediatric/EI Setting & Nature-based OT
• Graduated in 2017 with a B.A. in Psychology from Kalamazoo College
• Worked as an assistant toddler/preschool teacher at Montessori School
• Worked as Horticultural Therapy Assistant

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Rachel

1. Your Name

2. Favorite Toy

3. Least Favorite Food

THINK

(1 min)

PAIR

(4 min)

SHARE

(5 min)

The Room No. VI

by Eldzier Cortor (Link to Art Institute)

• Learn about what your partner thinks about this picture: “What do you see in this picture?”

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• Practice:
• Active listening and observation
• Nonverbal validation
• Summary statements
• Deepening questions

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Getting Started

Appreciative Inquiry

Ap-pre’ci-ate, v., 1. valuing; the act of recognizing the best in people or the world around us; affirming past and present strengths, successes, and potentials.

• Synonyms: VALUING, PRIZING, ESTEEMING, and HONORING.

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In-quire’ (kwir), v., 1. the act of exploration and discovery. 2. To ask questions; to be open to seeing new potentials and possibilities.

• Synonyms: DISCOVERY, SEARCH, and SYSTEMATIC EXPLORATION, STUDY.

• Appreciative Inquiry = a strengths-based approach to searching for the best in people, communities, and the world around them

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• “Art and science” of asking questions that strengthen a person's ability and capacity to anticipate and use their best potential

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• Involves the use of an “unconditional positive question”

Appreciative-Inquiry-Positive-Questions

What are your strengths?

What are the family’s strengths?

What are the child’s strengths?

What are the available supports and resources?

What has worked in the past?

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What do you hope to see change in the future?

Why is this important to you?

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What steps can we take to get closer to the “ideal”?

How will you make sure to stay on track?

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Course Overview

• All assignments, handouts, and additional resources are available through Google Sites
• Catch me in person, email, or call me if you get stuck or need any help

• All assignments must be turned digitally through REDCap or in-person as a printout
• Catch me in person, email, or call me if you get stuck or need any help

“Flipped” Classroom Structure

• Sessions 1: Introduction
• Sessions 2 & 4: Self-paced learning using videos, handouts, and reflective assignments
• Sessions 3 & 5: Application of the material covered through discussion and activities
• Online assignments and reflection will…
• Help us answer any lingering questions you have by letting me post answers online as an additional resource between classes
• Help you get the most out of activities and group discussion by doing the individual work ahead of time
• Help me better prepare the materials for Session 3 & 5 in a manner that targets the needs of the whole group
• For more information about flipped learning: https://vimeo.com/70893101

What is your preferred

mode of learning?

• Reading:
• Articles, stories, research, handouts
• Seeing:
• Videos, role-play
• Doing:
• Trying in real life, role-play
• Hearing:
• Lecture, narrated video, discussion
• Thinking:
• Discussion, think-pair-share

Family and Child Engagement

• What went well during this interaction? Why?

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1. What could be improved during this interaction? Why?

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1. If you were the parent/caregiver OR therapist in this scenario, what would you want to happen next?

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Video Reflection:

King, Desmarais, Lindsay, Piérart & Tétreault, 2015

Supporting Family Engagement in Pediatrics

Supporting Family Engagement in Pediatrics

Family engagement in the rehabilitation process depends on the therapist’s ability to promote:

1. Effective communication and engagement that is reciprocal, purposeful, and goal-oriented
2. Critical awareness of lack of engagement or active disengagement
3. Coaching and family-directed learning opportunities

Principles of Learning &

“The Just Right Challenge”

The Goldilocks Principle

1. Assess the task
2. Pick the “just right” challenge
3. Evaluate your progress

Demand Impacts Ability

• “The Goldilocks Rule”
• “Just Right Challenge”
• “Flow” coined by Mihaly Csikszentmihalyi
• “Zone of Proximal Development” coined by Lev Vygotsky

Social Learning Theory

• Was developed to explain human development
• Stresses the importance of the “social environment” as a barrier or the enabler of learning
• Explains that the “zone of proximal development” is “the distance between the actual developmental level as determined by independent problem solving and the level of potential development as determined through problem-solving under adult guidance, or in collaboration with more capable peers" (Vygotsky, 1978, p. 86)
• Recommends that we use “scaffolding” to help others to achieve something new and challenging things outside of their comfort zone

Social Learning Theory

Mindful Empathy

mind·ful·ness

ˈmīn(d)f(ə)lnəs/

noun

1. ​
1. the quality or state of being conscious or aware of something
2. "their mindfulness of the wider cinematic tradition"
1. ​
1. a mental state achieved by focusing one's awareness on the present moment, while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations, used as a therapeutic technique.

Practicing Mindful Empathy

What is mindfulness?

• Being present and in the moment
• Learning how to remain intentional
• Video: https://youtu.be/w6T02g5hnT4

What is empathy?

• Perspective taking
• Objectivity
• Recognizing emotions in other people
• Video: https://youtu.be/1Evwgu369Jw

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Intentional Relationship Model (Taylor, 2020)

Therapeutic use of self

‘is a skill that must be developed,

reinforced, monitored, and refined’

(Taylor, 2020, p. 45)

Video Link: http://www.youtube.com/watch?v=-4EDhdAHrOg

in·ten·tion·al·i·ty

inˌten(t)SHəˈnalədē/

noun

1. the fact of being deliberate or purposive.
• PHILOSOPHY
• the quality of mental states (e.g., thoughts, beliefs, desires, hopes) that consists in their being directed toward some object or state of affairs.

Therapeutic Communication: �Intentional Relationship Model (Taylor, 2020)

• Emphasis on therapists' responsibility over positive and negative interpersonal events that occur in therapy:
• Intentional use of verbal & non-verbal communication
• Critical self-awareness
• Interpersonal reasoning process

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Inevitable Interpersonal Events

Client’s Interpersonal Characteristics

Therapist’s Interpersonal Skills

Client’s Engagement

Six Therapeutic Communication Modes

Advocating

Collaborating

Encouraging

​

Empathizing

Instructing

Problem-solving

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Advocating Mode

Definition:

Working with the client on overcoming physical, social, and environmental barriers that they may encounter, supporting the client’s access to resources and services, normalizing the client’s experience.

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Examples:

• Providing information about about an accessible playground in the community.
• Providing information about local peer support and advocacy groups.
• Providing information about legal rights of children, parents, and families with disabilities.

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Collaborating Mode

Definition:

Letting go of control and supporting the client’s autonomy and independence in the decision-making process, ensuring that the client has an active role throughout the treatment process.

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Examples:

• Facilitating opportunities for the person to select an activity of their choice.
• Facilitating opportunities for the person to select their own rehabilitation goals.
• Following the person’s lead during an activity or a situation.

Empathizing Mode

Definition:

Understanding and validating the client’s physical, psychological, and emotional experience, use of summary statements, active listening.

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Examples:

• Actively listening to the person’s concerns and challenges.
• Validating the person’s experience using summary statements.
• Validating the person’s experience by mirroring the client's emotional tone and feelings and non-verbal communication.

Encouraging Mode

Definition:

Fostering hope, use of positive reinforcement and encouragement, rewarding the client.

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Examples:

• Praising the person for successful completing a challenging or novel task.
• Rewarding positive behavior through tangible reinforcement or social praise.
• Instilling hope by reminding the person of their accomplishments.

Instructing Mode

Definition:

Taking on a role of an expert guide or a teacher, providing structure and feedback, providing clear feedback on the client’s performance.

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Examples:

• Teaching the strategies and techniques (e.g., self-management or self-regulation strategies)
• Demonstrating, physically cuing, or providing physical assistance
• Explaining the order of activities or the steps required to complete a task

Problem-Solving Mode

Definition:

Utilizing logic, facilitating problem-solving and analytic reasoning, use of strategic questioning, outlining the options available the their client as well as any potential outcomes.

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Examples:

• Supporting the person’s ability to think critically and problem-solve through a challenging task.
• Supporting the person’s ability to break down the steps of a new task.
• Outlining the pros and cons of a new task and potential safety concerns that might arise.

What is your preferred mode of communication?

Advocating

Collaborating

Encouraging

​

Empathizing

Instructing

Problem-solving

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Barriers to Therapeutic Communication

Therapeutic Communication Research

• Research in U.S. suggests that therapists in early intervention rely on empathizing, encouraging, and instructing modes most frequently (Popova et al., 2022)
• Research in U.S. and Singapore suggests that therapists in adult rehabilitation settings rely on the instructing mode the most frequently (Wong et al., 2020)
• Comparison studies in adult inpatient and outpatient settings found that while clients report therapists using instructing mode the most; therapists perceive themselves as using empathizing most frequently (Fan et al., 2022)

Interpersonal Reasoning Process

• Your client defines the successful relationship
• There is a difference between interpersonal and therapeutic goals
• It is important to maintain a balance between activity focus and interpersonal focus while working with others

Rush University | 3/17/22

48

Thoughts-Questions-Epiphanies

Share your thoughts, questions, and epiphanies!

Google Form Link: https://forms.gle/hTYEt7sE8NrECuCD8

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Preparing for October

• Review Session 1 and Session 2 resources posted in Google Sites
• Submit Session 2 reflection via REDCap
• Email with any questions!

Email me!

Evguenia S. Popova, MS, PhD, OTR/L

Evguenia_S_Popova@rush.edu

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Intentional Relationship Model Clearinghouse: https://moho-irm.uic.edu/

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References

American Occupational Therapy Association (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68 (Suppl.1), S1–S48. http://dx.doi.org/10.5014/ajot.2014.682006

King, G. (2015). The roles of effective communication and client engagement in delivering culturally sensitive care to immigrant parents of children with disabilities. Disability and Rehabilitation, 37(15), 1372-1381. https://doi.org/10.1080/01942638.2016.1185508

Solman, B., & Clouston, T. (2016). Occupational therapy and the therapeutic use of self. British Journal of Occupational Therapy, 79(8), 514–516. https://doi.org/10.1177/0308022616638675

Taylor, R. R. (2008). The intentional relationship: Occupational therapy and use of self. Philadelphia: F.A. Davis Co.

Taylor, R. R., Lee, S. W., Kielhofner, G., & Ketkar, M. (2009). Therapeutic use of self: A nationwide survey of practitioners’ attitudes and experiences. American Journal of Occupational Therapy, 63(2), 198–207.

Taylor, R. R., Lee, S. W., & Kielhofner, G. (2011). Practitioners’ use of interpersonal modes within the therapeutic relationship: Results from a nationwide study. OTJR: Occupation, Participation and Health, 31(1), 6–14. https://doi.org/10.3928/15394492-20100521-02