CHAPTER 11 Interactive Reasoning


happen to “hit it off” over mutual interests or understanding, or even through simi lar communication styles. In other situations, it may involve an intentional process that requires effort. In occupational therapy preentry training programs, students are encouraged to spend time building rapport with clients and families, often as the first task in a therapy session or professional encounter. In some cases, for ex ample when working with people from diverse cultural groups, it may be important to devote an extended period of time to relationship- and trust-building in order to gain a clear understanding of the client’s context and priorities (Hill et al., 2017). Second, although rapport can be developed reasonably quickly, working alli ances form over time. They are forged in the work of therapy, when clients and occupational therapists, together, share in achievements and failures and aspire to reach goals. Horton et al. (2021) found that progress toward goals was identified by both professionals and clients as the most prevalent positive turning point in ther apeutic relationships; the emotions associated with achievement positively affected the relationship, and clients often felt understood and became more empowered. Third, as therapeutic relationships mature and the therapeutic venture proceeds, maintaining stability through inevitable oscillations becomes a central task. As cli ents become increasingly secure within these relationships, they might more readily express their anger and frustration. Tickle-Degnan (2002) proposed the following strategies for regulating relationship fluctuations: (a) continuing to share informa tion; (b) attending to each other and to the relationship, using humor, and sincerely apologizing when mistakes have been made; and (c) altering actions and approaches and reevaluating goals and progress as needed. Evatt and Scanlan (2022) empha sized the importance of maintaining professional boundaries in the relationship. The therapeutic interaction used to build and maintain relationships aims to create a comfortable and easy mood in which clients can express concerns and openly share information. To achieve this, occupational therapists may need to vary their interactional style to suit the situation. Some considerations for tailoring verbal and nonverbal interaction to each therapeutic encounter are summarized in Table 11-1.

TABLE 11-1 Considerations for Tailoring Interaction to Individuals and Groups


Consider: proximity between participants; arrangement of furniture to facilitate open discussion; position of therapist to allow face-to-face ori entation to communicate attention, or side-by-side orientation to commu nicate partnership; position of the therapist to address both clients and significant others; position of the client in relation to others to allow best orientation to all participants Distinct facial expressions and consistent eye contact indicate atten tiveness, care, and concern. Expressions should be appropriate to the information being discussed and the mood of the interaction. (Smiling encourages further information sharing. A concerned expression is appro priate for sensitive information.) Clear, distinct gestures can punctuate and clarify questions or information being provided. Often, a reassuring touch on the client’s arm is used to communicate concern or reassurance. (How ever, be aware of whether the client has a positive or negative reaction to touch.) Use open body language (upright posture, leaning toward the client at times). ( continued )

Facial expression and gestures

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