Reasoning

CHAPTER 11 Interactive Reasoning

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therapy researchers suggest that engagement in therapy involves supporting cli ents’ self-determination so they can wholly commit to therapy from an affective, behavioral, and cognitive perspective (D’Arrigo et al., 2017; King et al., 2014). In addition to engaging the people who are receiving therapy, it is crucial to include in the decision-making process other people who share their lives and who are critical to their ability to consider, implement, and evaluate interventions. Often, these people are easily identified. In an in-depth observational study of an expert pediatric occupational therapist’s clinical decision-making, direct informa tion from parents and teachers was prioritized in the assessment and intervention process (Copley et al., 2010). Nelson and Allison (2007) emphasized the importance of developing relationships with family and community for culturally responsive practice when working with indigenous Australians. In various areas of practice, significant people may include the family members at the client’s hospital bed side; the caregivers attending appointments with clients; and the staff employed in schools, workplaces, or residential facilities who facilitate clients’ participation in preferred or required activities. However, such people may not be present with the client as a matter of course. Involving them should not be left to chance. Occupational therapists need to iden tify these people, seek them out, explicitly invite them to meetings and therapy sessions, and facilitate their input into the interactive reasoning process. It may be helpful to meet with the client in their usual environments (e.g., at home, in their local community) to facilitate this input. In some cases, clients’ cultural contexts place the extended family or the local neighborhood at the center of their lives. Sometimes, it is not viable to have in-person contact with these people, and their contribution must be obtained in other ways such as phone calls or written com munication. Engaging such people in the interactive reasoning process aims to do the following: • Help form a clear and comprehensive occupational picture of clients. • Understand the reality of the supports and assistance available to clients for implementing interventions and recommendations, including determining the attitudes and expectations of those people who are influential. • Share information about possible courses of action. Creating a Shared Vision of Hope Occupational therapists work with clients to convey hope and a meaningful vision of the future. Collaboratively setting realistic and achievable goals is one vehicle for establishing this vision. Substantial interactive reasoning can be required to establish goals that are meaningful and important to clients and significant others. The interactional dance is in full swing when this occurs. Occupational therapists gather information to help them understand clients’ needs, hopes, priorities, pref erences, and circumstances while also giving their clients and their significant others a sense of what occupational therapy can offer (Restall & Egan, 2022). Oc cupational therapy research has indicated that tailoring information for each cli ent is central to establishing realistic and achievable goals and possible outcomes (Colclough et al., 2015; Copley et al., 2008). Negotiating achievable goals can be difficult. Clients (particularly those with acquired conditions) and their significant others often do not know what to expect. Some may take an approach of seemingly unshakable optimism, whereas others might struggle to envisage a compromise between their previous hopes and their new reality. Still others might only see a dark future. This variability makes setting

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