Practitioners' preparation for, attitudes toward, and experience of the therapeutic relationship and use of self were explored using a survey study with a random sample of 1,000 American Occupational Therapy Association members. Participants reported a high value for the therapeutic relationship and use of self; most felt that they were inadequately trained and that the field lacks sufficient knowledge in these areas. Regardless of practitioners' age, gender, experience level, setting, treatment intensity, and client impairment, those who placed higher value on the use of self and had more training related to the therapeutic use of self were more likely to report interpersonal difficulties and feelings of positive regard for clients and were more likely to report concerns about clients. The findings suggest that more attention needs to be paid to the therapeutic relationship and to the therapeutic use of self in education and in research.
Payment by Results (PbR) is a funding mechanism used to pay for National Health Service (NHS) acute hospital services in England (Department of Health 2009). It reimburses for services on the basis of Healthcare Resource Groups. These groups are either condition-related categories (that imply the services to be provided) or categories of procedures, interventions or treatments. Until recently, this system of reimbursement has not been applied to mental health. Traditionally, hospitals providing mental health services were allocated funding of fixed sums, or block cost contracts. However, the financial reforms to deliver the NHS Plan (Department of Health 2002, 2010a) call for major changes to the way in which money flows within the NHS; according to current plans, it will begin to be based on PbR. In England, currencies (formulae for reimbursement) for mental health care are being introduced, with an expectation that, by 2011-2012, all health economies should be using the currencies in some form, and be establishing local prices (Department of Health 2008, 2010a). This will determine what services are commissioned and how funds will flow for service provision in mental health. As recently as July 2010, the coalition government reconfirmed the centrality of PbR as a system for paying providers of health care services (Department of Health 2010b).
key words: Intentional Relationship Model, use of self AbstRAct Although occupational therapy literature emphasizes the importance of therapeutic use of self, there have been few studies of the interpersonal strategies used in response to different client needs. This study sought to explore therapists' use of self according to the Intentional Relationship Model by examining the use of different modes of interacting with clients. A questionnaire was mailed to a random sample of 1,000 practicing occupational therapists. Sixtyfour percent responded and 563 met inclusion criteria. Modes used most to least often were: encouraging, collaborating, problem-solving, instructing, and empathizing. Mode use did not differ according to client population.Therapists who experienced more difficult behaviors and emotions reported higher levels of using all modes. Therapists facing difficult behavior in general were more likely to report use of the instructing and problem-solving modes. Therapists with anxious clients reported greater use of the problem-solving mode, whereas therapists with depressed clients reported increased use of problem-solving, collaborating, and empathizing modes. Implications for occupational therapy practice and education are discussed.
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