Correlation Between Therapeutic Use of Self and Clients’ Participation in Rehabilitation

PURPOSE AND BACKGROUND: This study used two well-developed assessments to measure therapists’ communication modes and their clients’ participation and examine their correlations. Therapeutic communication is emphasized in occupational therapy, but no study has examined the correlation between therapists’ use of self and clients’ participation in rehabilitation.

METHOD: This study used a quantitative design with a single group of participants. All new rehabilitation patients admitted to the inpatient and outpatient units at a large urban hospital from September 2012 to May 2013 were invited to participate. A total of 110 clients and 38 therapists were enrolled. Clients’ mean age was 50.14, the most common diagnoses were stroke (15.5%) and fracture (14.5%), and 51% were male.

Seven trained raters observed and rated the Model of Human Occupation Screening Tool (MOHOST; Parkinson et al., 2006) and the Clinical Assessment of Modes (CAM; Fan et al., 2013) at the third treatment session to evaluate clients’ overall participation and therapists’ mode use. The MOHOST provides a broad overview of all the concepts of the Model of Human Occupation that collectively define clients’ occupational participation. The six subdomains are Volition, Habituation, Communication and Interaction Skills, Process Skills, Motor Skills, and Environment. Items in MOHOST are scored on a 4-point ordinal scale; higher scores indicate better participation. The CAM measures therapeutic mode use (a specific approach to therapeutic communication) during therapy. There are six modes in CAM: Advocating, Collaborating, Empathizing, Encouraging, Instructing, and Problem Solving. The CAM is scored on a 5-point ordinal scale; higher scores indicate that a specific approach of communication is used more frequently than others.

Nonparametric correlation analyses among the six modes of the CAM and the six subdomains of the MOHOST were conducted. Correlation coefficients r > .35 were considered moderate correlation. Values smaller than p = .01 were considered significant (two-tailed).

RESULTS: The Empathizing mode was significantly correlated to five subdomains in the MOHOST (Volition, Habituation, Communication and Interaction Skills, Process Skills, and Motor Skills). The Volition subdomain in particular was moderately correlated with therapists’ Empathizing mode use (r = .387). Other modes used by therapists did not have significant correlations with clients’ overall participation.

CONCLUSION: In the Empathizing mode, therapists strive to understand clients’ thoughts and feelings by validating their emotions through nonjudgmental statements. This mode was highly correlated with clients’ motivation toward occupation and overall participation in rehabilitation.

IMPACT STATEMENT: The Intentional Relationship Model emphasizes that the effectiveness of therapeutic mode use is based on clients’ perspectives. The study results show that the Empathizing mode can be viewed as the foundation of building therapeutic relationships and improving clients’ participation.

References

Fan, C. W., Taylor, R. R., Wong, S., Kjellber, A., Alfredsson-Agren, K., Andersson, E., & Zubel, B. (2013). Clinical Assessment of Modes–Observational version (CAM–O): Communicating with your therapist–observational version. Chicago: University of Illinois at Chicago.

Parkinson, S., Forsyth, K., & Kielhofner, G. (2006). A user’s manual for the MOHOST: The Model of Human Occupation Screening Tool (Version 2.0). Chicago: Model of Human Occupation Clearinghouse.