By Grad II Matt Carpenter
When I first heard the term “therapeutic use of self” it reminded me of 1 Corinthians 9:19-23. In this passage, Paul talks about becoming all things to all people in order that they might better hear the gospel and have their lives thus transformed. And so, therapeutic use of self made sense to me. The idea of using yourself to best serve and help others was not only something I had been taught at church but studied and practiced during work at summer camp, especially on the ropes course, where our goals were to create situations with enough perceived risk to challenge groups (functional or dysfunctional) to reach beyond their individual capacities and jointly solve problems. And in so doing, develop transferable skills promoting success in the workplace.
That was then. In Fieldwork I here at VCU, I’ve learned that therapeutic use of self is, in practice, more difficult than it sounds and requires constant attention. I’ve learned that to be a good occupational therapist and truly facilitate health requires that you get to know your patient, their personality, their strengths and weaknesses, and ultimately their goals. You need to have a good sense of what they will and won’t do so that they actually complete their home exercise plan. Most importantly you need to know how to walk alongside someone in their recovery. That requires creating an open space between you and your client to allow for questions and vulnerability. It requires communicating encouragement in a way clients can hear and believe. It requires promoting self-awareness of limitations (and hopefully self-acceptance) in a way that is more sobering than ego-shattering. It also requires being able to motivate patients when they need a little boost. Therapeutic use of self is therefore an extension of client centered practice.
I’ve also learned that it takes time to build rapport with any patient or client, and time is in short supply in many settings. Family members have taught me that even the ‘simplest’ of OT treatments (for instance, teaching back precautions after surgery) happens to people who are experiencing a much more substantial life event and or role transition than any 15 minute therapy session can address. And so whether we have one 15 minute session per patient or a year’s worth of sessions to get to know them, to be an effective OT demands that before we walk in the door we put ourselves in a headspace that is free of productivity driven anxiety, the insecurities of decision making as a new therapist, and any other distractions, so that we can put in the mental effort required to do that therapeutic use of self thing: moment-by-moment, word by word performing as an element of the therapeutic environment, with an understanding that our only hope of understanding the subtleties of each patient’s situation is through relationships with them and their family members.
None of this is easy. I’ve found it helps to know the limits of both our scope of practice and our personal knowledge. It helps to know what we can control and what we can’t and that ultimately we are here to serve the patient as members of their team. Therefore, we are not alone.