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The 'therapeutic use of self' is a term that is often used in occupational therapy and other therapies. However, many clinicians do not know what the therapeutic use of self is, or why it is so important. Read on to find out more...
Therapeutic use of self 'The thoughtful and deliberate use of one’s personality, opinions and judgments as a component of the therapeutic process' (Mosby’s Medical Dictionary, 2009)
The term originates from philosophy and the theories of self. This demonstrates that researchers and practitioners acknowledge that, if you are asking a research question, completing research, running a business, or delivering care or a service, you will be influencing the outcome. What does this really mean though - and can therapy be delivered without considering the therapeutic use of self?
Why is therapeutic use of self important?
Asayand Lambert (1999) investigated what influenced change in psychotherapy clients, separating the possible influences for change into: therapeutic relationship, extra-therapeutic change (e.g. support, personality or 'ego strength'), placebo and technique. The results from their meta-analysis are as follows:
This indicates that therapy cannot be delivered without considering how the therapist is influencing the outcome, through their therapeutic use of self. If the therapeutic use of self is so important, more so than technique, shouldn’t there be a general consensus about how therapists are going to influence change?
Techniques to consider when using therapeutic use of self
Carl Beuhner is quoted as saying 'they may forget what you said - but they will never forget how you made them feel.' Consequently, therapists and care providers need to consider how they are making their clients feel. Ask yourself: are you rushing around and not giving clients the time they need when you are delivering care or treatment? We all do this at times because everyone is stretched, but if that feeling influences outcomes by 30%, then haven’t you just ruined the opportunity for change, by letting the client know you don’t have time for them?
'They may forget what you said - but they will never forget how you made them feel' - Carl Beuhner
The first technique then is attunement.
Attunement is the ability to be completely present with the client, developing a feeling of connectedness with them. The majority of the work around this is from psychotherapies however, as an occupational therapist, don’t you pride yourself as having origins in arts and crafts, psychology, architecture, nursing, social work, philosophy, teaching and psychiatry? Therefore, you should be considering all of these aspects within your work, both in everything you do and in what you recommend. Within attunement you should be considering what your body language is saying, how your tone of voice is delivering the message, if your facial expressions and body language (including eye contact) match what you are saying and if you need to mirror the client in order for them to recognise that they have your full attention.
The second technique is providing the client with unconditional positive regard.
Unconditional positive regard is the ability to accept that the client is trying their best and accepting where they are at that time. This does not mean you have to agree with their choices or even like them as a person. However, it does mean that you are providing client-centred care and treatment - whilst allowing the client to make mistakes, through their ability to make their own self-determined choices.
Self-disclosure is the third technique.
There are two types of self-disclosure; intra-session disclosure and extra-session disclosure. Intra-session refers to reflecting how something they have done or has happened during the session has made you feel. Extra-session disclosure is disclosing information about yourself, whether that be previous qualifications, family life or interests and events. Self-disclosure can be a positive experience for the client, building rapport with them and developing a therapeutic alliance. However, Leanne Hall states there are five golden rules to self-disclosure:
Waiting
Being brief
Being clear that this is your opinion
Considering the client’s values
Considering the impact self-disclosure is going to have
Waiting refers to the therapist considering why they are self-disclosing, whilst being brief is to ensure the client does not feel the therapist is hijacking their session. Therapists also need to ensure that when they are self-disclosing the client knows this is their opinion and is not part of their clinical expertise or experience, as the statement could be contrary to the client’s own beliefs and values.
Additionally, if the statement is contrary to the client’s own beliefs and values, consider if this self-disclosure is going to jeopardise the therapeutic relationship and alienate the client? This then leads to the final factor of considering the impact that self-disclosure can have, as clients may be left feeling burdened by the self-disclosure rather than aligned with the therapist. Whilst these 'golden rules' ensure self-disclosure is used appropriately, it is important to remember that it can assist the client with humanising the therapist.
The final technique is the ability to balance the power differential.
Clients often believe that the therapist or professional has greater power than them. However, this belief can lead to self-helplessness, whereas a therapist should be promoting self-empowerment and self-help. Therefore, it is essential to understand the client’s background and culture, whilst presenting yourself in an honest and congruent way. That means the power imbalance should be addressed during therapy or care. The acknowledgement that you may know more about a particular solution to their problem based on your training and experience should be made, whist acknowledging that they are the expert about themselves, their culture, their expectations and their own lives. The client and the therapist should then be working together to problem solve how the “solution” that the therapist suggests can be integrated into the client’s life, based on the information the client has about themselves.
Summary
In summary, based on my research and training, the therapeutic use of self encompasses four techniques:
Attunement
Unconditional positive regard
Self-disclosure
Balancing the power differential
If therapists and care providers incorporate these techniques in a positive and helpful way for the client, without hijacking the client’s treatment or care, then better outcomes should be gained.
