What is the IRM?

The Intentional Relationship Model defines how a client and therapist each contribute to the unique interpersonal dynamic that becomes the therapeutic relationship.

The Therapist

The therapist is responsible for facilitating and providing intentional therapeutic encounters with the client. The AOTA Practice Framework outlines the use of self as skill within the scope of practice for occupational therapy practitioners. 

The Client

Each client is equipped with a unique set of experiences and challenges, both past and present, that shape their interpretation of any given situation. Those distinct experiences inform behavior that may serve as a strength or an obstacle when striving for independence and engagement in meaningful occupations.

The Therapeutic Relationship

The therapeutic relationship is pervasive throughout the entire occupational therapy process, helping to evoke meaningful assessments, strengthen client-centered interventions, and elicit honest evaluations. During client-therapist interactions, it is the therapist’s responsibility to foster the therapeutic relationship and develop the client’s occupational engagement.A strong therapeutic relationship can help the client be comfortable expressing themselves honestly in therapy, allowing their interpersonal characteristics to emerge and help guide the therapeutic process. Every action, including verbal and nonverbal communication from the therapist, can meaningfully aim to facilitate occupational engagement with the client.

Underlying Principles

Contributions from therapists across the globe, theoretical principles in occupational therapy and psychologyoccupational therapy core values and ethics, and Dr. Taylor’s own clinical expertise in psychotherapy influenced the development of the ten underlying principles of the Intentional Relationship Model. 

  • Critical self-awareness is the key to intentional use of self
  • Interpersonal self-discipline is fundamental to effective use of self
  • It is necessary to keep head before heart
  • Mindful empathy is required to know one’s client
  • It is important to continually develop one’s interpersonal knowledge base
  • Provided that they are flexibly and purely applied, a wide range of therapeutic modes can work and be utilized interchangeably
  • The client defines a successful relationship
  • Activity focusing must be balanced with interpersonal focusing
  • Application of the model must be informed by OT core values and ethics
  • Cultural competency is central to practice‌

Interpersonal Characteristics

Each client’s own personal history contributes to a unique behavioral style. Emotions, behaviors, and reactions form enduring patterns within everyone, influencing how a client may respond in any of the 12 categories of interpersonal characteristics. Situational demands may elicit novel responses that differ from their enduring counterparts. Recognizing a client’s interpersonal characteristics enables the therapist to better engage in purposeful interactions during therapy.

  • Communication style: The client’s approaches to a formally spoken or signed language
  • Capacity for trust: Trust is built over the course of a therapeutic relationship, clients may have cautions or difficulty with trust
  • Need for control: The degree to which a client attempts to assume control over what is said and done during therapy
  • Capacity to assert needs: The client’s ability to discuss what they want from the therapist openly and directly
  • Response to change or challenge: How the client responds when presented with change or challenge
  • Affect: The client’s expression of emotion
  • Predisposition to giving feedback: The degree to which the client is comfortable with and predisposed towards appropriately providing feedback
  • Capacity to receive feedback: The client’s level of comfort with receiving positive or constructive feedback and the clients’ response to this feedback
  • Response to human diversity: The client’s response to a wide range of differences that distinguish individuals from one another
  • Orientation toward relating: The level at which the client expects and prefers the therapeutic relationship to be conducted. This varies between clients
  • Preference for touch: The client’s personal preference and interpretation of touch
  • Capacity for reciprocity: The capacity of giving and sharing between client and the therapist

Inevitable Interpersonal Events

Inevitable interpersonal events are naturally occurring communications, reactions, processes, tasks, or general circumstances that take place within the context of the client-therapist interaction. While these events may often seem unremarkable, any moment has the potential to become emotionally charged. These instances consist of emotion, threat, and opportunity for the client and therapist, and harbor the potential to enrich or harm the client-therapist relationship if not handled appropriately. It is the therapist’s responsibility to aptly navigate the inevitable interpersonal events with the client.

There are 11 categories of interpersonal events.

  • Expression of strong emotion: The client’s external displays of internal feelings that are shown with a level of intensity beyond usual cultural norms for interactions
  • Intimate self-disclosure: The client’s statements or stories that reveal something unobservable, private, or sensitive about the person making the disclosure
  • Power dilemmas: The dilemma is characterized by an undeniable power difference between the client and the therapist
  • Nonverbal cues: The client’s communications that do not involve the use of formal language such as facial expression or body posture
  • Crisis points: An unanticipated, stressful events that cause clients to become distracted and/or that temporarily interfere with the clients’ ability for occupational engagement
  • Resistance and reluctance: Resistance is a client’s passive or active refusal to participate in some or all aspects of therapy for reasons linked to the therapeutic relationship. Reluctance is disinclination toward some aspect of therapy for reasons outside the therapeutic relationship
  • Boundary testing: Boundaries provide limitations and help the client to understand what to expect during therapy sessions; boundary testing is when a client behavior violates or asks the therapist to act in ways that are not part of the therapeutic relationship
  • Empathetic breaks: Occur when a therapist fails to notice or understand a communication from a client or initiates a communication or behavior that is perceived by the client as hurtful or insensitive
  • Emotionally charged therapy tasks and situations: Activities or circumstances that can lead clients to become overwhelmed or experience uncomfortable emotional reactions such as embarrassment, humiliation, or shame
  • Limitations of therapy: The client’s restrictions on the available or possible services, time, resources, or therapist actions
  • Contextual inconsistencies: Any aspect of a client’s interpersonal or physical environment that changes during the course of therapy

Therapeutic Modes

The Intentional Relationship Model defines six modes of relating to a client that have been identified in occupational therapy practice.

Each therapist has their own preference based on personality traits and characteristics. While the therapist has a preference, the therapist should also attempt to best align the mode with the client’s preference within his or her personality and maintaining authenticity when relating to a client.

Advocating

Understanding that disability is a result of environmental barriers and as a therapist responding to physical, social, and environmental barriers that a client encounters

Collaborating

Making decisions jointly with the client and involving the client in reasoning, expectations, and having the client participate actively in these decisions

Empathizing

Bearing witness to and fully understanding a client’s physical, psychological, interpersonal and emotional experience

Encouraging

Providing the client with hope, courage, and the will to explore or perform a given activity

Instructing

Educating the client in therapy and assume a teaching style in their interactions with the client

Problem-solving

Relying heavily on using reason and logic in their relationships with the client

References

American Occupational Therapy Association (2008). Occupational therapy practice framework: Domain and process (2nd ed). American Journal of Occupational Therapy, 62, 625-683.

Taylor, R. R. (2008). The intentional relationship: Occupational therapy and use of self. Philadelphia, PA: F.A. Davis.

The Therapist

The therapist is not only delivering the technical aspects, but also responsible for facilitating and providing intentional therapeutic encounters with the client. The AOTA Practice Framework outlines the use of self as skill within the scope of practice for occupational therapy practitioners.

The Client

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Cras sed elit ligula. Ut vulputate condimentum lacus ac eleifend. Mauris sed lacinia urna, eget dignissim urna. Aliquam quis diam dignissim urna laoreet imperdiet. Nulla rutrum quam augue, eu congue risus sagittis a. Integer placerat nec elit id aliquet.

The Therapeutic Relationship

The therapeutic relationship is a socially defined and personally interpreted interactive process between the therapist and a client. During client-therapist interactions, it is the therapist’s responsibility to foster the therapeutic relationship and develop the client’s occupational engagement. Every action, including verbal and nonverbal communication from the therapist is purposeful and aims to facilitate occupational engagement with the client.

The Header

Vivamus luctus non elit tempor volutpat. Nullam sit amet dolor sed nunc tincidunt lobortis ut at ante. Pellentesque a semper leo. Aenean volutpat urna ac diam elementum dignissim.

Contributions from therapists across the globe, theoretical principles in occupational therapy and psychology, occupational therapy core values and ethics, and Dr. Taylor’s own clinical expertise in psychotherapy influenced the development of the ten underlying principles of the Intentional Relationship Model.

Ten underlying principles of IRM 

  1. Critical self-awareness is the key to intentional use of self
  2. Interpersonal self-discipline is fundamental to effective use of self
  3. It is necessary to keep head before heart
  4. Mindful empathy is required to know one’s client
  5. It is important to continually develop one’s interpersonal knowledge base
  6. Provided that they are flexibly and purely applied, a wide range of therapeutic modes can work and be utilized interchangeably in OT
  7. The client defines a successful relationship
  8. Activity focusing must be balanced with interpersonal focusing
  9. Application of the model must be informed by OT core values and ethics
  10. Cultural competency is central to practice‌

Each client’s own personal history contributes to a unique behavioral style. Emotions, behaviors, and reactions form enduring patterns within everyone, influencing how a client may respond in any of the 12 categories of interpersonal characteristics. Situational demands may elicit novel responses that differ from their enduring counterparts. Recognizing a client’s interpersonal characteristics enables the therapist to better engage in purposeful interactions during therapy.

  • Communication style: The client’s approaches to a formally spoken or signed language
  • Capacity for trust: Trust is built over the course of a therapeutic relationship, clients may have cautions or difficulty with trust
  • Need for control: The degree to which a client attempts to assume control over what is said and done during therapy
  • Capacity to assert needs: The client’s ability to discuss what they want from the therapist openly and directly
  • Response to change or challenge: How the client responds when presented with change or challenge
  • Affect: The client’s expression of emotion
  • Predisposition to giving feedback: The degree to which the client is comfortable with and predisposed towards appropriately providing feedback
  • Capacity to receive feedback: The client’s level of comfort with receiving positive or constructive feedback and the clients’ response to this feedback
  • Response to human diversity: The client’s response to a wide range of differences that distinguish individuals from one another
  • Orientation toward relating: The level at which the client expects and prefers the therapeutic relationship to be conducted. This varies between clients
  • Preference for touch: The client’s personal preference and interpretation of touch
  • Capacity for reciprocity: The capacity of giving and sharing between client and the therapist

Inevitable interpersonal events are naturally occurring communications, reactions, processes, tasks, or general circumstances that take place within the context of the client-therapist interaction. While these events may often seem unremarkable, any moment has the potential to become emotionally charged. These instances consist of emotion, threat, and opportunity for the client and therapist, and harbor the potential to enrich or harm the client-therapist relationship if not handled appropriately. It is the therapist’s responsibility to aptly navigate the inevitable interpersonal events with the client.

There are 11 categories of interpersonal events.

  • Expression of strong emotion: The client’s external displays of internal feelings that are shown with a level of intensity beyond usual cultural norms for interactions
  • Intimate self-disclosure: The client’s statements or stories that reveal something unobservable, private, or sensitive about the person making the disclosure
  • Power dilemmas: The dilemma is characterized by an undeniable power difference between the client and the therapist
  • Nonverbal cues: The client’s communications that do not involve the use of formal language such as facial expression or body posture
  • Crisis points: An unanticipated, stressful events that cause clients to become distracted and/or that temporarily interfere with the clients’ ability for occupational engagement
  • Resistance and reluctance: Resistance is a client’s passive or active refusal to participate in some or all aspects of therapy for reasons linked to the therapeutic relationship. Reluctance is disinclination toward some aspect of therapy for reasons outside the therapeutic relationship
  • Boundary testing: Boundaries provide limitations and help the client to understand what to expect during therapy sessions; boundary testing is when a client behavior violates or asks the therapist to act in ways that are not part of the therapeutic relationship
  • Empathetic breaks: Occur when a therapist fails to notice or understand a communication from a client or initiates a communication or behavior that is perceived by the client as hurtful or insensitive
  • Emotionally charged therapy tasks and situations: Activities or circumstances that can lead clients to become overwhelmed or experience uncomfortable emotional reactions such as embarrassment, humiliation, or shame
  • Limitations of therapy: The client’s restrictions on the available or possible services, time, resources, or therapist actions
  • Contextual inconsistencies: Any aspect of a client’s interpersonal or physical environment that changes during the course of therapy

The Intentional Relationship Model defines six modes of relating to a client that have been identified in occupational therapy practice.

Each therapist has their own preference based on personality traits and characteristics. While the therapist has a preference, the therapist should also attempt to best align the mode with the client’s preference within his or her personality and maintaining authenticity when relating to a client.

Advocating

Understanding that disability is a result of environmental barriers and as a therapist responding to physical, social, and environmental barriers that a client encounters

Collaborating

Making decisions jointly with the client and involving the client in reasoning, expectations, and having the client participate actively in these decisions

Empathizing

Bearing witness to and fully understanding a client’s physical, psychological, interpersonal and emotional experience

Encouraging

Providing the client with hope, courage, and the will to explore or perform a given activity

Instructing

Educating the client in therapy and assume a teaching style in their interactions with the client

Problem-solving

Relying heavily on using reason and logic in their relationships with the client

The Therapist

The therapist is not only delivering the technical aspects, but also responsible for facilitating and providing intentional therapeutic encounters with the client. The AOTA Practice Framework outlines the use of self as skill within the scope of practice for occupational therapy practitioners.