Saturday, January 12, 2008

Critical Appraisal of the Contribution Made by the Application of Advanced Communication Skills to the Practice of Occupational Therapy

By Sudipa Sarkar
Introduction

Occupational therapy can be described as an applied science which deals with the individuals aiming an overall development by regaining and maintaining skills necessary for participating in all surfaces of their lives, including professional facet. The job of occupational therapists primarily comprises of assisting individuals having difficulties originated from their birthing process, illness, accident or ageing process and lacking the ability to lead a normal life affecting mental, physical or social area. As the therapy session is intended to one-to-one basis, it is adapted to provide individualized treatment programmes facilitating each individual’s unique life styles. Hence, it is quite evident that the significant factor combining the responsibility as an occupational therapist must consider various ways of adapting treatment to make the therapy more effective, which is eventually dependent on the development of special skills at the part of the therapist such as creativity, adaptability, ability to design and develop treatments to suit individualized needs of the clients and communication skills both verbal and written. The communication skills play an important role in order to relate with the clients from different background and demographics as well as to interact with them or to deliver the appropriate therapeutic treatment to them. This paper critically evaluates the contribution made by the application of advanced communication skills to the practice of occupational therapy (Baum C., & Christiansen, C., 1997).

Ethical Principles of Advanced Communication

Communication can be defined as a method of production, conduction or reception of messages to oneself or another being via a mutually understandable set of signs and symbols. Communication itself is a deep-rooted factor which is responsible for affecting human behaviour, influencing human motivation and attitudes as well as society as a whole. In modern and advanced studies the practice of ethics is a significant part that contributes to the area of interpersonal, organizational and intercultural communication. The primary ethical principles incorporating the advanced communication prototype usually combines the following factors (Vernon Jensen J et al, 1997):

(I) Religious framework
(II) Individual system
(III) Group behaviour
(IV) Society values
(V) Society rules
(VI) Consequential principles
(VII) Non-consequential principles
(VIII) Enhancement of human nature
(IX) Dialogical spirit
(X) Golden rule

Since ancient period religious framework have contributed to the development of teaching, values and rules governing individuals as well as society – be it for worse or better, depending on how it has been applied (Vernon Jensen J, 1992). The religious framework encapsulated within a sophisticated background often serves a humanistic, psychological and societal body of thought – whether being a believer or a non-believer (Taylor & Arbuckle, 1995), people become greatly influenced by the theme and values expressed in various religious framework (Overmyer, 1985), which eventually plays a significant role in governing the life as a whole, leading an appreciation of centuries old struggles of human beings to ethical communication as an important phase of their coping strategy in life covering almost all dimensions including political, sociological, economic and cultural facets (Ames, 1984).

Apart from the above-mentioned factors, certain reprimands are particularly central to the ethical communication embedded in religious traditions. The first and foremost important among them is to avoid deception and to tell the truth, supported by various positive biblical literatures such as “Truthful individuals are always being praised”. On the other hand, being truthful and honest speech is the core value in Hinduism as well as Buddhism stressed on honesty by emphasizing on abstinence from false speech (Conze, 1984). Another ethical principle encapsulating within religious framework combines non-defaming another being – for example, Koran describes and warns who devalues human beings commits sins (Pickthall, 1953). The religious traditions also emphasize on the mutual trust development issues in order to communicate ethically and effectively. The adherence must be occurred by adapting the life qualities of communicator, not merely by their speech in general (Lin, 1942). Hence, the primary and final objective of ethical communication both in eastern and western religion is to set up an effective platform to enhance the ethical behaviour as much as possible to establish the role of the Supreme Being (Palmer, 1947).

Individuals can learn from their own role models and the ethical principles governing the communicative process are vastly influenced by the interpersonal relationships and close societal structure. Hence, it is evident that the formation of individualized agenda persuades the decision making styles and actions of an individual (Corgan, 1995). The role model, even in an imaginary form, may provide an important contribution by serving as standards for decision and actions. By this process, the potential danger of hero worship may become prevalent, which may lead to farcical degree by abandoning individual responsibility and portraying supra-humanly perfectionism (Chen, 1993). Apart from potential dangers, people may learn from role models in order to strive for high ethical quality communication.

People often may reveal compliance in their communication process in accordance with the group in which they belong by maintaining the ethical standards of the guidelines and expectations of the group. This phenomenon is known as group loyalties (Bormann E. G., 1985). The group loyalties play a significant role by influencing the interactive mode during a communication process as well as the time and situation of the communication process takes place.

A society is formed beyond an individual or a group; rather it is the manifestation of those elements political, social and cultural frameworks of the society. The social values are also intended for creating guidelines for ethical decision making and life coping strategies. Democratic society emphasises on individual freedom and responsibility with a core understanding of mutual respect. Behaviours especially intended to represent communicative act strengthens the society’s values and reflected as a higher rank in Ethical Quality (EQ) scale.

The Rogerian School of Counselling

The humanist psychotherapist Carl Ransom Roger (1902 – 1987) proposed a non-directive psychotherapeutic approach, initially termed as client-centred therapy and later renamed as Person Centred Approach (PCA) primarily focused on the positive and enhanced interaction among individuals. According to Carl Roger, the necessary factors responsible for influencing personality dynamics are equivalence, unconditional positive regard and empathy. He emphasized in a controlled therapeutic relationship the personality changes will occur among the clients who perceive the condition as mentioned (Klassen & Turgeon, 1981).

Being the founder of Humanistic Psychology along with Abraham Maslow, Carl Roger emphasized on the Human Potential Movement characterised and influenced by the Existential Approach describing that human growth and development is a result of direct experience and interaction with the environment rather than that of mere analytical reflection (Kovel, 1991). Moreover, Roger emphasized on the human potentiality as the fundamental factor of human nature and motivation, hence, human are basically social element, positive in nature, psyche and action, forward moving, realistic and rational (Roger, 1974), which is practically contrary to the Freudian approach. During his work as a psychologist and investigator of human nature and development, Carl Roger became interested in the interpersonal and intrapersonal communication between two individuals, between individual and group as well as between groups as a whole. This eventually leads him to research, hypothesize and theorize the motivational factor of human being and nature. In the course of his theory, he approached that the actualising tendency is inherent to all organisms, manifested from the basic drive towards the wholeness of organisms and actualization of its potentialities (Roger, 1978). Now as the actualization process itself is an operative one, it leads to conflicting event along with the second drive when the behaviour is reckoned threatening to the self-concept which may result in psychological tension generated from incongruence between internal experience and actual choice of behaviour pulling the drive in different direction. In order to find out the solution to the above mentioned phenomenon, Carl Roger coined the term called ‘psychological amniotic fluid’ for moving an organism forward towards a constructive framework (Roger, 1978). While describing the ideal environment for therapeutic approach, Carl Roger mentioned few potential conditions to hold in order to occur and facilitate constructive personality change:

Two individuals must be in psychological contact.
The client is in a state of incongruity, vulnerability or anxious.
The therapist is in a state of congruence and integrated to the formation of the relationship.
The therapist must convey the unconditional positive regard for the client.
The therapist must understand the client’s internal frame of reference with an empathetic view point as well as the therapist must possess the endeavours to communicate with the client in particular (Nelson-Jones, 1991).

It is thus quite evident that Carl Roger placed a great significance on the intrapersonal relationship among the therapist and the client with an special emphasis on the skills of the therapist such as:

Congruence – communication must be facilitated with appropriate congruence.
Empathic – being able to experience the client’s subjective frame of reference while performing communication process by drawing the feelings of the client into the edge of his awareness, this enables the therapist to symbolise the frame of reference of the client.
Unconditional positive regard – being able to accept the client unconditionally and to convey respect for the client and his point of view as well as frame of reference in general.
Tenderness – this factor has been added later by Carl Roger. He described it as an addition to empathy in relation to intuition and touching the inner spirits.

Hence, with these qualities described by Carl Roger, the therapist constructs an environment or relationship to facilitate the growth of the therapeutic process, where the client feels unconditionally accepted without any feelings of judgement; hence the need to defend the self-concept is being reduced. This enables the client to become able to re-evaluate own self by dissolving conditions of worth and reducing tension. Thus the therapeutic process is focused in building existentialism structure and new frame of reference based on present context by using currently available resources and information rather by blocking it and wasting psychic energy in defensive behaviour. The primary aim of Rogerian counselling is to eradicate the ‘imbalance in the power relationship’ between client and counsellor by ensuing to become a fully functional person (Masson, 1922).

Therapeutic Use of Communication

Therapeutic communication can be described as a composition or combination of verbal and non-verbal techniques that are used by health practitioners incorporating the potential communication with the client. The development of therapeutic relationship while providing the treatment is one of the most important responsibilities of the health workers. Likewise other therapeutic treatment procedure, occupational therapy combines the following factors that are primarily used as the backbone to facilitate the therapeutic communication (Meyer, A., 1922):

Confidentiality
Controlled self-disclosure
Empathy
Touch
Active listening ability and observation

The philosophy of occupational therapy is to make independence a reality – thus occupational therapists aim at human development and growth with emphasis on cognitive, affective, physiological, psychological, interpersonal and social components of disability or inability (Low, J., 1992). While it may not be possible all the time to become absolutely independent depending on the severity of the disability or environmental condition, but the therapists aim at providing the individualized strategies, techniques or treatment to enable the client to become self dependent as much as possible (Meyer, A., 1922). The essential components of therapeutic communication thus include:

Open-ended questions
Acceptance
Broad point of view
Intrinsic focusing
Observation
Encouraging perception
Reality presentation
Restatement
Clarification / Verification of statement, but not repeating the same statement over and over again
Pause within sentences / maintaining silence
Humour

The goals of therapeutic process are to establishing healthy and positive relationship by employing effective communication, to identify most important client concern at a given period of time, to assess client’s perception of the problem, to recognize and understand client’s underlying needs and desires, to guide the client to have socially acceptable solutions.

Conclusion
The role of advanced communication skill in occupational therapeutic approach is beneficial in order to collecting the information relating to the problem, assessing and modifying behaviour as well as providing the solution to the problem by employing various effective methodologies. Hence this is true that the application of advanced communication must incorporate a great deal of sensitivity as well as an effective listening skill in order to deliver a significant and worthy environment for therapeutic treatment at individualized level including the entire spectrum of healthcare services.
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