The Therapeutic Use of Self: Intentional and Purposeful Relationships.

Expectations.
What does a child expect when they start occupational therapy?
What do parents expect? 
What does a teacher expect?

What shapes these expectations?

Where does an OT start? What is the priority? 

It may be no surprise but the priority for me is always connection, developing the relationship for active engagement. Helping a child feel comfortable, relaxed, and actively wanting to participate.  Helping them to be motivated to work on goals (potentially set by their parents or teachers). Building a psychologically safe environment is intentional.

Occupational therapy is often new to children and to families.  What is that "you" do?  Even if the first face-to-face contact is an assessment, we can establish some rapport and connection before that happens. The initial interaction is so important. The way we greet a child, the way we introduce ourselves, the questions we ask and how we demonstrate our interest in the child are all important ways we build interpersonal connectedness.   Building a relationship to facilitate occupational performance and goals is purposeful. 

The intentional use of our personality, communication style, and professional presence is what occupational therapists describe as the therapeutic use of self (and it is a passion topic for me)!  The therapeutic relationship (with a child or adult) is a two way process. We each contribute, but as the therapist our role is to actively develop engagement so that we can be effective with what we do.  

Holmqvist, K., Holmefu, M. and Ivarsson, A. (2023) say "The therapeutic use of self has been described with intentions such as to alleviate a client's fear and anxiety, guide a client through an activity, a planned conscious action and a way to change occupational performance within the context of therapy".

Occupational therapists are intentional, purposeful and self-aware in how we approach children in a therapeutic context. Through a meaningful authentic relationship we can actively engage a child!

​Beyond the initial connection we make with a child, each time we see them we might consider how we contribue to a child's regulation and reponses.  Rapport and a deep connection develops with time, trust and respect. These are things that can't be demanded but are earnt through experiences. We are always concerned about the child's well-being. 

We might reflect on ... 
* Does the child feel understood and comfortable? 
* Does the child feel pressure to perform or comfortable making mistakes? 
* Does the child feel stressed or willing to try something new? 
* Are we addressing inner motivation and providing a just-right challenge?
* How can we help the child to regulate?
* Can we create curiosity or an invitation to play?

When a child feels understood and emotionally safe, they are more likely to explore, take risks, and attempt new challenges.

The importance of therapeutic relationships is explored in the Intentional Relationship Model (IRM) developed by Renée Taylor. The model encourages therapists to be critically self aware, intentional with our interpersonal approach and adapt it based on the needs of the client and the situation. For example:

• Some children may respond well to a playful, energetic style.
• Others may need a calm, steady presence.
• A frustrated child may need empathy and emotional support before they are ready to continue an activity.

​In a previous article, I wrote about a "Childrens's Rights in OT: What every child should expect!" but the other part to that is from a therapist's point of view. Our ability to be critically self-aware guides our intention and purposeful approach.  What do we contribute to the relationship? How do we manage compassion fatigue? How does a child affect us?  What happens when the children we work with don't want our help? 

The discussion on the Therapeutic Use of Self is a subject that I enjoy talking about as I continue to reflect on my practice as an OT (there are over 25 years to reflect on).  If you are a parent reading this, you may consider how your therapists are intentionally and purposefully building engagement to help achieve goals. If you are a therapist who would love to learn more, there are a few ways to do that! 

Find out MORE: 
* Therapeutic Use of Self Reflective Practice Tool: YKOT Shop ($AUS) or TPT Store ($US)
* Disability Spot Conference "Forging the Future Together: Innovation in Practice" - 30th May 2026. This is an online conference where speakers present in a live presentation on the day. Check out the conference program. 
* The Paediatric Occupational Therapy Conference Australia (POTCA) - 19- 20 November 2026, Brisbane Australia. Use the code "CINDY" for $25 off the registration fee.  This conference is both in-person and online. If you are an Australian OT, I would encourage you to get there in-person! This is the first time that a conference like this is happening!  This is not an academic conference. It is a clinically driven, application based event built around the realities of paediatric occupational therapy in private practice and NDIS contexts. Sessions are designed to translate directly into practice, providing therapists with strategies, frameworks and insight they can implement immediately.

I do not receive any renumeration for registration at either of these conferences. 

​I hope to see you there!

Cindy is a registered occupational therapist practising in Sydney, Australia.  She has two growing children who are a constant source of inspiration and learning.  Cindy loves working creatively to help children to reach their potential, finding opportunities in everyday living and making learning fun. She is also addicted to making printables (even when they take a long time to complete).  Cindy is the author of the Occupational Therapy blog Your Kids OT.  Read more articles from Your Kids OT at https://www.yourkidsot.com/blog

Cindy is a contributing author of the Functional Skills for Kids Therapy Team.  They have together published THE HANDWRITING BOOK, THE SCISSORS SKILLS BOOK and THE TOILETING BOOK.

​The information on this site is general in nature. The activities are safe for most children, however, you should consult an Occupational Therapist or health professional to address specific movement, sensory or other medical conditions. Affiliate links are used throughout this website to promote recommended products. Your Kids OT receives a small commission if any purchases are made through these links. Please see my disclosure policy for more details. ​​​
YKOT shop:  https://www.yourkidsot.com/store/c1/Featured_Products.html
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References:

• Holmqvist, K., Holmefur, M. and Ivarsson, A. (2012) ‘Therapeutic use of self as defined by swedish occupational therapists working with clients with cognitive impairments following acquired brain injury: A delphi study’, Australian Occupational Therapy Journal, 60(1), pp. 48–55. doi:10.1111/1440-1630.12001.
• Taylor, R. R. (2008). The Intentional Relationship. Occupational Therapy and the Use of Self. Philadelphia: FA Davis.