Use of the self as a therapeutic tool: a formative experience of occupational therapy in an undergraduate course¹

Abstract

Introduction

The use of the self as a therapeutic tool is a client-centered practice with the least evidence in the pedagogy of occupational therapy. In Chile, experiential subjects arise, linked to artistic/playful methods that seek to influence the skills of the undergraduate student for their development.

Objective

To analyze the experience of the students in relation to the learning, characteristics, and contributions of the subjects that contribute to the development of the use of the self as a therapeutic tool, in occupational therapy careers at universities in the south of Chile.

Method

Qualitative research, exploratory with a grounded theory design. The sampling was non-probabilistic, intentional, by criteria, of fifteen students in the professional internship stage. Data collection was through two focus groups, after signing informed consent. The analysis was carried out using the constant comparison method of Glaser and Strauss, using the Atlas Ti program to systematize the information. Scientific rigor was guarded by the criteria of Guba and Lincoln.

Results

530 units of meaning are identified, 30 descriptive open codes, grouped into eight axial categories, emerging two thematic nuclei that address the “Teaching-learning process in the formation of the Use of the Self” and the “Professional Development for the Use of the Self”.

Conclusion

For the students, the methodologies used to contribute in a relevant way to the development of self-knowledge and key generic competences for the “Use of the Self”. This pedagogy could be complemented with other active strategies to ensure the centrality of the user in occupational therapy.

Keywords:
Higher Education; Learning; Interpersonal Relations; Relationships; Professional-Patient Relations; Professional Practice

Resumen

Introducción

El uso del yo como herramienta terapéutica es una práctica centrada en el cliente y el pilar disciplinar con menor evidencia pedagógica en terapia ocupacional. En Chile, surgen asignaturas vivenciales, ligadas a métodos artísticos/lúdicos que buscan incidir en competencias del estudiante de pregrado para su desarrollo.

Objetivo

Analizar la experiencia de las estudiantes en relación a los aprendizajes, características y contribuciones de las asignaturas que aportan a la formación del uso del yo como herramienta terapéutica, en carreras de terapia ocupacional de universidades al sur de Chile.

Método

Investigación cualitativa, con diseño en teoría fundamentada de alcance exploratorio. El muestreo fue no probabilístico, intencionado, por criterio, conformado por quince estudiantes en etapa de internado profesional. La recolección de datos fue mediante dos grupos focales, previa firma de consentimiento informado. El análisis se realizó por método de comparación constante de Glaser y Strauss, utilizando el programa Atlas Ti para sistematizar la información. La rigurosidad científica fue cautelada por los criterios de Guba y Lincoln.

Resultados

Se identifican 530 unidades de significado, 30 códigos abiertos descriptivos, agrupados en ocho categorías axiales, emergiendo dos núcleos temáticos que abordan el “Proceso de enseñanza aprendizaje en la formación del Uso del Yo” y el “Desarrollo profesional para el Uso del Yo”.

Conclusión

Para los estudiantes las metodologías utilizadas contribuyen de manera relevante al desarrollo del autoconocimiento y competencias genéricas clave para el “Uso del Yo”. Esta pedagogía se podría complementar con otras estrategias activas para asegurar la centralidad del usuario en la terapia ocupacional.

Palabras-clave:
Educación Superior; Aprendizaje; Relaciones Interpersonales; Relaciones Profesional-Paciente; Práctica Profesional

Resumo

Introdução

O uso de si como ferramenta terapêutica é uma prática centrada no cliente e o pilar disciplinar com menor evidência pedagógica em terapia ocupacional. No Chile, surgem disciplinas vivenciais, vinculadas a métodos artísticos/lúdicos que buscam contribuir as habilidades do aluno de graduação para seu desenvolvimento.

Objetivo

Analisar a experiência dos alunos em relação à aprendizagem, características e contribuições das disciplinas que auxiliam para a formação do uso de si como ferramenta terapêutica, nos cursos de terapia ocupacional em universidades ao sul do Chile.

Método

Pesquisa qualitativa, com delineamento da teoria fundamentada de alcance exploratório. A amostragem foi não probabilística, intencional, por critério, composta por quinze alunos em etapa de estágio profissional. A coleta de dados se deu por meio de dois grupos focais, após assinatura do consentimento informado. A análise foi realizada pelo método de comparação constante de Glaser e Strauss, utilizando o programa Atlas Ti para sistematizar as informações. O rigor científico foi resguardado pelos critérios de Guba e Lincoln.

Resultados

Foram identificadas 530 unidades de sentido, 30 códigos abertos descritivos, agrupados em oito categorias axiais, emergindo dois núcleos temáticos que abordam o “Processo de ensino-aprendizagem na formação do Uso de Si” e o “Desenvolvimento profissional para o uso de Si”.

Conclusão

Para os alunos, as metodologias utilizadas contribuem de forma relevante para o desenvolvimento do autoconhecimento e das competências genéricas chave para o “Uso de Si”. Essa pedagogia poderia ser complementada com outras estratégias ativas para garantir a centralidade do usuário na terapia ocupacional.

Palavras-chave:
Ensino Superior; Aprendizagem; Relações Interpessoais; Relações Profissional-Paciente; Prática Profissional

Introduction

The person-centered approach is born within psychological therapy, by the Humanist Carl Rogers, and from his perspective, that is, effective therapy can only be explained by the quality of the interpersonal encounter with the patient, the element determines the experience that promotes the evolution and personal development of the other (Méndez-López, 2014; Rogers, 1972).

Since 1980, systematic studies have begun to support the therapeutic value of the positive relationship between professional and patient, believing that this interaction is an autonomously observable element of the intervention. The person-centered approach expands to other schools of psychology and other fields of social action, such as pedagogy and politics (Kallergis, 2019), as well as to the subject of Occupational Therapy.

In 1958, Frank introduces the term “Conscious/therapeutic use of the Self”, in the subject of Occupational Therapy, referring to the intentional use of the professional's personality, perceptions, introspection, and judgment, referring to this disciplinary practice (Aroca-Costa & Hermida-Carballido, 2016). Currently, the American Occupational Therapy Association (2020), recognizes this strategy of “Use of the Self” as a type of intervention and the Spanish association homologates this term to “therapeutic relationship” (Aroca-Costa & Hermida-Carballido, 2016).

The disciplinary practice of Occupational Therapy, in the contemporary conceptions of the profession, is based on a humanistic approach, and in this field, relationships are a critical aspect to influence and promote occupational adaptation processes that seek to enable significant roles and foster the personal identity of the individual or group in care (Aragonés-Fernández & Martínez-Sánchez, 2017; Castellanos, 2016; Talavera & Bartolomé, 2012; Taylor, 2016).

Throughout the history of Occupational Therapy, there has been no coherence in the conceptualization of the “Use of the Self”, mainly due to the paradigmatic changes that the subject has undergone, going from the moral treatment, the paradigm of internal mechanisms focused on the biomedical to the current contemporary paradigm centered on occupation, which perse influences the relationships generated with users (Castellanos, 2013), therefore, neither in the skills demanded by its practice.

The “Use of the Self as a Therapeutic Tool” is intertwined with professional reasoning and disciplinary ethical action, since the occupation of each individual or group is very diverse and unique; and the risk of not promoting autonomy is a major concern (Castellanos, 2013; Taylor, 2016).

Taylor (2011), in his model of intentional relationships for Occupational Therapy, highlights the need to develop advanced communication skills in therapeutic bonding, which are available to the users, their social environments, and work teams.

The American Association of Occupational Therapists, reports that:

Through the use of interpersonal communication skills, professionals shift the power of the relationship to allow users greater control in decision-making and problem-solving, which is essential for effective intervention (American Occupational Therapy Association, 2020, p. 19).

In the therapeutic relationship, a collaboration with the user is assumed, through professional reasoning and an empathetic attitude, providing a client-centered service (American Occupational Therapy Association, 2020). This relationship is not static and is situated in phases from delivery of more advice and information to a decrease in the frequency of meetings when the autonomy of the user is achieved when the therapeutic process is closed (Castellanos, 2016).

This vision has derived from the problem of the formation of the person of the therapist, which for Szmulewicz-Espinoza (2013), requires key visualizations related to the unveiling of the intervener, who acts from his subjectivity and puts it at the service of therapy, with creativity and mutuality interactions. The therapeutic relationship is framed in human interactions, which is why it will never be neutral and both systems will benefit (therapist and patient).

In the pedagogy of the Use of the Self, the work on “skills to coexist” can be visualized, from traditional curricula or “competencies linked to interrelation” in innovative curricula (Campo del Paso et al., 2014), the universities in this study with their Occupational Therapy courses maintain competency-based curricula.

The generic competencies conventionally suggested by the Health Sciences by the Tuning Project for Latin America (Beneitone et al., 2007), where Occupational Therapy courses in Chile are attached, are problem-solving, communication, decision-making, teamwork, leadership, and social responsibility, among others (Hanne, 2013; Rojo-Venegas & Navarro-Hernández, 2016; Sandoval-Pérez et al., 2021), and those significantly related to the “Conscious Use of the Self”, are empathy (American Occupational Therapy Association, 2020; Castellanos, 2013; Campo del Paso et al., 2014; Kallergis, 2019; Méndez-López, 2014; Rogers, 1972; Taylor, 2016), creativity (Castellanos, 2013; Méndez-López, 2014; Szmulewicz-Espinoza, 2013) and group management (Castellanos, 2013; Scaffa, 2016). In addition to these generic competencies, relevant values ​​and aspects of the personality of each individual in training in the subject are added, which require self-knowledge processes (Aroca-Costa & Hermida-Carballido, 2016; Castellanos, 2013; Campo del Paso et al., 2014; Rogers, 1972; Szmulewicz-Espinoza, 2013; Taylor, 2016), related to the personal development of the therapist in training. For this reason, there is an important challenge that implies a strengthening of the generic competences of the professional in Health Sciences (Villarroel & Bruna, 2014) and with greater preponderance in occupational therapists.

The experiential subjects to be known in this study begin at the University of Chile, and its courses in Occupational Therapy. Within its first curricular mesh, of 2500 hrs. total, about 1150 hours, corresponded to the learning of therapeutic activities, linked to ergotherapy and corporal expression. Then, the curricular mesh in its fifth reformulation in 1995, integrates the subject of “Creativity” (Gómez, 2013), which is replicated with different names and emphasis in the new courses of Occupational Therapy throughout the country, in other higher education institutions.

From the living history of the Occupational Therapy community and a large part of their courses in Chile, subjects are rescued that were formerly nominated as “Creativity”, characterized by the use of experiential group learning methodologies, which mainly favor the development of generic skills. They use various kinds of artistic expression techniques as a trigger for the experience. The students take previous experiences and resignify them in joint work in pairs and guided by teachers.

These subjects are born from experiential humanist workshops centered on the person, used mainly in the subject of psychology. Campo del Paso & Salazar-Garza (2015) characterize these workshops by maintaining a determined duration, predefined sessions in a group format, and guided by a facilitator. This author states that the workshops combine brief theoretical conceptualizations with experiential dynamics, self-reflection, and group feedback to generate learning and personal development in the participants, promoting new ways of being and relating to others.

Active learning methodologies based on the constructivist pedagogical paradigm seem to be the basis of this type of learning, in which the individuals build their knowledge from the interaction they make with the medium or object of learning, interpreting and explaining what happens around them, while sustaining their training and transforming their cognition, making this change an evolutionary process in constant transformation, through interaction with the object of knowledge or environment that surrounds them (Guerra-García, 2020). Specifically, the result in the pedagogy of the Use of the Self is that each professional therapist has an epistemology and a way of knowing, which would lead him to adopt models and his style. In this sense, the trainer urges that epistemology, with contemporary philosophical foundations at the base of current Occupational Therapy, the theoretical model, and its style are in a coherent relationship with each other. The therapist's behavior is defined as a transit in the margins of professional identity in no rigid way, subject to continuous modifications arising from professional experience, theoretical horizons, and personal changes (Casari et al., 2018; Taylor, 2016).

In Chile, there is no documented evidence about the pedagogy to develop the Use of the Self as a Therapeutic Tool, from traditional or private higher education institutions that maintain Occupational Therapy courses, despite the notable scientific evidence that favors the development of this scope, ensuring adherence to treatments and better results of therapeutic interventions, managing to rescue the needs expressed by the subject of care and motivating their active participation (American Occupational Therapy Association, 2020; Castellanos, 2013, 2016; Kallergis, 2019; Méndez-López, 2014; Szmulewicz-Espinoza, 2013; Taylor, 2016).

Aroca-Costa & Hermida-Carballido (2016) affirm that 80% of Occupational Therapists in the United States admit the importance of the Use of the Self in the intervention. However, two-thirds of them assume that they do not have sufficient training to make conscious use of this tool. Taylor (2011) points out that 83% of these professionals give importance to the therapeutic relationship and 72% describe it as a key aspect to optimize the results of the process. Taylor (2016) also reports that only 51% of Occupational Therapy students felt prepared to use themselves and only 5% assume the relevance of further training in this field. In the interdisciplinary pedagogical area, Campo del Paso et al. (2014) report that although there has been interesting in promoting coexistence and collaboration skills, as well as self-reflection in university students, using experiential workshops with a humanistic approach, there are still not many research reports on the results obtained and, in most cases, evaluations are carried out exclusively at the end of it. The experience of the participant and its applications in specific aspects of her life are not taken into account, once it concludes.

In higher education institutions in the south of Chile, the universities that deliver the training of Occupational Therapists in undergraduate courses, maintain integrated into their innovative educational curricula, subjects that aim to develop skills linked to this training.

Given the approach of constructivist pedagogy, which shows that knowledge is a dynamic and interactive process through which information is interpreted and reinterpreted to generate ad hoc training in a context, through feedback from the various actors in the continuous training to implement improvements (Guerra-García, 2020), this study aims to analyze the experience of students in the main learning, characteristics, and contributions of the experiential subjects that contribute to the formation of the Use of the Self as a Tool Therapeutic, to incorporate improvements to the methodological learning strategies mentioned in the Occupational Therapy course, which contribute to the user-centricity and verify the impact of constructivist pedagogy in this area, in universities in a region to the South of Chile.

Method

Methodological approach and study design

The investigative process of this study has been developed from the qualitative naturalistic paradigm, since it seeks to investigate, describe, classify concepts and generate evidence from the learning experiences of students in the process of professional internship, about the subjects that contribute to the formation of the Use of the Self as a Therapeutic Tool of the Occupational Therapy course, in the Los Ríos Region.

We used the design of the Grounded Theory of Glaser & Strauss (1967), investigating similarities and differences of the information, referencing the explanatory power of the different human behaviors within a certain field of study, as a way to approach social reality. The results are validated with the data obtained, their analysis and synthesis, to obtain and build theories, concepts, and/or propositions (Páramo-Morales, 2015). An open, flexible, and emergent design was used, which implied that data collection and analysis were simultaneous activities, which were mutually conditioned.

Population and sample

The universe population was Occupational Therapy students, who maintain training processes in two universities in a region in southern Chile, recognized and nationally accredited for undergraduate training. The students passed the subjects that contribute to training in the Use of the Self as a Therapeutic Tool in 2020 in face-to-face format (before the Covid-19 Pandemic) and they were at the professional internship level in 2021 (in hybrid, face-to-face, and telematic format), since it was expected that with pre-professional experience in intervention spaces, they would observe their skills in action and reflect on the contribution of these subjects retrospectively in their actions.

The number of subjects who met this criterion was 65 young people. The sample was non-probabilistic, by criteria and convenience (Mendieta-Izquierdo, 2015), made up of fifteen students after signing an informed consent term, who were contacted and invited to participate in this study, via email, using internal databases of each university. Through this link, the objectives of the research were exposed, in addition to informed consent, guaranteeing anonymity and confidentiality.

Data collection

The data collection technique was through two virtual focus groups (one for each university) in the first and second semesters of 2021, with the participation of between eight and seven students, each group holding two sessions, which included a script of open questions. in the areas of interest according to the objectives of the study. It was sought to characterize the methodologies of the subject, the skills developed through them, and the impact of this learning on the professional internship process of the students participating in the study until data saturation was achieved. That is, when the information collected did not contribute anything new to the development of the properties and dimensions of the analysis categories (Ardila-Suárez & Rueda-Arenas, 2013). The interviews were recorded and transcribed, leaving evidence of the work carried out.

Data analysis

The analysis was done under the constant comparative method of Glaser & Strauss (1967), which allowed analyzing the symbolic meanings of individuals, penetrating their interiority; relating time, context, and personal history. This analysis was characterized by the generalizations that emerged from the data to develop concepts, identify their properties, and explore their interrelationships (Strauss & Corbin, 2016). The process carried out was the one proposed by Miles & Huberman (1994): i) systematic reduction of data through the separation, grouping, identification, and classification of elements, ii) arrangement and transformation, and iii) obtaining and verifying the conclusions.

Data reduction was performed through: i) open coding, segmenting the data into units of meaning and identifying emerging descriptive concepts (codes); ii) axial coding, grouping the codes into categories and developing relationships between them and iii) selective coding, whose purpose was to identify the thematic core of the central category, in which the other developed categories were grouped and integrated (Flick, 2018), using the Atlas t 9.0 program for its systematization.

Criteria of scientific and ethical rigor

The rigor criteria used were based on those described by Guba & Lincoln (1985). For credibility, the findings were verified with the participants about the data and interpretations. During the study process, the researcher omitted to make value judgments. A co-author monitored the data collection and analysis of the information using red alerts in the face of the cultural and disciplinary irruption of the main author and avoiding assumptions from her philosophical foundations. Transferability was achieved through a detailed description of the investigative process, the characteristics of the context, and the participants. In the dependency criterion, data stability was achieved by relating the data collection with the concordant evidence found on the subject. Finally, the criterion of confirmability or neutrality was guaranteed since the teacher in charge of the investigation does not maintain a temporary pedagogical action to collect data. That triangulation was carried out by the researcher, with the contents of the programs of the subjects under study and teachers who taught them at that time, through their documented experiences in experiential workshops and field diaries, with the systematization of the sessions carried out. Finally, the emerging contents of the interviews were confirmed with students, when these seemed doubtful (Strauss & Corbin, 2016). The reflection on the investigative process was permanent, by the main author of the study.

Finally, the ethical principles for medical research in human beings of the Declaration of Helsinki (Asociación Médica Mundial, 2013) were respected and the study carried out was authorized by the regional Ethics Committee in Chile, in ordinary number 28, of the January 21, 2021, and by the directors of the Occupational Therapy courses relevant to the participating universities.

Results

In open coding, we identified 530 relevant units of meaning (those texts that reflected the same idea), which were grouped into 30 descriptive codes, based on the students' narratives of the topics explored, consistent with the objectives of the study. The process of constructing the descriptive codes was carried out in an inductive, open, and generative way.

Subsequently, in the axial coding, eight axial categories emerge from the descriptive codes, from a process of constant comparison between them, in which structural and theoretical similarities and common elements were sought (Table 1).

Table 1
Meaning Units, descriptive codes, and axial categories

Units of Meaning	Descriptive Codes	Axial Categories
62	Self-knowledge	i) Types of learning
40	Team Collaborative
18	Significant
27	Bodily activities
18	Group Workshops	ii) Methodologies
16	Improvements to methodologies
15	Playful recreational entertaining experience
18	Nice constructive
14	Trust and security	iii) Learning environment
6	Liberty feeling
7	Proactive student	iv) Teacher/student role
5	Facilitator teacher
17	Peer feedback
12	Teacher feedback	v) Formative evaluation
5	User feedback
50	Group management skill
27	Adaptation flexibility
18	Creativity
15	Tolerance
14	Empathy	vi) Development of generic skills and values
13	Communication skill
9	Reflection
7	Respect
4	Responsibility
20	Work on personal weaknesses
19	Therapeutic Bond	vii) Professional identity development
9	I use tools according to my seal
23	Self-knowledge valorization
16	Learning assessment in boarding school	viii) Importance of Use of the Self
6	Generic skills assessment
Total: 530

Finally, in the selective coding, two thematic nuclei were identified through a sequential and transversal analysis of the axial coding: i) Teaching/learning process in the formation of the Use of the Self and ii) Professional development for the Use of the Self, which accounts for the meaning of the experience of Occupational Therapy students in this undergraduate training. This interaction and dialogue between the subjective significance (emic) that the people participating in the study have contributed and the theoretical-conceptual frameworks of the researcher (etic), have gone through the entire process of analysis, constituting a double hermeneutic, as pointed out by Giddens (1979).

Both central nuclei relate all the axial categories, which allows for systematizing and interpreting the results of the study, which are described below.

1. i

   Teaching/learning process in the formation of the Use of the Self

This nucleus is related to the experience of students in experiential subjects, related to the environment in which the teaching process takes place, its main learning, the role that students and teachers assume, the main active methodologies used, and evaluation (Figure 1).

Figure 1
Nucleus 1: Association with its component axial categories.

In this nucleus, the key informants mention several types of learning, the most relevant being self-knowledge and collaborative learning in groups.

Being able to get to know each other also makes us understand what I can and cannot expose myself to, what I can help with and what I will have to ask for help with to benefit the user. I (5).

Participation was collaborative in group techniques, we had to take the ideas of all the partners. E (1).

As planned, the subject added up; everything was very significant, I liked everything that was done there, it was very free. I (13).

Regarding the teaching-learning methodologies, the students highlight the work in group workshops, mostly using diverse corporal expression techniques such as bio-dance and psychodrama, or dynamics connected to the game.

We participated in activities such as Bio-dance and body expression dynamics. I (9).

They divided us into groups, we had to prepare and direct sessions for our colleagues. I (5).

I liked startup activities. Well, I think it's well known, it's called the human knot. At this time, it is not possible to do it (participating laughter), but it was very fun, that one command, to go under... I liked the icebreaker a lot. E (1).

As a suggestion to improve this teaching-learning process, they highlight the increase in subjects and hours, as well as concatenating them to professional practice processes.

Yes, I think they should be more frequent within the course levels, not just in a specific year. I (8).

Many times, this process of reflection was rested on 'it will be good for you tomorrow' in cliché phrases, to improve the process of reflexivity. Make it more aware. Something very important is that of the practical approaches before. I (9)

These experiences inserted in an unconventional environment stand out, from the physical, using auditoriums or larger private rooms; and in the social sphere, from trust and cooperation with the teacher and peers. They describe this experience as the generation of a free learning space.

The comments [...] were always taken and said constructively, so it helped us, we understood in a good way. I (3).

Perhaps in trust, because we are all afraid to say what is wrong or something that the other has to fix, the person is going to take it badly. I (5).

What I remember most about the area was the freedom of not having to sit down writing, they made us do very specific things and other very abstract things. I (12).

There is a progression in the autonomy that students visualize within the process, affirming that the teacher is placed in a facilitator role.

They teach us about theory, sensations, experiences. At first, it was like a more passive role; at least for me. In fourth grade creativity, it was more active participation, they make us reflect a lot. I (13).

I feel that in the course from creativity one to creativity fourth, HTO 1 to HTO 2, we always start with a perhaps more passive role, of a student, of observing, looking and learning, [...] then one more of a therapist, practitioner, and co-therapist. I (15).

Finally, for students, formative evaluations, and feedback from teachers and peers are very valuable. In the context of their professional practices, they refer that this feedback is given by users of the Occupational Therapy service.

Taking into account how your peers see it or the feedback that they give you, that still helps to improve your weaknesses, which costs you more, I think, because if you don't experience it, you won't improve [...] you won't be able to improve it. I (3).

[...] always at the end of the activities, a space was opened for the teacher and classmates to give feedback on how our activity was, what it would improve, or any aspect that they wanted to mention. I (10).

Also, the same users, with their behavior one sees if they are feeling comfortable, [...] when one says goodbye, they still give their feedback. I (8).

1. ii

   Professional development for the Use of Self

In this nucleus, students point out the contributions of the subject and professional experiences in undergraduate studies, to develop generic skills and values, and their incipient professional identity. They also point out the importance of the use of the self for the Occupational Therapist professional (Figure 2).

Figure 2
Nucleus 2: Association with its component axial categories.

The narrative of the students expresses that for the professional development of the Use of the Self, enunciated generic competences are promoted. Among the most outstanding are adaptation, flexibility, communication, managing a group, reflection, empathy, and creativity. The informants also evoke relevant values, developed in these spaces, such as tolerance, respect, and responsibility.

I think that the goal was still to be able to develop personal tools for group management. I (3).

As you mentioned before [...] adaptation still influences the different contexts in which we find ourselves, for example in this online modality, I think that what exploits the most or what we use the most is adaptation. I (7).

The only more negative expectation was bio-dance, because I am very tactile defensive and that activity involved a lot of touching each other too much and it bothered me a lot in the first sessions, I felt very bad I was desperate, but in the end, I went down my barriers. I (12).

For example, in empathy, when more personal storytelling activities were carried out, we had to be super careful and know how to read the other person's body language [...] respect and not demand more than what the person can express at the time. E (2).

It is in knowing how to relate and how to say things and being more mature or professional to know how to be receptive, because at the same time you work on how to say things well and that the other does not get angry; and the one who is receiving, knowing that he has to be self-critical that it is all for construction. I (5).

I believe that the capacity for reflection that they had mentioned in the previous meeting because things always happen when one is trying to intervene or evaluate. I (5).

The responsibility of not interfering with the work of colleagues if one was late, for example, or with the users. I (7).

The Use of the Self as a Therapeutic Tool is valued by the students in the professional internship. In this context, they must apply self-knowledge and acquire generic skills since it is where they experience a real therapeutic relationship, expressing that from self-knowledge they identify strengths and weaknesses to face the therapeutic link.

I believe that from this type of experience, it has been possible to work on all the skills, both the weak ones and those that we maintain and strengthen more. I (3).

I have developed skills to be able to connect with people, with occupational therapy, but that moment comes when one begins to ask new things about oneself, and we will always have new users, different people. I (9).

[...] important is to have these social skills or these positive skills, skills that we are promoting and are different in each person. They make us unique in relating and working with ourselves and also with the other. I (10).

From this learning, they are also able to select the tools that favor the link with another, generating their styles in this interaction, and developing their professional identity.

Self-knowledge, I think you have to start from knowing what I'm good at and what my limitations are so that I know what to deal with and not deal with in certain circumstances. I (12).

I think that when we finished the class, I didn't realize so much of everything I had learned, until boarding school, where I had to apply everything that I learned. I (3).

These characteristics that we are talking about are necessary to be able to internalize the role of the therapist or professional; finally, they are characteristics that the people we assist will see. I (10).

Discussion

Regarding the teaching-learning process in the formation of the Use of the Self , the key informants identify in the subjects experienced characteristics similar to those reported by Campo del Paso et al. (2014), who mention significant learning, strong group cohesion, and the development of teamwork, as well as self-knowledge, emotional and attitudinal changes.

Castellanos (2016), after reviewing the situation of this pedagogy in Spain, points out that the use of active experimentation methodologies in teaching the therapeutic relationship is essential. Training on this complex phenomenon requires an understanding of the concept at a theoretical level, of the experiential experience of human relationships among classmates, with teachers, and with future subjects of care.

Students highlight corporal expression as the main learning technique, which is described as an excellent pedagogical tool for the development of more advanced communication and interaction. The didactics of corporal expression favors interpersonal relationships and creativity (Coterón-López & Sánchez-Sánchez, 2012). Significant changes in the integrity of the person are visualized, when the student experiences learning for the stability of his personality, reflection, and interrelation (Campino-Muñoz et al., 2017).

Thus, the participants of the study mention the game in the adult as a methodological strategy, where subjectivity is rescued in its value and appears transversally in the subjects. Leisure and Play as an experience (Primeau, 2016) has an important power to intrinsically motivate student learning, through fun, active participation, and self-expression. The game awakens the adult artist, inciting intuition and imagination, which are the real powers and promoters of experimentation and creation (León-Río, 2020).

All the experiences described by the informants in the subjects highlight their value in doing, the fact of experiencing recreational activities or body expression, as a means of learning and in a group format, considering that the generic competences described have a close relationship with the greater development of human interrelation (Campino-Muñoz et al., 2017; Castellanos, 2016; Campo del Paso et al., 2014).

The study shows that the teacher expected by the students must assume the role of facilitator, which must promote concordance between theory, technique, and praxis; favoring creativity (Casari et al., 2018; Szmulewicz-Espinoza, 2013), and maintaining a close link with the student body, which generates an environment of trust (Casari et al., 2018; Farías & López, 2013) for the development of the “Use of the Self as a Therapeutic Tool”.

In this learning process, the key informants highlight as relevant the constructive feedback (Guerra-García, 2020) generated by teachers, peers, and users, which should be generated in a protected environment, promoting permanent reflection of the future Occupational Therapy professional (Campo del Paso & Salazar-Garza, 2015; Farías & López, 2013; Renés-Arellano, 2018).

The students, despite maintaining summative evaluations in these subjects, give great relevance to the element of the teaching-learning process described as formative evaluation. In this sense, the high motivation and autonomy generated in the student stand out, where the evaluation also becomes learning content, improving it when it is given with help and not a control approach. The formative evaluation element promotes the development of skills in university students (Fraile-Aranda et al., 2013; Campo del Paso & Salazar-Garza, 2015). The vision of the peer giving feedback encourages social and autonomous learning of the student body (Calzada-Prado, 2020; Campo del Paso & Salazar-Garza, 2015).

Regarding the professional development for the Use of the Self , the subjects recognize the progress of their generic competences, through the subjects under study. Among the most prominent are adaptation or flexibility, communication, and reflection, which are consistent with the generic skills proposed in the Tuning Project for Latin America (Beneitone et al., 2007; Hanne, 2013; Rojo-Venegas & Navarro-Hernández, 2016; Sandoval-Pérez et al., 2021), for the training of subjects in Health Sciences. Also, it emerges from collaborative learning and its resulting group work, a strategy to build “Team Work” (Ariño, 2017) as a future Occupational Therapy professional.

They move away from the generic skills suggested by the Tuning Project for training in Health Sciences, specifically in learning the “Use of the Self as a Therapeutic Tool”, self-knowledge (Aroca-Costa & Hermida-Carballido, 2016; Castellanos, 2013; Campo del Paso et al., 2014; Rogers, 1972; Szmulewicz-Espinoza, 2013; Taylor, 2016) identified by students as learning developed in the subjects studied as a continuous process and that implies “Learning to Learn” (Hanne, 2013; Villarroel & Bruna, 2014). On the other hand, generic skills such as empathy (American Occupational Therapy Association, 2020; Castellanos, 2013; Campo del Paso et al., 2014; Kallergis, 2019; Méndez-López, 2014; Rogers, 1972; Taylor, 2016), la creatividad (Castellanos, 2013; Méndez-López, 2014; Szmulewicz-Espinoza, 2013) and group management (Castellanos, 2013; Scaffa, 2016) would become specific skills for the disciplinary action of the Occupational Therapist in this area, linked to skills for practice disciplinary and necessary to promote, prevent, intervene and socially reintegrate the subjects of care under the singular prism of occupation, in diverse socio-cultural contexts, professional skills that are promoted in the graduate profiles of the higher education institutions participating in this study.

The values mentioned by the students, such as respect, tolerance, and responsibility, are defined from a competency perspective, by the Tuning Project for Latin America (Beneitone et al., 2007) as “Social Responsibility” and “Respect for diversity”, highly related to user-centered bonding, are mentioned less frequently and with partial descriptions, which could indicate a low incidence and development of them in the subjects reviewed.

Continuing in this area, learning must be situated in a context (Guerra-García, 2020) and this particular study, is situated in the therapeutic relationship, which is where the “Use of the Self as a Therapeutic Tool” is expressed, for professional development. Students identify themselves as the context of the subject in care. This must be enriched to promote desired occupational changes in users or groups (Castellanos, 2013; Taylor, 2011). This may be the main reason for the difficulties in appreciating the learning obtained in the subjects at the end of them, not maintaining a correlation with real experiences through professional practices.

The relevance of this learning for the student is focused on self-knowledge, which would strengthen the interrelationship with the subjects of care. In this area, the learning goals are personal; and likewise, the weaknesses and strengths (Campo del Paso et al., 2014) would allow the student intervener to act consciously from his subjectivity at the service of the therapeutic process (Szmulewicz-Espinoza, 2013).

Also, they appreciate the learning of positive attitudes to pour into the therapeutic process, demonstrating skills that favor the therapeutic relationship from their personalities, and what is easier for them to do from their self-knowledge, generating styles and personal stamps that are reflected in the intervention (Casari et al., 2018; Campo del Paso et al., 2014; Taylor, 2016).

The professional identity is not rigid, and within the factors that provide flexibility, we find professional experience, theoretical choices, and approaches, as well as personal changes (Casari et al., 2018; Taylor, 2016). In this study, we visualized as a result that the theoretical approaches do not appear widely valued in the Conscious Use of the Self, by undergraduate students, which can be attributed to the complexity involved in integrating cognitive, procedural, and generic competences in this field (Castellanos, 2016).

Finally, we find these subjects and learning linked to two main trends in constructivist pedagogy: 1) those that could be combined under Piaget, who are more concerned with understanding the cognitive processes themselves; mainly observed in the work of resignifying experiences by students and the need to safeguard healthy environments, from teacher-student trust and 2) those that highlight the importance of the social in learning, related above all to Vygotsky's sociocultural theory, which gives a social origin to language and thought, observed in group learning methodologies, the generation of transversal knowledge from experiences, the circular and constructive feedback of the process, promoting the permanent reflection of the student in the field of social relations and their self-knowledge (Guerra-García, 2020).

Conclusions

From the experience of the teaching-learning process of Occupational Therapy students, it is possible to characterize the active methodology used by experiential workshops on the subject. They highlight safe group learning environments and the teaching role of the facilitator that contributes to the proactivity and autonomy of the student. The strategy generates an important adherence to learning from the feedback of peers and teachers, thus positively valuing the formative evaluation.

As a relevant characteristic of the humanistic workshops centered on the person, carried out from the pedagogical area of Occupational Therapy, the use of artistic techniques appears, mainly those of corporal expression and dynamics linked to the game, which strengthens meaningful, cooperative learning and self-knowledge of the student.

These characteristics, of pedagogy at the forefront of the constructivist educational paradigm, generate skills that prepare the student to achieve professional effectiveness in the complex learning for the “Use of the Self as a Therapeutic Tool”.

The subjects have great strength in the development of advanced communication skills, development of empathy, ability to manage groups, flexibility, creativity, and promote permanent reflection of students. Some of them become course specific. However, competencies such as respect for diversity and social responsibility should be approached with other active methodologies, since a low development of them appears from the student inquiry.

The constructivist paradigm describes that the teaching-learning experiences of the student body maintain diverse results, depending on the motivations, life experiences, and personalities of the student body.

Regarding the professional development for the “Use of the Self”, the students report a high value to the therapeutic link and the generation of personal stamps for the disciplinary practice, based on their self-knowledge. From the results obtained, there are still difficulties in integrating theoretical knowledge to linking styles.

The difficulties described around low development skills and theoretical difficulties could put Occupational Therapy centered on the person at risk, generating links focused on external motivation used in moral treatment; or else, centered on professional power described in the positivist disciplinary paradigm.

The limitations of this study are related to the low adherence of students to participate in research in times of pandemic and the virtual resources to be used for data collection, which limited the methods for this purpose.

We suggest other active methodologies that could prove to contribute to Occupational Therapy with a student-centered pedagogical approach are learning and service (L+S) and clinical simulation (CS). The first methodology can be ideally implemented in subjects with socio-community practices in a real and continuous context over time, rescuing the needs of the population subject to intervention and favoring respect for diversity and social responsibility as competencies. This practice would require the accompaniment of a disciplinary tutor with experience in person-centered community practices. Through clinical simulation, narrative reasoning could be favored, the key to achieving person-centered practice, which can be developed in subjects that address the assessment and intervention of individuals or groups under disciplinary care.

This study maintains exploratory scope since it seeks to rescue and analyze the opinion of Occupational Therapy students about the Use of the Self pedagogy at a given moment in a region in southern Chile, finding little existing evidence on the topic. This study can be continued through pedagogical action research methodological designs, seeking permanent improvement and curricular adjustments that are necessary to increase the suitability, effectiveness, and involvement of the student in the teaching-learning processes in this theme.

• 1
  The study carried out was authorized by the Ethics Committee of the Health Service of Valdivia, Chile, in the Ordinary N° 28, of January 21, 2021.
• How to cite: Valenzuela León, J., Cirineu, C. T., & Navarro Hernández, N. (2022). Use of the self as a therapeutic tool: a formative experience of occupational therapy in an undergraduate course. Cadernos Brasileiros de Terapia Ocupacional, 30, e3280. https://doi.org/10.1590/2526-8910.ctoAO251232802

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Edited by

Section editor

Prof. Dr. Ana Paula Serrata Malfitano

Publication Dates

• Publication in this collection
  10 Oct 2022
• Date of issue
  2022

History

• Received
  21 Feb 2022
• Reviewed
  07 Mar 2022
• Reviewed
  19 Apr 2022
• Accepted
  02 Aug 2022