Exploring Culture and Therapeutic Communication: Therapeutic Mode Use by Occupational Therapists in the United States and Singapore

Importance: According to the Intentional Relationship Model, six therapeutic modes characterize client-therapist interactions in occupational therapy: advocating, collaborating, empathizing, encouraging, instructing, and problem solving. However, whether these modes hold across cultural contexts is not clear. Objective: To compare therapeutic mode use in occupational therapy interactions in the United States and Singapore. Design: Cross-sectional observational study; questionnaires were collected and compared from two convenience samples of occupational therapists from the United States and Singapore, and results were analyzed using t tests and general linear modeling. Setting: Large tertiary hospitals. Participants: Occupational therapists were recruited if they had at least 6 mo experience in their clinical specialty. Adult client participants were recruited if they had or planned to have at least three occupational therapy sessions. Outcomes and Measures: The therapist version of the Clinical Assessment of Modes (CAM-T) was used to assess occupational therapists' therapeutic mode use in interactions with specific clients. Results: A total of 74 U.S. and 39 Singaporean client-therapist interactions were assessed. U.S. therapists were more likely to use the upper end of the response scale; after we corrected for this, the pattern of mode use was similar in both cultural contexts, with instructing mode used the most. In absolute terms, U.S. therapists used the instructing mode more frequently than Singaporean therapists. Conclusion and Relevance: Further research should be done to examine the sociocultural factors that affect responses on the CAM-T and mode use. What This Article Adds: This study is the first to compare therapeutic mode use in different cultural settings. With the globalization of occupational therapy practice, it is important to consider the generalizability of occupational therapy concepts across cultures.