The psychoanalytic frame of reference (FOR) emphasizes on the unconscious aspect of what is done and said, and it is embedded in an occupational therapy relationship model of practice - the Vivaio model (MOVI). The central element of the MOVI is the recognition of constant emotions that exist in the interdependent relationship between the three elements of patient, therapist and ‘doing’. All the three elements are considered protagonists; each communicates and transfers something to the other, creating a dynamic transference (unconscious links with other relationships in the patient’s or therapist’s past or present lives). This model uniquely includes theorization of the presence of the therapist and emphasizes the dynamic of the therapeutic change. The seven interconnected components of MOVI are, with emotions in the relationship as the central concept:
Evaluation: attentive observation to offer respect and create an atmosphere of containment, an emotional climate that allows therapists to identify two areas of functioning: patient’s external, visual lives and internal lives linked to fantasies, dreams and desires. The use of activities like human figure with clay, free painting, structured tasks is included in the process,
The interactive process: it contributes to growth of mental function,
The space and time settings: stability and a space of trust, fixed time schedule,
Choice and play: by client’s choice, self-initiated, original and creative,
Materials and transformations: transformation of materials by cutting, pounding, cooking, playing, etc.,
Sensory experience and thought: “doing” as a means to gain access to the mind,
Nonhuman environment: materials, objects, landscapes, etc.
The MOVI is based on psychoanalytic thinking and it helps occupational therapists in examining the meaning of ‘doing’, therapeutic relationship, and unconscious elements during the interactions.
Frame of reference
Domain of occupation
It contributes to facilitation of therapists’ understanding in meaning of unconscious and unspoken elements during therapeutic relationship.
Nicholls, L., Cunningham-Piergrossi, J., de Sena-Gibertoni, C., & Daniel, M. (2013). Psychoanalytic thinking in occupational therapy: Symbolic, relational, and transformative. Chichester, West Sussex: Wiley-Blackwell.
Psychodynamic Frame of Reference (psychodynamic FOR) is based on Dr. Sigmund Freud’s idea that human has the initiative to invest emotions and psychic energy to achieve basic needs and maintain relationship. When an individual fails to maintain healthy relationships due to the conflicts or insufficient ego defense mechanism, dysfunction will occur. Occupational therapists can base this psychodynamic FOR to help treat the dysfunction using two main approaches including explorative and supportive approach.
The Framework of Doing-Being-Becoming describes the theme of “doing”, “being”, and “becoming” in occupational therapy practice. In this framework, “Doing” refers to occupation and occupational performance of an individual, which is essential for the individual to interact with others and develop own identity, and to create and shape the society. “Being” refers to being true to self, that people are required to spend time thinking and reflecting themselves. This helps an individual describes and sustains the own roles.
This model comprises the complexity and multi-dimensionality of the relation between persons with motor disabilities and their environment. It addresses the personalized accessibility (i.e., unique needs of a person living in a specific environment that is central to this person). It defines the relationship of the person-environment interaction using six concepts, they are:
This model aims to conceptualize children’s underlying skills and behavioral elements characteristic of play, as well as the influences that both individual and environmental factors. Embedded in the play environment and cultural and familial milieu, this model includes developmental play capacities (cognitive, physical and social play skills) and individual play style (internal control, freedom to suspend reality and intrinsic motivation) that make up the child’s contribution to the play transaction. Play reflects the child’s cognitive, motor, language and social skills.
The Meaning Perspectives Transformation Model is characterised by three phases: the trigger phase, the changing phase, and the outcome phase. These three phases move the process of meaning perspective transformation in the physical, emotional, cognitive, or spiritual dimensions. Critical self-reflection acts as a catalyst and represents as a moment of “readiness of change”. This allows clients to identify their assumptions, question meaning, and develop alternative ways of performing.