SPECIFIC

INTERVENTION
PRINCIPLES
M.R. MPHOHONI
 SPECIFIC PROBLEMS
 THOUGHT PROCESS
 ORIENTATION
 MOTIVATION
 MEMORY
 ATTENTION/CONCENTRATION
 EMOTIONS
 ANXIETY
 MOTOR BEHAVIOUR
 PERCEPTION
 INSIGHT
 SELF-ESTEEM
 BADL/IADL PARTICIPATION
 WORK/VOCATIONAL PARTICIPATION
 LEISURE PARTICIPATION
 SOCIAL PARTICIPATION
 THOUGHT PROCESS
DISTURBANCES
 AIM: Thought Process Organization
 GENERAL PRINCIPLES: (Applicable throughout the
treatment session)
 Promote goal-directed flow of thought that follows a logical
sequence.
 Promote concept formation.
 Verbalize about what is happening in the patient’s environment
and during activity participation.
 Use concepts correctly.
 Divert the patient’s attention from the idea or object of
preoccupation.
 Encourage patient to express his or her thoughts.
THOUGHT PROCESS DISTURBANCES
 HANDLING PRINCIPLES (USE OF THE SELF)
 Accept the patient.
 Correct patient if a concept is referred to or used incorrectly.
 Correct delusions.

 PRESENTATION PRINCIPLES
 Demonstrations
 Step-by-step instructions
 Repetition

 STRUCTURING PRINCIPLES
 One-to-one initially.
 Situation must be realistically structured
THOUGHT PROCESS DISTURBANCES
 PRINCIPLES FOR ACTIVITY SELECTION (ACTIVITY
REQUIREMENTS)
 Concrete activities
 Activities or tasks that follow a logical sequence.
 Activities or tasks that involve concepts related to the patient’s
problem area.
 Give examples of Activities

 GRADING PRINCIPLES
 Concepts
 Duration of session
 External stimuli
DISORIENTATION (TIME, PLACE &
PERSON)
LOSS

OF CONTACT WITH REALITY
AIMS: To improve orientation
To improve reality orientation

 GENERAL PRINCIPLES
 Enable patient to apprehend his environment and locate himself in
relation to it.
 Continuous orientation throughout the day (person, place and time).
 Physical contact and constant verbalization to promote orientation
to reality.
 Represent reality to patient.
DISORIENTATION (TIME, PLACE & PERSON)
LOSS OF CONTACT WITH REALITY

 HANDLING
 Call patient by correct name.
 Correct delusions.
 Encourage patient to participate in situations

 PRESENTATION
 Use correct names for tools, materials and
equipment.
 Repetition.
DISORIENTATION (TIME, PLACE & PERSON)
LOSS OF CONTACT WITH REALITY

 STRUCTURING
 One – to-one initially.
 Situation must be realistically structured.

 ACTIVITY REQUIREMENTS
 Concrete activities.
 Activities that encourages orientation of self, time, place
and environment.

 GRADING
 Stimuli
 Therapist directed > Patient directed.
POOR MOTIVATION
 AIMS: To improve motivation by encouraging patient to:
 Find meaningful replacement of substances
 Participate in daily activities
 Solve own problems
 Interact with others

 GENERAL PRINCIPLES:
 Elicit desire to be involved in his/her environment and self.
 Expose patient to as many different situations or activities as possible.
 Determine activities with patient enjoys doing.
 Introduce some form of reward (material, “therapeutic”).
 Participate with the patient.
 Determine the cause of demotivation.
POOR MOTIVATION
 HANDLING
 Recognition of effort; Encouragement & Praise.
 Firm (participation).

 PRESENTATION
 Direct and indirect approach.
 Step-by-step demonstrations.
 Show examples.

 STRUCTURING
 One – to-one initially.
 Group sessions.
 Industrious area (where others are participating).
POOR MOTIVATION
 ACTIVITY REQUIREMENTS
 Those activities that stimulate inquisitiveness OR patient’s interest.
 Unknown elements.
 Flop proof.
 Competition element.
 Fast tempo.
 Outer range.
 Decision-making.
 Responsibility.

 GRADING
 Patient involvement (spectator -> active involvement -> leader).
 Gratification.
 Handling (support and encouragement).
 POOR MEMORY
AIMS:
 To improve memory.
 To compensate for loss of memory.

PRINCIPLES:
 Repetition.
 Improve ability to focus attention and to concentrate.
 Short sessions.
 Use a diary or a notebook.
 Use cues.
 Rehearsal to enhance retention and recall.
 Present one activity/task at a time.
 Make use of memory games.
 POOR MEMORY
HANDLING:
 Recognition of effort.
 Encouragement.
 Recognition.

PRESENTATION:
 Step-by-step (whole) with demonstrations.
 Repeat instructions.

STRUCTURING:
 One – to-one initially.
 Group sessions.
 Industrious area (where others are participating).
 POOR MEMORY

ACTIVITY REQUIREMENTS:
 Repetitive tasks.
 Activities that are within patient’s concentration ability.
 More than one-step activity.

GRADING:
 Number of steps.
 Complexity of activities.
 POOR
ATTENTION/CONCENTRATION
AIM: To improve attention or concentration
PRINCIPLES:
 Improve the ability to focus attention.
 Improve ability to concentrate on one subject for a specific
period of time (active span ≤ 45 minutes; passive 1 hour
+).
 Motivation encourages patient’s concentration.
 Give breaks in
 Present one activity/task at a time.

HANDLING:
 Bring patient back if distracted.
 Firm expectations with duration of concentration span.
 POOR
ATTENTION/CONCENTRATION
PRESENTATION:
 Step-by-step (whole) instructions.

STRUCTURING:
 Quiet area with minimal stimuli.
 Physically comfortable area.
 POOR
ATTENTION/CONCENTRATION
ACTIVITY REQUIREMENTS:
 Unknown activities.
 Complex tasks.
 Accuracy, planning.
 Fine dexterity.
 No repetitive tasks.

GRADING:
 Duration of session.
 Number of steps.
 External stimuli.
 Gratification.
DEPRESSED MOOD
 AIM: To alleviate feelings of depression - hopelessness, sadness,
despondency, hostility and guilt

 GENERAL PRINCIPLES
 Recognize these feelings and accept them.
 Facilitate involvement in pleasurable activities.
 Encourage expression of emotions.
 Improve psychomotor activities.
 Improve physical fitness through exercises to address vegetative system.
 Stimulate positive thoughts by improving cognitive processes.
 Repeat stimulus if a response is given.
 Build up a therapeutic relationship based on trust.
DEPRESSED MOOD
 HANDLING
 Support
 Recognition of any effort the patient makes.
 Acceptance
 Be patient

 PRESENTATION
 Direct involvement in activities (low level).
 Step-by-step instructions.
 Demonstrations.
 Repetition.
DEPRESSED MOOD
 STRUCTURING
 One-to-one initially

 ACTIVITY REQUIREMENTS
 Unknown activities.
 Immediate gratification.
 Outdoor activities.
 Flop proof.
 Activities that stimulate enjoyment and expression of emotions.
 Patient determines the speed of activity.

 GRADING
 Gratification
 Handling (decrease support).
ELEVATED MOOD
 AIM: To stabilize mood

 GENERAL PRINCIPLES:
 Constantly bring the patient’s attention back to the task or subject at
hand.
 Do not force the patient to sit still.
 Orientate the patient to reality with regard to interpretation and
evaluations of situations and incidents.
 Encourage role-play of different roles.
 Channelization of hyperactivity.
 Set definite limits for behaviour.

 HANDLING:
 Firm (with regard to unacceptable, manipulative, domineering, behaviour
and task performance).
 Acknowledge and encourage any attempts by the patient to do a task
ELEVATED MOOD

 PRESENTATION:
 Step-by-step with demonstrations

 STRUCTURING:
 Individual, later group.
 Area to accommodate hyperactivity.
 Minimize external stimuli
ELEVATED MOOD
 ACTIVITY REQUIREMENTS:
 Individual to Group activities.
 Activities that determines the speed of participation.
 Gross motor activities initially (wide range of
movement).
 Concrete.

 GRADING:
 Stimuli.
 Range of movement.
 Speed of activity
INAPPROPRIATE EMOTIONAL
RESPONSES
 AIM: To stimulate appropriate emotional responses

 GENERAL PRINCIPLES:
 Orientate the patient to reality (with regard to interpretation and
evaluations of situations and incidents).
 Expose patient situations where a variety of emotions could be
experienced.
 Repeat stimulus if a response is given.
 Promote appropriate emotional responses with regards to stimulus,
intensity and continuation.

 HANDLING:
 Recognition of any efforts (s).
INAPPROPRIATE EMOTIONAL
RESPONSES
 PRESENTATION:
 Direct involvement (low level patients)
 Step-by-step with demonstrations.

 STRUCTUTING: Group

 ACTIVITY REQUIREMENTS: Immediate

gratification

 GRADING: Gratification
 ANXIETY
AIMS:
 To reduce level of anxiety.
 To enable patient to cope with anxiety adequately.

PRINCIPLES:
 Identify the basic cause of anxiety in the patient.
 Improve patient’s self-esteem (anxiety due to feeling of
inadequately).
 Practical tips:
 Relaxation technique.
 To take a deep breath in and out slowly.
 Attend to one thing at a time, not many things at the same time.
 Discourage dependency.
 ANXIETY
HANDLING:
 Be consistent.
 Support.
 Give recognition.
 Reassurance.

PRESENTATION:
 Clear instructions.
 Step-by-step with demonstrations (one-step at the time initially).

STRUCTURING:
 Relaxed area.
 Limit external stimuli.
 Patient should be positioned such that he or she can observe what
happening in the treatment area.
 ANXIETY
ACTIVITY REQUIREMENTS:
 Flop proof.
 Few steps.
 Know activities.
 Concrete.

GRADING:
 Number of steps.
 Support.
 Structuring
 MOTOR BEHAVIOUR
PROBLEM: Psychomotor PROBLEM: Hyperactivity
Retardation
AIM: To channelize hyperactivity in order
AIM: Psychomotor Activation to promote constructive utilization of time.

PRINCIPLES:
PRINCIPLES:  Decrease distractibility and improve
 concentration.
Facilitate normal psychomotor
activity.  Set limits for behaviour.
 Stimulate physical, cognitive  Promote patient’s understanding of how
and psychological aspects. hyperactivity influences his functioning
 and how it affects others.
Start treatments on patient’s
level of psychomotor activity.  Be firm with task performance.
 Structure patient’s daily programme into a
routine.
 Limit number of activities at a time.
 MOTOR BEHAVIOUR
HANDLING (Retardation): HANDLING (Hyperactivity):
  Be firm with task performance and
Be patient and give time to
respond. behaviours.
 Acknowledge and encourage any attempts to
 Recognition of efforts.
do task correctly and control behaviour.
 Direct involvement (if patient
resists).
PRESENTATION:
 Step-by-step with demonstrations.
PRESENTATION:
 Step-by-step with demonstrations. STRUCTURING:
 One-to-one initially.
STRUCTURING:  Limit stimuli initially.
 Outdoor area.  Well controlled and organized environment.
 An area that is able to withstand boisterous
(energetic or cheerful) activity.
 MOTOR BEHAVIOUR
ACTIVITY REQUIREMENTS ACTIVITY REQUIREMENTS
(Retardation): (Hyperactivity):
 Wide range of movement.  Simple and concrete with a logical
 Patient determines the speed pattern.
initially.  Activities that allow the patient to set
 Short-term activities with few the speed.
steps.  Materials, tools and equipment that will
withstand rough handling.
 Wide range of movement.
GRADING:
 Speed. GRADING:
 Number of steps.  Speed.
 Duration.  Range of movement.
 Physical requirements.  Stimuli.
 PERCEPTION:
BODY AWARENESS DISTURBANCE
AIM: Body awareness retraining
PRINCIPLES:
 Encourage execution of coordinated movement.
 Encourage functional use of the body and various body parts.
 Work out a body awareness-training programme with specific
activities related to the problem areas.
 Group patients according to specific problems.
 Verbalize what the patient is doing.

HANDLING:
 Support.
 PERCEPTION:
BODY AWARENESS
PRESENTATION:
DISTURBANCE
 Demonstrations.

STRUCTURING:
 An area with a full-length mirror.
 Area where copying each other is possible

ACTIVITY REQUIREMENTS:
 Group.
 Wide range of movements.
 Physical movements
 Coordinated movements.
 PERCEPTION:
HALLUCINATIONS
AIM: Bring patient back to reality

PRINCIPLES:
 Call patient by his/her name.
 Verbalize what is happening around him/her.
 Make physical contact around him/her.

HANDLING:
 Acceptance.
 Support.
 PERCEPTION:
HALLUCINATIONS
PRESENTATION:
 Step-by-step with demonstrations.

STRUCTURING:
 One-to-one initially->group.

 ACTIVITY REQUIREMENTS:
 Concrete.
 Short-term
 Tangible product.
 POOR INSIGHT

 AIM: To improve insight

 GENERAL PRINCIPLES:
 Stimulate development of emotional and intellectual insight.
 Expose patient to an education programme about his condition
and behaviour.
 Teach problems solving techniques.
 Teach decision-making process.

 HANDLING, PRESENTATION AND ACTIVITY

REQUIREMENTS:
 Apply the Basic Principles
 LOW SELF-ESTEEM &
INFLATED SELF-ESTEEM
 AIM: To improve self-esteem
To encourage realistic evaluation of self

 GENERAL PRINCIPLES:
 Indicate to the patient that he/she is still capable of
successfully completing various tasks.
 Make the patient aware of own potential.
 Teach new skills.
 Correct delusions (inflated self-esteem).
 Improve insight (inflated self-esteem).
 LOW SELF-ESTEEM &
INFLATED SELF-ESTEEM
 HANDLING:
 Acceptance.
 Encouragement.
 Praise and recognition.

 PRESENTATION: Consider the level of Creative

Ability – Apply Basic principles

 STRUCTURING: Realistic (Consider different levels)

 LOW SELF-ESTEEM &
INFLATED SELF-ESTEEM
 ACTIVITY REQUIREMENTS:
 Accommodate for the improvement of all aspects of Personal
Management.
 Realistic to patient background and future.

 GRADING:
 Risk involvement in activity.
 Gratification.
 Decision-making.
 Responsibility.
 Handling (decrease support).
 STRESS
 AIM: To manage stress
 GENERAL PRINCIPLES:
 Make patient aware of adaptive and non-adaptive
behaviour.
Note!
Adaptive behaviour – deals with both the stress and the
stressor by admitting stress and implementing solutions.

Non –adaptive behaviour – does not deal directly with

stressors and denies that stress is felt; which leads to self-
protecting reactions (defense mechanisms).
STRESS
 GENERAL PRINCIPLES:
 Teach patient steps in solving stress situations (stress
management) namely:
Identifying stressors.
Clarifying exactly why you perceive these situations as
stressors.
Identifying your habitual responses/reactions to these
stressors and clarifying whether they are adaptive or
maladaptive.
Considering alternative ways of coping with this stressors.
Planning steps to be taken to manage the stressors in
future.