Abstract: Aim: There is limited understanding of therapeutic relationships in community occupational therapy from a psychodynamic perspective. I explored community occupational therapists’ lived experiences of therapeutic relationships with special attention to countertransference. Methods: Interpretive and descriptive phenomenology was used. Eight occupational therapists with experience providing occupational therapy to people in their homes completed two qualitative interviews. Epoche and reduction analysis methods were applied during the thematic analysis and phenomenological writing phases of the study. Findings: Themes related to the therapeutic relationship illuminated tensions therapists experienced between 1) the need to obtain “buy-in” from clients and insecurity regarding their expertise and the potential effectiveness of occupational therapy; 2) self-disclosure and self-protection, and 3) “planting the seed” and feeling responsible for immediate therapeutic outcomes. Therapists voiced difficulty understanding the concept of countertransference but were able to provide powerful examples. They experienced objective, subjective, positive, and negative countertransference. Themes included: 1) fear: experiencing physical vulnerability; 2) sadness: experiencing emotional vulnerability; and 3) frustration: experiencing social vulnerability, all of which impacted therapists’ conscious and unconscious behaviours. Discussion: When reflected upon, countertransference appeared to be a powerful source of information during therapeutic clinical reasoning. It informed the therapists’ use of therapeutic skills including boundary setting, self-disclosure, compassion, empathy, and containment in a diverse array of therapeutic relationships. Significance: Occupational therapy may benefit from a more transparent discussion and acceptance of the emotional dimensions of practice. Integrating a greater awareness and understanding of the intersubjective dynamics of the therapeutic relationship in practice may be beneficial for community occupational therapists.

Yes / Living well with dementia is promoted nationally and internationally (Department of Health, 2009: Global Action Against Dementia, 2013). UK health policy recommends post-diagnostic support to enable people to live well in the community for as long as possible (Department of Health, 2015; NHS England, 2017; Scottish Government, 2017; Welsh Government, 2017). This is important given that a cure for dementia is not imminent. A growing evidence base demonstrates that psychosocial interventions can benefit people with mild to moderate dementia, by improving cognition, performance in valued activities or daily living skills, maintaining quality of life or carer coping. (Clare et al., 2011;2017; Graff et al.,2006,2007; Streater et al.,2016). Occupational therapists offer interventions to people living with mild to moderate dementia and family carers (Swinson et al.,2016;Streater et al.,2016;Yuill and Hollis,2011). The National Institute for Clinical Excellence and Social Care Institute for Excellence (2006) recommended occupational therapists provide skills training for activities of daily living. Also, the Memory Services National Accreditation Programme recommends people with dementia have access to occupational therapy and other psychosocial interventions such as reminiscence, life story work or cognitive stimulation therapy, for the cognitive, emotional, occupational and functional aspects of dementia (Hodge et al.,2016). Such interventions can be delivered by occupational therapists. The focus on the benefits of non-pharmacological interventions provides occupational therapists with an opportunity, to deliver services that improve lives and the experience of dementia (Collier and Pool, 2016). Understanding what may influence uptake of such interventions is important if people with dementia and their carers are to benefit from what occupational therapists can offer. Yet what supports the uptake of such interventions, specifically by people with mild to moderate dementia and their family carers, living in the community is poorly understood and limited research about this topic exists. ‘Uptake’, in this paper, is defined as initial acceptance of an offer, of intervention, support or services, rather than continued engagement or adherence to an intervention over time. / National Institute for Health Research’s Programme Grants for Applied Research Programme (RP-PG 0610-10108)