Instructors Guide Therapeutic Recreation Processes and Techniques Fifth Edition

1
Instructors GuideTherapeutic Recreation
Processes and TechniquesFifth Edition

• Youngkhill Lee
• Bryan P. McCormick

2
Table 2-1Four Major Theories of Helping
3
Table 2-1Four Major Theories of Helping (Cont.)
4
Table 2-1Four Major Theories of Helping (Cont.)
5
Table 2-1Four Major Theories of Helping (Cont.)
6
Table 2-2Freuds States of Psychosexual
Development

• Oral Stage
• Anal Stage
• Phallic Stage
• Latency Stage
• Genital Stage

Sources Murray Huelskoetter (1991)
Okun (2002) Rawlins, Williams, Beck (1993)
Rowe Mink (1993) Townsend (2000).
7
Table 2-3Common Defenses

• Denial. The source of distress is not
  acknowledged or perceived because it is too
  threatening. The person refuses to admit being
  frightened by an event or action of another
  individual.
• Repression. Unacceptable or anxiety-provoking
  thoughts or feelings are blotted out of
  consciousness. People forget threatening
  occurrences.
• Displacement. Emotions are transferred from the
  original person or object to a less formidable,
  or safer, target. It is the kick the cat
  defense.

8
Table 2-3Common Defenses (Cont.)

• Projection. Rejecting an unacceptable thought or
  feeling by blaming it on another person. By
  attributing it to someone else, the unacceptable
  thought or feeling is removed from the person.
• Sublimation. Directing a socially unacceptable
  desire or activity into a socially acceptable
  one. For example, releasing sexual urges though
  dance.
• Rationalization. A socially acceptable reason is
  given to avoid having to face a nonacceptable
  belief about oneself.
• Intellectualization. Painful emotions or feelings
  associated with an event are explained away by
  the use of a rational explanation.

9
Figure 2-1Parallel and Crossed Transactions
10
Table 3-1McDowells Levels of Counseling

• Leisure-Related Behavioral Problems
• Leisure Lifestyle Awareness Orientation
• Leisure Resource Guidance Orientation
• Leisure-Related Skills-Development Orientation

Source McDowell, C.F. (1984). Leisure
Consciousness, well-being, and counseling. In
E.T. Dowd (Ed.), Leisure counseling Concepts and
applications. Springfield, IL Charles C. Thomas.
11
Table 3-1McDowells Levels of Counseling (Cont.)

• Leisure-Related Behavioral Problems. To help
  clients resolve behavioral concerns. Clients
  develop effective coping skills and
  problem-solving abilities to deal with chronic or
  excessively expressed leisure-related behavioral
  concerns (e.g., boredom, TR watching, etc.).
• Leisure Lifestyle Awareness Orientation. To help
  clients improve self-knowledge and understanding
  pertaining to leisure values, beliefs, and
  attitudes. Clients develop understanding
  regarding leisure and issues such as personal
  lifestyle, family relations, and transitions
  (e.g., aging retirement, relocation, divorce).

12
Table 3-1McDowells Levels of Counseling (Cont.)

• Leisure Resource Guidance Orientation. To help
  clients match leisure interests with community
  resources. Clients need to identify leisure
  interests, or what to do in their free time and
  information regarding opportunities needs to be
  provided to them.
• Leisure-Related Skills-Development Orientation.
  To help clients develop the leisure-related
  skills and abilities that they lack. Clients
  develop skills in areas such as assertiveness,
  social skills, grooming, motor abilities,
  effective use of transportation, and recreation
  activities.

13
Figure 4-1Illness-Wellness Continuum
Illness
Wellness
Peak health
Death
(Concern with growth)
(Concern with disease)
14
Figure 4-2Health Protection/Health Promotion
Model
Stability Tendency (client choice is limited)
Stability Tendency Declines (TRS role narrows)
Actualization Tendency (clients has freedom of
choice)
TRS DRIVEN
Actualization Tendency Grows (clients role
enlarges)
(Client control is small)
CLIENT DIRECTED
15
Figure 4-3Cyclical Nature of the Therapeutic
Recreation Process
16
Table 4-1Guidelines for Using Standardized
Assessments

• Guidelines for Selection of Assessment Procedures
• Guidelines for Assessment Use
• Guidelines for Administering, Scoring, and
  Reporting
• Guidelines for Protecting the Rights of Clients

Source Dunn., J.D. (1989). Guidelines for
using published assessment procedures.
Therapeutic Recreation Journal, 23(2), 59-69.
17
Table 4-2Suggested Areas for Information Seeking
During Assessment Interviews

• Readiness for treatment or participation in
  recreation activities or leisure counseling.
• Degree of rationality (for psychiatric and other
  appropriate clients).
• Strength and number of relationships with others.
• Resources for support (financial, psychological,
  personal).
• Leisure-related problems.

Source Items drawn from Ferguson, D. D.
(1983). Assessment interviewing techniques A
useful tool in developing individual program
plans. Therapeutic Recreation Journal, 17(2),
16-22.
18
Table 4-2Suggested Areas for Information Seeking
During Assessment Interviews (Cont.)

• 6. Leisure values held.
• 7. Awareness of resources available for
  leisure.
• 8. Basic skills needed to develop leisure
  skills.
• 9. Client's leisure history.
• 10. Personal appearance, hygiene, and other
  habits.
• 11. Other problem areas.

Source Items drawn from Ferguson, D. D.
(1983). Assessment interviewing techniques A
useful tool in developing individual program
plans. Therapeutic Recreation Journal, 17(2),
16-22.
19
Table 4-5Outline for program protocols

• Program Title
• Time and Place of Program
• Target Population/ Size of Group
• Client Referral Criteria
• General Program Purpose
• Program description
• Problems or Deficits the Program Might Address

Source Cole, M. B. (1993). Group dynamics
in occupational therapy The theoretical basis
and practice application of group treatment.
Thorofare, NJ SLACK Incorporated Kelland, J.
(Editor) (1995). Protocols for recreation therapy
program. State College, PA Venture Publishing
OMorrow, G.S. Carter, M. J. (1997). Effective
management in therapeutic creation service. State
College, PA Venture Publishing, Inc.
20
Table 4-5Outline for program protocols (Cont.)

• Interventions or Facilitation Techniques to be
  Employed
• Staff Program Responsibilities
• Training Requirements for Staff
• Risk Management Considerations
• Expected Program Outcomes
• Program Evaluation Methods/ Frequency

Source Cole, M. B. (1993). Group dynamics
in occupational therapy The theoretical basis
and practice application of group treatment.
Thorofare, NJ SLACK Incorporated Kelland, J.
(Editor) (1995). Protocols for recreation therapy
program. State College, PA Venture Publishing
OMorrow, G.S. Carter, M. J. (1997). Effective
management in therapeutic creation service. State
College, PA Venture Publishing, Inc.
21
Table 6-1Attentive Listening Using Acronym
SOLER

• S - Sit squarely facing the clients.
• O - Observe an open posture.
• L - Lean forward toward the client.
• E - Establish eye contact.
• R - Relax.

Source Adapted from Egan, G. (2002). The
skilled helper A problem management approach to
helping (7th edition). Pacific Grove, CA Brooks/
Cole Publishing Company Townsend, M. C. (2000).
Psychiatric mental health nursing Concepts of
care (3rd edition). Philadelphia F. A. Davis
Company.
22
Table 6-2Verbal Techniques

• Informing
• Summarizing
• Self-disclosing
• Focusing
• Making observations
• Closed questions
• Facilitative questions and statements

• Minimal verbal responses
• Paraphrasing
• Checking out
• Clarifying
• Probing
• Reflecting
• Interpreting
• Confronting

23
Table 6-6Communication with Clients with Special
Needs

• Clients Who Are Visually Impaired
• Clients Who Are Hearing Impaired
• Clients Who Use Wheelchairs
• Clients Who Speak a Foreign Language

24
Figure 7-1Factors Influencing Choices of
Leadership Style
Leader (ability and personality)
25
Figure 7-2Continuum of Leadership Styles
Autocratic
Laissez-faire
Democratic
(Leader centered)
(Client centered)
Dependency
Independency
26
Table 10-3Anticonvulsant Drugs (Standard Agents)

• Phenobarbital (Luminal, Mysoline)
• Possible side effects sedation, lethargy,
  mental dullness, hyperactivity, skin rash.
• Phenytoin (Dilantin)
• Possible side effects unsteady gain, slurred
  speech, drowsiness, fatigue, gum swelling, skin
  rash, hair growth, anemia, infections.
• Carbamazepine (Tegretol)
• Possible side effects sedation, unsteady gain,
  anemia, infections.
• Valproic acid (Depakote)
• Possible side effects nausea and vomiting,
  decreased liver function, decreased platelets,
  unsteady gait, weight gain.

Sources Mattson (1998) Pellock (1998)
27
Table 10-3Anticonvulsant Drugs (New Agents)

• Lamotrigine (Lamictal)
• Possible side effects skin rash, lethargy,
  stomach upset, unsteady gait, respiratory
  infections.
• Gabapentin (Neurontin)
• Possible side effects sedation, lethargy,
  hyperactivity, irritability, dizziness, headache.
• Topiramate (Topamax)
• Possible side effects sedation, dizziness,
  unsteadiness, nausea, numbness.
• Tiagabine (Gabitril)
• Possible side effects dizziness, lethargy,
  nervousness, tremor, stomach upset.

Sources Mattson (1998) Pellock (1998)
28
Table 10-4Antipsychotic Drugs

• Typical antipsychotics
• 1. Chlorpromazine (Thorazine)
• 2. Thioridazine (Mellaril)
• 3. Fluphenazine (Prolixin)
• 4. Thiothixene (Navane)
• 5. Haloperidol (Haldol)
• 6. Primozide (Orap)

• Atypical antipsychotics
• 1. Clozapine (Clozaril)
• 2. Risperidone (Risperdal)
• 3. Olanzapine (Zypreza)
• 4. Quetiapine (Seroquel)

Source Schatzberg Nemeroff (1998)
29
Table 10-4Antipsychotic Drugs (Cont.)

• Desired Effects
• Major actions include the reduction of symptoms
  of psychosis (i.e., hallucinations, delusions,
  disordered thinking processes, and social
  withdrawal). The antipsychotic drugs have been
  used in the pervasive developmental disorders for
  reducing hyperactivity, emotional quieting, and
  decreased anxiety, and in Tourettes syndrome to
  decrease tics.

Source Schatzberg Nemeroff (1998)
30
Table 10-5Antipsychotic Drug Side Effects

• Extrapyramidal Side Effects (EPS)
• Motor restlessness where the client cannot spot
  moving (akathisia).
• Involuntary jerking and bizarre movements of
  muscles in the face, neck, tongue, eyes, arms,
  and legs.
• Tremors, muscle weakness, and fatigue.
• Parkinson-like symptoms such as rigidity,
  drooling, difficulty in speaking, slow movement,
  and an unusual gait when walking, where the
  client has trouble slowing down.

Source Appleton (1998) Newton et al. (1978)
Schatzberg Nemeroff (1988)
31
Table 10-5Antipsychotic Drug Side Effects (Cont.)

• Tardive Dyskinesia (TD)
• Abnormal mouth motion such as lip smacking,
  chewing, sucking, moving the tongue in and out of
  the mouth quickly, and pushing out the cheeks.
• Involuntary movements of the jaw, increase
  blinking, and spasms of muscles in the face,
  neck, back, eyes, arms, and legs.

Source Appleton (1998) Newton et al. (1978)
Schatzberg Nemeroff (1988)
32
Table 10-5Antipsychotic Drug Side Effects (Cont.)
Other Side Effects

• Drowsiness
• Low blood pressure
• Nausea
• Vomiting
• Rash
• Dry mouth
• Urinary retention
• Blood destruction
• Photosensitivity
• (especially with Thorazine)

• Edema
• Weight gain
• Feminizing effects
• Menstrual irregularities
• Blurred vision
• Constipation
• Seizures
• Skin discoloration
• Fever
• Drop in blood cell count (especially with
  Clozapine)

Source Appleton (1998) Newton et al.
(1978) Schatzberg Nemeroff (1988)
33
Table 10-6Antidepressants
Drug

• Serotonin reuptake inhibitors
• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Paroxetine (Paxil)
• Fluvoxamine (Luvox)
• Others
• Buproprion (Wellbutrin)
• Venlafaxine (Effexor)
• Mirtazapine (Remeron)

• Tricyclic antidepressants
• Imipramine (Tofranil)
• Amitriptyline (Elavil)
• Desipramine (Norpramin)
• Nortriptyline (Pamelor)
• Heterocyclic antidepressants
• Trazadone (Desyrel)
• Nefazadone (Serzone)

Source Appleton (1988) Schatzberg
Nemeroff (1998)
34
Table 10-6Antidepressants

• Desired Effects
• Relief of feelings such as hopelessness,
  sadness, helplessness, anxiety, worthlessness,
  and fatigue that are associated with depression.

Source Appleton (1988) Schatzberg Nemeroff
(1998)
35
Table 10-7 Antianxiety Drugs
Drug

• Benzodiazepines
• Alprazolam (Xanax)
• Chlordiazepoxide (Librium)
• Clonazepam (Klonopin)
• Diazepam (Valium)
• Flurazepam (Dalmane)
• Lorazepam (Ativan)
• Temazepam (Restoril)
• Triazolam (Halcion)
• Serotonin reuptake inhibitors
• Tricyclic antidepressants

• Azapirone
• Buspirone (BuSpar)

SourceNewton et al. (1978) Appleton (1998)
Schatzberg Nemeroff (1998)
36
Table 10-7 (cont.)Antianxiety Drugs

• Desired Effects
• Reduction of anxiety, relaxation of skeletal
  muscles, relief of symptoms of tension and
  insomnia, and anticonvulsant properties.

Source Appleton (1998) Newton et al. (1978)
Schatzberg Nemeroff (1988)
37
Figure 10-1Transferring a Client from a
Wheelchair to a Bed
38
Figure 10-2Transferring a Client from a Bed to a
Wheelchair