The book describes a theory as a lighthouse to help direct therapy efforts in a certain direction.

In order to help a client one may use any of the following approaches however you need to be familiar with all of the concepts.

Why do you think it is important to know about all of the approaches to therapy?

Person-centered Approach Behaviorism Theory Attribution Theory Self-Efficacy Theory Psychoanalytic Theory

This approach was initially developed by Carl Rogers.

Rogers identified 3 critical elements to a successful therapy relationship.

1. Unconditional Positive Regard - all people are inherently good, only behavior is bad

2. Congruence or genuineness - really trying to help

3. Accuracy and Empathy - accurate about their

situation and show empathy

A critical part of this approach is the development of certain skills.

Look in your book on page 154 Table 10.1 for these skills.

Behaviorism represents a cluster of therapy modalities.

These are based on B.F. Skinner who is perhaps the most influential American psychologist of the 1900s concept of operant conditions.

There are 3 elements of the operant conditioning.

1. Trigger2. Behavior (response to the trigger)3. Consequence (desirable or

undesirable)4. Example Skinner Box

There are 4 operant conditioning concepts.

1. Positive Reinforcement2. Negative Reinforcement3. Punishment 4. Extinction

Positive reinforcement – strengthening (increasing) a behavior by presenting a positive stimulus immediately after the behavior has occurred.

Examples include Smiling at students after a correct response, commending students for their work, selecting them for a special project.

Negative reinforcement – strengthening (increasing) a behavior by removing a negative stimulus immediately after the behavior has occurred. Take away something they don’t want.

Obtaining a score of 80% or higher makes the final exam optional, submitting all assignments on time results in the lowest grade being dropped, perfect attendance is rewarded with a "homework pass, or stopping the seatbelt noise once you put you seatbelt on.

Punishment – a particular behavior is weakened by the consequence of experiencing a negative condition.

Rat presses bar and gets electrical shock, rat presses bar again and again is shocked, behavior is weakened by receiving a shock, students who fight are immediately referred to the principal, late assignments are given a grade of "0".

Extinction – a particular behavior is weakened by the consequence of not experiencing a positive condition or stopping a negative condition.

Rat presses a bar and nothing happens Presses bar again and nothing happens Behavior of pressing the bar is weakened

by not experiencing anything positive or stopping anything negative.

Look on page 155-156 for the various techniques used for behavior modifications.

Attribution theory is concerned with how individuals interpret events and how this relates to their thinking and behavior.

Attribution theory assumes that people try to determine why people do what they do, i.e., attribute causes to behavior.

Attribution theory has been used to explain the difference in motivation between high and low achievers. According to attribution theory, high achievers will approach rather than avoid tasks related to succeeding because they believe success is due to high ability and effort which they are confident of.

Failure is thought to be caused by bad luck or a poor exam, i.e. not their fault. Thus, failure doesn't affect their self-esteem but success builds pride and confidence.

On the other hand, low achievers avoid success-related chores because they tend to (a) doubt their ability and/or (b) assume success is related to luck or to "who you know" or to other factors beyond their control.

Thus, even when successful, it isn't as rewarding to the low achiever because he/she doesn't feel responsible, i.e., it doesn't increase his/her pride and confidence.

Self-efficacy is the belief in one's effectiveness in performing specific tasks.

This is based on 4 factors.1. Past performance2. Vicarious experiences (show them)3. Level of arousal (hype them up or relax

them)4. Verbal persuasion

Most important thing to remember about this approach require action on the Rt during the session or activity.

Simply watching is not enough. You may need to manipulate the

environment for success. Success must be genuine and not the

result of too much help.

The psychoanalytic theory acknowledges that the unconscious mind can influence behavior.

These unconscious behaviors can often take the form of defense mechanisms.

A defense mechanism is a tool that the unconscious uses to protect the ego (conscious) from anxiety-provoking thoughts, beliefs, or situations.

This can either be a good thing or a bad thing.

Example, If you use a sport to redirect aggression related to work difficulties then this is a positive thing.

You just learned of a positive example.

What is an example of a bad one?

All of the Common defense mechanisms can be found on page 158 table 10.3

Let’s discuss them.

• Models of therapeutic recreation practice are designed to provide frameworks for the delivery of services and for conducting research.

• They provide specific frames of reference to describe and direct professional practice.

• Since 1970 many models have been proposed and today specialists continue to use several different models as well as personal adaptations of models.

Leisure Ability Model Health protection – Health Promotion

Model Recreation Service Model

• The Leisure Ability Model is one of the oldest, most widely used, and most often critiqued therapeutic recreation practice models.

• It is based on the concepts of internal locus of control, intrinsic motivation, personal causality, freedom of choice, and flow.

• The Leisure Ability Model uses these ideas as the basis for three components of service: treatment, leisure education, and recreation participation.

• These three areas of service supply the content for creating, developing, implementing, and evaluating therapeutic recreation programs that are based on client need.

• The overall intended outcome of therapeutic recreation services, as defined by the Leisure Ability Model, is a satisfying, independent, and freely chosen leisure lifestyle.

• The Leisure Ability Model (Peterson & Gunn, 1984) is one of the oldest, most widely used, and yet most widely debated conceptual models of therapeutic recreation service delivery.

• Peterson (1989) outlined the major reason that the Leisure Ability Model has received such extensive debate.

• In a time when many therapeutic recreation professionals want to cling strongly to a more medical or "therapy" model of services, the Leisure Ability Model represents a strong "leisure" orientation

The Leisure Ability Model was constructed with the belief that the end product of therapeutic recreation services for clients was improved independent and satisfying leisure functioning, also referred to as a "leisure lifestyle" (Peterson, 1981, 1989; Peterson & Gunn, 1984).

• Leisure lifestyle is the day-to-day behavioral expression of one's leisure related attitudes, awareness, and activities revealed within the context and composite of the total life experience. (Peterson & Gunn, p. 4)

• Leisure lifestyle implies that an individual has sufficient skills, knowledge, attitudes, and abilities to participate successfully in and be satisfied with leisure and recreation experiences that are incorporated into his or her individual life pattern.

These participation and satisfaction levels ultimately speak to a person's quality of life and happiness.

The Leisure Ability Model contains three major categories of service: treatment, leisure education, and recreation participation.

• Each of these three service areas is based on distinct client needs and has specific purposes, expected behavior of clients, roles of the specialist, and targeted client outcomes.

• The overall anticipated outcome of therapeutic recreation service delivery is a satisfying leisure lifestyle; that is, the independent functioning of the client in leisure experiences and activities of his or her choice.

• Treatment services are provided based on client deficits in four functional domains related to leisure involvement: (a) physical, (b) mental, (c) emotional/affective, and (d) social.

• Deficits in these areas prevent the client from participating fully in recreation and leisure activities; that is, they are prerequisite to the client's successful, daily involvement in leisure.

• For the most part, the deficits represent functional limitations that typical counterparts (individuals without disabilities and/or illnesses) would not experience.

• For example, a child with behavior disorders may have social skills deficits (hitting, kicking, scratching) to the degree that this individual cannot participate with others in a socially acceptable manner.

• Until these disruptive behaviors are minimized or replaced by appropriate social behaviors, the child will not be very successful in learning about or experiencing leisure.

• For example, a child with behavior disorders may have social skills deficits (hitting, kicking, scratching) to the degree that this individual cannot participate with others in a socially acceptable manner.

• Until these disruptive behaviors are minimized or replaced by appropriate social behaviors, the child will not be very successful in learning about or experiencing leisure.

Can you think of any other examples of how the leisure ability model can be applied to real life situations based on what you have learned so far?

• The ultimate outcome of treatment services is to eliminate, significantly improve, or teach the client to adapt to existing functional limitations that hamper efforts to engage fully in leisure pursuits.

• Often these functional deficits are to the degree that the client has difficulty learning, developing his or her full potential, interacting with others, or being independent.

The aim of treatment services is to reduce these barriers so further learning and involvement by the client can take place.

Leisure education services focus on the client acquiring leisure-related attitudes, knowledge, and skills.

• Participating successfully in leisure requires a diverse range of skills and abilities, and many clients of therapeutic recreation services do not possess these, have not been able to use them in their leisure time, or need to re-learn them incorporating the effects of their illness and/ or disability.

• Leisure education services are provided to meet a wide range of client needs related to engaging in a variety of leisure activities and experiences

• Leisure education has four components: (a) leisure awareness, (b) social interaction skills, (c) leisure activity skills, and (d) leisure resources.

• Leisure awareness services focus on the cognitive appreciation of leisure. Content in this area may include, but is not limited to: (a) knowledge of leisure, (b) self-awareness in relation to leisure, (c) leisure and play attitudes, and (d) related participatory and decision-making skills.

It is felt that these four subcomponents represent areas of understanding that are needed to appreciate fully the importance of and need for leisure involvement.

These four areas can be taught separately, or in combination, as the client's needs and abilities dictate.

• Recreation participation programs are structured activities that allow the client to practice newly acquired skills, and/or experience enjoyment and self-expression.

• These programs are provided to allow the client greater freedom of choice within an organized delivery system and may, in fact, be part of the individual's leisure lifestyle.

• The Health Protection/Health Promotion Model rests on a humanistic perspective.

• Those who embrace the humanistic perspective believe that each of us has the responsibility for his or her own health and the capacity for making self-directed and wise choices regarding our health.

Health Protection/Health Promotion Model stipulates that the purpose of therapeutic recreation is to assist persons to recover following threats to health (health protection) and to achieve as high a level of health as possible (health promotion).

Under this model, "The mission of therapeutic recreation is to use activity, recreation, and leisure to help people to deal with problems that serve as barriers to health and to assist them to grow toward their highest levels of health and wellness" (Austin, 1997, p. 144).

• This model is more in line with the goals of modern health care than the Leisure ability model.

• However it is similar in that it organizes therapeutic recreation services into three components.

i. Prescriptive activitiesii. Recreationiii. Health

• When clients initially encounter illnesses or disorders, often they become self-absorbed.

• They have a tendency to withdraw from their usual life activities and to experience a loss of control over their lives (Flynn, 1980). Research (e.g., Langer & Rodin, 1976; Seligman & Maier, 1967) has shown that feelings of lack of control may bring about a sense of helplessness that can ultimately produce severe depression.

• At times such as this clients are encountering a significant threat to their health and are not prepared to enjoy and benefit from recreation or leisure.

• For these individuals, activity is a necessary prerequisite to health restoration.

• Activity is a means for them to begin to gain control over their situation and to overcome feelings of helplessness and depression that regularly accompany loss of control.

• Through recreation, clients begin to regain their equilibrium disrupted by stressors so that they may once again resume their quest for actualization.

• They take part in intrinsically motivated recreation experiences that produce a sense of mastery and accomplishment within a supportive and nonthreatening atmosphere.

• Clients have fun as they learn new skills, new behaviors, new ways to interact with others, new philosophies and values, and new cognition about themselves

In short, they learn that they can be successful in their interactions with the world.

Through recreation they are able to re-create themselves, thus combating threats to health and restoring stability

This model was designed on a comprehensive model of health care service proposed by the World Health Organization (WHO).

This model attempted to integrate TR into the wider system of health care.

This model mirrors the WHO services into level of care.

These levels include disease, impairment, disability, and handicap.

Each level has its own definition of the scope of disease with types of treatment.

This provides the therapist with all the tools necessary to match assessments, interventions pre-established by the health care community.

What are the similarities and differences of each model?

All three models offer structure and guidance to the specialist when working to provide the best care.

The model used often reflects the mission of the agency, clients served, as well as personal philosopy.

What model would you choose and why?

What are treatment modalities?

A Treatment modality is a term used to describe recreation or other activities used to help clients meet goals.

Look over page 71-72 Review the other treatment

modalities on pages 73-76

Leisure Education Values Clarification Stress Management Group Initiatives Self esteem Programs Expressive Therapies

Get into 6 groups and come up with an activity that would help to focus on these areas.

Leisure Education Values Clarification Stress Management Group Initiatives Self esteem Programs Expressive Therapies

Cognitive rehabilitation Physical rehabilitation Social-Emotional rehabilitation

Cognitive rehab serves to restore cognitive functions in persons with TBI, stroke, or other deficits in cognitive functions.

The therapist can use daily recreation and leisure activities to help people use their memory, recognize shapes and colors and perform complex tasks.

Give me an example of activities that You could use to help to help reinforce cognitive function.

Physical rehab is used to address physical deficits.

This approach is similar to the approach taken with the cognitive patients.

Give me an example of activities that You could use to help to help improve physical functions.

This is probably mort relevant to those with TBI but other conditions can also affect social skills and emotional state.

For example, stroke and MS can both affect emotional functions.

Give me an example of activities that You could use to help to help improve social emotional skills.