Shank & Coyle, Chapter 11

Shank & Coyle (2002) Activity-based interventions Supportive environment Therapeutic/helping relationship

“Of these three, the relationship between a client and a recreation therapist is most essential” (p. 189)

Austin (2002) Little has been written in TR literature about

describing or creating therapeutic relationships.

How do they differ from social relationships or friendships? Focus solely on needs of client Assist client to achieve goals Assist client to grow toward self-sufficiency &

independence Are not reciprocal Are not automatic Need to learn & practice skills

Identify 10-15 therapeutic/helping relationship skills needed for CTRS working with Homeless Substance abuse Spinal cord injury Mental retardation Psychiatric problems Dementia

Compare

Sprouse, 2004 Ability to develop rapport Boundaries Empathy Hope and connectedness Ethical behavior Sense of humor Self-disclosure Compassion & empathy

To be effective, need to understand what aspects of themselves influence client change & growth

Altruism & compassion Desire to serve

Openness & flexibility Genuineness

Congruence between words & actions Positive regard & respect for others

Unconditional positive regard Belief in value of play, recreation, &

leisure

Awareness of self Ability to analyze own feelings Empathy Courage

Courage to seek help & acknowledge limitations

Inventive & creative

Stamina Job can be physically & emotionally

demanding Enthusiasm Pressure

Need reliable social support system Nurture self Sense of humor Laugh at yourself Use leisure to renew physical & mental health

Ability to create partnerships/collaborate Clients Colleagues

Ability to empower clients Cultural competence

Communication competence Listening & responding skills Verbal & nonverbal Interpersonal space Using touch when communicating

Time Takes time Decreased length of stay Starts when first meet (assessment)

Emotional Closeness How close?

Self-disclosure How much?

CPI Crisis Prevention Institute World’s leading training organization Management of disruptive & assaultive

behavior Started 1980 In the past approved for NCTRC CEUs

CPI One-day seminar

Identify behaviors that could lead to a crisis Respond to prevent escalation Verbal and nonverbal techniques to defuse Cope with own fear & anxiety Principles of personal safety to avoid injury $699 per person

CPI Two-day workshop

When appropriate to physically intervene Team intervention strategies & techniques Physical & psychological well-being of those involved

in the crisis Safety & how to transport individual How to maintain rapport Steps for debriefing Documentation $1,099 per person

CPI Four-day instructor certification program Learn to conduct in-house training Learn to customize for agency Learn how to test participant’s competency in

skills $2,125

TCI Therapeutic Crisis Intervention Training program for staff that work with

youth in residential settings 5 day curriculum Train-the-trainer course

TCI Day 1: Crisis as Opportunity

Prevention of crisis situations Maintain self-control Awareness of person Awareness of environment Assessing the situation

TCI Day 2: Triggering & Escalation

Verbal crisis communication Nonverbal crisis communication Behavior management Protective interventions Teach alternatives to acting out

TCI Day 3: Escalation, Outburst & Recovery

When restraint should or should not be used Team restraint Small child restraint Breaking up fights Standing hold Recovery process

TCI Day 4: Outburst & Recovery

3 person restraint Transferring control Responding to feelings vs. behavior Practice role plays

TCI Day 5: Implementing the TCI System

Recovery for staff Documentation Evaluation and testing

Termination End relationship

Ritual, parties, tokens Reunions

Client’s death Impact on you Impact on other clients

Burnout (Austin, 1999) What is burnout?

Emotional & physical exhaustion Professional’s attitudes & behaviors change in

negative ways in response to job strain Loss of idealism, energy, and purpose as a result

of work conditions

Who are candidates for burnout? Repetitive contact with people Intense interpersonal contacts The “giving” role Job monotony

What are some signs of burnout? More difficult to get work done during normal

hours Lose sense of humor, effectively flat Physical fatigue Become more irritable Become more susceptible to illness,

headaches, back pain, etc. Social withdrawal Increased absenteeism

How can we prevent burnout? Develop support system Learn how to manage time effectively Know & respect your own skills, energy, &

level of commitment Spent time out of work role Take time off (mental health days, vacations) Use relaxation techniques Cry “uncle” when you need help Learn to laugh at yourself & the situation