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Therapeutic Recreation Essay
Cathy O=Keefe,
M.Ed., CTRS, has been an instructor in therapeutic recreation at the University
of South Alabama since 1975. She
has served on the Board of Directors for the National Council for Therapeutic
Recreation Certification and as the chairperson of the Ethical Practices for the
National Therapeutic Recreation Society and serves as the Alabama representative
for NTRS. She also holds membership
in the American Therapeutic Recreation Society.
Mrs. O=Keefe
has worked in adult psychiatry, in residential programs for adults with
developmental disabilities, with acute and chronically ill children in hospital
pediatric medicine, with nursing home and assisted living residents, and with
persons who are dying.
The primary focus of Mrs. O=Keefe=s
professional writing lies with emphasizing the ethics of caring; the need to
address suffering; the role of spirituality in habilitation and rehabilitation,
and; how existential outcomes of happiness, joy, inner peace, and meaning
positively affects the quality of life.
Please read the following essay written to explain the
wonderful work done by therapeutic recreation specialists.
Perhaps it will help you, the reader, discover if the field is right for
you.
AN
ESSAY FOR STUDENTS
INTERESTED
IN THERAPEUTIC RECREATION
Thank you for search out material on therapeutic
recreation. My name is Cathy
O'Keefe, and I have taught therapeutic recreation for over twenty years here at
the University of South Alabama in Mobile, Alabama, a city that sits just north
of the Gulf of Mexico in the Southern United States.
My hope is that this essay becomes part of a larger internet dialogue among professionals and students currently enrolled in TR programs and those seeking a direction of study in either the graduate or undergraduate environment. Perhaps it can also include our consumers who have already benefited from TR services or are searching for what we offer. You have taken the first step already, and I look forward to hearing from you.
This paper reflects on a comment that consistently
emerges from students as they search for a major field of study or are moving
through our courses here at the University of South Alabama.
"I have trouble getting a handle on a good explanation of
therapeutic recreation, one that really says it all," most students admit.
In addition, when parents ask what this TR major is all about, it is
often difficult, beyond offering a few brochures, to help them understand.
Ironically, what creates the problem of searching for a
neatly packaged explanation of therapeutic recreation is really my greatest
source of joy. We are a field of
broad applications and diverse service populations. This translates into a
variety of career environments with opportunities for enrichment of depth and
new practice at all disability and age levels.
New students usually lack sufficient exposure to such a broad range of
service settings to really appreciate them, and some of our own professionals
who work strictly in one setting for their entire career may strain against what
they perceive as a lack of specificity or focus for the field.
I thought it might be helpful to trace my own journey to show you how an
understanding of therapeutic recreation has unfolded in my life.
******
In 1972, I began working as an activities therapist in
an in-patient psychiatric unit treating emotionally disturbed patients, drug
addicts, and older adults with dementia. I
found that my program could add invaluable behavioral information to the
treatment team helping them correctly diagnose problems and track improvement
over the course of hospitalization. My observations were critically important because I had
continuous contact with patients, and the other members of the team did not.
Patients frequently shared hidden fears and thoughts as we worked
individually or in groups because they perceived my modality of service as
non-threatening, and enabled me to develop good rapport.
Some of our recreation programming was specifically geared toward
reducing stressors, improving physical health, connecting patients with loved
ones at home, and enhancing social skills that would help them adjust to living
outside the hospital after discharge. I
found my work challenging and intense at times because of the nature of
psychiatric illness, but it was always exciting and appreciated by our clients.
Conclusion:
I
saw TR as a modality that could provide valuable diagnostic feedback and as a
respite from the intensity of psychiatric illness as clients experienced it.
*******
In 1973, my husband and I began working with
disadvantaged youth. We volunteered
at the local detention facility and worked in a Catholic parish in an area of
town called Plateau where the last ship of slaves was brought to the United
States from Africa in the early 1860s. These
families, while extremely poor, had a wonderful sense of their roots.
Recreation was the vehicle that we frequently used to take the children
outside their usual environment in order to see new possibilities and gain
experience interacting with other economic groups.
During the summer, I accompanied inner city youth to camp settings where
we focused, through recreation, on improved self-image, communication, and
socialization skills.
TR jobs were available in those days with the
disadvantaged. Sadly, however, they
evaporated for the most part during the eighties and we are now playing catch up
via new recreation initiatives aimed at gang prevention and anti-recidivism.
I learned from these experiences that TR is an incredibly effective
vehicle for educating children about the importance of leisure and recreation as
a life long source of healthy behavior. We
call this leisure education.
Conclusion:
TR holds the ability to develop skills in children and youth that can
diminish the negative affects of poverty, create potential for sound and healthy
behavior, and bridge the gap between economic groups that often keep people
unaware of their similarities to others. I
also learned that the value of work with a specific population should never be
tied to financial support for that work from either government or insurance
agencies. Work with the poor should
never go out of style or become politically unpopular.
Support for this work within our field must remain a priority.
Since many of these youth are at risk for legal trouble and eventual
incarceration, it is especially critical to teach them recreation skills that
have the potential to keep them away from dangerous situations involving drugs
or violence.
******
In 1976, with the premature birth of my twin sons, I
found it necessary to stop working full time.
I had been concerned for years about the condition of nursing homes and
the lack of quality TR services found in most institutions.
I started a long-term care consultation practice that lasted over fifteen
years. It enabled me to elevate the
level of skill needed by staff in nursing homes to successfully address
physical, intellectual, social, and emotional needs.
I learned, as well, the value of spiritual growth as residents struggled
to combat feelings of abandonment, helplessness, and isolation.
In this setting, group activity promoted community and a feeling of being
at home with others. However,
nothing compared to the quiet moments at the bedside of patients too ill to get
up. I found this to be rewarding
work because it enabled me to experience my patients as unique individuals whose
quality of life could only be defined by them.
I learned that an inability to function didn't necessitate a poor quality
of life and that internal peace and happiness spring from being valued by others
and finding meaning in one's daily life. The
truly wonderful thing about therapeutic recreation is that by its very nature it
honors and nurtures autonomy and meaning.
Conclusion: TR contributes not only to improved functioning but also to the more essential human experience - meaning and value. Additionally, TR has the ability to nurture autonomy. Helping individuals who must live in institutional settings to express their uniqueness force staffers who care for them to honor their dignity as persons. TR humanizes nursing homes and assisted living facilities, making them more home-like places to live.
******
In 1978, my twin sons required surgery, and I was
appalled by the lack of child-centered activity at our pediatric unit within our
general hospital. Since the
university owned this hospital, I decided to attempt to create a child life
program there. This type
programming addresses the psychosocial needs of children and families so that
the trauma of sickness and hospitalization is minimized and normal developmental
growth can occur. My initial offer
to the administrator to voluntarily design the program was met with disinterest.
It was a good idea but not the right time.
You, too, may have many good ideas about therapeutic recreation
programming but find that they fall on deaf ears until others, particularly
clients, speak up for TR. Finally,
a few years later, I linked up with some other interested families and
professionals to help create a new children's and women's hospital.
My TR students have been part of this program for over ten years now, and
the hands-on experience with the children is incredible. Children in the hospital who are acutely or chronically ill
need two kinds of play: that which
addresses particular medical concerns (needle, surgical, or procedural play) and
normal developmental play to counteract the negative affects of hospitalization.
Conclusion:
TR specialists are often hired in pediatric child life settings.
Their job is to use play to address particular medical needs and to help
children express their fears and feelings.
Additionally, age appropriate developmental play helps children normalize
their experiences and offers a respite from the more difficult challenges of
illness and treatment.
******
For the past twenty-five years my husband and I have
been affiliated with a community called L'Arche (a French word meaning the Ark.)
This is an international movement based on the premise that able-bodied
assistants living in community with persons who have developmental disabilities
are a sign to the public at large of the value of persons with disabilities.
There are approximately 100 L'Arche communities around the world, each
taking on the cultural and spiritual characteristics of their environment.
In Mobile, the community is Christian, so the core members and assistants
live out their commitment to one another in context of the beatitudes.
We truly find that we are blessed by their friendship and warmth.
I clearly saw the value of TR in the L'Arche community
many years ago when I showed a film to my students about a trip that L'Arche
Canada took to France with over 4,000 people.
Jean Vanier, founder of L'Arche, noted that everyone needs something to
look forward to, to experience, and to look back on as a memory.
Recreation at L'Arche centers on the creation of a family atmosphere, but
each core member develops individual recreation interests and skills that
dovetail with goals for independence and self care.
L'Arche's recreation is unique in that core members and assistants are
able to connect with the larger L'Arche family via trips and conferences making
even long distance friendships easy to develop.
Conclusion:
Persons
with developmental disabilities are living actively in our communities as never
before. TR can be used in the
school setting to provide leisure education and build recreation skills that
offer life long enjoyment and social experiences to children and adults.
In addition, recreation provides a common ground where able bodied and
differently abled children and adults can interact meaningfully, creating
respect and opportunities for understanding.
******
During the summer of '96, my husband was diagnosed with
prostate cancer. It was a time to
face the fear of death and come to grips with the reality of a serious physical
illness. I was fortunate in 1978 to
have met Dr. Elizabeth Kübler Ross, a physician who wrote extensively about
death and dying and who laid important groundwork for palliative care for the
dying. So far, his cancer has been
arrested by surgery, but I was reminded through our ordeal of the vital
importance of TR in the hospice setting when we felt our own time together
possibly running out. We have five
children, all of whom share our philosophical belief that nothing is more
precious than time, so it should be spent on the things that mean the most.
In our case, that means family, and we have planned many recreational
experiences over the years with our children so they will have great memories of
our family life.
When I work in TR with hospice patients, I remind them
that while it may seem absurd to seek the services of a TR specialist in
hospice, the very word leisure means freedom, so we work to maximize the freedom
to make choices about how one's time is spent when time is of the essence.
Today I offer my services to persons who are dying by
helping them to make videotapes for their families, especially if they have
young children. Using an expressive
arts medium like video, I believe people facing death can tell their stories,
make meaning of their life experiences, and can leave for their children gifts
of wisdom, advice, support, and love.
Conclusion:
In
reality, our leisure experiences should be healthy and life giving through all
the years that we live. When we consciously reflect on experiences to make
meaning of them for our personal growth and happiness, we contribute to our own
therapy. In the sense that
recreation heightens our awareness of this and creates the ability to generate
self-acceptance, love, and enjoyment in life, all recreation is therapeutic.
The help of people educated in therapeutic recreation principles and
practices allows those we serve to better access this therapeutic value.
******
On Super Bowl Sunday, 1997, one of my closest friends
suffered a stroke and was admitted to a rehabilitation hospital for therapy
after being stabilized medically. For
years I have taken students to the physical rehabilitation setting to work with
persons who have had spinal cord injuries, strokes, joint replacements and the
like. This was my first chance to
be part of the family's viewpoint of therapy and to see from start to finish the
whole process with one patient.
When the physical rehabilitation team works well
together, the patient sets goals that are realistic and achievable, and the team
uses all its skills to lay a course toward those goals.
It is a long process for most patients, and TR's contribution is to
accompany the patient through it, keying in on recreational interests that have
been sources of personal motivation for the patient in the past.
Those valued recreation experiences that can be enjoyed again form a base
of familiarity and success for the patient.
Some illnesses, however, present great barriers to patients who must then
look to new sources of leisure and recreation to prepare for life with a
disability. The TR specialist helps
the client identify new and potentially enjoyable interests and then proceeds to
teach the skills and adaptations necessary to make them part of the client's
life.
During
rehabilitation, patients must confront the outside world again learning to
successfully deal with a variety of obstacles.
The TR specialist takes the client back into the community to practice
techniques learned in therapy and to gain the confidence to negotiate the tasks
of everyday living after discharge. Because
therapy is a long process, many patients form close personal bonds with their
therapists as they work from a state of dependence to independence.
Making this transition requires the TR specialist to connect the client
to resources in the community where physical healing, socialization,
intellectual stimulation, and spiritual growth can be nurtured.
In the best sense, the client learns to "re-create" his true
self, letting go of the past and moving ahead either to total recovery or a
meaningful life in spite of a disability. I
asked my friend to speak to my Introduction to Therapeutic Recreation class and
was happily surprised to learn that he had plans to resume his hobby of
traveling this summer. He used the
Internet to make his travel arrangements, and with only the use of a cane,
toured the northern tier states by train during the month of July.
Though 74 years old, he had a determination characteristic of men half
his age, and his love of recreation continued to contribute to his well being
for the remainder of his life.
Conclusion:
TR
in the physical rehabilitation setting is usually part of an intensive,
functionally oriented process. We are fortunate as therapists in being able to help clients
develop recreational strategies for use after discharge when exercises and
activities must be continued without the presence of the physical, occupational,
and speech therapists. We
believe that clients are more likely to continue rehabilitation exercises if the
context in which they do them is enjoyable. Rehabilitation from physical illness
goes beyond simple functioning, however. We
Afunction@
in order to do something beyond functioning, i.e., to enjoy life.
Ultimately, outcomes that are linked to one’s spirit, often called
Aexistential,@
must be addressed, too. TR is a wholistic approach to wellness, and happiness is an
experience that may require physical preconditions, but certainly does not stop
there. Some of the most exciting
work done in TR in physical rehabilitation settings is done in this realm of
existential outcomes.
******
When I assumed my first job in TR in 1972 I could not
have articulated what I believe is the essence of therapeutic recreation.
An African American woman in the Plateau neighborhood put it well when
she said, "You can't be what you don't see."
New students need experiences that allow them to see TR in action and to
connect personally with recipients of our services.
One woman at a local rehabilitation hospital replied when asked what TR
did for her, "The physical
therapist helped me learn to walk, but you asked the essential question - where
do you want to go?"
You
can see that my own understanding of TR has been solidified over years of
experience in a variety of settings and client groups.
My own philosophy of TR leads me to celebrate our diversity of service
rather than lament a seeming lack of focus on one population or one modality.
When I am with my colleagues, what I enjoy most is hearing about new ways
of meeting needs in our communities - using TR services with persons who have
AIDS, developing home health plans involving family recreation, or adding TR
services in our public schools for students in special education programs.
TR defies our attempts to package it neatly or to briefly "say it
all," not because we have nothing specific to contribute but because the
nature of what we do is as unique and varied as the people we serve are.
So,
when people ask me what I do, I tell them how fortunate I feel to be able to
devote my life to helping people find meaning and personal satisfaction through
choices that they make with their time. I
tell them that recreation and leisure should be critically important to all of
us, and our mission is to spread their value. I tell them that, in the end, what
really makes life meaningful are the experiences that give us joy, and our work
with those whose lives have often been affected by loss, suffering, illness,
disability, marginalization, and alienation is extraordinarily good and
valuable. I believe that our
purpose is grounded in the spiritual value of leisure, which I see as the
freedom to become our truest selves. That=s
not a destination but a process. Those
of us who work in the field of TR are privileged to accompany people in the
process of personal development and growth.
We operate as guides, advocates and, hopefully, friends, but let us never
forget that the ultimate power to change, mature, and discover happiness lies
within each person, not acquired like a product, but nurtured like a flowering
seed.
If you have browsed the web in search of information on
TR that might help you discern if it is a field of interest to you, I recommend
that you contact some of the people whose names appear with various Internet
sites. Also, call TR specialists in
your area to inquire about therapeutic recreation programs in your vicinity.
If you are a student already enrolled in a TR program and want to
increase your contacts with other students and professionals working in the
field, tell your teachers that you have found this paper on the Internet and
want them to help generate more information on the field for others like you.
Ask your teachers to share their personal philosophy of TR with you and
encourage them to invite professionals working in the field to do the same.
Thank you for permitting me to share my own experiences
with you. It is my hope that you
will be open to similar opportunities to expand and deepen your understanding of
therapeutic recreation. Should you
make this field your own, I would welcome you as a colleague and friend.
In the meantime, please feel free to share your academic journey with
others over the net.
Cathy O'Keefe
University of South Alabama
Dept. of HPELS
Mobile, AL 36688
Phone: (251) 460-7131
Fax: (251) 460-7252
E-mail:
cokeefe@usouthal.edu