- Home
- Recreation and Leisure
- Physical Therapy/Physiotherapy
- Health Care in Exercise and Sport
- Foundations of Therapeutic Recreation
One of the more significant updates to the second edition of Foundations of Therapeutic Recreation is a more contemporary description of models of practice, including significant attention to strength-based models and approaches to practice. In addition, the second edition has been updated to reflect current National Council for Therapeutic Recreation Certification (NCTRC) requirements for obtaining the Certified Therapeutic Recreation Specialist (CTRS) credential. Other updates to this edition include the following:
- Integration of more global perspectives on therapeutic recreation
- Greater emphasis of evidence-based practice for designing and delivering enjoyable and beneficial therapeutic recreation interventions
- Streamlined content and reorganized chapters to facilitate a natural progression throughout the semester
Students will discover potential areas in which therapeutic recreation can be practiced—including mental health centers, programs for those with developmental disabilities, physical rehabilitation facilities, youth development programs, and programs for the aging population—and will also be exposed to potential changes and uses of therapeutic recreation as technology innovations, public policy, and service demand trends evolve.
Plus, instructors will find a suite of ancillaries to assist in managing their course. The instructor guide includes learning objectives for each chapter along with sample classroom activities and assignments. The test bank has been expanded, and the presentation package has undergone significant revisions to reflect the content of the text.
Foundations of Therapeutic Recreation, Second Edition, provides students with evidence-based information on fundamental concepts in the field of therapeutic recreation. With a reader-friendly format and engaging style, this text will help students explore the various career possibilities in the field.
Chapter 1. Considering Therapeutic Recreation as Your Profession
Terry Robertson
Terry Long
What Is Therapeutic Recreation?
A Diverse Profession
Choosing a Profession
Summary
Discussion Questions
Chapter 2. History of Therapeutic Recreation
Rodney Dieser
Importance of History
Origins of the Profession (Late 1700s to Mid-1900s)
Philosophical Battles in Therapeutic Recreation (1945-1965)
The Utopian Years of Therapeutic Recreation (1966-1984)
The Fragmentation Years of Therapeutic Recreation (1985-2000)
Therapeutic Recreation in the 21st Century
Summary
Discussion Questions
Chapter 3. Professional Opportunities in Therapeutic Recreation
Michal Anne Lord
Ramon B. Zabriskie
Characteristics of a Profession
Professional Preparation in Therapeutic Recreation
Professional Organizations
Professional Networking
Summary
Discussion Questions
Chapter 4. Person-First Philosophy in Therapeutic Recreation
Mary Ann Devine
Jessie L. Bennett
Who Is the Person With a Disability?
Person-First Philosophy
Using Person-First Philosophy
Attitudes Toward People With Disabilities
Service Delivery
Summary
Discussion Questions
Chapter 5. Models and Modalities of Practice
Jamie Hoffman
Terry Long
Therapeutic Recreation Practice Models
Broader Models of Practice
Therapeutic Recreation Treatment Modalities
Summary
Discussion Questions
Part II. Potential Areas of Practice
Chapter 6. The Therapeutic Recreation Process
Terry Long
Assessment
Planning
Implementation
Evaluation
Summary
Discussion Questions
Chapter 7. Therapeutic Recreation and Mental Health
Melissa D’Eloia
Keith Fulthorp
Terry Long
Components of a Healthy Mind
What Is a Mental Disorder?
Role of Therapeutic Recreation in Treating Mental Disorders
Levels of Care in Mental Health
Diagnostic Categories
Theoretical Considerations
Positive Psychology and Related Paradigms
Mental Health and Secondary Disabilities
Common Therapeutic Recreation Modalities for Mental Health
Summary
Discussion Questions
Chapter 8. Therapeutic Recreation and Developmental Disabilities
Susan Myllykangas
Alice Foose
Patricia Ardovino
What Are Developmental Disabilities?
Practice Settings
Neurodevelopmental Disorders
Sensory-Related Developmental Disabilities
Metabolic Disabilities
Degenerative Disabilities
Best Practices
Summary
Discussion Questions
Chapter 9. Therapeutic Recreation and Physical Rehabilitation
Terry Robertson
Jody Cormack
Terry Long
Common Diagnostic Groups in Rehabilitation
Common Therapeutic Recreation Modalities in Rehabilitation
Best Practices
Summary
Discussion Questions
Chapter 10. Youth Development and Therapeutic Recreation
Sydney L. Sklar
Cari E. Autry
Positive Youth Development
Challenges to Positive Development
Theories That Guide Therapeutic Recreation Practice
Prevention, Intervention, and the Therapeutic Process: APIED
Settings and Opportunities
Modalities for Youth Development
Summary
Discussion Questions
Chapter 11. Therapeutic Recreation and Senior Populations
Laura Covert-Miller
Cameo Rogers
The Aging Population
Career Opportunities With Seniors
Theories of Successful Aging
Common Modalities
Dementia Frameworks
Summary
Discussion Questions
Chapter 12. A Global Perspective of Therapeutic Recreation
Rodney Dieser
Heewon Yang
Shane Pegg
Shinichi Nagata
Therapeutic Recreation in Canada
Therapeutic Recreation in South Korea
Therapeutic Recreation in Japan
Therapeutic Recreation in Australia
Summary
Discussion Questions
Chapter 13. Envisioning the Future: Therapeutic Recreation as a Profession
Terry Robertson
Erick Kong
Embracing Our History
The Emergence of a Global Society
The Future of Therapeutic Recreation as a Profession
Worldviews: Finding the Optimal Perspective
Summary
Discussion Questions
Terry Robertson, PhD, is an associate professor and department chair in the department of health, physical education, recreation, and dance at Northwest Missouri State University. He has worked in therapeutic recreation for over 30 years as a practitioner, consultant, and educator.
Dr. Robertson is a past president of the National Therapeutic Recreation Society, the regional independent living center, the Missouri Therapeutic Recreation Society, and the Nevada Therapeutic Recreation Society. He also served on the Utah Therapeutic Recreation Licensure for 6 years and was the director of CEUs for the Midwest Symposium on Therapeutic Recreation for over 20 years. Dr. Robertson is currently serving a 4-year, publicly elected term on his county's health board and has served on numerous other boards and in other leadership capacities for related organizations. He is currently serving locally on his county's organization for group homes. Dr. Robertson was also a codeveloper of the Case Histories section of the Therapeutic Recreation Journal. Currently known as Practice Perspectives, this section helps the profession examine individual and group interventions and contributes information on best practices, interventions, and treatment concerns to research literature.
Terry Long, PhD, is an associate professor in the department of health, physical education, recreation, and dance at Northwest Missouri State University, where he has coordinated the therapeutic recreation curriculum since 2000. He is also the director of the HPERD Abilities Laboratory. His specialty is applications of therapeutic recreation in the mental health realm, particularly in the area of behavior disorders. Dr. Long also has a master's degree in clinical psychology and worked with various mental health agencies and facilities over the past 10 years in both clinical and outdoor settings.
Dr. Long is an associate editor for Therapeutic Recreation Journal and an associate editor for SCHOLE. He is past president of the Missouri Therapeutic Recreation Society, at-large director for the National Therapeutic Recreation Society Board of Directors (2006-2008 term), and the board president for the independent living center serving the Northwest Region of Missouri. He is past president of the Missouri Park and Recreation Association Educators Section.
A legacy of leisure at the Mayo Clinic
Year after year, the U.S. News and World Report, along with other publications, ranks the Mayo Clinic as one of the best hospitals in the United States (see Eisenman, 2014).
Year after year, the U.S. News and World Report, along with other publications, ranks the Mayo Clinic as one of the best hospitals in the United States (see Eisenman, 2014). The Mayo Clinic employs 4,100 physicians/scientists and 53,600 practitioners in allied health professions and sees more than 1 million patients each year (Olsen & Dacy, 2014).
Leisure for enjoyment has a long history at the Mayo Clinic, dating back to 1914 (Mayo Foundation for Medical Education and Research, 2014). “Man and Recreation,” the large sculpture on the south façade of the Mayo building, represents the importance of rest, play, joyful moments, physical activities, rejuvenation, introspection, and enjoyment of nature (Mayo Clinic, 1984). Through a cafeteria and quality-of-life programming approach, the Mayo Clinic provides a plethora of diverse leisure activities through many organizational units. For example, the Peregrine Falcon Program at the Rochester campus allows patients to view and interact with Peregrine falcons that nest on the top of the 20-story Mayo and Gonda buildings (see http://history.mayoclinic.org/tours-events/mayo-clinic-peregrine-falcon-program.php).
The art collection at the Rochester campus presents thousands of art pieces from the media of glass, textiles, paintings, prints, ancient/ethnographic/folk art, sculptures, photography, and ceramics. Internationally known artists, such as Barbara Hepworth and Ivan Meštrovic´, are represented. Each year, the Art and Ability exhibit at the Rochester campus celebrates artworks from people with disabilities.
The Center for Humanities in Medicine at the Mayo Clinic Jacksonville (Florida) campus has professional musicians perform daily concerts in hospital lounges and local artists work one on one at the bedside with patients and families, exploring creative expression (see www.mayoclinic.org/patient-visitor-guide/humanities-in-medicine/florida-schedule). A 56-bell carillon on top of the Plummer building on the Rochester campus is rung regularly throughout the week (Mayo Clinic, 2006); patients can sit in the many outdoor courtyards and atriums or in the Feith Family Statuary Park in the center of campus to hear this musical performance. In keeping with a strengths-based approach, sometimes called the “Mayo way . . . to look at the strengths of individuals rather than at the deficiencies” (p. 150), grand pianos are placed at certain locations on the Rochester campus so that patients can perform impromptu concerts with crowds of other patients and staff singing or listening (Berry & Seltman, 2008; see also Mayo Clinic, 2001).
The Florida campus has a large park with lakes and a bridge to Louchery Island, where patients can contemplate and reflect (Mayo Clinic, 2011). The Scottsdale/Phoenix (Arizona) campus has a one-third-mile trail that includes more than 40 species of cacti and plants, where patients sometimes encounter roadrunners, quail, or horned owls (Mayo Clinic, 2011).
The St. Mary's Hospital Patient Library, on the Rochester campus—a community-based patient library—provides DVDs, music CDs, books/audiobooks, magazines and newspapers, desktop and laptop computers with Internet access, board games, video consoles and games, and crafts for patients and their families as well as a daily morning coffee social activity (St. Mary's Patient Library, 2016).
These examples illustrate how leisure remains an inherent part of the Mayo philosophy and culture. This philosophy, linked to a community parks and recreation approach, has allowed therapeutic recreation to exist not only as a formal service within the Mayo system, but also as a fundamental element of care and the overall patient experience.
Therapeutic recreation is a diverse profession
Therapeutic recreation has emerged from a dynamic and ever-evolving mix of perspectives, converging schools of thought, borrowed and original theories, and unique interventions and services.
Therapeutic recreation has emerged from a dynamic and ever-evolving mix of perspectives, converging schools of thought, borrowed and original theories, and unique interventions and services. This diverse background offers potential for a large variety of service applications. Some have referred to therapeutic recreation as being eclectic in nature. Others have referred to it as a strengths-based approach. Some suggest that therapeutic recreation is unique in that it involves use of recreation or leisure. Others say that it is a mix of philosophy, psychology, the arts, and physical therapy and occupational therapy techniques—all used by a trained professional to bring about functional change within another person or group of people.
Regardless of the perspective chosen, therapeutic recreation is a profession that has tremendous potential for growth and evolution. The diverse philosophical positions or perspectives within the profession provide numerous opportunities for flexible application and professional growth. This diversity tends to produce a well-rounded college graduate who is capable of working within, on the fringes of, or outside of therapeutic recreation. Likewise, therapeutic recreation training programs have traditionally been ideal for those seeking a bachelor's degree before moving into a graduate degree program. A therapeutic recreation degree has also helped professionals enter community-based recreation and administrative positions within a variety of fields. If you are searching for a degree that could prepare you for a wide variety of occupations or you are looking for a specific career, then therapeutic recreation may be right for you. Are you still interested?
Choosing a Profession
As a bright person capable of choosing from among many occupations, you should think about why you are interested in therapeutic recreation. Are you interested in helping others? Are you interested in physical activity or psychological processes? Do you or any members of your family have a disability? Are you deciding between this major and some other therapy-oriented degree such as occupational therapy, physical therapy, or nursing? Maybe you are interested in broader topics such as social justice, aging, or health and wellness, or maybe you simply know someone in this major or profession. You are the only one who can answer the why questions. If you have not done so, try to answer the question for yourself right now—why choose this profession?
Your interest and motivation in this course and profession will have an effect on what you study, how you study, and whether you will succeed in your academic performance. Your motives can also influence who you might study or work with as well as where you might eventually work and ultimately live. So do you know where or with whom you might want to work? Do you know how this course could benefit you regardless of your major? If you answered no or have other questions, ask the course instructor and your advisor for some individual attention.
If the answer to either question is yes, then we would simply ask that you keep yourself open to more possibilities as you go through this text and course. If you are unsure about how all of this information is relevant to you, then we would ask that you try to focus a bit and select a temporary answer to these questions to help you reflect on and understand concepts as you move through the book and explore this profession. Whether you answered yes or no, before you try to finalize your decisions, you should learn the basic therapeutic recreation process, understand some of the basic techniques utilized during this process, and become familiar with what therapeutic recreation services have to offer clients who participate in this process (what benefits might come to clients from provision of this service). Later chapters will explore these topics in detail.
Finding a Personal Fit
Success in the therapeutic recreation profession requires commitment, forethought, and a willingness to engage others. The working professional generally has the ability to organize experiences, motivate others, be flexible, and work on several tasks simultaneously. The ability to communicate to diverse audiences (e.g., individuals, groups, and other professionals) in a variety of ways (e.g., oral, written, in person, electronically) and to be both understanding and assertive are also important characteristics. In plain words, therapeutic recreation is a people profession; a major job skill for a therapeutic recreation professional is to relate to people in an understanding and accepting way. Because creating effective interactions and experiences requires use of a systematic method, the successful professional must be competent at planning, organizing, solving problems, and managing several tasks and programs at once. To succeed in this profession, a person must be responsible, knowledgeable, and genuinely compassionate.
Employment Options
Therapeutic recreation specialists work in a variety of settings, and often those settings include a mix of clientele. Breaking down the profession based on client population reveals that about 37 percent work in mental health, 29 percent work in geriatrics, 20 percent work in physical medicine, and 14 percent work with individuals with developmental disabilities (National Council for Therapeutic Recreation Certification [NCTRC], 2015). The nature of therapeutic recreation services for each of these populations is addressed further in chapters 7 to 11, but this diversity is mentioned here to illustrate the options that are available to professionals. In addition, these categories are very general, and you will find that there are many specializations within each area.
Work-setting options for therapeutic recreation professionals are equally diverse and include hospitals, psychiatric facilities, long-term-care facilities, and community-based settings. It is also true that the boundaries between these settings are difficult if not impossible to define.
Who is the person with a disability?
Over the years, people with disabilities have been stereotyped as limited in potential. This generalization is based on a comparison of them with people who do not have the same characteristic.
Over the years, people with disabilities have been stereotyped as limited in potential. This generalization is based on a comparison of them with people who do not have the same characteristic. Labels drive such stereotypes, and these labels can originate from several sources, some of which were originally intended for good. Labels referring to disabilities have been medically based, such as the labeling of a person as blind because he or she cannot see. Labels can be socially based. For example, a person who uses a wheelchair may be assumed to be disabled in ways that exceed his or her actual impairments. Labels can even be legally based and are often required for the provision of supportive services in school and recreation. For example, to qualify for certain special education services, a child must fall into specific diagnostic categories, such as autism or attention-deficit/hyperactivity disorder. Regardless of the mechanisms through which a person is labeled, the person with a disability is someone who has a limitation in some aspect of his or her functioning according to our social norms.
All people tend to be identified by and associated with characteristics that really are only superficial indicators of who they are. Society worships celebrities based solely on public personas that are crafted by Hollywood moguls and music industry executives. Likewise, society has a history of ridiculing and ostracizing those who do not meet these unrealistic standards. This superficial idea of perfection leads to judgmental standards built on trivial characteristics that have no relationship to the essence of a person. The labeling of people, and the stereotypical assumptions that we make based on those labels, discounts the true value of the person. In other words, labels and inaccurate stereotypes of society often overshadow the strengths, potential, and accomplishments of persons with disabilities.
To be fair, labels can serve a valuable purpose because they facilitate communication of the nature of a particular condition to others. This message in turn allows for the provision of appropriate care, access to resources or accommodations, and program enrollment. The danger of labels comes from people's misuse and misunderstanding of them as well as the tendency to generalize impairment of one particular area of functioning to the overall abilities of the person. An example of such a generalization would be assuming that a person has difficulty solving problems because he or she cannot hear. Even worse, we begin to focus so much on the disability that the differentiating characteristic overshadows the person.
According to the Americans with Disabilities Act (ADA, 1991), legally, a person with a disability is someone who
- has a physical, mental, or cognitive impairment that substantially limits one or more major life functions or activities;
- has a record of such an impairment; or
- is regarded as having such an impairment.
This legal definition requires the disability to result in a substantial limitation in one or more major life activities, such as walking, breathing, seeing, thinking, performing tasks, speaking, learning, working, driving, and participating in community life. Although this definition is clear, it goes beyond how well a person can function and the degree to which he or she can be independent. The spirit of the ADA also embraces a philosophy or belief system that the person should not be taken out of the equation. In other words, the person is much more than his or her disability. People with disabilities have the right to be treated as a person first, not as their disability. Beyond the individual's physical, mental, or cognitive limitations, the constant factor is his or her humanity (Bogdan & Taylor, 1992). Thus, the humanity should be our first consideration.
Each of the hundreds of disabilities has a differing degree of severity. Chapters 7 to 11 discuss characteristics and aspects of various disabilities from the perspective of disability-related characteristics and programs. Here, we will explore the idea of viewing a person with a disability as a person first, with the focus not on the person's limitations but on the individual as a person. This perspective is a key element in the prevention of handicaps. A handicap is a situation in which a person can be disadvantaged not by the disability but by other factors. These disadvantages may result from a preventable or removable barrier to performance of a particular activity or skill. Handicaps can include physical barriers but can also come from society's negligence or negative personal attitudes, beliefs, or knowledge. This chapter focuses on the social issue of how society perceives and interacts with people with disabilities. In particular, we discuss person-first aspects of disability, the effect of negative perceptions of disability, and the role of therapeutic recreation relative to people with disabilities.
A legacy of leisure at the Mayo Clinic
Year after year, the U.S. News and World Report, along with other publications, ranks the Mayo Clinic as one of the best hospitals in the United States (see Eisenman, 2014).
Year after year, the U.S. News and World Report, along with other publications, ranks the Mayo Clinic as one of the best hospitals in the United States (see Eisenman, 2014). The Mayo Clinic employs 4,100 physicians/scientists and 53,600 practitioners in allied health professions and sees more than 1 million patients each year (Olsen & Dacy, 2014).
Leisure for enjoyment has a long history at the Mayo Clinic, dating back to 1914 (Mayo Foundation for Medical Education and Research, 2014). “Man and Recreation,” the large sculpture on the south façade of the Mayo building, represents the importance of rest, play, joyful moments, physical activities, rejuvenation, introspection, and enjoyment of nature (Mayo Clinic, 1984). Through a cafeteria and quality-of-life programming approach, the Mayo Clinic provides a plethora of diverse leisure activities through many organizational units. For example, the Peregrine Falcon Program at the Rochester campus allows patients to view and interact with Peregrine falcons that nest on the top of the 20-story Mayo and Gonda buildings (see http://history.mayoclinic.org/tours-events/mayo-clinic-peregrine-falcon-program.php).
The art collection at the Rochester campus presents thousands of art pieces from the media of glass, textiles, paintings, prints, ancient/ethnographic/folk art, sculptures, photography, and ceramics. Internationally known artists, such as Barbara Hepworth and Ivan Meštrovic´, are represented. Each year, the Art and Ability exhibit at the Rochester campus celebrates artworks from people with disabilities.
The Center for Humanities in Medicine at the Mayo Clinic Jacksonville (Florida) campus has professional musicians perform daily concerts in hospital lounges and local artists work one on one at the bedside with patients and families, exploring creative expression (see www.mayoclinic.org/patient-visitor-guide/humanities-in-medicine/florida-schedule). A 56-bell carillon on top of the Plummer building on the Rochester campus is rung regularly throughout the week (Mayo Clinic, 2006); patients can sit in the many outdoor courtyards and atriums or in the Feith Family Statuary Park in the center of campus to hear this musical performance. In keeping with a strengths-based approach, sometimes called the “Mayo way . . . to look at the strengths of individuals rather than at the deficiencies” (p. 150), grand pianos are placed at certain locations on the Rochester campus so that patients can perform impromptu concerts with crowds of other patients and staff singing or listening (Berry & Seltman, 2008; see also Mayo Clinic, 2001).
The Florida campus has a large park with lakes and a bridge to Louchery Island, where patients can contemplate and reflect (Mayo Clinic, 2011). The Scottsdale/Phoenix (Arizona) campus has a one-third-mile trail that includes more than 40 species of cacti and plants, where patients sometimes encounter roadrunners, quail, or horned owls (Mayo Clinic, 2011).
The St. Mary's Hospital Patient Library, on the Rochester campus—a community-based patient library—provides DVDs, music CDs, books/audiobooks, magazines and newspapers, desktop and laptop computers with Internet access, board games, video consoles and games, and crafts for patients and their families as well as a daily morning coffee social activity (St. Mary's Patient Library, 2016).
These examples illustrate how leisure remains an inherent part of the Mayo philosophy and culture. This philosophy, linked to a community parks and recreation approach, has allowed therapeutic recreation to exist not only as a formal service within the Mayo system, but also as a fundamental element of care and the overall patient experience.
Therapeutic recreation is a diverse profession
Therapeutic recreation has emerged from a dynamic and ever-evolving mix of perspectives, converging schools of thought, borrowed and original theories, and unique interventions and services.
Therapeutic recreation has emerged from a dynamic and ever-evolving mix of perspectives, converging schools of thought, borrowed and original theories, and unique interventions and services. This diverse background offers potential for a large variety of service applications. Some have referred to therapeutic recreation as being eclectic in nature. Others have referred to it as a strengths-based approach. Some suggest that therapeutic recreation is unique in that it involves use of recreation or leisure. Others say that it is a mix of philosophy, psychology, the arts, and physical therapy and occupational therapy techniques—all used by a trained professional to bring about functional change within another person or group of people.
Regardless of the perspective chosen, therapeutic recreation is a profession that has tremendous potential for growth and evolution. The diverse philosophical positions or perspectives within the profession provide numerous opportunities for flexible application and professional growth. This diversity tends to produce a well-rounded college graduate who is capable of working within, on the fringes of, or outside of therapeutic recreation. Likewise, therapeutic recreation training programs have traditionally been ideal for those seeking a bachelor's degree before moving into a graduate degree program. A therapeutic recreation degree has also helped professionals enter community-based recreation and administrative positions within a variety of fields. If you are searching for a degree that could prepare you for a wide variety of occupations or you are looking for a specific career, then therapeutic recreation may be right for you. Are you still interested?
Choosing a Profession
As a bright person capable of choosing from among many occupations, you should think about why you are interested in therapeutic recreation. Are you interested in helping others? Are you interested in physical activity or psychological processes? Do you or any members of your family have a disability? Are you deciding between this major and some other therapy-oriented degree such as occupational therapy, physical therapy, or nursing? Maybe you are interested in broader topics such as social justice, aging, or health and wellness, or maybe you simply know someone in this major or profession. You are the only one who can answer the why questions. If you have not done so, try to answer the question for yourself right now—why choose this profession?
Your interest and motivation in this course and profession will have an effect on what you study, how you study, and whether you will succeed in your academic performance. Your motives can also influence who you might study or work with as well as where you might eventually work and ultimately live. So do you know where or with whom you might want to work? Do you know how this course could benefit you regardless of your major? If you answered no or have other questions, ask the course instructor and your advisor for some individual attention.
If the answer to either question is yes, then we would simply ask that you keep yourself open to more possibilities as you go through this text and course. If you are unsure about how all of this information is relevant to you, then we would ask that you try to focus a bit and select a temporary answer to these questions to help you reflect on and understand concepts as you move through the book and explore this profession. Whether you answered yes or no, before you try to finalize your decisions, you should learn the basic therapeutic recreation process, understand some of the basic techniques utilized during this process, and become familiar with what therapeutic recreation services have to offer clients who participate in this process (what benefits might come to clients from provision of this service). Later chapters will explore these topics in detail.
Finding a Personal Fit
Success in the therapeutic recreation profession requires commitment, forethought, and a willingness to engage others. The working professional generally has the ability to organize experiences, motivate others, be flexible, and work on several tasks simultaneously. The ability to communicate to diverse audiences (e.g., individuals, groups, and other professionals) in a variety of ways (e.g., oral, written, in person, electronically) and to be both understanding and assertive are also important characteristics. In plain words, therapeutic recreation is a people profession; a major job skill for a therapeutic recreation professional is to relate to people in an understanding and accepting way. Because creating effective interactions and experiences requires use of a systematic method, the successful professional must be competent at planning, organizing, solving problems, and managing several tasks and programs at once. To succeed in this profession, a person must be responsible, knowledgeable, and genuinely compassionate.
Employment Options
Therapeutic recreation specialists work in a variety of settings, and often those settings include a mix of clientele. Breaking down the profession based on client population reveals that about 37 percent work in mental health, 29 percent work in geriatrics, 20 percent work in physical medicine, and 14 percent work with individuals with developmental disabilities (National Council for Therapeutic Recreation Certification [NCTRC], 2015). The nature of therapeutic recreation services for each of these populations is addressed further in chapters 7 to 11, but this diversity is mentioned here to illustrate the options that are available to professionals. In addition, these categories are very general, and you will find that there are many specializations within each area.
Work-setting options for therapeutic recreation professionals are equally diverse and include hospitals, psychiatric facilities, long-term-care facilities, and community-based settings. It is also true that the boundaries between these settings are difficult if not impossible to define.
Who is the person with a disability?
Over the years, people with disabilities have been stereotyped as limited in potential. This generalization is based on a comparison of them with people who do not have the same characteristic.
Over the years, people with disabilities have been stereotyped as limited in potential. This generalization is based on a comparison of them with people who do not have the same characteristic. Labels drive such stereotypes, and these labels can originate from several sources, some of which were originally intended for good. Labels referring to disabilities have been medically based, such as the labeling of a person as blind because he or she cannot see. Labels can be socially based. For example, a person who uses a wheelchair may be assumed to be disabled in ways that exceed his or her actual impairments. Labels can even be legally based and are often required for the provision of supportive services in school and recreation. For example, to qualify for certain special education services, a child must fall into specific diagnostic categories, such as autism or attention-deficit/hyperactivity disorder. Regardless of the mechanisms through which a person is labeled, the person with a disability is someone who has a limitation in some aspect of his or her functioning according to our social norms.
All people tend to be identified by and associated with characteristics that really are only superficial indicators of who they are. Society worships celebrities based solely on public personas that are crafted by Hollywood moguls and music industry executives. Likewise, society has a history of ridiculing and ostracizing those who do not meet these unrealistic standards. This superficial idea of perfection leads to judgmental standards built on trivial characteristics that have no relationship to the essence of a person. The labeling of people, and the stereotypical assumptions that we make based on those labels, discounts the true value of the person. In other words, labels and inaccurate stereotypes of society often overshadow the strengths, potential, and accomplishments of persons with disabilities.
To be fair, labels can serve a valuable purpose because they facilitate communication of the nature of a particular condition to others. This message in turn allows for the provision of appropriate care, access to resources or accommodations, and program enrollment. The danger of labels comes from people's misuse and misunderstanding of them as well as the tendency to generalize impairment of one particular area of functioning to the overall abilities of the person. An example of such a generalization would be assuming that a person has difficulty solving problems because he or she cannot hear. Even worse, we begin to focus so much on the disability that the differentiating characteristic overshadows the person.
According to the Americans with Disabilities Act (ADA, 1991), legally, a person with a disability is someone who
- has a physical, mental, or cognitive impairment that substantially limits one or more major life functions or activities;
- has a record of such an impairment; or
- is regarded as having such an impairment.
This legal definition requires the disability to result in a substantial limitation in one or more major life activities, such as walking, breathing, seeing, thinking, performing tasks, speaking, learning, working, driving, and participating in community life. Although this definition is clear, it goes beyond how well a person can function and the degree to which he or she can be independent. The spirit of the ADA also embraces a philosophy or belief system that the person should not be taken out of the equation. In other words, the person is much more than his or her disability. People with disabilities have the right to be treated as a person first, not as their disability. Beyond the individual's physical, mental, or cognitive limitations, the constant factor is his or her humanity (Bogdan & Taylor, 1992). Thus, the humanity should be our first consideration.
Each of the hundreds of disabilities has a differing degree of severity. Chapters 7 to 11 discuss characteristics and aspects of various disabilities from the perspective of disability-related characteristics and programs. Here, we will explore the idea of viewing a person with a disability as a person first, with the focus not on the person's limitations but on the individual as a person. This perspective is a key element in the prevention of handicaps. A handicap is a situation in which a person can be disadvantaged not by the disability but by other factors. These disadvantages may result from a preventable or removable barrier to performance of a particular activity or skill. Handicaps can include physical barriers but can also come from society's negligence or negative personal attitudes, beliefs, or knowledge. This chapter focuses on the social issue of how society perceives and interacts with people with disabilities. In particular, we discuss person-first aspects of disability, the effect of negative perceptions of disability, and the role of therapeutic recreation relative to people with disabilities.
A legacy of leisure at the Mayo Clinic
Year after year, the U.S. News and World Report, along with other publications, ranks the Mayo Clinic as one of the best hospitals in the United States (see Eisenman, 2014).
Year after year, the U.S. News and World Report, along with other publications, ranks the Mayo Clinic as one of the best hospitals in the United States (see Eisenman, 2014). The Mayo Clinic employs 4,100 physicians/scientists and 53,600 practitioners in allied health professions and sees more than 1 million patients each year (Olsen & Dacy, 2014).
Leisure for enjoyment has a long history at the Mayo Clinic, dating back to 1914 (Mayo Foundation for Medical Education and Research, 2014). “Man and Recreation,” the large sculpture on the south façade of the Mayo building, represents the importance of rest, play, joyful moments, physical activities, rejuvenation, introspection, and enjoyment of nature (Mayo Clinic, 1984). Through a cafeteria and quality-of-life programming approach, the Mayo Clinic provides a plethora of diverse leisure activities through many organizational units. For example, the Peregrine Falcon Program at the Rochester campus allows patients to view and interact with Peregrine falcons that nest on the top of the 20-story Mayo and Gonda buildings (see http://history.mayoclinic.org/tours-events/mayo-clinic-peregrine-falcon-program.php).
The art collection at the Rochester campus presents thousands of art pieces from the media of glass, textiles, paintings, prints, ancient/ethnographic/folk art, sculptures, photography, and ceramics. Internationally known artists, such as Barbara Hepworth and Ivan Meštrovic´, are represented. Each year, the Art and Ability exhibit at the Rochester campus celebrates artworks from people with disabilities.
The Center for Humanities in Medicine at the Mayo Clinic Jacksonville (Florida) campus has professional musicians perform daily concerts in hospital lounges and local artists work one on one at the bedside with patients and families, exploring creative expression (see www.mayoclinic.org/patient-visitor-guide/humanities-in-medicine/florida-schedule). A 56-bell carillon on top of the Plummer building on the Rochester campus is rung regularly throughout the week (Mayo Clinic, 2006); patients can sit in the many outdoor courtyards and atriums or in the Feith Family Statuary Park in the center of campus to hear this musical performance. In keeping with a strengths-based approach, sometimes called the “Mayo way . . . to look at the strengths of individuals rather than at the deficiencies” (p. 150), grand pianos are placed at certain locations on the Rochester campus so that patients can perform impromptu concerts with crowds of other patients and staff singing or listening (Berry & Seltman, 2008; see also Mayo Clinic, 2001).
The Florida campus has a large park with lakes and a bridge to Louchery Island, where patients can contemplate and reflect (Mayo Clinic, 2011). The Scottsdale/Phoenix (Arizona) campus has a one-third-mile trail that includes more than 40 species of cacti and plants, where patients sometimes encounter roadrunners, quail, or horned owls (Mayo Clinic, 2011).
The St. Mary's Hospital Patient Library, on the Rochester campus—a community-based patient library—provides DVDs, music CDs, books/audiobooks, magazines and newspapers, desktop and laptop computers with Internet access, board games, video consoles and games, and crafts for patients and their families as well as a daily morning coffee social activity (St. Mary's Patient Library, 2016).
These examples illustrate how leisure remains an inherent part of the Mayo philosophy and culture. This philosophy, linked to a community parks and recreation approach, has allowed therapeutic recreation to exist not only as a formal service within the Mayo system, but also as a fundamental element of care and the overall patient experience.
Therapeutic recreation is a diverse profession
Therapeutic recreation has emerged from a dynamic and ever-evolving mix of perspectives, converging schools of thought, borrowed and original theories, and unique interventions and services.
Therapeutic recreation has emerged from a dynamic and ever-evolving mix of perspectives, converging schools of thought, borrowed and original theories, and unique interventions and services. This diverse background offers potential for a large variety of service applications. Some have referred to therapeutic recreation as being eclectic in nature. Others have referred to it as a strengths-based approach. Some suggest that therapeutic recreation is unique in that it involves use of recreation or leisure. Others say that it is a mix of philosophy, psychology, the arts, and physical therapy and occupational therapy techniques—all used by a trained professional to bring about functional change within another person or group of people.
Regardless of the perspective chosen, therapeutic recreation is a profession that has tremendous potential for growth and evolution. The diverse philosophical positions or perspectives within the profession provide numerous opportunities for flexible application and professional growth. This diversity tends to produce a well-rounded college graduate who is capable of working within, on the fringes of, or outside of therapeutic recreation. Likewise, therapeutic recreation training programs have traditionally been ideal for those seeking a bachelor's degree before moving into a graduate degree program. A therapeutic recreation degree has also helped professionals enter community-based recreation and administrative positions within a variety of fields. If you are searching for a degree that could prepare you for a wide variety of occupations or you are looking for a specific career, then therapeutic recreation may be right for you. Are you still interested?
Choosing a Profession
As a bright person capable of choosing from among many occupations, you should think about why you are interested in therapeutic recreation. Are you interested in helping others? Are you interested in physical activity or psychological processes? Do you or any members of your family have a disability? Are you deciding between this major and some other therapy-oriented degree such as occupational therapy, physical therapy, or nursing? Maybe you are interested in broader topics such as social justice, aging, or health and wellness, or maybe you simply know someone in this major or profession. You are the only one who can answer the why questions. If you have not done so, try to answer the question for yourself right now—why choose this profession?
Your interest and motivation in this course and profession will have an effect on what you study, how you study, and whether you will succeed in your academic performance. Your motives can also influence who you might study or work with as well as where you might eventually work and ultimately live. So do you know where or with whom you might want to work? Do you know how this course could benefit you regardless of your major? If you answered no or have other questions, ask the course instructor and your advisor for some individual attention.
If the answer to either question is yes, then we would simply ask that you keep yourself open to more possibilities as you go through this text and course. If you are unsure about how all of this information is relevant to you, then we would ask that you try to focus a bit and select a temporary answer to these questions to help you reflect on and understand concepts as you move through the book and explore this profession. Whether you answered yes or no, before you try to finalize your decisions, you should learn the basic therapeutic recreation process, understand some of the basic techniques utilized during this process, and become familiar with what therapeutic recreation services have to offer clients who participate in this process (what benefits might come to clients from provision of this service). Later chapters will explore these topics in detail.
Finding a Personal Fit
Success in the therapeutic recreation profession requires commitment, forethought, and a willingness to engage others. The working professional generally has the ability to organize experiences, motivate others, be flexible, and work on several tasks simultaneously. The ability to communicate to diverse audiences (e.g., individuals, groups, and other professionals) in a variety of ways (e.g., oral, written, in person, electronically) and to be both understanding and assertive are also important characteristics. In plain words, therapeutic recreation is a people profession; a major job skill for a therapeutic recreation professional is to relate to people in an understanding and accepting way. Because creating effective interactions and experiences requires use of a systematic method, the successful professional must be competent at planning, organizing, solving problems, and managing several tasks and programs at once. To succeed in this profession, a person must be responsible, knowledgeable, and genuinely compassionate.
Employment Options
Therapeutic recreation specialists work in a variety of settings, and often those settings include a mix of clientele. Breaking down the profession based on client population reveals that about 37 percent work in mental health, 29 percent work in geriatrics, 20 percent work in physical medicine, and 14 percent work with individuals with developmental disabilities (National Council for Therapeutic Recreation Certification [NCTRC], 2015). The nature of therapeutic recreation services for each of these populations is addressed further in chapters 7 to 11, but this diversity is mentioned here to illustrate the options that are available to professionals. In addition, these categories are very general, and you will find that there are many specializations within each area.
Work-setting options for therapeutic recreation professionals are equally diverse and include hospitals, psychiatric facilities, long-term-care facilities, and community-based settings. It is also true that the boundaries between these settings are difficult if not impossible to define.
Who is the person with a disability?
Over the years, people with disabilities have been stereotyped as limited in potential. This generalization is based on a comparison of them with people who do not have the same characteristic.
Over the years, people with disabilities have been stereotyped as limited in potential. This generalization is based on a comparison of them with people who do not have the same characteristic. Labels drive such stereotypes, and these labels can originate from several sources, some of which were originally intended for good. Labels referring to disabilities have been medically based, such as the labeling of a person as blind because he or she cannot see. Labels can be socially based. For example, a person who uses a wheelchair may be assumed to be disabled in ways that exceed his or her actual impairments. Labels can even be legally based and are often required for the provision of supportive services in school and recreation. For example, to qualify for certain special education services, a child must fall into specific diagnostic categories, such as autism or attention-deficit/hyperactivity disorder. Regardless of the mechanisms through which a person is labeled, the person with a disability is someone who has a limitation in some aspect of his or her functioning according to our social norms.
All people tend to be identified by and associated with characteristics that really are only superficial indicators of who they are. Society worships celebrities based solely on public personas that are crafted by Hollywood moguls and music industry executives. Likewise, society has a history of ridiculing and ostracizing those who do not meet these unrealistic standards. This superficial idea of perfection leads to judgmental standards built on trivial characteristics that have no relationship to the essence of a person. The labeling of people, and the stereotypical assumptions that we make based on those labels, discounts the true value of the person. In other words, labels and inaccurate stereotypes of society often overshadow the strengths, potential, and accomplishments of persons with disabilities.
To be fair, labels can serve a valuable purpose because they facilitate communication of the nature of a particular condition to others. This message in turn allows for the provision of appropriate care, access to resources or accommodations, and program enrollment. The danger of labels comes from people's misuse and misunderstanding of them as well as the tendency to generalize impairment of one particular area of functioning to the overall abilities of the person. An example of such a generalization would be assuming that a person has difficulty solving problems because he or she cannot hear. Even worse, we begin to focus so much on the disability that the differentiating characteristic overshadows the person.
According to the Americans with Disabilities Act (ADA, 1991), legally, a person with a disability is someone who
- has a physical, mental, or cognitive impairment that substantially limits one or more major life functions or activities;
- has a record of such an impairment; or
- is regarded as having such an impairment.
This legal definition requires the disability to result in a substantial limitation in one or more major life activities, such as walking, breathing, seeing, thinking, performing tasks, speaking, learning, working, driving, and participating in community life. Although this definition is clear, it goes beyond how well a person can function and the degree to which he or she can be independent. The spirit of the ADA also embraces a philosophy or belief system that the person should not be taken out of the equation. In other words, the person is much more than his or her disability. People with disabilities have the right to be treated as a person first, not as their disability. Beyond the individual's physical, mental, or cognitive limitations, the constant factor is his or her humanity (Bogdan & Taylor, 1992). Thus, the humanity should be our first consideration.
Each of the hundreds of disabilities has a differing degree of severity. Chapters 7 to 11 discuss characteristics and aspects of various disabilities from the perspective of disability-related characteristics and programs. Here, we will explore the idea of viewing a person with a disability as a person first, with the focus not on the person's limitations but on the individual as a person. This perspective is a key element in the prevention of handicaps. A handicap is a situation in which a person can be disadvantaged not by the disability but by other factors. These disadvantages may result from a preventable or removable barrier to performance of a particular activity or skill. Handicaps can include physical barriers but can also come from society's negligence or negative personal attitudes, beliefs, or knowledge. This chapter focuses on the social issue of how society perceives and interacts with people with disabilities. In particular, we discuss person-first aspects of disability, the effect of negative perceptions of disability, and the role of therapeutic recreation relative to people with disabilities.
A legacy of leisure at the Mayo Clinic
Year after year, the U.S. News and World Report, along with other publications, ranks the Mayo Clinic as one of the best hospitals in the United States (see Eisenman, 2014).
Year after year, the U.S. News and World Report, along with other publications, ranks the Mayo Clinic as one of the best hospitals in the United States (see Eisenman, 2014). The Mayo Clinic employs 4,100 physicians/scientists and 53,600 practitioners in allied health professions and sees more than 1 million patients each year (Olsen & Dacy, 2014).
Leisure for enjoyment has a long history at the Mayo Clinic, dating back to 1914 (Mayo Foundation for Medical Education and Research, 2014). “Man and Recreation,” the large sculpture on the south façade of the Mayo building, represents the importance of rest, play, joyful moments, physical activities, rejuvenation, introspection, and enjoyment of nature (Mayo Clinic, 1984). Through a cafeteria and quality-of-life programming approach, the Mayo Clinic provides a plethora of diverse leisure activities through many organizational units. For example, the Peregrine Falcon Program at the Rochester campus allows patients to view and interact with Peregrine falcons that nest on the top of the 20-story Mayo and Gonda buildings (see http://history.mayoclinic.org/tours-events/mayo-clinic-peregrine-falcon-program.php).
The art collection at the Rochester campus presents thousands of art pieces from the media of glass, textiles, paintings, prints, ancient/ethnographic/folk art, sculptures, photography, and ceramics. Internationally known artists, such as Barbara Hepworth and Ivan Meštrovic´, are represented. Each year, the Art and Ability exhibit at the Rochester campus celebrates artworks from people with disabilities.
The Center for Humanities in Medicine at the Mayo Clinic Jacksonville (Florida) campus has professional musicians perform daily concerts in hospital lounges and local artists work one on one at the bedside with patients and families, exploring creative expression (see www.mayoclinic.org/patient-visitor-guide/humanities-in-medicine/florida-schedule). A 56-bell carillon on top of the Plummer building on the Rochester campus is rung regularly throughout the week (Mayo Clinic, 2006); patients can sit in the many outdoor courtyards and atriums or in the Feith Family Statuary Park in the center of campus to hear this musical performance. In keeping with a strengths-based approach, sometimes called the “Mayo way . . . to look at the strengths of individuals rather than at the deficiencies” (p. 150), grand pianos are placed at certain locations on the Rochester campus so that patients can perform impromptu concerts with crowds of other patients and staff singing or listening (Berry & Seltman, 2008; see also Mayo Clinic, 2001).
The Florida campus has a large park with lakes and a bridge to Louchery Island, where patients can contemplate and reflect (Mayo Clinic, 2011). The Scottsdale/Phoenix (Arizona) campus has a one-third-mile trail that includes more than 40 species of cacti and plants, where patients sometimes encounter roadrunners, quail, or horned owls (Mayo Clinic, 2011).
The St. Mary's Hospital Patient Library, on the Rochester campus—a community-based patient library—provides DVDs, music CDs, books/audiobooks, magazines and newspapers, desktop and laptop computers with Internet access, board games, video consoles and games, and crafts for patients and their families as well as a daily morning coffee social activity (St. Mary's Patient Library, 2016).
These examples illustrate how leisure remains an inherent part of the Mayo philosophy and culture. This philosophy, linked to a community parks and recreation approach, has allowed therapeutic recreation to exist not only as a formal service within the Mayo system, but also as a fundamental element of care and the overall patient experience.
Therapeutic recreation is a diverse profession
Therapeutic recreation has emerged from a dynamic and ever-evolving mix of perspectives, converging schools of thought, borrowed and original theories, and unique interventions and services.
Therapeutic recreation has emerged from a dynamic and ever-evolving mix of perspectives, converging schools of thought, borrowed and original theories, and unique interventions and services. This diverse background offers potential for a large variety of service applications. Some have referred to therapeutic recreation as being eclectic in nature. Others have referred to it as a strengths-based approach. Some suggest that therapeutic recreation is unique in that it involves use of recreation or leisure. Others say that it is a mix of philosophy, psychology, the arts, and physical therapy and occupational therapy techniques—all used by a trained professional to bring about functional change within another person or group of people.
Regardless of the perspective chosen, therapeutic recreation is a profession that has tremendous potential for growth and evolution. The diverse philosophical positions or perspectives within the profession provide numerous opportunities for flexible application and professional growth. This diversity tends to produce a well-rounded college graduate who is capable of working within, on the fringes of, or outside of therapeutic recreation. Likewise, therapeutic recreation training programs have traditionally been ideal for those seeking a bachelor's degree before moving into a graduate degree program. A therapeutic recreation degree has also helped professionals enter community-based recreation and administrative positions within a variety of fields. If you are searching for a degree that could prepare you for a wide variety of occupations or you are looking for a specific career, then therapeutic recreation may be right for you. Are you still interested?
Choosing a Profession
As a bright person capable of choosing from among many occupations, you should think about why you are interested in therapeutic recreation. Are you interested in helping others? Are you interested in physical activity or psychological processes? Do you or any members of your family have a disability? Are you deciding between this major and some other therapy-oriented degree such as occupational therapy, physical therapy, or nursing? Maybe you are interested in broader topics such as social justice, aging, or health and wellness, or maybe you simply know someone in this major or profession. You are the only one who can answer the why questions. If you have not done so, try to answer the question for yourself right now—why choose this profession?
Your interest and motivation in this course and profession will have an effect on what you study, how you study, and whether you will succeed in your academic performance. Your motives can also influence who you might study or work with as well as where you might eventually work and ultimately live. So do you know where or with whom you might want to work? Do you know how this course could benefit you regardless of your major? If you answered no or have other questions, ask the course instructor and your advisor for some individual attention.
If the answer to either question is yes, then we would simply ask that you keep yourself open to more possibilities as you go through this text and course. If you are unsure about how all of this information is relevant to you, then we would ask that you try to focus a bit and select a temporary answer to these questions to help you reflect on and understand concepts as you move through the book and explore this profession. Whether you answered yes or no, before you try to finalize your decisions, you should learn the basic therapeutic recreation process, understand some of the basic techniques utilized during this process, and become familiar with what therapeutic recreation services have to offer clients who participate in this process (what benefits might come to clients from provision of this service). Later chapters will explore these topics in detail.
Finding a Personal Fit
Success in the therapeutic recreation profession requires commitment, forethought, and a willingness to engage others. The working professional generally has the ability to organize experiences, motivate others, be flexible, and work on several tasks simultaneously. The ability to communicate to diverse audiences (e.g., individuals, groups, and other professionals) in a variety of ways (e.g., oral, written, in person, electronically) and to be both understanding and assertive are also important characteristics. In plain words, therapeutic recreation is a people profession; a major job skill for a therapeutic recreation professional is to relate to people in an understanding and accepting way. Because creating effective interactions and experiences requires use of a systematic method, the successful professional must be competent at planning, organizing, solving problems, and managing several tasks and programs at once. To succeed in this profession, a person must be responsible, knowledgeable, and genuinely compassionate.
Employment Options
Therapeutic recreation specialists work in a variety of settings, and often those settings include a mix of clientele. Breaking down the profession based on client population reveals that about 37 percent work in mental health, 29 percent work in geriatrics, 20 percent work in physical medicine, and 14 percent work with individuals with developmental disabilities (National Council for Therapeutic Recreation Certification [NCTRC], 2015). The nature of therapeutic recreation services for each of these populations is addressed further in chapters 7 to 11, but this diversity is mentioned here to illustrate the options that are available to professionals. In addition, these categories are very general, and you will find that there are many specializations within each area.
Work-setting options for therapeutic recreation professionals are equally diverse and include hospitals, psychiatric facilities, long-term-care facilities, and community-based settings. It is also true that the boundaries between these settings are difficult if not impossible to define.
Who is the person with a disability?
Over the years, people with disabilities have been stereotyped as limited in potential. This generalization is based on a comparison of them with people who do not have the same characteristic.
Over the years, people with disabilities have been stereotyped as limited in potential. This generalization is based on a comparison of them with people who do not have the same characteristic. Labels drive such stereotypes, and these labels can originate from several sources, some of which were originally intended for good. Labels referring to disabilities have been medically based, such as the labeling of a person as blind because he or she cannot see. Labels can be socially based. For example, a person who uses a wheelchair may be assumed to be disabled in ways that exceed his or her actual impairments. Labels can even be legally based and are often required for the provision of supportive services in school and recreation. For example, to qualify for certain special education services, a child must fall into specific diagnostic categories, such as autism or attention-deficit/hyperactivity disorder. Regardless of the mechanisms through which a person is labeled, the person with a disability is someone who has a limitation in some aspect of his or her functioning according to our social norms.
All people tend to be identified by and associated with characteristics that really are only superficial indicators of who they are. Society worships celebrities based solely on public personas that are crafted by Hollywood moguls and music industry executives. Likewise, society has a history of ridiculing and ostracizing those who do not meet these unrealistic standards. This superficial idea of perfection leads to judgmental standards built on trivial characteristics that have no relationship to the essence of a person. The labeling of people, and the stereotypical assumptions that we make based on those labels, discounts the true value of the person. In other words, labels and inaccurate stereotypes of society often overshadow the strengths, potential, and accomplishments of persons with disabilities.
To be fair, labels can serve a valuable purpose because they facilitate communication of the nature of a particular condition to others. This message in turn allows for the provision of appropriate care, access to resources or accommodations, and program enrollment. The danger of labels comes from people's misuse and misunderstanding of them as well as the tendency to generalize impairment of one particular area of functioning to the overall abilities of the person. An example of such a generalization would be assuming that a person has difficulty solving problems because he or she cannot hear. Even worse, we begin to focus so much on the disability that the differentiating characteristic overshadows the person.
According to the Americans with Disabilities Act (ADA, 1991), legally, a person with a disability is someone who
- has a physical, mental, or cognitive impairment that substantially limits one or more major life functions or activities;
- has a record of such an impairment; or
- is regarded as having such an impairment.
This legal definition requires the disability to result in a substantial limitation in one or more major life activities, such as walking, breathing, seeing, thinking, performing tasks, speaking, learning, working, driving, and participating in community life. Although this definition is clear, it goes beyond how well a person can function and the degree to which he or she can be independent. The spirit of the ADA also embraces a philosophy or belief system that the person should not be taken out of the equation. In other words, the person is much more than his or her disability. People with disabilities have the right to be treated as a person first, not as their disability. Beyond the individual's physical, mental, or cognitive limitations, the constant factor is his or her humanity (Bogdan & Taylor, 1992). Thus, the humanity should be our first consideration.
Each of the hundreds of disabilities has a differing degree of severity. Chapters 7 to 11 discuss characteristics and aspects of various disabilities from the perspective of disability-related characteristics and programs. Here, we will explore the idea of viewing a person with a disability as a person first, with the focus not on the person's limitations but on the individual as a person. This perspective is a key element in the prevention of handicaps. A handicap is a situation in which a person can be disadvantaged not by the disability but by other factors. These disadvantages may result from a preventable or removable barrier to performance of a particular activity or skill. Handicaps can include physical barriers but can also come from society's negligence or negative personal attitudes, beliefs, or knowledge. This chapter focuses on the social issue of how society perceives and interacts with people with disabilities. In particular, we discuss person-first aspects of disability, the effect of negative perceptions of disability, and the role of therapeutic recreation relative to people with disabilities.
A legacy of leisure at the Mayo Clinic
Year after year, the U.S. News and World Report, along with other publications, ranks the Mayo Clinic as one of the best hospitals in the United States (see Eisenman, 2014).
Year after year, the U.S. News and World Report, along with other publications, ranks the Mayo Clinic as one of the best hospitals in the United States (see Eisenman, 2014). The Mayo Clinic employs 4,100 physicians/scientists and 53,600 practitioners in allied health professions and sees more than 1 million patients each year (Olsen & Dacy, 2014).
Leisure for enjoyment has a long history at the Mayo Clinic, dating back to 1914 (Mayo Foundation for Medical Education and Research, 2014). “Man and Recreation,” the large sculpture on the south façade of the Mayo building, represents the importance of rest, play, joyful moments, physical activities, rejuvenation, introspection, and enjoyment of nature (Mayo Clinic, 1984). Through a cafeteria and quality-of-life programming approach, the Mayo Clinic provides a plethora of diverse leisure activities through many organizational units. For example, the Peregrine Falcon Program at the Rochester campus allows patients to view and interact with Peregrine falcons that nest on the top of the 20-story Mayo and Gonda buildings (see http://history.mayoclinic.org/tours-events/mayo-clinic-peregrine-falcon-program.php).
The art collection at the Rochester campus presents thousands of art pieces from the media of glass, textiles, paintings, prints, ancient/ethnographic/folk art, sculptures, photography, and ceramics. Internationally known artists, such as Barbara Hepworth and Ivan Meštrovic´, are represented. Each year, the Art and Ability exhibit at the Rochester campus celebrates artworks from people with disabilities.
The Center for Humanities in Medicine at the Mayo Clinic Jacksonville (Florida) campus has professional musicians perform daily concerts in hospital lounges and local artists work one on one at the bedside with patients and families, exploring creative expression (see www.mayoclinic.org/patient-visitor-guide/humanities-in-medicine/florida-schedule). A 56-bell carillon on top of the Plummer building on the Rochester campus is rung regularly throughout the week (Mayo Clinic, 2006); patients can sit in the many outdoor courtyards and atriums or in the Feith Family Statuary Park in the center of campus to hear this musical performance. In keeping with a strengths-based approach, sometimes called the “Mayo way . . . to look at the strengths of individuals rather than at the deficiencies” (p. 150), grand pianos are placed at certain locations on the Rochester campus so that patients can perform impromptu concerts with crowds of other patients and staff singing or listening (Berry & Seltman, 2008; see also Mayo Clinic, 2001).
The Florida campus has a large park with lakes and a bridge to Louchery Island, where patients can contemplate and reflect (Mayo Clinic, 2011). The Scottsdale/Phoenix (Arizona) campus has a one-third-mile trail that includes more than 40 species of cacti and plants, where patients sometimes encounter roadrunners, quail, or horned owls (Mayo Clinic, 2011).
The St. Mary's Hospital Patient Library, on the Rochester campus—a community-based patient library—provides DVDs, music CDs, books/audiobooks, magazines and newspapers, desktop and laptop computers with Internet access, board games, video consoles and games, and crafts for patients and their families as well as a daily morning coffee social activity (St. Mary's Patient Library, 2016).
These examples illustrate how leisure remains an inherent part of the Mayo philosophy and culture. This philosophy, linked to a community parks and recreation approach, has allowed therapeutic recreation to exist not only as a formal service within the Mayo system, but also as a fundamental element of care and the overall patient experience.
Therapeutic recreation is a diverse profession
Therapeutic recreation has emerged from a dynamic and ever-evolving mix of perspectives, converging schools of thought, borrowed and original theories, and unique interventions and services.
Therapeutic recreation has emerged from a dynamic and ever-evolving mix of perspectives, converging schools of thought, borrowed and original theories, and unique interventions and services. This diverse background offers potential for a large variety of service applications. Some have referred to therapeutic recreation as being eclectic in nature. Others have referred to it as a strengths-based approach. Some suggest that therapeutic recreation is unique in that it involves use of recreation or leisure. Others say that it is a mix of philosophy, psychology, the arts, and physical therapy and occupational therapy techniques—all used by a trained professional to bring about functional change within another person or group of people.
Regardless of the perspective chosen, therapeutic recreation is a profession that has tremendous potential for growth and evolution. The diverse philosophical positions or perspectives within the profession provide numerous opportunities for flexible application and professional growth. This diversity tends to produce a well-rounded college graduate who is capable of working within, on the fringes of, or outside of therapeutic recreation. Likewise, therapeutic recreation training programs have traditionally been ideal for those seeking a bachelor's degree before moving into a graduate degree program. A therapeutic recreation degree has also helped professionals enter community-based recreation and administrative positions within a variety of fields. If you are searching for a degree that could prepare you for a wide variety of occupations or you are looking for a specific career, then therapeutic recreation may be right for you. Are you still interested?
Choosing a Profession
As a bright person capable of choosing from among many occupations, you should think about why you are interested in therapeutic recreation. Are you interested in helping others? Are you interested in physical activity or psychological processes? Do you or any members of your family have a disability? Are you deciding between this major and some other therapy-oriented degree such as occupational therapy, physical therapy, or nursing? Maybe you are interested in broader topics such as social justice, aging, or health and wellness, or maybe you simply know someone in this major or profession. You are the only one who can answer the why questions. If you have not done so, try to answer the question for yourself right now—why choose this profession?
Your interest and motivation in this course and profession will have an effect on what you study, how you study, and whether you will succeed in your academic performance. Your motives can also influence who you might study or work with as well as where you might eventually work and ultimately live. So do you know where or with whom you might want to work? Do you know how this course could benefit you regardless of your major? If you answered no or have other questions, ask the course instructor and your advisor for some individual attention.
If the answer to either question is yes, then we would simply ask that you keep yourself open to more possibilities as you go through this text and course. If you are unsure about how all of this information is relevant to you, then we would ask that you try to focus a bit and select a temporary answer to these questions to help you reflect on and understand concepts as you move through the book and explore this profession. Whether you answered yes or no, before you try to finalize your decisions, you should learn the basic therapeutic recreation process, understand some of the basic techniques utilized during this process, and become familiar with what therapeutic recreation services have to offer clients who participate in this process (what benefits might come to clients from provision of this service). Later chapters will explore these topics in detail.
Finding a Personal Fit
Success in the therapeutic recreation profession requires commitment, forethought, and a willingness to engage others. The working professional generally has the ability to organize experiences, motivate others, be flexible, and work on several tasks simultaneously. The ability to communicate to diverse audiences (e.g., individuals, groups, and other professionals) in a variety of ways (e.g., oral, written, in person, electronically) and to be both understanding and assertive are also important characteristics. In plain words, therapeutic recreation is a people profession; a major job skill for a therapeutic recreation professional is to relate to people in an understanding and accepting way. Because creating effective interactions and experiences requires use of a systematic method, the successful professional must be competent at planning, organizing, solving problems, and managing several tasks and programs at once. To succeed in this profession, a person must be responsible, knowledgeable, and genuinely compassionate.
Employment Options
Therapeutic recreation specialists work in a variety of settings, and often those settings include a mix of clientele. Breaking down the profession based on client population reveals that about 37 percent work in mental health, 29 percent work in geriatrics, 20 percent work in physical medicine, and 14 percent work with individuals with developmental disabilities (National Council for Therapeutic Recreation Certification [NCTRC], 2015). The nature of therapeutic recreation services for each of these populations is addressed further in chapters 7 to 11, but this diversity is mentioned here to illustrate the options that are available to professionals. In addition, these categories are very general, and you will find that there are many specializations within each area.
Work-setting options for therapeutic recreation professionals are equally diverse and include hospitals, psychiatric facilities, long-term-care facilities, and community-based settings. It is also true that the boundaries between these settings are difficult if not impossible to define.
Who is the person with a disability?
Over the years, people with disabilities have been stereotyped as limited in potential. This generalization is based on a comparison of them with people who do not have the same characteristic.
Over the years, people with disabilities have been stereotyped as limited in potential. This generalization is based on a comparison of them with people who do not have the same characteristic. Labels drive such stereotypes, and these labels can originate from several sources, some of which were originally intended for good. Labels referring to disabilities have been medically based, such as the labeling of a person as blind because he or she cannot see. Labels can be socially based. For example, a person who uses a wheelchair may be assumed to be disabled in ways that exceed his or her actual impairments. Labels can even be legally based and are often required for the provision of supportive services in school and recreation. For example, to qualify for certain special education services, a child must fall into specific diagnostic categories, such as autism or attention-deficit/hyperactivity disorder. Regardless of the mechanisms through which a person is labeled, the person with a disability is someone who has a limitation in some aspect of his or her functioning according to our social norms.
All people tend to be identified by and associated with characteristics that really are only superficial indicators of who they are. Society worships celebrities based solely on public personas that are crafted by Hollywood moguls and music industry executives. Likewise, society has a history of ridiculing and ostracizing those who do not meet these unrealistic standards. This superficial idea of perfection leads to judgmental standards built on trivial characteristics that have no relationship to the essence of a person. The labeling of people, and the stereotypical assumptions that we make based on those labels, discounts the true value of the person. In other words, labels and inaccurate stereotypes of society often overshadow the strengths, potential, and accomplishments of persons with disabilities.
To be fair, labels can serve a valuable purpose because they facilitate communication of the nature of a particular condition to others. This message in turn allows for the provision of appropriate care, access to resources or accommodations, and program enrollment. The danger of labels comes from people's misuse and misunderstanding of them as well as the tendency to generalize impairment of one particular area of functioning to the overall abilities of the person. An example of such a generalization would be assuming that a person has difficulty solving problems because he or she cannot hear. Even worse, we begin to focus so much on the disability that the differentiating characteristic overshadows the person.
According to the Americans with Disabilities Act (ADA, 1991), legally, a person with a disability is someone who
- has a physical, mental, or cognitive impairment that substantially limits one or more major life functions or activities;
- has a record of such an impairment; or
- is regarded as having such an impairment.
This legal definition requires the disability to result in a substantial limitation in one or more major life activities, such as walking, breathing, seeing, thinking, performing tasks, speaking, learning, working, driving, and participating in community life. Although this definition is clear, it goes beyond how well a person can function and the degree to which he or she can be independent. The spirit of the ADA also embraces a philosophy or belief system that the person should not be taken out of the equation. In other words, the person is much more than his or her disability. People with disabilities have the right to be treated as a person first, not as their disability. Beyond the individual's physical, mental, or cognitive limitations, the constant factor is his or her humanity (Bogdan & Taylor, 1992). Thus, the humanity should be our first consideration.
Each of the hundreds of disabilities has a differing degree of severity. Chapters 7 to 11 discuss characteristics and aspects of various disabilities from the perspective of disability-related characteristics and programs. Here, we will explore the idea of viewing a person with a disability as a person first, with the focus not on the person's limitations but on the individual as a person. This perspective is a key element in the prevention of handicaps. A handicap is a situation in which a person can be disadvantaged not by the disability but by other factors. These disadvantages may result from a preventable or removable barrier to performance of a particular activity or skill. Handicaps can include physical barriers but can also come from society's negligence or negative personal attitudes, beliefs, or knowledge. This chapter focuses on the social issue of how society perceives and interacts with people with disabilities. In particular, we discuss person-first aspects of disability, the effect of negative perceptions of disability, and the role of therapeutic recreation relative to people with disabilities.
A legacy of leisure at the Mayo Clinic
Year after year, the U.S. News and World Report, along with other publications, ranks the Mayo Clinic as one of the best hospitals in the United States (see Eisenman, 2014).
Year after year, the U.S. News and World Report, along with other publications, ranks the Mayo Clinic as one of the best hospitals in the United States (see Eisenman, 2014). The Mayo Clinic employs 4,100 physicians/scientists and 53,600 practitioners in allied health professions and sees more than 1 million patients each year (Olsen & Dacy, 2014).
Leisure for enjoyment has a long history at the Mayo Clinic, dating back to 1914 (Mayo Foundation for Medical Education and Research, 2014). “Man and Recreation,” the large sculpture on the south façade of the Mayo building, represents the importance of rest, play, joyful moments, physical activities, rejuvenation, introspection, and enjoyment of nature (Mayo Clinic, 1984). Through a cafeteria and quality-of-life programming approach, the Mayo Clinic provides a plethora of diverse leisure activities through many organizational units. For example, the Peregrine Falcon Program at the Rochester campus allows patients to view and interact with Peregrine falcons that nest on the top of the 20-story Mayo and Gonda buildings (see http://history.mayoclinic.org/tours-events/mayo-clinic-peregrine-falcon-program.php).
The art collection at the Rochester campus presents thousands of art pieces from the media of glass, textiles, paintings, prints, ancient/ethnographic/folk art, sculptures, photography, and ceramics. Internationally known artists, such as Barbara Hepworth and Ivan Meštrovic´, are represented. Each year, the Art and Ability exhibit at the Rochester campus celebrates artworks from people with disabilities.
The Center for Humanities in Medicine at the Mayo Clinic Jacksonville (Florida) campus has professional musicians perform daily concerts in hospital lounges and local artists work one on one at the bedside with patients and families, exploring creative expression (see www.mayoclinic.org/patient-visitor-guide/humanities-in-medicine/florida-schedule). A 56-bell carillon on top of the Plummer building on the Rochester campus is rung regularly throughout the week (Mayo Clinic, 2006); patients can sit in the many outdoor courtyards and atriums or in the Feith Family Statuary Park in the center of campus to hear this musical performance. In keeping with a strengths-based approach, sometimes called the “Mayo way . . . to look at the strengths of individuals rather than at the deficiencies” (p. 150), grand pianos are placed at certain locations on the Rochester campus so that patients can perform impromptu concerts with crowds of other patients and staff singing or listening (Berry & Seltman, 2008; see also Mayo Clinic, 2001).
The Florida campus has a large park with lakes and a bridge to Louchery Island, where patients can contemplate and reflect (Mayo Clinic, 2011). The Scottsdale/Phoenix (Arizona) campus has a one-third-mile trail that includes more than 40 species of cacti and plants, where patients sometimes encounter roadrunners, quail, or horned owls (Mayo Clinic, 2011).
The St. Mary's Hospital Patient Library, on the Rochester campus—a community-based patient library—provides DVDs, music CDs, books/audiobooks, magazines and newspapers, desktop and laptop computers with Internet access, board games, video consoles and games, and crafts for patients and their families as well as a daily morning coffee social activity (St. Mary's Patient Library, 2016).
These examples illustrate how leisure remains an inherent part of the Mayo philosophy and culture. This philosophy, linked to a community parks and recreation approach, has allowed therapeutic recreation to exist not only as a formal service within the Mayo system, but also as a fundamental element of care and the overall patient experience.
Therapeutic recreation is a diverse profession
Therapeutic recreation has emerged from a dynamic and ever-evolving mix of perspectives, converging schools of thought, borrowed and original theories, and unique interventions and services.
Therapeutic recreation has emerged from a dynamic and ever-evolving mix of perspectives, converging schools of thought, borrowed and original theories, and unique interventions and services. This diverse background offers potential for a large variety of service applications. Some have referred to therapeutic recreation as being eclectic in nature. Others have referred to it as a strengths-based approach. Some suggest that therapeutic recreation is unique in that it involves use of recreation or leisure. Others say that it is a mix of philosophy, psychology, the arts, and physical therapy and occupational therapy techniques—all used by a trained professional to bring about functional change within another person or group of people.
Regardless of the perspective chosen, therapeutic recreation is a profession that has tremendous potential for growth and evolution. The diverse philosophical positions or perspectives within the profession provide numerous opportunities for flexible application and professional growth. This diversity tends to produce a well-rounded college graduate who is capable of working within, on the fringes of, or outside of therapeutic recreation. Likewise, therapeutic recreation training programs have traditionally been ideal for those seeking a bachelor's degree before moving into a graduate degree program. A therapeutic recreation degree has also helped professionals enter community-based recreation and administrative positions within a variety of fields. If you are searching for a degree that could prepare you for a wide variety of occupations or you are looking for a specific career, then therapeutic recreation may be right for you. Are you still interested?
Choosing a Profession
As a bright person capable of choosing from among many occupations, you should think about why you are interested in therapeutic recreation. Are you interested in helping others? Are you interested in physical activity or psychological processes? Do you or any members of your family have a disability? Are you deciding between this major and some other therapy-oriented degree such as occupational therapy, physical therapy, or nursing? Maybe you are interested in broader topics such as social justice, aging, or health and wellness, or maybe you simply know someone in this major or profession. You are the only one who can answer the why questions. If you have not done so, try to answer the question for yourself right now—why choose this profession?
Your interest and motivation in this course and profession will have an effect on what you study, how you study, and whether you will succeed in your academic performance. Your motives can also influence who you might study or work with as well as where you might eventually work and ultimately live. So do you know where or with whom you might want to work? Do you know how this course could benefit you regardless of your major? If you answered no or have other questions, ask the course instructor and your advisor for some individual attention.
If the answer to either question is yes, then we would simply ask that you keep yourself open to more possibilities as you go through this text and course. If you are unsure about how all of this information is relevant to you, then we would ask that you try to focus a bit and select a temporary answer to these questions to help you reflect on and understand concepts as you move through the book and explore this profession. Whether you answered yes or no, before you try to finalize your decisions, you should learn the basic therapeutic recreation process, understand some of the basic techniques utilized during this process, and become familiar with what therapeutic recreation services have to offer clients who participate in this process (what benefits might come to clients from provision of this service). Later chapters will explore these topics in detail.
Finding a Personal Fit
Success in the therapeutic recreation profession requires commitment, forethought, and a willingness to engage others. The working professional generally has the ability to organize experiences, motivate others, be flexible, and work on several tasks simultaneously. The ability to communicate to diverse audiences (e.g., individuals, groups, and other professionals) in a variety of ways (e.g., oral, written, in person, electronically) and to be both understanding and assertive are also important characteristics. In plain words, therapeutic recreation is a people profession; a major job skill for a therapeutic recreation professional is to relate to people in an understanding and accepting way. Because creating effective interactions and experiences requires use of a systematic method, the successful professional must be competent at planning, organizing, solving problems, and managing several tasks and programs at once. To succeed in this profession, a person must be responsible, knowledgeable, and genuinely compassionate.
Employment Options
Therapeutic recreation specialists work in a variety of settings, and often those settings include a mix of clientele. Breaking down the profession based on client population reveals that about 37 percent work in mental health, 29 percent work in geriatrics, 20 percent work in physical medicine, and 14 percent work with individuals with developmental disabilities (National Council for Therapeutic Recreation Certification [NCTRC], 2015). The nature of therapeutic recreation services for each of these populations is addressed further in chapters 7 to 11, but this diversity is mentioned here to illustrate the options that are available to professionals. In addition, these categories are very general, and you will find that there are many specializations within each area.
Work-setting options for therapeutic recreation professionals are equally diverse and include hospitals, psychiatric facilities, long-term-care facilities, and community-based settings. It is also true that the boundaries between these settings are difficult if not impossible to define.
Who is the person with a disability?
Over the years, people with disabilities have been stereotyped as limited in potential. This generalization is based on a comparison of them with people who do not have the same characteristic.
Over the years, people with disabilities have been stereotyped as limited in potential. This generalization is based on a comparison of them with people who do not have the same characteristic. Labels drive such stereotypes, and these labels can originate from several sources, some of which were originally intended for good. Labels referring to disabilities have been medically based, such as the labeling of a person as blind because he or she cannot see. Labels can be socially based. For example, a person who uses a wheelchair may be assumed to be disabled in ways that exceed his or her actual impairments. Labels can even be legally based and are often required for the provision of supportive services in school and recreation. For example, to qualify for certain special education services, a child must fall into specific diagnostic categories, such as autism or attention-deficit/hyperactivity disorder. Regardless of the mechanisms through which a person is labeled, the person with a disability is someone who has a limitation in some aspect of his or her functioning according to our social norms.
All people tend to be identified by and associated with characteristics that really are only superficial indicators of who they are. Society worships celebrities based solely on public personas that are crafted by Hollywood moguls and music industry executives. Likewise, society has a history of ridiculing and ostracizing those who do not meet these unrealistic standards. This superficial idea of perfection leads to judgmental standards built on trivial characteristics that have no relationship to the essence of a person. The labeling of people, and the stereotypical assumptions that we make based on those labels, discounts the true value of the person. In other words, labels and inaccurate stereotypes of society often overshadow the strengths, potential, and accomplishments of persons with disabilities.
To be fair, labels can serve a valuable purpose because they facilitate communication of the nature of a particular condition to others. This message in turn allows for the provision of appropriate care, access to resources or accommodations, and program enrollment. The danger of labels comes from people's misuse and misunderstanding of them as well as the tendency to generalize impairment of one particular area of functioning to the overall abilities of the person. An example of such a generalization would be assuming that a person has difficulty solving problems because he or she cannot hear. Even worse, we begin to focus so much on the disability that the differentiating characteristic overshadows the person.
According to the Americans with Disabilities Act (ADA, 1991), legally, a person with a disability is someone who
- has a physical, mental, or cognitive impairment that substantially limits one or more major life functions or activities;
- has a record of such an impairment; or
- is regarded as having such an impairment.
This legal definition requires the disability to result in a substantial limitation in one or more major life activities, such as walking, breathing, seeing, thinking, performing tasks, speaking, learning, working, driving, and participating in community life. Although this definition is clear, it goes beyond how well a person can function and the degree to which he or she can be independent. The spirit of the ADA also embraces a philosophy or belief system that the person should not be taken out of the equation. In other words, the person is much more than his or her disability. People with disabilities have the right to be treated as a person first, not as their disability. Beyond the individual's physical, mental, or cognitive limitations, the constant factor is his or her humanity (Bogdan & Taylor, 1992). Thus, the humanity should be our first consideration.
Each of the hundreds of disabilities has a differing degree of severity. Chapters 7 to 11 discuss characteristics and aspects of various disabilities from the perspective of disability-related characteristics and programs. Here, we will explore the idea of viewing a person with a disability as a person first, with the focus not on the person's limitations but on the individual as a person. This perspective is a key element in the prevention of handicaps. A handicap is a situation in which a person can be disadvantaged not by the disability but by other factors. These disadvantages may result from a preventable or removable barrier to performance of a particular activity or skill. Handicaps can include physical barriers but can also come from society's negligence or negative personal attitudes, beliefs, or knowledge. This chapter focuses on the social issue of how society perceives and interacts with people with disabilities. In particular, we discuss person-first aspects of disability, the effect of negative perceptions of disability, and the role of therapeutic recreation relative to people with disabilities.
A legacy of leisure at the Mayo Clinic
Year after year, the U.S. News and World Report, along with other publications, ranks the Mayo Clinic as one of the best hospitals in the United States (see Eisenman, 2014).
Year after year, the U.S. News and World Report, along with other publications, ranks the Mayo Clinic as one of the best hospitals in the United States (see Eisenman, 2014). The Mayo Clinic employs 4,100 physicians/scientists and 53,600 practitioners in allied health professions and sees more than 1 million patients each year (Olsen & Dacy, 2014).
Leisure for enjoyment has a long history at the Mayo Clinic, dating back to 1914 (Mayo Foundation for Medical Education and Research, 2014). “Man and Recreation,” the large sculpture on the south façade of the Mayo building, represents the importance of rest, play, joyful moments, physical activities, rejuvenation, introspection, and enjoyment of nature (Mayo Clinic, 1984). Through a cafeteria and quality-of-life programming approach, the Mayo Clinic provides a plethora of diverse leisure activities through many organizational units. For example, the Peregrine Falcon Program at the Rochester campus allows patients to view and interact with Peregrine falcons that nest on the top of the 20-story Mayo and Gonda buildings (see http://history.mayoclinic.org/tours-events/mayo-clinic-peregrine-falcon-program.php).
The art collection at the Rochester campus presents thousands of art pieces from the media of glass, textiles, paintings, prints, ancient/ethnographic/folk art, sculptures, photography, and ceramics. Internationally known artists, such as Barbara Hepworth and Ivan Meštrovic´, are represented. Each year, the Art and Ability exhibit at the Rochester campus celebrates artworks from people with disabilities.
The Center for Humanities in Medicine at the Mayo Clinic Jacksonville (Florida) campus has professional musicians perform daily concerts in hospital lounges and local artists work one on one at the bedside with patients and families, exploring creative expression (see www.mayoclinic.org/patient-visitor-guide/humanities-in-medicine/florida-schedule). A 56-bell carillon on top of the Plummer building on the Rochester campus is rung regularly throughout the week (Mayo Clinic, 2006); patients can sit in the many outdoor courtyards and atriums or in the Feith Family Statuary Park in the center of campus to hear this musical performance. In keeping with a strengths-based approach, sometimes called the “Mayo way . . . to look at the strengths of individuals rather than at the deficiencies” (p. 150), grand pianos are placed at certain locations on the Rochester campus so that patients can perform impromptu concerts with crowds of other patients and staff singing or listening (Berry & Seltman, 2008; see also Mayo Clinic, 2001).
The Florida campus has a large park with lakes and a bridge to Louchery Island, where patients can contemplate and reflect (Mayo Clinic, 2011). The Scottsdale/Phoenix (Arizona) campus has a one-third-mile trail that includes more than 40 species of cacti and plants, where patients sometimes encounter roadrunners, quail, or horned owls (Mayo Clinic, 2011).
The St. Mary's Hospital Patient Library, on the Rochester campus—a community-based patient library—provides DVDs, music CDs, books/audiobooks, magazines and newspapers, desktop and laptop computers with Internet access, board games, video consoles and games, and crafts for patients and their families as well as a daily morning coffee social activity (St. Mary's Patient Library, 2016).
These examples illustrate how leisure remains an inherent part of the Mayo philosophy and culture. This philosophy, linked to a community parks and recreation approach, has allowed therapeutic recreation to exist not only as a formal service within the Mayo system, but also as a fundamental element of care and the overall patient experience.
Therapeutic recreation is a diverse profession
Therapeutic recreation has emerged from a dynamic and ever-evolving mix of perspectives, converging schools of thought, borrowed and original theories, and unique interventions and services.
Therapeutic recreation has emerged from a dynamic and ever-evolving mix of perspectives, converging schools of thought, borrowed and original theories, and unique interventions and services. This diverse background offers potential for a large variety of service applications. Some have referred to therapeutic recreation as being eclectic in nature. Others have referred to it as a strengths-based approach. Some suggest that therapeutic recreation is unique in that it involves use of recreation or leisure. Others say that it is a mix of philosophy, psychology, the arts, and physical therapy and occupational therapy techniques—all used by a trained professional to bring about functional change within another person or group of people.
Regardless of the perspective chosen, therapeutic recreation is a profession that has tremendous potential for growth and evolution. The diverse philosophical positions or perspectives within the profession provide numerous opportunities for flexible application and professional growth. This diversity tends to produce a well-rounded college graduate who is capable of working within, on the fringes of, or outside of therapeutic recreation. Likewise, therapeutic recreation training programs have traditionally been ideal for those seeking a bachelor's degree before moving into a graduate degree program. A therapeutic recreation degree has also helped professionals enter community-based recreation and administrative positions within a variety of fields. If you are searching for a degree that could prepare you for a wide variety of occupations or you are looking for a specific career, then therapeutic recreation may be right for you. Are you still interested?
Choosing a Profession
As a bright person capable of choosing from among many occupations, you should think about why you are interested in therapeutic recreation. Are you interested in helping others? Are you interested in physical activity or psychological processes? Do you or any members of your family have a disability? Are you deciding between this major and some other therapy-oriented degree such as occupational therapy, physical therapy, or nursing? Maybe you are interested in broader topics such as social justice, aging, or health and wellness, or maybe you simply know someone in this major or profession. You are the only one who can answer the why questions. If you have not done so, try to answer the question for yourself right now—why choose this profession?
Your interest and motivation in this course and profession will have an effect on what you study, how you study, and whether you will succeed in your academic performance. Your motives can also influence who you might study or work with as well as where you might eventually work and ultimately live. So do you know where or with whom you might want to work? Do you know how this course could benefit you regardless of your major? If you answered no or have other questions, ask the course instructor and your advisor for some individual attention.
If the answer to either question is yes, then we would simply ask that you keep yourself open to more possibilities as you go through this text and course. If you are unsure about how all of this information is relevant to you, then we would ask that you try to focus a bit and select a temporary answer to these questions to help you reflect on and understand concepts as you move through the book and explore this profession. Whether you answered yes or no, before you try to finalize your decisions, you should learn the basic therapeutic recreation process, understand some of the basic techniques utilized during this process, and become familiar with what therapeutic recreation services have to offer clients who participate in this process (what benefits might come to clients from provision of this service). Later chapters will explore these topics in detail.
Finding a Personal Fit
Success in the therapeutic recreation profession requires commitment, forethought, and a willingness to engage others. The working professional generally has the ability to organize experiences, motivate others, be flexible, and work on several tasks simultaneously. The ability to communicate to diverse audiences (e.g., individuals, groups, and other professionals) in a variety of ways (e.g., oral, written, in person, electronically) and to be both understanding and assertive are also important characteristics. In plain words, therapeutic recreation is a people profession; a major job skill for a therapeutic recreation professional is to relate to people in an understanding and accepting way. Because creating effective interactions and experiences requires use of a systematic method, the successful professional must be competent at planning, organizing, solving problems, and managing several tasks and programs at once. To succeed in this profession, a person must be responsible, knowledgeable, and genuinely compassionate.
Employment Options
Therapeutic recreation specialists work in a variety of settings, and often those settings include a mix of clientele. Breaking down the profession based on client population reveals that about 37 percent work in mental health, 29 percent work in geriatrics, 20 percent work in physical medicine, and 14 percent work with individuals with developmental disabilities (National Council for Therapeutic Recreation Certification [NCTRC], 2015). The nature of therapeutic recreation services for each of these populations is addressed further in chapters 7 to 11, but this diversity is mentioned here to illustrate the options that are available to professionals. In addition, these categories are very general, and you will find that there are many specializations within each area.
Work-setting options for therapeutic recreation professionals are equally diverse and include hospitals, psychiatric facilities, long-term-care facilities, and community-based settings. It is also true that the boundaries between these settings are difficult if not impossible to define.
Who is the person with a disability?
Over the years, people with disabilities have been stereotyped as limited in potential. This generalization is based on a comparison of them with people who do not have the same characteristic.
Over the years, people with disabilities have been stereotyped as limited in potential. This generalization is based on a comparison of them with people who do not have the same characteristic. Labels drive such stereotypes, and these labels can originate from several sources, some of which were originally intended for good. Labels referring to disabilities have been medically based, such as the labeling of a person as blind because he or she cannot see. Labels can be socially based. For example, a person who uses a wheelchair may be assumed to be disabled in ways that exceed his or her actual impairments. Labels can even be legally based and are often required for the provision of supportive services in school and recreation. For example, to qualify for certain special education services, a child must fall into specific diagnostic categories, such as autism or attention-deficit/hyperactivity disorder. Regardless of the mechanisms through which a person is labeled, the person with a disability is someone who has a limitation in some aspect of his or her functioning according to our social norms.
All people tend to be identified by and associated with characteristics that really are only superficial indicators of who they are. Society worships celebrities based solely on public personas that are crafted by Hollywood moguls and music industry executives. Likewise, society has a history of ridiculing and ostracizing those who do not meet these unrealistic standards. This superficial idea of perfection leads to judgmental standards built on trivial characteristics that have no relationship to the essence of a person. The labeling of people, and the stereotypical assumptions that we make based on those labels, discounts the true value of the person. In other words, labels and inaccurate stereotypes of society often overshadow the strengths, potential, and accomplishments of persons with disabilities.
To be fair, labels can serve a valuable purpose because they facilitate communication of the nature of a particular condition to others. This message in turn allows for the provision of appropriate care, access to resources or accommodations, and program enrollment. The danger of labels comes from people's misuse and misunderstanding of them as well as the tendency to generalize impairment of one particular area of functioning to the overall abilities of the person. An example of such a generalization would be assuming that a person has difficulty solving problems because he or she cannot hear. Even worse, we begin to focus so much on the disability that the differentiating characteristic overshadows the person.
According to the Americans with Disabilities Act (ADA, 1991), legally, a person with a disability is someone who
- has a physical, mental, or cognitive impairment that substantially limits one or more major life functions or activities;
- has a record of such an impairment; or
- is regarded as having such an impairment.
This legal definition requires the disability to result in a substantial limitation in one or more major life activities, such as walking, breathing, seeing, thinking, performing tasks, speaking, learning, working, driving, and participating in community life. Although this definition is clear, it goes beyond how well a person can function and the degree to which he or she can be independent. The spirit of the ADA also embraces a philosophy or belief system that the person should not be taken out of the equation. In other words, the person is much more than his or her disability. People with disabilities have the right to be treated as a person first, not as their disability. Beyond the individual's physical, mental, or cognitive limitations, the constant factor is his or her humanity (Bogdan & Taylor, 1992). Thus, the humanity should be our first consideration.
Each of the hundreds of disabilities has a differing degree of severity. Chapters 7 to 11 discuss characteristics and aspects of various disabilities from the perspective of disability-related characteristics and programs. Here, we will explore the idea of viewing a person with a disability as a person first, with the focus not on the person's limitations but on the individual as a person. This perspective is a key element in the prevention of handicaps. A handicap is a situation in which a person can be disadvantaged not by the disability but by other factors. These disadvantages may result from a preventable or removable barrier to performance of a particular activity or skill. Handicaps can include physical barriers but can also come from society's negligence or negative personal attitudes, beliefs, or knowledge. This chapter focuses on the social issue of how society perceives and interacts with people with disabilities. In particular, we discuss person-first aspects of disability, the effect of negative perceptions of disability, and the role of therapeutic recreation relative to people with disabilities.
A legacy of leisure at the Mayo Clinic
Year after year, the U.S. News and World Report, along with other publications, ranks the Mayo Clinic as one of the best hospitals in the United States (see Eisenman, 2014).
Year after year, the U.S. News and World Report, along with other publications, ranks the Mayo Clinic as one of the best hospitals in the United States (see Eisenman, 2014). The Mayo Clinic employs 4,100 physicians/scientists and 53,600 practitioners in allied health professions and sees more than 1 million patients each year (Olsen & Dacy, 2014).
Leisure for enjoyment has a long history at the Mayo Clinic, dating back to 1914 (Mayo Foundation for Medical Education and Research, 2014). “Man and Recreation,” the large sculpture on the south façade of the Mayo building, represents the importance of rest, play, joyful moments, physical activities, rejuvenation, introspection, and enjoyment of nature (Mayo Clinic, 1984). Through a cafeteria and quality-of-life programming approach, the Mayo Clinic provides a plethora of diverse leisure activities through many organizational units. For example, the Peregrine Falcon Program at the Rochester campus allows patients to view and interact with Peregrine falcons that nest on the top of the 20-story Mayo and Gonda buildings (see http://history.mayoclinic.org/tours-events/mayo-clinic-peregrine-falcon-program.php).
The art collection at the Rochester campus presents thousands of art pieces from the media of glass, textiles, paintings, prints, ancient/ethnographic/folk art, sculptures, photography, and ceramics. Internationally known artists, such as Barbara Hepworth and Ivan Meštrovic´, are represented. Each year, the Art and Ability exhibit at the Rochester campus celebrates artworks from people with disabilities.
The Center for Humanities in Medicine at the Mayo Clinic Jacksonville (Florida) campus has professional musicians perform daily concerts in hospital lounges and local artists work one on one at the bedside with patients and families, exploring creative expression (see www.mayoclinic.org/patient-visitor-guide/humanities-in-medicine/florida-schedule). A 56-bell carillon on top of the Plummer building on the Rochester campus is rung regularly throughout the week (Mayo Clinic, 2006); patients can sit in the many outdoor courtyards and atriums or in the Feith Family Statuary Park in the center of campus to hear this musical performance. In keeping with a strengths-based approach, sometimes called the “Mayo way . . . to look at the strengths of individuals rather than at the deficiencies” (p. 150), grand pianos are placed at certain locations on the Rochester campus so that patients can perform impromptu concerts with crowds of other patients and staff singing or listening (Berry & Seltman, 2008; see also Mayo Clinic, 2001).
The Florida campus has a large park with lakes and a bridge to Louchery Island, where patients can contemplate and reflect (Mayo Clinic, 2011). The Scottsdale/Phoenix (Arizona) campus has a one-third-mile trail that includes more than 40 species of cacti and plants, where patients sometimes encounter roadrunners, quail, or horned owls (Mayo Clinic, 2011).
The St. Mary's Hospital Patient Library, on the Rochester campus—a community-based patient library—provides DVDs, music CDs, books/audiobooks, magazines and newspapers, desktop and laptop computers with Internet access, board games, video consoles and games, and crafts for patients and their families as well as a daily morning coffee social activity (St. Mary's Patient Library, 2016).
These examples illustrate how leisure remains an inherent part of the Mayo philosophy and culture. This philosophy, linked to a community parks and recreation approach, has allowed therapeutic recreation to exist not only as a formal service within the Mayo system, but also as a fundamental element of care and the overall patient experience.
Therapeutic recreation is a diverse profession
Therapeutic recreation has emerged from a dynamic and ever-evolving mix of perspectives, converging schools of thought, borrowed and original theories, and unique interventions and services.
Therapeutic recreation has emerged from a dynamic and ever-evolving mix of perspectives, converging schools of thought, borrowed and original theories, and unique interventions and services. This diverse background offers potential for a large variety of service applications. Some have referred to therapeutic recreation as being eclectic in nature. Others have referred to it as a strengths-based approach. Some suggest that therapeutic recreation is unique in that it involves use of recreation or leisure. Others say that it is a mix of philosophy, psychology, the arts, and physical therapy and occupational therapy techniques—all used by a trained professional to bring about functional change within another person or group of people.
Regardless of the perspective chosen, therapeutic recreation is a profession that has tremendous potential for growth and evolution. The diverse philosophical positions or perspectives within the profession provide numerous opportunities for flexible application and professional growth. This diversity tends to produce a well-rounded college graduate who is capable of working within, on the fringes of, or outside of therapeutic recreation. Likewise, therapeutic recreation training programs have traditionally been ideal for those seeking a bachelor's degree before moving into a graduate degree program. A therapeutic recreation degree has also helped professionals enter community-based recreation and administrative positions within a variety of fields. If you are searching for a degree that could prepare you for a wide variety of occupations or you are looking for a specific career, then therapeutic recreation may be right for you. Are you still interested?
Choosing a Profession
As a bright person capable of choosing from among many occupations, you should think about why you are interested in therapeutic recreation. Are you interested in helping others? Are you interested in physical activity or psychological processes? Do you or any members of your family have a disability? Are you deciding between this major and some other therapy-oriented degree such as occupational therapy, physical therapy, or nursing? Maybe you are interested in broader topics such as social justice, aging, or health and wellness, or maybe you simply know someone in this major or profession. You are the only one who can answer the why questions. If you have not done so, try to answer the question for yourself right now—why choose this profession?
Your interest and motivation in this course and profession will have an effect on what you study, how you study, and whether you will succeed in your academic performance. Your motives can also influence who you might study or work with as well as where you might eventually work and ultimately live. So do you know where or with whom you might want to work? Do you know how this course could benefit you regardless of your major? If you answered no or have other questions, ask the course instructor and your advisor for some individual attention.
If the answer to either question is yes, then we would simply ask that you keep yourself open to more possibilities as you go through this text and course. If you are unsure about how all of this information is relevant to you, then we would ask that you try to focus a bit and select a temporary answer to these questions to help you reflect on and understand concepts as you move through the book and explore this profession. Whether you answered yes or no, before you try to finalize your decisions, you should learn the basic therapeutic recreation process, understand some of the basic techniques utilized during this process, and become familiar with what therapeutic recreation services have to offer clients who participate in this process (what benefits might come to clients from provision of this service). Later chapters will explore these topics in detail.
Finding a Personal Fit
Success in the therapeutic recreation profession requires commitment, forethought, and a willingness to engage others. The working professional generally has the ability to organize experiences, motivate others, be flexible, and work on several tasks simultaneously. The ability to communicate to diverse audiences (e.g., individuals, groups, and other professionals) in a variety of ways (e.g., oral, written, in person, electronically) and to be both understanding and assertive are also important characteristics. In plain words, therapeutic recreation is a people profession; a major job skill for a therapeutic recreation professional is to relate to people in an understanding and accepting way. Because creating effective interactions and experiences requires use of a systematic method, the successful professional must be competent at planning, organizing, solving problems, and managing several tasks and programs at once. To succeed in this profession, a person must be responsible, knowledgeable, and genuinely compassionate.
Employment Options
Therapeutic recreation specialists work in a variety of settings, and often those settings include a mix of clientele. Breaking down the profession based on client population reveals that about 37 percent work in mental health, 29 percent work in geriatrics, 20 percent work in physical medicine, and 14 percent work with individuals with developmental disabilities (National Council for Therapeutic Recreation Certification [NCTRC], 2015). The nature of therapeutic recreation services for each of these populations is addressed further in chapters 7 to 11, but this diversity is mentioned here to illustrate the options that are available to professionals. In addition, these categories are very general, and you will find that there are many specializations within each area.
Work-setting options for therapeutic recreation professionals are equally diverse and include hospitals, psychiatric facilities, long-term-care facilities, and community-based settings. It is also true that the boundaries between these settings are difficult if not impossible to define.
Who is the person with a disability?
Over the years, people with disabilities have been stereotyped as limited in potential. This generalization is based on a comparison of them with people who do not have the same characteristic.
Over the years, people with disabilities have been stereotyped as limited in potential. This generalization is based on a comparison of them with people who do not have the same characteristic. Labels drive such stereotypes, and these labels can originate from several sources, some of which were originally intended for good. Labels referring to disabilities have been medically based, such as the labeling of a person as blind because he or she cannot see. Labels can be socially based. For example, a person who uses a wheelchair may be assumed to be disabled in ways that exceed his or her actual impairments. Labels can even be legally based and are often required for the provision of supportive services in school and recreation. For example, to qualify for certain special education services, a child must fall into specific diagnostic categories, such as autism or attention-deficit/hyperactivity disorder. Regardless of the mechanisms through which a person is labeled, the person with a disability is someone who has a limitation in some aspect of his or her functioning according to our social norms.
All people tend to be identified by and associated with characteristics that really are only superficial indicators of who they are. Society worships celebrities based solely on public personas that are crafted by Hollywood moguls and music industry executives. Likewise, society has a history of ridiculing and ostracizing those who do not meet these unrealistic standards. This superficial idea of perfection leads to judgmental standards built on trivial characteristics that have no relationship to the essence of a person. The labeling of people, and the stereotypical assumptions that we make based on those labels, discounts the true value of the person. In other words, labels and inaccurate stereotypes of society often overshadow the strengths, potential, and accomplishments of persons with disabilities.
To be fair, labels can serve a valuable purpose because they facilitate communication of the nature of a particular condition to others. This message in turn allows for the provision of appropriate care, access to resources or accommodations, and program enrollment. The danger of labels comes from people's misuse and misunderstanding of them as well as the tendency to generalize impairment of one particular area of functioning to the overall abilities of the person. An example of such a generalization would be assuming that a person has difficulty solving problems because he or she cannot hear. Even worse, we begin to focus so much on the disability that the differentiating characteristic overshadows the person.
According to the Americans with Disabilities Act (ADA, 1991), legally, a person with a disability is someone who
- has a physical, mental, or cognitive impairment that substantially limits one or more major life functions or activities;
- has a record of such an impairment; or
- is regarded as having such an impairment.
This legal definition requires the disability to result in a substantial limitation in one or more major life activities, such as walking, breathing, seeing, thinking, performing tasks, speaking, learning, working, driving, and participating in community life. Although this definition is clear, it goes beyond how well a person can function and the degree to which he or she can be independent. The spirit of the ADA also embraces a philosophy or belief system that the person should not be taken out of the equation. In other words, the person is much more than his or her disability. People with disabilities have the right to be treated as a person first, not as their disability. Beyond the individual's physical, mental, or cognitive limitations, the constant factor is his or her humanity (Bogdan & Taylor, 1992). Thus, the humanity should be our first consideration.
Each of the hundreds of disabilities has a differing degree of severity. Chapters 7 to 11 discuss characteristics and aspects of various disabilities from the perspective of disability-related characteristics and programs. Here, we will explore the idea of viewing a person with a disability as a person first, with the focus not on the person's limitations but on the individual as a person. This perspective is a key element in the prevention of handicaps. A handicap is a situation in which a person can be disadvantaged not by the disability but by other factors. These disadvantages may result from a preventable or removable barrier to performance of a particular activity or skill. Handicaps can include physical barriers but can also come from society's negligence or negative personal attitudes, beliefs, or knowledge. This chapter focuses on the social issue of how society perceives and interacts with people with disabilities. In particular, we discuss person-first aspects of disability, the effect of negative perceptions of disability, and the role of therapeutic recreation relative to people with disabilities.
A legacy of leisure at the Mayo Clinic
Year after year, the U.S. News and World Report, along with other publications, ranks the Mayo Clinic as one of the best hospitals in the United States (see Eisenman, 2014).
Year after year, the U.S. News and World Report, along with other publications, ranks the Mayo Clinic as one of the best hospitals in the United States (see Eisenman, 2014). The Mayo Clinic employs 4,100 physicians/scientists and 53,600 practitioners in allied health professions and sees more than 1 million patients each year (Olsen & Dacy, 2014).
Leisure for enjoyment has a long history at the Mayo Clinic, dating back to 1914 (Mayo Foundation for Medical Education and Research, 2014). “Man and Recreation,” the large sculpture on the south façade of the Mayo building, represents the importance of rest, play, joyful moments, physical activities, rejuvenation, introspection, and enjoyment of nature (Mayo Clinic, 1984). Through a cafeteria and quality-of-life programming approach, the Mayo Clinic provides a plethora of diverse leisure activities through many organizational units. For example, the Peregrine Falcon Program at the Rochester campus allows patients to view and interact with Peregrine falcons that nest on the top of the 20-story Mayo and Gonda buildings (see http://history.mayoclinic.org/tours-events/mayo-clinic-peregrine-falcon-program.php).
The art collection at the Rochester campus presents thousands of art pieces from the media of glass, textiles, paintings, prints, ancient/ethnographic/folk art, sculptures, photography, and ceramics. Internationally known artists, such as Barbara Hepworth and Ivan Meštrovic´, are represented. Each year, the Art and Ability exhibit at the Rochester campus celebrates artworks from people with disabilities.
The Center for Humanities in Medicine at the Mayo Clinic Jacksonville (Florida) campus has professional musicians perform daily concerts in hospital lounges and local artists work one on one at the bedside with patients and families, exploring creative expression (see www.mayoclinic.org/patient-visitor-guide/humanities-in-medicine/florida-schedule). A 56-bell carillon on top of the Plummer building on the Rochester campus is rung regularly throughout the week (Mayo Clinic, 2006); patients can sit in the many outdoor courtyards and atriums or in the Feith Family Statuary Park in the center of campus to hear this musical performance. In keeping with a strengths-based approach, sometimes called the “Mayo way . . . to look at the strengths of individuals rather than at the deficiencies” (p. 150), grand pianos are placed at certain locations on the Rochester campus so that patients can perform impromptu concerts with crowds of other patients and staff singing or listening (Berry & Seltman, 2008; see also Mayo Clinic, 2001).
The Florida campus has a large park with lakes and a bridge to Louchery Island, where patients can contemplate and reflect (Mayo Clinic, 2011). The Scottsdale/Phoenix (Arizona) campus has a one-third-mile trail that includes more than 40 species of cacti and plants, where patients sometimes encounter roadrunners, quail, or horned owls (Mayo Clinic, 2011).
The St. Mary's Hospital Patient Library, on the Rochester campus—a community-based patient library—provides DVDs, music CDs, books/audiobooks, magazines and newspapers, desktop and laptop computers with Internet access, board games, video consoles and games, and crafts for patients and their families as well as a daily morning coffee social activity (St. Mary's Patient Library, 2016).
These examples illustrate how leisure remains an inherent part of the Mayo philosophy and culture. This philosophy, linked to a community parks and recreation approach, has allowed therapeutic recreation to exist not only as a formal service within the Mayo system, but also as a fundamental element of care and the overall patient experience.
Therapeutic recreation is a diverse profession
Therapeutic recreation has emerged from a dynamic and ever-evolving mix of perspectives, converging schools of thought, borrowed and original theories, and unique interventions and services.
Therapeutic recreation has emerged from a dynamic and ever-evolving mix of perspectives, converging schools of thought, borrowed and original theories, and unique interventions and services. This diverse background offers potential for a large variety of service applications. Some have referred to therapeutic recreation as being eclectic in nature. Others have referred to it as a strengths-based approach. Some suggest that therapeutic recreation is unique in that it involves use of recreation or leisure. Others say that it is a mix of philosophy, psychology, the arts, and physical therapy and occupational therapy techniques—all used by a trained professional to bring about functional change within another person or group of people.
Regardless of the perspective chosen, therapeutic recreation is a profession that has tremendous potential for growth and evolution. The diverse philosophical positions or perspectives within the profession provide numerous opportunities for flexible application and professional growth. This diversity tends to produce a well-rounded college graduate who is capable of working within, on the fringes of, or outside of therapeutic recreation. Likewise, therapeutic recreation training programs have traditionally been ideal for those seeking a bachelor's degree before moving into a graduate degree program. A therapeutic recreation degree has also helped professionals enter community-based recreation and administrative positions within a variety of fields. If you are searching for a degree that could prepare you for a wide variety of occupations or you are looking for a specific career, then therapeutic recreation may be right for you. Are you still interested?
Choosing a Profession
As a bright person capable of choosing from among many occupations, you should think about why you are interested in therapeutic recreation. Are you interested in helping others? Are you interested in physical activity or psychological processes? Do you or any members of your family have a disability? Are you deciding between this major and some other therapy-oriented degree such as occupational therapy, physical therapy, or nursing? Maybe you are interested in broader topics such as social justice, aging, or health and wellness, or maybe you simply know someone in this major or profession. You are the only one who can answer the why questions. If you have not done so, try to answer the question for yourself right now—why choose this profession?
Your interest and motivation in this course and profession will have an effect on what you study, how you study, and whether you will succeed in your academic performance. Your motives can also influence who you might study or work with as well as where you might eventually work and ultimately live. So do you know where or with whom you might want to work? Do you know how this course could benefit you regardless of your major? If you answered no or have other questions, ask the course instructor and your advisor for some individual attention.
If the answer to either question is yes, then we would simply ask that you keep yourself open to more possibilities as you go through this text and course. If you are unsure about how all of this information is relevant to you, then we would ask that you try to focus a bit and select a temporary answer to these questions to help you reflect on and understand concepts as you move through the book and explore this profession. Whether you answered yes or no, before you try to finalize your decisions, you should learn the basic therapeutic recreation process, understand some of the basic techniques utilized during this process, and become familiar with what therapeutic recreation services have to offer clients who participate in this process (what benefits might come to clients from provision of this service). Later chapters will explore these topics in detail.
Finding a Personal Fit
Success in the therapeutic recreation profession requires commitment, forethought, and a willingness to engage others. The working professional generally has the ability to organize experiences, motivate others, be flexible, and work on several tasks simultaneously. The ability to communicate to diverse audiences (e.g., individuals, groups, and other professionals) in a variety of ways (e.g., oral, written, in person, electronically) and to be both understanding and assertive are also important characteristics. In plain words, therapeutic recreation is a people profession; a major job skill for a therapeutic recreation professional is to relate to people in an understanding and accepting way. Because creating effective interactions and experiences requires use of a systematic method, the successful professional must be competent at planning, organizing, solving problems, and managing several tasks and programs at once. To succeed in this profession, a person must be responsible, knowledgeable, and genuinely compassionate.
Employment Options
Therapeutic recreation specialists work in a variety of settings, and often those settings include a mix of clientele. Breaking down the profession based on client population reveals that about 37 percent work in mental health, 29 percent work in geriatrics, 20 percent work in physical medicine, and 14 percent work with individuals with developmental disabilities (National Council for Therapeutic Recreation Certification [NCTRC], 2015). The nature of therapeutic recreation services for each of these populations is addressed further in chapters 7 to 11, but this diversity is mentioned here to illustrate the options that are available to professionals. In addition, these categories are very general, and you will find that there are many specializations within each area.
Work-setting options for therapeutic recreation professionals are equally diverse and include hospitals, psychiatric facilities, long-term-care facilities, and community-based settings. It is also true that the boundaries between these settings are difficult if not impossible to define.
Who is the person with a disability?
Over the years, people with disabilities have been stereotyped as limited in potential. This generalization is based on a comparison of them with people who do not have the same characteristic.
Over the years, people with disabilities have been stereotyped as limited in potential. This generalization is based on a comparison of them with people who do not have the same characteristic. Labels drive such stereotypes, and these labels can originate from several sources, some of which were originally intended for good. Labels referring to disabilities have been medically based, such as the labeling of a person as blind because he or she cannot see. Labels can be socially based. For example, a person who uses a wheelchair may be assumed to be disabled in ways that exceed his or her actual impairments. Labels can even be legally based and are often required for the provision of supportive services in school and recreation. For example, to qualify for certain special education services, a child must fall into specific diagnostic categories, such as autism or attention-deficit/hyperactivity disorder. Regardless of the mechanisms through which a person is labeled, the person with a disability is someone who has a limitation in some aspect of his or her functioning according to our social norms.
All people tend to be identified by and associated with characteristics that really are only superficial indicators of who they are. Society worships celebrities based solely on public personas that are crafted by Hollywood moguls and music industry executives. Likewise, society has a history of ridiculing and ostracizing those who do not meet these unrealistic standards. This superficial idea of perfection leads to judgmental standards built on trivial characteristics that have no relationship to the essence of a person. The labeling of people, and the stereotypical assumptions that we make based on those labels, discounts the true value of the person. In other words, labels and inaccurate stereotypes of society often overshadow the strengths, potential, and accomplishments of persons with disabilities.
To be fair, labels can serve a valuable purpose because they facilitate communication of the nature of a particular condition to others. This message in turn allows for the provision of appropriate care, access to resources or accommodations, and program enrollment. The danger of labels comes from people's misuse and misunderstanding of them as well as the tendency to generalize impairment of one particular area of functioning to the overall abilities of the person. An example of such a generalization would be assuming that a person has difficulty solving problems because he or she cannot hear. Even worse, we begin to focus so much on the disability that the differentiating characteristic overshadows the person.
According to the Americans with Disabilities Act (ADA, 1991), legally, a person with a disability is someone who
- has a physical, mental, or cognitive impairment that substantially limits one or more major life functions or activities;
- has a record of such an impairment; or
- is regarded as having such an impairment.
This legal definition requires the disability to result in a substantial limitation in one or more major life activities, such as walking, breathing, seeing, thinking, performing tasks, speaking, learning, working, driving, and participating in community life. Although this definition is clear, it goes beyond how well a person can function and the degree to which he or she can be independent. The spirit of the ADA also embraces a philosophy or belief system that the person should not be taken out of the equation. In other words, the person is much more than his or her disability. People with disabilities have the right to be treated as a person first, not as their disability. Beyond the individual's physical, mental, or cognitive limitations, the constant factor is his or her humanity (Bogdan & Taylor, 1992). Thus, the humanity should be our first consideration.
Each of the hundreds of disabilities has a differing degree of severity. Chapters 7 to 11 discuss characteristics and aspects of various disabilities from the perspective of disability-related characteristics and programs. Here, we will explore the idea of viewing a person with a disability as a person first, with the focus not on the person's limitations but on the individual as a person. This perspective is a key element in the prevention of handicaps. A handicap is a situation in which a person can be disadvantaged not by the disability but by other factors. These disadvantages may result from a preventable or removable barrier to performance of a particular activity or skill. Handicaps can include physical barriers but can also come from society's negligence or negative personal attitudes, beliefs, or knowledge. This chapter focuses on the social issue of how society perceives and interacts with people with disabilities. In particular, we discuss person-first aspects of disability, the effect of negative perceptions of disability, and the role of therapeutic recreation relative to people with disabilities.
A legacy of leisure at the Mayo Clinic
Year after year, the U.S. News and World Report, along with other publications, ranks the Mayo Clinic as one of the best hospitals in the United States (see Eisenman, 2014).
Year after year, the U.S. News and World Report, along with other publications, ranks the Mayo Clinic as one of the best hospitals in the United States (see Eisenman, 2014). The Mayo Clinic employs 4,100 physicians/scientists and 53,600 practitioners in allied health professions and sees more than 1 million patients each year (Olsen & Dacy, 2014).
Leisure for enjoyment has a long history at the Mayo Clinic, dating back to 1914 (Mayo Foundation for Medical Education and Research, 2014). “Man and Recreation,” the large sculpture on the south façade of the Mayo building, represents the importance of rest, play, joyful moments, physical activities, rejuvenation, introspection, and enjoyment of nature (Mayo Clinic, 1984). Through a cafeteria and quality-of-life programming approach, the Mayo Clinic provides a plethora of diverse leisure activities through many organizational units. For example, the Peregrine Falcon Program at the Rochester campus allows patients to view and interact with Peregrine falcons that nest on the top of the 20-story Mayo and Gonda buildings (see http://history.mayoclinic.org/tours-events/mayo-clinic-peregrine-falcon-program.php).
The art collection at the Rochester campus presents thousands of art pieces from the media of glass, textiles, paintings, prints, ancient/ethnographic/folk art, sculptures, photography, and ceramics. Internationally known artists, such as Barbara Hepworth and Ivan Meštrovic´, are represented. Each year, the Art and Ability exhibit at the Rochester campus celebrates artworks from people with disabilities.
The Center for Humanities in Medicine at the Mayo Clinic Jacksonville (Florida) campus has professional musicians perform daily concerts in hospital lounges and local artists work one on one at the bedside with patients and families, exploring creative expression (see www.mayoclinic.org/patient-visitor-guide/humanities-in-medicine/florida-schedule). A 56-bell carillon on top of the Plummer building on the Rochester campus is rung regularly throughout the week (Mayo Clinic, 2006); patients can sit in the many outdoor courtyards and atriums or in the Feith Family Statuary Park in the center of campus to hear this musical performance. In keeping with a strengths-based approach, sometimes called the “Mayo way . . . to look at the strengths of individuals rather than at the deficiencies” (p. 150), grand pianos are placed at certain locations on the Rochester campus so that patients can perform impromptu concerts with crowds of other patients and staff singing or listening (Berry & Seltman, 2008; see also Mayo Clinic, 2001).
The Florida campus has a large park with lakes and a bridge to Louchery Island, where patients can contemplate and reflect (Mayo Clinic, 2011). The Scottsdale/Phoenix (Arizona) campus has a one-third-mile trail that includes more than 40 species of cacti and plants, where patients sometimes encounter roadrunners, quail, or horned owls (Mayo Clinic, 2011).
The St. Mary's Hospital Patient Library, on the Rochester campus—a community-based patient library—provides DVDs, music CDs, books/audiobooks, magazines and newspapers, desktop and laptop computers with Internet access, board games, video consoles and games, and crafts for patients and their families as well as a daily morning coffee social activity (St. Mary's Patient Library, 2016).
These examples illustrate how leisure remains an inherent part of the Mayo philosophy and culture. This philosophy, linked to a community parks and recreation approach, has allowed therapeutic recreation to exist not only as a formal service within the Mayo system, but also as a fundamental element of care and the overall patient experience.
Therapeutic recreation is a diverse profession
Therapeutic recreation has emerged from a dynamic and ever-evolving mix of perspectives, converging schools of thought, borrowed and original theories, and unique interventions and services.
Therapeutic recreation has emerged from a dynamic and ever-evolving mix of perspectives, converging schools of thought, borrowed and original theories, and unique interventions and services. This diverse background offers potential for a large variety of service applications. Some have referred to therapeutic recreation as being eclectic in nature. Others have referred to it as a strengths-based approach. Some suggest that therapeutic recreation is unique in that it involves use of recreation or leisure. Others say that it is a mix of philosophy, psychology, the arts, and physical therapy and occupational therapy techniques—all used by a trained professional to bring about functional change within another person or group of people.
Regardless of the perspective chosen, therapeutic recreation is a profession that has tremendous potential for growth and evolution. The diverse philosophical positions or perspectives within the profession provide numerous opportunities for flexible application and professional growth. This diversity tends to produce a well-rounded college graduate who is capable of working within, on the fringes of, or outside of therapeutic recreation. Likewise, therapeutic recreation training programs have traditionally been ideal for those seeking a bachelor's degree before moving into a graduate degree program. A therapeutic recreation degree has also helped professionals enter community-based recreation and administrative positions within a variety of fields. If you are searching for a degree that could prepare you for a wide variety of occupations or you are looking for a specific career, then therapeutic recreation may be right for you. Are you still interested?
Choosing a Profession
As a bright person capable of choosing from among many occupations, you should think about why you are interested in therapeutic recreation. Are you interested in helping others? Are you interested in physical activity or psychological processes? Do you or any members of your family have a disability? Are you deciding between this major and some other therapy-oriented degree such as occupational therapy, physical therapy, or nursing? Maybe you are interested in broader topics such as social justice, aging, or health and wellness, or maybe you simply know someone in this major or profession. You are the only one who can answer the why questions. If you have not done so, try to answer the question for yourself right now—why choose this profession?
Your interest and motivation in this course and profession will have an effect on what you study, how you study, and whether you will succeed in your academic performance. Your motives can also influence who you might study or work with as well as where you might eventually work and ultimately live. So do you know where or with whom you might want to work? Do you know how this course could benefit you regardless of your major? If you answered no or have other questions, ask the course instructor and your advisor for some individual attention.
If the answer to either question is yes, then we would simply ask that you keep yourself open to more possibilities as you go through this text and course. If you are unsure about how all of this information is relevant to you, then we would ask that you try to focus a bit and select a temporary answer to these questions to help you reflect on and understand concepts as you move through the book and explore this profession. Whether you answered yes or no, before you try to finalize your decisions, you should learn the basic therapeutic recreation process, understand some of the basic techniques utilized during this process, and become familiar with what therapeutic recreation services have to offer clients who participate in this process (what benefits might come to clients from provision of this service). Later chapters will explore these topics in detail.
Finding a Personal Fit
Success in the therapeutic recreation profession requires commitment, forethought, and a willingness to engage others. The working professional generally has the ability to organize experiences, motivate others, be flexible, and work on several tasks simultaneously. The ability to communicate to diverse audiences (e.g., individuals, groups, and other professionals) in a variety of ways (e.g., oral, written, in person, electronically) and to be both understanding and assertive are also important characteristics. In plain words, therapeutic recreation is a people profession; a major job skill for a therapeutic recreation professional is to relate to people in an understanding and accepting way. Because creating effective interactions and experiences requires use of a systematic method, the successful professional must be competent at planning, organizing, solving problems, and managing several tasks and programs at once. To succeed in this profession, a person must be responsible, knowledgeable, and genuinely compassionate.
Employment Options
Therapeutic recreation specialists work in a variety of settings, and often those settings include a mix of clientele. Breaking down the profession based on client population reveals that about 37 percent work in mental health, 29 percent work in geriatrics, 20 percent work in physical medicine, and 14 percent work with individuals with developmental disabilities (National Council for Therapeutic Recreation Certification [NCTRC], 2015). The nature of therapeutic recreation services for each of these populations is addressed further in chapters 7 to 11, but this diversity is mentioned here to illustrate the options that are available to professionals. In addition, these categories are very general, and you will find that there are many specializations within each area.
Work-setting options for therapeutic recreation professionals are equally diverse and include hospitals, psychiatric facilities, long-term-care facilities, and community-based settings. It is also true that the boundaries between these settings are difficult if not impossible to define.
Who is the person with a disability?
Over the years, people with disabilities have been stereotyped as limited in potential. This generalization is based on a comparison of them with people who do not have the same characteristic.
Over the years, people with disabilities have been stereotyped as limited in potential. This generalization is based on a comparison of them with people who do not have the same characteristic. Labels drive such stereotypes, and these labels can originate from several sources, some of which were originally intended for good. Labels referring to disabilities have been medically based, such as the labeling of a person as blind because he or she cannot see. Labels can be socially based. For example, a person who uses a wheelchair may be assumed to be disabled in ways that exceed his or her actual impairments. Labels can even be legally based and are often required for the provision of supportive services in school and recreation. For example, to qualify for certain special education services, a child must fall into specific diagnostic categories, such as autism or attention-deficit/hyperactivity disorder. Regardless of the mechanisms through which a person is labeled, the person with a disability is someone who has a limitation in some aspect of his or her functioning according to our social norms.
All people tend to be identified by and associated with characteristics that really are only superficial indicators of who they are. Society worships celebrities based solely on public personas that are crafted by Hollywood moguls and music industry executives. Likewise, society has a history of ridiculing and ostracizing those who do not meet these unrealistic standards. This superficial idea of perfection leads to judgmental standards built on trivial characteristics that have no relationship to the essence of a person. The labeling of people, and the stereotypical assumptions that we make based on those labels, discounts the true value of the person. In other words, labels and inaccurate stereotypes of society often overshadow the strengths, potential, and accomplishments of persons with disabilities.
To be fair, labels can serve a valuable purpose because they facilitate communication of the nature of a particular condition to others. This message in turn allows for the provision of appropriate care, access to resources or accommodations, and program enrollment. The danger of labels comes from people's misuse and misunderstanding of them as well as the tendency to generalize impairment of one particular area of functioning to the overall abilities of the person. An example of such a generalization would be assuming that a person has difficulty solving problems because he or she cannot hear. Even worse, we begin to focus so much on the disability that the differentiating characteristic overshadows the person.
According to the Americans with Disabilities Act (ADA, 1991), legally, a person with a disability is someone who
- has a physical, mental, or cognitive impairment that substantially limits one or more major life functions or activities;
- has a record of such an impairment; or
- is regarded as having such an impairment.
This legal definition requires the disability to result in a substantial limitation in one or more major life activities, such as walking, breathing, seeing, thinking, performing tasks, speaking, learning, working, driving, and participating in community life. Although this definition is clear, it goes beyond how well a person can function and the degree to which he or she can be independent. The spirit of the ADA also embraces a philosophy or belief system that the person should not be taken out of the equation. In other words, the person is much more than his or her disability. People with disabilities have the right to be treated as a person first, not as their disability. Beyond the individual's physical, mental, or cognitive limitations, the constant factor is his or her humanity (Bogdan & Taylor, 1992). Thus, the humanity should be our first consideration.
Each of the hundreds of disabilities has a differing degree of severity. Chapters 7 to 11 discuss characteristics and aspects of various disabilities from the perspective of disability-related characteristics and programs. Here, we will explore the idea of viewing a person with a disability as a person first, with the focus not on the person's limitations but on the individual as a person. This perspective is a key element in the prevention of handicaps. A handicap is a situation in which a person can be disadvantaged not by the disability but by other factors. These disadvantages may result from a preventable or removable barrier to performance of a particular activity or skill. Handicaps can include physical barriers but can also come from society's negligence or negative personal attitudes, beliefs, or knowledge. This chapter focuses on the social issue of how society perceives and interacts with people with disabilities. In particular, we discuss person-first aspects of disability, the effect of negative perceptions of disability, and the role of therapeutic recreation relative to people with disabilities.
Related Books
