HPR 453 Chapter 22

1. HPR 453 Chapter 22 Walking The Tightrope, Juggling, and Slow Dancing: Metaphors for Building Effective Therapeutic Relationships

2. This Chapter explores the challenges and dilemmas associated with establishing effective therapeutic alliances • What knowledge, skills, awareness, and abilities should the TR possess to build relationships with clients and their family members/care providers to facilitate change through the TR process? • What do you see as key to building and maintaining a healthy therapeutic relationship with clients?

3. Your experiences and beliefs are important guides in building and maintaining effective therapeutic relationships • Students grasp • Designing programs to meet client needs • Writing goals and objectives • Enhancing clients’ abilities and strengths • Believing in the power of leisure and recreation

4. Do students understand the nature of relationships with clients and cultivating the relationship? • Seasoned practitioners often struggle with effective therapist/client relationships • Principles are consistent across disciplines and practice settings • Many students often use the term “friend”

5. This chapter reflects research and thinking that evolved from an ethnographic case study in a rehab setting and are framed within the context of building therapeutic alliances with clients who possess the cognitive (e.g., memory, problem-solving) and communicative abilities to actively participate in setting the course for their participation in a TR change process

6. Walking the Tightrope while Juggling:TR Relationship Dilemmas • Nonjudgmental attitude and caring contribute to friendships and therapeutic relationships • Reciprocity (equality and mutuality) in sharing confidences and personal problems essential in friendships but inappropriate in therapeutic relationships

7. Being a Helper presents challenges such as • Clients’ over-identification with the therapist • Therapist’s own motivations and behaviors that are affected by self-esteem, status, and intimacy needs • Must walk the tightrope between being an effective educator, facilitator, expert, and cheerleader and finding one’s self in an unhealthy relationship with a client

8. Ethical dilemmas when a balance can’t be created • 60% of ethical problems are identified by TRs involved with improper therapist-client relationships (see question posed on pg 359) • Danger signals • Therapist’s over-identification with client • Need to be needed and appreciated by client

9. Spending an inordinate amount of time with one client including off-duty time • Keeping secrets the client shared • Withholding information from the rest of the treatment team • The above not only violate ethical practice but can lead to potential for exploitation and manipulation and undermine the potential for meaningful change through TR Process

10. How does a therapist • Quickly build a rapport and open, caring relationship while clearly communicating the purpose of TR and the role of the therapist? • At the same time • Assessing needs, strengths, abilities • Relieving fears or confusions and negotiating tx goals

11. Juggling and tightrope walking • Relationships with other clients, their families, other staff, volunteers, allied professionals, managers • Team meetings, acquiring resources, documentation, maintaining physical spaces, planning and implementing programs • Changing healthcare arena, personal life

12. Can you leave personal baggage at the door?

13. Slow Dancing • The process of rehab for clients • Flow of actions and interactions between client and TR as they share understanding of respective roles in TR process and working together • Therapists are trying to gain trust and accomplish multiple goals at one time, understand leisure in the clients’ past, present fears, and build hopes for the future

14. “Talking a problem into being” • Clients do not come into rehab with expectation of facing leisure as a need • TRs must assist client in identifying a problem/need that makes sense to them based on their present, future, values and beliefs • Goes beyond assessment and goal setting and into the slow dance of building a therapeutic relationship

15. The CTRS explain TR and its purpose to client and the family? • Explain their role? • Focus on past leisure experiences in the initial description? • Then link the purpose and the past to the future for the client? • Not focus on barriers to returning to past but emphasize the potential and benefits during rehab and into the future?

16. Slow Dancing involves learning together • What are the client’s goals and expectations? • What are their leisure values? • Ongoing negotiations: what issues to address, next steps in the therapy process • Dilemma: How can this be done with increasing requirements for standardized tx processes?

17. CTRSs must be more than empathetic, caring and genuine (good friend) • Must understand and be able to communicate the purpose of TR in a way that makes sense to the client • Framing actions and interactions in a way to help clients clearly see the benefits of and experience meaning from, their participation in TR

18. How do we develop relationship-building skills? • Students and practitioners need opportunities for self-reflection to obtain a clear understanding of • Your own beliefs and philosophies of being a professional, a helper, and a therapist • How your training and membership in prof orgs has influenced how you understand and operationalize your role as a TR • How your own needs, desires, motivations and experiences influence interactions w/ clients

19. How your other life roles/responsibilities affect your practice • TRs must understand the culture of the setting and the needs and abilities of the client group you serve • You must reflect on what you learned, practiced or observed and apply it to the way you think you should work with your clients • Enjoy the dance and share with others along the way!!