KNR 273: Therapeutic/Helping Relationships

1. KNR 273: Therapeutic/Helping Relationships Shank & Coyle, Chapter 11

2. Elements of TR Practice • Shank & Coyle (2002) • Activity-based interventions • Supportive environment • Therapeutic/helping relationship • “Of these three, the relationship between a client and a recreation therapist is most essential” (p. 189)

3. Therapeutic/Helping Relationships • Austin (2002) • Little has been written in TR literature about describing or creating therapeutic relationships.

4. Therapeutic/Helping Relationships • How do they differ from social relationships or friendships? • Focus solely on needs of client • Assist client to achieve goals • Assist client to grow toward self-sufficiency & independence • Are not reciprocal • Are not automatic • Need to learn & practice skills

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

6. Youth at Risk • Sprouse, 2004 • Ability to develop rapport • Boundaries • Empathy • Hope and connectedness • Ethical behavior • Sense of humor • Self-disclosure • Compassion & empathy

7. Shank & Coyle • To be effective, need to understand what aspects of themselves influence client change & growth

8. Personal Attributes • Altruism & compassion • Desire to serve • Openness & flexibility • Genuineness • Congruence between words & actions • Positive regard & respect for others • Unconditional positive regard • Belief in value of play, recreation, & leisure

9. Characteristic Skills • Awareness of self • Ability to analyze own feelings • Empathy • Courage • Courage to seek help & acknowledge limitations • Inventive & creative

10. Characteristic Skills • Stamina • Job can be physically & emotionally demanding • Enthusiasm • Pressure • Need reliable social support system • Nurture self • Sense of humor • Laugh at yourself • Use leisure to renew physical & mental health

11. Competencies Needed • Ability to create partnerships/collaborate • Clients • Colleagues • Ability to empower clients • Cultural competence

12. Competencies Needed • Communication competence • Listening & responding skills • Verbal & nonverbal • Interpersonal space • Using touch when communicating

13. Issues in Therapeutic Relationships • Time • Takes time • Decreased length of stay • Starts when first meet (assessment) • Emotional Closeness • How close? • Self-disclosure • How much?

14. Issues in Therapeutic Relationships – Crisis Prevention • CPI • Crisis Prevention Institute • World’s leading training organization • Management of disruptive & assaultive behavior • Started 1980 • In the past approved for NCTRC CEUs

15. Issues in Therapeutic Relationships – Crisis Prevention • CPI • One-day seminar • Identify behaviors that could lead to a crisis • Respond to prevent escalation • Verbal and nonverbal techniques to defuse • Cope with own fear & anxiety • Principles of personal safety to avoid injury • $699 per person

16. Issues in Therapeutic Relationships – Crisis Prevention • CPI • Two-day workshop • When appropriate to physically intervene • Team intervention strategies & techniques • Physical & psychological well-being of those involved in the crisis • Safety & how to transport individual • How to maintain rapport • Steps for debriefing • Documentation • $1,099 per person

17. Issues in Therapeutic Relationships – Crisis Prevention • CPI • Four-day instructor certification program • Learn to conduct in-house training • Learn to customize for agency • Learn how to test participant’s competency in skills • $2,125

18. Issues in Therapeutic Relationships – Crisis Prevention • TCI • Therapeutic Crisis Intervention • Training program for staff that work with youth in residential settings • 5 day curriculum • Train-the-trainer course

19. Issues in Therapeutic Relationships – Crisis Prevention • TCI • Day 1: Crisis as Opportunity • Prevention of crisis situations • Maintain self-control • Awareness of person • Awareness of environment • Assessing the situation

20. Issues in Therapeutic Relationships – Crisis Prevention • TCI • Day 2: Triggering & Escalation • Verbal crisis communication • Nonverbal crisis communication • Behavior management • Protective interventions • Teach alternatives to acting out

21. Issues in Therapeutic Relationships – Crisis Prevention • TCI • Day 3: Escalation, Outburst & Recovery • When restraint should or should not be used • Team restraint • Small child restraint • Breaking up fights • Standing hold • Recovery process

22. Issues in Therapeutic Relationships – Crisis Prevention • TCI • Day 4: Outburst & Recovery • 3 person restraint • Transferring control • Responding to feelings vs. behavior • Practice role plays

23. Issues in Therapeutic Relationships – Crisis Prevention • TCI • Day 5: Implementing the TCI System • Recovery for staff • Documentation • Evaluation and testing

24. Issues in Therapeutic Relationships • Termination • End relationship • Ritual, parties, tokens • Reunions • Client’s death • Impact on you • Impact on other clients

25. Issues in Therapeutic Relationships • Burnout (Austin, 1999) • What is burnout? • Emotional & physical exhaustion • Professional’s attitudes & behaviors change in negative ways in response to job strain • Loss of idealism, energy, and purpose as a result of work conditions

26. Issues in Therapeutic Relationships • Who are candidates for burnout? • Repetitive contact with people • Intense interpersonal contacts • The “giving” role • Job monotony

27. Issues in Therapeutic Relationships • What are some signs of burnout? • More difficult to get work done during normal hours • Lose sense of humor, effectively flat • Physical fatigue • Become more irritable • Become more susceptible to illness, headaches, back pain, etc. • Social withdrawal • Increased absenteeism

28. Issues in Therapeutic Relationships • How can we prevent burnout? • Develop support system • Learn how to manage time effectively • Know & respect your own skills, energy, & level of commitment • Spent time out of work role • Take time off (mental health days, vacations) • Use relaxation techniques • Cry “uncle” when you need help • Learn to laugh at yourself & the situation