1. Shank & Coyle, Chapter 11

2.  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.  Austin (2002)  Little has been written in TR literature about describing or creating therapeutic relationships.

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

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

8.  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.  Awareness of self  Ability to analyze own feelings  Empathy  Courage  Courage to seek help & acknowledge limitations  Inventive & creative

10.  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.  Ability to create partnerships/collaborate  Clients  Colleagues  Ability to empower clients  Cultural competence

12.  Communication competence  Listening & responding skills  Verbal & nonverbal  Interpersonal space  Using touch when communicating

13.  Time  Takes time  Decreased length of stay  Starts when first meet (assessment)  Emotional Closeness  How close?  Self-disclosure  How much?

14.  CPI  Crisis Prevention Institute  World’s leading training organization  Management of disruptive & assaultive behavior  Started 1980  In the past approved for NCTRC CEUs

15.  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.  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.  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.  TCI  Therapeutic Crisis Intervention  Training program for staff that work with youth in residential settings  5 day curriculum  Train-the-trainer course

19.  TCI  Day 1: Crisis as Opportunity  Prevention of crisis situations  Maintain self-control  Awareness of person  Awareness of environment  Assessing the situation

20.  TCI  Day 2: Triggering & Escalation  Verbal crisis communication  Nonverbal crisis communication  Behavior management  Protective interventions  Teach alternatives to acting out

21.  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.  TCI  Day 4: Outburst & Recovery  3 person restraint  Transferring control  Responding to feelings vs. behavior  Practice role plays

23.  TCI  Day 5: Implementing the TCI System  Recovery for staff  Documentation  Evaluation and testing

24.  Termination  End relationship  Ritual, parties, tokens  Reunions  Client’s death  Impact on you  Impact on other clients

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

27.  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.  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