AN ESSAY FOR STUDENTS INTERESTED IN THERAPEUTIC RECREATION

Thank you for search out material on therapeutic recreation.  My name is Cathy O'Keefe, and I have taught therapeutic recreation for over twenty years here at the University of South Alabama in Mobile, Alabama, a city that sits just north of the Gulf of Mexico in the Southern United States. 

My hope is that this essay becomes part of a larger internet dialogue among professionals and students currently enrolled in TR programs and those seeking a direction of study in either the graduate or undergraduate environment.  Perhaps it can also include our consumers who have already benefited from TR services or are searching for what we offer.  You have taken the first step already, and I look forward to hearing from you.

This paper reflects on a comment that consistently emerges from students as they search for a major field of study or are moving through our courses here at the University of South Alabama.  "I have trouble getting a handle on a good explanation of therapeutic recreation, one that really says it all," most students admit.  In addition, when parents ask what this TR major is all about, it is often difficult, beyond offering a few brochures, to help them understand.

Ironically, what creates the problem of searching for a neatly packaged explanation of therapeutic recreation is really my greatest source of joy.  We are a field of broad applications and diverse service populations. This translates into a variety of career environments with opportunities for enrichment of depth and new practice at all disability and age levels.  New students usually lack sufficient exposure to such a broad range of service settings to really appreciate them, and some of our own professionals who work strictly in one setting for their entire career may strain against what they perceive as a lack of specificity or focus for the field.  I thought it might be helpful to trace my own journey to show you how an understanding of therapeutic recreation has unfolded in my life.

In 1972, I began working as an activities therapist in an in-patient psychiatric unit treating emotionally disturbed patients, drug addicts, and older adults with dementia.  I found that my program could add invaluable behavioral information to the treatment team helping them correctly diagnose problems and track improvement over the course of hospitalization.  My observations were critically important because I had continuous contact with patients, and the other members of the team did not.  Patients frequently shared hidden fears and thoughts as we worked individually or in groups because they perceived my modality of service as non-threatening, and enabled me to develop good rapport.  Some of our recreation programming was specifically geared toward reducing stressors, improving physical health, connecting patients with loved ones at home, and enhancing social skills that would help them adjust to living outside the hospital after discharge.  I found my work challenging and intense at times because of the nature of psychiatric illness, but it was always exciting and appreciated by our clients.

Conclusion:  I saw TR as a modality that could provide valuable diagnostic feedback and as a respite from the intensity of psychiatric illness as clients experienced it. 

In 1973, my husband and I began working with disadvantaged youth.  We volunteered at the local detention facility and worked in a Catholic parish in an area of town called Plateau where the last ship of slaves was brought to the United States from Africa in the early 1860s.  These families, while extremely poor, had a wonderful sense of their roots.  Recreation was the vehicle that we frequently used to take the children outside their usual environment in order to see new possibilities and gain experience interacting with other economic groups.  During the summer, I accompanied inner city youth to camp settings where we focused, through recreation, on improved self-image, communication, and socialization skills.

TR jobs were available in those days with the disadvantaged.  Sadly, however, they evaporated for the most part during the eighties and we are now playing catch up via new recreation initiatives aimed at gang prevention and anti-recidivism.  I learned from these experiences that TR is an incredibly effective vehicle for educating children about the importance of leisure and recreation as a life long source of healthy behavior.  We call this leisure education.

Conclusion:  TR holds the ability to develop skills in children and youth that can diminish the negative affects of poverty, create potential for sound and healthy behavior, and bridge the gap between economic groups that often keep people unaware of their similarities to others.  I also learned that the value of work with a specific population should never be tied to financial support for that work from either government or insurance agencies.  Work with the poor should never go out of style or become politically unpopular.  Support for this work within our field must remain a priority.  Since many of these youth are at risk for legal trouble and eventual incarceration, it is especially critical to teach them recreation skills that have the potential to keep them away from dangerous situations involving drugs or violence.

In 1976, with the premature birth of my twin sons, I found it necessary to stop working full time.  I had been concerned for years about the condition of nursing homes and the lack of quality TR services found in most institutions.  I started a long-term care consultation practice that lasted over fifteen years.  It enabled me to elevate the level of skill needed by staff in nursing homes to successfully address physical, intellectual, social, and emotional needs.  I learned, as well, the value of spiritual growth as residents struggled to combat feelings of abandonment, helplessness, and isolation.  In this setting, group activity promoted community and a feeling of being at home with others.  However, nothing compared to the quiet moments at the bedside of patients too ill to get up.  I found this to be rewarding work because it enabled me to experience my patients as unique individuals whose quality of life could only be defined by them.  I learned that an inability to function didn't necessitate a poor quality of life and that internal peace and happiness spring from being valued by others and finding meaning in one's daily life.  The truly wonderful thing about therapeutic recreation is that by its very nature it honors and nurtures autonomy and meaning.

Conclusion:  TR contributes not only to improved functioning but also to the more essential human experience - meaning and value.  Additionally, TR has the ability to nurture autonomy.  Helping individuals who must live in institutional settings to express their uniqueness force staffers who care for them to honor their dignity as persons.  TR humanizes nursing homes and assisted living facilities, making them more home-like places to live. 

In 1978, my twin sons required surgery, and I was appalled by the lack of child-centered activity at our pediatric unit within our general hospital.  Since the university owned this hospital, I decided to attempt to create a child life program there.  This type programming addresses the psychosocial needs of children and families so that the trauma of sickness and hospitalization is minimized and normal developmental growth can occur.  My initial offer to the administrator to voluntarily design the program was met with disinterest.  It was a good idea but not the right time.  You, too, may have many good ideas about therapeutic recreation programming but find that they fall on deaf ears until others, particularly clients, speak up for TR.  Finally, a few years later, I linked up with some other interested families and professionals to help create a new children's and women's hospital.  My TR students have been part of this program for over ten years now, and the hands-on experience with the children is incredible.  Children in the hospital who are acutely or chronically ill need two kinds of play:  that which addresses particular medical concerns (needle, surgical, or procedural play) and normal developmental play to counteract the negative affects of hospitalization. 

Conclusion:  TR specialists are often hired in pediatric child life settings.  Their job is to use play to address particular medical needs and to help children express their fears and feelings.  Additionally, age appropriate developmental play helps children normalize their experiences and offers a respite from the more difficult challenges of illness and treatment. 

For the past twenty-five years my husband and I have been affiliated with a community called L'Arche (a French word meaning the Ark.)  This is an international movement based on the premise that able-bodied assistants living in community with persons who have developmental disabilities are a sign to the public at large of the value of persons with disabilities.  There are approximately 100 L'Arche communities around the world, each taking on the cultural and spiritual characteristics of their environment.  In Mobile, the community is Christian, so the core members and assistants live out their commitment to one another in context of the beatitudes.  We truly find that we are blessed by their friendship and warmth.

I clearly saw the value of TR in the L'Arche community many years ago when I showed a film to my students about a trip that L'Arche Canada took to France with over 4,000 people.  Jean Vanier, founder of L'Arche, noted that everyone needs something to look forward to, to experience, and to look back on as a memory.  Recreation at L'Arche centers on the creation of a family atmosphere, but each core member develops individual recreation interests and skills that dovetail with goals for independence and self care.  L'Arche's recreation is unique in that core members and assistants are able to connect with the larger L'Arche family via trips and conferences making even long distance friendships easy to develop. 

Conclusion:  Persons with developmental disabilities are living actively in our communities as never before.  TR can be used in the school setting to provide leisure education and build recreation skills that offer life long enjoyment and social experiences to children and adults.  In addition, recreation provides a common ground where able bodied and differently abled children and adults can interact meaningfully, creating respect and opportunities for understanding. 

During the summer of '96, my husband was diagnosed with prostate cancer.  It was a time to face the fear of death and come to grips with the reality of a serious physical illness.  I was fortunate in 1978 to have met Dr. Elizabeth Kübler Ross, a physician who wrote extensively about death and dying and who laid important groundwork for palliative care for the dying.  So far, his cancer has been arrested by surgery, but I was reminded through our ordeal of the vital importance of TR in the hospice setting when we felt our own time together possibly running out.  We have five children, all of whom share our philosophical belief that nothing is more precious than time, so it should be spent on the things that mean the most.  In our case, that means family, and we have planned many recreational experiences over the years with our children so they will have great memories of our family life. 

When I work in TR with hospice patients, I remind them that while it may seem absurd to seek the services of a TR specialist in hospice, the very word leisure means freedom, so we work to maximize the freedom to make choices about how one's time is spent when time is of the essence. 

Today I offer my services to persons who are dying by helping them to make videotapes for their families, especially if they have young children.  Using an expressive arts medium like video, I believe people facing death can tell their stories, make meaning of their life experiences, and can leave for their children gifts of wisdom, advice, support, and love.

Conclusion:  In reality, our leisure experiences should be healthy and life giving through all the years that we live.   When we consciously reflect on experiences to make meaning of them for our personal growth and happiness, we contribute to our own therapy.  In the sense that recreation heightens our awareness of this and creates the ability to generate self-acceptance, love, and enjoyment in life, all recreation is therapeutic.  The help of people educated in therapeutic recreation principles and practices allows those we serve to better access this therapeutic value.

On Super Bowl Sunday, 1997, one of my closest friends suffered a stroke and was admitted to a rehabilitation hospital for therapy after being stabilized medically.  For years I have taken students to the physical rehabilitation setting to work with persons who have had spinal cord injuries, strokes, joint replacements and the like.  This was my first chance to be part of the family's viewpoint of therapy and to see from start to finish the whole process with one patient. 

When the physical rehabilitation team works well together, the patient sets goals that are realistic and achievable, and the team uses all its skills to lay a course toward those goals.  It is a long process for most patients, and TR's contribution is to accompany the patient through it, keying in on recreational interests that have been sources of personal motivation for the patient in the past.  Those valued recreation experiences that can be enjoyed again form a base of familiarity and success for the patient.  Some illnesses, however, present great barriers to patients who must then look to new sources of leisure and recreation to prepare for life with a disability.  The TR specialist helps the client identify new and potentially enjoyable interests and then proceeds to teach the skills and adaptations necessary to make them part of the client's life. 

During rehabilitation, patients must confront the outside world again learning to successfully deal with a variety of obstacles.  The TR specialist takes the client back into the community to practice techniques learned in therapy and to gain the confidence to negotiate the tasks of everyday living after discharge.  Because therapy is a long process, many patients form close personal bonds with their therapists as they work from a state of dependence to independence.  Making this transition requires the TR specialist to connect the client to resources in the community where physical healing, socialization, intellectual stimulation, and spiritual growth can be nurtured.  In the best sense, the client learns to "re-create" his true self, letting go of the past and moving ahead either to total recovery or a meaningful life in spite of a disability.   I asked my friend to speak to my Introduction to Therapeutic Recreation class and was happily surprised to learn that he had plans to resume his hobby of traveling this summer.  He used the Internet to make his travel arrangements, and with only the use of a cane, toured the northern tier states by train during the month of July.  Though 74 years old, he had a determination characteristic of men half his age, and his love of recreation continued to contribute to his well being for the remainder of his life.

Conclusion:  TR in the physical rehabilitation setting is usually part of an intensive, functionally oriented process.  We are fortunate as therapists in being able to help clients develop recreational strategies for use after discharge when exercises and activities must be continued without the presence of the physical, occupational, and speech therapists.   We believe that clients are more likely to continue rehabilitation exercises if the context in which they do them is enjoyable. Rehabilitation from physical illness goes beyond simple functioning, however.  We Afunction@ in order to do something beyond functioning, i.e., to enjoy life.  Ultimately, outcomes that are linked to one’s spirit, often called Aexistential,@ must be addressed, too.  TR is a wholistic approach to wellness, and happiness is an experience that may require physical preconditions, but certainly does not stop there.  Some of the most exciting work done in TR in physical rehabilitation settings is done in this realm of existential outcomes.                                                            

A FEW FINAL THOUGHTS

When I assumed my first job in TR in 1972 I could not have articulated what I believe is the essence of therapeutic recreation.  An African American woman in the Plateau neighborhood put it well when she said, "You can't be what you don't see."  New students need experiences that allow them to see TR in action and to connect personally with recipients of our services.  One woman at a local rehabilitation hospital replied when asked what TR did for her,  "The physical therapist helped me learn to walk, but you asked the essential question - where do you want to go?" 

You can see that my own understanding of TR has been solidified over years of experience in a variety of settings and client groups.  My own philosophy of TR leads me to celebrate our diversity of service rather than lament a seeming lack of focus on one population or one modality.  When I am with my colleagues, what I enjoy most is hearing about new ways of meeting needs in our communities - using TR services with persons who have AIDS, developing home health plans involving family recreation, or adding TR services in our public schools for students in special education programs.  TR defies our attempts to package it neatly or to briefly "say it all," not because we have nothing specific to contribute but because the nature of what we do is as unique and varied as the people we serve are. 

So, when people ask me what I do, I tell them how fortunate I feel to be able to devote my life to helping people find meaning and personal satisfaction through choices that they make with their time.  I tell them that recreation and leisure should be critically important to all of us, and our mission is to spread their value. I tell them that, in the end, what really makes life meaningful are the experiences that give us joy, and our work with those whose lives have often been affected by loss, suffering, illness, disability, marginalization, and alienation is extraordinarily good and valuable.  I believe that our purpose is grounded in the spiritual value of leisure, which I see as the freedom to become our truest selves. That=s not a destination but a process.  Those of us who work in the field of TR are privileged to accompany people in the process of personal development and growth.  We operate as guides, advocates and, hopefully, friends, but let us never forget that the ultimate power to change, mature, and discover happiness lies within each person, not acquired like a product, but nurtured like a flowering seed.  

If you have browsed the web in search of information on TR that might help you discern if it is a field of interest to you, I recommend that you contact some of the people whose names appear with various Internet sites.  Also, call TR specialists in your area to inquire about therapeutic recreation programs in your vicinity.  If you are a student already enrolled in a TR program and want to increase your contacts with other students and professionals working in the field, tell your teachers that you have found this paper on the Internet and want them to help generate more information on the field for others like you.  Ask your teachers to share their personal philosophy of TR with you and encourage them to invite professionals working in the field to do the same. 

Thank you for permitting me to share my own experiences with you.  It is my hope that you will be open to similar opportunities to expand and deepen your understanding of therapeutic recreation.  Should you make this field your own, I would welcome you as a colleague and friend.  In the meantime, please feel free to share your academic journey with others over the net.

Cathy O'Keefe
University of South Alabama
Dept. of HPELS
Mobile, AL 36688
Phone: (251) 460-7131
Fax: (251) 460-7252
E-mail:  cokeefe @ usouthal.edu

Cathy O'Keefe, M.Ed., CTRS, has been an instructor in therapeutic recreation at the University of South Alabama since 1975.  She has served on the Board of Directors for the National Council for Therapeutic Recreation Certification and as the chairperson of the Ethical Practices for the National Therapeutic Recreation Society and serves as the Alabama representative for NTRS.  She also holds membership in the American Therapeutic Recreation Society.  

Mrs. O'Keefe has worked in adult psychiatry, in residential programs for adults with developmental disabilities, with acute and chronically ill children in hospital pediatric medicine, with nursing home and assisted living residents, and with persons who are dying.  

The primary focus of Mrs. O'Keefe's professional writing lies with emphasizing the ethics of caring; the need to address suffering; the role of spirituality in habilitation and rehabilitation, and; how existential outcomes of happiness, joy, inner peace, and meaning positively affects the quality of life.