TR Process/ Therapeutic Relationships/ TR Prodession Flashcards
what is the TR process?
- a systematic and complex planning process:
- > person-centeres
- > goal-directed
- > framework for providing services
what are the 4 phases of the TR process (APIE)?
- assessing
- planning
- implementation
- evaluation
describe the 4 phases of the TR process
- First, the recreational therapist collects data and analyzes them to determine the clients problems or concerns and strengths and needs (during assessment)
- Then the recreational therapist makes a plan to meet the clients problem or concerns (during planning)
- Once in place the recreational therapist puts the plan into action and with the client conducts the designed interventions (during implementation)
- Finally, the recreational therapist conducts an assessment to determine the validity of the plan and the effectiveness of the intervention (during evaluation)
why is APIE important?
- Provides a problem-solving structure to accomplish delivery of effective, customized care
- Involves sequential step-by-step actions directed to achieve stated goals
- Promotes customized care by providing a system to meet specific, unique client needs
- Tailors interventions addressed to the individual’s needs (and not the disease/disability)
- Increases client participation in care (client/therapist collaboration)
- Person-centered, systematic approach
- Allows delivery of care that is organized, continuous, and systematic
- Goal-directed approach and measurable outcomes
- Accountability through evaluation
- Interrelationship among and between phases—ensures all parts work together
- Offers means to interpret/communicate to others how TR contributes to client care
what is assessment?
-first phase of APIE
- gathering an analysis of data to identify strengths, problems, needs, leisure interests: What data we choose to gather and how we use data is influenced by conceptual TR model of practice
-Involves clinical reasoning:
Ie: similar to medical diagnosis for doctors
-Avoiding pre-packaged programs!:
->Individualization and person-centered approach
->Agency requirements
what is the method of assessment?
- Observations
- > Specific goal observations
- > Time-Interval Observations
- > Standardized observations
- Interviews
- > Can range from highly structured to very informal
- > Some agencies use inventories during interview process
- Secondary sources
- > Family members, friends, staff/interdisciplinary team
- > Medical records/charts
- > Social histories
- > Other professional assessments/tests
- > Progress notes
areas of assessment
- General Information
- International Classification of Function, Disability and Health (ICF) outcome domains
- > Emphasizes function (rehabilitation)
- > Body structure/function, participation, environment
- Other areas suggested in TR Literature
- > Biological functioning
- > Psychological functioning
- > Social functioning
- > Spiritual functioning
- Strengths Assessment characteristics, social support and recreational ability
- > Important—most clients need help in identifying strengths
what is the four-step procedure of planning
- Setting Priorities
Identifying needs & professional help required to meet those needs (follows analysis of data gathered in the assessment phase) - Formulating Goals and Objectives (TPOs, EOs, PMs)
Goals -> Flow directly from needs; describe client outcomes (intended results). Stated in BROAD terms
Objectives-> Specify clients behaviors related to reaching the goal; break down goals into measurable behaviours
SMART Goals
Specific-> States one behavior or criteria
Measurable-> How to measure the behavior/criteria
Attainable -> Realistic
Relevant -> Relevant to individuals needs
Time-bound-> Objectives are to reach a specific deadline - Determining strategies or Actions to Meet the Goals
Program is selected (this is the intervention!)
Ideally along with the client
Evidence-Based Practice (EBP): A problem-solving approach that integrates the best evidence from well-designed studies with a clinician’s expertise and a patient’s preferences and values
Considers research findings when developing the intervention plan - Selecting methods to assess progress made towards goals
IMPORTANT: What evaluation procedure(s) will you use? This selection happens in the planning phase, and NOT in the evaluation phase!!
what is implementation?
-“Action” Phase
-Skills Required:
Interpersonal
Observational
Decision-making
Technical skills
-Characteristics of Therapeutic Activities
1.Goal Directed
2.Require participants to actively participate
3.Have meaning and value to the client
4.Offer potential for pleasure and satisfaction
5.Are selected with the guidance of the recreational therapist
The implementation phase is the action phase of the RT process. Implementation involves the recreational therapist and client (ideally) executing the clients intervention plan. Recreational therapist are responsible for coordinating client-focused and goal directed activities consistent with the proposed plan of action. They guide the client until he or she can assume self-responsibility. Recreational therapists also ensure that the client’s actions and responses are fully documented throughout the implementation phase
->Facilitation Techniques
For example: Adventure Therapy, physical activity, yoga, meditation, horticulture therapy, humor,
->Skills that are necessary to put the intervention plan into action: Interpersonal, Observational, Decision-making, Technical kills
1. Goal Directed-> activities are done for a reason, not for passing the time
2.Require participants to actively participate-> clients should have a role in choosing the activity and having an affect on the outcome
3. Have meaning and value to the client ->Demonstrate that activities are a means to an end
4. Offer potential for pleasure and satisfaction ->activities should be somewhat satisfying and enjoyable for the client
5. Are selected with the guidance of the recreational therapist -> RT need to draw on their professional knowledge of activities to help meet clients needs while and that uses the clients strengths
what is evaluation?
- Same methods as initial assessment
- > Re-assessment
- Review Progress Notes
- Interview Clients
- Meet with interdisciplinary team to discuss the client
Evaluation is the fourth and final phase in the RT process. Evaluation reveals whether the plan has been effective or requires revision. Common means of evaluating are to conduct a review of progress notes, interview clients so they may respond retrospectively after participating in the intervention program, and hold an interdisciplinary team meeting to discuss the progress of each client.
what is documentation?
- If it’s not documented, it didn’t happen!
- > Means of communication
- > Determining quality of services
- > Accountability/transparency
- Clinical vs Community
- > Client chart, progress notes, discharge summaries etc.
- > Log books, report cards, certificates, etc.
- Form of documentation
- > Agency requirements
- > SOAP(E), DARE, charting by exception
Subjective- what the patient reports
Objective- what the therapist observes and standardized gathered data
Analysis- summary of data and justification of course of action
Plan- specific course of action
Evaluation- how will outcomes be monitored
Data
Action
Response
Evaluation
how important are Therapeutic Relationships?
Research has indicated that 40% of the variance in outcome in all forms of psychotherapy can be accounted for by the strength and quality of the therapeutic alliance. Facilitating the development of a strong therapeutic alliance must be seen as the essential work for psychotherapy (American Psychiatric Association, 1993)
what is a therapeutic relationship?
- Does not involve resolving problems for clients
- Assisting clients to assume responsibility to cope with their problems and develop competence to meet future challenges
- The general goal is enhanced wellness, including improved functioning and well-being
- A safe environment for the client to express their thoughts and feelings
- Goal-directed outcome focused on client needs
- Empathetic understanding, a genuine approach and nonjudgmental acceptance of clients
A TR relationship will allow the client to use the TR practitioner for support and assistance and the RT to better understand client needs feelings and motivations. Shared knowledge of the client’s experiences with his or her illness or disorder provides a special kind of bond between the client and the therapist and creates an atmosphere of caring and trust from which the therapist can apply his or her skills to meet client needs.
what is NOT a therapeutic relationship?
- Client becoming dependent on the practitioner
- The helper does not take power and responsibility away from the client
- > A relationship that involves the dominance of one over another leads to a power struggle and negative ramifications
- > Helper having power = client being helpless, healing and growth will not transpire, and a true therapeutic relationship will not exist.
what is walking the “tightrope”?
- 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 potentially finding one’s self in an unhealthy relationship with a client
