KNR 273: Therapeutic/Helping
Relationships
Shank & Coyle, Chapter 11
(Also graduate school)
Graduate School
Who has thought about going to graduate
school?
Why?
Where?
What major?
When?
Questions about graduate school?
P.S. Graduate classes can count toward
NCTRC recertification
Graduate School
Typical requirements
Bachelor’s degree in related area from
accredited university
(or additional course work)
3.0 (out of 4.0) GPA
Overall undergraduate
La Crosse: 2.85/4.0 GPA
For junior & senior year
Last 60 hours
Graduate School
Typical requirements
Acceptance into graduate college (university
requirements)
Graduate Record Examination
500 on verbal / ISU 440 (200-800)
450 on quantitative /ISU 540 (200-800)
3.5 on analytical (0-6)
Professional recommendations
Undergraduate faculty familiar with academic
preparation
2-3
Graduate School
Typical requirements
Application fee (non-refundable)
Additional requirements
2 hour on campus writing exercise
On campus faculty interview
Statement of career goals
Resume
Graduate School
Deadlines vary by university
ISU Fall
March 1 – July 1
ISU Spring
October 15 – December 1
UofI Fall
February 1
UofI Spring
October 1
Graduate School
Financial Assistance
Tuition/fee waivers
Graduate assistantships
Scholarships
Culminating experience
Thesis
Non-thesis (sometimes more hours)
Graduate School
Not like undergraduate
Need to read, think, write
Need to be self motivated
Need to be able to structure time
Need to be able to work independently
Not for everyone or needed by everyone
Shortage of TR Ph.D.s
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)
Therapeutic/Helping
Relationships
Austin (2002)
Little has been written in TR literature
about describing or creating therapeutic
relationships.
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
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
Youth at Risk
Sprouse, 2004
Ability to develop rapport
Boundaries
Empathy
Hope and connectedness
Ethical behavior
Sense of humor
Self-disclosure
Compassion & empathy
Shank & Coyle
To be effective, need to understand
what aspects of themselves influence
client change & growth
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
Characteristic Skills
Awareness of self
Ability to analyze own feelings
Empathy
Courage
Courage to seek help & acknowledge
limitations
Inventive & creative
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
Competencies Needed
Ability to create
partnerships/collaborate
Clients
Colleagues
Ability to empower clients
Cultural competence
Competencies Needed
Communication competence
Listening & responding skills
Verbal & nonverbal
Interpersonal space
Using touch when communicating
Issues in Therapeutic
Relationships
Time
Takes time
Decreased length of stay
Starts when first meet (assessment)
Emotional Closeness
How close?
Self-disclosure
How much?
Issues in Therapeutic
Relationships – Crisis Prevention
CPI
Crisis Prevention Institute
World’s leading training organization
Management of disruptive & assaultive
behavior
Started 1980
Approved by ATRA for 1.8 CEUs
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
$349
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
$649
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
$1,099
Issues in Therapeutic
Relationships – Crisis Prevention
TCI
Therapeutic Crisis Intervention
Training program for staff that work with
youth
5 day curriculum
Train-the-trainer course
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
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
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
Issues in Therapeutic
Relationships – Crisis Prevention
TCI
Day 4: Outburst & Recovery
3 person restraint
Transferring control
Responding to feelings vs. behavior
Practice role plays
Issues in Therapeutic
Relationships – Crisis Prevention
TCI
Day 5: Implementing the TCI System
Recovery for staff
Documentation
Evaluation and testing
Issues in Therapeutic
Relationships
Termination
End relationship
Ritual, parties, tokens
Reunions
Client’s death
Impact on you
Impact on other clients
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
Issues in Therapeutic
Relationships
Who are candidates for burnout?
Repetitive contact with people
Intense interpersonal contacts
The “giving” role
Job monotony
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
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