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Therapeutic Recreation Models

Info: 4681 words (19 pages) Nursing Essay
Published: 11th Feb 2020

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Tagged: penders health promotion model

Therapeutic Recreation seeks to promote the capacity and ability of groups and individuals to make self determined and responsible choices, in light of their needs to grow, to explore new perspectives and possibilities, and to realise their full potential.

Within this assignment I am going to critically compare and evaluate the use of the following models in the Therapeutic Recreation Service: The Leisure Ability Model and the Health Promotion/ Health Protection Model. In doing so I will firstly describe the two models in detail and then critically compare and evaluate them both and their use in the therapeutic recreation service.

The Leisure Ability Model:

Every human being needs, wants, and deserves leisure. Leisure presents opportunities to experience mastery, learn new skills, meet new people, deepen existing relationships, and develop a clearer sense of self. Leisure provides the context in which people can learn, interact, express individualism, and self-actualize (Kelly, 1990).

A large number of individuals are constrained from full and satisfying leisure experiences. It then follows that many individuals with disabilities and/or illnesses may experience more frequent, severe, or lasting barriers compared with their non-disabled counterparts, simply due to the presence of disability and/or illness.

The Leisure Ability Models underlying basis stems from the concepts of: (a) learned helplessness vs. mastery or self-determination; (b) intrinsic motivation, internal locus of control, and causal attribution; (c) choice; and (d) flow.

Learned Helplessness:

Learned helplessness is the perception by an individual that events happening in his or her life are beyond his or her personal control, and therefore, the individual stops trying to effect changes or outcomes with his or her life (Seligman, 1975). They will eventually stop wanting to participate in activity or participate in any other way. They will learn that the rules are outside of their control and someone else is in charge of setting the rules. Their ability to take a risk will be diminished and they will learn to be helpless. Learned helplessness may present a psychological barrier to full leisure participation and it may, conversely, be unlearned with the provision of well-designed services.

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Intrinsic Motivation, Internal Locus of Control, and Causal Attribution:

All individuals are intrinsically motivated toward behaviour in which they can experience competence and self-determination. As such, individuals seek experiences of incongruity or challenges in which they can master the situation, reduce the incongruity, and show competence. This process is continual and through skill acquisition and mastery, produces feelings of satisfaction, competence, and control.

An internal locus of control implies that the individual has the orientation that he or she is responsible for the behaviour and outcomes he or she produces (Deci, 1975). Typically individuals with an internal locus of control take responsibility for their decisions and the consequences of their decisions, while an individual with an external locus of control will place responsibility, credit, and blame on other individuals. An internal locus of control is important for the individual to feel self-directed or responsible, be motivated to continue to seek challenges, and develop a sense of self-competence. http://dw.com.com/redir?tag=rbxira.2.a.10&destUrl=http://www.cnet.com/b.gif

Attribution implies that an individual believes that he or she can affect a particular outcome (Deci, 1975; Seligman, 1975). An important aspect of the sense of accomplishment, competence, and control is the individual’s interpretation of personal contribution to the outcome. Without a sense of personal causation, the likelihood of the individual developing learned helplessness increases greatly.


The Leisure Ability Model also relies heavily on the concept of choice, choice implies that the individual has sufficient skills, knowledge, and attitudes to be able to have options from which to choose, and the skills and desires to make appropriate choices. Lee and Mobily (1988) stated that therapeutic recreation services should build skills and provide participants with options for participation.


When skill level is high and activity challenge is low, the individual is quite likely to be bored. When the skill level is low and the activity challenge is high, the individual is most likely to be anxious. When the skill level and activity challenge are identical or nearly identical, the individual is most able to achieve a state of concentration and energy expenditure that Csikszentmihalyi (1990) has labeled “flow.”

Treatment Services

During treatment services, the client generally has less control over the intent of the programs and is dependent on the professional judgment and guidance provided by the specialist. The client experiences less freedom of choice during treatment services than any other category of therapeutic recreation service. The role of the specialist providing treatment services is that of therapist. Within treatment services, the client has minimal control and the therapist has maximum control. The specialist typically designates the client’s level and type of involvement, with considerably little input from the client. In order to successfully produce client outcomes, the specialist must be able to assess accurately the client’s functional deficits; create, design, and implement specific interventions to improve these deficits; and evaluate the client outcomes achieved from treatment programs.

http://dw.com.com/redir?tag=rbxira.2.a.10&destUrl=http://www.cnet.com/b.gifThe ultimate outcome of treatment services is to eliminate, significantly improve, or teach the client to adapt to existing functional limitations that hamper efforts to engage fully in leisure pursuits. Often these functional deficits are to the degree that the client has difficulty learning, developing his or her full potential, interacting with others, or being independent. The aim of treatment services is to reduce these barriers so further learning and involvement by the client can take place.

Leisure Education:

Leisure education services focus on the client acquiring leisure-related attitudes, knowledge, and skills. Participating successfully in leisure requires a diverse range of skills and abilities, and many clients of therapeutic recreation services do not possess these, have not been able to use them in their leisure time, or need to re-learn them incorporating the effects of their illness and/ or disability. Leisure education services are provided to meet a wide range of client needs related to engaging in a variety of leisure activities and experiences. (Howe, 1989, p. 207).

The overall outcome sought through leisure education services is a client who has enough knowledge and skills that an informed and independent choice can be made for his or her future leisure participation. Leisure education means increased freedom of choice, increased locus of control, increased intrinsic motivation, and increased independence for the client.

Recreation Participation: http://dw.com.com/redir?tag=rbxira.2.a.10&destUrl=http://www.cnet.com/b.gif

Recreation participation programs are structured activities that allow the client to practice newly acquired skills, and/or experience enjoyment and self-expression. These programs are provided to allow the client greater freedom of choice within an organized delivery system and may, in fact, be part of the individual’s leisure lifestyle. The client’s role in recreation participation programs includes greater decision making and increased self-regulated behaviour. The client has increased freedom of choice and his or her motivation is largely intrinsic. In these programs, the specialist is generally no longer teaching or “in charge” per se. The client becomes largely responsible for his or her own experience and outcome, with the specialist moving to an organizer and/or supervisor role.

As Stumbo and Peterson (1998) noted, recreation participation allows the client an opportunity to practice new skills, experience enjoyment, and achieve self-expression. From a clinical perspective, recreation participation does much more. For instance, recreation opportunities provide clients with respite from other, more arduous, therapy services.

Leisure education programs may focus on: (a) self-awareness in relation to clients’ new status; (b) learning social skills such as assertiveness, coping, and friendship making; (c) re-learning or adapting pre-morbid leisure skills; and (d) locating leisure resources appropriate to new interests and that are accessible. Recreation participation programs may involve practicing a variety of new leisure and social skills in a safe, structured environment.

In designing and implementing these programs, the specialist builds on opportunities for the individual to exercise control, mastery, intrinsic motivation, and choice. The ultimate outcome would be for each client to be able to adapt to and cope with individual disability to the extent that he or she will experience a satisfying and independent leisure lifestyle, and be able to master skills to achieve flow.

Health Promotion/ Health Protection Model:

The Health Protection/Health Promotion Model (Austin, 1996, 1997) stipulates that the purpose of therapeutic recreation is to assist persons to recover following threats to health, by helping them to restore themselves or regain stability. (health protection), and secondly, optimising their potentials in order that they may enjoy as high a quality of health as possible (health promotion).

Within this model (Austin, 1997, p. 144) states that

“the mission of therapeutic recreation is to use activity, recreation, and leisure to help people to deal with problems that serve as barriers to health and to assist them to grow toward their highest levels of health and wellness”

The health promotion, health protection model is broken up into four broad concepts which are the humanistic perspective, high level wellness, stabilisation and actualisation and health.

  • Humanistic Perspective:

Those who embrace the humanistic perspective believe that each of us has the responsibility for his or her own health and the capacity for making self-directed and wise choices regarding our health. Since individuals are responsible for their own health, it is critical to empower individuals to become involved in decision-making to the fullest extent possible (Austin, 1997).

  • High-Level Wellness:

High-level wellness deals with helping persons to achieve as high a level of wellness as they are capable of achieving (Austin, 1997). Therapeutic Recreation professionals have concern for the full range of the illness-wellness continuum (Austin, 1997). http://dw.com.com/redir?tag=rbxira.2.a.10&destUrl=http://www.cnet.com/b.gif

  • Stabilization and Actualization Tendencies:

The stabilizing tendency is concerned with maintaining the “steady state” of the individual. It is an adaptation mechanism that helps us keep stress in a manageable range. It protects us from biophysical and psychosocial harm. The stabilizing tendency is the motivational force behind health protection that “focuses on efforts to move away from or avoid negatively valence states of illness and injury” (Pender, 1996, p. 34). The actualization tendency drives us toward health promotion that “focuses on efforts to approach or move toward a positively valence state of high-level health and well-being” (Pender, 1996, p. 34).

  • Health:

King (1971) and Pender (1996) health encompasses both coping adaptively and growing and becoming. Healthy people can cope with life’s stressors. Those who enjoy optimal health have the opportunity to pursue the highest levels of personal growth and development.

Under the Health Protection/Health Promotion Model, therapists* recognize that to help clients strive toward health promotion is the ultimate goal of therapeutic recreation. Further, therapists prize the right of each individual to pursue his or her highest state of well-being, or optimal health. TR practice is therefore based on a philosophy that encourages clients to attempt to achieve maximum health, rather than just recover from illness (Austin, 1997).

  • The Component of Prescriptive Activities:

When clients initially encounter illnesses or disorders, often they become self-absorbed. They have a tendency to withdraw from their usual life activities and to experience a loss of control over their lives (Flynn, 1980). Research (e.g., Langer & Rodin, 1976; Seligman & Maier, 1967) has shown that feelings of lack of control may bring about a sense of helplessness that can ultimately produce severe depression. At times such as this clients are encountering a significant threat to their health and are not prepared to enjoy and benefit from recreation or leisure. For these individuals, activity is a necessary prerequisite to health restoration. Activity is a means for them to begin to gain control over their situation and to overcome feelings of helplessness and depression that regularly accompany loss of control.

At this point on the continuum, Therapeutic Recreation professionals provide direction and structure for prescribed activities. Once engaged in activity, clients can begin to perceive themselves as being able to successfully interact with their environments, to start to experience feelings of success and mastery, and to take steps toward regaining a sense of control. Clients come to realise that they are not passive victims but can take action to restore their health. They are then ready to partake in the recreation component of treatment.

  • The Recreation Component:

Recreation is activities that take place during leisure time (Kraus. 1971). Client need to take part in intrinsically motivated recreation experiences that produce a sense of mastery and accomplishment within a supportive and nonthreatening atmosphere. Clients have fun as they learn new skills, new behaviors, new ways to interact with others, new philosophies and values, and new cognition about themselves. In short, they learn that they can be successful in their interactions with the world. Through recreation they are able to re-create themselves, thus combating threats to health and restoring stability. http://dw.com.com/redir?tag=rbxira.2.a.10&destUrl=http://www.cnet.com/b.gif

  • The Leisure Component:

Whereas recreation allows people to restore themselves, leisure is growth promoting. Leisure is a means to self-actualisation because it allows people to have self-determined opportunities to expand themselves by successfully using their abilities to meet challenges. Feelings of accomplishment, confidence and pleasure result from such growth producing experiences. Thus leisure assumes an important role in assisting people to reach their potentials (Iso-Ahola, 1989). Core elements in leisure seem to be that it is freely chosen and intrinsically motivated.

  • The Recreation and Leisure Components:

Although recreation and leisure differ in that recreation is an adaptive device that allows us to restore ourselves and leisure is a phenomenon that allows growth, they share commonalities. Both recreation and leisure are free from constraint. Both involve intrinsic motivation and both provide an opportunity for people to experience a tremendous amount of control in their lives. Both permit us to suspend everyday rules and conventions in order to “be ourselves” and “let our hair down.” Both allow us to be human with all of our imperfections and frailties. It is the task of the therapeutic recreation professional to maintain an open, supportive, and nonthreatening atmosphere that encourages these positive attributes of recreation and leisure and which help to bring about therapeutic benefit (Austin, 1996).


According to Bandura (1986), bolstered efficacy expectations allow clients to have confidence in themselves and in their abilities to succeed in the face of frustration. Thus, clients feel more and more able to be in control of their lives and to meet adversity as they move along the continuum toward higher levels of health. It is the role of the TR professional to help each client assume increasing levels of independence as he or she moves along the illness-wellness continuum. Of course, the client with the greatest dependence on the therapist will be the individual who is in the poorest health. At this point the stabilizing tendency is paramount while the client attempts to ward off the threat to health and to return to his or her usual stable state. At this time the therapist engages the client in prescriptive activities or recreation experiences in order to assist the client with health protection. During prescriptive activities the client’s control is the smallest and the therapist’s is the largest. During recreation there is more of a mutual participation by the client and therapist. With the help of the therapist, the client learns to select, and participate in, recreation experiences that promote health improvement. Approximately midway across the continuum, the stabilising tendency reduces and the actualising tendency begins to arise. Leisure begins to emerge as the paramount paradigm. As the actualisation tendency increases, the client becomes less and less dependent on the therapist and more and more responsible for self-determination. The role of the therapist continues to diminish until the client is able to function without the helper. At this point the client can function relatively independently of the TR professional and there is no need for TR service delivery (Austin, 1997).

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Comparison of the use of the Leisure Ability Model to the Health Promotion/ Health Protection Model in Therapeutic Recreation Services:

The role of the therapeutic recreation specialist, in order to reverse the consequences of learned helplessness, is to assist the individual in: (a) increasing the sense of personal causation and internal control, (b) increasing intrinsic motivation, (c) increasing the sense of personal choice and alternatives, and (d) achieving the state of optimal experience or “flow.”

In theory, then, therapeutic recreation is provided to affect the total leisure behaviour (leisure lifestyle) of individuals with disabilities and/or illnesses through decreasing learned helplessness, and increasing personal control, intrinsic motivation, and personal choice. This outcome is accomplished through the specific provision of treatment, leisure education, and recreation participation services which teach specific skills, knowledges, and abilities, and take into consideration the matching of client skill and activity challenge.

Another strength is the Model’s flexibility. One level of flexibility is with the three components of service. Each component of service is selected and programmed based on client need. That is, some clients will need treatment and leisure education services, without recreation participation. Other clients will need only leisure education and recreation participation services. Clearly, services are selected based on client need. In addition, programs conceptualized within each service component are selected based on client need.

flexibility allow the specialist to custom design programs to fit the needs of every and any client group served by therapeutic recreation. The ultimate goal of leisure lifestyle remains the same for every client, but since it is based on the individual, how the lifestyle will be implemented by the individual and what it contains may differ. As such, the content of the Leisure Ability Model is not specific to any one population or client group, nor is it confined to any specific service or delivery setting. Some authors, including Kinney and Shank (1989), have reported this as a strength of the Model.

According to the model, intervention may occur in a wide range of settings and addresses individuals with “physical, mental, social, or emotional limitations” (Peterson & Gunn, p. 4). The intervention model is conceptually divided into three phases along a continuum of client functioning and restrictiveness. The three phases of therapeutic recreation intervention are arranged in a sequence, from greater therapist control to lesser therapist control, and from lesser client independence to greater client independence. This arrangement is purposeful and is meant to convey that the ultimate aim of the “appropriate leisure lifestyle” is that it be engaged in independently and freely.


The Health Protection/Health Promotion Model contains three major components (i.e., prescribed activities, recreation, and leisure) that range along an illness-wellness continuum. According to their needs, clients may enter anywhere along the continuum. The model emphasizes the active role of the client who becomes less and less reliant on the TR professional as he or she moves toward higher levels of health. Initially, direction and structure are provided through prescriptive activities to help activate the client. During recreation, the client and therapist join together in a mutual effort to restore normal functioning. During leisure, the client assumes primary responsibility for his or her own health and well-being.

Evaluation of both models and there use in therapeutic recreation services:

The overall intended outcome of therapeutic recreation services, as defined by the Leisure Ability Model, is a satisfying, independent, and freely chosen leisure lifestyle.

In order to facilitate these perceptions, therapeutic recreation specialists must be able to design, implement, and evaluate a variety of activities that increase the person’s individual competence and sense of control. In relation to leisure behaviour, Peterson (1989) felt that this includes improving functional abilities, improving leisure-related attitudes, skills, knowledge, and abilities, and voluntarily engaging in self-directed leisure behaviour. Thus, the three service areas of treatment, leisure education, and recreation participation are designed to teach specific skills to improve personal competence and a sense of accomplishment. Csikszentmihalyi (1990) summed up the importance of these perceptions: “In the long run optimal experiences add up to a sense of mastery-or perhaps better, a sense of participation in determining the content of life-that comes as close to what is usually meant by happiness as anything else we can conceivably imagine” (p. 4).

The therapeutic recreation specialist must be able to adequately assess clients’ skill level (through client assessment) and activity requirements (through activity analysis) in order for the two to approximate one another. Given Deci’s (1975) theory of intrinsic motivation which includes the concept of incongruity, therapeutic recreation specialists may provide activities slightly above the skill level of clients in order to increase the sense of mastery. When this match between the activity requirements and client skill levels occurs, clients are most able to learn and experience a higher quality leisure. To facilitate this, therapeutic recreation specialists become responsible for comprehending and incorporating the: (a) theoretical bases (including but not limited to internal locus of control, intrinsic motivation, personal causation, freedom of choice, and flow); (b) typical client characteristics, including needs and deficits; (c) aspects of quality therapeutic recreation program delivery process (e.g., client assessment, activity analysis, outcome evaluation, etc.); and (d) therapeutic recreation content (treatment, leisure education, and recreation participation).

These areas of understanding are important for the therapeutic recreation specialist to be able to design a series of coherent, organized programs that meet client needs and move the client further toward an independent and satisfactory leisure lifestyle. Again, the success of that lifestyle is dependent on the client gaining a sense of control and choice over leisure options, and having an orientation toward intrinsic motivation, an internal locus of control, and a personal sense of causality. The Leisure Ability Model provides specific content that can be addressed with clients in order to facilitate their development, maintenance, and expression of a successful leisure lifestyle. Each aspect of this content applies to the future success, independence, and well-being of clients in regard to their leisure. http://dw.com.com/redir?tag=rbxira.2.a.10&destUrl=http://www.cnet.com/b.gif

The client has reduced major functional limitations that prohibit or significantly limit leisure involvement (or at least has learned ways to overcome these barriers); understands and values the importance of leisure in the totality of life experiences; has adequate social skills for involvement with others; is able to choose between several leisure activity options on a daily basis, and make decisions for leisure participation; is able to locate and use leisure resources as necessary; and has increased perceptions of choice, motivation, freedom, responsibility, causality, and independence with regard to his or her leisure. These outcomes are targeted through the identification of client needs, the provision of programs to meet those needs, and the evaluation of outcomes during and after program delivery. A therapeutic recreation specialist designs, implements, and evaluates services aimed at these outcomes

Austin (1989) objected to the Leisure Ability Model on the basis that is supporting a leisure behaviour orientation, instead of the therapy orientation. “A number of authors have objected to the Leisure Ability Model, having observed that its all-encompassing approach is too broad and lacks the focus needed to direct a profession” (Austin, p. 147). Austin advocated an alignment of therapeutic recreation with allied health and medical science disciplines, rather than leisure and recreation professionals

The Model in Practice

The Health Protection/Health Promotion Model may be applied in any setting (i.e., clinical or community) in which the goal of therapeutic recreation is holistic health and well-being. Thus, anyone who wishes to improve his or her level of health can become a TR client. TR professionals view all clients as having abilities and intact strengths, as well as possessing intrinsic worth and the potential for change. Through purposeful intervention using the TR process (i.e., assessment, planning, implementation, evaluation), therapeutic outcomes emphasize enhanced client functioning. Typical therapeutic outcomes include increasing personal awareness, improving social skills, enhancing leisure abilities, decreasing stress, improving physical functioning, and developing feelings of positive self-regard, self-efficacy and perceived control (Austin, 1996).


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The health promotion model was developed in 1982 by Dr. Nola J. Pender. Pender believed that the goal of nursing care was to help patients achieve optimal health and well-being. The model was created following Pender’s work examining health promoting and preventative behaviours.

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