1. HPR 453 Chapter 22

2.  This Chapter explores the challenges and dilemmas associated with establishing effective therapeutic alliances What knowledge, skills, awareness, and abilities should the TR possess to build relationships with clients and their family members/care providers to facilitate change through the TR process? What do you see as key to building and maintaining a healthy therapeutic relationship with clients?

3.  Your experiences and beliefs are important guides in building and maintaining effective therapeutic relationships  Students grasp Designing programs to meet client needs Writing goals and objectives Enhancing clients’ abilities and strengths Believing in the power of leisure and recreation

4.  Do students understand the nature of relationships with clients and cultivating the relationship?  Seasoned practitioners often struggle with effective therapist/client relationships  Principles are consistent across disciplines and practice settings  Many students often use the term “friend”

5.  This chapter reflects research and thinking that evolved from an ethnographic case study in a rehab setting and are framed within the context of building therapeutic alliances with clients who possess the cognitive (e.g., memory, problem-solving) and communicative abilities to actively participate in setting the course for their participation in a TR change process

6. Walking the Tightrope while Juggling: TR Relationship Dilemmas  Nonjudgmental attitude and caring contribute to friendships and therapeutic relationships  Reciprocity (equality and mutuality) in sharing confidences and personal problems essential in friendships but inappropriate in therapeutic relationships

7.  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 finding one’s self in an unhealthy relationship with a client

8.  Ethical dilemmas when a balance can’t be created  60% of ethical problems are identified by TRs involved with improper therapist- client relationships (see question posed on pg 359)  Danger signals Therapist’s over-identification with client Need to be needed and appreciated by client

9. Spending an inordinate amount of time with one client including off-duty time Keeping secrets the client shared Withholding information from the rest of the treatment team  The above not only violate ethical practice but can lead to potential for exploitation and manipulation and undermine the potential for meaningful change through TR Process

10.  How does a therapist Quickly build a rapport and open, caring relationship while clearly communicating the purpose of TR and the role of the therapist?  At the same time Assessing needs, strengths, abilities Relieving fears or confusions and negotiating tx goals

11.  Juggling and tightrope walking Relationships with other clients, their families, other staff, volunteers, allied professionals, managers Team meetings, acquiring resources, documentation, maintaining physical spaces, planning and implementing programs Changing healthcare arena, personal life

12.  Can you leave personal baggage at the door?

13. Slow Dancing  The process of rehab for clients  Flow of actions and interactions between client and TR as they share understanding of respective roles in TR process and working together  Therapists are trying to gain trust and accomplish multiple goals at one time, understand leisure in the clients’ past, present fears, and build hopes for the future

14. “Talking a problem into being”  Clients do not come into rehab with expectation of facing leisure as a need  TRs must assist client in identifying a problem/need that makes sense to them based on their present, future, values and beliefs  Goes beyond assessment and goal setting and into the slow dance of building a therapeutic relationship

15.  The CTRS explain TR and its purpose to client and the family?  Explain their role?  Focus on past leisure experiences in the initial description?  Then link the purpose and the past to the future for the client?  Not focus on barriers to returning to past but emphasize the potential and benefits during rehab and into the future?

16. Slow Dancing involves learning together  What are the client’s goals and expectations?  What are their leisure values?  Ongoing negotiations: what issues to address, next steps in the therapy process  Dilemma: How can this be done with increasing requirements for standardized tx processes?

17.  CTRSs must be more than empathetic, caring and genuine (good friend)  Must understand and be able to communicate the purpose of TR in a way that makes sense to the client  Framing actions and interactions in a way to help clients clearly see the benefits of and experience meaning from, their participation in TR

18. How do we develop relationship- building skills?  Students and practitioners need opportunities for self-reflection to obtain a clear understanding of Your own beliefs and philosophies of being a professional, a helper, and a therapist How your training and membership in prof orgs has influenced how you understand and operationalize your role as a TR How your own needs, desires, motivations and experiences influence interactions w/ clients

19. How your other life roles/responsibilities affect your practice  TRs must understand the culture of the setting and the needs and abilities of the client group you serve  You must reflect on what you learned, practiced or observed and apply it to the way you think you should work with your clients  Enjoy the dance and share with others along the way!!