This is an excerpt from Therapeutic Recreation Leadership and Programming by Robin Kunstler & Frances Stavola Daly.
Four Core TR Values
Values may be characterized as the established ideals of a profession and are reflected in professional ethics. Values identify what the profession considers to be worthy and useful as a guide for practice. They may even arouse an emotional response in us because of their meaning and importance. A profession's values should become part of the pattern of one's daily practice. The TRS not only cherishes these values, but articulates and expresses them in her work (Purtilo & Haddad, 2002). Values influence the types of services a profession provides and the methods it uses to deliver those services. As the TRS matures as a professional, her values may evolve as a result of her experiences and continued learning. Thus, the TRS develops a professional personality based on the values of the profession. The four core TR values are the right to leisure, autonomy, optimal health, and quality of life. The TR professional safeguards these values for clients, advocating for their rights to these values in their lives and providing the services to ensure them.
Right to Leisure
The right to leisure means that all individuals, regardless of their special needs, illnesses, disabilities, limitations, or other circumstances that may affect their full participation, have the right to pursue leisure as “a condition necessary for human dignity and well-being” (National Recreation and Park Association, 1999, p. 1) and are entitled to the assistance required to facilitate the leisure experience. Leisure is characterized by
- perceived freedom from barriers and constraints, and perceived freedom to choose one's actions without the interference or control of another;
- perceived competence that one has the skills and abilities necessary for successful participation in satisfying experiences;
- intrinsic motivation to engage in an activity for personal feelings of satisfaction and enjoyment rather than due to any extrinsic factors that influence the behavior; and
- feeling that one has the ability to have an influence or impact on an experience (Edginton, DeGraaf, Dieser & Edginton, 2006).
Particularly powerful leisure experiences are often characterized by a feeling of being connected to oneself and to the universe, and waking up to see “a glimmer of what is true” (Howe-Murphy & Charboneau, 1987, p. 45). This experience has the potential to be a turning point in the process of healing from either a physical or an emotional harm. Leisure, therefore, can contribute to a better quality of life and a higher level of well-being.
Understanding the meaning of leisure is essential to practicing TR. The focus on leisure experience is the unique contribution of TR to health care and human services. In a traditional medical model, or in a society that has negative attitudes toward the capabilities of people with disabilities and limiting conditions, access to leisure experiences has been restricted, to the detriment of those individuals. For them, leisure may be the one area of their lives in which they choose activities for the personal meaning and fulfillment those activities bring. They are intrinsically motivated to be involved in leisure experiences because the rewards and benefits are in the “doing” of the activity itself and not derived from an external source. Leisure is an opportunity for the individual to express and develop his talents and interests. It may be seen as an arena for the expression of one's unique identity, in which a person is free from constraints on that identity and free to express identity. “One of the potential joys of participating in therapeutic recreation is that individuals have an opportunity to explore their true selves in a challenging, accepting, supportive and conscious environment” (Howe-Murphy & Charboneau, 1987, p. 47). Therapeutic recreation is the only helping profession that has the right to leisure as one of its foundational principles and acts as an advocate for the rights of all individuals to leisure. The TR profession's responsibility to articulate the value of leisure to other health professionals is vital to meeting the needs of clients.
The concept of leisure also has been discussed in terms of flow. Flow is an optimal experience that may occur when the challenges of an activity are matched to the skill level of the individual. If an activity is too challenging and the participant does not perceive she has the skills to successfully engage in it, she may feel frustrated and give up. On the other hand, if the activity is not sufficiently demanding of the participant's skills and abilities, she may feel bored or apathetic. But when there is a satisfactory match between challenge and skill, flow results. Flow is characterized by feelings of perceived competence, loss of awareness of time, deep concentration, and feelings of intense involvement (Csikszentmihalyi, 1990). Recreation activities, the primary modality of TR, often result in flow (or leisure) because they involve challenge, excitement, rewards, choices, concentration, structure, and pure fun.
Most definitions of leisure emphasize individualistic values as opposed to the collective or communal values of groups such as Native Americans, Asians, and Latinos. A growing professional concern is that TR practice does not adequately acknowledge a cultural bias in favor of Western values based on individualism. A conceptualization of leisure that goes beyond intrinsic motivation to incorporate a social orientation has been recommended (Dieser, 2004). A social orientation recognizes the influence of our relationships (e.g., family, ethnic group) and the social roles that people fill (e.g., parent, child) as motivators for leisure and as sources of meaning. The social orientation is very much in keeping with the core principles of TR, as the profession acknowledges and incorporates others in planning clients' leisure opportunities. Whether or not one takes an individualistic or social orientation to leisure, expressing one's right to leisure is closely related to the value of autonomy.
Autonomy can be defined as the right to govern oneself, to make one's own decisions and choices, and to be self-determining. Autonomy, as discussed in chapter 1, is also a key bioethical principle. One very meaningful contribution that TR makes to the lives of its clients is helping them maintain some degree of autonomy by providing opportunities to make choices. Leisure may offer the most opportunity for clients to experience autonomy because leisure is characterized by freedom and self-determination (Lahey, 1987). Embracing autonomy as a value means basing services on what the individual defines as his needs and goals. However, in health care settings, people often find their self-determination and autonomy eroded by the nature of the institution, their compromised health status, and their placement (rightly or not) in a dependent role.
Ethical practice requires that the TRS not violate clients' autonomy by making decisions for them, justified as “the professional knows best.” Without autonomy, TR loses the qualities that make it most meaningful to the client. While a certain amount of dependency may be needed as clients give their consent to be treated, they trust that the health care team is acting in their best interests (Austin, 2004). “If limits are to be placed on the client's autonomy, this needs to be discussed by the treatment team and communicated to the patient at the outset of treatment” (Jacobson & James, 2001, p. 242). The hope is that clients will then make the choice that is in their best interests. If the choice still poses a danger to the client, the team may choose to intervene to protect him. This is a course of action professionals should reflect upon carefully in their decision-making process. The TRS may help clients learn, if necessary, a process for making and acting upon decisions.
Another concern regarding autonomy is that it is seen as primarily a Western cultural value, which may cause conflict in individuals from cultures that emphasize a more collective approach to decision making. For example, a person from a non-Western culture may value the needs and wishes of the whole group over his own, which affects his decisions about his leisure pursuits, health care choices, or both. While a cross-cultural perspective encourages TRSs to examine both their biases and their competence to effectively serve people from all cultures, autonomy can be upheld as an ethical principle (and a core TR value) as long as individuals can make their decisions and choices “according to their cultural world-view” (Sylvester, Voelkl & Ellis, 2001, p. 73). Research studies have shown that self-determination, the “perception of freedom to make choices and the ability to initiate choices,” contributes to enjoyment (Devine & O'Brien, 2004, p. 210). Clients whose cultural values place a high priority on relational and role-determined leisure may benefit from the group participation and opportunities to fulfill meaningful roles and responsibilities that TR programs offer. This high regard for the individual's total being relates closely to the third value, optimal health.
The commitment to the right of all individuals to strive for and experience optimal health is one of the fundamental values of the TR profession. “The mission and purpose of TR has always been anchored in a commitment to facilitating the achievement and maintenance of health” (Coyle & Shank, 2004, p. 112). Therapeutic recreation recognizes and provides services from the perspective that an individual's state of health is a result of the relationships among physical, social, spiritual, psychological, and emotional factors; lifestyle habits, environmental conditions, culture, family, and social supports are also acknowledged as significant influences on health. The World Health Organization (WHO) defines health as “a state of complete physical, social, and mental well-being, and not merely the absence of disease or infirmity” (Fazio, 2008, p. 113). Well-being, the “achievement of a good and satisfactory existence as defined by the individual” (Fazio, p. 363), is closely related to one's perception of health. People served by TR have impairments that may preclude them from achieving complete or optimal health. However, emphasizing a person's intact strengths, what the individual can do, is a foundation of TR practice. In fact, today, all health and human services emphasize looking at the whole person when providing services, taking into account that all parts of a person are interrelated and affect one another. The factors that have the greatest influence on health, such as exercise, diet, safe behaviors, and recreation participation, are under the individual's control and can be seen as reflecting a person's beliefs and values regarding what is meaningful and important to life. Utilizing one's abilities and strengths reinforces a positive identity and can serve as a tool to engage in healthy behaviors. The TRS can encourage clients to take more responsibility for their own health as they learn about healthy behaviors.
This holistic approach to health is often referred to as wellness. Wellness emphasizes individual responsibility for health through the practice of a health-promoting lifestyle (Stumbo & Peterson, 2004). Recreation participation, as part of a healthy lifestyle, contributes to wellness. Wellness can be achieved within the limitations imposed by a disease or disability (Carter, Van Andel & Robb, 2003). Persons who are ill or at the end of life can experience wellness if they are responding to life's challenges according to their own life plan and achieving the potential they feel capable of achieving. The following is a definition of health perhaps more suited to the realities of the circumstances that can affect health status:
a dynamic level of psychophysical well-functioning, suitable for adapting to one's circumstances and effective for choosing and acting on the private and public values that constitute one's plan for life. (Sylvester, 1987, p. 79)
This definition also acknowledges health as a significant value, worthy of the attention of the TR profession. As a vital component of health services, TR can incorporate the holistic approach by supporting Healthy People 2010, the national health agenda put forth by the U.S. Department of Health and Human Services. The first goal of Healthy People 2010 is to increase not just longevity, but also the quality of life (Fazio, 2008), which is one of the core TR values. Other nations, such as Canada and Australia, have launched similar initiatives. In Australia, the National Health Strategy was established in 1994 to promote better health and health practices. Active Australia serves this national agenda by encouraging people to participate in sport and physical activity. In Canada, the Health Act was passed in 1984 to ensure that all Canadians have access to essential health services and to promote their physical and mental well-being.
Quality of Life
Quality of life is a person's assessment of her position in life, taking into consideration her perception of her physical and psychological health, family and social relationships, level of independence, work, financial status, and living situation in the context of her environment and values. Quality of life involves both subjective measures, such as one's sense of well-being and availability of opportunities, and objective measures, including functional status and access to resources (Lehman, 1995). This assessment will vary from person to person even when the overall circumstances seem quite similar. A person who seems to have everything may not be happy, whereas a person who is quite ill and without apparent resources or family ties may feel very positive about life. Perceptions of quality of life vary with the passage of time, changes in relationships, and changes in circumstances, particularly after a life-altering event that requires professional services (Drench et al., 2007). Quality of life “touches the heart of what life is about, what it means to be human” (Carter et al., 2003, p. 19). It directs the TRS to treat a client as a whole person, with unique needs, desires, and interests that affect the selection of services. Therapeutic recreation can contribute to people's perception of their quality of life by “opening the fullness of leisure to all citizens” (Lahey, 1996, p. 27). Leisure experiences, which produce feelings of freedom, joy, and satisfaction, are essential to quality of life (Carter et al., 2003).
These four values of TR—the right to leisure, autonomy, optimal health, and quality of life—are closely related. Taken together, they express key beliefs about the value of TR as it offers the opportunity to experience leisure, to make choices within the context of one's cultural values and beliefs, to strive for health, and to enhance quality of life. A strong theme linking TR values is respect for the uniqueness of each human being, each with his own specific beliefs, viewpoints, needs, and desires that affect his attitudes and actions. Therapeutic recreation specialists treat all persons with dignity and respect for their individuality and the many contexts of their lives. Therapeutic recreation services focus on improving functioning in all domains to promote health and wellness, providing supports and resources and facilitating self-determined leisure experiences. Professional values are brought to life as principles that guide practice.
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