HPR 453
Chapter 22
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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?
Your experiences and beliefs are
important guides in building and
maintaining effective therapeutic
relationships
 Students grasp
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Designing programs to meet client needs
Writing goals and objectives
Enhancing clients’ abilities and strengths
Believing in the power of leisure and
recreation
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”
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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
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
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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
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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
Ethical dilemmas when a balance can’t
be created
 60% of ethical problems are identified by
TRs involved with improper therapistclient relationships (see question posed
on pg 359)
 Danger signals
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 Therapist’s over-identification with client
 Need to be needed and appreciated by
client
 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
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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
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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?
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At the same time
 Assessing needs, strengths, abilities
 Relieving fears or confusions and
negotiating tx goals
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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
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Can you leave personal baggage at the
door?
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
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“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
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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?
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?
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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
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How do we develop relationshipbuilding skills?
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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
 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!!
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