December/January 2001

The Labor of Leisure

By Karen C. Wenzel, CTRS/CPRP; Kevin V. Rath, CTRS; and Leslie A. De Vries

How recreation therapy services address the importance of leisure time and activities for people with serious illness and disabilities

Most people treasure their free time and the recreational activities that fill it. These activities provide self-expression, tension release, and social interaction. The benefits of leisure contribute to people’s well-being and life satisfaction. For those with an illness or disability, leisure can be an opportunity or an additional burden.

The Importance of Leisure

Illness and disability are more than just physical and psychological distress. An illness or disability disrupts an individual’s sense of well-being and personal continuity. The disruption of the ability to participate in preferred activities is devastating to an individual’s sense of identity. Illness and disability frequently shrink people’s social world and friendships, which forces them to pull into their inner circle, away from others.

Many of these negative effects are associated with the loss of companions in leisure. Leisure activities are usually less important than the relationships they maintain or enhance.¹ The dependency created by illness or disability impacts leisure behavior and relationships. As people respond to the changes that illness or disability impose, they rewrite their life story accordingly. Reconstructing or creating a new leisure lifestyle plays a significant role in the critical and ongoing experience of an illness or disability.

According to Trieschmann, the focus of rehabilitation tends to emphasize tasks related to physical functioning and ignore those involving psychosocial functioning, such as recreation and leisure activities.² The reconstruction of a leisure lifestyle, realized with varying degrees of continuity and adaptation, is important in the rehabilitation process and in promoting the likelihood of ongoing life satisfaction, health maintenance, and well-being. Several studies have indicated that leisure behavior is perhaps the most important or one of the most important determinants of life satisfaction and psychological well-being.^3,4 Additionally, leisure is a tool by which health is pursued and obtained, and it creates a lifestyle that promotes health.⁵ The related constructs of well-being, quality of life, happiness, and self-actualization are conditions and opportunities required to live a full, meaningful, worthwhile and satisfying life. Leisure is a core value—a prerequisite to achieving happiness and fulfillment as a person.⁶

Coyle et al identified people with disabilities as having significantly lower satisfaction with leisure.⁷ Leisure activities are often the first to suffer in the event of a disabling illness due to the frequent inability to work, which creates more available leisure time.

The development of a meaningful leisure lifestyle facilitates adjustment to disability and promotes life satisfaction. Leisure can act as an important buffer in adjusting to the stress associated with difficult life events, either in the continuation of familiar and satisfying activities, or in the development of new ones.

Participating in artistic activities is a valuable coping tool for people living with debilitating and irreversible physical conditions. Leisure adjustment is defined as the ability to structure personally satisfying discretionary activity following the onset of a physical, cognitive, or emotional disability. Trieschmann claimed that the key to coping with disability is to receive enough satisfaction and reward to make life worthwhile.² Leisure interventions designed to revive and facilitate involvement in leisure interests and to build social support systems may significantly enhance quality of life.

Recreation Therapy’s role in Rehab

The current and future roles of recreation therapy in rehabilitation must be clearly defined in order for all those working within the continuum to respect the discipline and understand the contribution that recreation therapy can make to patients’ recovery.

The National Therapeutic Recreation Society (NTRS) defines recreation therapy as: "using treatment, education, and recreation services to help people with illnesses, disabilities, and other conditions to develop and use their leisure in ways that enhance their health, functional abilities, independence, and quality of life."⁸ Recreation therapists provide the following services: activities to remediate or rehabilitate functional abilities and assist with diagnosis; activities to acquire life skills, knowledge, and abilities that facilitate an independent leisure lifestyle; and provide opportunities to engage in leisure activities that enhance health, growth, development, and well-being.

Recreation therapy utilizes a large repertoire of modalities. Following an assessment of patient needs and interests, interventions are individually selected to meet identified needs. Modalities include: leisure education, hydrotherapy, experiential therapies, community integration, animal facilitated therapies, hippotherapy, expressive arts, social skills training, stress management and relaxation training, and exercise and fitness activities. Recreation therapists may work individually with a patient or family, but more frequently they work with groups of patients.

Recreation therapy activities provide opportunities to improve general physical and perceptual motor function, and reduce the risk of cardiovascular and respiratory complications secondary to a disability. Activities impact patients' self-confidence, attitudes toward disability, social behaviors, and successful community reintegration. Benefits include: improving general cognitive functioning, increasing short- and long-term memory, decreasing confusion and disorientation, and enhancing new learning.

For younger patients, recreation therapy activities provide opportunities for continued development in acquiring physical, communication, and language skills. The development of leisure participation patterns and discretionary time usage is also important. For families, recreation therapy activities promote the overall quality of family life by helping members develop life-long leisure skills, values, and links to community services and social support, in addition to providing the family with an escape from the daily routine.

Adjustment to a disability is obviously very difficult and can lead to major psychological difficulties. The adaptive coping model views physical illness or disability as a life crisis, which results in severely increased long-term stress and calls for a number of cognitive, affective, and behavioral responses to the variety of physical and psychosocial changes.⁹ Recreation therapy activities benefit patients by reducing depression, anxiety, and stress levels, and by improving coping behavior, self-control, self-esteem, self-concept, and adjustment to disability.

What the Future Holds

The decline of inpatient treatment and the growth of outpatient services are greatly affecting the profession of recreation therapy. This transition is due in large part to the reimbursement factor, technological improvements, and better utilization controls. Adapting to change in the managed care environment is one of the main goals of the recreation therapist.

Recreation therapy has always had a service model that incorporated a full continuum of services and naturally created community networks that support successful integration and community living. Recreation therapy will continue to be a cost-effective service that provides positive patient outcomes.

Karen C. Wenzel, CTRS/CPRP, is the Director of the Specialized Adult Day Program for Individuals with Neurodisabilities at the Rocky Mountain Multiple Sclerosis Center in Denver. Kevin V. Rath, CTRS, is the clinical manager for Outpatient Services at Children’s Memorial Hospital in Chicago and serves on the Board of Directors of the National Therapeutic Recreation Society. Leslie A. De Vries is currently a recreation therapy intern at Children’s Memorial Hospital in Chicago.

References

1. Kelly JR. Leisure Identities and Interactions. London: George Allen & Unwein; 1983.
2. Trieshmann RB. Spinal Cord Injuries: Psychological, Social and Vocational Adjustment. 2nd ed. New York: Pergamon Press; 1988.
3. Sneegas JJ. Components of life satisfaction in middle and later life adults: perceived social competence, leisure participation, and life satisfaction. J Leisure Res. 1986;18:248-258.
4. Campbell A, Converse P, Rogers W. The Quality of American Life: Perceptions, Evaluations, and Satisfactions. New York: Russell Sage; 1976.
5. Iso Ahola SE. Leisure lifestyle and health. In: Compton DM, Iso Ahola SE, ed. Leisure and Mental Health. Park City, Utah: Family Development Resources Inc; 1994:42-60.
6. Sylvester C. Therapeutic recreation and the right to leisure. Ther Rec J. 1992:26:9-20.
7. Coyle CP, Kinney WB, Riley B, Shank J. Benefits of Therapeutic Recreation: A Consensus View. Philadelphia: Temple University Press; 1991.
8. National Therapeutic Recreation Society. Definition of Therapeutic Recreation. Ashburn, Va: National Recreation and Park Association; 2000.
9. Vanderplate C. Psychological aspects of multiple sclerosis and its treatment: toward a biopsychosocial perspective. Health Psychol. 1984:3:253-272.

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