Therapeutic Recreation Talk Show Episode 7

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hello and welcome to the TR talk-show I am your host Hawk Robinson and this is
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episode 7 of the therapeutic recreation talk show this is November 12th 2019
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today we're going to be touching base on the latest update from the BCI game jam
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brain computer interface game jam that just took place this past weekend in calgary canada and then we're gonna
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start talking about the t TM SOC the transtheoretical or stages of change
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model and how that relates to recreation therapy and different modalities so the
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BCI game jam I've talked about previously was leading up to on one of my other talk shows the RPG talk show we had one of the organizers of that show
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on or of that or event on our show about a month and a half ago leading up to
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this event and so this weekend they did a multi-day event they had people taking
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the available software and kit and putting together some video games that were controlled through the brain
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computer interface rather than more physical tactile controls and they did
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it with a number of different games some you might find somewhat familiar and others more unique they have a youtube
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channel if you want to check out their videos from the streaming they were streaming live on and off and we will
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kind of show you a few of it so it's neural matrix the productions D'Arnot
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neural matrix entertainment so neural matrix entertainment is their YouTube channel and see if I can sign in and go
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ahead and I'll do it under RPG resource that's fine all right grab to them and
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so there you can find their various videos from that weekend and you'll
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notice here if you're if you're watching the visual version of the stream rather than the Podcast which you can always get links
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to at TR talk-show comm you'll see that a number of different games they start
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out kind of explaining in their earliest videos explaining the different what
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basically what BCI is how brain computer interface works now those of us have been involved with this on and off over
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the decades I've been involved since the 80s on and off we'll know other things like EEG electroencephalogram bio
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neurofeedback specifically neurofeedback different terms all leading up to BCI brain computer interface which is
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basically all the same concepts but it's got a catchy or acronym and maybe a little bit better marketing to it and so
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they give you a good summary if you go back to their first video of what BCI and a BCI device is how they work and
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what this has to do with recreation therapy is number one accessibility and
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adaptive equipment you can do amazing things for people with all kinds of
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physical disabilities to enable them to
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be able to interact in the world then there's the neurofeedback option neurofeedback helps with basically
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learning how to control your brain so for example with ADHD which we may talk a little bit later depending the tunnel
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time here otherwise we'll save that for another episode there's a lot of executive function challenges and one of
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them is sitting still focusing concentrating etc and neurofeedback is one of the tools that's found to be
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fairly effective with helping with those kinds of things concentration focus
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those areas and the way it works is there's different brain waves you have beta Delta Gamma etc and you pick a
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certain brain wave that you're going for and then in those parameters they're all numbers but they show up as a graph you
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set parameters than that as long as you're within a certain parameter for the majority that it's basically a
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binary threshold that yes this is working and then when you're outside of
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it it's a no it's a zero it's not working and these neurofeedback games and such they as you get the right focus and in
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the right frequency ranges give feedback through a game or other
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interface to affirm that you're doing the correct thing and that you want to keep doing more of what you're doing so
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that's a form of reinforcement and so that can be very handy to help develop those skills with with focus and others
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other people that they're tired it helps them work on their energy levels there's a lot of different ways you can focus on it for disabilities not only is it
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create the possibility in the future and already kind of here still at a primitive state - you know virtual world
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do things that before they couldn't have done so I worked when as a habilitation therapist and CNA and LPN trainee at doc
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C hatch on the second floor which they called the death floor unfortunately we had comatose terminal and long-term
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completely paralyzed patients neck down at best they might have eye movement and
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I had one patient there that he was 19 20 years old he's only a year 2 younger than I was at the time back in the 80s
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90s and oh it was really service so he'd had a skiing accident this is back in Utah
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lots of skiing there and the the nature of his injuries he basically he couldn't
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even use an AI interface he didn't have control over his eyes but he was fully aware he was trapped in a body that
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would not let him communicate in any way shape or form but was fully aware
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receiving stimulus and he was on you know he's on equipment and he was on the gelatinous bed and we had to keep moving
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and you know all of that with the bed sores and all of that and he'd been there over an a year or two by the time I was there and people it's you know
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hurt at first everybody came and visit him all the time but because he couldn't really respond even though they know
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he's fully conscious and aware and needed that stimulus people just slowly started showing up less and less and
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less my time I was there year two after he'd been admitted people only showed up maybe once or twice a month sometimes
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once a week it was really whoa boy so and I was just like man if only there
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was some technology or some way that he could like talk through a computer or do something so because since we know his
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brain is working and he's aware it's just that the the signals to the motor controls are all shut off
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if only there was some way and that's where this kind of EEG brain computer interface stuff can be incredibly
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helpful now that's an extreme case you can there are prosthetics that use similar technologies to actuate an arm etc and
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they all follow similar principles of those signals in in different ways but
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it's all related and fast forward I did a paper I don't know 10 12 innings 12
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years ago on an experiment maybe it wasn't that maybe seven years ago on an
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experiment with TBI brain injury VR and EEG and let's see biofeedback game
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environment yeah I'm not sure there's
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right now but and this person in the past had been a software developer I believe and but was was paralyzed using
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the AI interface was difficult and so they experimented with an EEG setup a
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brain computer interface in a VR setting so he's in an immersive world got the
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goggles on everything and can move around through neural Focus and slowly
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over time be able to type and that created a means of communication this virtual world which eventually meant
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being able to do things like a chat room on the Internet very slow but the more you do it the faster you get the better
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yet as quick as the equipment gets better at differentiating spurious signals versus desired targeted goals
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gets better and better and eventually this person could have some level of communication social interaction and
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virtually walk around in a VR environment now if we start adding down the road
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physical avatars where you have a rolling computer screen and such with a webcam that you can actually move around
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in the world real world and such you then take it to another level of enabling and accessibility and
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adaptiveness and you could even directly turn that into physical games so talk about layers of complexity here but I I
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think it'll happen eventually so now you can play games using your brain and then
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you can now move devices remotely using your brain through these control interfaces now let's maybe play soccer
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with your two little physical avatars knocking a ball or huh it depends on how
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far you want to take it down the road but it gets giving control back to this
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person in the physical world and then creating recreational possibilities so if first just deal with the
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functioning the communication but then you know we all know as recreation therapists how critical Recreation
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leisure is to a healthy balanced lifestyle for mental health and all of it and this really opens that up so I've
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really encourage you to check this out at HIO forward slash Jam /bc I - game -
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Jam and then on their YouTube channel you can go to the neuro-matrix
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entertainment channel again you just go to youtube and type in neural n.e you are al neural matrix entertainment and
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check out the videos there the games I'll show you a quick little clip here they got like a Super Mario Brothers clone where you've got one person so you
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see in the lower corner in fact I think that person there with the beard is actually one of her volunteers over at
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RPG research he was visiting he's down here in Spokane but he's up in Calgary I think that's Eric so he's got a neural
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interface on his head and then the person next to him with the weather is
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controlling the left and right and so Eric is controlling - up and down jumping of the little Mario character
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while the other one does the left and right so they're trying to do that so that's because of limitations of the
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hardware and the software and the computer and all that right now with with beefier tech you can do more so
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this is just a first brain gems of the first ever BCI game jam and these are
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one of many experiments and that's not the only game they had they had a number of different games they had six
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different entries all coming up with different types of games using this same
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type of interface and some of this equipments more affordable someone's more expensive so here's one where you
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get a little directional such and so he's setting up the equipment and getting everything configured here
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okay so that's so again I encourage you to go check those out I won't but it was
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one year it was very different than the others we'll turn the audio on because the squeals are quite different this is
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this game is different sumo butl so you get the direction you wait for the arrow and then you think it to activate it so
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you see that going and you get it ready and activate and they're explaining it
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in the YouTube videos how to play the game and you get better and better at it
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the more you do it like anything else through practice you get better and better so really check this out for
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recreation accessibility adaptive equipment you should know about this because this is coming and we as
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recreational therapists need to be in the loop on this my hope is I've got an electronic role-playing game software division over
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at RPG research my end goal is I'm hoping someday and I'm an experiment the EEG equipment for decades that we will
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have full EEG role-playing game interactive capabilities in a VR and AR
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setting for people with with these kinds of disabilities so that they get there
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they can have as much of their life back as possible through this kind of equipment I think it'd be really really
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beneficial so take a look at that and yeah so it happened we were talking about it for weeks leading up to it it
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has now happened and you can now watch all those wonderful little video clips they're not super exciting but but if
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you get what's going on it's actually quite exciting so check that out alright
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so one of the topics let's consider today I don't think I've covered on this
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show yet I've covered it on others is the transtheoretical model or the stages
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of change so let me get my paper up so this is from one of my papers you can
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find it on academia.edu research guide not nate and elsewhere on and it tends
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to be role-playing game focus because I was doing all the papers on but you can apply this to most recreational
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intervention modalities that you might want to use we're trying we're looking at different
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stages so we're gonna talk about the overview the origins evolution debate
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and current applications relevant to the TTM the transtheoretical model also known as the SOC or Salk stages of
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change and the relevance to certain activities in the paper it's role-playing games but we can broaden
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that include some of the debate about the viability or argued lack thereof for
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programs based on the TTM in any setting so remember I'll bring up these controversial things I have been talking before about the fundamental flaw with
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rec therapy unfortunately I'm a huge advocate for it and very disheartened to find that one of the core components of
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our practice the activity analysis form doesn't have any good metrics for
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reliability validity etc and I've talked to many practitioners now and looked at their different forms and none of them
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have been through proper peer review and when we've gone through a peer review of them they have not held up well at all
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the binary options hold up fairly well at a point nine or better inter-rater
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reliability for example but then all of the scaled and blank and open-ended
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questions end up having basically close to a zero to 0.2 inter-rater reliability
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they're basically useless inter-rater reliability they may be useful for an individual but your clients will not get
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consistent care from different practitioners unfortunately and so
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that's a controversial controversial topic it's but I think it's important to be brought up so same thing with the T TM which which is something that's been
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taught on and often you know depends on where you went for your training and such so then also suggestions for
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potential relevance that it may have in the development and use of recreation education and therapeutic recreation
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interventions and some examples of potential implementations based on the T TM or slash SOC approach and then using
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the t TM as a guide from the TR perspective it might be possible to create various graduated implementations
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of different interventions for various populations mm excuse me so that's we're gonna cover
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here in just a second let me clear my throat
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so the inherently flexible and diverse nature of the therapeutic recreation field draws upon many other knowledge
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and professional domains as part of what I like about it is it's so diverse includes psychological counseling
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theories and practices one theory from that domain currently used in a number of counseling areas is the
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transtheoretical model TTM also known as stages of change or SLC based on the
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existing research published in diet exercise and substance abuse counseling journals there are a number of
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indicators that the T TM / SOC may be useful as a guide for leisure and
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physical education according to Chico Moscow Lo and Robbie 2008 and recreation
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therapy program development and implementation they also may be relevant in predicting success rates in
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conjunction with grit perseverance grit etc for moderate to higher levels of
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challenge as illustrated by Reed Pritchett and Kooten in 2012 though the
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use of T TM / SOC is not without some detractors see West's 2005 many programs
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including government agencies utilize the model in their publications Health and Human Services 1999 and some
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programs in other countries as recently as 2013 about when this paper was written by Jones Jan see how it do
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Dilawar burns McManus Hills and Anderson the roots the TTM could arguably be
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traced as far back as the earliest stages of psychiatry in psychology beginning with frayed psychoanalytic
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approach Humes analytical psychology and Rogers humanistic approach quote a
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relationship encompassing empathy genuineness and respect of course that's Carl Rogers 1957 developing the ideas of
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a need for trust and respect in the client / therapist relationship as an important relationship though research
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does shows not completely sufficient component in a client's recovery
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prospect so it's not air as much as some claim it to be based on the conflicting research so this builds on
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five theories five theories of helping a psychoanalytic behaviorist cognitive
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behavioral growth psychology and positive psychology according stumbo and Whitman 2011 page
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116 as a beginning continuing to take shape with common factors
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the TTM model was evolving as a distinctly specific theory in the 1980s
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progressing towards substantiation and subsequent publications by Prashad
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DiClemente and Norcross and others with ongoing implementations based on the model published in 2013 but probably
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should do an update on this since it's been six years since I wrote this while TTM does not actually provide any
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specific techniques of implementation it can provide a template for processes
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that can be used in a variety of therapeutic modalities that mapped well to the stages of change addressed within
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the theory so Stumbo and Ward lon 2011 provide an example of a specific therapy
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that has been developed using the T TM to help clients achieve measurable change with the motivational
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interviewing approach the mi however there are arguments about t TM and SOC
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by the way do feel free to comment either during this live stream well I would look forward to your comments and
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questions if you need further elaborate or if you have conflicting viewpoints wonderful love that and so you can post
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that here in the YouTube stream or you can do it after if it's not if you don't
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catch this while it's live and you're at the recording you can post comments on the video and then I'll get notified and be able to respond to that as well and
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then usually I try to respond to those on the following show so we welcome that and also remember we are looking
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actively for recreation therapy therapeutic recreation guests and even
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co-hosts it's much more interesting when you have two or more people having a discussion or even a panel then to just
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listen to me doing these monologues I would think I hope you enjoy the content well enough but I think it's much more
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interesting when there's multiple viewpoints and experience so if you are interested please email RPG therapeutics actually TR talk show
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at gmail.com and we can get you hooked up you can join remotely you don't have to be in Spokane area we have a way for
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you to join remotely fairly easily through something called jitsi it's open source and they can get you here virtual
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presence so we are looking for that so if you have experience of this and thoughts about this please post them
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really look forward to your comments so there have been some detractors of the t
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TM and SOC model claiming that it's too linear assumes too much clarity of
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forethought by the clients that it's too arbitrary and boundaries between stages
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and that the stages are of such divergent construct types that they do
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not integrate coherently and so that it ignores motivational underpinnings and is ineffective in making accurate
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predictions and this is a big problem for a lot of the stage theories right you know we look at Eric's and all the others and they all have these kinds of
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problems where they've made these seemingly arbitrary delineations and really it they're their general concepts
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and they've had to for the sake of publishing and explaining create these boundaries but they don't tend to really
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hold up well in the real world they're they're great for theoretical discussions and and expressing concepts
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but they tend to break down when you start trying to do empirical research to validate these theories and so this is
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yet another one and that's why we see more and more of the tendency towards a spectra rather than everything being you
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know quite as categorized and separated as they used to be a lot more fuzzy boundaries than we used to see so though
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Robert West 2006 argues that the TTM is too linear and while the TTM SOC stages
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are considered to flow more effectively when performed in a more linear fashion the tedium does allow for the nonlinear
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nature of individuals motivation and action levels due to people's variability and drive and behavior
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allowing that there will be ups and downs setbacks and other unforeseen
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changes the TTM allows for cycling through these stages to varying degrees
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so it does take some of that into account in the same above sighted to the journal editor while arguing
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against the continued use of t TM SOC Robert West points out just how widely used the model is for just one area
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focus for example smoking cessation and other substance abuse quote of 540
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articles found in PubMed using the search phrase stages of change 174 also
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had smoking in the abstract or title 60 had alcohol 7 had cocaine 2 had heroin
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or opiate and 1 had gambling now Stumbo and Wittman claimed that
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quote TTM is the most popular health behavior change theory in the health literature now that's back in 2011
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there's there been changes and in the process of researching this paper I found that many stage based
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interventions were easily found to be published though many seemed focus on physical exercise and substance use or abuse
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cessation despite the ongoing debate the t TM SOC model is frequently used for
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dietary and physical exercise compliance a whole bunch of citations on that and has become standard for use in many
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substance abuse programs and unfortunately as we've seen you know a lot of rehab programs like that
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substance create programs depending upon the study may only have a 17 20 30 % efficacy rate the first time they go
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through which is abysmal as an efficacy we luckily there are other more creative
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solutions out there now that are starting to have a lot better numbers as we break out of a lot of these things
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have been done since the 1950s or even longer so differentiation between leisure education and leisure counseling
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while counseling techniques are important and useful for therapeutic recreation professionals it's important
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to note that according to Stumbo and Whitman 2011 there is distinct difference between leisure education and
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leisure counseling according to them leisure education has a specific and
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predetermined content while leisure counseling has the focus of which
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problems to address in the counseling it originates from the individual client so
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Lambert 1992 claimed the greatest factor in predicting a client's complete and success with therapy is quote
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pre-existing client qualities such as length of time and level of impairment
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then of course we have as many of TRS describe to the holistic perspective a
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relevant quote that is a favorite of mine is from the introduction to TR textbook
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by Austin and Crawford I think was around 2001 was the book against a 77
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quote holistic medicine treats the person rather than disease dot dot
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concern lies with the whole person and with permitting individuals to assume
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self responsibility for their own health that's Austin 1999 Ardell 77 whereas illness is the sole concern of
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traditional medicine well medicine deals with wellness or our health promotion end quote
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so that's that's a favorite quote I like to reference in a lot of our approach and such the TTM addresses this approach
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as a multi-faceted model that quote harnesses knowledge about specific ways
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that people change change processes based on different levels of readiness
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to change states of change stages of change while attending to relationship
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factors best suited for differential readiness to change right so we've got
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our change processes our stages of change and our differential readiness for change
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that's from Prochaska at all 1992 initially defined five stages in the TTM
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SOC later adding termination as a sixth stage so the six stages of change the
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model posits that there are six stages of change pre contemplation
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contemplation preparation action maintenance and then the sixth one
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termination in the pre contemplation stage the client is unaware and part or
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in whole of any need for change they just they're just oblivious they don't know right we hear all the time like well the first step is acknowledge
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awareness that there's a problem when the client is in the contemplation stage the client is aware of an issue or
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issues and the possible need for change but has not yet taken any action
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typically the TRS might in this stage encourage the client to explore and
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choose their own options while in the preparation stage the client is aware
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there is an issue understands the need to take action and has made some
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preliminary plans toward taking action relevant to the desired outcomes at the
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stage the TRS could assume for those who aren't records therapist TRS is therapeutic recreation specialist it
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could assume the role of a coaching relationship providing guidance and ideas of at regular intervals
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now once the clients in the action stage to various degrees this is the stage when the client actually engages in the
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activities themselves necessary to cause change towards the desired outcomes at
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this stage the TRS may be directly engaged or may step aside and act more in a consulting role right we've talked
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about that with the linear progression and such yeah on previous episodes we
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talked about that at length from TR lots of control client very little control to
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increasing client control in the TR the less control and it towards self actualization self-sufficiency etc so
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this is the where it's a more a more
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clearly obvious stage for the client but the TTM viewpoint states at this stage would not be possible without the
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previous stages first taking place some degree in order they're not really aware of the pre contemplation and
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contemplation phase they only become aware when they're finally at the action phase the you know preparation may be
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but especially at the action phase at
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some point the client achieves the maintenance stage and the TTM view is that just as clients are variable in
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and drive to get to the first four stages maintaining the activity over time will likely have variability as
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well the TRS provides contact information the client encourages client to utilize the TR the TRS in the future
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and ongoing constitutional as needed but you know we have some sort of exit strategy a transition plan for them to
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do it on their own hopefully we found what is intrinsically motivating enough to keep them doing it
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right this is one of the key things we as recreation therapists are supposed to differentiate ourselves from PT and ot
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and the others is that because we've found what they enjoy they're intrinsically motivated they're going to
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keep doing what normally would be tedious and difficult if they had been you know just given a prescription by a physical therapist or other to just do
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these activities over and over because it's good for and you know it's good for you but they're not very rewarding other than the long-term benefit that they
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some you know many clients have trouble with but if we find it that what's intrinsically motivating in an activity
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they'll just keep doing it cuz they enjoy it anyway and then they will keep their maintenance level of progress at a
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higher level so there's a number of different examples this is going to use
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an example from role-playing games because you know that's kind of my specialty area also music as well if I
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think of some others to interject in here and we'll but that's where this paper is coming from but again insert
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whatever recreational activity that you think you can handle it stages this is just a template that you can you could
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use and insert so this example is application of TTN using graduated
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role-playing game formats for at-risk youth and young adults the following
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series of recreational activities could be described using the TTM theories these programs are designed to address
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populations including at-risk youth and/or juveniles in legal system that may have issues with aggressive behavior
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maladaptive problem-solving approaches or other antisocial issues the
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intervention approach is a series of graduated role-playing game RPG format variants with specific adventure
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scenarios focused on alternative approaches to problem solving rather than resorting to violence crime or
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other antisocial behavior so pre contemplation stage in the pre
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contemplates stage the client does not initially see a reason need or have any desire to
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address currently maladaptive problem-solving skills but it may be on the radar
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due to recent encounters with law enforcement or other authorities indicating there might be something that
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needs addressing however the client does not yet have any intention to make any
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effort to change their current behavior
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by the stage it's recommended that the TRS act as a guide emulating a trusted
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individual who helps the client consider options introducing a client to the concept that there might be other
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approaches to problem-solving that could be more productive towards the clients intended long-term life goals for
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example moving out of parents or guardians home reducing real-world physical combat encounter risks having
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their own residence getting a job staying out of jail having opportunities for travel finishing school purchasing
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to maintain an automobile etc and that various role-playing game formats may be
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able to help the client learn more constructive approaches because of the and these scenarios that you're able to
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set up and practice and learn contemplation stage as the client
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increases their awareness in the contemplation stage the client may have been nudged into this stage by receiving
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a warning from school they face potential suspension or received an edict for court-ordered fines
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restitution or community service to address behavioral issues within the next six months though the client may be
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highly distressed in a end still expressing considerable anger the TRS
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could provide some positive motivators for them to consider using insert activity in this case we use
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role-playing games to improve the current stress situation now again it's we based on doing an assessment of your
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client figuring out what their activities are going through the recreation leisure education process and maybe find out you know maybe
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role-playing game might be a fit or maybe a music it would be a fit or maybe something you know there's all sorts of different options baseball whatever
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and the TRS could brides from some puzzle motivators consider using role-playing games to improve the current stress situation perhaps from
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prior experience or newly introduced by the TRS because we could be working with baby boomers here to know right now
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we're focusing on adolescents but remember a lot of people grew up with this activity in the 70s and 80s as baby
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boomers now they're coming into retirement they have a lot more free time they're having trouble making new friends this can be a great activity to
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solve a lot of issues there so it also applies to adult and culture concentrated populations and at-risk populations there as well but we're
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focusing on youth but you can you can extrapolate it from the same information
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consider neither paper or electronic versions of solo adventure books or modules in a role-playing game format or
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if the client already enjoys video games or adventure movies the TRS could introduce the client to solo problem
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solving centric focused electronic role-playing games then graduate towards
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some socially cooperative computer RPGs instead of the solo ones so multiplayer em RPGs MMORPG etc you want to be
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careful about those we tend to recommend Neverwinter Nights because it gives the therapists a lot of control over the
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environment on a percent control it's been reissued it's very affordable and
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it's cross-platform on Windows Mac Linux Android iOS and soon on consoles and
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it's been around since 2002 so doesn't require a lot of hardware and yet it's still a very engaging activity and the
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therapist can maintain control the entire environment and you can control who it comes into that group etc if if
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there's less concern you can always put them on a public multiplayer game like World of Warcraft or something but
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generally don't recommend that off the bat there are issues there so never learn rights you find to be a really good control for it and we do
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never wear Knights training of every other week through over at RPG research and then we also do it in our private practice LLC for clients works quite
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well the TRS could also discuss the ideas of tabletop and live-action
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role-playing as such as LARP for consideration down the road to
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further refine their basic problem-solving skills that will introduce that they're introduced to in the electronic role-playing in the ER PG
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and the computer base subtype as well as the positive physical outlet and exercise preparation stage
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once the client acknowledges that something needs to be done now in the preparation phase they agree to some of
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the suggestions by the TRS the therapist can help the client create a proposed schedule devise acquisition of resources
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and establish some specific goals first
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with the computer based RPG then migrating toward tabletop RPG and live-action role-playing games and I
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just thought of something I need to remember about a client of mine I need
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to send them a link for some movies action stages now that the client has
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buy-in and is willing to take action the TRS facilitates the client engaging the
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client initially with controlled solo computer based RPGs with specific problem solving scenarios now again if
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you can do the computer-based version never Knights is by far the best tool we found for the job there there's no other
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video role-playing game that gives you so much control it can be solo it can be multiplayer you can create all custom
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scenarios from scratch or you can pick from thousands of existing ones it's amazing I just wow if you're going to use an
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electronic role-playing game really check that out if you're looking at like a print version like a choose your own
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adventure book and such which isn't really a role-playing game there are others like lone wolf which actually are rolling games you get to actually create
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a character and roll dice and you have cumulative consequences that are measurable the these role-playing games
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actually create measurable numbers to track progression between different
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clients so there's assessment built into the games that can be view very helpful
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information instead of instead of a more subjective interpretation of progress
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you can actually see numbers as part of the activity and that can help you to see how your different clients do from
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week to week and over time and such so the clients guided through processing what they learned from different
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outcomes of various adventure scenarios as each is completed and this is all a part of that exploration as an important
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form of learning that dr. Janelle talks about out of Penn State in his book
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facilitation techniques in therapeutic recreation and then also some of the conference's we've been out and so they
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get learned from the different outcomes of various adventure scenarios as each is completed building on these
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introductory skills with increasingly challenging adventures so trying to keep them in flow state as best as possible right keep that balance between enough
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challenge without it being too much and not too little so that they get bored and maybe later introduced them to
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online variants interacting with other player characters experiencing the consequences of solo versus cooperative
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play with others the client can learn that they can't compete so they can't
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complete the quest or beat the boss without help and ideas from others there is no way to win unless you work with
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others is is some of the advantages of these cooperative multiplayer ones and the increasing need for others to help
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the client achieve more challenging and more rewarding goals so sometimes it can be pretty simple but over time you need
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to kind of up the ante to something that keeps them engaged at the appropriate time the TRS can introduce the client to
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tabletop role-playing game maybe at first is just a one-on-one with the therapist as a GM or somebody else's GM
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guided by the therapist and then later with a larger group of three to six players we general recommend four to
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five four or five players the sweet spot seeing the game master and four players that is just the right amount for people
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not having to wait too long to take a turn etc using what was previously learned as concepts in general concepts
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from the video game in a role-playing game creation of a character rules for resolution of act action approaches to
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problem solving etc the client now engages in a fully local rather than
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online in-person social situation working to cooperatively achieve mutual
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and personal goals beginning at first with simpler adventure challenges but gradually increasing the challenge and
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then subsequent rewards realized within the game setting finally when the client
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has shown significant improvement in individual and socially cooperative problem-solving skills the TRS introduces the client for
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example to live-action role-playing LARP either combat action centric or drama
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non-combat style depending on propensity is physical coordination abilities behavioral control and the individual
50:34
interests client as well as facilities and resource availability engaging in even more socially complex cooperative
50:41
and competitive scenarios then we get to the maintenance stage in the maintenance
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stage the client continues to iterate between computer-based tabletops live-action role-playing gaming as appropriate to client needs and success
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levels the TRS will help the client realize and illustrate all that they have learned guiding the client to see
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the social liberation that their social norms are changing in the directions as
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quote social norms are changing the direction of supporting the healthy behavior change Stumbo and Wittman 2011
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by having the client explained to the TRS and potentially other participants
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what they have learned through the process what worked well what did not
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what was more motivating and what was discouraging this is all those pre and post-processing conversations we always
51:29
like to have using the clients own feedback the TRS can help the client develop an ongoing maintenance schedule
51:35
for sustaining the current levels of functioning and then set goals for ongoing potential continued growth
51:42
rather than just maintaining continue their growth through regular gaming group sessions established schedules etc
51:48
and some specific goals then we get to the termination phase and wrap up this topic so at some point the client may
51:56
reach the termination stage when the legal educational social physical financial health or other issues have
52:02
been resolved in one form or another the client may no longer have the external pressures to engage in the activity the
52:09
client may choose to continue on their own for the enjoyment and intrinsic motivation or desire to continue towards
52:15
ongoing growth or the client may choose to discontinue the activities either abruptly or gradually over time without
52:23
the external forces if the motivation was mostly extrinsic so that's why that intrinsic motivation is so critical if
52:29
you force it on them there likely continue it so make sure you're matching the right activities to the
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right person they're not just knotting to get through it and move on that you've actually found what clicks for
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them so that gives you kind of a brief discussion of theoretical model and then
52:45
some example applications that you can then insert so again it makes a very good template and even though there are
52:52
some issues with these kind of rigid stages if you loosen up and don't get too hung up on the stages being rigid if
52:58
you allow for iteration and variability and and and such which is the human nature this can be a great guide line
53:05
and scaffold when you're putting your program plan together and again you can insert different activities and you can
53:11
insert different populations with different goals this is just to give you some tangible examples taking an
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abstract theory and putting it into application and then we have done this in practice so we have a lot of evidence
53:23
and practice of exactly this kind of program with that particular modality with that particular population being
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highly effective for example transition plans from inpatient to outpatient substance pendency and gang violence
53:35
members giving them you have to replace if you're gonna take away their substance or you take away their social
53:42
peer group say you can't do drugs anymore and you can't hang out with the group you hang out with before well you have to give them a new activity that
53:49
they're gonna enjoy and a new peer group to hang out with or it's gonna be next to impossible for them to resist going
53:55
back because of the lonely it is bored when a view forget the chemical withdrawal at all other stuff just that
54:01
alone just that human need even even with introverts there's still gonna be some level of that human need for
54:07
connection and something to do and you want to give them something else and too many programs just say no take away and
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don't fill that vacancy with something better and so this is an example of
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where we take get them day passes escort them have the meat group at a game store get to know the folks participate and
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build that up before they have their exit and have a robust transition plan
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by the time they get out they've got a new peer group they have a new activity it gives them lots of engagement they
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can do both on their own and solo time and with groups and you've got a whole flexibility of
54:42
things to keep helping them stay out of trouble and those that we put through these programs so far we're having a
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phenomenal success rate for example one location alone after about five years so far for this
54:54
population that typically about 80 percent reoffending 18 months we've had
55:01
zero recidivism now it's not a huge number we're talking about a half-dozen different individual clients over the
55:06
years but that's promising and then with others with other areas we see similar
55:11
results and such so these these can all be very helpful so insert whatever you
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think is best activity for your person do the proper assessment and hopefully you found this a useful example and
55:22
there again different ways to look at these a lot of ways to skin these cats but I hope you found this now this was a
55:27
more lecture oriented episode of the TR talk show again we're looking for guests and co-hosts to make it more of a
55:33
dialogue and but you know different days I'm gonna have try to cover different
55:39
topics let me know if you look at the other six episodes and this is episode seven how did you like this episode
55:45
compared to the other episodes do you want to see more of this lecture type do you want to see more of the other more
55:51
dynamic ones that covered a broader range in shorter pieces you know do you like this deep dive or would you rather
55:57
just state a lot of just introduce you to a few concepts and then just moved on to the next one and didn't spend maybe
56:03
more than five to 15 minutes on a particular topic instead of most of the show let me know what you'd like to see
56:08
and we'll go ahead and mix that up and around as needed so I think we're going
56:13
to unwrap it up there remember you can contact us at TR talk show at gmail.com
56:18
and we'll be back I believe next Tuesday we're good to go I believe yeah I think
56:24
next Tuesday is good and of course if you missed the live episodes we have the links on the website at T our talk show
56:30
calm and do please check that out so wherever you may be be well and happy
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recreation therapy therapeutic recreation [Music]
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