The Conceptual Development of Recreational Therapy
Ann James, PhD, CTRS
This article is from Perspectives in Recreational Therapy: Issues of a Dynamic Profession edited by F. Brasile, T. Skalko and j. burlingame, 1998. With the permission of the author, this history of the field of recreational therapy has been selected as the first article for Idyll Arbors Journals of Practice: Recreational Therapy Journal (IAJP/RTJ). The editors of the IAJP/RTJ felt that it was fitting to start with a look backward from whence we came.
Tracing the development of recreational therapy from idea to idea leads one on a journey first traversed by men and women who shared a common conviction that experiences yielding perceptions of peacefulness, well-being, mastery, joy, discovery, concentration, belonging, support and delight had positive impacts on the physical and mental health of human beings and aided their recovery from illness or injury. They found that experiences could be constructed to teach skills enabling people to live more effectively, independently and happily. These concepts and the practices to enact them were developed over a long and crooked path with segments of backtracking. This chapter traces the development of recreational therapy from 1855 to the present.
Emerson declared that all history is biography and so it appears with much of the history of recreational therapy. It is largely a story about people, people whose observations brought them to acknowledge the great impact that certain experiences imbue on the learning, functioning and health of individuals. Further, these people were able to interact with the circumstances of their places and times to advance the provision of these experiences to increasing numbers of beneficiaries.
Ancient teachings are replete with assertions on the benefits of some recreation experiences: "A merry heart doeth good like a medicine (Proverbs);" "You can learn more about a man in an hour of play than in a lifetime of conversation (Plato)." But it is not until the 19th century that we see these principles applied in health care settings in a purposeful, organized manner. And the initial effort focused around one person, Florence Nightingale.
Nightingale descended upon the British military hospital scene in eastern Europe, in the midst of the Crimean War, to organize and reform the profession of nursing. But once she had largely accomplished this task, she expanded her vision to changing medicines entire approach to treating patients. Nightingale arrived in the area to find a system in which the physicians administration of drugs or performance of surgery was largely the beginning and end of the treatment process. Following surgery the patient was deposited onto his cot in a drab ward and left to lie there, receiving minimal custodial care, until the treatment succeeded or failed (Woodham-Smith, 1951).
Nightingale protested to all who would listen that the dreary conditions of the hospital were counterproductive and that the monotony endured by the patients adversely affected their recoveries.
People say the effect [of a pleasing environment] is only on the mind. It is no such thing. The effect is on the body too. Little as we know about the way in which we are affected by form, by color and light, we do know this, that they have an actual physical effect. (Nightingale, 1859, p. 34)
Nightingales observations also led her to conclude:
It is a matter of painful wonder to the sick themselves how much painful ideas predominate over pleasurable ones in their impressions; they reason with themselves; they think themselves ungrateful; it is all of no use. The fact is that these painful impressions are far better dismissed by a real laugh, if you can excite one by books or conversation, than by any direct reasoning; or if the patient is too weak to laugh, some impression from nature is what he wants. (Nightingale, 1859, p. 34)
Nightingale wrote of the benefits that accrued to patients from caring for pets, listening to and performing music, doing needle-work and writing. She chastised health care administrators to be more inclusive in their provision of services to patients: "Bearing in mind that you have all these varieties of employment which the sick cannot have, bear also in mind to obtain them all the varieties which they can enjoy" (Nightingale, 1859, p. 36).
In September of 1855 many of Nightingales theories were manifested in the establishment of the Inkerman Cafe. This wooden hut, situated at the center of the hospital complex, served as a large recreation room and coffee house. Nightingale wrote that "Football and other games for the healthy, dominoes and chess for the sick, were in great request." She helped patients to organize singing classes and urged friends in England to send costumes and materials for the theatrical group that the patients formed. She also received books, games, music scores, maps and "magic lanterns" to stock "the Inkerman" (Andrews, 1929, p. 157).
One of the main reasons that Nightingale established the recreation center was to give some competition to the bars that surrounded the hospital and the military installation. With nothing else to do, the common practice for patients receiving evening passes was to head straight for the bars. A large portion of the convalescents were carried back to the hospital drunk. "Dead drunk," complained Nightingale, "for they die of it and the officers look on with composure. Give them books and games and amusements and they will leave off drinking" (Woodham-Smith, 1951, p. 166).
Morally Based Recreation
In the United States, the physician Benjamin Rush had voiced convictions similar to Nightingales and had made opportunities and equipment for recreation available to convalescing patients (Morton, 1973). A few caregivers in mental health facilities, mostly Quakers, had imported the principles of "Moral Treatment" developed in France by Phillipe Pinel. Pinel had protested the harsh conditions and brutal treatments that were too often the fate of persons receiving care for psychiatric disorders. He had replaced dungeon-like warehouses with more pleasant, home-like environments that had included ample gardens. He had trained his staff to model healthy behaviors and to treat clients with patience and kindness, "fettering strong madness with a silken thread" (Guthrie, 1946, p. 233).
Unfortunately the Civil War and booming immigration of the 1800s made for large, crowded, understaffed hospitals. Widespread fear and ignorance regarding the nature of illness, particularly mental illness, made humane treatments that included opportunities for recreation the rare exception to the rule.
During the latter part of the 19th and beginning of the 20th centuries, the industrial revolution peaked, leaving America transformed from a land of self-sufficient farmers to one of interdependent factory workers. The urban environment during the last quarter of the 19th century had degenerated in several aspects. Factory jobs left many human needs unmet and, besides the ever-present bars, the cities offered few opportunities for involvement in meaningful activity. Immigration soared and outpaced the availability of housing and supportive resources to assimilate foreigners into a new culture. The industrial revolution stabilized allowing reformers to succeed with legislative efforts restricting the employment of children in manufacturing. Factories spewed surplus children into the growing crowd milling in the city streets. The stress from battling to succeed or to just survive in this environment was considerable. Rampant alcoholism further impaired the social health of the cities and the occupancy rates of "insane asylums" and prisons soared. Voices for reform began to emerge. The accepted thesis that heredity and nature were the primary determinants of a persons fate was being replaced by theories that favored the roles of environment and nurturance in developing human capacity. Municipal reformers of the 1890s felt that society could be improved if only people were given a favorable environment in which to develop.
By 1894 there were eighty citizen-led municipal reform groups, sixty of them founded after 1890. Recreation was seized upon by many of these groups as one of the vehicles through which reform could be achieved. The profession of social work emerged as paid workers replaced volunteers in organizing specific services to ameliorate the ills of urban society. By 1903 the New York School of Philanthropy offered a full years course in social work. Social workers addressed education, housing, child welfare, health and crime. They expanded upon Nightingales thesis that recreation experiences could be drawn upon to improve the human condition (Knapp & Hartsoe, 1979).
Leaders in social work, education and municipal reform were experimenting with the uses of recreation activities to transform the raw material of youth into vigorous adults who embraced high moral and democratic values and who were eager and able to uplift their fellow citizens as well as themselves. These interests were drawn together and for several years worked synergistically to propel play and recreation from its disdained status as a frivolous pastime to a tool for the social transformation of America. This period of joint activity to build the "play and recreation movement" could largely be attributed to the work of Joseph Lee. Lee was born to a wealthy Boston family and took to heart the admonishment of noblesse oblige, that with fortune comes responsibility. After completing law school at Harvard he set upon a lifetime of philanthropy. Lee viewed the problems of the time as the results of limited access to an environment in which people could develop into happy, responsible citizens. He saw overpopulation as one of the primary forces that limited peoples access to the resources of this environment and thus he directed a portion of his efforts to the support of birth control, sterilization and restricted immigration. He devoted the rest of his attention to expanding peoples access to the experiences that would enable them to develop their potentials as human beings. He saw recreation activities as major structures for delivering these nurturing, educational and character-building experiences (Knapp & Hartsoe, 1979).
Borrowing from a practice initiated in the crowded housing areas in Berlin, Germany, a Boston charity established a series of sand-pile play areas among the Boston tenements. In the early 1890s, Joseph Lee became very interested in this development, so much so, that he established his own playground for research and demonstration purposes. Lee hired and trained leaders to supervise his playground and for several years he studiously observed and recorded the outcomes of this project. Lees observations along with his study of the sociological, educational and philosophical ideas of the period led him to acknowledge Aristotles conclusion that play was indeed the "architect of man" (Rainwater, 1922).
Lees speeches and articles in support of the playground movement spread his thesis across the continent. When the American Civic Association sponsored a "model street" for the 1904 Worlds Fair in St. Louis, Lee designed and financed the streets model playground. Lee became the director of the Associations Department of Public Recreation and drew together an advisory committee of leaders in recreation from the fields of social work and education (Knapp & Hartsoe, 1979).
Luther Gulick, an educator on that team, earned an MD degree at New York University before taking a faculty position at the YMCA college at Springfield, Massachusetts. There he transformed the physical education program from one of calisthenics to one based on games and sports. His creed on the interdependence of a healthy body, mind and spirit formed the familiar triangular logo of the YMCA. Gulick also taught that recreation activities had great formative power but he stressed that this power could have either positive or negative effects on the development of character. Skilled leadership was needed, he insisted, to insure that participants were enriched by the experience rather than degraded by it. (Knapp & Hartsoe, 1979).
Gulick proposed that a national playground association be formed to advance and unite the various recreation efforts emerging across the country. Several other leaders added their organizational skills to Gulicks vision and energy and in April of 1906 the founding meeting of the Playground Association of America (PAA) was held in Washington, DC. The eighteen educators, social workers and settlement workers present, eight of whom were women, were feted to a reception at the White House by Theodore Roosevelt and then set about the business of establishing this new association. Luther Gulick was elected president and Jane Addams and Joseph Lee, both absent, were elected vice-presidents. Gulick led the Association until 1910 and then passed the presidency to Lee who continued in that capacity for the next 30 years (Knapp & Hartsoe, 1979).
In April 1907 the group published its first issue of Playgrounds (later to become Recreation) and in June, held its second annual meeting in Chicago. The 200 delegates from 30 cities heard presentations on the relation of play to democracy, health, citizenship and social morality. The PAA established about a dozen national study and advisory committees, one of which focused on "play in institutions" (Knapp & Hartsoe, 1979). These social reformers not only further developed the ideas of Nightingale on the potentials of recreation experiences but added a new dimension that emphasized the need for trained recreation specialists to ensure that those potentials were achieved.
One of the most zestful participants in the playground and recreation movement was a diminutive social worker named Neva Leona Boyd. "She was a multifaceted, charismatic personality who swept you into her confidence, and in spite of being a short woman, could literally swing you into a mean turn during a folk dance pattern" (Katz, 1975, p. 1). Neva Boyd was born in Iowa in 1876 to parents whom she characterized as having independent and pioneering spirit. Having some of that spirit herself, she left her small town after graduating from high school and enrolled in the Chicago Kindergarten Institute in pursuit of one of the few career areas open to women. In Chicago, Boyd discovered Hull House, the famous settlement house established by Jane Addams that became the model for community centers providing social services to inner city immigrant populations. Prior to that time recreation activities for youth were recognized chiefly as stimuli to proper physical growth and development. In working with the youth at Hull House, Boyd became determined that society had missed many of the contributions that recreation experiences could give to the social and behavioral development of youth. Given an insightful leader with the skills to play an activity, releasing its opportunities for learning effective behaviors, Boyd felt certain that recreation could be an important tool in social education (Simon, 1971).
After finishing her study in Chicago, Boyd accepted a position with a kindergarten program at a settlement house in Buffalo. She returned to the Midwest in 1908 and enrolled in the University of Chicago. She again volunteered her services at Hull House and her work attracted the attention of the Chicago Womens Club, a local supporter of the playground movement. The club persuaded the park commission to employ Boyd to direct "informal social activities" at Eckhart Park. "She was officially titled social worker and her duties included organization of social clubs, direction of dramatics, supervision of social dances and play activities quite different from those usually directed by physical education teachers. The experiment was so successful that the commission voted to hire such a person for each playground and to adopt a policy of developing social work in the parks" (Simon, 1971, p. 10).
"The utilization of games and play as media for producing change in the participants was always the central core of her philosophy" (Simon, 1971, p. 13). To help others successfully guide this process, Boyd developed her own training program. In 1911 she established the Chicago Training School for Playground Workers. Over time the curriculum evolved with Boyds developing theory and practice to become a course of study in the emerging field of group work. Defined by Simon (1971, p. 13) as "the deliberate and purposeful use of activities in work with groups," group works kinship to recreational therapy is easily recognizable. Most of Boyds students had completed at least two years of college before enrolling in this one-year program. Besides offering extensive technical training in group games, gymnastics, dancing and dramatic arts, the school provided course work in the theory and psychology of play, social behavior problems and "preventive and remedial social efforts" (Simon, 1971, p. 14). The school was located at Hull House and the settlement house was a ready lab for class demonstrations and served as one of the sites for the field work that was required of all students (Simon, 1971).
In 1927 Boyd accepted an invitation from Northwestern University to place her program under its auspices. In a letter to former students, Boyd voiced mixed sentiments, which elicit empathy from recreational therapy educators today: "I am sure you all feel as I do, that we shall miss the freedom we enjoyed at Hull House but let us dry our tears with the comforting picture of a monthly check I hope you all realize that my latch string will still respond to your gentle pull for always and always, Neva L. Boyd" (Simon, 1971, p. 15).
Unfortunately, Boyd devoted little time to writing, but she responded to voluminous requests for lectures throughout Europe and the US and many of these manuscripts remain (Simon, 1971). Paul Simon of the University of Chicago cited Boyds work as contributing to the development of game theory, problem solving methodology, play theory and to our knowledge of small group development, leadership principles, early childhood development, socialization patterns, psychodrama and administration. "She found application for these not only in settlement houses, community centers and recreational programs, but also in hospitals, institutions, community organizations, and rural settings" (p. 4).
World War I
In 1917 the United States entered World War I and Boyd and others soon had many more clients for their services. Military hospitals sprang up all over the country as the wounded returned from Europe. In the largest single project yet undertaken to aid the countrys servicemen, the American Red Cross spent over a million dollars in donations to build 52 recreation centers, called convalescent houses, at military hospitals.
All of the centers were built from the same plans and completed in 1918. The Red Cross director at Quantico, VA described the facility as follows:
The center of the building is entirely taken up by a general lounging and reading room. Great windows all around flood the room with light and sunshine, and in spite of its size the room has an atmosphere of cheer and restfulness and even coziness. Immense fireplaces occupy the center of each side of the room, with big easy chairs all about. Four sides have well-stocked bookshelves. A piano and a phonograph supply music, and already the boys have formed an orchestra. At one end of the Convalescent House is a stage and at the other, a gallery housing a moving-picture machine. (Convalescent House at Quantico, 1919, p. 3)
The Red Cross hired the chairman of the Department of Recreational Leadership, Teachers College, Columbia University to hire and supervise several hundred "highly specialized and technically trained recreation and entertainment personnel" (Convalescent House at Quantico, 1919, p. 6). The Red Cross also hired a corps of recreation consultants to visit and advise the hospital staff. The philosophy of the program was reflected in this description:
Actual participation is necessary if the patient is to encourage his own initiative and develop the spirit of cooperation. Various games and contests have been devised to meet the limited physical possibilities of the disabled patients Such play does wonders to restore self-confidence and banish self-consciousness. (Convalescent House at Quantico, 1919, p. 3)
The programs took different approaches at acute and chronic care hospitals. At the former "the program is not prepared with an idea of attempting even preliminary preparation of the patients for the vocational or semi-educational activities incident to the reconstruction work" (Manual of Red Cross Camp Service, 1919, p. 46).
The program drew from activity areas consistent with those used by group work services at the time. Among those were music, dance, gardening, community trips, drama, games and social recreation. The military was assigned supervision of physical education. Following the precedents established by the terms social work and group work, the Red Cross titled this new service: Hospital Recreation Work (Program of Recreation, 1919).
In 1919 the Red Cross newsletter informed hospital recreation workers of a new resource to help them in their planning: Hospital and Bedside Games by Neva L. Boyd. In the foreword to the booklet, Boyd said that she compiled the activities at the request of workers in civilian as well as military hospitals. "The work that they have done has convinced them that such games have curative value." Boyd quoted a hospital officer who reported, "Sluggish wounds that failed to heal after months of ordinary treatment are now showing remarkable improvement wholly due to increased circulation through pleasurable exercise and to quickened interest in the normal things of life." Boyd further supported these efforts by citing the Swiss scholar, Karl Groos, whose "experiments show that pleasure is accompanied by strengthened muscular activity, quickened pulse-beat and respiration, increased peripheral circulation and a heightened excitation of the sensor and motor centers of the cerebrum." Boyd also underlined the importance of the role of the recreation worker: "Any attempt at classification of these games relative to treatment has been studiously avoided because the use of games should be under the supervision of the person responsible for the treatment of the case" (1919, p. 3).
Between the World Wars
The war ended in November 1918 and by November of the following year the Red Cross staffed only 26 of the original 52 hospitals. The flurry of exploratory activity into the possible applications of experiential therapy in physical rehabilitation decreased as more workers were withdrawn from hospitals with dwindling patient loads. The Veterans Bureau (later to become the Veterans Administration and then Department of Veterans Affairs) assumed control of many of the former military hospitals in 1921. At the request of the government, the Red Cross continued services in those hospitals until 1931 when the Veterans Bureau hired 49 Red Cross hospital recreation workers and established oversight of their own program (Becker, 1950).
Although development slowed in one area of the profession, interest in using recreational therapy with other populations was growing. In 1918 a two-year experiment to explore the efficacy of recreational therapy (the term used by Boyd) was undertaken by the state mental health system of Illinois. According to Boyd, an observer of the project reported that "the selection of recreational activities was placed not on entertainment, nor on mere physical exercise, but rather on group activity in the form of games" (Boyd, 1935, p. 56). Dancing, marching and gymnastics were included for patients unable to function at the level required of game structures and strategies.
A report of the project noted that, "some of the results of this early experiment were so obvious that many of the medical doctors who had offered opposition in the beginning became ardent supporters of the work A leading psychiatrist closely associated with the experiment said, when speaking before the managing officers of state institutions, that in his opinion neither medicine nor physiotherapy nor occupational therapy had anything to offer in the treatment of mental patients, but that effective treatment could be found in recreation" (Boyd, 1935, p. 56).
In 1919 Karl Menninger also referred to the contribution of "recreational therapy" in the treatment of persons with psychiatric disorders. In 1925 he joined his father, C.F., and his brother, William, to found the Menninger Clinic in Topeka, Kansas. Modeled on the Mayo Clinic, which united many specialists in one practice to collaborate in their fight against disease, the Menninger Clinic gathered a group of mental health professionals to create the same team effort to assist persons with mental health problems (Menninger Clinic, 1995).
The Menninger brothers experimented with various uses of recreational therapy and became enthusiastic advocates of its inclusion in the treatment of persons with mental health disorders. William Menninger believed that activities could be structured to simulate most of the demands and conditions that patients would confront in their daily living. The pliability of recreation activities allowed skilled therapists to increase the intensity of a situation or reduce threatening aspects. Social demands, task demands and other elements could be controlled, thereby creating a laboratory for assessing and improving patient functioning (Menninger & McColl, 1937).
Both Karl and William Menninger became respected authors in the area of mental health. Not only did they advocate the inclusion of recreational therapy (their term) in mental health treatment programs, but they also disseminated their firm beliefs in the significant contributions that active leisure lifestyles made to everyones mental health. One of the issues of the Menninger Clinics newsletter was devoted solely to staff analyses, including those by the Menninger brothers, of their hobbies and leisure preferences (Menninger, 1942).
Recreation had also been incorporated into the education of persons with developmental disabilities during the reform zeal of the latter 1800s. Unfortunately, unrealistic expectations of "cures" resulted in the termination of many of these programs. In the 1920s, more realistic efforts were reestablished. Bertha Schlotter recorded many of the efforts instituted by recreational therapy staff at the Lincoln (IL) State School and Colony for the Mentally Retarded. Schlotter was among the pioneers in this area who studiously tried to find the best contribution that recreational therapy could make to the lives of people with mental retardation. In 1929 she documented the results of a three-year project to uncover the potentials of recreational therapy with clients of Illinois state institutions. Sponsors of the study concluded "that by selecting those activities which hold the greatest possibilities for growth and directing them in such a way that the potentialities of the individual, however limited, are called into action, a fuller utilization of the individuals powers may be accomplished and a more harmonious, constructive social life achieved" (Boyd, 1935, p. 59).
Recreational therapy was also introduced in correctional settings. Boyd (1935) reported on a program begun in 1932 at a training school for girls. Under the guidance of group workers, the students not only selected their recreation activities but set group objectives and standards of behavior. "As group activity developed, the girls began to have more self-confidence and to show more self-control. Their feeling of group responsibility was evidenced in their desire to improve the personal appearance of the whole group" (p. 58).
While recreational therapy was developing in a variety of settings, the public recreation movement in the US had changed considerably since its inception in 1906. The triad of professions (education, social work and recreation) that had envisioned community and school-sponsored, small group recreation opportunities under the direction of leaders trained in youth development and group dynamics, as well as in recreation leadership, had pulled apart, and with it the vision. The public recreation movement soon changed its focus from the leadership level to the management level, from guiding developmental experiences to providing systems that offered facilities and opportunities for recreation. Leaders, volunteers where possible, were selected for their knowledge of activity skills, not of conflict-resolution skills. Most public youth programs lost the diversity of the playground movement and became team sports programs (Knapp & Hartsoe, 1979).
In 1929 a Dutch historian diverged from his usual discourse on medieval Europe to publish his thoughts on leisure. In so doing, Johan Huizinga carved a fond niche in the hearts of current and future recreation managers. Huizinga (1944) defined play as voluntary activity characterized by freedom. Boyd agreed with this view and found in Huizingas treatise confirmation of her previous assertions that play was a universal form of behavior indulged in for its own satisfaction (Simon, 1971). The public recreation movement, however, found in Huizingas pronouncements liberation from the need to benefit their consumers in any way other than in the provision of the recreation experience. Huizingas assertion that play was an end unto itself and was not required to produce other benefits to justify its existence was seized upon by leaders of the recreation movement to lend theoretical credence to the direction that public recreation had set upon long before the publication of Huizingas treatise.
With a few exceptions, as in Milwaukee where in-depth city-school recreation programs were developed, municipal recreation and school programs went their separate ways (Knapp & Hartsoe, 1979). As the social work profession grew, it pulled further away from the changing mission of public recreation. As group work methodology developed, the area became recognized as a part of social work. In 1935 the National Conference of Social Work established a section on social group work. To the frustration of many group workers, however, the medium never attained parity with counseling skills in the social work profession. Some attributed this to the influence of Freudian psychology that had swept the country by the 1920s and firmly set treatment on an individual basis and in a talking mode (Simon, 1971). It would be many decades before mainstream psychology would "discover" the effectiveness of working in groups or the potentials of action therapies. As group work grew closer to social work, it grew further from its recreation roots. And, not withstanding the work of Neva Boyd and her students, the field largely targeted its services to "normal" populations (Simon, 1971).
World War II
When the US became involved in World War II, the Red Cross needed a great number of hospital recreation workers in a hurry. Recruits, women with college degrees in any area of study, were given four weeks of training in recreation leadership and three more weeks of orientation to working with patients in military hospitals. At their assigned hospitals they received additional help from a contingent of regional consultants, most of whom had degrees in group work. By 1945, the number of hospital recreation workers reached 1,808. Although the training program was a heroic effort to compensate for the lack of education programs available in recreational therapy, the knowledge imparted through it was minuscule in comparison to what was learned on the job throughout the war years. Never before had so many hospital recreation workers extended services to so many patients. New adaptations of equipment and activities were developed for patients with physical disabilities. Special techniques and programs were devised to serve patients in various diagnostic groups. For the first time, many physicians and psychologists were exposed to the applications of recreation in the treatment process (James, 1979).
Not among those initiates was Col. William Menninger who was appointed Consultant to the Neuropsychiatric Division of the Medical Corps. Throughout World War II he promoted the expansion of recreational therapy services in mental health treatment units. Menninger prepared a technical bulletin on the "Treatment Program for Psychiatric Patients in Station and General Hospitals" in which he stated that recreation was a very definite part of treatment. He felt that recreation services should be broad, varied and "definitely prescribed by the doctor" (Schuyler, 1944, p. 1).
Although the Red Cross provided extensive pre-service and in-service training, it never considered these programs to be a substitute for professional education. Wanting to establish a continuing education scholarship program for hospital recreation workers but not knowing where to send them, the Red Cross called for a curriculum conference in 1945. The organization invited the presidents of the American Recreation Society and the American Association of Group Workers and "educators and recognized leaders in the field of recreation" (Scholarship program, 1947, p. 40). After three days of deliberations the conferees emerged from the meeting with the first proposed graduate curriculum in the area of recreational therapy. Five universities, all meeting the stipulation of having medical and psychiatric social work programs, agreed to provide 21 Red Cross employees with the elements of the designated curriculum through their majors in group work. Unfortunately, Red Cross revenues plummeted before the students could begin their second year of study and the program was discontinued (Summers, 1962).
As the war ended and physicians returned to civilian practice, the demand for recreational therapy programs grew across the country. As they had since the beginning of the century, recreational therapists continued their efforts to increase their effectiveness in drawing growth and health enhancing experiences from recreation activities. Up until this time, this quest had proceeded unchallenged. But the compass arrow that had held so steady up until now was about to vacillate.
Recreation as Freedom of Choice
Anticipating the end of World War II and subsequent expansion of public recreation services in the United States, G. Ott Romney, one of the national leaders in the recreation movement, put forth a rationale to undergird and encourage this postwar development. In his book, Off the Job Living, co-published in 1945 by the American Recreation Association, Romney developed a position that sought to (1) place the provision of leisure services under the auspices of the recreation profession, (2) circumscribe the recreators responsibilities to the provision of recreation opportunities and facilities and (3) make the receipt of these services an individual right and a public obligation.
To expand the market, Romney needed to democratize leisure, to erase the earlier notion that leisure was the realm of a privileged, wealthy few. Addressing a population that had worked hard and long throughout the war years, Romney managed this transformation the old-fashioned way, he told Americans that they had earned it: "Leisure is the time-off-the-job. It is earned choosing time. It belongs to all" (1945, p. 5).
If the individuals own choosing-time, rich in self-respect because he has earned it in honorable, useful work, his time to feel lifes warm breath on his heart and to call his soul his own if this, his leisure, is barren because society has failed to show him how to use it, and provide him opportunity, democracy is a promise not entirely fulfilled. Man must work at democracy to make it live and democracy, in turn, must help man live and live fully. (Romney, 1945, p. 10)
To reserve the provision of recreation services to its rightful providers, Romney had to denigrate former allies:
Time was when recreation as a social concern was led by the hand of her dignified elders, Character-building, Physical Education, Delinquency Prevention, Citizenship Education and their ilk, into the living room of social welfare Now she should be easily distinguished from physical education, occupational therapy, regimented character-building services, and group work All of which intends to say that recreation is an end unto itself It does not hide behind the skirts of therapy nor find only group work reflected in its mirror. (Romney, 1945, p. 35)
To justify his opposition to the therapeutic use of recreation activities, Romney coupled recreation and free choice, and refused to combine the terms recreation and therapy. "If the patient is required for curative purposes to weave a basket at a scheduled hour, whether he likes it or not, he is receiving occupational therapy. If he may exercise freedom of choice, he is indulging in recreation" (Romney, 1945, p. 42).
Few recreational therapists would argue with Romneys distinction between group work (or recreational therapy) and recreation.
Group work is a method. Recreation is a function. Recreation is the what; group work is sometimes its how. The fundamentals of the group work method include voluntary participation, common interest, purpose, skilled leadership, interaction of group members, program development keyed to the ability and needs of the group and evaluation in terms of group and individual growth. Group work is a democratic process which provides needed group experiences for social adjustment. The group work method is widely used in hospitals and institutions for the physically handicapped and the socially ill. (Romney, 1945, p. 49)
It is unfortunate that, in establishing the parameters of municipal recreation, Romney felt it necessary to ridicule the role that activities served to enable other professions to help people in need.
Surely it is not a prerequisite to a selection of recreation that the individual catechize himself as to whether he has had his group work vitamins for the week Must the seeker of creative expression ask, "Does this activity offer an adequate supply of character calories?" To subject the emotionally under-nourished seeking balance, relaxation, expression or adjustment to a lot of strictures, and a painfully conscious self-analysis, is to squeeze out of recreation its very essence. (Romney, 1945, p. 51)
Romney was irritated by the existence of professions in which recreation services formed only a portion of the disciplines efforts as they did in social work (Romney, 1945). Professions that used recreation activity to help people achieve treatment, educational or developmental goals posed a threat to the universal application of Romneys recreation-must-be-an-end-in-itself thesis. Not only did he criticize these professions but he challenged the capacity of recreation activity to alter behavior (Romney, 1945). Romney supported recreation programs in institutional settings as long as they were conducted for recreation purposes. Any incidental benefits that accrued were to be referred to as "by-products" (1945, p. 42).
By 1948 the Red Cross had eliminated more than four fifths of its hospital recreation positions. The reduction, due to a drastic drop in donations, far outstripped the postwar reduction in the military patient load. The skeleton staffs that remained could not possibly continue to provide the depth of service previously extended without greatly restricting the number of patients eligible to receive these services. The directors of the non-profit organization decided that the mission of the Red Cross would be better served by providing recreation to all military patients rather than by extending recreational therapy services to a vastly restricted number (James, 1979). Reversing the direction of a thirty-year heritage, Carolyn Nice, the national supervisor of the hospital recreation program wrote:
The purpose of the recreation program in the hospital is the same as that of any recreation program in any setting, namely to provide opportunities for individuals to do the things of their choice, in their leisure time, for the satisfaction derived from the doing Hospital recreation leaders are not therapists whose primary purpose is treatment, and they should not be asked to participate in providing treatment. (Nice, 1948, p. 642)
Affirming this decision, Red Cross recreation supervisors from the national and regional offices, turned away from group work and realigned with the recreation movement. In September of 1948, thirty-seven people in attendance at the annual conference of the American Recreation Society, established a committee to pursue the formation of an affiliation with the ARS. The committee was composed of six management level staff from the Red Cross and Veterans Administration (VA) and four people from private and public psychiatric hospitals (Committee at work, 1949). In October 1949, at the 31st National Recreation Congress in New Orleans, the Hospital Section became the first "special interest group" to form within the American Recreation Society (History, 1964).
Among the founding members of the Hospital Section of the ARS was Harold D. Meyer, chairman of the recreation curriculum at the University of North Carolina. As chairman of the education advisory committee, Meyer was instrumental in the development of hospital recreation curricula that began to appear in 1951 (History, 1964). An enthusiastic, animated speaker, Meyer championed the transfer of recreational therapy from group work to recreation and led his students in the often repeated exclamation, "I AM A REC-RE-A-TOR FIRST!"
Curricula diverged from the original plan-of-studies drawn in 1945, with its emphasis on content related to medicine and psychiatry, and came to more closely resemble the studies existing in the sponsoring departments of recreation or physical education. Some curricula were only one course and a fieldwork site away from being identical to their departments majors in community recreation. Practitioners complaints of being unprepared to deliver the knowledge and skills demanded of their positions were frequently dismissed with the response that students were being educated to make intelligent decisions and that "technical matters" could be mastered on the job. Students, and the recreational therapy profession as a whole, undoubtedly benefited from access to knowledge on leisure theory, philosophy and behavior. But individual and professional progress was also undoubtedly stalled by the hours spent in park planning classes instead of in treatment planning courses.
In the meantime, officers of the Hospital Section of ARS were at work developing the groups position statement on the purpose and nature of hospital recreation. As it became increasingly evident that the Hospital Section was going to declare its allegiance to the precepts of Ott Romney, dissenting recreational therapists began to pull away from the organization.
B. E. Phillips and several of his colleagues from the VA drew like-minded associates to the Recreation Division of the American Association for Health, Physical Education and Recreation and, in 1952, formed the Recreational Therapy section (Phillips, 1952b). Phillips described the VA program as providing for the leisure of hospitalized veterans but "its primary purpose is to assist physicians in their treatment of patients" (p. 2). Contrary to the dominant thesis of the Hospital Recreation Section, Phillips viewed recreational therapy as a "means toward patient recovery rather than as an end in itself. This concept dictates the selection of activities primarily on the basis of needs and capabilities, and secondarily on the basis of interests" (Phillips, 1952a, p. 29). In time, however, the Recreational Therapy section drew its membership from professionals associated with its parent group, recreation educators with ties to physical education, rather than from practitioners attracted by a particular philosophical position.
Charles Cottle, Director of Recreation and Education at Mississippi State Hospital, shared Phillips position but perceived little relationship between the provision of recreational therapy in mental health treatment centers and physical education. In February of 1953, Cottle gathered 23 recreational therapists from 19 state mental health facilities and two state schools for persons with developmental disabilities and formed the National Association of Recreational Therapists (NART). Thus, in less than five years, the profession traversed from having no organizational affiliation to having three. Members from each group recognized the need for communication among the organizations to deal with matters of mutual interest. Within the year, representatives from each group formed the Council for the Advancement of Hospital Recreation. The Council was successful in establishing qualifying standards for hospital recreation personnel and the national registration program became the forerunner of todays certification program. By 1959 members of the Council examined the possibility of merging the three organizations. Several compromises were proposed, including the term therapeutic recreation, but the Council was not able to budge the groups from their disparate positions (Cox & Dobbins, 1970).
Throughout the fifties and into the sixties, few meetings of hospital recreators or of recreational therapists adjourned without one or more orations on the true nature of the art. Each school of thought trotted out physicians who championed the perspectives of its position.
In the hospital recreation corner was George S. Stevenson, medical director of the National Association for Mental Health. In 1951, Stevenson wrote that,
recreation affects the individual deeply, somewhat akin to therapy, but is more positive than therapy. Recreation is pointed less toward the correction of a disorder than toward the elevation of the quality of living The distinctive quality of recreation is its permissiveness. It can not be forced Recreation may be therapeutic, but that is a byproduct. Its goal is not therapy and its therapeutic value is apt to be greatest when the person is least conscious of its therapeutic influences. (p. 1)
Stevenson did not perceive of hospital recreation as an altered process but only as recreation in a different setting.
Another psychiatrist, Paul Haun, held views very similar to Stevensons:
The very fact that [the hospital recreators] work is not narrowly clinical, that it is fun, that it is spontaneous, is the quality that makes it important He asks nothing of the patient but that he enjoy himself Here is relief for the patient from the stare of clinical appraisal, from lips pursed over a thermometer reading, from laden glances and pregnant silences. (Haun, 1952, p. 7)
Hauns somewhat romanticized view of hospital recreation praised the creation of a hospital atmosphere that facilitated the treatment extended by physicians. Haun embraced the concept espoused by Alan Gregg, whom Haun called "the greatest physician of his generation," that the hospital was a temple of healing, not an institution devoted solely to the elimination of disease (Haun, 1965, p. 23). "A major improvement can be confidently expected in the ambiance of the institution where budgets permit the establishment of a recreation program" (Haun, 1969, p. 16).
Unfortunately, few hospital budgets today have major line items for "ambiance." Haun, however, became quite voluble in extolling the benefits of recreation while degrading the value of recreational therapy. He produced more than 20 speeches and articles on the subject, excerpts of which were reprinted by the National Therapeutic Recreation Society in "The Wisdom of Paul Haun" as recently as 1987 (Sylvester, 1987).
Haun expressed concern for recreations lack of specificity as a treatment agent. He scoffed at suggestions that recreation could be prescribed.
A true prescription for recreation would have to be something like this:
Rx John Doe, Ward 18
32 quanta of moderate pleasure
Sig. 10:00 a.m. and 4:00 a.m. q.d. for one week.
Richard Doe, MD (Haun, 1965, p. 23)
Some have pointed out that Haun did not apply this test to his own work in psychotherapy which, like recreational therapy, is experientially based rather than chemically based.
But while some physicians ridiculed the efforts of recreational therapists, other physicians joined them in research activities to test their hypotheses. Cardiologist Joseph B. Wolffe was one such physician. In 1962 he reported one of the first scientific studies in the young field. Patients on one of his cardiac units received focused recreation activities each evening while patients on a second unit received none. At the conclusion of the study, it was found that members of the treatment group had made far fewer requests for sleep medications than had patients who had not received the recreational therapy services.
Wolffes direct work with recreational therapists brought him to the following conclusion:
They are professionals the men and women skilled in the arts of recreational therapy are capable of making clinical observations that are on a par with those produced by the best of physicians.
There is an area of diagnostic acumen and treatment know-how which, under the supervision of medical authority, can make the recreational therapist an invaluable member of the broad team involving the cardiologist, the neuropsychiatrist, the surgeon, and other specialists. (Wolffe, 1962, p. 18)
Contrary to Haun and Stevenson, Wolffe asserted that "cooperative planning by the physician, the recreational therapist and the patient, or group of patients, is essential. The patient must be made aware that this is an important form of therapy and not entertainment" (Wolffe, 1962, p. 18).
In a discussion chaired by Paul Haun, psychiatrist F. A. S. Jensen countered Hauns contention that hospital recreations lack of precise measurability excluded it from the list of therapies. "[Prescribing] is knowing where you are going through conscious effort. This is a purposive action. This is therapy Is there any scientific approach to the situation other than by a conscious knowledge of what were doing? I dont think theres any question but that we have to indulge in the prescription of recreation. We have to go on the idea that we are interposing in the process of illness we are interposing some measures which in some way, are going to complete a retrogression of that illness" (Haun, 1962, p. 28).
By 1962 the Hospital Recreation Sections publication Recreation in Treatment Centers had begun to reflect some diversity of opinion within the organization. The September issue was prefaced with the following remarks by Robert Felix, Director of the National Institute of Mental Health: "The greatest value of recreation is that it can be prescribed as a definitive therapeutic treatment" (Felix, 1962, p. 3). That same issue carried an article by Martin Meyer, "The Rationale of Recreation as Therapy." Noting that "no other issue has been so provocative and disuniting to the profession," Meyer gently proceeded to build a rationale that drew from both positions (Meyer, 1962, p. 23).
A movement began in the early 1960s to bring all organizations with interests in leisure services together into one loosely connected organization. Member organizations were to maintain autonomy over their operations while delegating daily business tasks to the central structure. When issues of common concern arose, the member organizations could rise to the occasion with one voice. Thus, five organizations aligned in 1965 to form the National Recreation and Park Association (NRPA).
The underlying principles supporting such an alliance were so attractive to members of NART and of the Hospital Section of ARS that they put aside their philosophical differences, voted to merge, agreed to a charter and bylaws and elected officers, all within a year. On Sunday, October 9, 1966, the Board of Trustees of NRPA approved the Charter of the National Therapeutic Recreation Society. The first official meeting was convened in January 1967 (OMorrow, 1986).
At that meeting, President Ira Hutchison assured the Board of Directors that "there has not been a single instance whereby the officers and staff of the Association have made any attempt to usurp the autonomy of our Society. I have every intention of protecting our right to plot our own course within the framework of the NTRS and NRPA constitutions" (Hutchison, 1967, p. 2). The treasurers report from the same meeting indicated that members dues went to NTRS with a portion being designated to NRPA (Hutchison, 1967).
Within the next ten years, however, the Association changed significantly. All dues went to NRPA with budgetary authority placed in the hands of the Board of Trustees and the executive director. With no funds to command for its activities, NTRS was forced to discontinue two of its serial publications (OMorrow, 1986).
In 1977 NRPA moved to complete the centralization of the Association by encouraging the dissolution of all branch organizations. NTRS was required to petition the Board of Trustees to be allowed to continue as a "special interest group" (Goals report, 1976, p. 5). The title of the executive secretary for NTRS was changed to branch liaison and the duties of the position were expanded to include other NRPA assignments.
During the first decade of NTRSs existence, efforts were focused internally on the development and refinement of professional structures. The membership, catalyzed by a dedicated leadership, worked earnestly to establish curriculum standards and field training guidelines, to develop a quality research journal, to prepare ethics and standards-of-practice documents, to sponsor an annual continuing education institute of high quality and diverse offerings, to develop a communication network with state therapeutic recreation groups and to refine the certification program, which became an independent entity, the National Council for Therapeutic Recreation Certification, in the early 1980s. Thus, in spite of fiscal and staff limitations, progress in developing the structures of the young profession remained steady (OMorrow, 1986).
One area that did not receive significant attention was the adoption of a statement setting forth the nature, purpose and scope of therapeutic recreation. By and large, the unity of the Society had been maintained by avoiding deliberations of this divisive subject. In 1969, a group of participants at the Southern Regional Therapeutic Recreation Institute sponsored by the University of North Carolina at Chapel Hill drafted a position paper defining therapeutic recreation as "a process which utilized recreation services for purposive intervention in some physical, emotional and/or social behavior to bring about a desired change in the behavior and to promote the growth and development of the individual" (OMorrow, 1980, p. 122). The statement was never adopted by NTRS, however, and the only people who cited it were the individuals who embraced its concepts.
By the mid-seventies it was becoming increasingly awkward for NTRS to present itself without a statement of basic tenants. With the passage of time, NTRS had gained more and more young members who were naive as to the divisive history of the philosophical issue and who were growing in impatience that the matter be finalized. Past president Lee Meyer was asked to lay out the various positions that could reflect the organizations interests. These positions were to be discussed during the next year at state and regional conferences and then voted upon by the membership.
The first position, often referred to as the "special recreation" position, stated that therapeutic recreation was "the provision of recreation services and opportunities to persons with disabling conditions." The role of the special recreator was chiefly to adapt recreation opportunities and facilities to enable persons with disabilities to reap the same benefits from recreation as could their nondisabled counterparts. (Park, 1981, p. 6)
A second position, the therapy position, posited that the primary purpose of therapeutic recreation was to provide "experiences and opportunities to help treat, change, or otherwise ameliorate effects of illness and disability The goal would be to provide services which would contribute to the achievement of optimal functioning and independence" (Park, 1981, p. 9).
A third position, sometimes referred to as the umbrella or therapeutic recreation position, stated that therapeutic recreation was both special recreation and therapy. This position acknowledged these services as separate specializations but held that the two specializations combined to constitute the therapeutic recreation profession (Park, 1981, p. 16).
The final option that was put forward was frequently associated with its authors, Carol Peterson and Scout Lee Gunn, as the Peterson/Gunn model. This position stated "that the uniqueness of therapeutic recreation is that it utilizes three specific types of services as part of a comprehensive approach toward enabling leisure ability" (Park, 1981, p. 12). (Thus, it was also dubbed the "leisure ability" position.) The three types of services were identified as therapy, leisure education and recreation facilitation. The decision as to which service was to be employed was to be based on the assessment of client need. Regardless of the service, the ultimate goal of this model was to assist individuals in the establishment and expression of an "independent leisure lifestyle" (Park, 1981, p. 12).
The continuum of services featured in this model was very appealing to members and Peterson, a past president of NTRS, defended the position very articulately at discussions held during the year. At one of these discussions, Fred Humphrey, a proponent of the special recreation position, put forth his contention that the continuum was of a procedural rather than a philosophical nature and that similar continuums could be practiced within the other models. Proponents of the therapy position, perhaps because they were represented on one end of the continuum of services, were uncharacteristically reserved in voicing their criticism. For some therapists who had sought to help their clients according to their assessed needs, it was difficult to replace the goal of optimum functioning with "leisure ability." Proponents of the leisure ability position responded that the therapy services in this model were justified because improvement of a functional behavior was prerequisite to achieving meaningful leisure experiences. To the therapists, these cognitive gyrations were unnecessary, it was perfectly appropriate to assist a person to attain better functioning so that the person could apply it in any way they wished, not just in their leisure realm. Recreational therapists felt that they were wholly justified in joining other treatment professionals in seeking optimum health and functioning for their clients. The uniqueness of their contribution lay in the resources and skills that they commanded on behalf of the client. The leisure ability proponents felt that in order for the profession to make a distinct contribution in the health care field it was necessary to seek a goal separate from other therapies. In addition, Peterson leaned toward the Haun definition of therapy that required specific measurability and reliability of treatment protocols such as those expected in drug therapies. Advocates of the therapy position were comfortable using a definition that placed its emphases on the goals and procedural distinctions between recreational therapy and special recreation, which was the accepted usage by other counseling and experiential modalities.
The leisure ability position received a majority of the votes cast for the four positions as shown in Table 2.1. In May 1982, it was adopted by NTRS as its official philosophical position.
In the meantime, if the expanded presence of therapeutic recreators among the players from the public recreation and park movement had any effect on the ways in which the latter viewed their mission, it was not immediately discernible. In an address presented at the 1970 National Recreation and Park Associations annual conference in Philadelphia, Fred Humphrey, former president of NTRS, introduced his version of concepts earlier asserted by Luther Gulick. He said that contrary to the prose set forth in most introductory recreation texts, recreation was not an inherently good entity. He affirmed that recreation activity formed a neutral structure that could yield either positive or negative experiences for participants. He maintained that effective leadership was the primary factor that was needed to fulfill recreations potential to benefit participants. In exercising that influence on the experience, Humphrey said to the recreation profession, "we are all therapeutic recreation specialists" (Humphrey, 1970). Humphreys vision did not divert the movement from its focus on providing facilities and programs to one that emphasized leadership in releasing the benefits of recreation. In fact his words drew some irritation of the "who-do-these-people-think-they-are" variety. Even the challenges to "the establishment" and the social turmoil of the latter 1960s and early 1970s had little effect in budging the recreation movement from its adherence to the postwar principles of Ott Romney. Although the profession received more than one challenge to make its recreation centers and programs more involved in addressing the social ills of the day, the majority held that that was not the business of recreation.
One area in which NTRS did appear to effect some positive outcomes by working with NRPA was in increasing the opportunities for citizens with disabilities to join other beneficiaries of community, state and federal park and recreation services. In fact, this is what many members of NRPA thought that recreational therapists did: enabled people with disabilities to participate in recreation. It was one area in which therapists and general recreators could work without encountering philosophical differences.
In the latter 1970s and early 1980s, however, the parent organization had little interest in health care issues. As NRPA became more centralized, NTRS lost any influence it may have once had on the goals and resources of the association. NRPA was not directly involved in the arenas in which health care issues were being resolved. For example, while the American Occupational Therapy Association and the American Physical Therapy Association were involved in writing the home health care legislation, NRPA legislative staff were preoccupied with the Land and Water Conservation Fund and the Bureau of Outdoor Recreation. As fiscal management issues and changes became of critical importance to recreational therapists working in the health care industry, their frustration and impatience with NRPAs lack of leadership in confronting these issues grew. In October 1982, NTRS President Viki Annand asked the Council of Past Presidents to advise the Board of Directors. Specifically, a motion was laid before the Council that advised the Board to study alternative organizational structures, both within NRPA and apart from NRPA, through which NTRS might more effectively serve the needs of the profession. Nine former presidents of the society attended the meeting. "The consensus, from the opinions proffered, was that the Society was not where it ought to be and that the existing organizational structure was impeding rather than enhancing progress" (NTRS Council of Past Presidents, 1982, p. 1). There was much less agreement, however, on measures that should be taken to rectify the situation, but, after much discussion, the motion passed with six members voting for the exploration of other structures and three dissenting (NTRS Council, 1982).
After eight months of investigating structural options and many conversations with NRPA authorities, Ann James, the director of the study, called Ray West, chairman of the committee investigating external structures, and reported that NRPA officials had made it clear that they wanted no alterations in the NTRS/NRPA relationship that might set a precedent for the return to a decentralized organization. She concluded that modification of the relationship with NRPA was not a realistic option and advised West that he and like-minded colleagues should earnestly pursue the feasibility of establishing an independent organization (authors notes, 1983).
West solicited the help of Dave Park, former executive secretary and past president of NTRS, to establish the legal and organizational ground work. After surveying 25 colleagues to establish a proposal, Park summoned all interested persons to meet in his hotel room at the 1983 NRPA convention in Kansas City. At the appointed hour, every square foot of floor space and every piece of furniture appeared to be occupied by recreational therapists. People strained to hear from the doorway and the hallway. The temperature increased with the mixture of excitement and apprehension emanating from the crowded room. Park reiterated that there were respected leaders who said that an organization could not thrive apart from NRPA. "There are also some individuals who are opposed to this move, and that also is to be expected. It is my firm conviction that this move is necessary for the future of the therapeutic recreation profession and that we should press forward with vigor" (Park, 1983).
Park cautioned founding members to be focused in defining the new associations purpose and goals: "Another organization with an umbrella orientation will not be any more successful than the present one" (Park, 1983). He also noted that since many of the people expressing an interest in the new organization were employed in the health care industry, some had characterized the organizational separation as the clinical proponents versus the community practitioners. Park contended that the distinction had nothing to do with setting and everything to do with process. He affirmed that using recreation experiences as an intervention to achieve a predetermined goal was the essence of therapeutic recreation and that this could "occur in a community recreation department, in a school, or in a clinical setting" (Park, 1983, p. 1). When asked whether the term for that concept might be more appropriately denoted as recreational therapy, Park responded pragmatically that the term therapeutic recreation had burrowed its way into common usage and that a change at this time would only further confuse the public and other health care professionals.
Despite Parks urging, the statement-of-purpose committee composed of Carol Peterson, Dave Austin, Ray West, Dick Beckley and Melinda Conway proposed a definition with recreational therapy at the core but with enough added to the fringes to provide something for everyone:
Therapeutic Recreation is the application, by qualified professionals, of appropriate intervention strategies utilizing recreation services to promote independent functioning and to enhance optimal health and well-being of individuals with illnesses and/or disabling conditions. Therapeutic Recreation places a special emphasis on the development of an appropriate leisure lifestyle as an integral part of that independent functioning. The underlying philosophy of Therapeutic Recreation is that all human beings have the right to and need for leisure involvement as a necessary aspect of optimal health and, as such, Therapeutic Recreation can be used as an important tool in becoming and remaining well. (Park, 1983, p. 1)
Needless to say, it did not flow readily off the tongue and was later replaced with the slightly more succinct:
Therapeutic Recreation is the provision of treatment services and the provision of recreation services to persons with illnesses or disabling conditions. The primary purposes of treatment services, which are often referred to as recreational therapy, are to restore, remediate or rehabilitate in order to improve functioning and independence as well as reduce or eliminate the effects of illness or disability. The primary purposes of recreation services are to provide recreation resources and opportunities in order to improve health and well-being. Therapeutic recreation is provided by professionals who are trained and certified, registered and/or licensed to provide therapeutic recreation. (American Therapeutic Recreation Association, undated)
Clinicians who were responsible for facilitating leisure participation for their clients during evenings and weekends, which constituted most recreational therapists, felt that role needed to be reflected in the statement along with the therapy functions. Thus, the statement specifies two functions: treatment services and recreation services. Denoting them both as therapeutic recreation, however, reverted the statement to the umbrella dilemma.
By February 1984, fifty "founding members" had contributed one hundred dollars each to the establishment of the new association. These members elected an Interim Board of Directors, with Peg Connolly as the president, to complete the Articles of Incorporation. On June 12, 1984, the American Therapeutic Recreation Association was officially incorporated in Washington, DC (Connolly, 1984; Park, 1984a).
In the meantime, the officers of NTRS brought a list of the societys "most urgent needs" to the attention of the executive committee of NRPA (James, 1984). The NRPA officers responded with the provision of additional legislative assistance and a member of the Board of Trustees donated funding for additional staff assistance. For a while, the relationship grew more productive and tensions eased. Then in the summer of 1984, the executive director of NRPA pulled a manuscript from imminent publication in the Therapeutic Recreation Journal. Although the executive director objected to passages critical of NRPA, the article had passed review of the established editorial processes. This act of censorship again strained relations between NTRS and the parent organization (James, 1984). By July 1985, the membership of ATRA had grown to 300 (Membership Directory, 1985).
Evolving Concepts Based on Efficacy
Concepts of recreational therapy in the eighties and nineties were impacted by two elements: (1) increased research demonstrating the efficacy of recreational therapy and (2) the unsettling transition in the structure of American medicine.
More than a century after Florence Nightingale voiced her contention that laughter contributed to the recovery process, scientists confirmed that laughter altered the body chemistry in humans, increasing the presence of immune factors in the blood (Berk et al., 1988). This finding by immunologists was joined by the research of physiologists, physicians and psychologists, as well as by the research of recreational therapists. Evidence mounted indicating the contributions of recreational therapy interventions to achieving desired physical, cognitive, psychological and social outcomes (Coyle, Kinney, Riley & Shank, 1991). Increasing empirical evidence replaced the intuitive contentions of the sixties and earlier, contributed to the refinement and modification of some interventions and reinforced the confidence with which recreational therapy interventions were applied.
Thorough assessment and evaluation procedures became universally applied by professionals further adding to the documentation of treatment outcomes. Although the experiential nature of recreational therapy still does not allow the medium to approach the specificity usually expected of medications, the practice has come a long way since the tenuously-based activity of Paul Hauns era.
The changing structure of medical care in the United States has had a major effect on recreational therapy. During the first half of this century, the free enterprise basis of American medicine motivated the development of new information, technologies and medications until it offered the most advanced treatment opportunities in the world. However, by the mid-seventies, it was becoming increasingly difficult for individuals and their health insurers to pay for the more expensive care that these advances made possible. The assortment of measures instituted to contain costs have had considerable effects on recreational therapy as they have had on all components of health care. Most notably, the limitations of insurance covering mental health treatment costs have caused drastic reductions in hospital stays with concomitant reductions in services and personnel. Whereas twenty years ago the profession was heavily concentrated in mental health treatment settings, there has been a major shift of personnel to physical rehabilitation centers. Although many of the cost containment measures have brought constricting forces to the profession, some have propelled growth or at least reinforced stability. The new willingness and, in some cases, eagerness of medicine to look beyond technology and drugs for effective interventions places recreational therapy in an advantageous position. The cost-effectiveness of recreational therapy in comparison to many other treatments has also been noted by clinical directors, as well as by hospital administrators. Lastly, the marketing advantage afforded to institutions with leisure opportunities and recreational therapy programs has affirmed the value of recreational therapy services in increasingly competitive health care venues.
Recreational therapy has not been the only profession to undergo changes due to fiscal pressures. Increasing costs of government have led to tax protests and funding cutbacks in states and cities across the United States. Increased competition for remaining tax dollars have motivated public recreation professionals to become more persuasive in advocating for their shares of the budgets. At a press conference convened in 1994 in Washington, DC, the National Recreation and Park Association announced the results of a new study suggesting that many serious social issues, including juvenile crime, could be ameliorated through participation in recreation programs such as those found in many park and recreation departments. "The study, Beyond Fun and Games: Emerging Roles of Public Recreation, illustrates recreation-based programs that are successful at reducing crime, improving health and quality of life, and creating safer communities" (Kraus, 1997, p. 270).
Almost a century after Joseph Lee, Luther Gulick and Jane Addams brought together their respective fields of recreation, education and social work to provide recreation experiences for youth-at-risk in America, the National Recreation and Park Association was reaffirming the potential of recreation to yield personal and community benefits. The pendulum had swung from one extreme in 1890 when recreation was sanctioned only for its auxiliary benefits to the opposite extreme in mid-century when it was blasphemous to propose that recreation activities be conducted to produce anything other than inherent enjoyment. Perhaps this pendulum would now hold near the center where professionals could delight in recreation as being totally justified by its own reward while at the same time recognizing the tremendous potential of recreation experiences to achieve additional benefits. Recent NRPA sponsored continuing education programs have featured a Benefits-Based Management (BBM) system for program design. With its emphasis on (1) identifying benefits to be achieved by participants, (2) implementing program elements in ways needed to achieve the desired benefits and (3) evaluating results in terms of benefits achieved (Kraus, 1997), it is easy to see parallels to recreational therapy. In fact, developers of BBM seminars admit to drawing freely upon the body of knowledge established by recreational therapy (Allen, 1997). It is heartening to again see recreation professionals point with pride to the benefits their programs have generated for their communities. It is certainly a much more hospitable climate for recreational therapists than was the Romney era.
As the twentieth century draws to a close, many of the struggles experienced by the field because of the existence of two national organizations seem to be resolving. Both ATRA and NTRS have been working on creating a foundation for future collaboration between the two organizations for the past three years. In the summer of 1996 they joined together to form a joint committee on credentialing and in the summer of 1998 both organizations mutually developed a resolution and a letter of agreement which acknowledge that recreational therapists are represented by two national organizations, each making its own unique and valuable contribution to the continued growth of the field (Wenzel, 1998). The primary purpose of both the resolution and letter of agreement is to allow both the professional and the consumer to benefit from an effective and efficient use of opportunities and resources available. The resolution signed by both organizations is shown below:
ATRA and NTRS Joint Resolution
WHEREAS, professional involvement at the local, state and national level is imperative to enhance and promote the therapeutic recreation profession, and
WHEREAS, it is the responsibility of professional organizations to guide the growth and development of a professional body of knowledge, codes of ethical conduct, standards of professional practice, credentialing standards, professional preparation programs, and public recognition and support, and
WHEREAS, the profession of therapeutic recreation is served by two national organizations, each with a unique identity and each making valuable contributions, and
WHEREAS, both the American Therapeutic Recreation Association (ATRA) and the National Therapeutic Recreation Society (NTRS) recognize that the therapeutic recreation process is fundamental to service provision and endorse its implantation across all service settings, and
WHEREAS, communication, cooperation and collaboration are consistent with both originations mission and professional codes of ethics, and are therefore integral to professional behavior and relationships,
NOW, THEREFORE, IT IS RESOLVED that the American Therapeutic Recreation Association (ATRA) and the National Therapeutic Recreation Society (NTRS) will communicate, cooperate and collaborate in the best interest of consumers and the therapeutic recreation profession, and will enter into a letter of agreement to operationalize the above stated intentions. (ATRA, NTRS Resolution, June, 1998)
Recreational therapy traces its roots to ancient teachings and more directly to the principles espoused by Florence Nightingale. In the United States, it was born with the reform movement at the turn of the twentieth century. Its early identification with the social work profession was transferred to the leisure service professions after World War II as part of several other larger organizations in recreation, most significantly NTRS. In the mid-eighties an independent professional association (ATRA) was established. Both organizations assisted the advancement of the field at a very critical time in its historical development but the existence of two national organizations representing the field of recreational therapy led to much energy being spent defining differences, similarities and rightful areas of jurisdiction. With the development of a more open atmosphere between the two professional associations, it appears that the field of recreational therapy is taking a purposeful step forward in providing the field with a stronger professional basis on which to develop practice and professional commitment for the benefit of the consumers whom we serve.
Allen, L. (1997). Benefits-based management. Address delivered at the SC Park and Recreation Management Conference, February 24.
American Therapeutic Recreation Association. (undated). Membership information. Hattiesburg, MS: American Therapeutic Recreation Association.
Andrews, M. (1929). A lost commander: Florence Nightingale. Garden City, NY: Double Day.
Becker, S. (1950). The history of hospital service, 1918-1947. Washington, DC: The American National Red Cross.
Berk, L., Tan, S., Nehlsen-Cannarella, S., Napier, B., Lee, J., Lewis, J., Hubbard, R. & Eby, W. (1988). Humor associated laughter decreases cortisol and increases spontaneous lymphocyte blastogenesis. Clinical Research, 36, 435.
Boyd, N. L. (1919). Hospital and bedside games. Chicago: N. L. Boyd.
Boyd, N. L. (1935). Group work experiments in state institutions in Illinois. Proceedings of the National Conference on Social Work. Chicago: The University of Chicago Press.
Committee at work on Hospital Section of American Recreation Society. (1949, July). American Recreation Society Quarterly Bulletin, 2(21), 8.
Connolly, P. (1984). Letter to founding members. July 27.
Convalescent House at Quantico. (1919, March 31). The Red Cross Bulletin.
Cox, C. L. & Dobbins, V. (1970). Before the merger. Therapeutic Recreation Journal, 4(1), 3-8.
Coyle, C. P., Kinney, W. B., Riley, B. & Shank, J. W. (Eds.). (1991). Benefits of Therapeutic Recreation. Ravensdale, WA: Idyll Arbor.
Felix, R. H. (1962). Preface. Recreation in Treatment Centers, 1, 3.
Guthrie, D. (1946). A history of medicine. Philadelphia: J. B. Lippincott Co.
Haun, P. (1952). Recreation in the mental hospital: A philosophy. Journal of the American Association for Health, Physical Education and Recreation, 7, 55.
Haun, P. (1962). Mental and emotional ills: A discussion. North Carolina Recreation Commission Bulletin, No. 30, p. 51.
Haun, P. (1965). Prescribed recreation. Recreation in Treatment Centers, 5, 7.
Haun, P. (1969). The psychiatrist looks at recreation. Proceedings, Mental Health Institute, Independence, IA.
History of the American Recreation Society. (1964). American Recreation Journal, 5(3), 70-72.
Hospital Service. (1919, June 30). The Red Cross Bulletin, 3(27), 2-3.
Huizinga, J. (1944). Homo ludens: A study of play elements in culture. Boston: Beacon Press.
Humphrey, F. (1970). NTRS Institute Address. Authors notes.
Hutchison, I. (1967, January 28). Report to the board of directors. Minutes of the National Therapeutic Recreation Society.
James, A. (1979). Therapeutic recreation in military hospitals. Unpublished doctoral dissertation, University of New Mexico, Albuquerque.
James, A. (1984). Editorial control of Therapeutic Recreation Journal. Letter to Executive Committee, NRPA Board of Trustees, August 13.
Katz, H. F. (1974-1975, Winter). [Review of the book Play and game theory in group work: A collection of papers by Neva Leona Boyd.] Program Aids. New York: National Jewish Welfare Board.
Knapp, R. & Hartsoe, C. (1979). Play for America: The National Recreation Association 1906-1965. Ashburn, VA: National Recreation and Park Association.
Kraus, R. (1997). Recreation and leisure in modern society. New York: Addison-Wesley.
Manual of Red Cross Camp Service. (1919). Washington, DC: American Red Cross.
Membership directory. (1985). The American Therapeutic Recreation Association.
Menninger Clinic. (1995). A national resource. Topeka, KS: Menninger Clinic.
Menninger, K. & Jeanetta, L. (1942). Recreation for morale: Some tentative conclusions. Bulletin of the Menninger Clinic, 6, 96-102.
Menninger, W. C. (1942). Psychological aspects of hobbies. American Journal of Psychiatry, 99, 122-129.
Menninger, W. C. & McColl, I. (1937). Recreational therapy as applied in a modern psychiatric hospital. Occupational Therapy and Rehabilitation, 16, 296-302.
Meyer, M. W. (1962). The rationale of recreation as therapy. Recreation in Treatment Centers, 1, 23-26.
Morton, T. G. (1973). History of Pennsylvania hospitals, 1751-1895. New York: Arno Press.
Nice, C. J. (1948). Recreation is not therapy. The Journal of Health and Physical Education, 19, 642-643.
Nightingale, F. (1859/1946). Notes on nursing: What it is, and what it is not. Philadelphia: J. B. Lippincott Co. (Facsimile of the first edition that was printed in London by Harrison & Sons, 1859.)
NTRS Council of Past Presidents. (1982, October 26). Minutes of the meeting.
OMorrow, G. S. (1980). Therapeutic recreation: A helping profession. Reston, VA: Reston.
OMorrow, G. S. (1986). National Therapeutic Recreation Society: The first twenty years: 1966-1986. Ashburn, VA: National Recreation and Park Association.
Park, D. (1981). Philosophical Issues Report. NTRS document.
Park, D. (1983). Memo to founding members. September 30.
Park, D. (1984a). Memo to founding members. March 2.
Park, D. (1984b). Memo to all founding members. May 22.
Phillips, B. E. (1952a). Hospital recreation is unique. Journal of the American Association for Health, Physical Education and Recreation, 23(5), 29-30, 35.
Phillips, B. E. (1952b). Recreation therapy. Journal of the American Association for Health, Physical Education, and Recreation, 23(6), 23-24.
Program of recreation. (1919, January 27). The Red Cross Bulletin.
Rainwater, C. E. (1992). (See Knapp & Hartsoe, p. 4) The play movement in the United States. Chicago.
Romney, G. O. (1945). Off the job living. Washington, DC: McGrath Publishing Co. and National Recreation and Park Association.
Scholarship program. (1947). Washington, DC: The American National Red Cross.
Schuyler, D. (1944, March 8). Conference with Col. Menninger. American Red Cross Archival File, 616.22.
Simon, P. (1971). Play and game theory in group work: A collection of papers by Neva Leona Boyd. Chicago: University of Illinois at Chicago Circle.
Stevenson, G. S. (1951). Mental hygiene concept of recreation in the national emergency. Recreation Service Exchange Bulletin. (American Red Cross), June, 1.
Summers, L. (1962). The American Red Cross program of recreation in military hospitals: A retrospective view. Recreation in Treatment Centers, 1, 18-21.
Sylvester, C. (Ed.) (1987). Philosophy of therapeutic recreation. Ashburn, VA: National Recreation and Parks Association.
Wenzel, K. (1998, May, June, July). Presidents message. NTRS Report, 23(3), 1-5.
Wolffe, J. B. (1962). Recreation, medicine and the humanities. North Carolina Recreation Commission Bulletin, No. 30, 18-21.
Woodham-Smith, C. (1951). Florence Nightingale: 1820-1910. New York: McGraw-Hill.