Activity Therapies
Activity Therapies
Activity Therapies
ACTIVITY THERAPIES
developed and were categorized by their purpose. The first kind \was designed to
provide diverincry activities, primarily through the use of arts and crafts, hospitalized
persons were caught to make simple objects such as ashtrays, leather slippers, and
wallets. Other activities as painting and sculpturing were also available. Some patients
were quite talented in these areas and created objects that were not only aesthetically
pleasing but that also could be sold for profit. Many persons, however, used these
activities merely as a means of shiling away the hours in an effort so combat the
medium of long-term hospitalization.
The second type of occupational therapy at that time involved the functional
usefulness of the activity. Large state mental hospitals, in particular carried on the
centuries old conditions of silating the mentally ill in rural settings that were designed
to be as self-sufficient as possible. This means that the hospital often includes a
machine shop, heating plant, farm, kitchen, and laundry. These departments were
major enterprises since they had to meet the living needs of thousand of patients as
well as many of the staff who lived on his hospital’s grounds. Clients who were able
to work were assigned task that included farming, meal preparation and serving,
cleaning, sewing, machine maintenance and repair, and grounds maintenance.
Although there is no doubt that many clients learned valuable skills as result of these
activities, economic factors played a large part in their use that did therapeutic factors.
Clients who worked in the hospital were not paid even a token salary; in fact it was
seen as a privilege to be given a work assignment. Therefore the hospital did not have
to employ outside workers. Contributing to the overall welfare of the institution and
its inmates must certainly have created a sense of dependency on the hospital, thereby
increasing the syndrome of institutionalization.
Aside from these activities, the field of activity therapies was still very limited,
since many authorities believed that the best treatment for emotional illnesses was a
strict regime of rest and inactivity. This belief resulted on many persons spending
their days sitting side-by-side on uncomfortable ward benches not having sufficient
ego strength to interact with each other or to structure their time in a meaningful way.
The trained nurses who worked in such settings must be given credit for seeing the
lack of therapeutic effect of idleness and for attempting to engage patients in
diversionary or functional activities. In fact, the first book written on the subject of
occupational therapy was writte4n by a nurse, Miss Susan E. Tracy. This book
“Studies in Invalid Occupation”was published in 1910. Miss Tracy also give the first
course of instruction on the subject in 1906 at the Adams Nervine in Boston. As such,
nurses were the first occupational therapists, although the term was not used not until
1921.
Activity programs for mentally ill patient were formerly called workoures and
moral treatment. These terms provide insight into both the way in which mental
illness was conceptualized at the time as well as the dominance of the word ethnic in
activity, regardless of its purpose or outcome. It was not until 1921 that the term
“occupational therapy” was coined and defined. After that time, activity programs for
the mentally ill increased, but their primary purpose was to keep the patient busy, with
scant attention paid to the therapeutic benefits that could be achieved. In recent
decades, with advent of a greater number of professionally trained activity therapists,
there has been increased recognition for the positive role the discipline can play in the
diagnosis and treatment of emotional disturbances.
All activity therapies have in common the fact that they are purposely designed to
achieve a specified goal, and the role therapists is observe, direct and guide the
client in the activity. The therapists continuously assesses the client’s reactions to
the activity both as a means of providing information to the other memers of the
treatment team and as a basis on which to alter the activity as the need of the
client change.
Occupational Therapy
Occupational therapy is defined by the American Occupational Therapy
Association as the art and science of directing man’s response to selected activity to
promote and maintain health, to prevent disability to evaluate behavior, and to treat or
train clients with physical of psychosocial dysfunction. This bread definition
compasses many activities, and thus the occupational therapy department is usually
the largest of the activity therapy departments is usually the largest of the activity
therapy departments found in mental health settings. Although all occupational
therapists have an educational and experiential background in the use of a wide
variety of activities for many purposes, most develop particular expertise in the use a
few activities for many purposes, most develop particular expertise in the use of a few
activities for a specified purpose. For example, occupational therapists who work with
the mentally ill have more skill in the utilization of objects that help people identify,
express, and resolve their feelings, than they do in the utilization of objects that are
designed physically handicapped in carrying out the activities of daily living.
Although occupational therapy can be carried out in almost any setting, most
mental health centers have an occupational therapy departments to which clients go.
This setting may be one or large, brightly decorated rooms that contains types of
equipment, which is organized into different section of the rooms. For example, all
the artistic supplies may be on one side of the room and the weaving and sewing
equipment on another. The advantage of this arrangements is more than
organizational in that clients who are engaged in similar kinds of activities will be
working in physical proximity to another, which promotes social interaction. Often
persons who lack the social skills required to converse spontaneously with others will
be able to do so if they can focus their conversation on an object in which all are
interested. An individual’s self-esteem can be increased by the positive regard shown
by others for a painting or other project on which he’s working.
RECREATIONAL ACTIVITY
Recreational therapy is described as the use of recreational activities,
including but not limited to games, sports, crafts and discussion groups, community
functions for the purposes of aiding the client’s recovery from illness and injury and
assisting him in his adjustment to hospitalization. The latter purpose of recreational
therapy has been widely known and utilized in the past through the use of
diversionary activities. It has not been recently, however, that the therapeutic effects
of recreational activities have been recognized. A dramatic example occurs when a
group of schizophrenic individuals who have probably never achieve the
developmental tasks of learning how to compete and compromise are successful in
engaging in a team sport such as basketball or football. Card games such as bridge
that require the cooperation between two players can accomplish the same objective
in a less dramatic but equally effective manner.
One of the many values of recreational therapy is to help the client develop
skill in diversionary activity that he finds enjoyable that he can engage in by himself.
Some emotionally disturbed individuals become immobilized when left by themselves
with nothing to do. This can result in a marked increase in anxiety, causing the
individual to retreat into a fantasy world or utilize other unhealthy defenses. The
person who is helped to develop an interest in such activities as stamp or coin
collecting will be helped to develop a socially constructive and emotionally healthy
means of coping with unstructured time. This goal is particularly appropriate for
persons whose depression has been precipitated by such events as retirement from an
active career of the youngest child’s leaving home.
MUSIC THERAPY
For reasons that are not clearly known, many emotionally disturbed persons
derive a great deal of enjoyment from music. In fact it is not unusual for a several
emotionally disturbed person who seems unresponsive to everything else to respond
to music. Music therapy is described simply as the purposeful use of music as a
participative or listening experience in the treatment of clients to improve their health.
Mental health centers with sufficient financial resources provide a music library for
their clients. Clients are encouraged to select records to play in soundproof rooms.
The person’s selection is often an indication of his emotional state at the time; persons
who feel sad tend to select music that expresses sadness and the client may even cry
while listening. This emotional response may sometimes misinterpreted by the staff as
meaning that the client should be directed toward music that is more cheerful, rather
than being recognized as a therapeutic emotional release. Changes in the nature of the
person’s selection of music overtime provide some indication as to the progress he is
making in the treatment. Group activities structured around music are also a
commonly used therapeutic endeavor. Clients discuss not only the history of the
musical selection and its composer but also can be helped to discuss the feelings the
music but learn that others may share these feelings, thereby decreasing his sense of
aloneness.
VOCATIONAL THERAPY
Vocational therapy is sometimes termed industrial therapy. This form of
activity therapy deals with the development and provision of therapeutic work
opportunities for clients under medical care, especially for those who are emotionally
disturbed. Many sick persons have never developed an occupational skill or find
themselves unable to engage in the occupation for which they are trained. Vocational
therapy recognizes that in American society the ability to earn a living is a major
factor in enhancing a person’s self-concept and thereby his mental health. Vocational
therapists are often trained in the administration and interpretation of vocational
interests and aptitude tests. After the results have been interpreted by the therapist, he
head the client engage in the discussion about the results and mutually evolve a plan
whereby the client will improve an existent skill or develop a new one. Whenever
possible the client is helped to develop these skills in an on the job setting where he is
paid as he learns.
The purpose of vocational therapy is not to find something for the client
merely to pass the time or to utilize his abilities to meet the needs of an institution but
rather to place the client in a situation where he will be able to develop skills that will
be relevant and applicable in the future. Therefore it is important that the client’s
needs of the work situation be closely matched. This sometimes means that the client
will work in the mental health setting itself doing such jobs in the community since
the community needs are wider in scope that are the needs of the institution, thereby
providing larger variety of appropriate work opportunities. Positive relationships
between the community and the mental health center are therefore becoming
increasingly important. Although many employees in the community have little, if
any understanding of the dynamics of mental illness, most have been found to be very
cooperative when the vocational therapist takes the time to elicit their help.
Some clients who are still hospitalized may progress to the point that they are
working in the community full time through the vocational department of the hospital
then return to the unit in the evening. If these instances, the most qualified nursing
staff should be available during these times when the clients are present rather than
automatically working during the day, as is usually the case. Halfway houses provide
the best setting for such a client, but these are not always available.
It should be noted that vocational therapy not only provides the client with the
opportunity to learn and practice a marketable skill but also with the opportunity to
interact with peers in a work situation. Some clients quickly become skilled in the
assigned tasks but have difficulty in relating with co-workers. The sensitive
vocational therapist will recognize these problems and either help the clients deal with
the more suggest that the interpersonal difficulties be discussed in
psychotherapeutically oriented sessions.
EDUCATIONAL THERAPY
Educational therapy is closely related to vocational therapy but has as its
specific focus the gathering of information and providing the clients with credentials
rather done the development of skills. Some clients have never completed high school
or may have begun but not completed their college education, due to their emotional
disturbance. This is not to say that all these persons are intellectually incompetent but
rather that their emotional problems have interfered with their intellectual
achievement. In American society, having the proper credentials is seen as a pre-
requisite to many types of employment and one of the goals of the educational
therapist is to assist such an individual to complete his education usually through non-
traditional routes such as the High School Equivalency program or external degree
programs. The establishment of programs of this type many states has provided the
emotionally disturbed individual with an opportunity to obtain credentials without
further lowering his self-esteem by forcing him to attend classes with persons much
younger than him.
Educational therapy is also utilized in instances where the client has problems
that result from a great deal of misinformation. Although this problems may be
emotional, they may partially stem from years of reinforcement of inaccurate
information. The educational therapist has the opportunity to provide the client with
readings and learning experiences that can do a great deal to eliminate this
misinformation and resultant anxiety. The emotional conflict that this precipitates is
usually explored in psychotherapeutic sessions, but is sometimes dealt with by a
skilled educational therapist.
The nurse has an important role in enhancing the therapeutic effects of activity
therapies. The activity in which a client is engaged elicits different feelings in which
he will express not only to the therapist but also to the nurse.
Close coordination between the nursing staff and the activity therapist is
essential. The activity therapist usually takes the initiative to establish and maintain
this coordination, but the nursing staff member should be receptive to the conference
thereby acknowledging the therapeutic value of activity therapies in the total
treatment program.
The nurse’s interest in the client’s project enhances the therapeutic effects of
the activity therapies. This is particularly true if the client’s program of activities
centers around the activities of daily living because the nurse is in a position to
supervise and reinforce the use of these skills learned in activity therapy. It is, also the
nurse who has often has the opportunity to gather clients together in formal groups.
The projects being worked on in the activity therapy program provide an excellence
topic for discussion.
REMOTIVATION-MODIFIED
These are five steps upon which Group Conversation Activity is based: