A cross-cultural critique of newer therapeutic recreation practice models: The self-determination and enjoyment enhancement model, Aristotelian good life model, and the optimizing lifelong health through therapeutic recreation model
Dieser, Rodney B
Three years ago, Dieser and Peregoy (1999) provided a multicultural critique of the Leisure Ability model, the Health Protection/Health Promotion model, and the Therapeutic Recreation Service Delivery/Outcome model. Since then, three new practice models have been developed. These include the Self-Determination and Enjoyment Enhancement model, the Aristotelian Good Life (AGL) model, and the Optimizing Lifelong Health Through Therapeutic Recreation model. The purpose of this paper is to add to the discussion regarding cross-cultural appropriateness of therapeutic recreation practice models. In particular, building upon and paralleling the multicultural critique by Dieser and Peregoy (1999), this article used Pedersen’s (1994) culturally biased assumption framework of human services to provide a multicultural critique of these three newer practice models. Of the three therapeutic recreation practice models reviewed in this paper, the Aristotelian Good Life model has few culturally biased assumptions. The Self-Determination and Enjoyment Enhancement model and the Optimizing Lifelong Health Through Therapeutic Recreation model have many culturally biased assumptions. In regard to cross-cultural therapeutic recreation service delivery, a partnership among a therapeutic recreation specialist who has a solid understanding of cross-cultural differences and the AGL model has a high probability of fostering multicultural therapeutic recreation service delivery. Future recommendations regarding cross-cultural therapeutic recreation practice models and service delivery are provided.
KEY WORDS: Culture, Culturally Biased Assumptions, Multiculturalism, Therapeutic Recreation Practice Models
A common element of a profession is a distinct body of knowledge that separates it from an occupation or other professions (Edginton, Jordan, DeGraaf, & Edginton, 2002; Greenwood, 1957; Sessoms, 1991; Wilensky, 1964). The following quotation from Sylvester (1989) describes the manner in which a profession develops from a body of knowledge: A profession, therefore, is based on a body of theory-knowledge, which is founded on and funded by ideas … without a valid body of knowledge, practitioners would literally have no idea of what to do, how to do it, and most importantly, why they do it (p. 2).
Although the profession of therapeutic recreation has been developing a distinct body of knowledge for many years (e.g., Compton & Price, 1975; Frye & Peters, 1972; Peterson & Gunn, 1984), therapeutic recreation took a step toward professional clarity in 1998 when a special series issue of the Therapeutic Recreation Journal dedicated the second, third, and fourth journal to dialogue and development of differing therapeutic recreation practice models.’ This discussion expanded beyond these three journal issues and included the development of new models (e.g., Wilhite, Keller, & Caldwell, 1999), personal response letters (Dieser, 1999; Witman, 1999) and an excellent summary article of therapeutic recreation pracrice models (Mobily, 1999). However, during this time period only one article, which appeared in the Annual of Therapeutic Recreation, was dedicated to understanding therapeutic recreation practice models from a multicultural perspective (Dieser & Peregoy, 1999). In that article, Dieser and Peregoy, building upon Pedersen’s (1994) culturally biased assumption of human services, critiqued the leisure ability model (Stumbo & Peterson, 1998), the health protection/health promotion model (Austin, 1998) and the therapeutic recreation service delivery/outcome model (Van Andel, 1998). Dieser and Peregoy (1999) posited:
Of the models reviewed in this paper, all three have culturally biased assumptions. Both the leisurability and health protection/health promotion models assume that [Euro-North American] individualistic values are normal across culture … The therapeutic recreation service delivery and outcome model does have some important multiculturally sensitive assumptions, but could become more multiculturally inclusive with adaptations (p. 64).
Dieser and Peregoy concluded their multicultural critique by suggesting that these three therapeutic recreation practice models should not be used blindly across culture. Rather, these practice models should be modified to meet the needs of differing cultural groups.
The purpose of this paper is to add to the discussion regarding cross-cultural appropriateness of therapeutic recreation practice models. Since Dieser and Peregoy’s (1999) multicultural critique of therapeutic recreation practice models, three new practice models have been developed. These include the Self– Determination and Enjoyment Enhancement model (Dattilo, Kleiber, & Williams, 1998), Aristotelian Good Life model (Widmer & Ellis, 1998), and the Optimizing Lifelong Health Through Therapeutic Recreation model (Wilhite et al., 1999). Building upon and paralleling the multicultural critique by Dieser and Peregoy (1999), this article will also use Pedersen’s (1994) culturally biased assumption framework of human services to provide a multicultural critique of these three newer practice models. Understanding cross-cultural issues is paramount because a lack of culturally sensitivity and understanding can harm clients, rather than help them (Waldram, 1997; McIntosh, 1986; Sue & Sue, 1990). For example, Dieser’s (2002) personal narrative highlighted how the lack of cross-cultural competencies among human service professionals, including therapeutic recreation intervention, ended with two clients from ethnic minority backgrounds prematurely terminating treatment. Hence, the first section of this paper will explain Pedersen’s (1994) culturally biased assumptions. This will be followed by an overview of the three newer therapeutic recreation practice models and a multicultural critique of each model.
Culturally Biased Assumptions in Human Services
Multicultural considerations and competencies are starting to become an integral aspect of professionalism within therapeutic recreation (see Austin, 1999; Dattilo, 1999; Dieser, 1997; Jacobson, Carruthers, & Keller, 2001; Peregoy & Dieser, 1997; Sylvester, Voelkl, & Ellis, 2001) and in other human services (Arrendondo, et al., 1996; Corey, 2001; Schram & Mandell, 2000; Schulman, et al., 1999; Turner & Turner, 1995). To this end, Pedersen (1994) underscored seven culturally biased assumptions that are prominent in the human service professions in North America.
The first culturally biased assumption is that people share a single measure of normal behavior. That is to say, this assumption suggests that the definition of normal behavior is universal across cultural backgrounds. An example of this culturally learned assumption is the dominant individualistic-oriented view in therapeutic recreation that people with special needs should gain independence (Peregoy & Dieser, 1997). In this regard, Mobily (1999) underscored the complacency of standardized thinking in therapeutic recreation practice models-there is an informal manner of normal behavior related to individualistically-oriented concepts of intrinsic motivation, perceived freedom and control, independence, and personal mastery. Recent research and scholarship in cross-cultural psychology and anthropology suggested that individualistic and independent self-oriented concepts such as independence, personal freedom and control, and intrinsic motivation are not universal notions; rather, they are values associated with White Euro-North American individualistic cultures (Choi, Nisbett, & Norenzayan, 1999; Heine, Lehman, Markus, & Kitayama, 1999; Iyengar & Lepper, 1999; Rose, 1998). Moreover, Iyengar and Lepper (1999) argued that:
So ingrained is the American assumption that people will find choice intrinsically motivating that psychologists have rarely paused to examine the more general applicability of these findings … Now consider a different cultural context, one in which the participants possess a more interdependent model of the self … Interdependent selves, therefore, might sometimes actually prefer to submit to choices expressed by others if the situation enables them to fulfill superordinate cultural goals of belongingness (p. 350).
Furthermore, cross-cultural scholars have argued that self and internal-oriented concepts, such as self-actualization, self-esteem, and independence may not be appropriate wellness variables for people who embrace collectivistic values2 (Choi, et al., 1999; Heine et al., 1999; Iyengar & Lepper, 1999; Matsumoto, 1996), such as American Indian (LaFromboise, Trimble, & Mohatt, 1990) and First Nation communities in Canada (Mawhiney, 1995; Waldram, 1997).
A second culturally biased assumption is that individuals are the basic building blocks of a society. In therapy and human services, this assumption is illustrated when intervention is primarily directed toward the development of individuals rather than groups or social variables that an individual is affiliated with, such as family or tribal systems. Although an individualized or person centered approach is advocated by many therapeutic recreation scholars and practitioners (e.g., Austin, 1999; Bullock & Mahon, 2000; Carter, et al., 1995; Peterson & Stumbo, 2000), such an approach is premised upon Euro-North American values of individualism. Sue and Sue (1990) argued:
Such terms as “person-centered” or “person-blame” indicate a focus on the individual… In essence, these people adhere strongly to the Protestant ethic that idealizes “rugged individualism.” On the other hand, “situation-centered” or “system-blame” people view the sociocultural environment as more potent than the individual (p. 143-144).
To this end, Triandis (1995) reported that three-quarters of psychotherapists who work in the United States premise therapy on individualistic values and lack skills to work with clients from collectivistic cultures.
The third assumption is that differing clients understand abstractions in the same way that human service workers intend them. Constructs have little meaning without putting the concepts in a contextual setting. For example, the term self-determination has differing definitions depending upon historical, contextual, and cultural perspectives. Within a Euro-North American leisure theory perspective, Dattilo (2002) defined self-determination as a feeling of being the origin of the activity. The concept of self-determination in certain American Indian cultures refers to collectivistic action in which a group can control its destiny and behaviors (Edwards, Drews, Seaman, & Edwards, 1994). These two definitions of self– determination vary greatly due to a cultural context.
The fourth assumption is that independence is desirable and dependence is undesirable. Although independence is a value held by the majority of people living in Canada and the United States, many cultures do not embrace independence-rather, they view interdependence and dependence as healthy and absolutely necessary. For example, Hofstede’s (1991) classic study highlighted that the majority of people in the United States, Australia, Britain, and Canada embrace individualistic values and the majority of people residing in Pakistan, Colombia, and Venezuela embraced collectivistic values. Furthermore, within the United States some people from minority backgrounds (e.g., Asian-Americans, Mexican-Americans) believe that interdependence and dependence are more important than independence (Matsumoto, 1996).
The fifth culturally encapsulating assumption is that clients are helped more by formal therapy than by their culturally appropriate support systems. Often cultural ly-oriented support systems, such as a sweat ceremony for First Nation people, are viewed as trivial or secondary by human service professions (Herberg & Herberg, 1995; Waldram, 1997). Waldram (1997) articulated how symbolic healing during First Nation spiritual ceremonies is critical to overall health: “Although technology can rid one of disease, ‘healing’ can only occur where the medical system is interpretable between the healer and patient” (p. 71). Additionally, Waldram underscored how contemporary biomedicine has constructed a system of treatment that is premised upon the assumption that the mind and body are separate biological entities, which is a foreign and confusing paradigm to many First Nations people.
The sixth assumption is that all people depend upon linear thinking to understand the world around them, where each cause has an effect and each effect is attached to a cause. Moreover, people from differing cultures may perceive cause and effect as two aspects of the same undifferentiated reality with neither cause nor effect being separate from each other. Lee and Armstrong (1995) and Ross (1992) underscored how differing cultures (e.g., First Nation people) value circular thinking and intuitive reasoning. Mobily (1999) highlighted that many therapeutic recreation practice models are premised upon linear thinking-which is not an appropriate treatment assumption for people from cultures that embrace circular reasoning.
The seventh assumption is that cultural history is not relevant for a proper understanding of a client or contemporary issue. Regarding social and human services, Turner (1995) highlighted that professional helpers should understand the historical basis of differing clients (e.g., ethnicities, nationalities): “Scholars learned many centuries ago that history has much to teach us about present society and perhaps most of all about human complexities. We can learn from the success and failures of history . . .” (p. 75). Understanding the cultural history of clients, such as the dynamics of oppression and racism,3 improves program interventions because they add greater breadth, depth, and clarity to the client’s life, worldview, and problematic behaviors (McFadden, 1993). In this regard, cross-cultural psychologists (e.g., Ridley, 1985; Sue & Sue, 1990) underscored how clients from ethnic minority cultures can experience differing degrees of healthy and unhealthy paranoia in which they have a suspicion and distrust for White therapists. Recently Dahl, Dieser, Fox, Kahakalau, Martin, and Trillo (2002) raised numerous concerns with the oppressive practices of leisure education models, theories, and practices grounded in Euro-North American individualistic perspectives-contemporary leisure education interventions lack a solid understanding of differing cultural histories.
The subsequent section will briefly explain the Self-Determination and Enjoyment Enhancement model, the Aristotelian Good Life model, and the Optimizing Lifelong Health Through Therapeutic Recreation model in relation to Pedersen’s (1994) seven culturally biased assumptions, The last section of this paper will summarize these models and provide recommendations for future development of therapeutic recreation practice models and service delivery.
Therapeutic Recreation Practice Models
Models are paramount in therapeutic recreation practice because they guide the practitioner in the process of intervention (Austin, 1999; Bullock & Mahon, 2000). A practice model provides the framework for selecting, sequencing, and organizing therapeutic recreation intervention (Bullock, 1998; Bullock & Mahon, 2000). That is to say, practice models provide professionals with a framework for thinking; models shape what professionals see, the questions professionals ask, and the answers professionals provide (Freysinger, 1999).
Self-Determination and Enjoyment Enhancement Model
The Self-Determination and Enjoyment Enhancement (SDEE) model of therapeutic recreation service delivery initially began with a theoretical explanation of the relationship between self-determination and enjoyment (Dattilo & Kleiber, 1993). Dattilo et al. (1998) described the manner in which therapeutic recreation services and strategies can foster the relationship between self-determination and enjoyment, ultimately leading to an increase in functional improvement. According to Dattilo et al. (1998) this model has six components. First, self-determination involves acting as a primary causal agent in making choices. Second, intrinsic motivation is activity engaged in for its own sake. Third, perception of manageable challenge is the ability of a person to manage changes so that the challenge presented by the activity and the skill level of the participant can match. Fourth, investment of attention occurs when attention becomes fully invested, when goals are clear, when feedback is relevant, and when challenge and skill levels are balanced. Fifth, enjoyment or flow occurs when an individual becomes deeply absorbed in a leisure activity. Enjoyment occurs when there is a match between the challenge presented by the activity and the skill level of the participant. Sixth, functional improvements occur “when participants access enjoyment and create environments conducive to enjoyment” (p. 262). The ultimate goal of this model is to enhance functional improvement within any health domain (e.g., physical, emotional).
Dattilo et al. (1998) posited that in regard to the four components of self determination, intrinsic motivation, perception of manageable challenge, and investment of attention, therapeutic recreation intervention or strategies can help guide the client to enhance enjoyment (which will ultimately lead to functional improvement). During the self-determination component, therapeutic recreation strategies can be utilized to develop self-awareness in leisure contexts, encourage decision making skills, provide participants with opportunities to express preferences and make choices, create supportive environments that stimulate participants to communicate needs and preferences, and advocate goal setting. In the intrinsic motivation phase, therapeutic recreation interventions can be used to emphasize the inherent rewards while participating in leisure, learn to listen to positive feedback about individual performance as opposed to comparison to other people, encourage competition against oneself or internal standards, and gain exposure to activities or self-examination of potential interests so that the participant will become intrinsically motivated in some type of activity. During the perception of manageable challenge component, therapeutic recreation interventions can be used to teach clients how to assess their skill levels to ensure a match between challenges and skills, learn to make adaptations associated with leisure activities to sustain a match between challenges and skills, help to teach how to gain a realistic appraisal of the degree of challenge associated with a leisure endeavor, and develop activity skills. In the investment of attention phase, therapeutic recreation interventions can be utilized to reduce distractions from activities that produce enjoyment and alleviate maladaptive attributions for success and failure-failures should be attributed to external factors and success to internal causes. Providing therapeutic recreation interventions in these four components enhance enjoyment and result in an improvement of functioning.
A Multicultural Critique of the SDEE Model
In relation to Pedersen’s (1994) culturally biased framework, the SDEE model has many culturally biased assumptions. First, numerous constructs (e.g., self-determination) imply that differing people share a single measure of normal behavior. The core leisure components of self-determination and intrinsic motivation are not universal norms and would be inappropriate for people from differing cultures (Fox, 2000a). Likewise, therapeutic recreation tasks such as developing self-awareness and using internal attributions for successes and external attributions for failures are Western-based individualistic values (Matsumoto, 1996). As mentioned early in this paper, individualistic and independent self-oriented concepts (e.g., internal attributes, intrinsic motivation) are values associated with White Euro-North American individualistic cultures (Choi, et al., 1999; Heine, et al., 1999; Iyengar & Lepper, 1999; Rose, 1998). For example, Asian psychotherapies such as Morita and Naikan therapy deflect attention away from oneself (the opposite of self-awareness) and internalize or accept problems (Walsh, 1995). This aspect of Asian psychotherapy is summarized in the following quotation by Walsh (1995):
Patients are taught to accept and reinterpret their symptoms (what Western behaviorists call reattributions) not as a sign of weakness and inadequacy, but rather as reflections of strong ideals … through engagements, attention is directed away from the self … The aim is to foster recognition of human interdependence, of how much we have received from others (p. 393).
This is in contrast to self-awareness and selfknowledge that is embraced in Western-based psychotherapies (Torrey, 1986) or by the SDEE model.
Likewise, this model also asserts that individuals are the basic aim of practice. Throughout the model, the onus is on the individual to change (e.g., assessing skills, making adaptations, focusing on internal standards, setting personal goals) and little attention is focused on changing social or collectivistic-based variables, such as the family or community. For example, Dattilo et al. (1998) posited that functional improvements should occur “When participants independently access enjoyment and create environments conducive to enjoyment” (p. 262, italic added). For diverse cultures that believe that a group or entire community is responsible for the functional improvements of a sole individual (Sue & Sue, 1990), this model would make little sense. Additional culturally biased assumptions of this model are its explicit and implicit axioms that independence is desirable, that clients are helped more by formal interventions, and the lack of a cultural history being used.
The Aristotelian Good Life Model
The Aristotelian Good Life (AGL) model of therapeutic recreation service delivery was initially premised on Peterson and Gunn’s (1984) leisurability model with an ethical extension rooted in Aristotelian ethics (Widmer & Ellis, 1997). Within a year, Widmer and Ellis (1998) reconceptualized the AGL model. The foundation of this model is built on the Aristotelian concept of happiness, which is eudaemonia. Eudaemonia is the habit of following the proper course of action throughout life. Likewise, in this model, three Aristotelian principles are needed to acquire a good life. First, the ethic of enough is the belief that too little or too much of anything leads to problems. There is no absolute or universal standard of what constitutes enough, rather enough takes into account individual and group variation. Second, real goods are those that lead to eudaemonia and apparent goods were sought for the sake of happiness, but usually thwart eudaemonia. There are two types of real goods, primary goods, which are associated with basic survival (e.g., biological needs) and secondary needs, which are associated with learning, creating, and developing meaningful relationships. Third, right desires are habits that lead one to the good life and wrong desires lead one away from the good life. In the AGL model the virtue of eudaemonism is the classic view of leisure, which is associated with activities by which people learn, grow, and thereby progress toward happiness.
In the AGL model there are three components and four roles for the therapeutic recreation specialist. First, affliction and opposition is characterized by a person having an illness or a disabling condition. The role of the therapeutic recreation specialist is that of a therapist who focuses intervention toward having the client gain real goods, specifically oriented toward primary goods. Second, Aristotelian goods embody target outcomes that move a client toward the secondary goods of learning, creating, and the developing of meaningful relationships. The role of the therapeutic recreation professional is an educator, in which his/her primary duty is to help the client make a transition toward the attainment of secondary goods from primary goods. Third, freedom and responsibility occurs when a client overcomes afflictions and opposition, and thus increases freedom (which ultimately leads to eudaemonia). The role of the therapeutic recreation specialist is that of a facilitator who aids the clients’ movement from secondary goods to happiness (or leisure). The last role of the therapeutic recreation specialist is that of a resource advocate, who simply supports the client’s involvement in leisure.
A Multicultural Critique of the AGL Model
Based upon Pedersen’s (1994) culturally biased assumption perspective, the AGL model has few culturally biased assumptions. First, the AGL model can be considered culturally sensitive primarily because the end state of eudaemonia, which is the habit of following the proper course of action throughout life, is not connected to a specific universal objective of normal behavior. Rather, it is up to the client and his/her cultural values to specify what secondary goods lead to learning, creating, and the developing of meaningful relationships. This lack of a universal standard is summarized by McCormick (1998):
I find that a strength of this model is that with its foundation in moral philosophy it begins with an assumption that the end state is not an objective certainty … In contrast, other models have offered end states (eg., appropriate leisure lifestyle, health) which have been seen as objective realities. Too often our field has proceeded to use practice models on the assumption that there is consensus on the end state; although we still debate the appropriateness of the various end states (p. 305).
To this end, a meaningful relationship can embrace diverse cultures, such as individualistic or collectivistic values. Likewise, the ethic of enough accounts for individual and cultural variation, thus a client’s cultural background and values would be the beacon of what is deemed appropriate intervention. Furthermore, having a flexible and generic-oriented end state is a recommendation that differing cross-cultural scholars have recommended both within therapeutic recreation (Dieser & Peregoy, 1999) and in other helping professions (Ibrahim, 1991; Pedersen & Jandt, 1996; Pedersen, 1991, 1994, 1999).
Second, the AGL model does not presuppose that individualistic values (e.g., independence) are desirable, nor does it assume that other people understand abstractions in the same way as the dominant culture. Rather, appropriate intervention depends upon the client (or group) and his/her cultural system. In this regard, Widmer and Ellis (1998) posited that the AGL model does not “. . . suggest an absolute standard of enough that applies to all human beings. Rather enough takes into account variation from individual to individual” (p. 293). Furthermore, this model does not assume that formal intervention is more appropriate than culturally appropriate support systems, again, it is flexible and it depends upon the cultural background of the client.
Third, although the AGL model does not include a formal cultural history, it does include an explicit discussion regarding human conditions that are relevant to cultural histories. According to Widmer and Ellis (1998), a human condition applicable to therapeutic recreation intervention can include “. . . challenges associated with oppression would include people disadvantaged because of discrimination by race, sex, ethnicity, disability, and other forms of group association and stereotyping” (p. 296).
Perhaps the AGL model primary culturally biased assumption is that it rests upon linear thinking-the therapeutic recreation specialist does have four distinct roles that move the client toward eudaemonia. This type of structuring may be problematic to some people from differing cultures. For example, Ross (1992) underscored how Native American reality can be premised upon circular reasoning and a perception that life is revolving. Thus, a linear progression toward happiness that has clear separations may not be appropriate; rather a circular approach where the therapeutic recreation specialist has a multidimensional and rotating role may be more appropriate. For example, a therapeutic recreation specialist could be a resource advocate and educator simultaneously in supporting a Native American healing ceremony in which intellectual virtues are aligned with gaining knowledge via communicating with relevant people living in a differing spirit world. Further, a therapeutic recreation specialist could then move into a facilitator role by supporting this same client to return to the land of his great-great grandfather to repeat past lives (see Ross, 1992). Following these three potential therapeutic recreation activities would underscore the multidimensional role and circular approach to therapeutic recreation via the AGL model.
The Optimizing Lifelong Health Through Therapeutic Recreation Model
Wilhite et al. (1999) developed the Optimizing Lifelong Health Through Therapeutic Recreation model (OHL-TR) for practice based upon the assumed need for intervention with the intent of influencing personal and leisure function of clients. The OHL-TR model is premised upon Baltes’ and Baltes’ (1990) developmental model of aging from a psychological perspective. According to Wilhite et al. (1999) the OHL-TR model has four basic principles: (1) clients become active agents in securing and maintaining their own well-being while maximizing their individual capacities for growth and creative adaptation, (2) health enhancement strategies are client– initiated and reflect self-determined decision making, (3) optimal health can be achieved by individualizing resources and opportunities, and (4) the therapeutic recreation specialist’s task is to help clients facilitate adjustments while allowing maximum client choice, control, and preservation of selfhood. Binkley (1999) advocated that a strength of the OHL-TR model is its universal trend in health and human services that clients should take an active role in their treatment and desire to be self-empowered: “the authors of the OHL-TR model have recognized the significance of this trend by incorporating self-empowerment and self-efficacy as key elements of their model” (p. 117).
There are four components to the OHL-TR model (Wilhite et al., 1999). First, selecting focuses attention on functional domains that match environmental demands with client capacities, which should maximize personal control and choice. During this stage, a therapeutic recreation assessment takes place and goal setting and recreation/leisure activities are selected. Second, optimizing is when the client engages in activities that maximize personal and environmental resources that make it possible for clients to pursue their chosen leisure. That is, during this stage activities are implemented that are premised upon a client’s intrinsic values. Third, compensating occurs when psychological, social, and technological compensatory efforts or adaptations take place when certain behavioral abilities are lost. For example, a client might substitute one recreation activity for another recreation activity. Fourth, evaluating addresses inputs (e.g., cost) with outputs (e.g., outcome measures) to gain information if recreation and leisure activities increase personal meaning and well-being. In summarizing the OHL-TR model, Wilhite et al. (1999) remarked:
The OHL-TR model recognizes that independent leisure functioning (i.e., with minimal support for TRSs and other care providers, family, friends) is not always possible or desirable. Thus, during the process of selecting, optimizing, compensating, and evaluating, individuals learn (a) that interdependent leisure functioning (i.e., with optimal support for TRSs and other care providers, family, friends) might be ideal and (b) that interacting cooperatively with others in a self-determined manner enables goal attainment. This perspective allows individuals with varying abilities to maintain maximum levels of personal control and active decision-making over the life course (p. 104).
That is, the ultimate goal of the OHL-TR model is to allow client self empowerment (Binkley, 1999).
A Multicultural Critique of the OHL-TR Model
In relation to Pedersen’s culturally biased framework, the OHL-TR model has many culturally biased assumptions. First, numerous constructs imply that differing people share a single measure of normal behavior-which in this case is self-empowerment and self-determination. Self-determination and self-empowerment are not universal norms and would be inappropriate for people from differing cultures. Empowering the self is premised upon an independent construal of self with ego– focused emotions-collectivistic cultures embrace an interdependent construal of self with other focused emotions and rely on other people (Markus & Kitayama, 1991). Hence, the “universal trend” in human services that clients should take an active role in their treatment and desire to be self-empowered (see Binkley, 1999, p. 117) is associated with people who have individualistic values and uphold an independent construal of self (Sue & Sue, 1990). Simply put, client self-empowerment is not a universal or cross cultural value.
Furthermore the OHL-TR model also asserts that individuals are the basic aim of practice. Throughout the OHL-TR model the onus is on the individual to change (a primary assumption is that people should become active agents in securing their well-being and maximizing individual capabilities and growth) and little attention is focused on collectivistic-based variables, such as the family or community. Although the OHL-TR model acknowledges interdependence, it is clear that interdependence is secondary to independence. Interdependence is an option or an ideal if independent leisure functioning is not possible (see Wilhite et al., 1999). The emphasis of individualism and independence is clearly expressed by Freysinger (1999):
… there is a tendency in the OHL-TR model to focus on the individual and individual change. Even though the authors acknowledge the role of the environment (e.g., families, communities, and health care providers) in constructing disability and “recovery,” the model is essentially individualistic. It is the individual who needs to adapt and the individual who has choices. It is up to the individual (with the assistance of the TRS) to make choices about for healthy leisure lifestyle (p. 112).
As already mentioned in this paper, many cultures believe that the entire community is responsible for the functional improvements of a sole individual (Sue & Sue, 1990; Waldram, 1997). Hence, this model would have little or no relevance for collectivistic-oriented American-Indian clients who believe that the entire community is involved in his/her intervention plan (see LaFromboise et al., 1990). Further, the focus on independence and individualism also connects with the culturally biased assumption that independence is desirable. Other culturally biased assumptions of the OHL-TR model are that it depends upon linear thinking (linear components of selecting, optimizing, compensating, and evaluating) and that a cultural history is not relevant to therapeutic recreation practice.
Of the three therapeutic recreation models reviewed in this paper, the AGL model (Widmer & Ellis, 1998) is sensitive to the culturally biased assumptions outlined by Pedersen (1994). The SDEE model (Dattilo et al., 1998), and the OHL-TR model (see Wilhite, et al., 1999) have many culturally biased assumptions.
Future Directions and Recommendations
Although therapeutic recreation scholars and practitioners have developed three differing practice models in the past three to five years, two of the three newer therapeutic recreation practice models critiqued in this paper are premised upon Euro-North American culturally biased assumptions. That is to say, in regard to Pedersen’s (1994) North American culturally biased assumption of human services, the SDEE model and the OHL-TR model maintain numerous dominant-oriented cultural biases and should not be used blindly across cultures unless cultural adaptations occur.4 Furthermore, combining the three therapeutic recreation practice models that were critiqued from a cross-cultural perspective in this paper with the three practice models previously critiqued by Dieser and Peregoy (1999),5 suggests that the only therapeutic recreation practice model which has relatively few culturally biased assumptions is the AGL model. In regard to cross-cultural therapeutic recreation service delivery, a partnership among a therapeutic recreation specialist who has a solid understanding of cross-cultural differences (see Peregoy & Dieser, 1997) and the AGL model has a high probability of fostering cross-cultural therapeutic recreation service delivery.
In regard to developing therapeutic recreation practice models, Mobily (1999) challenged therapeutic recreation professionals to think differently about leisure behavior and therapeutic recreation practice. Building upon Mobily’s thinking, the following section outlines three suggestions regarding future directions for the development of cross-cultural therapeutic recreation practice models and service delivery: conduct a cross-cultural assessment to judge appropriate therapeutic recreation practice models, include and develop cross-cultural perspectives and assumptions from diverse academic and cultural fields in therapeutic recreation practice models, and embrace multicultural perspectives at the individual and organizational level so that crosscultural therapeutic recreation practice can be developed.
Conduct Cross-Cultural Assessment to Judge Appropriate Therapeutic Recreation Practice Models
In choosing an appropriate therapeutic recreation practice model, it is imperative that therapeutic recreation specialists gain an understanding of the client’s worldviews and values. For example, if a client from an ethnic minority culture values a Euro-North American definition of self-determination, utilizing the SDEE model may be appropriate. However, if another client from an ethnic minority background values dependency and collectivistic values, using the SDEE model may cause harm by creating cultural or cognitive dissonance (see Dieser, 2002). Hence, a therapeutic recreation cross-cultural assessment to determine client values and collect cultural relevant information is paramount (Sylvester et al., 2001). Building upon the academic work of Ridley, Li, and Hill (1998), Sylvester et al. (2001) provided fifteen recommendations oriented toward multicultural considerations for assessment.
Furthermore, Lonner and Ibrahim (1989) argued that before implementing any therapeutic intervention clients should be assessed culturally to make possible the development of appropriate treatment goals and practices. To this end, Ibrahim and Kahn (1987) developed the Scale to Assess World Views (SAWV) to help human service professionals understand client values and provide greater clarity to the issues that bring clients to helpers. Moreover, Ibrahim (1991) suggested that the following cultural identity information should be gathered in an interview assessment:
* Sociopolitical histories of client’s cultural group.
* Language(s) spoken.
* Impact of gender from an ethnic/cultural and majority culture perspective.
* Neighborhood influences.
* Family life/cycle history.
Utilizing a cultural identity interview or SAWV should be used by a therapeutic recreation specialist to judge an appropriate therapeutic recreation practice models. Client values should be aligned with practice model value assumptions.
Include and Develop Cross– Cultural Perspectives and Assumptions from Diverse Academic and Cultural Fields into Therapeutic Recreation Practice Models
A second future action is to include and develop cross-cultural perspectives from diverse academic and cultural fields. Although there are many differing ways to include and develop cross-cultural perspectives, this section will include three methods: (1) using generic goals and assumptions within therapeutic recreation practice models, (2) employing therapeutic practice models in a flexible manner in partnership with ethnic and cultural groups, (3) constructing a therapeutic recreation practice model that extends beyond the complacency of standardized thinking in therapeutic recreation and other mainstream human service professions.
First, therapeutic recreation practice model goals and assumptions can be used in a generic and broad manner so that therapeutic recreation specialists can adapt practice models to meet the needs of clients from diverse cultures (Dieser & Peregoy, 1999). For example, in the SDEE therapeutic recreation practice model self-determination can be a generic term that can have a flexible definition related to both Euro-North American definitions of self-determination (see Dattilo, 2002) and American Indian definitions of self-determination (see Edwards et al., 1994; Waldram, 1997). As already mentioned in this paper, having flexible and generic goals and assumptions is a recommendation that differing cross-cultural scholars have recommended in human service professions (Ibrahim, 1991; Pedersen & Jandt, 1996; Pedersen, 1991, 1994, 1999; Matsuoka & Sorenson, 1991).
Second, therapeutic recreation specialists can use therapeutic recreation practice models in a flexible manner in partnership with a culturally different group (e.g., ethnic-oriented human service agency), thereby drawing on the expertise of both sectors (Dieser & Wilson, 2002). As such, culturally-oriented human service organizations (e.g., the National Alliance for Hispanic Health) could suggest differing aspects of a therapeutic recreation practice model that is appropriate and inappropriate for certain clients. For example, within the AGL therapeutic recreation practice model an American-Indian Elder might suggest that becoming independent during a leisure lifestyle is a wrong desire and developing a dependent leisure lifestyle is a right desire.
Third, a therapeutic recreation practice model could be constructed that extends beyond the complacency of standardized thinking from past therapeutic recreation practice models and human service delivery. For example, although there are differing definitions and concepts of leisure, leisure theory is still fundamentally rooted in a Euro-North American perspectives (Fox, 2000a; Chick, 1998; Mannell & Kleiber, 1997; Walker, Deng, & Dieser, 2001; Wearing, 1998). In this regard, therapeutic recreation educators and practitioners need to conduct research and empirical practice toward understanding the manner in which differing cultures experience leisure (see Chick, 1998; Gramann & Allison, 1999). For example, Fox (2000a) underlined that the Native Hawaiian concept of leisure combines the elements of manawa (lingering, gentle ebb of water across a tranquil bay) and nenea (relaxing or at ease with gentle voices of the birds). Such elements of leisure are very different from the traditional Euro-North American social psychological approach to leisure that focuses on perceived freedom and intrinsic motivation.
Furthermore, a therapeutic recreation practice model could be developed that is in opposition to Pedersen’s (1994) culturally biased assumptions in human services. As such, a practice model could be developed that is built upon some, or all, of the following assumptions:
* People do not share a single measure of normal behavior.
* Individuals are not the basic building blocks of society or therapy.
* Clients understand abstractions (e.g., leisure) in differing ways than therapeutic recreation specialists.
* Dependence and interdependence is a value held by certain clients.
* Clients are helped more by culturally appropriate support systems than by formal therapy.
* Clients rely on circular thinking instead of linear thinking.
* A cultural history and assessment is relevant within a practice model.
Furthermore, therapeutic recreation practice models could be developed from research and theories regarding health, wellness, and quality of life drawn from diverse academic and cultural fields. Academic fields such as anthropology, cultural studies, family ecology, feminist studies, First Nation studies, natural resources management, philosophy, and sociology offer knowledge regarding differing concepts of health, wellness, and disabilities. For example, Machlis, Force, and Burch’s (1997), human ecosystem framework provides an interdisciplinary understanding of human development from an ecological and environmental perspective. Social variables that influence human behavior include: social institutions (e.g., education), social order (e.g., social norms), social cycles (e.g., individual), cultural systems (e.g., beliefs), socioeconomic resources (e.g., capital), and natural resources (e.g., land). Additionally, understanding health, disabilities, or mental disorders from a sociological perspective (e.g., Eaton, 2001; Moore & Sinclair, 1995) would move therapeutic recreation specialists toward developing practice models that highlight the social contexts and variables that influence the lives of clients.
Embrace Multicultural Perspectives at the Individual and Organizational Level so that Cross-Cultural Therapeutic Recreation Practice can be Developed
To enhance the two future directions stated above, therapeutic recreation specialists and organizations need to gain cross-cultural competencies. Peregoy and Dieser (1997) developed a two-phases multicultural curriculum oriented toward therapeutic recreation practitioners and students. The first phase is oriented toward gaining an understanding of one’s own culture. To do this, therapeutic recreation specialists should gain awareness of attitudes and beliefs of their own culture, knowledge about their own cultures, and articulate multicultural skills within their own culture. For example, therapeutic recreation specialists can learn to identify the cultural assumptions of strategies used, such as identifying cultural assumptions of different therapeutic recreation practice models. The second step involves gaining an understanding of other cultures. To accomplish this, therapeutic recreation specialists need to develop awareness of attitudes and beliefs regarding differing cultures, knowledge about other cultures, and demonstrate multicultural skills pertaining to people from diverse backgrounds. For example, in regard to the SDEE model, therapeutic recreation specialists can learn to identify differences concepts of self, self-determination, and attributions.
Furthermore, therapeutic recreation organizations need to provide multicultural organizational policies (Allison, 2000; Dahl, 2000; Dieser & Wilson, 2002). By gaining organizational cross-cultural competencies, therapeutic recreation specialists will be in a better position to deliver therapeutic recreation intervention for people who are from differing cultures. The following points offer a sampling of possible cross-cultural organizational inclusion within the field of therapeutic recreation (Allison, 2000):
* Flexible and responsive organizational structure
* People of difference are integral in shaping organizational goals.
* Diverse teams work together at all level of the organization
* Organization reflects contributions and interests of various groups in mission and operation
* Organization is equitable, responsive, and accessible at all levels.
* Ongoing organizational assessment of success/failure with input from diverse constituents.
Although organization change is difficult, providing cross-cultural organizational inclusion provides a framework that promotes diversity not just in a therapeutic recreation setting or through therapeutic recreation practice models, but promotes diversity within society.
1 Therapeutic recreation practice models underscore a distinct body of applied knowledge which separates it from other human professions (see Austin, 1999; Voelkl, Carruthers, & Hawkins, 1997).
2 People who belong to collectivistic cultures give priority to the goals of a group (opposed to individual/personal goals) and perceive an interdependent self that is inseparable from specific social contexts which overlaps with relevant others (see Markus & Kitayama, 1991; Matsumoto, 1997).
3See Dickerson (1992) or Neihardt (1979) for examples of how the Canadian and United States government treated First Nation and American Indian people.
4From a Euro-North American individualistic perspective, the SDEE model and the OHL-TR model are excellent models that have clarity, precision, depth, breadth and theoretical rigor. Furthermore, these are models that should be used with people who embrace individualistic values.
5 The leisure ability model, the health protection/ health promotion model, and the therapeutic recreation service delivery and outcome model.
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Rodney B. Dieser, Ph.D., Assistant Professor, School of Health, Physical Education, and Leisure Services, University of Northern Iowa.
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