Nothing but Net: Therapeutic Recreation and the Web.

As global networks expand to allow for many new types of interaction, technology is quickly becoming an essential element within the communication process. This is changing the way the world functions personally, socially, and professionally. Computer-based communication has virtually eliminated time and place constraints on person-to-person communication. Therapeutic recreation professionals could benefit greatly from this new type of communication. Understanding how technology complements, not replaces, traditional communication is the key to advancing with the Internet. This article offers an overview of the development of Internet use in psychotherapy and therapeutic recreation.

Historical Perspectives

The psychology profession has been testing computerized communication for many years, and several computer-assisted therapy (CAT) programs have achieved mixed results. However, these CAT programs have definitely sparked debate and led to many questions. The research and literature on CAT programs is found mostly from the mid-1960s through the early '80s. As microcomputers became much more powerful and programming languages were simplified, psychologists again discussed CAT programs in the '90s, although from a different perspective: concentrating on the pros and cons, including the ethical issues, involved in using CAT programs with clients.

The motivations for using the computer in psychotherapy are the same today as they were 30 years ago. Computers are economical and can be much less expensive than spending time with a psychotherapist. Computers have a perfect memory because the information is stored in a data bank. Important also is that computers make no moral judgments. Finally, computers are available 24 hours a day, 365 days a year, especially since the advent of the Internet, and they never get tired or bored.

Joseph Weizenbaum developed one of the earliest and most significant examples of CAT programs in 1965. Interestingly, his goal was to demonstrate that there were certain tasks that computers should not be employed to do, and he warned of dehumanizing the psychotherapeutic experience. Weizenbaum believed that in order for psychotherapy to be successful, it was important that the client develop a feeling of being liked by the therapist. Believing that this was impossible for a computer to do, Weizenbaum created a program, ELIZA, by the standards of person-centered therapy to prove its failure.

Person-centered therapy is a nondirective type of therapy that stresses reflection on the part of the therapist in a warm, friendly, and accepting environment. ELIZA was able to reflect its client's input and form open-ended questions based on that information using a type of natural language-processing system. The program would create several responses from which the client could choose, thereby creating a tree-like, branching path leading toward a solution. Much to Weizenbaum's surprise, ELIZA's client expressed that he liked using the computer, wanted to interact with it, and attributed to it human motivation and feeling. ELIZA was so successful that it had the opposite effect of what Weizenbaum had intended. However, even 10 years later, Weizenbaum was still adamant about not using computers in place of psychotherapists because of the dehumanizing aspect of exchanging personal information with a machine.

Another CAT program that has received much attention in psychotherapy is Wagman's PLATO DCS (Dilemma Counseling System). This model contains 69 representative life-choice problems such as school issues, dating, dropping out of school, drugs, and smoking. PLATO DCS offers more than 400 specific and general solutions to these life-choice problems. The client first describes the problem and answers a few questions. Various solutions are then presented, each of which the client rates on a semantic differential with anchors of good and bad as that solution might apply personally. Wagman found that college students working with PLATO DCS demonstrated a greater reduction in their problems than those who received no treatment. This finding was substantiated after one-month follow-ups as well. Students also reported a preference for working with a computer, perhaps because of the nonjudgmental nature of the computer.

MORTON, which focused on the treatment of depression and used principles of cognitive behavior therapy, was developed by researchers in the early 1980s. The Beck Depression Inventory was administered at every session to assess differences in levels of depression. MORTON used a multiple-choice format with case vignettes to identify and deal with dysfunctional thoughts. This program, in keeping with cognitive behavior therapy, provided feedback to clients' responses and assigned homework. In a 1983 study, three groups of 19. depressed patients were compared. The first group used MORTON for its therapy, a second group met with a cognitive behavior therapist, and the final 12 subjects were treated on demand by a therapist. As reported by the researchers, the group that used MORTON for therapy demonstrated the most improvement.

Therapeutic recreation has incorporated the use of computers into its field of practice. There have been examples of some use of computers in all aspects of therapeutic recreation; however, the effort has not been persistent. Certified therapeutic recreation specialists have used computers with assessment instruments since the early 1980s. Datillo's Developmental Equipment Switch Interface and Edward's LeisurePref are two programs used to assess leisure preferences. Ryan and Heaven's FANTASTIC is used to assess clients' lifestyles. Dixon's Leisure Interest Survey was developed to determine clients' interests, skills, and participation information. Currently, specialists are using programs such as Meditech to document treatment goals and procedures for specific disabilities or illnesses. Simply entering client information and type of dilemma is enough to generate goals and objectives that can be linked to the patient's file, and the critical pathway generated can be followed to achieve desired outcomes.

Certified therapeutic recreation specialists also have used computer hardware in treatment settings and have used software to elicit behavioral changes in people with social, emotional, or mental disabilities. Realon, Favell, and McGimsey used computers to successfully alert staff to the time and types of reinforcement required to improve behavioral problems in adults with severe mental retardation. The Rehabilitation Institution of Detroit purchased a variety of computer games to treat attention span, perception, spatial relations, fine motor coordination, language, and cognitive deficits. McConatha, McConatha, Deaner, and Dermigny used the Internet for an intergenerational program connecting institutionalized older adults with middle school students. The results of this study indicated that computer interaction was an effective tool for increasing the older adults' cognitive abilities and daily living skills and for decreasing depression. In a recent pilot study, grounded in social learning theory, Mainville demonstrated that leisure education services can be delivered on the Internet. The study, completed entirely online, focused on decreasing alcohol expectancies and increasing leisure motivations through the manipulation of parallel benefits found in consuming alcohol and participating in leisure.

Current Trends

Rapid advances in technology are changing the dimensions of work, allowing people to access databases and communicate via the Internet from almost anywhere, from the office to the beach. Much attention has been dedicated to incorporating computer technology in therapeutic recreation during the past several years, as evidenced by the topics addressed at conferences and in field literature. The United States has approximately 1.5 million domains that are collections of related sites on the Internet. Four years after the public availability of the World Wide Web, 37 percent of agencies responding to health care surveys had Web sites, and another 36 percent were creating them. Half the respondents believed access to online health care information and services from home would occur during the next three years. Twenty-five percent of these respondents believed that within five years, they would be able to access medical records online, and home-based telemedicine would be available via the Internet.

The current trends of the Internet include full-scale publishing, voting, live interactive entertainment, news, and distance education and presentations. The therapeutic recreation profession has established a few Web sites. They serve primarily to communicate information to certified specialists and students, organize networking, provide mentoring in the profession, and indirectly address Web surfers who happen across the page.

Although the concept of having a computer in every home has not yet been realized, the Internet population has been conservatively estimated at more than 25 million. Web sites cater to the young and old. R.P. Hey reported that 15 percent of Americans online are over the age of 50. It is reasonable to assume that many clients of therapeutic recreation services, from all age groups, have Internet access and may enjoy the freedom from time and place constraints.

Health care provision via the Internet, or telemedicine, has become a central focus for the health care industry and government alike. The health care industry is researching the seemingly limitless benefits the Internet has to offer, while government agencies are encouraging application of the findings. Laws have been enacted and passed in several states encouraging health care professionals to work online. The California Telemedicine Act of 1996 mandates third-party carriers to reimburse for telemedicine services without requiring face-to-face contact. The therapeutic recreation profession needs to actively include itself in this revolution. In keeping with professional definitions related to telemedicine, "CyberTR" is the practice of therapeutic recreation services and information delivery that occur when clients and certified specialists are geographically isolated and utilize electronic means to communicate over the Internet.

We began with CAT in the 60s and now, with more user-friendly computer-aided therapies readily available at the click of a mouse, therapeutic recreation has the opportunity to employ technology to aid in various therapies. The 30-year-old evolution of the use of computers in treatment within the health care industry is still happening. While it appears that CyberTR is a burgeoning modality that may be effective as a treatment tool, the need for systematic evaluation is critical.

As the face of health care changes dramatically over the next few years, CyberTR may prove to be an important component in the delivery of therapeutic recreation services. As Niccolo Machiavelli noted in The Prince, "there is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things."

The importance of computer usage in therapy has been established. The challenge has been presented. Will therapeutic recreation professionals accept the "new order of things" as we continue to chart the field's history?

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RELATED ARTICLE:

Commission for Accreditation of Park and Recreation Agencies Accredited Agencies

1. Monmouth County Park System, New Jersey Board of Recreation Commissioners Accredited February 1994

2. Parish of East Baton Rouge, Louisiana Accredited February 1994

3. Northbrook Park District, Illinois Accredited February 1994

4. City of Asheville, North Carolina Parks, Recreation & Public Facilities Department Accredited February 1994

5. City of Greenfield, Indiana Parks and Recreation Department Accredited October 1994

6. City of Piano, Texas Parks and Recreation Department Accredited October 1994

7. City of Roseville, Minnesota Parks and Recreation Department. Accredited October 1994

8. City of Scottsdale, Arizona Community Services Department Accredited October 1994

9. Metro-Dade County, Florida Parks and Recreation Department Accredited October 1995

10. City of Lenexa, Kansas Parks and Recreation Department Accredited October 1995

11. Newton Recreation Commission Board, Kansas Accredited October 1996

12. City of Germantown, Tennessee Parks and Recreation Department Accredited October 1996

13. City of Kettering, Ohio Parks, Recreation and Cultural Arts Department Accredited November 1996

14. Broward County, Florida Park and Recreation Division Accredited February 1997

15. Town of Gates, New York Recreation and Parks Department Accredited October 1997

16. City of Franklin, Indiana Parks and Recreation Accredited October 1997

17. City of Columbus, Georgia Parks and Recreation Department Accredited September 1998

18. Chicago Park District, Illinois Accredited September 1998

19. City of Virginia Beach, Virginia Department of Parks and Recreation Accredited February 1999

20. City of Alpharetta, Georgia Recreation and Parks Department Accredited February 1999

21. Kansas City, Missouri Parks and Recreation Department Accredited February 1999

For further information on how your agency can become accredited, contact NRPA, Michelle Herrera, CLP, at [phone]; e-mail: [e-mail] or on-line at www.nrpa. orgtinfoctr/accred.htm

Sylvie Mainville, M.S., chair of the National Therapeutic Recreation Society's Technology Task Force.

Laura Valerius, Ph.D., an assistant professor at the University of North Texas. Computers are economical, have a near-perfect memory, make no moral judgments, and are available 24 hours a day. Understanding how technology complements, not replaces, human-to-human communication is the key to success (p. 86).

United Cerebrals Palsy's first computer camp was developed to facilitate and encourage the use of technology by people with disabilities.