a cross-cultural critique of newer therapeutic recreation

THERAPEUTIC RECREATION JOURNAL Vol. 36, No. 4, 352-368, 2002

A Cross-Cultural Critique of NewerTherapeutic Recreation PracticeModels: The Self-Determination andEnjoyment Enhancement Model,Aristotelian Good Life Model, and theOptimizing Lifelong Health ThroughTherapeutic Recreation Model

Rodney B. Dieser, Ph.D.

Three years ago, Dieser and Peregoy (1999) provided a multicultural critique of the LeisureAbility model, the Health Protection/Health Promotion model, and the Therapeutic RecreationService Delivery/Outcome model. Since then, three new practice models have been developed.These include the Self-Determination and Enjoyment Enhancement model, the Aristotelian GoodLife (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 oftherapeutic recreation practice models. In particular, building upon and paralleling the multicul-tural critique by Dieser and Peregoy (1999), this article used Pedersen's (1994) culturally biasedassumption framework of human services to provide a multicultural critique of these three newerpractice models. Of the three therapeutic recreation practice models reviewed in this paper, theAristotelian Good Life model has few culturally biased assumptions. The Self-Determination andEnjoyment Enhancement model and the Optimizing Lifelong Health Through Therapeutic

Rodney B. Dieser, Ph.D., Assistant Professor, School of Health, Physical Education, andLeisure Services, University of Northern Iowa.

352 Therapeutic Recreation Journal

Recreation model have many culturally biased assumptions. In regard to cross-cultural thera-peutic recreation service delivery, a partnership among a therapeutic recreation specialist whohas a solid understanding of cross-cultural differences and the AGL model has a high probabilityof fostering multicultural therapeutic recreation service delivery. Future recommendationsregarding cross-cultural therapeutic recreation practice models and service delivery are provided.

KEY WORDS: Culture, Culturally Biased Assumptions, Multiculturalism, Therapeutic Recre-ation Practice Models

A common element of a profession is adistinct body of knowledge that separates itfrom an occupation or other professions (Edg-inton, Jordan, DeGraaf, & Edginton, 2002;Greenwood, 1957; Sessoms, 1991; Wilensky,1964). The following quotation from Sylvester(1989) describes the manner in which a pro-fession develops from a body of knowledge:

A profession, therefore, is based on abody of theory-knowledge, which isfounded on and funded by ideas. . . without a valid body of knowledge,practitioners would literally have noidea of what to do, how to do it, andmost importantly, why they do it (p. 2).

Although the profession of therapeutic rec-reation has been developing a distinct body ofknowledge for many years (e.g., Compton &Price, 1975; Frye & Peters, 1972; Peterson &Gunn, 1984), therapeutic recreation took a steptoward professional clarity in 1998 when aspecial series issue of the Therapeutic Recre-ation Journal dedicated the second, third, andfourth journal to dialogue and development ofdiffering therapeutic recreation practice mod-els.1 This discussion expanded beyond thesethree journal issues and included the develop-ment of new models (e.g., Wilhite, Keller, &Caldwell, 1999), personal response letters(Dieser, 1999; Witman, 1999) and an excellentsummary article of therapeutic recreation prac-

1 Therapeutic recreation practice models under-score a distinct body of applied knowledge whichseparates it from other human professions (see Aus-tin, 1999; Voelkl, Carruthers, & Hawkins, 1997).

tice models (Mobily, 1999). However, duringthis time period only one article, which ap-peared in the Annual of Therapeutic Recre-ation, was dedicated to understanding thera-peutic recreation practice models from amulticultural perspective (Dieser & Peregoy,1999). In that article, Dieser and Peregoy,building upon Pedersen's (1994) culturally bi-ased assumption of human services, critiquedthe leisure ability model (Stumbo & Peterson,1998), the health protection/health promotionmodel (Austin, 1998) and the therapeutic rec-reation service delivery/outcome model (VanAndel, 1998). Dieser and Peregoy (1999) pos-ited:

Of the models reviewed in this paper,all three have culturally biased assump-tions. Both the leisurability and healthprotection/health promotion models as-sume that [Euro-North American] indi-vidualistic values are normal across cul-ture . . . The therapeutic recreation servicedelivery and outcome model does havesome important multiculturally sensi-tive assumptions, but could becomemore multiculturally inclusive with ad-aptations (p. 64).

Dieser and Peregoy concluded their multicul-tural critique by suggesting that these threetherapeutic recreation practice models shouldnot be used blindly across culture. Rather,these practice models should be modified tomeet the needs of differing cultural groups.

The purpose of this paper is to add to thediscussion regarding cross-cultural appropri-ateness of therapeutic recreation practice mod-

Fourth Quarter 2002 353

els. Since Dieser and Peregoy's (1999) multi-cultural critique of therapeutic recreationpractice models, three new practice modelshave been developed. These include the Self-Determination and Enjoyment Enhancementmodel (Dattilo, Kleiber, & Williams, 1998),Aristotelian Good Life model (Widmer & El-lis, 1998), and the Optimizing Lifelong HealthThrough Therapeutic Recreation model (Wil-hite et al., 1999). Building upon and parallel-ing the multicultural critique by Dieser andPeregoy (1999), this article will also use Ped-ersen's (1994) culturally biased assumptionframework of human services to provide amulticultural critique of these three newerpractice models. Understanding cross-culturalissues is paramount because a lack of cultur-ally sensitivity and understanding can harmclients, rather than help them (Waldram, 1997;Mclntosh, 1986; Sue & Sue, 1990). For exam-ple, Dieser's (2002) personal narrative high-lighted how the lack of cross-cultural compe-tencies among human service professionals,including therapeutic recreation intervention,ended with two clients from ethnic minoritybackgrounds prematurely terminating treat-ment. Hence, the first section of this paper willexplain Pedersen's (1994) culturally biasedassumptions. This will be followed by an over-view of the three newer therapeutic recreationpractice models and a multicultural critique ofeach model.

Culturally Biased Assumptions inHuman Services

Multicultural considerations and compe-tencies are starting to become an integral as-pect of professionalism within therapeutic rec-reation (see Austin, 1999; Dattilo, 1999;Dieser, 1997; Jacobson, Carruthers, & Keller,2001; Peregoy & Dieser, 1997; Sylvester,Voelkl, & Ellis, 2001) and in other humanservices (Arrendondo, et al., 1996; Corey,2001; Schram & Mandell, 2000; Schulman, etal., 1999; Turner & Turner, 1995). To this end,Pedersen (1994) underscored seven culturally

biased assumptions that are prominent in thehuman service professions in North America.

The first culturally biased assumption isthat people share a single measure of normalbehavior. That is to say, this assumption sug-gests that the definition of normal behavior isuniversal across cultural backgrounds. An ex-ample of this culturally learned assumption isthe dominant individualistic-oriented view intherapeutic recreation that people with specialneeds should gain independence (Peregoy &Dieser, 1997). In this regard, Mobily (1999)underscored the complacency of standardizedthinking in therapeutic recreation practicemodels—there is an informal manner of nor-mal behavior related to individualistically-ori-ented concepts of intrinsic motivation, per-ceived freedom and control, independence,and personal mastery. Recent research andscholarship in cross-cultural psychology andanthropology suggested that individualisticand independent self-oriented concepts such asindependence, personal freedom and control,and intrinsic motivation are not universal no-tions; rather, they are values associated withWhite Euro-North American individualisticcultures (Choi, Nisbett, & Norenzayan, 1999;Heine, Lehman, Markus, & Kitayama, 1999;Iyengar & Lepper, 1999; Rose, 1998). More-over, Iyengar and Lepper (1999) argued that:

So ingrained is the American assump-tion that people will find choice intrin-sically motivating that psychologistshave rarely paused to examine the moregeneral applicability of these findings. . . Now consider a different culturalcontext, one in which the participantspossess a more interdependent model ofthe self... Interdependent selves, there-fore, might sometimes actually prefer tosubmit to choices expressed by others ifthe situation enables them to fulfill su-perordinate cultural goals of belonging-ness (p. 350).

Furthermore, cross-cultural scholars have ar-gued that self and internal-oriented concepts,


such as self-actualization, self-esteem, and in-dependence may not be appropriate wellnessvariables for people who embrace collectivis-tic values2 (Choi, et al., 1999; Heine et al.,1999; Iyengar & Lepper, 1999; Matsumoto,1996), such as American Indian (LaFrom-boise, Trimble, & Mohatt, 1990) and FirstNation communities in Canada (Mawhiney,1995; Waldram, 1997).

A second culturally biased assumption isthat individuals are the basic building blocksof a society. In therapy and human services,this assumption is illustrated when interven-tion is primarily directed toward the develop-ment of individuals rather than groups or so-cial variables that an individual is affiliatedwith, such as family or tribal systems. Al-though an individualized or person centeredapproach is advocated by many therapeuticrecreation scholars and practitioners (e.g.,Austin, 1999; Bullock & Mahon, 2000; Carter,et al., 1995; Peterson & Stumbo, 2000), suchan approach is premised upon Euro-NorthAmerican values of individualism. Sue andSue (1990) argued:

Such terms as "person-centered" or"person-blame" indicate a focus on theindividual... In essence, these peopleadhere strongly to the Protestant ethicthat idealizes "rugged individualism."On the other hand, "situation-centered"or "system-blame" people view the so-ciocultural environment as more potentthan the individual (p. 143-144).

To this end, Triandis (1995) reported thatthree-quarters of psychotherapists who workin the United States premise therapy on indi-vidualistic values and lack skills to work withclients from collectivistic cultures.

2 People who belong to collectivistic culturesgive priority to the goals of a group (opposed toindividual/personal goals) and perceive an interde-pendent self that is inseparable from specific socialcontexts which overlaps with relevant others (seeMarkus & Kitayama, 1991; Matsumoto, 1997).

The third assumption is that differing cli-ents understand abstractions in the same waythat human service workers intend them. Con-structs have little meaning without putting theconcepts in a contextual setting. For example,the term self-determination has differing defi-nitions depending upon historical, contextual,and cultural perspectives. Within a Euro-NorthAmerican leisure theory perspective, Dattilo(2002) defined self-determination as a feelingof being the origin of the activity. The conceptof self-determination in certain American In-dian cultures refers to collectivistic action inwhich a group can control its destiny andbehaviors (Edwards, Drews, Seaman, & Ed-wards, 1994). These two definitions of self-determination vary greatly due to a culturalcontext.

The fourth assumption is that independenceis desirable and dependence is undesirable.Although independence is a value held by themajority of people living in Canada and theUnited States, many cultures do not embraceindependence—rather, they view interdepen-dence and dependence as healthy and abso-lutely necessary. For example, Hofstede's(1991) classic study highlighted that the ma-jority of people in the United States, Australia,Britain, and Canada embrace individualisticvalues and the majority of people residing inPakistan, Colombia, and Venezuela embracedcollectivistic values. Furthermore, within theUnited States some people from minoritybackgrounds (e.g., Asian-Americans, Mexi-can-Americans) believe that interdependenceand dependence are more important than inde-pendence (Matsumoto, 1996).

The fifth culturally encapsulating assump-tion is that clients are helped more by formaltherapy than by their culturally appropriatesupport systems. Often culturally-orientedsupport systems, such as a sweat ceremony forFirst Nation people, are viewed as trivial orsecondary by human service professions (Her-berg & Herberg, 1995; Waldram, 1997).Waldram (1997) articulated how symbolichealing during First Nation spiritual ceremo-nies is critical to overall health: "Although


technology can rid one of disease, 'healing'can only occur where the medical system isinterpretable between the healer and patient"(p. 71). Additionally, Waldram underscoredhow contemporary biomedicine has con-structed a system of treatment that is premisedupon the assumption that the mind and bodyare separate biological entities, which is aforeign and confusing paradigm to many FirstNations people.

The sixth assumption is that all peopledepend upon linear thinking to understand theworld around them, where each cause has aneffect and each effect is attached to a cause.Moreover, people from differing cultures mayperceive cause and effect as two aspects of thesame undifferentiated reality with neithercause nor effect being separate from eachother. Lee and Armstrong (1995) and Ross(1992) underscored how differing cultures(e.g., First Nation people) value circular think-ing and intuitive reasoning. Mobily (1999)highlighted that many therapeutic recreationpractice models are premised upon linearthinking—which is not an appropriate treat-ment assumption for people from cultures thatembrace circular reasoning.

The seventh assumption is that culturalhistory is not relevant for a proper understand-ing of a client or contemporary issue. Regard-ing social and human services, Turner (1995)highlighted that professional helpers shouldunderstand the historical basis of differing cli-ents (e.g., ethnicities, nationalities): "Scholarslearned many centuries ago that history hasmuch to teach us about present society andperhaps most of all about human complexities.We can learn from the success and failures ofhistory . . ." (p. 75). Understanding the culturalhistory of clients, such as the dynamics ofoppression and racism,3 improves program in-terventions because they add greater breadth,depth, and clarity to the client's life, world-

3 See Dickerson (1992) or Neihardt (1979) forexamples of how the Canadian and United Statesgovernment treated First Nation and American In-dian people.

view, and problematic behaviors (McFadden,1993). In this regard, cross-cultural psycholo-gists (e.g., Ridley, 1985; Sue & Sue, 1990)underscored how clients from ethnic minoritycultures can experience differing degrees ofhealthy and unhealthy paranoia in which theyhave a suspicion and distrust for White thera-pists. Recently Dahl, Dieser, Fox, Kahakalau,Martin, and Trillo (2002) raised numerousconcerns with the oppressive practices of lei-sure education models, theories, and practicesgrounded in Euro-North American individual-istic perspectives—contemporary leisure edu-cation interventions lack a solid understandingof differing cultural histories.

The subsequent section will briefly explainthe Self-Determination and Enjoyment En-hancement model, the Aristotelian Good Lifemodel, and the Optimizing Lifelong HealthThrough Therapeutic Recreation model in re-lation to Pedersen's (1994) seven culturallybiased assumptions. The last section of thispaper will summarize these models and pro-vide recommendations for future developmentof therapeutic recreation practice models andservice delivery.

Therapeutic Recreation PracticeModels

Models are paramount in therapeutic rec-reation practice because they guide the practi-tioner in the process of intervention (Austin,1999; Bullock & Mahon, 2000). A practicemodel provides the framework for selecting,sequencing, and organizing therapeutic recre-ation intervention (Bullock, 1998; Bullock &Mahon, 2000). That is to say, practice modelsprovide professionals with a framework forthinking; models shape what professionals see,the questions professionals ask, and the an-swers professionals provide (Freysinger,1999).

Self-Determination and EnjoymentEnhancement Model

The Self-Determination and EnjoymentEnhancement (SDEE) model of therapeutic


recreation service delivery initially began witha theoretical explanation of the relationshipbetween self-determination and enjoyment(Dattilo & Kleiber, 1993). Dattilo et al. (1998)described the manner in which therapeuticrecreation services and strategies can foster therelationship between self-determination andenjoyment, ultimately leading to an increase infunctional improvement. According to Dattiloet al. (1998) this model has six components.First, self-determination involves acting as aprimary causal agent in making choices. Sec-ond, intrinsic motivation is activity engaged infor its own sake. Third, perception of manage-able challenge is the ability of a person tomanage changes so that the challenge pre-sented by the activity and the skill level of theparticipant can match. Fourth, investment ofattention occurs when attention becomes fullyinvested, when goals are clear, when feedbackis relevant, and when challenge and skill levelsare balanced. Fifth, enjoyment or flow occurswhen an individual becomes deeply absorbedin a leisure activity. Enjoyment occurs whenthere is a match between the challenge pre-sented by the activity and the skill level of theparticipant. Sixth, functional improvementsoccur "when participants access enjoymentand create environments conducive to enjoy-ment" (p. 262). The ultimate goal of thismodel is to enhance functional improvementwithin any health domain (e.g., physical, emo-tional).

Dattilo et al. (1998) posited that in regardto the four components of self determination,intrinsic motivation, perception of manageablechallenge, and investment of attention, thera-peutic recreation intervention or strategies canhelp guide the client to enhance enjoyment(which will ultimately lead to functional im-provement). During the self-determinationcomponent, therapeutic recreation strategiescan be utilized to develop self-awareness inleisure contexts, encourage decision makingskills, provide participants with opportunitiesto express preferences and make choices, cre-ate supportive environments that stimulateparticipants to communicate needs and prefer-

ences, and advocate goal setting. In the intrin-sic motivation phase, therapeutic recreationinterventions can be used to emphasize theinherent rewards while participating in leisure,learn to listen to positive feedback about indi-vidual performance as opposed to comparisonto other people, encourage competition againstoneself or internal standards, and gain expo-sure to activities or self-examination of poten-tial interests so that the participant will be-come intrinsically motivated in some type ofactivity. During the perception of manageablechallenge component, therapeutic recreationinterventions can be used to teach clients howto assess their skill levels to ensure a matchbetween challenges and skills, learn to makeadaptations associated with leisure activities tosustain a match between challenges and skills,help to teach how to gain a realistic appraisalof the degree of challenge associated with aleisure endeavor, and develop activity skills.In the investment of attention phase, therapeu-tic recreation interventions can be utilized toreduce distractions from activities that produceenjoyment and alleviate maladaptive attribu-tions for success and failure—failures shouldbe attributed to external factors and success tointernal causes. Providing therapeutic recre-ation interventions in these four componentsenhance enjoyment and result in an improve-ment of functioning.

A Multicultural Critique of theSDEE Model

In relation to Pedersen's (1994) culturallybiased framework, the SDEE model has manyculturally biased assumptions. First, numerousconstructs (e.g., self-determination) imply thatdiffering people share a single measure ofnormal behavior. The core leisure componentsof self-determination and intrinsic motivationare not universal norms and would be inappro-priate for people from differing cultures (Fox,2000a). Likewise, therapeutic recreation taskssuch as developing self-awareness and usinginternal attributions for successes and externalattributions for failures are Western-based in-


dividualistic values (Matsumoto, 1996). Asmentioned early in this paper, individualisticand independent self-oriented concepts (e.g.,internal attributes, intrinsic motivation) arevalues associated with White Euro-NorthAmerican individualistic cultures (Choi, et al.,1999; Heine, et al., 1999; Iyengar & Lepper,1999; Rose, 1998). For example, Asian psy-chotherapies such as Morita and Naikan ther-apy deflect attention away from oneself (theopposite of self-awareness) and internalize oraccept problems (Walsh, 1995). This aspect ofAsian psychotherapy is summarized in thefollowing quotation by Walsh (1995):

Patients are taught to accept and rein-terpret their symptoms (what Westernbehaviorists call reattributions) not as asign of weakness and inadequacy, butrather as reflections of strong ideals. . . through engagements, attention isdirected away from the self.. . The aimis to foster recognition of human inter-dependence, of how much we have re-ceived from others (p. 393).

This is in contrast to self-awareness and self-knowledge that is embraced in Western-basedpsychotherapies (Torrey, 1986) or by theSDEE model.

Likewise, this model also asserts that indi-viduals are the basic aim of practice. Through-out the model, the onus is on the individual tochange (e.g., assessing skills, making adapta-tions, focusing on internal standards, settingpersonal goals) and little attention is focusedon changing social or collectivistic-based vari-ables, such as the family or community. Forexample, Dattilo et al. (1998) posited thatfunctional improvements should occur "Whenparticipants independently access enjoymentand create environments conducive to enjoy-ment" (p. 262, italic added). For diverse cul-tures that believe that a group or entire com-munity is responsible for the functionalimprovements 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 axiomsthat independence is desirable, that clients arehelped more by formal interventions, and thelack of a cultural history being used.

The Aristotelian Good Life ModelThe Aristotelian Good Life (AGL) model

of therapeutic recreation service delivery wasinitially premised on Peterson and Gunn's(1984) leisurability model with an ethical ex-tension rooted in Aristotelian ethics (Widmer& Ellis, 1997). Within a year, Widmer andEllis (1998) reconceptualized the AGL model.The foundation of this model is built on theAristotelian concept of happiness, which iseudaemonia. Eudaemonia is the habit of fol-lowing the proper course of action throughoutlife. Likewise, in this model, three Aristotelianprinciples are needed to acquire a good life.First, the ethic of enough is the belief that toolittle or too much of anything leads to prob-lems. There is no absolute or universal stan-dard of what constitutes enough, rather enoughtakes into account individual and group vari-ation. Second, real goods are those that lead toeudaemonia and apparent goods were soughtfor the sake of happiness, but usually thwarteudaemonia. There are two types of realgoods, primary goods, which are associatedwith basic survival (e.g., biological needs) andsecondary needs, which are associated withlearning, creating, and developing meaningfulrelationships. Third, right desires are habitsthat lead one to the good life and wrongdesires lead one away from the good life. Inthe AGL model the virtue of eudaemonism isthe classic view of leisure, which is associatedwith activities by which people learn, grow,and thereby progress toward happiness.

In the AGL model there are three compo-nents and four roles for the therapeutic recre-ation specialist. First, affliction and oppositionis characterized by a person having an illnessor a disabling condition. The role of the ther-apeutic recreation specialist is that of a thera-pist who focuses intervention toward havingthe client gain real goods, specifically orientedtoward primary goods. Second, Aristotelian


goods embody target outcomes that move aclient toward the secondary goods of learning,creating, and the developing of meaningfulrelationships. The role of the therapeutic rec-reation professional is an educator, in whichhis/her primary duty is to help the client makea transition toward the attainment of secondarygoods from primary goods. Third, freedomand responsibility occurs when a client over-comes afflictions and opposition, and thus in-creases freedom (which ultimately leads toeudaemonia). The role of the therapeutic rec-reation specialist is that of a facilitator whoaids the clients' movement from secondarygoods to happiness (or leisure). The last role ofthe therapeutic recreation specialist is that of aresource advocate, who simply supports theclient's involvement in leisure.

A Multicultural Critique of theAGL Model

Based upon Pedersen's (1994) culturallybiased assumption perspective, the AGLmodel has few culturally biased assumptions.First, the AGL model can be considered cul-turally sensitive primarily because the endstate of eudaemonia, which is the habit offollowing the proper course of action through-out life, is not connected to a specific universalobjective of normal behavior. Rather, it is upto the client and his/her cultural values tospecify what secondary goods lead to learning,creating, and the developing of meaningfulrelationships. This lack of a universal standardis summarized by McCormick (1998):

I find that a strength of this model is thatwith its foundation in moral philosophyit begins with an assumption that theend state is not an objective certainty. . . In contrast, other models have of-fered end states (e.g., appropriate lei-sure lifestyle, health) which have beenseen as objective realities. Too oftenour field has proceeded to use practicemodels on the assumption that there isconsensus on the end state; although we

still debate the appropriateness of thevarious end states (p. 305).

To this end, a meaningful relationship canembrace diverse cultures, such as individual-istic or collectivistic values. Likewise, theethic of enough accounts for individual andcultural variation, thus a client's cultural back-ground and values would be the beacon ofwhat is deemed appropriate intervention. Fur-thermore, having a flexible and generic-ori-ented end state is a recommendation that dif-fering cross-cultural scholars have recommendedboth within therapeutic recreation (Dieser &Peregoy, 1999) and in other helping profes-sions (Ibrahim, 1991; Pedersen & Jandt, 1996;Pedersen, 1991, 1994, 1999).

Second, the AGL model does not presup-pose that individualistic values (e.g., indepen-dence) are desirable, nor does it assume thatother people understand abstractions in thesame way as the dominant culture. Rather,appropriate intervention depends upon the cli-ent (or group) and his/her cultural system. Inthis regard, Widmer and Ellis (1998) positedthat the AGL model does not ". . . suggest anabsolute standard of enough that applies to allhuman beings. Rather enough takes into ac-count variation from individual to individual"(p. 293). Furthermore, this model does notassume that formal intervention is more appro-priate than culturally appropriate support sys-tems, again, it is flexible and it depends uponthe cultural background of the client.

Third, although the AGL model does notinclude a formal cultural history, it does in-clude an explicit discussion regarding humanconditions that are relevant to cultural histo-ries. According to Widmer and Ellis (1998), ahuman condition applicable to therapeutic rec-reation intervention can include " . . . challengesassociated with oppression would include peo-ple disadvantaged because of discriminationby race, sex, ethnicity, disability, and otherforms of group association and stereotyping"(p. 296).

Perhaps the AGL model primary culturallybiased assumption is that it rests upon linear


thinking—the therapeutic recreation specialistdoes have four distinct roles that move theclient toward eudaemonia. This type of struc-turing may be problematic to some peoplefrom differing cultures. For example, Ross(1992) underscored how Native American re-ality can be premised upon circular reasoningand a perception that life is revolving. Thus, alinear progression toward happiness that hasclear separations may not be appropriate;rather a circular approach where the therapeu-tic recreation specialist has a multidimensionaland rotating role may be more appropriate. Forexample, a therapeutic recreation specialistcould be a resource advocate and educatorsimultaneously in supporting a Native Ameri-can healing ceremony in which intellectualvirtues are aligned with gaining knowledge viacommunicating with relevant people living ina differing spirit world. Further, a therapeuticrecreation specialist could then move into afacilitator role by supporting this same clientto return to the land of his great-great grand-father to repeat past lives (see Ross, 1992).Following these three potential therapeuticrecreation activities would underscore themultidimensional role and circular approach totherapeutic recreation via the AGL model.

The Optimizing Lifelong HealthThrough Therapeutic RecreationModel

Wilhite et al. (1999) developed the Opti-mizing Lifelong Health Through TherapeuticRecreation model (OHL-TR) for practicebased upon the assumed need for interventionwith the intent of influencing personal andleisure function of clients. The OHL-TRmodel is premised upon Baltes' and Baltes'(1990) developmental model of aging from apsychological perspective. According to Wil-hite et al. (1999) the OHL-TR model has fourbasic principles: (1) clients become activeagents in securing and maintaining their ownwell-being while maximizing their individualcapacities for growth and creative adaptation,(2) health enhancement strategies are client-

initiated and reflect self-determined decisionmaking, (3) optimal health can be achieved byindividualizing resources and opportunities,and (4) the therapeutic recreation specialist'stask is to help clients facilitate adjustmentswhile allowing maximum client choice, con-trol, and preservation of selfhood. Binkley(1999) advocated that a strength of theOHL-TR model is its universal trend in healthand human services that clients should take anactive role in their treatment and desire to beself-empowered: "the authors of the OHL-TRmodel have recognized the significance of thistrend by incorporating self-empowerment andself-efficacy as key elements of their model"(p. 117).

There are four components to the OHL-TRmodel (Wilhite et al., 1999). First, selectingfocuses attention on functional domains thatmatch environmental demands with client ca-pacities, which should maximize personal con-trol and choice. During this stage, a therapeu-tic recreation assessment takes place and goalsetting and recreation/leisure activities are se-lected. Second, optimizing is when the clientengages in activities that maximize personaland environmental resources that make it pos-sible for clients to pursue their chosen leisure.That is, during this stage activities are imple-mented that are premised upon a client's in-trinsic values. Third, compensating occurswhen psychological, social, and technologicalcompensatory efforts or adaptations take placewhen certain behavioral abilities are lost. Forexample, a client might substitute one recre-ation activity for another recreation activity.Fourth, evaluating addresses inputs (e.g., cost)with outputs (e.g., outcome measures) to gaininformation if recreation and leisure activitiesincrease personal meaning and well-being. Insummarizing the OHL-TR model, Wilhite etal. (1999) remarked:

The OHL-TR model recognizes that in-dependent leisure functioning (i.e., withminimal support for TRSs and othercare providers, family, friends) is notalways possible or desirable. Thus, dur-


ing the process of selecting, optimizing,compensating, and evaluating, individ-uals learn (a) that interdependent leisurefunctioning (i.e., with optimal supportfor TRSs and other care providers, fam-ily, friends) might be ideal and (b) thatinteracting cooperatively with others ina self-determined manner enables goalattainment. This perspective allows in-dividuals with varying abilities to main-tain maximum levels of personal con-trol and active decision-making over thelife course (p. 104).

That is, the ultimate goal of the OHL-TRmodel is to allow client self empowerment(Binkley, 1999).

A Multicultural Critique of theOHL-TR Model

In relation to Pedersen's culturally biasedframework, the OHL-TR model has many cul-turally biased assumptions. First, numerousconstructs imply that differing people share asingle measure of normal behavior—which inthis case is self-empowerment and self-deter-mination. Self-determination and self-empow-erment are not universal norms and would beinappropriate for people from differing cul-tures. Empowering the self is premised uponan independent construal of self with ego-focused emotions—collectivistic cultures em-brace an interdependent construal of self withother focused emotions and rely on other peo-ple (Markus & Kitayama, 1991). Hence, the"universal trend" in human services that cli-ents should take an active role in their treat-ment and desire to be self-empowered (seeBinkley, 1999, p. 117) is associated with peo-ple who have individualistic values and upholdan independent construal of self (Sue & Sue,1990). Simply put, client self-empowerment isnot a universal or cross cultural value.

Furthermore the OHL-TR model also as-serts that individuals are the basic aim ofpractice. Throughout the OHL-TR model theonus is on the individual to change (a primary

assumption is that people should become ac-tive agents in securing their well-being andmaximizing individual capabilities andgrowth) and little attention is focused on col-lectivistic-based variables, such as the familyor community. Although the OHL-TR modelacknowledges interdependence, it is clear thatinterdependence is secondary to indepen-dence. Interdependence is an option or an idealif independent leisure functioning is not pos-sible (see Wilhite et al., 1999). The emphasisof individualism and independence is clearlyexpressed by Freysinger (1999):

. . . there is a tendency in the OHL-TRmodel to focus on the individual andindividual change. Even though the au-thors acknowledge the role of the envi-ronment (e.g., families, communities,and health care providers) in construct-ing disability and "recovery," the modelis essentially individualistic. It is theindividual who needs to adapt and theindividual who has choices. It is up tothe individual (with the assistance of theTRS) to make choices about for healthyleisure lifestyle (p. 112).

As already mentioned in this paper, manycultures believe that the entire community isresponsible for the functional improvements ofa sole individual (Sue & Sue, 1990; Waldram,1997). Hence, this model would have little orno relevance for collectivistic-oriented Amer-ican-Indian clients who believe that the entirecommunity is involved in his/her interventionplan (see LaFromboise et al., 1990). Further,the focus on independence and individualismalso connects with the culturally biased as-sumption that independence is desirable. Otherculturally biased assumptions of the OHL-TRmodel are that it depends upon linear thinking(linear components of selecting, optimizing,compensating, and evaluating) and that a cul-tural history is not relevant to therapeutic rec-reation practice.

Of the three therapeutic recreation modelsreviewed in this paper, the AGL model (Wid-


mer & Ellis, 1998) is sensitive to the culturallybiased 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 assump-tions.

Future Directions andRecommendations

Although therapeutic recreation scholarsand practitioners have developed three differ-ing practice models in the past three to fiveyears, two of the three newer therapeutic rec-reation practice models critiqued in this paperare premised upon Euro-North American cul-turally biased assumptions. That is to say, inregard to Pedersen's (1994) North Americanculturally biased assumption of human ser-vices, the SDEE model and the OHL-TRmodel maintain numerous dominant-orientedcultural biases and should not be used blindlyacross cultures unless cultural adaptations oc-cur.4 Furthermore, combining the three thera-peutic recreation practice models that werecritiqued from a cross-cultural perspective inthis paper with the three practice models pre-viously critiqued by Dieser and Peregoy(1999),5 suggests that the only therapeutic rec-reation practice model which has relativelyfew culturally biased assumptions is the AGLmodel. In regard to cross-cultural therapeuticrecreation service delivery, a partnershipamong a therapeutic recreation specialist whohas a solid understanding of cross-cultural dif-ferences (see Peregoy & Dieser, 1997) and theAGL model has a high probability of fosteringcross-cultural therapeutic recreation servicedelivery.

4 From a Euro-North American individualisticperspective, the SDEE model and the OHL-TRmodel are excellent models that have clarity, preci-sion, depth, breadth and theoretical rigor. Further-more, these are models that should be used withpeople who embrace individualistic values.

5 The leisure ability model, the health protection/health promotion model, and the therapeutic recre-ation service delivery and outcome model.

In regard to developing therapeutic recre-ation practice models, Mobily (1999) chal-lenged therapeutic recreation professionals tothink differently about leisure behavior andtherapeutic recreation practice. Building uponMobily's thinking, the following section out-lines three suggestions regarding future direc-tions for the development of cross-culturaltherapeutic recreation practice models and ser-vice delivery: conduct a cross-cultural assess-ment to judge appropriate therapeutic recre-ation practice models, include and developcross-cultural perspectives and assumptionsfrom diverse academic and cultural fields intherapeutic recreation practice models, andembrace multicultural perspectives at the indi-vidual and organizational level so that cross-cultural therapeutic recreation practice can bedeveloped.

Conduct Cross-CulturalAssessment to Judge AppropriateTherapeutic Recreation PracticeModels

In choosing an appropriate therapeutic rec-reation practice model, it is imperative thattherapeutic recreation specialists gain an un-derstanding of the client's worldviews andvalues. For example, if a client from an ethnicminority culture values a Euro-North Ameri-can definition of self-determination, utilizingthe SDEE model may be appropriate. How-ever, if another client from an ethnic minoritybackground values dependency and collectiv-istic values, using the SDEE model may causeharm by creating cultural or cognitive disso-nance (see Dieser, 2002). Hence, a therapeuticrecreation cross-cultural assessment to deter-mine client values and collect cultural relevantinformation is paramount (Sylvester et al.,2001). Building upon the academic work ofRidley, Li, and Hill (1998), Sylvester et al.(2001) provided fifteen recommendations ori-ented toward multicultural considerations forassessment.

Furthermore, Lonner and Ibrahim (1989)argued that before implementing any therapeu-


tic intervention clients should be assessed cul-turally to make possible the development ofappropriate treatment goals and practices. Tothis end, Ibrahim and Kahn (1987) developedthe Scale to Assess World Views (SAWV) tohelp human service professionals understandclient values and provide greater clarity to theissues that bring clients to helpers. Moreover,Ibrahim (1991) suggested that the followingcultural identity information should be gath-ered in an interview assessment:

• Sociopolitical histories of client's cul-tural group.

• Language(s) spoken.

• Impact of gender from an ethnic/culturaland majority culture perspective.

• Neighborhood influences.

• Religion.

• Family life/cycle history.

Utilizing a cultural identity interview orSAWV should be used by a therapeutic recre-ation specialist to judge an appropriate thera-peutic recreation practice models. Client val-ues should be aligned with practice modelvalue assumptions.

Include and Develop Cross-Cultural Perspectives andAssumptions from DiverseAcademic and Cultural Fields intoTherapeutic Recreation PracticeModels

A second future action is to include anddevelop cross-cultural perspectives from di-verse academic and cultural fields. Althoughthere are many differing ways to include anddevelop cross-cultural perspectives, this sec-tion will include three methods: (1) using ge-neric goals and assumptions within therapeuticrecreation practice models, (2) employingtherapeutic practice models in a flexible man-ner in partnership with ethnic and culturalgroups, (3) constructing a therapeutic recre-ation practice model that extends beyond the

complacency of standardized thinking in ther-apeutic recreation and other mainstream hu-man service professions.

First, therapeutic recreation practice modelgoals and assumptions can be used in a genericand broad manner so that therapeutic recre-ation specialists can adapt practice models tomeet the needs of clients from diverse cultures(Dieser & Peregoy, 1999). For example, in theSDEE therapeutic recreation practice modelself-determination can be a generic term thatcan have a flexible definition related to bothEuro-North American definitions of self-deter-mination (see Dattilo, 2002) and AmericanIndian definitions of self-determination (seeEdwards et al., 1994; Waldram, 1997). Asalready mentioned in this paper, having flexi-ble and generic goals and assumptions is arecommendation that differing cross-culturalscholars have recommended in human serviceprofessions (Ibrahim, 1991; Pedersen & Jandt,1996; Pedersen, 1991, 1994, 1999; Matsuoka& Sorenson, 1991).

Second, therapeutic recreation specialistscan use therapeutic recreation practice modelsin a flexible manner in partnership with aculturally different group (e.g., ethnic-orientedhuman service agency), thereby drawing onthe expertise of both sectors (Dieser & Wilson,2002). As such, culturally-oriented human ser-vice organizations (e.g., the National Alliancefor Hispanic Health) could suggest differingaspects of a therapeutic recreation practicemodel that is appropriate and inappropriate forcertain clients. For example, within the AGLtherapeutic recreation practice model anAmerican-Indian Elder might suggest that be-coming independent during a leisure lifestyleis a wrong desire and developing a dependentleisure lifestyle is a right desire.

Third, a therapeutic recreation practicemodel could be constructed that extends be-yond the complacency of standardized think-ing from past therapeutic recreation practicemodels and human service delivery. For ex-ample, although there are differing definitionsand concepts of leisure, leisure theory is stillfundamentally rooted in a Euro-North Ameri-


can perspectives (Fox, 2000a; Chick, 1998;Mannell & Kleiber, 1997; Walker, Deng, &Dieser, 2001; Wearing, 1998). In this regard,therapeutic recreation educators and practitio-ners need to conduct research and empiricalpractice toward understanding the manner inwhich differing cultures experience leisure(see Chick, 1998; Gramann & Allison, 1999).For example, Fox (2000a) underlined that theNative Hawaiian concept of leisure combinesthe elements of manawa (lingering, gentle ebbof water across a tranquil bay) and nenea(relaxing or at ease with gentle voices of thebirds). Such elements of leisure are very dif-ferent from the traditional Euro-North Ameri-can social psychological approach to leisurethat focuses on perceived freedom and intrin-sic motivation.

Furthermore, a therapeutic recreation prac-tice model could be developed that is in op-position to Pedersen's (1994) culturally biasedassumptions in human services. As such, apractice model could be developed that is builtupon some, or all, of the following assump-tions:

• People do not share a single measure ofnormal behavior.

• Individuals are not the basic buildingblocks of society or therapy.

• Clients understand abstractions (e.g., lei-sure) in differing ways than therapeuticrecreation specialists.

• Dependence and interdependence is avalue held by certain clients.

• Clients are helped more by culturallyappropriate support systems than by for-mal therapy.

• Clients rely on circular thinking insteadof linear thinking.

• A cultural history and assessment is rel-evant within a practice model.

Furthermore, therapeutic recreation prac-tice models could be developed from researchand theories regarding health, wellness, andquality of life drawn from diverse academic

and cultural fields. Academic fields such asanthropology, cultural studies, family ecology,feminist studies, First Nation studies, naturalresources management, philosophy, and soci-ology offer knowledge regarding differingconcepts of health, wellness, and disabilities.For example, Machlis, Force, and Burch's(1997), human ecosystem framework providesan interdisciplinary understanding of humandevelopment from an ecological and environ-mental perspective. Social variables that influ-ence human behavior include: social institu-tions (e.g., education), social order (e.g., socialnorms), social cycles (e.g., individual), cul-tural systems (e.g., beliefs), socioeconomic re-sources (e.g., capital), and natural resources(e.g., land). Additionally, understandinghealth, disabilities, or mental disorders from asociological perspective (e.g., Eaton, 2001;Moore & Sinclair, 1995) would move thera-peutic recreation specialists toward developingpractice models that highlight the social con-texts and variables that influence the lives ofclients.

Embrace MulticulturalPerspectives at the Individual andOrganizational Level so thatCross-Cultural TherapeuticRecreation Practice can beDeveloped

To enhance the two future directions statedabove, therapeutic recreation specialists andorganizations need to gain cross-cultural com-petencies. Peregoy and Dieser (1997) devel-oped a two-phases multicultural curriculumoriented toward therapeutic recreation practi-tioners and students. The first phase is orientedtoward gaining an understanding of one's ownculture. To do this, therapeutic recreation spe-cialists should gain awareness of attitudes andbeliefs of their own culture, knowledge abouttheir own cultures, and articulate multiculturalskills within their own culture. For example,therapeutic recreation specialists can learn toidentify the cultural assumptions of strategiesused, such as identifying cultural assumptions


of different therapeutic recreation practicemodels. The second step involves gaining anunderstanding of other cultures. To accom-plish this, therapeutic recreation specialistsneed to develop awareness of attitudes andbeliefs regarding differing cultures, knowl-edge about other cultures, and demonstratemulticultural skills pertaining to people fromdiverse backgrounds. For example, in regardto the SDEE model, therapeutic recreationspecialists can learn to identify differencesconcepts of self, self-determination, and attri-butions.

Furthermore, therapeutic recreation organi-zations need to provide multicultural organi-zational policies (Allison, 2000; Dahl, 2000;Dieser & Wilson, 2002). By gaining organiza-tional cross-cultural competencies, therapeuticrecreation specialists will be in a better posi-tion to deliver therapeutic recreation interven-tion for people who are from differing cul-tures. The following points offer a sampling ofpossible cross-cultural organizational inclu-sion within the field of therapeutic recreation(Allison, 2000):

• Flexible and responsive organizationalstructure

• People of difference are integral in shap-ing organizational goals.

• Diverse teams work together at all levelof the organization

• Organization reflects contributions andinterests of various groups in missionand operation

• Organization is equitable, responsive,and accessible at all levels.

• Ongoing organizational assessment ofsuccess/failure with input from diverseconstituents.

Although organization change is difficult, pro-viding cross-cultural organizational inclusionprovides a framework that promotes diversitynot just in a therapeutic recreation setting orthrough therapeutic recreation practice mod-els, but promotes diversity within society.

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a cross-cultural critique of newer therapeutic recreation

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