Recreational therapy at Sanford Comprehensive Treatment for Eating Disorders (Sanford CTED) is “a bit hard to define,” according to Tori TerAvest, CTRS, and Raina Bawden, CTRS. Both are certified DBT specialists, and Tori is a certified yoga instructor, but they wear many hats. You might find them running process groups, leading a light yoga session, driving a van on an excursion to a restaurant, or in a huddle with the interdisciplinary team. They do anything that helps their clients return to “their new sense of normal.” We sat down with Tori and Raina to hear all about their busy days at Sanford CTED.
“Recreational Therapists use a wide range of activity and community-based interventions and techniques to improve patients’ physical, cognitive, emotional, social, and leisure needs. Therapists work with the patient and their family to incorporate specific interests and community resources into therapy to achieve optimal outcomes that transfer to their real-life situation.” National Institutes of Health
Recreational Therapy – The Limelight Interview Part 1
SBH – Let’s start by having each one of you talk a little bit about your primary focus at Sanford CTED
I am a recreational therapist, and our primary focus is running client groups. We also help out with meal support and teach different coping skills. Much work is done on value clarification in groups because our clients need help finding their authentic selves and identity. We provide leisure education because many people with eating disorders isolate themselves. They forget what brings them joy, so we help them find happiness again.
I would reiterate much of what Raina said, but we help clients return to their new normal. So whether they are returning to the things that brought them joy or contentment, or discovering what they would like to do in the future, we help them reevaluate what that looks like. How to implement it. It is about dealing more effectively with stress. And how to reintegrate back into life with the most enjoyment. One of the big things about eating disorders is that they rob your autonomy. Many behaviors that come with eating disorders represent a loss of control.
SBH – What is an example of a loss of control?
With an eating disorder, you spend more time thinking about and preparing food. As a result, you can’t be spontaneous with friends and go to a movie and get popcorn. That is something that a person without an eating disorder wouldn’t think twice about.
SBH – Could you walk me through a day in the life of a recreational therapist at Sanford CTED?
We have a schedule for residential programs, PHP (day programs), and IOP (half-day programs). Our day starts at 9:00 am with an interdisciplinary team huddle to discuss anything going on with clients. It can be good progress or concerns we need to address. We work as a team to check in with one another and make sure things go smoothly during the day. After that, we run to groups or prepare or plan for groups. We touch base with clients, are present in the milieu, and help with meals, snacks, and breaks. We’re all over the place! On Wednesday and Friday, we load up in the van for excursions to restaurants or other outings in the community.
SBH – What about a “typical” day for clients?
Clients start waking up at 6:00 am. Their first group session is at 9:00 am, so there is a lot to do before the group. First, they do vitals and medication, shower, and prepare for the day. Then they have breakfast, which can be challenging for some clients because they are used to skipping breakfast. This is the first meal support of the day. Clinical staff may provide support during this time, or support staff are available. There is a group from 9:00 to 10:00 am, a snack, and another group from 10:30 to 11:30. There is free time for laptops or phones before lunch if approved. We encourage them to engage in games with each other, but free time is often spent relaxing because they work hard and they are tired. Lunch is at noon, and we try to have a group right after lunch because some clients struggle with discomfort after lunch. On Wednesday, we have a meal outing. There is a snack at 3:00 and another group at 3:30, some free time, and dinner. On Tuesdays, there is an experiential outing in the evening, and on Sundays, they have a social excursion in the community. Their days are full of recreational therapy.
SBH – Are meals therapy?
Meals and snacks are some of the most significant parts of the therapy we do at Sanford CTED, especially in the residential level of care. The function of eating disorder treatment is that food and how we interact with food is medicine. So, we are honoring hunger and fullness cues, challenging foods that maybe feel unsafe to them. We are also redirecting our clients from ingrained behaviors that might come up during the meal. In fact, the meal and snack process is a huge part of therapy.
SBH – Why is recreational therapy included in the treatment of eating disorders?
Defining recreational therapy is difficult, especially in the behavioral health realm. Because we wear so many hats and run many different types of groups. But the excursion or outing piece of what we do is particularly helpful. In a treatment setting, you are working on recovery all day, every day; it is a heavy schedule. But in reality, life happens outside these four walls. So even if we are going out and doing something “fun,” it is an acknowledgment of what the new normal will be. Like I want to go to the movies with my friends. Or to get support from your therapist when you think, I want to play mini golf. I’m going to eat out in a restaurant. Our clients are beginning to do things that make up a joyful life. When they go on an outing, they can see how it feels and return to Sanford CTED and discuss it. On Sundays, they have more social outings. They might go to a bookstore or get coffee and shop at Target – things you would do with friends in everyday life.
In outpatient, our excursions are typically lunch because we do not have the luxury of time. Maybe pizza and a walk in the park. It depends on the dietary needs and challenges of the group. Sometimes we process in the car on the way back to Sanford CTED. This population tends to turn inward, and a car feels like a safe space to vocalize.
We get to see our clients out in the community. And in those moments when they don’t have scheduled things happening. So it reflects what their behavior would be like if they were home in real life.
SBH – Please talk about the interdisciplinary team.
We work on a really great interdisciplinary team. We all want to communicate; I can walk into our Nurse Practitioner’s office anytime and say I noticed that one of our clients seemed off or sleepy. I can tell one of the clinical therapists that a client refused food. We do not have to wait because the entire team is accessible.
That is an excellent place to pause! Thank you, Raina and Tori.
In Part 2 of this Limelight Interview, we discuss art therapy, the impact of social media and diet culture on young adults, and authenticity in recovery. Click here to read!