Recreational Therapy During the Holidays (It’s Spooky Spirit Week)
Recreational therapists Adeline VanNoller, CTRS, and Amy Kosiba, CTRS, helping their clients re-engage with the things they love to do!
The holiday season has begun, and one of the biggest reasons we hear for putting off residential treatment is, “I do not want to be in a treatment facility during the holidays.” At Sanford Behavioral Health, we think the holidays are a very good time to commit to getting help for an eating disorder. Why? Because an eating disorder saps an individual of all the things they used to love to do. In treatment, we encourage recreational activities that literally bring color back into our clients’ lives. This includes art therapy, outdoor activities, seasonal group projects, movement, and excursions into the community.
Recreational Therapy During the Holidays
We sat down with Amy Kosiba, CTRS, and Adeline VanNoller, CTRS, to discuss the role of recreational therapy, especially during the ongoing “Spooky Spirit Week” at Sanford Comprehensive Treatment for Eating Disorders (Sanford CTED). Their enthusiasm is catching!
Sanford – Why is recreational therapy important to eating disorder treatment?
Adeline – We help people get back into the groove of things with leisure and recreation. With recreational therapy, they can re-engage with the things they love to do and have lost because of an eating disorder. In addition, we create a group setting where social skills are more normalized after being isolated in their eating disorders. We also conduct individual sessions, which is awesome! Individual sessions are curated for each person, and we get to work on their goals and things that they aspire to do while in treatment and beyond.
Amy – We just started the individual sessions this past year. Normally, clients have separate sessions with their dietitian and therapist, but now they have individual sessions with recreational therapists, too. I do not think this is common in other treatment centers. We are very fortunate that we get to do the assessments and have a client caseload. So, as Adeline was saying, we get to spend more one-on-one time with our clients and experience their individualized goals. We get to help them return to the things they lost during their disorder. Essentially, we connect them back with life.
It’s really cool to see them slowly start to regain their light and personality. When they first come through the doors, they are sick and seem blunted. They basically have no mood or mood shifts. Over their progress at Sanford CTED, we slowly start to see their personality come back. [Smiles] They are making jokes with us in groups instead of staring into space.
While evidence-based, we have done a good job of giving Sanford CTED a safe and homelike atmosphere.
Excursions in the Community
For our residential clients at Sanford CTED, there is a meal outing once a week. Outings are chosen because they are appropriate and fun but also challenging (for example, a fast-food restaurant that serves items clients might want to avoid). On Saturdays, the recreational therapists also take clients on excursions into the community. Recently, they went to Barnes and Noble, the Grand Rapids Public Museum, and Frederick Meyer Gardens. Our facility is lovely, but it is nice to get our clients out in the community. Especially because a lot of clients are not from the Grand Rapids area, and there is a lot to offer here.
ย Adeline says, “Excursions in the community provide a therapeutic group setting, social interaction, community resources, education, and new interests.”
Sanford – What happens if someone has a triggering experience on an outing?
Amy – Clients at Sanford CTED have several process groups with therapists throughout the week. We line up process groups around outings and things that we know will cause our clients high anxiety and stress levels. But we also have coping skills in place for when clients experience these feelings in the moment. We often use a code word like “yellow.” In other words, if you are experiencing high emotions or stress during the meal, you can use the code word. One of the staff members will step outside with you and use a coping skill. However, we will not stay away from the table for longer than five minutes. We return and try to use our skills. We also divert triggering feelings to a process group or individual sessions with their therapist.
Sanford – How do you work with the eating disorder team?
Amy – We have an opportunity to sit down with the entire eating disorder team and talk about what took place during an outing. We can also make plans based on how someone is reacting. We have a 15-minute huddle every morning to catch up on what happened the day before, make sure we’re all on the same page, and ensure that no groups need to be covered or anything is missing from the previous week.
Adeline – The huddle is also an opportunity to discuss things we could do better, such as whether clients need extra support, staff members need help with a client, or how our team can help us feel more supported.
Who you recover with is a large piece of the puzzle.
Sanford – What is Spooky Spirit Week?
Amy – Being in treatment is hard around the holidays, and this is the start of the holiday season. So, our job as recreational therapists is to do our best to normalize the holidays while clients are in treatment. We start with our Spooky Spirit Week. We have Spooky Sock Day, Adam Sandler Day, where you get to wear baggy clothes, Spooky Shirt Day, Flannel Friday, and on Halloween, we have Costume Day. There is an outing to a pumpkin patch where we will pick pumpkins and paint them back at Sanford. The pumpkin outing provides a good opportunity for a snack exposure; we sit outside and eat a doughnut and drink cider. We also have themed mindful movement, where the clients either do yoga, go for a mindful walk, or sit outside and practice grounding.
During Spirit Week, we’ll have sporadic Halloween activities like Halloween music bingo and an outdoor scavenger hunt. We are focusing on gratitude, and we created a gratitude tree in the PHP area where clients and staff can write what they are grateful for on an autumn leaf.
Adeline – We have a weekly baking group, and we coordinate our baking with a seasonal or holiday theme. Last week, we went apple picking at a local orchard and baked apples into an apple crisp and a cinnamon-sugar apple cake. This week will be different but geared toward Halloween!
Sanford – How does peer support work within treatment?
Adeline – I had one of my first clients graduate.ย We had a graduation ceremony for them, and it was really awesome to recap their journey. At the end of treatment or when a client steps down to IOP or virtual treatment, we do a reflection where we ask questions about the highlights of their treatment and things that impacted them most. My client said the staff was the highlight. That was really cool to hear! They also saw their admissions photo and said, “It does not look like me. I am not the same person.” That is how far this individual has come in their growth! It was motivational to all our other clients to see their progress in recovery.
Amy – To add to that, I would say a huge part of treatment here, besides bringing the color back to our clients, is peer support. We call it partners in recovery.ย On excursions, we might have them partner up.ย Actually, support from a peer means more than support from a staff member. Knowing that they’re in this together and that they have someone who is also experiencing what they’re going through is validating. Who you recover with is a huge piece of the puzzle.
Working on gratitude…
Building a Homelike Atmosphere
When Sanford CTED clients enter treatment, they expect a sterile environment, such as an institution or a doctor’s office. While treatment is evidence-based and rigorous, recreational therapists have worked hard to give Sanford CTED a safe and homelike atmosphere. Our clients create artwork and murals on the walls, which provide new clients with a snapshot of what will happen in the future. Also, everything posted is positive. There are positive affirmations and intentional reminders from past clients, which provide continuity and history.
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Amy says, “We create the seasonal decorations together with our clients in group sessions. We have a group where we brainstorm what kind of things we would like on the wall. Then, we slowly start using construction paper, and they may not know how it will turn out. It might make them anxiousโthere are so many people involved! But when they work together, it turns out beautifully. This collaborative project brings life and a personal touch to our space.”
Sanford – Thank you. We love your energy!
