Therapeutic Thematic Arts Programming for Older Adults By Linda Levine Madori, Ph.D., CTRS, ATR-BC

Excerpted from the Introduction of Therapeutic Thematic Arts Programming for Older Adults by Linda Levine Madori, Ph.D., CTRS, ATR-BC

Copyright © 2007 by Health Professions Press. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the author.

Introduction

The foundations of this book come from more than 25 years of the author's hands-on experience in working with older adults as a Certified Recreation Therapist and a Board-Certified Art Therapist. The Therapeutic Thematic Arts Programming (TTAP™) method is an enjoining of the principles of therapeutic recreation and the creative arts therapies into a singular technique for therapists who work with older adults at all stages in the continuum of elder care, including community services for well elderly, rehabilitation programs, assisted living facilities, skilled nursing care, and services for Alzheimer's disease. The TTAP method is based on new research that has enhanced the understanding of the connection between how humans learn physiologically and how humans age developmentally, thereby enabling therapists to develop and facilitate more biologically effective, time-efficient, and creative programming for what is fast becoming the largest special group of the 21st century: older adults.

The TTAP method has five main objectives:

1. To embrace the concept of use it or lose it by stimulating all areas of brain functioning to enhance cognitive, emotional, physical, and social capacity

2. To provide opportunities for the individual to integrate life experiences into group experiences through object relations in the creative arts process

3. To provide a system in which the individual can reintegrate into a supportive social group to foster feelings of safety and support and thereby increase social participation

4. To engage the participant in a multitude of creative arts experiences: music, drawing, sculpture, movement, poetry, and special theme events

5. To provide programming that enables the flow to flourish

Chapter 1 offers an overview of the current research on brain growth, development, and cell regrowth. Case studies from the late 20th century to the beginning of the 21st century provide a stimulating new understanding of how brain functioning can be enhanced through therapeutic activities that use both the right and the left hemispheres of the brain. The TTAP method reflects this new understanding of brain functioning in a nine-step method that integrates and stimulates various areas of the brain through a variety of specific therapeutic activities. This chapter also reviews current research on the physiology of the brain (the motor cortex, the sensory cortex, the parietal lobe, the occipital lobe, the cerebellum, the brain stem, reticular formation, Wernicke's area, the temporal lobe, and Broca's area) and how the brain processes memory and language as well as learning and intelligence. In Bloom's six stages of learning, knowledge and how humans understand through recall of previously learned information and/or tasks are discussed in relation to how the therapist can use recall in the interactive creative arts experience. Understanding that individuals comprehend information differently validates and gives reason to approaching the therapeutic experience using varying learning styles, an inherent feature of the TTAP. Examples illustrate how the therapist can increase his or her understanding of the group dynamics through TTAP. Also discussed is how analysis, synthesis, and evaluation of learning are basic concepts on which the TTAP method is based. In addition, Chapter 1 explains how three systems of the brain-the recognition system, the strategic system, and the affective system-are applied and used in the TTAP method.

Chapter 2 discusses two distinct areas that are the theoretical underpinnings of the TTAP method: theories on aging that stress the importance of activities throughout the life span and the theoretical framework on which therapeutic recreation was founded. The theories of aging first are explored from a humanistic perspective in developmental theory and life-span theory. These theories explain why people do what they do and are the theoretical structures out of which the TTAP method has grown. Through the understanding of the theoretical framework also comes the understanding of why and how the TTAP method naturally creates a structure in which the therapist can facilitate self-determination, self-efficacy, optimal experiences, and a sense of overall wellbeing, which are discussed in detail in Chapter 3.

Chapter 3 provides a history of therapeutic recreation and examines and analyzes how the TTAP method facilitates activities that provide opportunities for development of self-esteem, self-development, and self-awareness through self-expression in the creative arts. TTAP is a structured way to incorporate and stimulate the three systems of the brain while developing and implementing therapeutic recreation activities. Some of the benefits of TTAP that are discussed include the following:

• Provides a natural way of learning and processing information through activities
  
  
• Offers the participants a deep understanding of the subject or topic
  
  
• Is structured yet flexible and is individualized for each participant's learning needs or interests
  
  
• Incorporates all creative arts therapies to complement the therapeutic process
  
  
• Establishes a flow between each activity
  
  
• Can incorporate broad subject matter to allow for brainstorming within a structured yet flexible environment
  
  
• Can provide significant relevance to real life

A significant goal of the TTAP method is to allow the participant to experience all types of creative art, including music, movement, writing, sculpture, movement and music combined, poetry, culinary activities, theme events, and photography. These nine types of creative arts are the foundation of the nine steps of TTAP and are discussed in depth in Chapter 4. Three main goals are woven into the TTAP method:

1. To identify a fundamental link among self-esteem, self-worth, and intrinsic motivation and encourage this process to take place continually within the group through the ongoing use of creativity

2. To elevate each individual's self-expression to a central position in all programming
through the continual use of past and present personal pursuits, life experiences, and interests that have accrued across the life span

3. To develop each individual's unique combination of skills, multiple intelligences, and capabilities for self-expression by using individual activities and cooperative groups and stimulating multiple perspectives

Chapter 5 discusses the Continuum of Psychological Domains and how it expands on the Accountability Model of Service (Stumbo & Peterson, 2004) to develop activities that best meet the social, emotional, cognitive, physical, and spiritual needs of the individual at each stage of wellness. The TTAP method focuses on the overall enhancement of the leisure function but also addresses the individual's specific needs in five domains related to where he or she is along the health spectrum of aging, allowing for customized programming directly to their needs. These five domains can be analyzed in each area of aging: well elderly, assisted living, skilled nursing, cognitive impairment, and hospice care. Individuals in various areas of health care have different needs in each domain, and each individual can have different needs within that special group. Furthermore, each domain can be targeted by programming, and the chosen theme can focus on a specific psychological need. This approach has never been taken before in developing therapeutic recreation for older adults. Through the use of TTAP, therefore, the therapist can assess where along the Continuum of Psychological Domains each individual falls and develop programming that best meets the individual's needs at various points through the continuum. Most important, the therapist can develop programming that is designed specifically for the emotional, social, physical, or cognitive benefit of the individual at that particular moment. There is a TTAP assessment form in Appendix B.

Chapter 6 discusses how the Continuum of Psychological Domains in used in each area of aging care, including assisted living, rehabilitation, skilled nursing care, and Alzheimer's care. It provides specific examples of how each of the nine steps of TTAP can be tailored to meet the needs of these varied groups of older adults. In addition, a detailed overview of Alzheimer's disease is presented.

The 21st century has started off with great new discoveries in the workings of the various areas of the brain as a result of modern advances in medicine and technology. The brain can be examined for the first time while a person is alive and well. Scientists can see brain activity in neurons through positron emission tomography emulsion scans, computerized axial tomography scans, and other noninvasive methods while a person is at rest or engaging in an activity. This was virtually impossible in the early 1990s. Eastern and western medicine both suggest that physiological connections exist among body, mind, and spirit. Brain research now has revealed that continual stimulation of memory, both short and long term, plays an integral role in the wellness of the brain, and thus, in overall quality of life. Research is demonstrating a high correlation between creative processes and decreased heart rate, increased brain activity in specific pleasure areas of the brain, and an overall sense of well-being.

This book is intended to bring a new body of knowledge to the field of creative arts therapy to assist therapists in better assessing, implementing, developing, planning, and evaluating the therapeutic process with the assistance of the TTAP method. It is recommended for the professional therapist who is teaching or practicing; for the instructor who is teaching in creative arts therapy; for the student in creative arts therapy and/or therapeutic recreation; and for the sibling, parent, or friend who needs direction with what to do with an older parent who is well or has some dementia. This new approach in program planning is designed specifically for therapists who work with the largest special group ever to exist: older adults. The more that therapists understand about the physiological, psychological, and social needs of individuals, the better they can provide therapeutic recreation through the use of creative arts.