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Copyright 2004-PRESENT
The Activity Director's Office
All rights reserved
Dedicated to helping Activity
Professionals with the daily
operation of their department.
What Is the Therapeutic Process?
By Debbie Hommel, BA, CRA, ACC
Executive Director of
DH Special Services

As we enter the activity profession, one of the first ideas we are introduced to is the “therapeutic process”.   
Therapeutic interventions, therapeutic care plans, pet facilitated therapy, therapeutic groups, therapeutic
activities - and the list goes on. Through our formal and informal training, we quickly learn the meaning behind
this frequently used term.  Therapy is commonly defined as a “curative process which brings about a positive
change in an individual’s physical, mental or emotional well-being”.  It is important to note the use of the word
“process”.  In using this word to describe what therapy is, it implies that it is something that occurs over time.  
Just one activity or one room visit is not always the answer, just like one dose of medicine is not the cure
either.    The second aspect of this definition worth discussing is use of the word well-being.   In geriatrics, with
the various aging diseases we encounter, our elders are not going to be “cured”.  But, we do know they can live
life well, happily and with purpose - in spite of the limitations and losses associated with aging.  It is this idea of
wellness that we embrace, knowing it has to do with spirit and state of mind
- rather than with disease and diagnosis.  

The therapeutic process gives meaning to our methods.  Unlike a cruise ship director, there is a significant
reasoning behind each activity we plan and who we encourage to participate in our programs.  The therapeutic
process begins with the formal activity assessment, where we gather pertinent information about the resident.  
Physical, cognitive, social, leisure and recreational aspects of the resident are reviewed and documented.   If
we work in a nursing home setting, we are completing our section of the Minimum Data Set as well.   With this
information, we are ready for the second step of the therapeutic process which is establishing a plan of care.  
With pertinent information about the resident, the activity professional joins the rest of the health care team in
creating an interdisciplinary plan of care.  Being a member of the team is a privilege and responsibility, which
requires commitment on our part.  The team discusses the resident’s needs, defining goals and interventions.  
The activity department can play a significant role in assisting interdisciplinary concerns such as mobility,
behavioral symptoms, communication, mood, and nutrition.   If the activity professional is approaching the care
plan in a single minded way, meaning only thinking of activity based concerns or needs, they are missing many
opportunities to contribute to the resident’s overall improvement.   

Once the plan of care is finalized, the third step of the therapeutic process begins.  Following through on
documented care plan interventions is a legal, professional and ethical commitment for the activity
professional.  Communication is essential between the care plan team and the activity professionals conducting
programming and 1-1 interventions.   Methods to ensure care plan interventions occur as noted include
meetings with the activity staff, targeted lists of participants, and permanent assignment of staff.

The last step of the therapeutic process is evaluation.  As the activity professional works with the resident,
engaging them in programs according to the plan of care, we observe participation, notice responses, and
identify barriers to participation.  These responses are noted within an activity progress note or an
interdisciplinary team note. This last step of the therapeutic process brings us back to the beginning  -
reassessing and re-defining the plan of care.  The therapeutic process will never let us down.  It guides the
activity professional in addressing resident needs consistently, ensuring programs and interventions which
enhance quality of life - are created and implemented.
About Debbie

Debbie Hommel, BA, CRA, ACC, is
the Executive Director of DH Special
Services. She is a Certified Activity
Consultant on State and National
level, with over twenty-seven years of
experience in providing direct care
and consultation to long term care,
medical day care, assisted living, and
ICF/MR facilities throughout New
Jersey, New York, Maryland, and
Pennsylvania. She is an experienced
trainer and workshop presenter,
conducting a variety of seminars
throughout the Tri-State area for the
Activity Professional, Administrator,
and allied healthcare professional.
Debbie Hommel is an active member
of Activity Professional Associations
on State and National levels. She is
ACC certified through the NCCAP.
She is a founding member of the New
Jersey Activity Professionals'
Association, serving terms as Vice
President and President. She
received the Weidner Lifetime
Achievement Award in 1994 and the
Monmouth & Ocean County Activity
Professionals Life Achievement
Award in 1999.
Book Review 1

Assessment, the Cornerstone of Activity Programs” by
Ruth Perschbacher.  Published by
Venture Publishing.

If one wants a good book which provides an overview of the
assessment process while also reviewing aspects of aging
and concepts related to understanding the elderly,  this
book is one you want for your library.  It is a great book for
the novice activity professional, seeking basics and
fundamental ideas associated with activity assessment and
care planning.  However, the experienced activity
professional will also find it informative as it also provides
more in depth information about coordinating program
choices with assessment information.    The book is easy to
read, well organized and includes a number of case studies
to illustrate certain points.  There is also some discussion
of the Minimum Data Set, Resident Assessment Protocols
and management of documentation requirements.  The
book is available through Venture Publishing.  
Book Review 3

The Activity Care Planning Cookbook” by Hall and Nolta.  
Published by
Recreation Therapy Consultants.  

Every activity department needs a good care planning
guidebook.  This “cookbook” is a practical tool which many
activity professionals find helpful.  The first section of the
book covers care planning basics, providing a few lists of
action verbs and descriptive terms.  The majority of the book
are sample care plans.  The care plans are created from
triggers in the Minimum Data Set.  The care plans are
grouped by topic or problem and include sample
problems/needs, goals, and interventions.  There are
spaces allowed for individualization of the goals and
interventions.  There is also a comprehensive listing of
medical abbreviations and medical terminology.  It is a
available through Recreation Therapy Consultants.
Recommended Reading
Book Review 2

The RAP Handbook for Activities – The Assessment
Success Guide
” is also by Hall and Nolta, along with
Monaco.  It is available through
Recreation Therapy Consultants.

This is the only book for activity professionals which
focuses on understanding and creating activity based RAP
notes.  The beginning of the book offers some basics
associated with the Minimum Data Set, the Resident
Assessment Protocols and understanding them specifically
from an activity perspective.  The book goes into great detail,
offering sample documentation for substantiating
documentation.  The remainder of the book offers a number
of sample RAP notes, based on specific issues which may
trigger in the MDS.  Finally, there are clear guides for writing
progress notes and evaluative documentation.  There is a
lot of information packed into this practical guide for activity
professionals.   It is also available through Recreation
Therapy Consultants.