Recreational Therapist

A recreational therapist utilizes a wide range of interventions and techniques to improve the physical, cognitive, emotional, social and leisure needs of their clients.

Recreational therapist with child patientA recreational therapist works with the client, their family members and others significant to the improvement of their health condition. Recreational therapists assist clients to develop skills, knowledge and behaviors for daily living and community involvement. The goal of recreational therapy is to restore, remediate or rehabilitate in order to improve functioning and independence as well as reduce or eliminate the effects of illness or disability.

A recreational therapist will use recreational therapy interventions and techniques, which may include:
Behavior modification Biofeedback
Cognitive retraining Family interventions
Loss counseling Group interventions
Guided imagery Leisure education
Play/therapy skills Pre/post op procedural training
Re-motivation Re-socialization
Reality orientation Reminiscence
Sensory stimulation Social skills training
Stress management and relaxation Therapeutic community
Values clarification Community integration
  Wellness Training

A recreational therapist will base these interventions by using recreational modalities and “real” life activities to assist in meaningful activity.

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What clients do recreational therapists serve and where can you find recreational therapists working?

Recreational Therapists may work with a wide range of individuals requiring health services including geriatric, mental health, addictions, general medicine, physical medicine and rehabilitation, developmental disabilities and pediatric clients.

Most recreational therapists are employed by health care agencies and work in traditional inpatient hospitals or health facilities but an increasing number are being hired in residential facilities, community mental health centers, adult day care programs, substance abuse centers, hospice care, community centers and in school systems. There is a growing trend for recreational therapists to work in private practice providing services in the home and community as well.

Settings which employ recreational therapists
  • Acute care hospitals
  • Free standing rehabilitation hospitals
  • Rehabilitation units in acute care hospitals
  • Long-term care facilities or skilled nursing facilities
  • Comprehensive outpatient facilities
  • Inpatient and outpatient mental, behavioral health/psychiatric facilities
  • Addiction/substance abuse rehabilitation facilities
  • Home health care agencies
  • Residential facilities for persons with disabilities
  • Adult day care centers
  • Centers for independent living
  • Public and private school systems
  • Non-profit disability related/recreational agencies

A number of other types of settings and facilities may employ recreational therapists including organized community programs for individuals with disabilities and other human service agencies.

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How are recreational therapy services different from other therapies?

Patient with childRecreational therapy embraces a definition of "health" which includes not only the absence of "illness", but extends to enhancement of physical, cognitive, emotional, social and leisure development so the individual may participate fully and independently in chosen life pursuits.

The unique feature of recreational therapy that makes it different from other therapies is the use of recreational modalities in the designed intervention strategies. Although many of the treatment goals that a recreational therapist may work towards are similar to other disciplines on the rehabilitation team, the way a recreational therapist achieves those goals is what distinguishes this unique service.

Incorporating client's interests, and the client's family and/or community makes the therapy process meaningful and relevant. Recreational therapy is extremely individualized to each person, their past, present and future interests and lifestyle. The recreational therapist has a unique perspective regarding the social, cognitive, physical, and leisure needs of the patient. Recreational therapists weave the concept of healthy living into treatment to ensure not only improved functioning, but also to enhance independence and successful involvement in all aspects of life.

How are recreational therapy services recognized?

Recreational therapy is defined by the American Therapeutic Recreation Association (ATRA) as a health care and human service discipline that delivers treatment services designed to restore, remediate and/or rehabilitate functional capabilities for persons with injuries, chronic illnesses and all types of disabling conditions (ATRA 1986). Recreational therapists are standard treatment team members in rehabilitation services. Recreational therapy is listed as a rehabilitation therapy service in the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards.

In addition, recreational therapists are designated as treatment team members (based upon need) in the acute brain injury, the post-acute brain injury, and the inpatient rehabilitation standards of the Commission on Accreditation of Rehabilitation Facilities (CARF). The Centers for Medicare and Medicaid Services (CMS) includes recreational therapy in the mix of treatment and rehabilitation services used to determine federal compliance in skilled nursing, rehabilitation (physical and psychiatric) and long-term care facilities. Therapeutic Recreation is specifically indicated as a Related Service under the Individuals with Disabilities Education Act. A few states regulate this profession through licensure, certification, registration or regulation of titles. The National Council for Therapeutic Recreation Certification (NCTRC) provides national certification of recreational therapists, see credentials below.

What are the outcomes of recreational therapy?

Current research indicates a significant number of positive health outcomes resulting from participation in recreational therapy programs. Evidence based outcomes are critical to the viability of Recreational Therapy as a health care provider. For specific health outcomes as a result of Recreational Therapy interventions, see below:

Improvement in Physical Health Status

Participation in various physical activities result in:

  • Improvement in physical skill development
  • Increased mobility and muscular strength
  • Increased flexibility, ambulation, and range of motion
  • Improvement in perceptual-motor skill, balance, agility, and athletic skill
  • Improvement in cardiovascular and respiratory functioning
  • Increased strength, endurance, and coordination
  • Decreased pain and stiffness
  • Reduced reliance upon medication and other health care services
  • Reduced secondary disability and associated higher health care costs
  • Reduction in Complications Related to Secondary Disability (For example, decubitus ulcers & urinary tract infections were significantly reduced in a group of wheelchair athletes, as compared to non-athletes.)
Improvement in Psychosocial Status

Individuals with disabilities who participated in various structured recreational and social activities achieved the following results:

  • Increased self-efficacy, self-confidence, and acceptance of disability
  • Increased communication, trust and cooperation skills
  • Increased skills at managing stressors, anxiety, and boredom
  • Increased skills in conversation, assertion, cooperation, and competition
  • Decreased social isolation and increased affiliation with others
  • Increased verbal interaction
  • Lowered levels of depression
  • Enhanced feelings of well being
  • Improved morale and life satisfaction
  • Enhanced perceptions of personal control and competence
  • Increased relaxation and ability to effectively manage stress
  • Improved body image
  • Increased acceptance of disability
  • Increased self-efficacy and self-confidence
Improvement in Cognitive Status
  • Enhanced attention, memory, and perception
  • Improved organizational skills
  • Increased decision making and problem solving skills
  • Behavior management strategies
  • Increased alertness and awareness of surroundings
  • Reduced confusion and disorientation
Improvement in Life, Recreation and Community Activities
  • Improvement in community functioning and barrier management
  • Establishment of new life activities for continued growth
  • Improved ability to cope with substance-related stressors
  • Improved decision-making skills
  • Enhanced sober lifestyle and identity
  • Enhanced functional independence for community living
  • Improved ability to structure time
  • Increased quality of discretionary time use
For more information, see: Recreational Therapy: A Viable Option in Health and Rehabilitation Services - Treatment to Prevention

Consumers, administrators, and health care providers are challenged to make informed choices regarding a wide array of treatment options and interventions available in today's health care market. With an emphasis on quality, treatment, prevention, efficacy, efficiency, and customer satisfaction, it is critical that selected intervention strategies utilize approaches that not only address a wide array of health outcomes but also reflect best practices in providing a continuum of care from treatment to prevention.

What are a recreational therapist's education, qualifications and credentials?

A qualified recreational therapist is one who is nationally certified as a certified therapeutic recreation specialist (CTRS), usually referred to as recreational therapists. Qualified professionals are certified through the National Council for Therapeutic Recreation Certification (NCTRC), which requires a bachelors degree or higher from an accredited university, a formal internship and the passing of a national certification examination. In addition, a CTRS must maintain their credential every five years through the NCTRC recertification process.

Group playing golfAcademic programs in therapeutic recreation or recreational therapy emphasize course work in the physical, biological, and behavioral sciences and recreation and leisure theory. They also require an internship under the supervision of a Certified Therapeutic Recreation Specialist. ATRA maintains a comprehensive list of Therapeutic Recreation curriculum programs in the United States,

How did recreational therapy develop?

The recreational therapy profession can be traced back to the 1850's when Florence Nightingale proposed that recreation experiences could be drawn upon to improve the human condition. In 1931 the American Red Cross began hiring recreation hospital workers. The term "recreational therapy" was first coined by the Menninger brothers who were enthusiastic for the inclusion of recreational therapy as a treatment of persons with mental health disorders. Since the 1940's, recreational therapists have served as active members of the interdisciplinary treatment team addressing the psychosocial and physical rehabilitation needs of the consumer.

For more history,

Where is recreational therapy headed?

According to the US Department of Labor, "The rapidly growing number of older adults is expected to spur job growth for recreational therapy professionals and paraprofessionals in assisted-living facilities, adult daycare programs, and other social assistance agencies. Continued growth also is expected in community residential care facilities, as was daycare programs for individuals with disabilities."

Party imageIndividuals with disabling conditions represent a large and growing sector of the population that needs health care services. Over 54 million Americans have been identified as having a disability. By some estimates, the disability community comprises nearly one-fifth of the American population. According to the National Organization on Disability, individuals with disabling conditions spend significantly less time outside the home, socializing and going out, than individuals without disabilities. They tend to feel more isolated, and participate in fewer community activities than their non-disabled counterparts. The need for recreational therapy services is evident. Opportunities to provide recreational therapy services will continue to be an important factor in the health care of individuals with disabilities.

Elderly male reading to a childThe older population—persons 65 years or older—numbered 35.6 million in 2002. They represented 12.3% of the U.S. population, about one in every eight Americans. By 2030, there will be about 71.5 million older persons, more than twice their number in 2002. (Administration on Aging,

The promotion of pro-active health and wellness programs has recently become a focus of the health care industry. Older adults want to remain healthy and independent at home in their communities. Society wants to minimize the health care and economic costs associated with an increasing older population.

As a result, health promotion and disease prevention activities and programs are an increasing priority for older adults, their families, and the health care system. Recreational therapists can and will play a vital role in these type of programs and services. This is a wonderful opportunity for certified therapeutic recreation specialists to provide a service that not only improves the quality of life for older adults but also has a positive financial impact on facilities.

About the American Therapeutic Recreation Association

The American Therapeutic Recreation Association (ATRA) is the national membership organization representing the interests and needs of recreational therapists. The association is directed by an elected board of directors with over 42 volunteer teams and committees, focused on areas such as public policy, coverage and reimbursement, diagnostic specialty groups, education and research. An executive director leads the association national office in Alexandria, Virginia. The association provides a vast array of membership services focusing on professional practice, professional development, external affairs, advocacy, treatment networking and educational services. Specifically, ATRA leads the profession with nationally recognized professional standards of practice, code of ethics and competency guidelines.


American Therapeutic Recreation Association
414 Prince Street, Suite 204
Alexandria, VA 22314
(703) 683-9420

Last updated: July 2004