Sophisticated techniques/strategies used to improve or support clinical outcomes may include but are not limited to: develop positive patterns of behavior; relaxation and stress reduction; lifestyle alteration; social skills training; develop self-esteem; reinforce positive relationships; motor learning and training strategies; anger and pain management; identify risks; recovery support; lifestyle adjustment; conflict/problem resolution; adjustment to disability, including coping with grief and loss. Incorporating the four-step process of: assessment, planning, implementation, and evaluation of services delivered, the therapist constructs appropriate and evidence based recreation therapy interventions for treating patients with complex medical or mental health issues such as amputation, paralysis, neurological disorders, orthopedic conditions, behavioral health, psychiatric diagnoses, spinal cord injury, traumatic brain injuries, respiratory disorders, chronic cardiovascular diseases, blind rehabilitation, and Veterans with multiple diagnoses.