My last journal I will write about the Summit 2009. On Friday, staff, clients, and general public were invited to  this event. There was many speakers and a psychologist who spoke about different things. The doctor spoke about his personal struggle with schizophrenia. He still managed to become a doctor. A female spoke about domestic violence. Her ex-husband abusing her, he even stabbed her many times. She got through it and is now married to a good man.

The event provided a meal for everyone. I am not too sure what all it was- some chicken, rice, pasta..? It was not that great. The event itself, was pretty boring. I am not interested in going again.

My overall experience at SC was great. My field supervisor taught me alot. He even asked for my resume so I could sub part-time during the summer. I love mental health and still do!

I would have really liked to observe a clinical environment to get the feel for that, too. I am sure I will very soon.

Billie Wilson, S/OTA

Wednesdays group was called “Magic Box.” Therapists facilitated a goal review with clients. Clients will participate in an exercise where they look into a box and see what they discover. This exercise is used to increase awareness of individuals uniqueness.

The group started by asking patients who the most important person in their life is. Not one patient said themself. After the discussion, each patient came out in the hallway, with me. Where I had a box with a mirror on the bottom. They did not know that a mirror was in the box. As they came out to look in the box, they were told, “in the magic box you will see the most important person in your life.” Some of them did not understand. I had to explain that they seen themself and they are important. After everyone looked in the box, we had a group discussion about why they did not think of themselves as important. This group is a lower functioning group, so it took alot of discussion to help them understand that they are important. They said they were surprised to see a mirror in the box, they did not know what to expect.

Thursdays group was called “Bridge Drawings.” The focus was self-awareness. The patients were asked to draw a bridge and draw where they are today and where they want to be.

I will talk about a patient named J. She stated she has been going to auctions and getting out more, she appears to be calmer. J’s bridge was made of bright colors. J said she is in the middle of the bridge, she rates her depression as a 5. J stated at the beginning of her bridge, she had no friends and nothing to do. She said she is becoming more sociable and is not sure where she is at in life, right now.

For Tuesdays group therapy, a girl named T, she is 27 y.o., lives at home with her parents, she does not work or have a drivers license. Her Dx are schizophrenia and depression. I am not sure how to figure her out. All I know is her dad is an alcoholic and is mean to her and her mom works alot. She has met four males on an internet chat room (she did not no them) and got involved with them. It turned out they abused her and took advantage of her. She says she wants to get a job and move out on her own, but the therapists found her a job, she did not show up on the first day and when they asked her about it, she told them she did not want to work. During groups she has been talking about how much she wants to move out and live on her own. Today she said she has started talking to one of the guys she met online and he has been mean to her, but when the therapist asked her why she is still talking to him, she got a big smile on her face and said, “I don’t Know,” like she was proud of it. The therapist said she is not ready to move out and asked her what she would do if people started asking her for favors (if she lived on her own) she told them she would day “no,” buat her affect did not match her words. When asked if a guy wanted to stay overnight, what would she do. She, again, smiled and said she would let him stay. Then she was asked, what she would say if they wanted to have sex with her, she smiled and said “definately.” Thats where I am confused she wants to get better and have men treat her better, but it seems, as though, she actueally likes that attention, both from the men, therapists, and group members. I thought maybe she had been sexually abused as a child, but it is not in her chart. She talks about things she wants to accomplish, but when ways to do them are suggested, she comes up with an excuse.

Wednesdays group, the girl I spoke about in another journal (the cutter) came to group very tired and withdrawn. The therapist had to keep asking her to sit-up in the couch. The therapist asked her what was wrong, she would not look at him. Finally, she showed hem her arms. She had cut the front of her hands and arms. James asked her what was going on. She said her favorite aunt passed away. When asked why she cut herself, she said her mom told her she had to do it and be with her aunt. Thankfully, the staff at her group home caught her and stopped her. James made a phone call to her counselor to get her an appointment.

S- “My mom told me to hurt myself.”

O- Pt layed on the couch and would not look at therapist.

A- Pt is hearing a voice she protrays as her mother. Pt displays cuts on her arms and hands. Pt appeared    tired  and depressed.

P- Therapist contacted pt’s counselor to schedule a follow up visit.

Thursdays group

Before the activity began, James asked who needed to talk. P was very tearful today. P had been sexually abused by her brother-in-law for over 20 years. Her sister is 16 yrs older than her and her sister’s husband was 19 yrs older than P. This man had abused her since she was a young girl. She blames herself. It is very sad because P is a very nice women that would do anything for anyone. She continously says “sorry” when she does not do something correctly. The man who abused her passed away denying he hurt P. P’s sister blames herself for what her husband did to P. They are getting close and P is very happy to have her sister back. P does not blame her for what her husband did.

Todays group activity is Volcano Drawings. The focus is ventilation: projecting anger. The objectives are to provide an opportunity to express feelings of anger and frustration. To promote interpersonal learning through sharing constructive responses to negative experiences. To identify appropriate methods of dealing with anger, develop new coping strategies.

T’s volcano was brown with lots of red lave (representing anger). T titled her volcano “ex-daughter-in-law.” the situation T expressed about an incident that her ex-daughter-in-law threatened to keep the boys away from her. T snapped and cussed at her (over the phone) she screams and called her names. T responded back with n ame calling. This took place in front of the grandchildren. T interpretation of her volcano was tension and stress. She is trying to get herself under control and calm down and think of the consequences.

When group was finished, T asked me when I would be finished with school. She asked if I would be here (Six county) until I am finished. I told her no, that I would be finished with my hours in a couple weeks and would not be back. She stated that we should exchange numbers because she would miss me. I had to tell her that it was against the policy and I could get in trouble for that. She understood.

Billie Wilson, S/OTA

Before group started today, James told me I was going to lead the group. I was very nervous. Thankfully, only three patients came to group. It went alright. If I got stuck, James jumped in and asked a question.

The group therapy for today was “Do and Don’t Like.” The members were asked to make a list of what they liked about themselves and their life on one side of a sheet of paper. On the other side, they were to make a list of things they do not like about themselves or their lives. After they completed their lists, they choose one item from each list and discussed what they can do to change it or eliminate it from their life and have them engage in a contract with themselves to eliminate it from their life.

The members appeared to struggle with the “do like” list and how to change it. After we finished the activity, I played Uno with them. It was fun, but they kept forgetting whose turn it was. I did not tell them, I wanted them to think for themselves.

James told me I did a good job, next time, I need to ask about their symptoms. For example, depression, anxiety, sleep…

For Wednesdays group, only three patients came. It must be this week, everyone’s sick. This group activity was called “Making a Mural.” As a group, they were to choose a theme and what kind of pictures they wanted to use. They chose “A Wonderful Summer Day,” and chose a boat, fishing, a bumble bee, bike, swimming, and walking. They were given a four foot sheet of paper, magazines, markers, and crayons to create their mural. That was as far as they got while I was their. I did see it the next day and it looked great.

For Thursdays group, the activity was called “Mandala of Hands.” The focus was peer group identity and the object was to build and promote group identity and cohesion in order to create a supportive group environment. James put me in charge of the whole activity. I started out by reading to them the activity and clarified any questions they had, then I cut out an 18 inch circle and cut the circle into pie shaped segments. I gave all the members a segment. Each person was to trace their own hand, on the paper, and decorate it any way they wanted to. When everyone was finished, the members glued each  segments onto a large poster board. The members then proceeded to decorate the Mandala of Hands as a group. We then hung it up and discussed how each member thought of the activity.

When group was finished, I had to choose one patient and write a progress note. The facility’s technique is confusing (at least at my field site). I talked to James about it, so I could find a way that makes sense to me. I mentioned SOAP notes to him. He told me they use to do it like that but changed it. My plan is to look over the progress note options we were given and find one that makes sense to me and that James approves. He wants me to find my own way of writing progress notes (that also follows a general format on S.C. data sheet) that I feel comfortable with. He wants me to find my own way because if he takes a day off, after the quarter, I can come in and sub for him and know what I am doing.

Billie Wilson, S/OTA

Tuesdays group was a sad atmosphere. Over the weekend one of the group members passed away. Only four of the eight came to therapy. I do not know if the two are related. Those that were there, were sad. The counselors allowed everyone to discuss how they were feeling. After everyone spoke, we took a break. Tuesdays group was called “Time life Map.” The group was asked to draw different aspects of their life and the amount of time it consumes. Discuss changes that may need to devote more time to. The four group members pictures were similar. The pictures were like a pie chart. Many of the sections envolved lonliness, worry, and watching television. The only one that was different is a young mother. Two members have no children and the other is a grandmother. The young mother’s time is consumed with her children and the others were consumed of lonliness. The counselor suggested the young mom make time for herself and the other members should focus on something they enjoy.

Wednesdays group, James started group by asking each patient what they needed to talk about. One particular girl in group is a “cutter.” She is in her early 20’s and lives in a group home. The patient claimed her mother beat her everyday, for as long as, she could remember. Her mother passed away a few years ago. I have seen her in group since late March, she has not cut herself. Over the weekend was her mother’s birthday. The patient claimed her mom told her to hurt herself. The patient had scratched the first layer of her skin off the top of both her hands. Her hands looked very sore, she had them bandaged. James contacted her staff in the group home to ask them to watch her closely, especially, at night and contacted her counselor.

Billie Wilson, S/OTA

Today in group there was a new patient named B. She transferred from another state. B. was in therapy there, too. B. seems domineering and hyper. This therapy was titled “Where am I at?” To discuss what period of time one is in at this time in their life. discuss changes that they may want to make. One of the counselors was explaining the activity. B. did not let her finish explaining the whole activity and interrupted with her answer. The counselor was patient and let her tell her thoughts. When B. stopped the counselor thanked her and went on to finish the instructions. b. got up to go to her doctor appointment, when I noticed the back of her head. Her pony tail was about as thick as my fifth digit and from about half way down from the middle of the back of her head, she had no hair. At the end of group, I asked one of the counselors if they knew why her hair was like that. They told me she was diagnosed with Trichotillomania. I have never seen anyone with this, but have heard of it.

Wednesdays group was called Towers - An Inter group competition. This exercise creates an opportunity for nonthreatening group interaction. It also provides a basis for feedback to group members on their relations with other group members and their productivity in a task situation. In the activity, James divided the group into two, two person groups and each group had their own table. They were given about fifty stirofoam cups. The team members were to collaborate with one another and decide on a plan of how they want their tower to look like. The one group did not communicate well. They were each doing their own tower. Eventually, one member of the group got up and went to do something else. I told the other group member she could join the other group. Together, they built a big tower that looked great. The new group was having fun creating their tower. When they were finished, they asked me what they should do now. I told them to knock it down. The three group members laughed as they knocked it down. Then they picked them up and put them away.

On Thursdays group the technique is Theme Centered Group Murals (Fantasy Theme) “Life on an Island.” The focus is peer group dynamics. The objectives - to use teamwork in the development of shared decision-making and task-performance. To understand group dynamics and evaluate one’s role in the group. For the activity James divided the members into two, four person groups. Each group sat at their own table, were given paper, crayons, pencils, markers, and a large poster board. The group members were to collaborate with one another to decide how they wanted their island to look like. At first the groups were having trouble understand the task. James explained to them that each member was to discuss how they pictured their island and the others explained their ideas. They were to combine on anothers ideas into one island. They eventually got started. One group did a good job sharing ideas. They got on a roll and made a great island with lots of different things, like a bon fire, two palm trees with a hamock tied to them, coconuts, birds, flamingos, and a tent. They went into alot of detail. The other group did not seem to want to work together and communicate. They each drew something but it looked more like a deserted beach.

Before group started for the day, James told me to pick a patient to observe. I was to take notes throughout the whole group session. At the end of group I did a progress note on the computer about my chosen patient. James said I did pretty good, but next time go into more detail about what the counselor did. I did not even write anything about that in my hand written notes, James helped me with what to write in the progress note. He even said he was going to use my progress note to turn in! The patient I chose was P. As I watched her during the activity she was the anitiator and took the lead. At one point she drew an Oak tree, instead of a palm tree. Another group member brought this to her attention. P. apologized, erased it, and drew a palm tree. P. is very intimidated and is constently apologizing for her actions. Her diagnoses are depression and anxiety. So, I was proud of her for taking the initiative to get the activity started. P. is a perfectionist, after everyone was finished, she kept perfecting the island. Even when everyone was explaining their island to the group, P. was thinking of more things to draw. I had a great experience today and I am sure I will get better at progress notes.

My second week started on Tuesday. This group therapy session was titled “My Inner and Outer Self. Toexamine conflict between the two and gain perspective. The patients were to take a few minutes and think about what comes to mind when they picture their inner self verses their outer self. They were asked to sit around the table and draw their thoughts on paper. When everyone was finished, they shared their picture. One person stands out in my mind, I will call him N. He drew a picture of a car being smashed by a big hammer. He had been working on another patents car and has had the car for several weeks. He cannot fix it and is getting frustrated. I did not think much about it, at the time.

My next day was Wednesday. The group therapy session was Listening- an exercise that required clients to listen to certain descriptions and clients will see how everyone has a different interpretation. Everyone sat around the table, while James described, step by step, a description of a bug. He gavestep at a time. For example, draw a circle on the paper. They all got a “kick” out the activity. Halfway through the activity, James had to take a phone call in his office. He asked me if I would take over the group activity. I wasreally nervous. But it turned out alright. The patients in the group are nice and patient with me. I had to finish describing the bug. Then I had to ask each patient several questions and write them down. James came back and took over because I had class.

The next day, I asked James what he thought and recommended on my note taking. He said I did not need to write so much and asked if I would rewrite them because he could not read my writing. I told him I was trying to hurry and get what the patient told me. He said, next time to just take my time and if I did not get everything someone said, just to ask them to repeat them self for me.

Thursday was my last day of week two. The focus of this group was Acceptance. The objective was to promote an atmosphere for socialization and positive peer interaction. To promote trust through risktaking and sharing and to increase understanding and acceptance ot others. The activity is called, magazine photo collage: “gift” collages. The point of the activity was for each patient to find and cut out words or pictures that represents the other patients. When everyone finished cutting things out, they gave them to the person they represent. Each person glued their pictures on a piece of paper. After everyone was finished, they had a chance to ask questions about their pictures and what they thought of their “gifts.” Some of the patients enjoyed the activity and others complained, but everyone completed the activity. One patient was having difficulty initiating the activity and displayed specific mental functions, attention functions, and higher-level cognitive functions. Jame and I helped her with who and why she could give the pictures to.

On Thursday, I got to attend my first meeting. The meeting consisted of James, Rainy Oliver, VP of Habilitation/Support Services, Mary Tigrom, PH-Day Treatment Director, and several people from Consumer Drop-In Day. The meeting took place because confidentially was not being followed. Certain patients of other therapy groups and people in the community that were involved in Consumer Drop-In Day. They were calling others and gossiping, using their names. In my opinion, the meeting seemed childish. Not the office personnel, but the patients and the community members. It certainly seemed like it was something that should of been handled differently. This deli ma has been an on going event that was not being resolved with out the help of those who run the treatment facility.

This week has definitely been a learning experience. I have seen many different personalities and learned alot in office procedures.

On my first day at Six County (SC) I was really nervous, but I quickly relaxed. My field supervisor (James), is great. He is funny and personable. My first day was on a Tuesday. It is an expressive therapy group. Since, it was the first day back and a new 12 week program, they discussed their goals. The second half of group, the patients were to think about how they felt. They were asked to draw a picture of their fears, then discussed their meaning and ways to relax. I left for the day really excited. I loved my experience and could not wait until the next day.

Wednesday was my second day at SC. I was not quite as nervous. This group is skill development/communication/team building. Since, this was the first week of the new 12 week program, James went over the patients’ goals. The activity allows them to see the importance of communicating openly. We all sat around the table. James started by whispering a few words in the person’s ear, beside him. That person was to use James’ words and add a few more to the next person. And so on. The last person said the story aloud. The point James was trying to make was that when you gossip or tell a story, it often gets changed.

My last day of the first week was on Thursday. This group is called community integration and focuses on self expression. James read the group a poem and they were to draw a picture of what came to their mind while the poem was being read. They discussed their thoughts.

My first week I got acquainted with everyone and the “feel for” group therapy. I met a couple of the counselors and office personnel. I made copies and stapled them for James. I had a great week and a good experience, overall.