Art Therapy | Spring Growth Drawing

In a  recent art therapy class, each client was given the directive to create either a flower or a tree. Then the clients were asked to write on the bloom/petals things that they want to grow/develop in their lives. On the stem, clients were asked to write what they will do to make these things happen; and at the roots, they were asked to write what will feed/support their growth. Here are some of the drawings the clients produced during this class.

 

 

 

Laughter Therapy

Today we had a laughter therapy group led by a certified laughter leader. Eleven clients participated (4 females; 7 males) of mixed ages and psychiatric diagnoses. The leader informed clients at the beginning that research shows fake laughter can turn into real laughter via exercises. As the hour unfolded, this was precisely the case.

The leader asked clients to think about why laughter could be good for them. Several clients stated that they thought it would help with “endorphins, increased eye contact, improves your insides, and reduces stress.”

A series of exercises progressed from small moments of joy to raucous and boisterous full-bellied laughter. The first exercise involved a “ho-ho, ha-ha” warm-up exercise, which clients slowly warmed to and which became the refrain throughout the whole class. The warm-up involved repeating the phrase ho-ho, ha-ha and following this up with a round of clapping.

The second exercise involved hand shakes and laughter. Clients were asked to move about the room, introducing themselves to one another and laughing while they shook hands. It was great to see some clients who are really plagued by anger and negative symptoms participate in the exercise. After this exercise the leader asked why clients believed children laugh much more than adults throughout the day. One astute client replied, “Because it’s not appropriate to laugh during the business work setting.”

The third exercise involved laughing while patting one’s legs and then raising one’s arms in the air. During this exercise, clients were asked how they felt so far. Three clients said that they felt “stronger; a lot better; and happy.”

The fourth and final exercise involved passing around balls of small, medium and large sizes. Clients were asked to laugh in a small, medium and hearty way depending on the size of the ball that was tossed to them. This exercise quickly turned into infectious laughter amongst group members. When an imaginary ball was tossed to a particular client who had previously been reticent to participate, she appeared to become more engaged. For some reason this exercise was more enticing to this participant. Perhaps it was somewhat less threatening to her. Another possible explanation is that she warmed up to the exercises over time.

The leader gave clients a laughter practice handout which offered suggestions for ways of integrating laughter into their daily lives and practices. One client began to immediately highlight sections of the practice handout that called to him.

All clients appeared to have a great time during the laughter therapy session. What is clear is that there was a natural progression from reserved and small laughs to a larger, communal and boisterous laughter for all.   

Art Therapy | Tissue Paper Painting

In a recent art therapy workshop, clients were asked to think about what their stress looked like and to create an abstract depiction of it using tissue paper and a mixture of glue and water paste.  Various colors of tissue on watercolor paper were used to create their tissue paper paintings. Below please find some of the paintings created by clients.

 

 

Writing Retreat | A Client's Poem

The warm summer sun feels good on your face, and the warm winds blow through your hair, and the wet sand through your toes, when you walk on the beach, on a warm summer day.

Developing the Workforce

A central player in the integrated care team is the peer recovery support member. This position is especially valuable for peers seeking to gain professional experience in the health care field and will aid in the increasing professionalization of the allied health worker. Here is how I envision the Peer Recovery Support staff member(s) working within and adding to our integrated health care team.

 
The peer recovery support position (PRS) partners with the Health & Wellness Program to provide the following types of service.

• Wellness coaching. PRS partners will be able to provide wellness coaching—that is, providing one-on-one or group counseling to help patients obtain their personal health objectives. This service will complement the rich array of wellness activities planned for the Health & Wellness program, including Yoga, music and art therapy, health cooking classes and cardiovascular exercise programs.  

 

• Recovery education and support. PRS partners will lead or co-lead self-help recovery services, perhaps even based on the 12-Step model.

• Chronic Disease Self-Management Program Leadership. PRS partners will be trained to lead or co-lead 6-week-long CDSMP workshops which instruct participants on ways in which to better manage their chronic illnesses, whether they are physical or emotional in nature. The Stanford University CDSMP model will be used for this instruction.

• Marketing. PRS partners will be able to assist with development of marketing and recruitment materials, including social and print media. CHD Health & Wellness has a Facebook and main webpage that require regular updating. PRS partners with interest in this work will be invited to update the pages, provide content and assist in designing other marketing materials.  

• Medical assistance. For PRS partners with a strong interest in health care, opportunities will be made available for assisting with obtaining patients’ vital signs, scheduling patient visits, collecting personal health information and arranging for medical taxi transport to and from visits.

Integration Case Report

Introduction

This case report describes the psychiatric behavior and primary care activities of a married 46 year old female diagnosed with major depressive disorder, severe in type, without psychotic features. What is perhaps most important to glean from this case is the benefit that the integration program, including primary care and behavioral health care, has had in the recovery experience evidenced by the patient.

Case Description & Discussion

The patient began experiencing depressive symptoms and was diagnosed with MDD in 2011, shortly after experiencing a spontaneous abortion of her first and only pregnancy. The patient was hospitalized and began a course of antidepressant therapy treatment— fluoxetine hydrochloride, 20 mg/day for 38 weeks. Meantime, the patient began participating in a weekly DBT group as well as attending individual psychotherapy of the psychodynamic type.

In 2012, the patient enrolled in the integrated services program through which she now obtains her medical care. The patient weighs 165 lbs and is 5’1 inches tall. Although she is not morbidly obese, the patient has been encouraged by the PCP to eat more nutritiously, exercise more regularly and lose approximately 20 lbs. The patient has gone to check out the gym and has been thinking more about how she wants to proceed long-term. She is feeling more stable and positive, but is worried about SI returning at some point. She agrees to get rid of anything she has held on to with which to hurt herself. According to the PCP, “she seems more hopeful overall.”

Through the integrated services program, the patient began, in 2013 ,to participate in an ongoing therapeutic writing workshop. In the workshops, the patient provides supportive dialogue and orients new members to the group. Her writing is strong and descriptive. She writes mostly about hopeful things, but she did, however, present one poem about the loss of someone close to her, which could well have been veiled reference to her miscarriage.

The patient will continue with weekly psychotherapy and DBT, as well as art therapy and writing therapy. While it is impossible to say for sure what trajectory her recovery would have taken without the integrative services program, it is clear that the patient has benefitted from the therapeutic and physical health care offerings she has received in one setting.

Healing Hearts Made by Clients