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Stress Management

Program:
Painting Emotions

Elisa Banyard, RT Student


Emma Bartlome, RT Student
Semi System
November 21, 2017
Table of Contents
Program: Stress Management ….…………………………………………………………………………………………………………3
Purpose ……………………………………………………………………………………………………………………………3
Program Objectives…………………………………………………………………………………………………………...…...3
Implementation Description ………..……………………………………………………………………………………………………..3
Population ………………………………………………………………………………………………………...……….……...3
Staff Training/Certifications.......……………………………………………………………………………………...……...…...4
Program Length and Duration ………………...…………………………………………..........................................…………...4
Facility & Equipment ……………………………………………………………………………………………………………………..4
Additional Information …………………………………………………………………………………………………………………...4
Referral Criteria …………………………………………………………………………………………………………………..4
Contraindicated Criteria …………………………………………………………………………………………………………..5
Risk Management Considerations ………………………………………………………………………………………………..5
A Note on the Use of Music………………………………………………………………………………………………………5
A Note on the Discussions ………………………………………………………………………………………………………..5
Evaluation of the Performance Measures ………………………………………………………………………………………...5
Objectives and Performance Measures.…………………………………………………………………………………………………...6
Content and Process Sheet……………………………………………………………...……………………………………………...6-13
Sequence Sheet………….…………………………………………………………..………………………………………………..….14
Performance Sheet…...…………………………………………………………………………………………………………………..15
Room Layout Diagram ………………………………………………………………………………………………………………16-17
Client Descriptions…………………………………………………………………………………………………………………...18-20
References………. ………………………………………………………………………………………………………………………21
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PROGRAM: Stress Management____________________________________________________
Purpose
The stress management program develops an understanding of stress and teaches stress management techniques in order to manage
personal stressors. Client will be able to increase their concentration and engagement in activities during and outside of treatment;
increase feelings of joy, happiness, relaxation, and contentment; decrease in number of incidents of irritable behavior/angry outbursts
and decrease in feelings of anxiety and depression.

Program Objectives
TPO 1. Client will demonstrate a knowledge of the concept of stress and personal stressors.
TPO 2. Client will develop the ability to identify the importance of expressing emotion as it relates to stress management.
EO1. Through creative expression, client will be able to evaluate current emotional state and identify primary emotions.
EO2. Client will be able to verbally identify the event or circumstance related to their emotion.
EO3. Client will be able to verbally identify strategies to effectively express their emotion.
TPO 3. Client will develop an understanding and demonstrate the ability to use “I feel..” statements.
TPO 4. Client will develop the ability to identify the physical manifestations of stress.
TPO 5. Client will demonstrate the ability to identify strategies to manage stress.
TPO 6. Clients will be able to identify instances in their own lives when stress management skills are to be utilized.
TPO 7. Clients will develop an awareness of the role others can play as assistants in managing stress.

Implementation Description____________________________________________________________________
Population
This program is designed for adolescents and young adults with diagnosed behavioral issues, depression and mood disorders, drug and
alcohol abuse, developmental disorders, and/or comorbid disorders such as post-traumatic stress disorder and/or anxiety. Clients must
be able to contribute verbally in ways that are relevant. Clients must have the ability to concentrate for at least 20 minutes on a
cognitive task. This program was developed for implementation in a wilderness and adventure treatment center, but can also be
modified slightly for use in clinical or other residential settings.

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Program Length and Duration
This stress management program is designed to be facilitated in an eight-session, group-based recreational therapy program, consisting
of 6-8 clients. Group will meet once a week for 50-minute to two-hour sessions. The group process will use experiential and creative-
based techniques to facilitate learning and to reach client outcomes.

Staff Training/Certifications
 Utah State license as a TRS or MTRS
 National certification (NCTRC) as a CTRS
 Training in wilderness survival
 Fire safety training
 First aid and CPR training
 Behavior management
 Camping and outdoor education
 Experiential Education
 Certification in mindfulness or additional training in stress management or breathing
 Facility trained staff will be present during the program to maintain a 4:1 ratio of clients to staff.

Facility and Equipment


The facility and equipment necessary will change each session. Specific instructions will be noted on the content and process sheets
for each session.

Additional Information
Referral Criteria
 Admission criteria
 Physician order
 Court order
 Case manager referral
 Recreational Therapist recommendation
 Client must be 1 week post admission

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Contraindicated Criteria
 Clients who are actively suicidal.
 Clients with severe social inadequacies or who exhibit severe hostile behavior
 Clients who experience multiple PTSD episodes in a short span.
 Clients who are unable to remain concentrated, focused, or engaged during activity.
 Clients whose PTSD or escalation of behavior is triggered through the interventions listed (i.e. creative arts).

Risk Management Considerations


 Clients using sharp objects– count sharps before and after group.
 Clients who may demonstrate irritable behavior, angry outbursts, or diminished interest in participation.
 Clients inability to comply with group instruction creating unsafe situations.
 Inclement weather may make task more difficult, monitor for safety (If intervention is being facilitated outdoors)
 Acknowledgement and possible removal of certain objects in each setting to reduce the risk of injury in case of physical
altercations or the throwing of objects.
 Acknowledgement and possible removal of certain objects in each setting to reduce barriers for those who use adaptive
equipment (i.e. wheelchairs, canes, prosthesis).
 Extra staffing in cases with clients/individuals who are known to be triggered easily and act out aggressively.
 Awareness of clients with allergies or diet restrictions in case food is provided.

A Note on the Use of Music


Background music may be used during the painting intervention. Music should not be distracting and should be played at a low
volume.

A Note on the Discussions


Processing does not need to wait until the end of the experience. If something arises that needs processing, stop the experience and
process at that time.

Evaluation of the Performance Measures


Facilitators will complete the performance sheet and write individual SOAP notes following group.

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Objectives and Performance Measures
PROGRAM: STRESS MANAGEMENT
TERMINAL PROGRAM OBJECTIVE: 2. Client will develop the ability to identify the importance of expressing emotion as it
relates to stress management.

ENABLING OBJECTIVE PERFORMANCE MEASURE


1. Through creative expression, client will be able to evaluate 1. Client will be able to identify two primary emotions
current emotional state and identify primary emotions. through group process, as facilitated by the recreational
therapist.
2. Client will be able to verbally identify the event or 2. Client will be able to verbally identify two primary
circumstance related to their emotion. emotions and the events or circumstances that elicit those
emotions through group process, as facilitated by the
3. Client will be able to verbally identify strategies to therapist.
effectively express their emotion. 3. Client will be able to identify, through group process two
strategies to effectively express their emotion.

Content and Process Description


TPO No.: 2
EO No.: 1. Through creative expression, client will be able to evaluate current emotional state and identify primary emotions.
2. Client will be able to verbally identify the event or circumstance related to their emotion.
3. Client will be able to verbally identify strategies to effectively express their emotion.

EQUIPMENT
1. Non-Toxic Pain
a. Blue
b. Red
c. Yellow
d. White
2. Paint Brushes (1 paint brush for each client)
3. Cups of water (1 per client)

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4. Paper Plates (1 per client)
5. Paint Aprons (1 per client)
6. Painting Drop Cloths (1 per client)
7. Art Easels (1 per client)
8. Painting Paper (2 per client plus a few extra)
9. Barstools or chairs (1 per client; chairs with lumbar and/or abdominal support if necessary)
10. Notecards (1 per client)
11. Pens (1 per client)
SETTING CONSIDERATIONS:
1. Art room (i.e. a room with sinks, floors that can be mopped, space for multiple art easels)
2. Natural light from windows as well as overhead lighting
3. Low noise room (i.e. a room that does not echo drastically)

RISK MANAGEMENT CONSIDERATIONS:


 Clients using sharp objects– count sharps before and after group.
 Clients who may demonstrate irritable behavior, angry outbursts, or diminished interest in participation.
 Clients inability to comply with group instruction creating unsafe situations.
 Inclement weather may make task more difficult, monitor for safety (If intervention is being facilitated outdoors)
 Acknowledgement and possible removal of certain objects in each setting to reduce the risk of injury in case of physical
altercations or the throwing of objects.
 Acknowledgement and possible removal of certain objects in each setting to reduce barriers for those who use adaptive
equipment (i.e. wheelchairs, canes, prosthesis).
 Extra staffing in cases with clients/individuals who are known to be triggered easily and act out aggressively.
 Awareness of clients with allergies or diet restrictions in case food is provided.

SET-UP:
1. Using the diagram provided, RT will set up art easels and barstools (or chairs) before class.
a. Place drop cloths under each art easel to catch any potential paint spills or drips. (Not pictured in diagram.)
b. Place a sheet of painting paper on each art easel.
2. Prefill cups of water and set them on a table near the group circle.
3. Set the additional painting supplies (i.e. paper plates, paint, paint brushes, paint aprons), along with the notecards and pens,
underneath the therapist’s chair.

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CONTENT PROCESS
1. Group Gathering and Opener – “Welcome to group today everyone. We will begin by gathering
a. Group members will sit in a circle in the location in a circle. Please face into the circle, disregard the art easel
designated by RT. behind you. We will use them later on.”
b. It is always important when sitting in a circle that the
two facilitator or staff to not sit side-by-side. Across
from each other is always good in order to have eye
contact with each other.
c. Feeling check-in “We are going to go around the circle and do a feeling check-in.
I would like everyone to share how you are feeling in one word.”
(Allow each person to share before moving on.)

2. Review Group Guidelines “Posted on the board, we have our group guidelines. Can I have
a. Proper use of equipment one person read 1?...2?...3?...4?...5? Thank you. Let’s remember
b. Respect others insight our guidelines throughout our activity today.”
c. Actively participate
d. Be mentally present
e. Group is a safe place

3. Purpose of group- To learn about primary emotions. To “Last group, we talked about stress, stressors, and the strategy of
develop an understanding of emotions and emotional deep breathing.We have just returned from our 10-day hiking
expression and to create a personal awareness of excursion where we experienced many different emotions. For
emotional regulation. Emotions drive decisions which today’s group we are going to be talking about emotions,
can lead to negative or positive actions. Through this understanding emotions, and processing through emotions. We
program, clients will increase the ability to understand need to become aware of our emotions as they are tied into the
and harness their emotions. Through this program clients idea of stress and how they relate to our behaviors. Does anyone
will learn to identify their emotions and consciously have any questions before we begin?”
choose their reactions to those emotions. Client will be
able to increase their concentration and engagement in
activities during and outside of treatment; increase
feelings of joy, happiness, relaxation, and contentment;
decrease in number of incidents or irritable

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behavior/angry outbursts and decrease in feelings of
anxiety and depression.
“I am going to pass around a stack of notecards and pens, please
4. Painting Emotions Activity take one of each.” (Pause for everyone to receive a pen and a
a. Group members will be given a note card as notecard.)
described in process section. “Think of an event, in the last two days, that caused you to be
b. Describe the rules for the painting activity as written stressed; please write the event in the center of your notecard.”
in process section. (pause for writing)
c. Ask group to turn around and face the art easels set- “Around the event you chose, write any emotions you felt during
up behind them as described in process section. that event.” (pause for writing)
d. Distribute paint and paint brushes to each client. “Now, on the back of your notecard write the behavior you used
e. Direct clients what to paint as described in process in response to the event and the emotions you were feeling.”
section. “We will now have you share the front of your notecard. Who
f. The intervention ends when everyone has finished would like to share first?”
painting or the group time of 15 minutes has ended (Listen to client responses and respond accordingly.)
and time is needed to share in processing.
g. Give a time limit warning at five minutes remaining “During our activity, please respect other participants and focus
and 1-minute remaining. on your painting as to not disturb those around you.”
“Please place notecards underneath your chair and turn your
chair around to face the art easel behind you.”
“The recreational therapists will hand out paint, paint brushes,
and water cups to rinse the brushes.” (Continue after distributing
supplies.)
“Using what you wrote on your notecard, paint a picture
depicting the emotions you felt during that event.” “The picture
does not need to be of the event but rather just the emotions you
experienced.”
“You will be given fifteen minutes to paint. If you finish early,
please sit quietly and wait for other participants to finish or until
time's up.”
“You will be given a warning at five minute remaining and one
minute remaining.”
(15 minutes allotted to paint)

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“Please finish what you are working on and turn your chair to
the right of the easel, facing the center of the circle.”

“We are now going to share what we painted. Who would like
5. Sharing and Processing to share first?”
a. Instruct the group to rotate chairs to the right of the a. Consider asking the following questions in response:
easel, facing the center of the circle. i. “Please tell us what colors you decided to use and
b. As appropriate follow the sequence of Blooms why.”
Taxonomy. What is most important in the processing ii. What emotions do those colors represent for you?
circle is to be attentive to the client’s verbal and non- Why?
verbal responses. Follow the lead of the clients when iii. I see you have a [purple] color here; which colors
asking questions. It is critically important that did you mix? What does that represent in relation to
processing is directed to the intended goals for group, your emotions?”
“Painting Emotions” as it relates to stress b. If none of the clients mixed colors, ask why they chose
management. not to. “We provided primary colors, however, what
c. After each client has shared their painting, instruct happens when you mix those colors? How can mixing
them to pull out the notecard from under their chair colors relate to emotions?”
as directed in the processing section. “Just like there are primary colors, there are primary emotions.
d. Introduce the concept of pausing. The emotion we state to be feeling is typically a secondary
emotion. Considering the emotion more deeply, we can identify
primary emotions that contribute to the secondary emotion(s).”
“Where can you identify primary emotions in your painting?
Where can you identify secondary emotions in your painting?
How are your primary emotions part of your secondary
emotions?”

Once clients have finished sharing their paintings, continue:


“Please pick up the notecard underneath your seat. We are going
to share the backside of our notecard. Who would like to share
first?”
a. Consider asking the following questions in response:
i. “How did that behavior response make you feel?”

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ii. “What were the results of your behavior?”
iii. “Did you consider your emotions before reacting?
“Emotions lead to behaviors. An event happens, which creates
emotion, which leads to an immediate reaction. What if we learn
to initiate a pause button? When you feel your emotions rising,
you can hit the pause button, acknowledge all of the emotions
going on inside of you, and identify a desired healthy behavior
reaction. Emotion is going, mind is going ‘PAUSE!’ identify,
then react. ‘PAUSE!’ is our new key phrase.”
“Returning to the behavior you wrote on the back of your
notecard, consider what we discussed today. How could you
express the emotions you were feeling, in a healthy way?”

Questions following the order of Bloom’s Taxonomy to be


considered during sharing of the paintings and processing:
Remembering
 “What is our key word?”
 “Who can tell me the purpose of today’s activity?”
Comprehending
 “Why do we try to reach and express our emotions?”
 “How does painting allow us to gain awareness of our
emotions?”
 “How do colors express emotion?”
Applying
 “What actions can you initiate that promote positive
behavior?”
 “What strategies can we use to effectively express
emotion?”
 “What behaviors can occur when we react instantly on
our emotions?”
 “How do you feel while painting?”
 “How do you think painting will allow you to reach your
goals?”

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Analyzing
 “How does emotion affect our behaviors?”
 “How do you act differently toward people based on the
current emotion you are feeling?”
 “How do you act differently toward people based on
whether or not you pause and think about the emotion
you are wanting to act on?”
 “How do you decide primary versus secondary
emotions?”
 “Thinking of the behavior written on your notecard, what
was a better way of handling the specific stressful
event?”
Evaluating
 “How was painting helpful to understanding the
emotions you are feeling or have felt in the past?”
 “How can you utilize creative expression in your life to
express your emotion?”
 “How has understanding emotion helped you to analyze
a situation and alter your behavior?”
 “What are unhealthy ways to express emotion?”
 “What are healthy ways to express emotion?”
 “How does initiating the pause allow you to alter your
behavior?”
 “How does expressing your emotions reduce stress?”
Creating
 “What are some ways we can remind ourselves to hit the
pause button and analyze our emotions before we react?”
 “How will remembering to pause affect our group as we
go on wilderness excursions?”
 “How will remembering to pause affect how we handle
stress in the future?”

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“Who can summarize the key points of group today?”

6. Closing Group-
a. Summarization of key points from group by
recreational therapist. Striving for these key points:
i. Clients are able to identify that
there are primary and
secondary emotions.
ii. Clients will understand that
emotions can arise out of
specific events.
iii. Clients understand healthy
strategies to effectively express
emotion.
b. Awareness of physical and emotional safety of
members by recreational therapist. “From now on, our key word is “PAUSE!” Any time a member
of our group notices themselves or another peer becoming
7. Homework wrapped up in emotion, they are to say our key phrase. The
a. Implementation of the key word, “pause” into whole group will then pause, acknowledge their emotions and
b. Journal reflection of “pause” experiences identify a desired healthy reaction. Because you are journaling
c. Preparation for next treatment session already, we encourage you to journal your “PAUSE!”
experiences addressing the following questions:
a. “What was the situation?”
b. “What were the emotions you felt?”
c. “How did you react to the situation?”
d. “What was the overall outcome of the event?”
That is our homework for group today. Next session we will
move on to learn how to state what you feel using “I feel..”
statements.”
“You have all done a great job today. Bring it in for PAUSE! on
3. Right hands in. Grab the thumb of the person to your right.”
“1, 2, 3, PAUSE!”

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Sequence Sheet
TPO EO DESCRIPTION SESSION NO. TIM
E
(MI
N)
2 1,2 Group Opener 2 5
2 2 Review Group Guidelines 2 2
2 1,2 Painting Intervention 2 15
2 1,2,3 Sharing of Paintings and Processing Questions 2 15
2 3 Analyzing Behaviors 2 10
2 3 Group Closing and Homework Assignment 2 3
Total Time: 50

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Performance Sheet
PROGRAM: Stress Management Staff: E. Banyard, E. Bartlome

Date: 11/21/2017
PROGRAM PERFORMANCE PERSONAL PERFORMANCE
Client

TPO 2: Client will develop the


Name

expression, client will be able


to evaluate current emotional

verbally identify strategies to


verbally identify the event or
emotion as it relates to stress

circumstance related to their


EO 2: Client will be able to

EO 3: Client will be able to


state and identify primary
importance of expressing

EO 1: Through creative

effectively express their


ability to identify the

Personal Objective
management.

Staff Initials
emotions.

emotion.

emotion.

Date
Maiya 4 3 4 4 PM 1: Client will be able to identify two primary emotions 2 EB 11/
through group process, as facilitated by the recreational therapist. EB 27/
17
Bonnie 3 3 4 3 PM 2: Client will be able to identify, through group process two 3 EB 11/
strategies to effectively express emotion. EB 27/
17
Erika 4 3 5 3 PM 3: Client will be able to verbally identify two primary 3 EB 11/
emotions and the factors that elicit those emotions through group EB 27/
process, as facilitated by the therapist. 17
Tara 3 3 4 2 PM 1: Client will be able to identify two primary emotions 2 EB 11/
through group process, as facilitated by the recreational therapist. EB 27/
17
Bergen 4 3 3 4 PM 2: Client will be able to identify, through group process two 3 EB 11/
strategies to effectively express emotion. EB 27/
17
Kristen 4 3 3 3 PM 3: Client will be able to verbally identify two primary 3 EB 11/
emotions and the factors that elicit those emotions through group EB 27/
process, as facilitated by the therapist. 17

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Room Diagram 1- Room set up before painting activity

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Room Diagram 2- Room set up after painting activity

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Client Descriptions
Client #1

Client is a 17-year-old Caucasian female from Brooklyn, New York. She was admitted to SUWS of the Carolina’s on November 6th
with a diagnosis of Conduct Disorder. Client was diagnosed when she was 13 years-old after being expelled from her junior high
school for physical altercations with other students as well as lying and skipping class. Client was attending an alternative high school
when she was put on suspension for another physical altercation toward a student. Mother reports that client has maintained a healthy
relationship with her two younger brothers, but has been disrespectful, defiant, and even aggressive toward her parents. Client also has
been caught stealing twice in the past month from a local grocery store near her home.

Intervention outcome for client: Client will be able to identify two primary emotions through group process, as facilitated by the
recreational therapist.

Client #2

Client is a 15-year-old Hispanic Female with a Catholic Religious background from Boulder, Colorado. She was admitted to SUWS
of the Carolina’s on October 17th with a diagnosis of Anxiety Disorder. Parents have reported that as a child client was very social
and outgoing, but once client began junior high she became withdrawn from social engagements and activities. Teachers reported
client experience bullying by peers on playground, but client denied any peer conflict. Client reports she feels more comfortable
staying home with her parents and younger brother rather than engaging in school functions or socializing with peers. Client has also
reported feeling overwhelmed and not in control of her life. Client’s mother has checked client out of school multiple times this
school year due to client having panic attacks in class. Client’s pediatrician has diagnosed client with having panic attacks that are
interfering with client’s activities of daily living (ADL). Treatment team will rule out physical or sexual abuse or trauma related event.

Intervention outcome for client: Client will be able to identify, through group process two strategies to effectively express emotion.

Client #3

Client is a 16-year-old Caucasian Female from Provo, Utah. She was admitted to SUWS of the Carolina’s on September 2nd with a
diagnosis of Obsessive Compulsive Disorder. Client’s diagnosis was first recognized at the age of five when she began a
handwashing ritual. Parents report that as a child, client washed hands a minimum of 8-10 times an hour and refrained from playing if
the activity risked her getting dirty. Parents report that client’s obsessions have gradually worsened as client grew up as well as new

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obsessions have emerged including an obsession with order (i.e. client’s belongings have specific places in client’s room, client
becomes anxious and irrational when someone else moves her belongings). Parents report that client’s obsession with order and
hygiene are beginning to interfere with her activities of daily living (ADLs). Parents report that client does not socialize with peers or
attend social events or activities. Client does not believe she has OCD and believes that her behavior is healthy. Client has four
siblings (all brothers, 2 older, 2 younger) and reports that she feels the house is always in a state of disorganized chaos.

Intervention outcome for client: Client will be able to verbally identify two primary emotions and the factors that elicit those emotions
through group process, as facilitated by the therapist.

Client # 4

Client is a 17-year-old female from Billings, Montana. She was admitted to SUWS of the Carolinas on November 1st, diagnosed with
PTSD. Client first recognized symptoms 6 months ago after being involved in a car accident caused by a drunk driver, that left her
best friend with an SCI affecting the lower extremities. She has verbalized feelings of guilt due to being the one driving. The client has
become very withdrawn in the past 6 months around family members and peers. She is becoming increasingly resistant to therapy and
will sit for most of the session in silence. She does everything she can to avoid riding in a car due to having panic attacks. Within the
month previous to admission, the panic attacks had increased to each time she was in the car. Two months ago, during therapy, it was
discovered that she had been inflicting physical self-harm through cutting as a means of exercising control in her life and releasing
emotion, as stated by the client. She has always expressed a spiritual connection with nature, so her therapist recommended SUWS of
the Carolinas to the client and her parents.

Intervention outcome: Client will be able to identify two primary emotions through group process, as facilitated by the recreational
therapist.

Client # 5

Client is a 16-year-old, African American, female, from Selma, Alabama, who was admitted to SUWS of the Carolinas on November
1st with a diagnosis of Oppositional Defiant Disorder. Client was referred by school counselors after being suspended from school for
the instigation of physical altercations. She is a sophomore in high school and did well in school until the second semester of her
freshman year. She has never had any really close friends, she only spends time with the students who use drugs and alcohol. She
deliberately annoys those around her and instigates fights, then blames others for it. Prior to admission, she instigated a physical fight
during class at school, when the teacher tried to stop the fight she ran away from the school. She was found that evening in an
abandoned building, passed out from alcohol abuse. She lives with her mother and two younger brothers; she has not had a father

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figure in her life. Her mom works a lot, but does her best to make time for her kids. Family is not affiliated with an organized religion.
Client’s past recreational interests include drawing and running.

Intervention outcome: Client will be able to identify, through group process two strategies to effectively express emotion.

Client #6

Client is a 15-year-old, middle eastern, female from Detroit Michigan. She was admitted to SUWS of the Carolinas on September
10th, diagnosed with Borderline Personality Disorder by her pediatrician. Over the past 12 months she has noticed feeling emotionally
unstable. She has had feelings of worthlessness, and insecurity. She exhibits impulsivity by binge eating as a means of coping with
stress. Another incident of her impulsivity occurred in May when another student cut in line during lunch. This resulted in the client
screaming at the other student and physically attacking her, which resulted in suspension from school. Her impulsive outbursts have
led to impaired social relationships with peers. She has had multiple boyfriends in the past year, each relationship ending in conflict.
Additionally, her parents have noted increased conflicts at home as she repeatedly plays mom and dad against each other.

Intervention outcome: Client will be able to verbally identify two primary emotions and the factors that elicit those emotions through
group process, as facilitated by the therapist.

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References

Austin, D. R. (2013). Therapeutic recreation processes & techniques: evidenced-based recreational therapy. Urbana, IL: Sagamore
Publishing.

Panda, S. (2014). Stress and Health: Symptoms and techniques of psychotherapeutic management. Indian Journal Of Positive
Psychology, 5(4), 516-520.

Stumbo, N. J., & Peterson, C. A. (2009). Therapeutic recreation program design: principles and procedures (5th ed.). San Francisco,
Calif. ;London: Pearson/Benjamin-Cummings.

Varvogli, L., & Darviri, C. (2011). Stress Management Techniques: evidence-based procedures that reduce stress and promote health.
Health Science Journal, 5(2), 74-89

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