**I am doing my clinical/counseling practicum at the Buffalo Psychiatric Center (BPC).** 
__Last Updated: Jan. 22__ 
//running total hours: 121.5 out of 120//

====September 18th, 2006====
I started my orientation by meeting with Sue Joffe. She is the director of Public Information and Volunteering at BPC.  After looking over my papers and asking me a few questions, she gave me some options as to where I wanted to be placed for volunteering.  I was then mandated to watch 2 1/2 hours worth of videos.  The first tape was made by the BPC and it gave information about the hospital, including an overview of the BPC and the different facilities available, the mission statement, volunteer procedures and rules, an explanation about the various treatments used to help patients recover, and a brief overview of mental illness.  The second video was a HIPAA (the Health Insurance Portability and Accountability Act)  training program, which is a New York State law that protects patients health information and the various methods of keeping that information safe.  In a similar light, the third video was an OMH (Office of Mental Health) security training program.

After the videos, I was able to meet my supervisor in my volunteer placement, a psychologist named Dr. Drew Messer.  He is a psychologist in the BRITE (Behavioral Rehabilitation and Interpersonal Treatment Environment) program, which contains patients who live in a ward and are treated based on principles that encourage social learning and proper behavior.  Some have been there for 20 years, and most of them have some form of schizophrenia, or another severe and chronic psychiatric disability.  He showed me around the ward and I was able to "meet" some of the patients who live there (there are about 27 currently residing there).  During my time here, he suggested that I learn and experience as much as I can, and this would include sitting in on therapy sessions, reading patient charts, and most importantly, interacting with the patients (such as doing activities with them or simply having a conversation with them).  He gave me some examples of how to establish relationships with them, including giving me a lesson on reflective listening, a form of therapy pioneered by Carl Rogers.  It was quite an exciting and overwhelming day! 
//:4hrs//

====September 25, 2006====
Dr. Messer explained more about the treatment programs implemented for the people living in the BRITE unit.   In a nutshell, the goal of 
treatment mostly consists of rehabilitating the patient to being able to live on their own (self-directed behaviors) and being able to care for themselves (self-care).  Most of his time is spent writing up treatment plans for every single patient living in the unit.  This is done by compiling notes from nurses, doctors, therapists, social workers, psychologists, etc. and seeing if/how they progressed with the goals set for each patient to accomplish within the past 3 months.

Next, Dr. Messer led me to the dining room where patients were having lunch.  He had me observe them and showed me the rating sheets that are used to assess patient's behaviors while they are eating.  They must display proper eating skills, such as not chewing with their mouth open, not being messy, using their fingers when appropriate, using utencils, engaging in appropriate converstaion and cleaning up after themselves.  These skills are things people without mental illnesses take for granted, but some these people that I observed cannot do these things like the rest of us.

I came along for a walk with the social worker for BRITE to escort one of the patients on the ward back to his new living unit in a place called SOCR, which is on the BPC campus, but it is not in the main hospital building, thus the place is more home-like and does not contain many locked doors.  Patients who are able to move off of the BRITE ward and into these special housing units must display progress and must meet their treatment goals.  Many of the other patients accosted Dr. Messer with inquiries about when they would be able to leave the ward and into one of the houses.  It seems as if many of them do not want to be on the ward, especially the higher functioning ones. 

Then, I participated in a group activity with one of the rehabilitation counselors.  It is called interpersonal group interaction and it is for 
encouraging patient interaction with others.  I painted with two patients while the others played gin rummy.  This reminded me of working with elementary school kids.  There were crayons, puzzles, coloring books, paints, and board games for patients to do.
For good behavior and for participating in groups, patients receive tokens.  These tokens are like a debit card that is marked down in a bank book. They can redeem these points for certain things, such as for buying things at the token store, or for opting out of group sessions.  If they display inappropriate behavior, ranging from hitting another person to smoking in the bathroom, points are deducted. This is simple behavior modification.  I took note that patients receive medications 4 times a day.  And everything they do is on a set schedule. 

Finally, I observed an informal group session.  During this activity, patients must be able to occupy themselves for 45 minutes, whether it be sitting and reading, or playing cards with someone else.  The rehab counselor does not interact with them, she only observes and assesses them with a rating sheet.  Only about 6 patients out of 28 were able to complete the activity.  Several were sleeping, others were wandering about and talking to themselves, and many refused to even participate.  Those who did well received one token.  This activity is for encouraging appropriate behavior in a community setting.  So, for example, if they were out in the world and they were talking to themselves with nonsensical dialoge, that would be behavior that would make people think they were "weird."  They must learn how to assimilate themselves if they are ever going to get off the ward.
//:5hrs//

====September 27, 2006====
I began my day by meeting with the teacher on the ward and learning about her program and the things she does to help the patients.  
Patients have the opportunity to attend class to enrich their reading, writing, and math skills.  Some are able to focus well and read, for example one woman was able to sit and read a few chapters (in a condensed version of) Little Women today.  Others do not have the ability to concentrate or do not have the intelligence or memory, such as this one woman who finally learned how to write out the alphabet after 6 attempts.  This may result from the medication they are on, from any learning disabilities they have, or because they do not even have a high school education.  Again, the workbooks and the fact that several of them have low attention span reminded me of working with elementary school kids.  The teacher also talked to me about the TABE, a standardized test for adult basic education.  The test is taken twice a year for assessment and has a grading that is based on a scale 1-12. These numbers indicate a grade level that these patients read and do math.  For instance, one patient had an english reading level equivalent to a child in third grade and a math level equivalent to a child in sixth grade. Most of the levels are really low.  I think the highest was sixth grade. The classroom contains books, computers, and other typical materials found in a classroom, but the teacher informed me that the patients do not like using or working on the computers despite all of her encouragement to try the machines.  I thought that this was unfortunate because if any of them ever do get discharged, knowing computer skills have now become an integral part in many jobs, and thus they would be at a disadvantage.

I then participated in another interpersonal group.  This time I played Uno and Sorry with an older lady who is one of the lesser functioning patients on the ward.  Surprisingly, she knew what was going on during the games and even beat me at Uno!   We played for about an hour and I noticed that as we went along, she got more tired and confused as we played Sorry. The recreational therapist encouraged her to engage in conversation with me, and that went well though it was quite a challenge because the patient is hard of hearing. 

Dr. Messer involved me in little "therapy" with a patient.  This particular patient had been discharged to RCCA, another supervised living 
community on the BPC campus.  However, due to a few misbehaviors, he was sent back to the BRITE ward and given a second chance to shape up and return to RCCA.  Dr. Messer informed him of the three tasks that he had to complete for five out of seven days in order to go back to RCCA.  One particular task was a little difficult for the patient, so Dr. Messer had me help him make the patient understand how the procedure worked.  We did some role playing with these index cards that the patient is supposed to carry around with him at all times.  Just to give an idea, one card said "I am not stupid."  This particular patient has terrible low self-esteem, so when he feels negative thoughts brewing in his head, he is supposed to take out the card and read what's on it and say to himself that he is not stupid.  He understood what he had to do, but I still don't know if the patient will remember what is expected of him. It will be interesting to see if he does end up going back to RCCA.

One little insight I would just like to add: reading about these mental illnesses in my abnormal psychology textbook, and then seeing them actually manifested in a patient...they're two totally different experiences.
//:5hrs//

====October 4, 2006====
I did a lot of observing today.  First, there was a woman who was in the isolation room yelling out things.  A week ago, this woman was quiet and perfectly normal, though a little depressed, and now she is lashing out. This is apparently because she goes through mood cycles, and this time she was "up" - I'm not sure if she is bipolar or not, but it sure seemed like she might be the way it was described to me.  Next, I observed the patients receiving their medication.  It is very similar to what they show in movies and on tv.  A nurse goes into a small room and has a giant booklet with all the patient medication information (as prescribed by the psychiatrist) and each patient's picture to ensure that they receive what they should .  She then gives each person a cup of water, and a little cup with their respective medication as they come up to a little window.  Patients who have special needs, such as being diabetic for instance, also receive their appropriate meds at this time.  All the medicine is stored in a cart, and each person has his or her own drawer full of medication. Fnally, I observed this one patient's behavior which i find particularly fascinating because he is clearly experiencing auditory and perhaps visual hallucinations.  He just walks around the ward the entire day talking to someone, I don't know who. I heard from the psychiatrist that he believes God is talking to him.  He has conversations with all sorts of topics with this person, and he even stood in front of a mirror and playfully "fought"  himself, though in his mind he was probably fighting the other person (it wasn't aggressive).  I've heard him discuss things about sports and a lot of delusions of grandeur.

One of the rehab counselors had me do some internet research to think of ideas of things to do during group programs that would engage the patients and help them in some way.  Some of the topics I looked into were dealing with grief, anger management, and self-esteem boosting. I had to research these topics with regards to how children cope with these things because these patients have more a child's mentality as opposed to an adult one.  Adult practices for dealing with problems would be over their heads.

I spoke with a lot of the patients today too.  They say some pretty interesting things.....  Most of it is nonsense. Some of it is a little too personal. It is very hard to keep a conversation with them.  Most of the time it's hard for me to even come up with things to ask them, but nevertheless it doesn't matter - they always end up saying something bizarre.  The lady that I played Uno and Sorry with last week did not remember who I was and did not remember that we had played those games.

Later, I went to music therapy, which is a group program that is off the ward and in an adjacent building . Only three patients were eligible to go. What happens at music therapy is a bunch of patients from all different wards meet and sit around and listen to music.  Individuals take turn and pick out what song they want to listen to.  Most of the music is on records! It is very old, like 1960s and 1970s records, and it is listened to on a record player.  That's all they do - sit around and listen to music.  I wasn't too sure what they learn from this program, but at least it gets them off the ward. Some of the patients from the ward I am in were already there when we brought the other three.  These patients have special privileges and are able to walk around the BPC campus by themselves without an escort.  They get to this privilege by exhibiting appropriate behaviors.  It is nice to see that some of the patients are able to be fairly independent, and I'm sure it makes them feel good too.
//:5hrs//

====October 11, 2006====
I spent a lot of time talking with Dr. Messer today.  He told me that I should just be out on the ward, perhaps sitting and doing school work, and observing who comes up to me to initiate conversation. When I asked him if I should go up to them and start conversations with the patients, he said that I should just let them approach and talk to me.  Later, Dr. Messer had me watch a video from a Massachusetts hospital that is on the internet.  It was a presentation about introducing Cognitive Behavioral Therapy (CBT) in the treatment of patients with schizophrenia and psychosis.  CBT is what the BPC uses to treat their patients, and the basic idea of it is to train patients to change their thoughts, which in turn, will change their behaviors. The video showed a step-by-step guide in doing this and made a lot of sense, and it provided me with a lot more information on using CBT with patients (though Dr. Messer said that I should not be using it, but only taking in the information on it).  For example, the presenter in the video gave a situation where a patient talks nonsense and the psychologist has no idea what the person is talking about and simply nods their head.  This is an inappropriate gesture because it reinforces that patient's garbled speech as something appropriate, when really it is not. Instead, the video suggested that you say to the patient "I do not understand what you are saying" or "I did understand this, but I don't understand what you mean by that," and refrain from nodding.

I sat in the classroom again today.  One patient read, one looked at pictures in a book, one did fraction problems in a math book, and one filled out a workbook about football - kind of sounds like an elementary school classroom, like I have been saying all along.  The teacher explained that a lot of the patients are good students, but sometimes the medication they take interfers with their functioning, for example, making them sleepy.  She also showed me all the weekly treatment information she prepares for each patient. Apparently, every Monday, everyone in the treatment team, which is the social worker, rehab counselor, recreational therapist, teacher, psychiatrist, psychologist, etc. sits around and discusses each patients increase in progress or decrease in progress.  From this it is determined which patients have privileges, such as being unescorted to off-ward activities.  This is called a Cardex meeting, and it happens on every ward in the hospital.

A few of the patients remember my name and ask me how I am doing.  My goal is to increase that number and establish a friendly relationship with them.
//:5hrs//

====October 16, 2006====
There were no classes today, so I was able to come to BPC a little earlier than usual.  Because of this, I was able to participate in an activity program on the ward called Skill Building Class, which I hadn't participated in before.  One of the rehab counselors runs the program that is geared toward the more higher-functioning patients. Today the patients were discussing responsibility.  The counselor found a sheet on the internet about taking responsibility for yourself, and after reading through, the patients were supposed to take a mini quiz assessing their own abilities to take responsibility. Most of them were not fully comprehending the exercise or caring.  Even though the self assessment questions were supposed to be rated from 1 to 5, with one being "I am always irresponsible" and 5 being "I am always responsible," someone still managed to put down "True" and "False." Other examples of activities the rehab counselor tries to do in this program might include something that might help build self-esteem, or how to deal with anger, and other life building skills of that nature.  

As I was walking around the ward, Dr. Messer told the one patient that always walks around and talks to himself to talk to me.   He said "okay" and then came up to me and said hi.  He didn't say anything after that, so I said "What are you up to?" and he responded "I'm just trying to get out of this place." And he started walking away from me (as if "hello" constituted a conversation). So I said "What do you like to do?" and he said I like sports so I asked what kind of sports he likes and he said basketball and football. And I asked him if he watched the sports on tv and he said yes. Then I asked if he liked the Bills and he said yes. By that point, he was ready to bolt far far away from me.  He was not too keen on having a conversation.  He immediately started talking to himself and walking about, just like he always does.  He told himself "I had to talk to her because she’s new here."  Later on that day, I played Battleship with him. The social worker watched as we played and tried to make sure that the patient was winning.  However, the patient kept giving me hints about where his ships were placed.  In one incident, he said "Hit, and you've come across two ships" and the social worker was like "Why did you tell her that? You're giving away too much information!" and he laughed, and he responded that Jesus had told him to tell me.  When patients experience auditory hallucinations, a lot of them either hear voices that make them "do bad things" or they believe that they are talking to a higher being (God).  I wonder why God is so prevalent in a lot of mental illnesses... 

Next I played checkers with another male patient.  The rehab counselor had previously told me that he hadn't wanted to play checkers for a while, ever since she beat him at the game. Nevertheless, he agreed to play with me.  He did not initiate any conversation; we just sat there in silence.  He is one of the many patients on the ward that displays a blunted affect (meaning he always seems like he's depressed and never expresses emotion). By the way, I let him win.
//:4.5hrs//

====October 18, 2006====
It was a slow day today at BPC.  I decided to help out the recreational therapist with a group activity, like I always do, thinking I would be able to get a lot of interaction with the patients.  Instead, all the patients either bought out of program (meaning they gave up some of their tokens so that they didn't have to attend) or they received a program refusal, which reflects badly on their progress. Thus, there was no one attending program today.  So I decided that it would be a good day to finally take a peek at all the patients' charts.  In looking at these charts, I was most interested in two things - what mediciations are they on, and what were they are diagnosed with.  There were three very common diagnoses: 1. schizoaffective disorder   2. schizophrenia (both paranoid and undifferentiated) 3. substance abuse.  Some even had some sort of combination of those things.  Schizoaffective disorder is a psychotic disorder that combines schizophrenic symptoms and either bipolar disorder or major depression.  Thus, this is why I had mentioned in one of my earlier entries about the woman who I suspected had bipolar disorder - this is where the bipolar comes into play.  Two of the patients were diagnosed as having antisocial personality disorder.  The most common substance abuse problem was with alcohol, but some patients were also polydrug users.  I recognized a lot of the medication from them being mentioned in some of my classes, for example I saw haloperidol, clozapine, chlorpromazine, and Seroquel mentioned in various people's charts.  All of these are antipsychotic medications. It was quite an overwhelming amount of information to read through, especially with there being about 28 charts.

After I was done with the charts, I sat in the program room with the recreational therapist and read a magazine since no one was coming to program.  Incidentally, one of the patients came into the room and the therapist talked her into playing a game.  So I played Uno and Checkers with her, it was the same old woman that I had played with before.  She is hard of hearing, so it is a little frustrating trying to communicate with her.  She was unexpectedly really good at checkers.
Speaking of checkers, the rehab counselor told me that it was very good that I had let that man win at checkers the other day because after that, he felt good about himself and was in a much better mood.
//:5hrs//

====October 23, 2006====
I thought today would be a quiet day, but boy was I wrong!  Things did start off normal and quiet, but by the end, I couldn't wait to get out of there because it was way too crazy.  When I walked in, the older lady that I always play games with smiled at me and asked if I was there for the day and later asked if we could play games.  A lot of the patients are already speaking to me, either by simple "hello"s or by conversation.  It is nice to know that they like you.  Although one patient is a little scary and perhaps likes me a little too much.  He apparently has a thing for young blonde girls and he kept saying inappropriate things and blew kisses at me.  It was very uncomfortable. I will have to talk to Dr. Messer about it if his behavior continues.  Today, three different patients told me that I looked like someone else in their life.  Sometimes the things they say are really uncomfortable for me.  I am also not sure if what they say is true or not.

In the afternoon, the rehabilitation counselor and I took out one patient off the ward. We played basketball with him.  At first, we tried playing basketball outside, but it was very cold and windy. I was really cold, but I didn't say anything. Before I knew it, the patient says "God told me that she's cold" to the counselor. So he told the rehab couselor for me.  We moved basketball to the gym indoors and played for a few minutes, just shooting balls at the basket and stuff.  Then, the patient wanted to go swimming, so we watched him swim.  This was only for a few minutes as well.  The rehab counselor was telling me that he has privileges to go out of the ward by himself and go to these activites, but he chooses not to.  She came up with a plan, and ran it by Dr. Messer, for the patient to be encouraged to go out on his own and do the things he likes.  The patient was open to the idea and Dr. Messer also thought it would be great for him to learn responsibility that way.  He is one of the younger patients on the ward.

When we came back to the ward, I played a few games of Sorry with the old lady, just like I promised her I would.  She was fine playing with me, but right after the program group ended, she started being really nasty to the other patients.  She got her arm ready to hit someone and she was screaming false accusations at the other patients and  screaming that they are stupid, or a bitch, or a liar.  She was sent into the time-out room to be alone.  I have no idea what set her off. It was very strange to see this little old lady get so angry and so mean.
Then, the basketball patient started becoming obsessed with the fact that we had played basketball together, and he boasted how he  played in highschool, college, and he also played for the Knicks, Lakers, and the Bulls.  Then he came up with some more irrational thoughts, saying that if I wanted to play college basketball or for the WNBA that I could if I just practiced. I assured him that I was only playing with him because I liked playing for fun.  He also thought that I was upset that he was a great basketball player and "kept scoring" when I wasn't scoring as much. He said that if I wanted to learn from his greatness that I could. None of this was true. We were only shooting basketballs randomly, there was no competition, and by no means did he make every shot he took. (Like I had mentioned in an earlier entry - it's delusions of grandeur.)  I do not know where he got all these ideas. 
//:5hrs//

====October 25, 2006====
Because a few patients had been discharged off the ward, there are opening spots in BRITE II, so two new patients were admitted. One is an elderly lady who has dementia. I did not speak to her yet. The other is a young man in his late twenties who has some problems with drugs.  Both were already in BPC but at other wards, and were transferred to BRITE in hopes that they would function better there.  I tagged along with Dr. Messer when he interviewed the man.  He told us his story, and it was a little shocking and sad.  He told us about his past and how he frequently used various drugs.  One particular drug really sent him over the edge because it made him hallucinate, have paranoid thoughts, and have panic attack-like symptoms. I looked up the drug in my textbook (I am currently taking a class on drugs and behavior) and sure enough, the drug does induce paranoid symptoms. I inquired about what his favorite activites, aside from doing drugs, would be, but he doesn't seem to have any.  I asked about his high school experience and he just told me that he did things to "get by" and did what he had to do, and thought it was boring and pointless. He has been off drugs for a while, but he is unsure if he would be let out today if he would turn back to them.  I hope this man finds something healthy that he enjoys because I believe that is the thing that will keep him off drugs, in addition to staying away from the bad influence his friends have on him.  He has slight tremors and he just kind of stares off, absolutely no emotions or even facial expressions that show that he is even paying attention to you talking to him.  

In the afternoon, I attended music group, an off-ward program, again with the rehab counselor.  One patient, the man whom I beat at checkers, had just received privileges to attend off-ward programs unescorted.  He was at the music group and he was, suprisingly, chatting with me.  He told me that he enjoys getting off the ward because staying in there all the time "makes him crazy".  Another patient, who has been known to steal things, returned a coffee container that one of the nurse's aids left lying around.  She could have stolen it, but she turned it in.  I like seeing and hearing about patients progessing.

An elder patient was sent into the isolation/time-out room today because he was, well, acting crazy.  He kept talking to himself, and it seemed as if the voices in his head were not saying pleasant things.  He was getting loud and rowdy, so he was put into the room. I heard the head nurse saying that she gave him some clozapine, which is an anti-psychotic medication, but she said it would take an hour to kick in and for him to calm down. 

I also met the ward's psychiatrist today.  He is getting ready to retire and was telling me some (unpleasant) stories about his job.  He is quite funny though.... 
//:5.5hrs// 

====October 30, 2006====
I started out the day coming in early and sitting in on a skill building program. This time I was with the recreational therapist who ran the group program for the people in A and B Group. The patients on the ward are placed into either A, B, C, or D group based on their functioning and privileges.  Those in A and B are lesser functioning than those in C and D.  The rec. therapist had them fill out a sheet with a bunch of random questions, and then would facilitate group discussion with them.  Some questions included "Do you like money?"  "What is the sales tax in Erie County?" "What makes you feel good/happy?" and the final question was to look around the room and ask someone else a question about themselves.  This last part seemed to be the most difficult for the group because no one interacts with each other socially.  To give an example of what someone asked someone else, one patient asked another patient if they believed in God.  It was a very slow and frustrating to watch these people struggle with something so simple as filling out a sheet about themselves and trying to engage in normal conversation.   A few of the patients said that their medications or visiting the doctor made them feel good.

Next, Dr. Messer brought me to a BRITE committee meeting.  Someone on the BRITE I ward, which is the ward on the other wing of the BRITE II ward that I am in, has requested to leave the BRITE program.  The committee, which consisted of three psychologists and the hospital attorney, met and discussed the procedures that they have to follow in order to deal with this particular patient's request.  They all seemed to agree that he would **not** be better off in a different type of treatment program in the hospital (the BRITE program is unique to the rest of the programs in BPC), but the patient still insists that he wants to leave.  It was interesting to be in on this meeting because I got a little taste of law and psychology working together. If the patient doesn't recind his request to leave, a hearing will be held to determine his outcome.

The rest of the day was really strange. I would like to blame it on Halloween.  Patients who are normally good were acting up, and patients who are normally bad were good today.  I went with the psychiatrist and the rehabilitation counselor outside for a walk and we took 5 patients with us.  They were really good.  One patient who is usually unstable was acting very pleasant and engaging in conversation with everyone.  She even asked one of the other patients what his view was on the war in Iraq!  When we got back, group program was still running so I played Sorry with the usual lady that I play games with.  This time I got tired of her always "cheating" so I would correct her if she did something wrong, such as going forward 4 spaces when the card really says go backward 4 spaces.  I think she got a little upset at me for telling her what to do.  At the end of the day she told me to go home because I didnt belong there.  She was getting nasty to other staff members too.  In fact, there were several outburts by various patients, lots of anger and upset people.   I was glad to get out of there when I did... 
//:5.5 hrs// 

====November 1, 2006====
Sometimes a patient is discharged to a housing unit, like RCCA or SOCR, but ends up coming back to the ward.  This can happen several times, - he/she can be discharged and have some sort of behavioral problem, and then end up right back in the BRITE ward, and if the behavior is something that can be easily fixed, the patient will get another try at living in the housing unit. Today, one particular patient, who has been back and forth from the housing unit and the ward two times now, .  Because he has such negative feelings ruminating in his head, he has problems when he becomes depressed.  An incident occurred where he threatened to harm himself, so he was sent back to BRITE.  BPC is always on guard with threats or attempts at suicide because certain disorders have a high occurrence of patients who attempt to commit suicide.  I was able to observe the psychologist and the social worker as they talked with the patient and attempted to figure out what they would do to help this patient take control of his thoughts and emotions so that they could eventually send him back to the housing unit.  The previous form of therapy they were using to help him obviously was not successful, so another course of action would need to be taken.  The issue would be addressed tomorrow at the treatment team meeting and from there all the staff that interact with the patient will need to use appropriate measures when dealing with him.

Group program was not very interactive today.  The patients that attended seemed to find something to do on their own (one was doing a puzzle, others were coloring) so I was off the hook with playing another game of Sorry (I'm so sick of that game now...).  There was still conversation going on between myself and the patients, so that is still good. One woman was telling me about what games she enjoys playing, but when I asked her if she wanted to play anything, she said that she wasn't feeling good so she didn't want to play. She told me that she used to know how to play pinochle, but forgot how to play because when she was younger she received shock treatment seven times.  She said that the shock treatment was awful, she hated it, and it made her forget lots of things.  I am curious as to how exactly it was performed back when she was in her 20s, because nowadays "shock treatment" or ECT is a rather harmless procedure. 

Late afternoon, just before it was time to leave, two patients started yelling back and forth at one another - a man and a woman.  The nurse ran over and told the man to go away.  He was screaming out nonsense phrases from then on and was walking around in anger.  If a patient gets agitated, the nurse can administer a medication that will calm them down.  They are usually also sent to the time out room.  This patient refused medication and was told to calm himself down.  It was a little frightening!
//:5.5 hrs//

====November 6, 2006====
Dr. Messer told me that he sees me being a lot more comfortable around the patients on the ward lately.  This is very true.  I also talked with him about some concerns I had in dealing with certain patients.  He helped me clear things up a bit.

It was a very exciting day for me today because I got to experience something new. I was able to go on a "van ride" with the recreational therapist (RT), who took six patients for an off-ward trip, and observe how these patients acted out in the community.  We drove down to Clarence to the pumpkin farm, and then drove through the town of Akron and ended our trip by getting treats at McDonald's.  The only time they actually got out of the van was when we went to McDonald's.  Other than that, the trip was basically just a senic drive.  The patients were very quiet on the drive there. The RT tried to engage the patients by explaining things, sort of like giving a tour, as she drove the van.  For example she told them that this would be a good chance for them to see all the damage the snowstorm caused in Buffalo if they look out their windows. She also pointed out certain landmarks and things like that.  I thought it was really nice.  Only a few patients reacted to observing things out of their window.  One patient is frightened of driving on highways, so she closed her eyes while we took the 198 to the 33.  At McDonald's, the patients could choose from getting ice cream or getting a soda.  The RT ordered the food while the patients sat down.  They were not disturbing other people, they weren't acting "crazy," they just looked like a regular group of people. Except for the fact that they are so anti-social that they won't sit at one table together, there was no way anyone from the community would ever know there was anything "wrong" with them.  The bus we took does not say "BPC" and the staff does not wear their badges, so it is all up to how the patients act - if they act normal, no one even knows they reside at the psychiatric center.  On the drive back to the hospital, the patients were talking to themselves just like they do when they are on the ward. I dont know if it was the food at McDonald's that instigates their behavior or what. One patient was giggling non stop.  One patient wouldn't stop talking to God. Two female patients were arguing with each other over nothing. Another patient told the RT that he was beginning to "hear the voices" and apologized for it. The RT told him that it wasn't his fault and that if he needed medication that he would be able to receive some from the nurse when we returned to the hospital.  He proceeded to say "leave me alone, leave me alone" to himself and then kept repeating a certain phrase the entire drive home.

When we returned, there was a patient who was out of control and screaming things at the staff and at Dr. Messer.  This is a patient who has so many fines already that fining her some more wouldn't be very effective.  The nurse gave her medicine to calm her down.  At one point I thought they were going to have to call safety for help.

Another patient came up to me to talk and told me that she was feeling very depressed.  I didn't know how to react because I didn't want to say the wrong thing. I finally just told her to think of some happy things, and it seem that just talking to me brightened her mood.  I think she had spent most of the day just sitting and staring off, probably ruminating sad thoughts.  She told me that she liked me and I told her that I liked her too. 
//:5 hrs//

====November 8, 2006====
For the next few times I go to my practicum, all the people on the ward are being "kicked off" during the day so that a cleaning crew can clean everything.  This means that the patients and staff are temporarily moved to the basement of the hospital, where there is a giant recreational room.  I thought that for sure this move to a new place would be a lot more fun for the patients (and for me too) because the room has pool tables, fuseball, and a basketball game.  But instead, things are a little edgy with everyone being in the same room together. Patients are getting on each others' nerves and there seems to be more misbehaviors.  I hope that the next time I come I'll try to get a patient to play one of the games with me.  It's funny because, like I said before, the patients are so antisocial with one another that several patients were just playing pool by themselves and not with anyone else.  The only advantage of being in the giant room is that I can observe everyone all at once, and I got a lot more patients coming up to me and trying to have conversations with me.

Later, I went to the off ward music program with the rehabilitation counselor.  I thought it would just be like the other times I went where everyone just sits around a table and listens to songs on a record player.  But today the lady that runs the group decided to try something different. She had her student volunteer play guitar while everyone sat in a circle of chairs and play some different kind of drums along with the guitar.  A lot of the patients had fun playing the drums while others did not want to participate.  She made everyone go around the circle and "drum" along while they say their name. Even I had to do it!  While the student played guitar, patients who had drums were supposed to make a beat that went along with the song, and the rest of the group was supposed to sing along.  Some songs were Beatles songs, others were just generic songs, like God Bless America and You Are My Sunshine.  Almost all of the patients participated.  I was surprised at home many patients remembered all the lyrics to the songs.  At one point a couple of patients started dancing in the middle of the circle.  After an hour of that, the program returned to just simply listening to music.
//:5hrs//
 
====November 13, 2006====
The ward was still being cleaned, so everyone was in the basement again.  As soon as I got there, I found someone who wanted to play Scrabble so I played with her. Eventually, another patient came and joined us.  The one lady was really slow at forming words to place on the board and kept getting distracted and talking nonsense. I had to remind her that it was her turn and I tried to help her think of words.  A few times she was fine and came up with words on her own. But then it was lunch time, so we had to put the game away. After lunch, I asked a male patient if he knew how to play foosball and if he would play with me.  We had fun - he was laughing and he beat me most of the time.  We played like 5 rounds, only lasting about 5 minutes.  For some reason, that particular patient won't do one thing for very lon - or maybe he was just shy having to interact with me.

The recreational therapist asked me if I wanted to go to another floor on the hospital where they have special programming for other wards. Because BRITE was in the basement, program wasn't going to be that structured so it would be difficult to participate in.  I said yes and she showed me around the third floor of the hospital where they have lots of program rooms.  I saw the room where she conducts monday night cooking classes with a few patients from the BRITE ward.  Also in that room was a whole bunch of "sponges."  Patients in the hospital can earn money for packing those "sponges" for the manufacturing company. The company has a contract with BPC and for every sponge that's packaged, the patient earns a few cents.  It is like a miniature assembly line at a plant.  Patients really enjoy doing this pre-vocational training because it gives them a "job" and something to do besides pacing about their ward.  I ended up staying on the third floor in one of the classrooms.  In there I helped a teacher with her "students."  The patients who attend that classroom actually use the computers they have there!  One lady was practicing her spelling, and a lot of other gentlemen were practicing math problems.  I helped correct their math and I even tried to tutor this one patient in algebra.  I could definitely see a difference between the patients that come to these programs than from the ones on the BRITE ward that I always see - they'd never do algebra or even touch the computers!  I also helped another man decorate the hallway in Thanksgiving themed decorations.  The teacher was very good about getting him to properly interact with me.  They have a lot better social skills than the BRITE patients.

A lot more patients are coming up to me and speaking to me.  I love hearing them say "Hello Emily!" because it means that 1. they remembered my name and 2. they are being socially friendly.  I don't really like it when they come up to me to talk and they just don't say anything that could be a back and forth type conversation.
//:5 hrs//

====November 15, 2006====
Everyone was back on the BRITE ward today. The rehabilitation counselor asked me if I was interested in running a special group during informal interactions.  Usually during informals, the patients are supposed to be sitting and doing something independently, such as reading a book or magazine, for 45 minutes.  The problem is that a lot of patients can't read or aren't interested in reading.  So the group I would run would be for those people who want to do something different during informals.  I would have a few people play computer games and the rest of them would sit together and have a discussion about something.  I would give them topics to discuss and would help facilitate "neighborly" conversation.  My first day with this will be on monday, so I came up with a few topics and a few pointers to remind the patients about, such as listening skills, thinking before you speak and appropriate conversation.  The rehab counselor told me that I shouldn't be disappointed if no one shows interest in attending my group because a lot of them hardly participate in other programs too.  It should be interesting....It is very difficult coming up with topics for them to discuss because they are so sheltered from the outside world, they barely know what's going on in current events, they don't have many interests except for smoking and sleeping, and they haven't really seen any new movies or know of any new music out there today. I know it's a little harsh saying all these things, but it's unfortunately true!  There is not a single person that works with these people every day that will tell you otherwise.

I went with the rehab. counselor to music therapy again because she had asked me to come along with her this week to help her with the patients she was taking.  These two individuals have never gone to the music group before and one of them had previously run away, so she wanted me to help out just in case something happened.  Nothing did happen - one patient was good, but didn't participate and they other participated but kept having a negative, nasty attitude toward his life with being in the hospital for so long.  I can't even begin to imagine how someone would counsel him to change his attitude, he seems so set in his ways.  I wish I could sit in on a counseling or therapy session, but I have no idea when they even run those things.

I had forgotten to mention in my earlier entries that BPC is going "smoke-free" in January, meaning that there is to be no smoking inside or outside on BPC grounds.  People will have to go to the sidewalk on Elmwood to smoke.  Patients are NOT happy about this because they live to have their next smoke.  Though the hospital is pushing and hoping that people start quitting smoking, I don't forsee a lot of them doing that - they all clearly have no motivation to change.  And I'm not just talking about the patients on BRITE, all the patients in the hospital have the same attitude and highly enjoy their cigarettes.

Lately I have been having lengthy conversations with the rec. therapist and rehab. counselor about dealing with the patients. I talk to them a lot more for the scoop on all the patients since they interact more with the patients than the psychologist, psychiatrist and social worker do.   I really enjoy hearing their insight into things, and because of their knowledge and experience, I learn a lot from them. Today we discussed how to deal with patients when they have delusional thinking, such as saying someone saying "oh I'm the queen of France, you can't treat me like that" or some other type of ridiculously false statement. One of things that is hard to deal with is the fact that these patients have chronic mental illnesses and have a history of being institutionalized, and it is hard to change them.  Medication helps a lot of the "voices" and creates clearer thinking for them, but medication doesn't work for every patient.  If the medication does work and helps them focus their thinking, then the activities in the various programs (that I talk about in my entries) do help. So for these types of patients, medication is definitely important for them to function somewhat normally.
//:5hrs//

====November 20, 2006====
I started out today sitting in on a group run by the rec. therapist with the lower functioning patients.  She was talking to them about discharge. She asked if they were to be discharged next week, where would they go and what would they do.  She said it is important for them to have a plan for discharge because even though they might not get off the ward next week or even in 6 months, having a plan and a goal is the first step.  A lot of patients responded that they would live with family, or that they would be in supervised living .  A few said they would find jobs when they were discharged.  Someone said that he did not want to leave the ward at all.  It was very interesting to hear them have a goal and a hope for getting out of the BRITE ward.

In the afternoon I played Scrabble with a couple patients.  The rec. therapist was helping one of the patients and she encouraged everyone to count up their points on their own, and to use the word they chose in a sentence.  I thought this was a very excellent way to positively engage the patients in the game and to hone in on some every day skills with math and language.   It's actually something similar to what a parent might do with their child to help build their math and language skills.  The game we played was fun and we all came up with good words.

Today was the first day that I held my own group.  It was a special discussion group held during informal interaction time when the patients are supposed to be keeping themselves occupied for 45 minutes.  I thought no one would be interested, but I had 5 people in my group! It didn't go as smoothly as I wanted it to - I had envisioned me giving them a topic, having them think about the topic and what they are going to say,  and then having them discuss the topic and asking each other questions about them.  It didn't really work that way, but hopefully I can build up to that. I introduced a topic - I started with thanksgiving - and asked everyone to contribute something based on the questions I asked, such as what is thanksgiving, what is your favorite thanksgiving memory, what is your favorite food at thanksgiving.  I tried to get them to ask each other questions, but I was unsuccessful. They had no problem talking to me, and they had no problem contributing to the group, and they had no problem listening to the person that was talking, but they just would not ask questions to each other.  From the discussion on thanksgiving, I moved the discussion on to having them express their opinions on the Smoke Free BPC starting January 2nd and what they are doing to prepare for it, we also talked about religion and if god is an important part of their life, and then we talked about dreams and their strangeness.   For the first time with this group, I guess I could say that it was definitely a trial period. I realized that I need to somehow make it more structured.  And I don't think I could handle more than five patients at a time.  They were very responsive and seemed to have a good time (as opposed to pretending they're reading a book for 45 minutes).  I got some genuine answers and opinons from people, and no one acted "crazy" - they were just regular people in this group.  It was almost like seeing a different side of them, like for once their mental illnesses weren't consuming their lives.
//:5.5hrs//

====November 27, 2006====
I don't even know what to write about for today.  It was certainly an "off" day at BRITE.  Dr. Messer wasn't there because he was at a conference and the staff seemed really stressed out because a lot of patients were acting up and giving them a hard time.  Patients also weren't motivated at all to attend any program.  I didn't get anyone in my discussion group.  I spent a lot of time at the nurse's station just observing everyone and trying to help out staff as much as I could because the ward was also short staffed today as well (to add to all the stresses).  I went with the rehab. counselor and three patients to play basketball at the gym.   I was able to see a lot of the dynamics of the hospital and in working on this particular ward.  I see a lot of inconsistencies with the way staff are executing the BRITE program procedures (or are not).  It seems like it would be very frustrating to try to fix all these problems though.  Needless to say, it was a difficult day to sit through...
//:5hrs//

====November 29, 2006====
It was another mess on the ward today.  A few patients were sick with a stomach flu/virus thing, and everyone else seemed really agitated.  At program time, I tried playing Scrabble with two patients and they nearly ate my head.  One told me I was the spawn of the devil and that I came from Hell and kept cursing at everyone.  She was asked to leave the program. Then this other patient became really agitated and kept screaming every time another patient said anything.  We played Scrabble for a few minutes but eventually she was asked to leave program too.  So then I moved on and played Uno with another patient.  I was observing her earlier when she sat in the classroom and did some reading and writing in a workbook and watching her as we played. She is a very slow individual and seems to have delayed reactions to everything.  I was very patient with her while we played cards and realized that I only had to say things once, then wait for her to process it. It saved the frustration of having to repeat everything.  She was the only patient today that was actually nice to me.  Later on during informal time, this other patient accused me of staring at her and became very agitated everytime I walked by, screaming stuff at me to leave her alone - I wasn't doing anything.  I had had enough of the patients and decided that I wasn't going to run that group today because everyone was being nasty to me.

There was a new student at the ward today.  She is a graduate student at UB and somehow got put on the BRITE ward.  She is mostly interested in one-on-one type of therapy, but there is none of that here, only group therapy.  I told her a few things and we looked over some patient charts.  A few of the patients were very receptive to a new person coming on the ward. I guess they're already tired of me. The student was able to have a conversation with one patient who never talks to anyone or participates in any group, and everyone was impressed.  Dr. Messer was still away at an out of town conference, and it seems that when he is gone things get chaotic.

I also was able to sit in on Women's Group.  Today, the group was discussing ways in which to eat healthy when eating out.  The rec. therapist quizzed the ladies about different things in fast food, such has "which has more calories, a mcdonald's cheeseburger or a starbucks coffee" and a lot of the ladies were very surprised at the answers. She advised them on what they should choose to eat, such as not picking anything that says "large" or "supersize" and using low fat milk and skipping sugar when drinking coffee.  She also sternly reminded them that BPC is going smoke-free starting January 2nd, and that it is not a joke.  The hospital will no longer provide patients with cigarettes or take them on cigarette breaks.  She told them they should really be thinking about a plan to quit smoking, or to be discharged.  I will be curious to see what is going to happen come January 2nd...
//:5.5hrs//


====December 4, 2006====
Today was a pretty typical day.  I played Scrabble again, and then later Uno with a higher functioning patient than the one I usually play Uno with.  It was more enjoyable with this patient because it was a faster-paced game.  I could definitely see the differences between patients with more intellectual ability and those who are not as functional.

I had group today and it went well.  I was grateful to have some help from the graduate student that is doing her internship here too. The group started a little chaotic because the first person that came in we asked him what he would like to discuss and he kept going on about getting out of the hospital and if we knew if he could get a lawyer to take the hospital to court.  But then more people came in and someone wanted to use the computer, so I briefly left the graduate student talking with the patients. I tried to encourage one patient to try a computer game, but with every game I mentioned she said no. She was not very enthusiastic about it and did not seem to know of the games.  I tried to get her to try one out by herself, but she wasn't interested in doing that either. Finally she settled with just listening to music on the comuter. But then, some other patients came in wanting to listen to music too, but there are only three computers, and that is when things became chaotic. Eventually I got it fixed and returned to the people discussing a topic at the table.  They were talking about ways in which they would want to be discharged, that kind of topic is a little too heavy to discuss, especially with me and the graduate student not knowing anything that extensive about the discharge procedure.  So we moved the discussion to holiday memories and favorite things about christmas.  I love hearing the patients talk about when they were younger. It is interesting to see people's personalities come through when we have these groups.  One patient just is very loquacious. Another always gives the year when he talks about memories, like "that was in 1973," and his memories seem to be only related to "stupid things" that he'd done or embarrasing moments.  The third patient we had has a tendency to make up words, kind of like a word salad, and talks nonsence. I thought for sure that he would be doing that in the group, but he was very good and coherent.  So far, no one has been expressing delusional thoughts in the group.  This is a very good thing.
//:5hrs//

====December 6, 2006====
The ward was full of Christmas spirit when I first walked in today.  The hallways and day rooms were all decorated for the holidays, and there was a christmas tree in one room and a blown-up snowman in the other room.  The rec. therapist was taking pictures of the patients next to these holiday decorations with a polaroid camera.  One patient wanted me and the grad student to be in a general picture with him.  It was funny that he requested a picture of us, and we were a little hesitant at first because he is kind of like a womanizer.  But later in the day, he ended up giving me the polaroid picture to keep. I am making the worst face ever! 

This week I chose to go with the rehab. counselor to music therapy at the Butler building on the BPC campus.  Instead of sitting around and picking records to play, this week the patients were able to watch a U2 concert from a DVD of their 2005 live performance in Chicago.  A few patients really go into the music and others liked being able to see a live show.  One patient was even dancing around to the music.

During the group discussion I held today, I received help from the rehab. counselor. It was still difficult to manage the patients because there is one patient that always comes and talks too much.  At first it was just me and this one patient who hasn't been a part of the group yet and I would ask her questions and she would just give brief answers. Eventually, she opened up and started talking more, but then when the rehab. counselor came in she started making up stories/being delusional.  We just talked about random things and let one topic flow to another.  It's a very relaxed atomosphere and like I've been saying, it's nice to interact with the patients in a different context. However, the patients still will not ask questions to one another or initiate topics.  I wish I knew a way to get them to socially interact more.

The latest news on the BRITE ward was that they were going to pick a patient to be "kicked off."  He or she would essentially trade spots
with another patient from a different ward.  I'm not sure how often this is done, or how the procedure is done, but I couldn't believe that they had the power to do something like this.  There were two female patients in the running to be traded, the two that give the staff a hard time the most.  It was interesting to hear arguments for both patients, and staff were going around and asking each other which one they would get rid of - even I was asked to vote!  
//:5hrs//

====December 15th, 2006====
Because this week was finals week, I was able to not only go into BPC on a different day, but I was also able to come in early.  On Fridays, different things happen than when I come in on Mondays or Wednesdays.  In the morning, the ward has two meetings.  The first today was the privilege meeting.  For this, patients line up one by one outside the door to the classroom. The social worker, rehab counselor, teacher and psychologist sit together and invite one patient in at a time.  As they come in, they are told what privilege level they have achieved, or went down from, and are informed of what they must improve on in order to get to the next privilege level.  After accomplishing 4 levels, they are considered for discharge. Some patients need to work on attending groups more, or waking up on time, or even going to appearance checks. They also discuss if the patient broke a rule, such as smoking in the bathroom or threatening another person.  In addition to these privileges at each level, patients receive money, ranging from $0 to $20.  As you go up in privilege level, you earn more money, so that is another incentive to cooperating with the rules of the BRITE ward.  It was interesting to see this because some patients come in and are either compliant with what is said or argue about certain things, and some patients don't even come in because they know that they have not achieved what they are supposed to.  The next meeting was the community meeting.  Everyone gathers in the day room and awards are given out to people who have either maintained their privilege level or achieved the next level.  The rehab counselor talked about the weather for the day and had one of the patient's read from a sheet events that happened today in history.  A few patients were sleeping or were disruptive while others paid attention and participated.

Mid morning, there was a slight crisis.  There was a power outage in the Strozzi building (the main building where all the inpatients live). It was stated that the power would not return for another 13 hours (!).  The staff were getting restless because they couldn't do very much of anything (no computers) and it there was very little light to see.  Several patients were taking advantage of the darkness and were sleeping in chairs.  Group was run anyway with light from the windows. The outage ended up lasting only like an hour and a half and we came to find that the whole thing was only a test.  It was pretty ridiculous.  I was just glad I wasn't in the elevator at that time.

I helped run a group program with the rehab counselor.  We talked to the patients about the importance of maintaining a budget and learning how to save money in order to "pay the bills."  Again, the idea behind these groups is to teach them life lessons they will need to know if/when they are released from BRITE.  I had to read a story to them and then they answered some questions about it.  We discussed tips for saving money and the difference between buying things we want and buying things we need. The patients seemed to understand the concept very well, but who knows if they will actually implement the advice.

Later we went to the New Beginnings building to the gym.  I played basketball with one of the patients again.  For a little while I was left alone with him while the rehab counselor went to the bowling alley with a few other patients.  I decided to initiate socialization with the patient by making basketball a two person activity instead of us just shooting at our own baskets.  We played the game P-I-G and then we did some passing and shooting exercises.  He initiated conversation, and he even remembered my name without me telling him! He eventually got really tired and sweaty so then we left.
//:6hrs//


====December 18th, 2006====
When I came onto the ward today, there was music playing and the ward was participating in the "ward walk".  The teacher monitors the patients while they walk around the whole ward in a circle.  It is used to encourage exercise and movement and is an easy way to earn some tokens.  Nevertheless, a few patients were having difficulties even walking around.  One patient invited me to walk around with her, so I did. Another patient took too long to walk around just once because they kept being distracted.  The patients must complete a certain number of laps in order to earn tokens.  This is the only exercise a lot of the patients receive!

I sat in on group today with the rehab counselor who had some of the higher functioning patients. We talked about accepting personal responsiblity for life choices, such as not making excuses for what has happened to you.  We related that to the patients' experience in the hospital, telling them that it is not good for them to be blaming other people as reasoning for why they are here in a mental hospital.  Other advice included recognizing that only you determine how you handle situations, so seeing the good even in a negative situation can help you become more personally responsbile.  One patient was really into the discussion and contributed a lot.  It was nice to see some interest in a group.

The rest of the day I spent with Dr. Messer and the graduate student, who came back for a few hours to learn how to administer a psychological test.  Dr. Messer taught us how to administer the WAIS-III (Weschler Adult Intelligence Scale) on a patient with average to above average intelligence.  We went down to another floor of the hospital where there were psychological tests on file.  The WAIS came in a brief case and contained a manual, some cards, blocks and a flip card booklet.  I learned all the protocols for adminstering the test, and it was hard to get used to at first - everything has to be done in the exact same way so that the test's reliability remains in tact.  It was also difficult to write down the examinee's responses and look up things in the manual at the same time.  Needless to say, we did not get through the whole test.  The patient was our guinea pig for about one hour, and then was tired and a little frustrated, so he left.  After he left, we performed the tests on each other just so that we received some data that we could later use to learn how to score. The WAIS includes tests for verbal and non-verbal reasoning.  To give some examples, one section of test had the examinee arrange blocks to fit a certain pattern, another was copying symbols, another was reading back a series of numbers, a third was explaining vocabulary words, another was asking every day questions like, "Who wrote Hamlet?," one was arranging a series of pictures to form a logical story, and another was identifying the missing piece in a picture.  A few of the tests eventually became very difficult for us to even figure out.  The blocks were by far the hardest.  The section of the test with the blocks was the part of test that the patient became a bit flustered with and said he wanted to leave.  Since we did not complete the whole test, and we haven't learned how to score it yet,  hopefully when both me and the graduate student are back in January we can finish learning about it.  I really enjoyed getting hands-on experience with psychological assessment - it was a nice change of pace.
//:4.5hrs//

=====January 17, 2007=====
After a month away, it was not difficult coming back.  Many of the patients remembered me and said hello and spoke with me.  Only a few things changed - the no smoking policy is in place, and one patient was moved to another ward while a new one came. Things haven't really changed since the no smoking policy.  There wasn't that much chaos as I had thought there would be.  There was a person smoking in the bathroom though, but a lot of patients are trying to manage their habit through either nicotine gum or the patch.  Additionally, the staff was having difficulties with a patient that suddenly decided to act out pretty bizarrely.  This particular patient normally just sat around all day and didn't speak or participate in groups. Suddenly she was demanding to be off the ward and decided to "act up" and seek attention from others so that she could leave and be on another ward.  It was a little disturbing seeing her act this way. One of the things she was doing was loudly humming nursery rhyme tunes.
At program time, I played scrabble with two patients, followed by the card game war.  It was hard trying to keep a particular patient's attention.  She kept talking to herself and wouldn't pay attention that it was her turn. I had to constantly remind her to come up with a word or to put a card down.  I wish I had more knowledge on what to do in that sort of situation.  When the rec therapist plays with her she gets the patient to respond quicker - I wish I had that magic touch.  It was a long game...
The social worker on the ward was swamped with some work and an urgent situation with some other patient so he asked me if I would conduct informals for him.  This is not the special group I used to run, it is the overall informals. I had to walk around with a clipboard of all the patient's names and mark down who was participating and eventually who actually performed appropriately and would thus receive a token.  Usually half the patients don't even participate.  The same occurred for today. Less than half the patients actually received a token.  I found it was easy being the one "in charge" and communicating with the patients that they should be partaking in this.  It's interesting to see a lot of patients being manipulative just for the token.  
//:5hrs//

=====January 22, 2007=====
Today was my last day at the Buffalo Psychiatric Center.  I passed to torch onto another Canisius student, who is also doing her practicum on the BRITE II ward, by showing her around and telling her things she needs to know about the patients and being on the ward.  
At program time, we convinced a patient who normally doesn't participate to play a few games of Uno with us.  We also played checkers and Battleship with another male patient who also doesn't normally participate in program.  We also were able to sit in on a treatment team meeting discussing one patient's return to RCCA.  This meeting was very interesting. The psychologist, psychiatrist, social worker, and a representative from RCCA came and sat down with the patient to discuss goals and a graduated plan to get him to start adapting to living in RCCA again. The patient was told to make up a list of goals and he even added a few of his own.  It was a little frustrating watching the patient because I could tell he wasn't fully understanding concepts that Dr. Messer was talking to him about in regards to his living back at RCCA.  This particular patient has problems with his emotions - he gets either too angry or too sad and it disrupts staff and sometimes gets out of control.  He has to follow certain procedures when he becomes emotional and he has to not engage in activities that instigate his extreme emotions.  I don't know what's going to happen to him because I have seen him come back to the ward to and from RCCA a few times already, I don't know if he can really pull through this time.  After the meeting, Dr. Messer sat down with us and we talked about our thoughts regarding the meeting.  It was a really "educational" last day.
I think that my experience at BPC has changed me for the better, made me more confident around a difficult population and helped me sort out what kind of career in psychology I want to pursue. It has helped me to understand mental illness, psychology, and therapist-client interaction better.  My expectations for when I first knew where I would be placed for volunteering were very different than what I actually experienced. It wasn't anything bad, it was just not what I was expecting.  Coming away from this educational experience, I have a lot of interesting stories to tell and a better understanding of myself.  I don't have any regrets.
//:5hrs//

EmilyParobek
PracticumExperiences