Katherine Carlson
Psychology 498 C: Clinical/Counseling Practium
Fall 2011
I went to my internship September 2nd, 3rd, 9th and 10th. I have completed 22 hours at my internship so far. The first weekend was a huge adjustment! The first day I felt a little uncomfortable because I was not used to the individuals I would be interacting with or their circumstances. I got to know a lot of individuals that come to the supplemental day hab frequently, and they all seem to get along with me very well! Some individuals are a little bit harder to deal with because they either have a hard time communicating (speech impediments and barriers) or simply do not wish to communicate. One particular individual wanted to communicate all the time, but his speech was so hard to understand he became frustrated when I did not understand what he was trying to tell me. A couple of the workers told me I was actually lucky that he did not become too frustrated because usually he will start self-injuring when he becomes too upset.
The last weekend (September 9th and 10th) seemed to be a little bit more relaxing, because I was more comfortable and there seemed to be less individuals than the last weekend. There are a couple of individuals I already find myself looking forward to seeing, because they have a very happy and outgoing personality. One older man with down's syndrome is always very happy to sit there and color. Usually he does not share his pictures nor his crayons because he wants to be left on his own with his own routine. He doesn't mind us talking to him, although he doesn't talk very much. This week he let me color one of his pictures with him, and he blew me a kiss, which honestly melted my heart! Some of the individuals have behaviors that they repeat frequently, whether it be things they say or hugging a person multiple times within minutes. This behaviors can be hard to handle, but sometimes all they need is a gentle reminder that they just said that a couple minutes ago, or they need to remember others' personal space.
My internship is at a Supplemental DayHab/Respite Opportunities Program through People Inc. They are only open 2 days a week (Friday and Saturday nights).
Days 5 and 6 (September 16th and 17th
So far I have completed 33 hours at my internship. This weekend was a bit harder because I had a cold and wasn't feeling too well. On Friday, we didn't have too many individuals, and a lot of them were individuals that did not want to participate in any activities. We watched a couple of movies, and I painted one of the girl's nails, which I found out was a good idea because she was going to a wedding the next day. One of the individuals is overly affectionate and constantly tries to hug people and touches your hair and sometimes your face if you do not remind her of being aware of others' personal space. Sometimes she will start to hug a pole that is in the room, and will sometimes do inappropriate things to the pole. A couple of us were curious if there was any reason that she did this. I decided to look at her book of personal information to see if there was anything I could find. I found out that she has cerebral palsy and moderate mental retardation, but there was nothing it in about any sort of psychological disturbances. She is mostly nonverbal, so maybe she has a hard time not being able to express her affection in a verbal manner. The only things she says is "How you (How are you?" "Pretty (I'm pretty, you pretty" and "Awwwwww."
Saturday was a much more productive day when it came to being with the individuals. There were a lot more individuals who wanted to participate in activities. I did a lot of coloring with them, and played many games with them to have fun and try and teach them how to follow instructions and be patient while waiting their turn. There was an individual that weekend that I had not met yet, and it seems that sometimes he can get on other people's nerves. He tries to behave in certain ways in order to get attention. Usually these behaviors are ignored until he properly asks for someone's attention. One of the individuals began to cry because his behaviors were bothering her. We calmed her down and told her to try and not to pay attention to him and that he was not bothering her on purpose. A couple of the individuals and myself played with play-doh and I had made a dinosaur out of play-doh that I had left out to dry and harden. One of the individuals took it and decided to smush it. I asked him why he did that, and he said "Katie mad?" I said I was disappointed because I made that and that was not his to take or touch. He said "Katie disappointed in (I am going to leave his name out for privacy purposes)" and I told him yes. He has moderate mental retardation, so while he knew I was disappointed, he really didn' t quite seem to get why or that he should apologize for his behaviors.
Days 7 and 8 (September 23 and 24) 44 hours
This weekend seemed to go by very fast. It was a hectic but fun weekend. On Friday, we didn't have too many individuals but they still kept me very busy. I have started to notice that a lot of the individuals seem to like to talk about the same topics frequently. One individual always tells us that we're lucky or perfect, she asks us if we like men, or women, and sometimes she asks if we like cars. I had a hard time with one individual this weekend. She wanted to sit by me everytime we moved or sat somewhere different, and I would find her staring at me if I wasn't paying attention to her. When I reminded her that I needed personal space, she was quick to say "I'm sorry, I'm sorry!" It made me wonder if she gets yelled at or scolded frequently for things.
Saturday we had a lot of people, and there was an outing to the plaza for people to go to Dollar Tree or Rite Aid and buy some things if they had money. Since we were at capacity, we were not allowed to accept anybody who did not have a reservation. One of the more difficult individuals had come in with his mother, but we told her that since they didn't have reservations, we couldn't let him stay. She was absolutely furious and stormed out. It was sad to see, because not only was the mother completely aware that the program requires reservations, but it was like she treated it like a babysitting service that she could simply drop her child off to whenever she felt like it. Another one of the individuals is a bit older and has Down's syndrome. She really seems to not get along with anybody besides the workers, and often wants to sit by herself and be left alone. One of the other individuals tried to help clean up after dinner, but the individual with Down's Syndrome threw a fit and starting crying because the other girl was trying to do her 'job.' Overall, this weekend taught me a lot about being patient and understanding, and really opened my eyes to the fact that even family members of people with disabilities do not understand the love and care their family members require.
Days 9 and 10 (September 30 and October 1st ) 55 hours
Friday proved to be a very very difficult day with one particular individual, whom I also had difficulty with the weekend before. Her book says she is moderately mentally retarded, but she also has depression, anxiety, and compulsion tendencies. She was 'wound up' that day to say the least. She kept asking numerous questions and the same questions over and over again. She kept sitting right next to me and asking me to do the same things over and over again. I told her that she did not need to sit so close to me but she could sit at the same table. When she would not stop asking me the same questions, I told her that if she sat quietly and relaxed for five minutes, I would paint her nails (since she had been asking me to do this repeatedly). Unfortunately, this did not seem to be enough of a reinforcer for her quiet behavior, and I did not paint her nails that night. She was upset, but I told her that the reason she didn't get her nails painted was because she did not sit still long enough to prove to me that she could let me paint her nails. I hope that if I see her next week maybe she will have learned that she needs to learn to relax a little more.
Saturday was a fairly slow day, but it was also a very sad day. We found out one of the individuals that would come to respite had passed away. She had only been at respite a few times since I had been there because every time she came, it seems that she would get sick and her dad would come to pick her up. We were unsure if she was anxious about being there, or if she was truly sick. Her book said that she had been diagnosed with PDD, Autism and that she has schizophrenic tendencies. She had a traumatic event in her past that seemed to have triggered all of these things to occur. I am sure she had PDD before these events occurred (which were said to be when she was the age of 13). She never wanted to participate in any activities, and sometimes she truly would not be herself (It almost appeared that she was hallucinating). When she wasn't herself, she would mumble things so fast that you could not understand a thing she was saying. It turns out that these things that she said were arguments that she had her in the past - which are obviously linked to the traumatic events she experienced). When she was herself, she would smile, and not say much but she would understand what you were saying to her. When she wasn't herself, and she was repeating those past arguments, she would stare right at you and keep talking. This upset some of the other individuals. We all wrote on a card for her, and had a hard time deciding whether or not to tell the individuals. So far, we have only told those who have asked why she has not been coming to respite.
Days 11 and 12 (October 7 and 8): 66 hours
This week seemed to go by very fast! There were not too many individuals on Friday, but it still seemed to be a really good night. We played a lot of games and started to talk about what we were going to be for Halloween this year. One of the individuals really caught my attention this day. In the past, he had been very quiet when he came to respite. He didn't really want to do anything, and wouldn't really talk to anyone (especially me since I was new). It turns out this was because a member of his family passed away, and he is very close with all of the members of his family. Now it seems he is back to normal, which can sometimes be a problem. He can be very talkative, although saying some of the same things. He likes to say "Boom (insert name of a staff member here)!" and he likes when we repeat it back using his name. Sometimes, however, if you engage in this behavior with him, he can become out of control. He will roll around on the floor screaming and laughing, causing other individuals to either become upset or want to engage in the behavior as well. We have to tell him to get back in his seat, and tell him that unless he stops, we will have to tell his parents that he is misbehaving. Although it seems like we a talking to a cihld, some of the individuals only have the mental capacity that a child would normally have.
Saturday was a very very busy day! There were a lot of individuals who all seemed to be very amped up and ready to have fun! We were supposed to be having both a new individual come into respite, and an individual that I had never met yet. It seems, however, that both of them would have been troublesome if they had come. It seems that when they get the chance they like to run away, and try and injure the staff members by throwing things at them. One individual in particular can be really hard to talk to. It is not as if he has a negative temperament, but he just never wants to talk or engage in any activities. He really likes to sing, and sometimes you can hear him singing popular songs on the radio or just humming to himself. He is autistic, and I think that sometimes all of the noise of the people around him can bother him because he sometimes sits with his hands over his eyes and ears, blocking everyone out. Both a staff member and myself have been trying to get him to verbalize more in order to get what he wants. He loes to be tickled, and sometimes he will come up to you and turn his back so you will tickle his back, so I will ask him "What do you want me to do?" and he won't do anything but turn his back again. I will tell him, "I don't know what you want me to do, can you please tell me what you want?" Usually after a couple tries he will do it, and then after that he will ask you right away "Tickle back please!" and this makes him incredibly happy. On a positive note, one of the staff members quit because she has too many other jobs, and I expressed my interest in replacing her. The program manager said that would be great because I already know the individuals really well, so once the job is posted online I will be applying! Now I can get my intership hours in and get paid for it too :) I know it will be a really great job not only for the experience, but for the future as well (getting into grad school, etc.) It is also rewarding working on skills with these individuals so they can have a better life.
Days 13 and 14 (Oct. 14 and 15) 77 hours
This week proved to be really testing! On Friday, there was one individual who said something incredibly inappropriate to me. This individual had just started coming back to respite right when I started, and I think it was taking him a long time to become comfortable with everyone. When he got there, he sat down near me and he essentially asked me if we were going to do something later. I was of course, shocked and I told him not to say that to me, and that it was incredibly inappropriate. He said, "Well it's over, so oh well." And I told him, yes he already said it, but I'm telling him not to say it again. In the past, he will call all the girls beautiful and cute and sweetheart and other nicknames, but nothing this extreme. About a half hour later, he said it to me again. I was even more upset and another one of the staff members came into the situation and helped me deal with it. He became so upset that he tried to run away and another staff member had to go catch him. We called his mother, and I talked to the program manager about the situation. Apparently he had gone to respite awhile ago, and he had displayed behaviors like this previously.
On Saturday, I went on an outing with 5 individuals and another staff member to the movies. It was a very difficult process making sure everyone got in the car and everyone buckled properly. Some individuals were just being difficult. Once we were at the movies, buying the tickets was a long process because we had to buy each ticket individually. The movie choice was not something I would have picked, but it had to be something that everyone would pay attention to. It was upsetting to see people staring at us and avoiding us as we walked by. People were staring as if they were something to gawk at. It was upsetting because in this day and age, people are still not accepting of people with disabilities being able to live their lives as normally as possible. I hope that being a part of this company will allow me to educate others about people with disabilities and how they really want to be treated.
Days 15 and 16 (October 28 and 29): 88 hours
I did not go the weekend of October 21 and 22 because of the emergency I went out of town for.
On Friday, some individuals went to the store in order to prepare for the Halloween party we would be having the next day. Those of us who stayed back talked a lot about the next day. We talked about costumes, our favorite candy, our favorite Halloween movies, etc. We played Halloween bingo and watched Charlie Brown and the Great Pumpkin Patch. Everyone was very excited for the next day. This night, we also found out that the program manager would be leaving very shortly to be transferred to another program. Although I would only be there for a couple weeks longer, I am curious as to how the next few weeks would play out.
On Saturday, the Halloween party had everyone very excited and animated. Everyone was dressed up and talking a lot about their favorite Halloween memories. We watched movies such as A Nightmare Before Christmas, told ‘scary’ stories, and listened to Halloween music. We enjoyed a delicious dinner and everyone got a goodie bag at the end of the night. Although the party was fun, I had problems with one of the individuals. I have talked about him previously – he likes to do things in order to get attention. I was talking to another individual when he kept interrupting our conversation. I told him numerous times that I would talk to him in a minute, but to let me finish this conversation first. He kept interrupting, so I told the other individual to wait a second so I could talk to the other. I told him it was impolite to keep interrupting because he needed to wait his turn. I told him this a few times because he kept asking why, and I told him if he kept doing it, he would not get a goodie bag at the end of the night. This caused him to become so angry that he hit me. The other staff members took him away from me immediately and his parents were called right away. He was not allowed to take a goodie bag home and he had to apologize to me.
Days 17 and 18 (99 hours): November 4 and 5
Since taking Behavior Modification and doing this internship at the same time, it has really made think I might want to continue on this kind of path, and I am taking Applied Behavioral Analysis next semester.
On Friday, there were not too many individuals there that night. We played a lot of games and had a lot of laughs. I decided to try to use my Behavior Modification techniques on an individual. He likes to ask a lot of questions (usually about the same things) and he knows that if he asks them repeatedly that it starts to annoy staff members. One of his favorite things to ask about is what we will be having for snack. The first time he asked me, I told him. The second time, I told him he already asked me and he knows the answer. The third time, I told him that I am no longer answering any questions about food. It took him a few times of asking before he realized that I would not be responding. He started talking to me about other things, but then went back to the food questions, which I did not respond to again. Although I know it would take a lot longer for this type of behavior to extinguish, and all of the other staff members would have to follow it, it was a start.
On Saturday, there were a lot more people. Some of the individuals went on a mall walk, and the rest of us stayed behind and watched Elf to start getting into the Christmas spirit already. Some people already started talking about what they want for Christmas. One of the verbal prompts for one of the individuals is to teach her manners. She often burps, and while she says excuse me, she does not cover her mouth. I asked her to politely, and she said “Yes mommy.” I asked her why she said this, and she said it was because I was talking to her like her mother. She doesn’t cover her mouth at home and it was her choice to make. While I told her I respected her responsibility for her actions, I needed her to not only respect others around her by behaving politely, but she needed to respect me as a staff member. Another individual who I have mentioned before (the autistic boy who sings to himself) spilled coffee. I asked him to help me pick it up and he said no. I asked him again, to which he again responded no. I told him if he did not help me, I would not be tickling him for the rest of the night. He did not help. I cleaned up the mess by myself. He asked me many times to “tickle him really fast please” but I told him no, and each time I told him why I would not be tickling him. Although I am not sure if he got it, he did stop asking me after awhile. I am hoping that he will now help me when I ask him.
Days 17 and 18: November 11 and 12: 110 hours
This was my second last week at the Respite program. Since having people come in and out of their lives can be a tough situation, I started bringing up the fact that next week was my last week to a lot of the individuals so they knew ahead of time and were not given a shock. Some of them were very sad to hear that, and told me they were going to miss me. Some did not quite understand that I was leaving, and I knew that after I left they would ask where I was for a few weeks before they realized I was not coming back. That Friday, there were very few people who were there because most of them went to a dance. I was hoping to be able to go to one of the dances before I left, but it didn't seem to be happening. We made some snowmen out of styrofoam balls and glitter glue, and asked everyone about their upcoming holiday plans and how they were getting excited for the holiday season.
On Saturday, we had two individuals that we don't see very often at Respite. One individual I had never worked with at all. She seems to have been diagnosed with Pervasive Developmental Disorder, but they also said that she has multiple disabilities. She is very very shy and does not like loud noises or being around a lot of people. Her parents brought her dinner with her and asked us to try to get her to eat, which seems to be a very long process. She spent most of her time in the bathroom, and it took a lot of coaxing to get her out. She is required to be one on one, meaning she alone gets the attention of one staff member, when the ratio is usually 4:1. She has the tendency to run away if you do not keep an eye on her. The other individual we have seen before, but he has not come back for awhile. This is the individual whose mother tried to bring him there when we were at capacity and she did not have reservations. He actually was not too difficult this time. He seemed to be content talking for the most part very quietly and one of the staff members who is very adept at understanding him stayed with him most of the night.
Days 19 and 20 (November 18 and 19): 121 hours
This was my last weekend at the Respite program and I was very sad for it to end. On Friday, we watched Shrek the Third and talked a lot about Thankgiving. We colored cornucopias and decorated foam leaves with jewels and glitter. The girl with PDD was back that night and she was being very difficult once again. I tried to keep an eye on her, but one staff member seems to have developed a bond with her, she she stuck with her most of the night. Her parents had warned us that she was having a bad day and that she might become aggressive if she is provoked. I am not sure what made her so angry, but she started slamming the door to the eating area multiple times while we were in there. She also tried to run away multiple times and came out of the bathroom with her pants down to try and cause a scene. Although we are not allowed to use the word "time out", that is essentially what we did. We excluded her from any positive stimuli that were in her environment and sat her down in a chair in a different room. We gave her some time to herself to relax and calm down before she was ready to behave calmly.
Saturday was honestly one of the best days I had at Respite - which was great for it being my last one. We had an outing to an Italian restaurant and I went as a celebration for my last day. The individual who never wants to do any activities or really talk to anyone was not signed up for the outing, but his mother came in saying that he wanted to go really badly and he never wants to do anything. We had room for one more individual, so he came with us to dinner. He was so excited
that he kept saying over and over to me, "Dinner?" When we were at dinner, one of the individuals was very difficult. I had never been on an outing with her before, but they had told me she really seems to misbehave when she is on an outing - and she definitely was! She was taking ice cubes out of people's drinks and was making a mess out of the napkins and wrappers. Then she pinched another one of the individuals on the hand. When we got back from dinner, we had her sit by herself for a little while until she was ready to apologize, which she did. The individual who is difficult to understand when he talks also came back that night. After a little while, we discovered that he had an accident, but we had no clothes to change him into. We had to call his dad to come and get him. He was clearly upset and we kept trying to keep him from crying and getting upset. I was trying to talk to him but I had difficulty understanding him. He stood up and started hitting himself in the head repeatedly. Once it happened once, I started seeing the warning signs and knew when he was going to get this upset again. Once his dad came, he told us that he was on a new seizure medication that decreases his senses, so it is hard for him to tell when he needs to use the bathroom. After all this, we had snack for the night. They bought me a cake thanking me for my service the past few months. They told me that I was one of the best interns they had, because most of them do not actually work or interact with the individuals. They wished that I would work for them and that they had a wonderful time working with me. I felt so happy knowing that I did a good job in the eyes of the staff members, and in the eyes of the individuals I worked with.
Summary
While I was working at Respite, taking Behavior Modification at the same time was an excellent choice because I was able to use a lot of the skills that I learned in class and apply them in real life situations. However, it is evident that because I was so excited to use the skills from this class, that I did not focus on things I had learned from other classes as well. A lot of the things I learned in Abnormal Psychology were also very useful to me, as well as in Child Psychopathology (although all of the individuals I worked with were adults). Although I did not use specific assessment tools while at Respite, I would try and remember symptoms from certain disorders to see if any of the individuals displayed them. If I knew the specific disorder an individual had, I would try and remember the symptoms to see if they applied. One of the individuals I worked with was diagnosed with PDD and she had schizophrenic tendencies. She had a lot of symptoms that I would have classified as a Schizoid Personality Disorder. She never wanted to do anything with anyone, had very few social relationships, and was very restless and seemed very emotionally distant and drained. I was able to observe and be knowledgeable of these symptoms because of Abnormal Psychology. Since I was mostly working with people with developmental disabilities, most of these were learned in Child Psychopathology. It is unfortunate that what we learned about this disabilities was vague, but I am hoping to take the Autism class next fall. A lot of the people who came to Respite had Cerebral Palsy with Mild-Moderate Mental retardation. A lot of them were able to speak appropriately and carry full conversations, while others needed guidance for the right things to say. I know for sure that one of the individuals had Autism, and when he made eye contact with me and would talk to me, it honestly made me so happy. He did not like to talk to anyone unless he liked them, and he often covered his eyes and ears because the surrounding noise and chaos bothered him. He often does repetitive behaviors often described of people with Autism such as rocking and finger flapping as he walks. He also likes to skip as he walks. Also, he tells his mom what time to pick him up every night and gets very upset when she is not there on time. I was also able to use my skills from Techniques in Counseling whenever one of the individuals got upset. One specficially would get upset and angry when people would try to talk to her or did things she found annoying. I would try and pull her aside and ask her how she was feeling, and try and do some Gestalt exercises like using imagery for relaxation in order to calm her down. Overall, taking all of these classes has helped me become a more understanding and caring individual and this internship helped me decide what I plan on doing in my future.
