// Location: Buffalo Psychiatric Center // // Total running time: 125.5 hours // === January 5, 2007 === Today was my orientation at the Buffalo Psychiatric Center. I started off by meeting with Sue Joffe who is head of public relations and volunteering. We sat in her office and went over my paper work and interests and then decided where I would fit in best. After that I was mandated to watch two videos. The first one was on HIPPA which is all about patients' right to confidentiality and how to best maintain their privacy. The second video was about the hospital and their missions, statements, treatments and what they try to accomplish with their patients. During this video many of the different professionals that work in the hospital talked about many important topics that I'm sure many volunteers ask about. This took about 2 1/2 hours to watch both of these videos. After that, I was able to meet with my supervisor, a psychologist named Dr. Drew Messer, who is in charge of the BRITE (Behavioral Rehabilitation and Interpersonal Treatment Environment) unit. He was especially excited to be able to work with me because he said he has had great experiences with students from Canisius. He seems like a very bright and friendly guy. He showed me around the floor and introduced me to the nurses, and other psychologists on the floors as well as some of the patients who were up and walking around. This floor contains mostly patients with schizophrenia and other more serious mental disorders. While I was up there I was able to see about 3 different rooms having different group activities going on. Dr. Messer explained to me that on the floor they try and engage the patients in activities and them just sitting around or sleeping isn't acceptable. There were a couple patients that I met that had been there for 30 years. I was amazed to here this because I wasn't aware that some patients do really stay in in-patient services for so long. Finally, Dr. Messer encouraged me a great deal to be aware of my surroundings and to maybe just sit in the common area and observe the patients. He stressed that I should come and sit in on activities with the patients and just listen to them and use a type called reflective listening which is where you repeat what someone said to you for the most part, this way you don't introduce anything surprising to them that they're not ready for. All in all, it was a very eventful day which I learned a lot about the center and some of the patients. // : 4 hours // === January 15, 2007 === Today was my first day at the BPC. I started off by picking up my badge which you have to wear at all times around the hospital. Then I made my way up to the BRITE floor. Today was a little different than any other day on the floor. Since it was a holiday, the patients had more of a choice what they wanted to do with their day. Usually the patients are woken up at 6am and given their medications and they must stay up all day and participate in different therapies and group events. Today though they had a choice to go back to sleep after they were given their medications and most of them did. So for about the first couple hours I just walked around to get a feel for the floor and interact with the few patients that were up. Once Dr. Messer came in, we stayed in the office for most of the time and talked about different therapies he's trying with children with ADHD at his own practice. We discussed different approaches to it and how it might work. What he has planned so far is called gaming therapy where children come once a week and play different video games and the instructors have worksheets to rate the children how they're doing with their anger or attention. It sounds like a good idea and when I have the chance to go their on a Monday night I'm going to go and help him with it to see how it actually works. Then we started discussing grad school and where I was looking and what he went for, which is actually the same major that I have so it's good to be able to talk to someone who is interested in the same thing that I am. Dr. Messer had to leave early so the rest of the time I was there I just helped the rehab therapists and play games with the patients and watch the Sabres game. I was playing scrabble with two women patients, another male was playing cards and another female was sewing. I've found that most of the patients really enjoy playing games and interacting with eachother. I've observed that they're almost like children because some of them put up fights and don't want to do any kinds of therapies but then when they see other patients having fun then they want to join in. Today was a very slow and relaxing day, but it was nice to have a day like this because I know that it will not always be like this. So it was nice to sit down and be able to just play some simple games and get to know a few of the patients. //: 5.5 hours // === January 19, 2007 === By the time I arrived at the BPC this morning I could already tell it was going to be a hectic day. Dr. Messer let me in the door and let me know that some of the patients weren't cooperating today and that he had to take headphones away from the one and that he was yelling at the staff and other patients. So I went right into the office and met the other rehab therapist, Darlene, and she was showing me the activity that she was getting ready for the group therapy. Dr. Messer was doing treatment plans so I decided to help Darlene out. The activity she had planned was to help the patients think about positive things in their lives. We went around the group and had different patients read the article and after we had an activity for them to fill in some questions. Some of them included questions like "one thing I want to try and start this year is..." and "I'll try to let go of something negative such as.." So I thought this group was very good, and it was also my first group session that I was able to see so I could see how groups are ran. The problems that you have to think about when making up the group activities is that not all patients are at the same reading, writing and comprehension levels, so you have to take that into account. But the group did go very well and most of the patients interacted and participated which gives them tokens. Tokens are used on the floor for patients to buy things such as snacks, pop, coffee or they can even "buy out" of going to group therapy for the day and maybe taking a nap instead. So after the group was done we took out the token book and Darlene showed me what to do. For every patient that arrived on time, they recieved 1 and for patients who actively participated they can get another one so the most they could get was 2. So we had to go through the book and add the tokens to the patients who earned them and then some of them that didn't show up we had to take points away which lead many of them to have "fines." Once a patient has fines, they can't buy anything extra or miss anything without paying off the fine. What I find interesting is that they try to treat everything on the floor like the real world. If a patient arrives late to the group session or anything else, they're aren't allowed in because they have to learn that they have to be on time which is just like getting on a bus. Also with the fines its is almost like traffic tickets from police, if you get in trouble you get a fine and if you don't pay it off you can't have any other privelages until you do. After that I went back into the office and made up my first group session which I'm excited about doing sometime this week. This session is going to be all about goals and how to achieve them and different steps so I think it will be good for the patients to have a session like that. //: 5 hours // === January 22, 2007 === When I came onto the ward today, it was pretty calm. The patients were in the living area watching tv or just sitting there and the rehab therapist was in the office finishing up her plans for the group session in a few minutes. Dr. Messer decided to implement a new thing in the ward - closing the two living room areas while group is held to prevent the patients from skipping group and just either sitting in the room or sleeping. This didn't go over very well with some of the patients. Two women in particular did not leave the room for about 15 minutes and Dr. Messer had to actually call a code on the one because she refused to get up. So nonetheless I expected that many of the patients were not going to be cooperative today. However, once group started almost all of the patients showed up and were behaving. The topic of the group one was managing anger and taking necessary steps for yourself when you know you're either starting to feel stressed or angry. The patients actually did a good job today participating by reading some of the passages and sharing with each other what happens to them when they start to get mad. I thought that the group today was very beneficial for the patients because most of them don't know how to manage their anger very well. After the group, the other Canisius student who did her practicum here last semester came in for her last day. It was nice to have someone to talk to and walk around with. She also answered most of the questions that I had either regarding the patients or the floor itself. After lunch, we went through a few of the patients' files and talked about a few of them, what they're diagnosed with and what medications they are on. This was so interesting because Dr. Messer told me before to not be afraid to read their files, but I wasn't sure if I could just take them or not and I've been curious about a few of the patients so it was very informative. Later in the afternoon, we were able to sit in on a treatment plan meeting for one of the patients who will start attending RCCA, which is a step towards being discharged. All during the meeting, the patient just kept talking about going back home with his mother, so finally Dr. Messer, the social worker, the psychiatrist and the counselor from RCCA all decided that he wasn't allowed to talk about that anymore because they didn't want him to get too ahead of himself and not understand everything else that he needs to get through before he can go back home. He had to come up with a list of goals that he has to accomplish which included not getting so upset or angry and try to manage it. It was hard to watch it though because it seemed like everything that Dr. Messer was saying, he didn't fully understand and he was just agreeing to make everyone happy. So we'll see what happens because I was informed that this patient has been to RCCA before and came back instead of being discharged. So it'll be interesting to see how he does. // : 6 hours // === January 26, 2007 === When I came on the ward today, the rehab therapist and Dr. Messer were holding a community meeting for all of the patients on the ward. During this meeting the patients who have moved up to a another level privelages were being recognized. Basically to move up to then next level, the patient must be cooperative, not have any fines, attend group sessions and actively participate in functions. There were about six patients who were able to move up to the next step, so it was good to see that there are few patients who are really trying and do cooperate with the staff and everything that they have to do. Then there were two more students who are doing interships too that were introduced to the floor. The one is from Fredonia and she'll basically be with me when she is there and the other one is doing more social work. So it was nice to have someone else again be there to keep me company. We were there when group started too so we were able to help Darlene run the group which we talked about current events in the news. We talked about the Super Bowl, Hilary Clinton running for President, Wal-Mart issues and some others. At the end there are usually a few questions that we try to have them answer from their readings and discuss them. Today we decided to have them answer the questions on their own and whoever had them right recieved 4 tokens instead of just 2. However, only 2 patients were able to get all of the questions right. The other ones either gave up and just walked out or just couldn't remember. It was hard to watch the patients that couldn't remember the answers because they were such easy questions and it's hard to imagine that someone can't remember something like that. Then in the afternoon, the other student had to leave so I stayed and helped Darlene. On Fridays, she tries to take some patients over to Butler and go bowling or swimming. Today, only 3 patients came with us, but it was actually nice because these patients are calm and we didn't have to worry about them leaving or running off. So we bowled 3 games and the one patient was really good! I think he was nervous at first and didn't play the first game because he has some anxiety problems, but once he saw the other patient and I playing and I asked him to join he decided he wanted too. This was one of the first times that I saw patients having a fun time and talking to Darlene and I about themselves and it was just nice to be able to have a fun and relaxing time off of the ward. So today was a fun day and I was able to get to know a few of the patients a little better and the one is about to be discharged in a week so I hope everything works out for him. // :5.5 hours // === January 29, 2007 === By the time I came to the ward this morning, the teacher on the floor was setting up ward walk. This is where the patients participate in walking laps around the ward. They usually must walk 10, unless the teacher lets them do less. A few of the patients really enjoy walking around, while others are easily distracted and didn't finish their laps. I started to walk and start a conversation with one of the patients and at first she was having fun walking and carrying on a conversation, and then she just disappeared and stopped walking. This was another example of how working with many of these patients is like working with children because of their attention spans. After that, group sessions were about to start. I decided to sit in the group with the teacher on the floor who had group D which is the highest functioning group on the ward. Since Dr. Messer started locking the living rooms during group, most patients are beginning to accept it and it shows by how many are starting to attend the group, but of course there will always be the few who won't cooperate. So the group I attended today was much different than the other ones I have been going to. First there were only 5 patients in the group and they all work independently, not like the others where everyone takes turns reading and then answer questions together. The patients all have their own workbooks, which some were math, reading, music activities, geography and the one patient has her own notebook to just write down whatever she is feeling. This group was very calm and more relaxed than the others. All the patients were doing work and participating whereas in the other groups there are patients who fall asleep, don't pay attention or get frustrated because they don't understand something. I also enjoyed sitting with the teacher because she took the time to tell me almost everything I need to know about the BRITE floor from when it started to all of the activity sheets and patients' records. After lunch, the staff and I were starting to notice one patient harrassing another and this was causing the one patient to become very upset. Dr. Messer tried to talk to the patient about it and he was too upset to even tell him what the patient was saying to him. So now, Dr. Messer is trying to come up with a way to keep the two of them apart so that this doesn't happen anymore. Then after lunch and everything was done, there was another activity group in the afternoon run by the recreational therapist. In the afternoon groups the patients may chose what they want to do from playing board games, card games, coloring or reading. I started to play Uno and then a game of Trouble with one of the patients until she became bored. So then we just had a conversation throughout the whole room. It started off with the Blizzard of 77 and the therapist started asking the patients where they were when it happened and then just went onto remembering things like prices when they were growing up. What amazed me so much was that the patient I was playing games with remembered so much about past events when she doesn't usually talk that much much less seems like she really remembers a lot. So it was just nice to see that many of these patients do remember their past and what they used to do for fun. // :6 hours // === February 2, 2007 === This morning when I came to the ward, the moment I walked in I could tell that something was wrong and that most of the staff was stressed and nervous. I was then told that one of the patients who normally seems so compliant and acts so well went off the grounds to program and never came back. This patient was found by his mother in her house so she called the hospital to arrange for someone to come pick him up. So all morning, Dr. Messer and the Social Worker were talking about how they were going to get him and in case anything were to happen. This really shocked me because like I said this patient always seems so willing to participate in activities and other things, but I was then told that this is part of his personality and manipulativeness that he always seems to say the right things and earn peoples' trust. So after this, I helped the Rehab Counselor start group. Today we were talking about current topics again which included the Super Bowl, the story about Barbaro and other different stories. Then after we did the same thing where we came up with four questions and whoever could answer them all right recieved double tokens instead of just two. This also still amazes me because we made up the most simple and easy questions and only two members of the group answered them correctly. The others either didn't want to try as long as they recieved their other two tokens, or they became very upset because they couldn't answer them. So it's always interesting to see how they react to this because some days are different than others where they might be more willing to try or not give up so easily. After lunch, I went over to the Butler Rehabilitation building again with the Rehab Counselor for New Beginnings. We had a few more people join us today and two of the women wanted to go shopping in the store and the male patient wanted to play basketball and the other woman just joined us and watched us play. I finally was able to interact with these two patients one and one and it was great. I played basketball with the male and he was having so much fun and told me how good I was, which I'm really not good at basketball at all so it was kind of funny. The other woman finally opened up to me and was carrying on different conversations with me from her not smoking for over a month, to how she loves pop and what she enjoys doing in her free time. Today, I finally felt comfortable and a lot closer to the patients and Dr. Messer even noticed it so I felt it was a fulfilling day. But I was excited because most of the patients started to remember my name and were finally carrying on conversations with me. Then after we came back to the Strozzi building, we had a little free time and played some games and then we had informals. I had never been there for informals yet so it was a little different for me. Informals are held for 40 minutes and each patient must occupy themselves with something for the whole time. They can read, write, color or hold quiet conversations with someone as long as it would be acceptable in public. As long as they're not sleeping, shouting or just sitting there they all get a token. So I was able to go around with the clipboard and record who was behaving or not. So today was more interesting than others and I had a lot of fun with the patients today. // :6.5 hours // === February 5, 2007 === The weather was terrible out today so Dr. Messer wasn't in which I was expecting so it was a little slow on the ward, but the normal everyday activities carried on. When I came in, I was suprised at how many patients really remembered my name and said hi to me. I like it so much more like this because I feel that I can finally get to know them and talk to them one on one about certain things. I sat in on group today with the teacher again who had group D which is the highest functioning group. This group is so much more relaxed and each of them have their own workbooks and they just quietly work on something for 45 minutes. There are less interuptions and less distracted. I also notice that they don't seem to get as worked up about something if they don't feel they can do it. Then another representative from RCCA came on the ward to talk to one patient about starting to attend programs there so I'm curious to see if she'll start going and how she'll do there because sometimes she doesn't act so pleasant and will start yelling at people on the ward. Then after lunch, we started group a little early. The afternoons are always more relaxed and more enjoyable because the patients are able to do something they like for the group. Today, we played UNO with one patient who really enjoys it and usually asks me to play everyday with her so that way fun. Other patients were coloring or playing Scrabble. After group was over I just sat around with a few patients and the Rehab Counselor and she told me some things about some of the patients and even she was saying she has questions about their therapies and what the floor is doing to try and get the patients out of the hospital. It was interesting because sometimes I wonder that too because the therapy here is group oriented and not really individualistic and it just seems to me that some patients need the one on one therapy. But today was pretty slow and relaxed so for the next week I am trying to come up with something crafty to do in group for Valentine's Day. // :5.5 hours // === February 9, 2007 === Today was a typical Friday, I came onto the ward and the community meeting was going on in which there are announcements made about the day and anything in specific that relates to the patients. And then some of the patients recieved their awards for either maintaining the step level that they are on, or moving up to the next level. I think that the patients really look forward to these meetings because they are really excited about the progress they make. Usually after, most of the patients come up to me with their awards to show it up how well they're doing, so I think this is something really good to keep encouraging them. After, we had the normal current events group activity where we find a few articles about current events in the news that they read about and then try to answer questions about them. Usually it is hard for them to remember what they read about so most of them can't answer the questions and only a few of them receive double tokens. Then the afternoon was usual, we took a small group over to the Butler center for new beginnings. I played basketball again with one of the patients who really enjoys it. I think he looks forward to going to New Beginnings just to play and show off his skills, which is good because besides this I don't see him interacting too much with other patients or staff too much. Then we headed back to the Strozzi building and let the patients who went with us have a snack if they bought it and let them play other board games or card games if they wanted. Today was a typical Friday, but was enjoyable because we are able to do different things besides just playing board games with the patients and I know I have a lot of fun and I think they do to. It's a great opportunity for them to get off the floor and relax and have fun. // :5.5 hours // === February 12, 2007 === Today was finally my first day to run group on my own. I was excited but pretty nervous too. I decided to make up an activity for Valentine's Day and the project I chose was for the patients to make collages of things they loved. I brought in some stickers, magazines, construction paper and markers hoping that they would get creative. I showed them one that I made which included pictures, cut outs from magazines and pictures I drew. However I've realized that many of the patients either don't listen to you, don't feel like doing something like that or do something completely different from what you asked them to do. There was actually only a couple patients who really listened and did what the project was supposed to be. For the most part, everyone just cut out random pictures that didn't make sense and then stuck the stickers on to fill up space. The group was fun though and seeing the patients try to get creative was interesting. I think for the most part they did have fun and enjoy doing something different from reading articles aloud to each other. In the afternoon group, some of the patients had a chance to make some collages if they weren't in the morning group because they were at program outside the hospital or something. So a few more were made and we hung up all the ones in on the ward that they made and they were all excited that we put them on display. I also brought some sherbet in for them for a treat in the afternoon during program but the rehab counselor had to leave early unexpectedly so we decided to save that for another day so I wouldn't have to give it out by myself just because sometimes they can be a handful. But today was fun and I was glad that I finally was able to run a group on my own and I definatly saw what I would do differently and some different ideas that I could have them do. // : 5 hours // === February 16. 2007 === When I got on the ward today the rehab counselor was running the community meeting as usual to discuss any issues on the floor and acknowledge who have maintained their step level or moved up to the next one. Then we had group with current events which is usual for Fridays. It's the same for the most part every week where we all read different articles for current events and then try to persuade some of the patients to answer a few questions about what they just read so they could recieve extra tokes. But most of the patients give up and there's only two of them who actually try to answer. After group we were trying to plan out what we were going to do for group in the afternoon. The rehab counselor and I will usually pick about 4 or 5 patients to come with us over to the Butler Center for bowling and swimming and then get permission to take them from the nurse. However today, we realized that we wouldn't be able to take them because the hospital started a new rule where they have a small bus just running between the two buildings because it was so cold out. We wouldn't make the bus on time because some of the patients that we wanted to take had to cash their money slips that they recieve each week and they wouldn't be done in time. So then we tried to go down to the basement to play some games so we could still get some physical activity in but that was being occupied too. So needless to say, this afternoon turned into just a typical afternoon where we just run group in one of the rooms and just play games and color and do whatever the patients want to do. But it actually turned out fun because I told the patients how the next week was my birthday and I wouldn't be there for the week because I was going to San Francisco for lacrosse. So most of them did get excited and asked me how old I was and then one of them told me how she went to San Francisco before and told me everything she had done there. To finish up the group we had the sherbet that I brought in on Monday for the patients. They all enjoyed and I think it was a great idea for them because most of them don't have enough tokens to buy the ice cream or any other snacks from the token store so they were really happy. // :5.5 hours // === March 2, 2007 === After being gone for two weeks because I was in California for lacrosse, I felt that I had been gone for a month. I came in and a couple of the patients remembered my name and asked me about my trip which really surprised me because most of the patients barely remember my name! So I was really excited and it really is a great way to start off the day when the patients are nice to me when I walk in. Then to my surprise, Dr. Messer finally got the Nintendo Wii video game system on the floor that he's been talking about for so long. The system itself is pretty interesting. For anyone who doesn't know, it's a video game that you hold the controller and the game does what your movement is. For example, there is a bowling game and you swing your arm like you're bowling and even if you tilt your wrist, it'll come out a curve ball like bowling. So in the morning after program patients now have the option to play a game and recieve extra tokens instead of just watching tv or sitting around. In the afternoon, we didn't go over to Butler because we didn't really have any patients to take. Any of the patients we asked the nurse to take had fines or have been acting up, and the other ones we asked if they wanted to go didn't. I find it really weird that the patients do not want to get off the ward and go out to do new things as much as you would think they would. If it was me, I would take every chance to go and do something else, but most patients don't want too. So instead, we just stayed in a played games. We played Scrabble and then one of the patients taught me how to play Rummy. It was pretty funny because I was so new at the card game that I wasn't really sure how to play at first and she just kept laughing at me because she was just beating me by a lot. But it was fun to learn a new game and do something different and I was glad that the patient had so much fun beating me! // : 5.5 hours // === March 5, 2007 === When I got on the ward today, Dr. Messer and the other staff on the floor were in a treatment meeting. I wanted to join but I didn't want to interrupt them, but Dr. Messer told me after that it doesn't matter if I'm late that I should just come in because it's important to hear those things. I really enjoy working with Dr. Messer because he really wants to show the students what is involved in this job and not just the usual everyday activities. Then the rehab counselor and I held group. We had the C group today so there's only about 7 patients in it and 3 of them were off at program out of the building so only 2 patients ended up coming. We thought this was fine though since it would be a good one on one in group. We started talking about our emotions and how to be happy and not be negative. However, about 5 minutes into the group, something that we said or there was something else going on, set him off and he wanted to leave the group. Then the other patient left, which we expected because I'm not sure of any patients on the ward who would just want to be by themself in the group. After we didn't have a group we decided to go into the lounge and try to get patients to play the Wii with us. But it just ended up being the rehab counselor and myself playing bowling. I think that once the patients see that it's not stressful and that no one will judge them if they're bad, they'll eventually join in and play more ofter. After lunch, we had the afternoon group which was the usual card games, board games and scrabble. I colored a picture first with a patient and then played Uno with this patient who loves to play that game. I think that the attendence at group is starting to get better and it's good to see that the patients are being rewarded for just coming, even if they're not really doing much because that's better than half of the other patients on the floor. After the afternoon group the rehab counselor had to fill out an evaluation sheet with a patient about her feels and anger. At first she wouldn't fill it out and would let the counselor talk to her, but eventually she did. She even let me come in the room with them to help her fill it out. These surveys are filled out once a year and they ask the patients questions such as "what makes you mad?" "what can we do to help you calm down?" Questions like this just for the staff to know what we can do to help the patient and not make them even more angry. After that it was time for informals. Informals are held everyday at 3:30 - 4 and this is where patients must chose something to do that is quiet and not disrupting to other patients. Today I was in charge of the clip board to make sure everyone was doing something and if they're not you have to mark down that they're not. I found that it's easy to be the one in charge and once the patients see that you are, they listen fairly well even if they don't see you as the authority figure. // : 6.5 // === March 9, 2007 === Today when I got to the ward, the other student from Fredonia was there, so I was excited to have someone else to talk to and do things with the patients with. It was real quiet when I first walked on and then I realized that the staff on the floor were in a treatment meeting which I didn't want to interrupt. Then we were ready to start group. Today, the rehab counselor pick out some handouts on emotions and expressing our feelings. Whenever we do things that have to do with our feelings, I think that the patients just zone it out almost. They just go through the motions of reading it, but not actually thinking about it. Only because when you try to have them interract and respond to what they read they never have anything to say and sometimes they don't even remember what they read. I'm not sure if it's only when it comes to talking about feelings, because I know most of them don't like to do it, or if it's just reading things in group in general. After group, the other student and I tried to get some patients to play the Wii with us. We had two patients who usually like playing it to play bowling. I'm not sure what my thoughts really are on the Wii yet. I feel that it is good for the patients to do and once they get the hang of it they really enjoy it, but it takes a lot for them to learn how to play. For example, in bowling you have to hold onto a button and then release it at the right time to make the ball go down the alley and if you don't it doesn't work. So for most patients they don't understand it and the more you try to show them, the more frustrated they get. And for the women, I rarely see any of them playing. I'm not sure if it's just because they don't like sports, or they're intimidated by the males playing. The rehab counselor and I sat down with Dr. Messer and expressed our concerns and he finally realized them, but we're not too sure what we can do about it. So we're all still working on that. Finally in the afternoon we went over to Butler again for bowling. No one wanted to go swimming today so it was just 2 quick games of bowling. One patient actually came out with us too that I never see go off the ward for program so I was really proud of him because he bowled too and did really well. Since we didn't stay there long, we came back to Strozzi and played card games since most of the patients enjoy that. It was a normal Friday, but we're getting better with engaging the patients more and more with the Wii and finding new ways everyday to get them to participate whether it's just watching and commenting or actually playing. // :5.5 hours // === March 19, 2007 === Just as any other Monday, when I came onto the ward, many of the patients were sleeping in the chairs in the common room while waiting for group to get started. Then I saw the other student from Fredonia there again so I went into one of the rooms and joined her with the other patients and just watched tv for awhile. Then I realized that the staff was in another treatment plan meeting which I always seem to miss and I want to go in, but I just feel rude coming in late. The meeting took longer than it usually does so time went by and group didn't even get started on time. Then the teacher for the ward came out of the meeting and started up the ward walk instead of group work today. During the ward walk, we turn on music and the patients must walk around the floor 10 times to get credit. Sometimes it's hard getting the patients to actually exercise because some of them are used to not doing any kind of physical activity. But most of them really enjoy it and like to show off how much they can walk. After the ward walk, the other student and I tried to get some of the patients to play the Wii again. We started playing with one of the patients who really enjoys it and plays all the time. This time we were playing golf, which is a little tricky to get used to. But it's also good because golf is hard for me too so I think that the patients see that even I have a hard time doing really well on some of the games so they're a little less intimidated. After lunch, the other student and I were sitting by the nurse's station just observing everyone and one patient who in particular is real fussy and complains all the time started screaming and yelling to be let into her room. Some days she yells so much that the staff will put her into her room just so she stops and then she sleeps all day. I personally think that this is just a learned behavior by this patient and whenever she feels tired or doesn't feel like going to group she just starts to carry on until somone gives in. However, today no one gave in. So instead of her just going to her room she started pacing around the floor screaming at the staff and then another patient when in turn started yelling at everyone as well. It was a big chain of events and took a lot to get it quiet and everyone calmed down. After that scene we were reading to start the afternoon group. We came up with a good idea to have some of the patients do marble paintings for Easter. A few of them did it and really enjoyed it and had fun with it, but then the others just played the normal card games and coloring. After that, the rehab counselor and I convinced a male patient to make up a profile for himself on the Wii and we played a few games with him. He was easier than most patients because even though he didn't get the hang of it right away, he kept trying and didn't get frustrated like many of the others, so it was easy to talk him through it and not get frustrated myself. I find it hard to try and tell the patients how to operate the control just because you can't show them and once they get frustrated, I'll get frustrated because I want to find an easier way to explain it to them and I can't. But everyday it's getting better and more patients are starting to try it which is the goal of the treatment. // :6.5 hours // === March 23, 2007 === When I came onto the ward today, I could tell that something was going on. Within 10 minutes of being on the ward, I learned that there was a patient, who is usually very calm, became very upset and tried to strangle another patient. So when I got there everyone was split up between the common rooms away from the time out room where the patient was staying and waiting for group. Since there is not a lot of staff on the floor, a nurse from another ward came up and just stayed to watch the patient in the room all day. I could tell that the events in the morning before I came in really affected the rest of the patients. A couple of the female patients, who I never see get upset, were yelling at each other and fighting. I think that many of the patients didn't really know how to respond to the violence so there way is to act out as well against each other. During group time, we did our usual current events which I think most of the patients look forward to because it's part of a routine. Then we decided after lunch that we weren't going to go over to wellness and go bowling but we were going to try to do something different. We decided to do regular group in the afternoon and do marble paintings. After lunch, I played the Wii for a little bit with a couple of the patients and I was surprisingly able to get a couple more of the patients who wouldn't try it to play. Even the rehab counselor was extremely impressed. The one patient wasn't able to play the game but he did try and he gave it a good effort, so even though he didn't play a game he still recieves tokens just for holding the controller. When we started group there were a few patients who were really excited about the marble paintings and finished a couple. The paintings were in the shape of an Easter egg so we can make Easter decorations for the floor. So I think most of them responded really well to the activity. The others who didn't paint, did the usual playing cards, coloring, scrabble and a few of the wanted to play the Wii, so we continued to do that as well. Then it was time for informals and most of the patients were still walking around with nothing to do and refused to participate in informals. Today was a very unusual day with everything going on and other patients acting up, but I was good to be over so that nothing else could happen. // :7 hours // === March 26, 2007 === Today when I came onto the ward, things were a lot more calmed down than on Friday - I could tell instantly. Since I came a little later today, I was in time for a fresh air break before group and token store. We went outside for a little while just for some of the patients to get a walk in and go outside since it's starting to get a lot warmer out. After that, we started group. The groups of patients were split up and we had C, which only had about 3 patients in it who would actually come. So we decided instead of holding group in a classroom we just played the Wii. This was actually a good choice because one of the patients in the group never even tried it before so we were actually able to get her to make a profile and play a whole game of bowling. At first she didn't want to play it, but then she saw how easy it was and she was actually pretty good at it, so she finished a game and had a very good score for a beginner. Like I said before, I think many of the patients are a little intimidated to play it in front of everyone, but once they realize how easy and fun it is, they'll continue playing and actually try to play again. After group a few more patients came in and joined the games that were going on on the Wii until lunch. After lunch, it was just the usual group with card games, coloring and board games. I colored some Easter pictures for awhile with another patient who likes coloring and after that I played UNO with another patient. Finally it was time for informals and today seemed extremely hard to get the patients' attention to do something productive during informals. After multiple promps to get the patients to do something, many of them followed and listened but there were the few who wouldn't listen at all. Today seemed a little calmer than Friday was, but it still seemed like the patients might be getting sick of being inside or something since it's getting nice out. We're not sure what's happening but my opinion is the weather. // :6 hours // === March 30, 2007=== Today, I was just in time for the community meeting being held in the living room. We all found out today that it was Van Gogh's birthday which I didn't even know. So we talked a little bit about him and what he did and what he was known for. Some of the patients knew who he was and others didn't. The significance of talking about him was that he finished many of his most famous paintings while he was in a mental hospital being treated for schizophrenia. Since the patients on this ward all have some form of schizophrenia, it was a good idea to talk about him. After the community meeting, we had all the groups with myself and rehab counselor. To go with the theme of the day, we decided to finish talking about Van Gogh and then we had everyone do a self portrait like he did before. During group, there was another new student who joined us who is from Brockport. I thought it was a little late to be doing an internship, but I think that's how the internship might be done because she doesn't have any other classes anymore to go to. After meeting her we all drew our own self portraits. Since I am very challenged in art, mine was not the greatest, but you could tell it was me. It was interesting to see what many of the patients drew. For some of them, their portraits didn't look anything like them, some did and others were just drawing things that had nothing to do with self portraits. Then we colored some of his famous pieces the way we would have colored them. During our lunch break, the other student, myself and the rehab counselor went searching around different stores in the area to try and find relaxation cds to try and have a different kind of group in the afternoon instead of just playing games or going bowling. But we were unsuccessful in finding any so we just decided to go bowling in the afternoon. This time when we went, we managed to get another patient to go who usually doesn't because he's usually very negative about everything, but he ended up doing awesome! He bowled a 199 and I've never seen him happier! He usually bullies other patients and always speaks about how the hospital is trying to kill him with his medication. So I was glad to be able to see another side of him that I always knew he had, but we just never were able to really see it before. After we got back from bowling, I left right away to get ready for a lacrosse game we had in the evening so I wasn't able to hang around to play the Wii or for informals like I usually do. // :5 hours // === April 2, 2007 === Today when I came on the ward, I was able to make it to the Treatment Plan meeting that usually starts much earlier than when I come in. It was the first time I sat in on one of these meetings and I was a little different than I thought. The nurse goes through the book of all the patients one by one and if there is anything to say or mention about that patient then they talk about it then. I was expecting more of talking about maybe one specific patient that they have had problems with and focus mainly on one person, but it wasn't like that. However, after seeing the meeting, I understand why they do it this way because it is a lot easier to go through all of the patients at once and talk about something if it comes up with that person. At the end when I started thinking about everything that happened, I'm not sure if I think that treatment with certain patients were really beneficial, or even talked about with more seriousness first, but we'll see if there is progress being made. After the meeting, we were ready for group and went downstairs to make some photocopies. Today, we just did a fun group to talk about Easter and do some activities for the holiday. We decided to color eggs and the patients really had a lot of fun doing it. Most of them color multiple eggs instead of just one like I thought they would. While they were coloring eggs, we also had them color Easter pictures and then we played charades with the patients getting a chance to win plastic eggs filled with prizes. The eggs were mostly filled with either token prizes so they could receive extra tokens, some patients were able to have candy, and there was also a picture of all the student interns in one. The patients responded really well to the activity and enjoyed playing charades which I wasn't sure if they would like it or not. After lunch, we just held normal group activities and had some more Easter pictures if anyone wanted to color those again. We played the Wii in the other room and were able to get a few more patients to play who normally doesn't. I'm not sure if the patients play it to have fun or if they just do it to get tokens because they know that even if the just hold the controller, they can receive extra tokens. I know it is a good incentive for the patients to really interact with the game and try it, but I sometimes feel that some of the patients just know what to do to make us happy and if they do it, even if just for a couple minutes, they can get a reward that they usually do not receive. // : 6 hours // === April 16, 2007 === After being gone a couple weeks due to Easter break and traveling for lacrosse, when I came in today, I could tell I missed a lot. I came in time to make it to the treatment plan meeting again and there I found out about a lot that has been going on. One patient who usually does bully other patients had threatened one of the staff. Before this, many of the staff members thought that he doesn't really have a mental illness, that he is just a "punk", but after this, it is clear to see that he clearly has a mental illness. I have observed him before in group where he will not listen to anyone and thinks that every conversation is about him. He started writing on his paper that everyone in the hospital is trying to kill him with his medications and everyone is out to get him. After this incident, I think it is clear to see that his treatment should change because for whatever reason, it is not helping him so far. After the meeting, we had a smaller group today because of the other staff having group as well. Since there were only a couple of patients who were actually participating in group, we decided to just have them play the Wii. Even though the rehab therapist and I do not think that the Wii is more beneficial to play instead having a conversation among each other and finding out about current events, since there were only 2 it is easier to have them play that than to get them to have a conversation with just them. After lunch, it was group time and instead of having it in the usual room, we decided to change it up and let them stay in the lounge and relax during group. This way, some of the patients could play the Wii, or watch or play games without us having to be in two places. I think the change actually worked out because even if the patients were sleeping or not doing anything, they did not receive tokens, but the patients who were participating in group had a few different options of what they wanted to do. I think that also being in that room so that no one had to move to a different room made most of the patients a lot happier. I think that this way they could also see that group isn't boring, but it can be a lot of fun and you really have a choice as to what you want to do with your time. After group, it was time for Informals. I know about Informals, but I have only been there a couple times while they actually do it. So today, I was able to walk around with the clipboard to mark down who was participating in them and who wasn't. Many of the patients feel that they do not have to participate in them for some reason, while some of them just make it look like they're doing something when they're not. However, it is easy to see who is pretending and who actually cares and wants to participate and earn tokens. // : 7 hours // === April 20, 2007 === When I got on the ward today, I couldn't really find any of the staff for some reason. The rehab therapist was downstairs and Dr. Messer wasn't there yet so I just sat with some of the patients in the living area until I found them again. Then the other student from Fredonia came in and I haven't been there with her together in a long time so I was excited. We then started catching up with each other about everything that we missed while we were both gone for different things. We both had some interesting stories to tell one another. After we caught up, we decided to sit in the classroom with the teacher and a couple other patients just because the other group started and we didn't want to walk in late and be rude. This actually turned out better because I was able to sit and talk to the one female patient who is getting discharged on Sunday! I was so happy for her and I know she will do really well living with her family on her own. So I was glad that I was able to spend some time with her before she left. After group we decided to take a fresh air break because it was so nice out. We didn't stay out for long because it was a little chilly and believe it or not, the patients actually want to go back in sooner than you would think. Then for lunch, Darlene who we spend most of our time with here decided to take us out for lunch because she knew that Monday would be my last day and the other student wouldn't be there then. After lunch, we ran some errands to pick up some things we would need for activities and then rushed back so we could take the patients over to wellness for bowling. We were actually able to take a couple patients who have had problems running away before back out so it was good to see that they earned their priviledges again and are able to go out and have fun. After we came back from bowling I was only able to stay around a little while longer because I had a lacrosse game in the evening. So I decided to play the Wii with a couple of the patients before I left. We were able to get a few good bowling games in and actually had another patient who never played it before try it, so that is always good to be able to teach them how to play. // : 5.5 hours // === April 23, 2007 === Today was finally my last day!! Although I'm happy that I finished I know that I will miss all of the patients and the staff here. Some of the patients actually remembered that it was my last day too. In group Darlene and I planned to do an Earth Day activity so we decided to replant a plant that has a lot of history on the floor being passed on by a few employees who are still here. It went well and all of the patients were really involved in the activity and took a lot of pride into the plant. We also read some history about Earth Day and some of them colored their own pictures of flowers and plants. Today was more of a relaxed day for everyone so after lunch we went to the new courtyard that they have been building for so long and it was finally open. So we all went down there for the afternoon group instead of staying inside. The patients were very active today and were playing football, frisbee and just talking to each other. I felt like today was a great day to end my internship. It was very calm, relaxed and there were not any problems with the patients to have to deal with today. I feel that I have learned a lot from this experience and even though I will be continuing with psychology, I know that I would never want to work in a state institution. The environment is just not something that I know I would want to come into everyday. Sometimes it is very hostile and you have to keep a close eye one some of them and some days it is very calm. The good thing about this hospital though is that there is something different everyday. It was not a boring internship because I learned how to deal with a lot of problems that patients would have and how to help them through it. I've seen physical violence towards one another, very unstable emotional patients as well as patients who do not want to participate in anything. I have a new perspective on how to handle every situation. This internship was completely rewarding and I would suggest it to anyone who is interested in psychology. // : 5 hours // PracticumExperiences