SCO 214. 4212
Rachel Bianca Mallari
Case Study Analysis
Prof. Mary Beth Early
John a 22-year-old single man is diagnosed with major depression and borderline
personality disorder. Based on his chronological age, he is expected to have
accomplished the process of selecting an occupational career, striving to succeed at it and
forming an intimate relationship. In early adulthood from the ages between 18 to
approximately 40, one must have attained a sense of self-identity as an individual (Early,
pg.115). This period is where young adults must form a concrete sense of oneself. Also,
they are driven by the desire to contribute to the community either through employment
or parenting.
The primary occupational roles that young adults embark on at this particular
stage are the worker and student roles. Most young adults are college students, full time
employed or a combination of both. Parent role is also an occupational role for young
adults. Young adult’s principal task is to develop friendships and intimacies with others.
Often times in search for intimacies young adults end up parenting a child. There is a
decline in the time spend in play during early adulthood. “Relaxation and Recreation
supports the worker role” (Early, pg.105).
Given that John has unstable career choices and poor work history suggests that
he isn’t ready to take up any of the said occupational roles. Although, there is no mention
of his behavior, it is said that generally people with Borderline Personality Disorder are
unstable with interpersonal relationships, self-image, mood and behavior. Thus, he won’t
be able to adapt to the transition of the worker responsibility of an adolescent into young
adult. The client’s suicidal attempt implies that he is not emotionally and psychologically
prepared to take on the responsibilities of a young adult. His repeated hospitalizations is
an evidence that he is not mentally stable. However, with supervision and continuous
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SCO 214. 4212
Rachel Bianca Mallari
Case Study Analysis
Prof. Mary Beth Early
treatment the client might be able to acquire the skills necessary to accomplish such roles
in the future.
In planning for a program for this particular client, the initial step is to consider
his cognitive, interpersonal, intrapersonal, productivity and leisure skills. Determining the
areas where the client has deficits will enable the therapist to create interventions in areas
that needs to be addressed. Second, the client’s interests and level of functioning should
also be considered in terms of providing activities to enable maximum engagement and
participation. Lastly, the client’s cognitive ability should be determined in order for the
therapist to choose a suitable and just-right activity.
Additional information such as the relationship of the client with foster parents
and siblings, his behavior in school and his response to previous therapy from his past
hospitalizations would be beneficial in selecting and rendering the utmost and appropriate
occupational therapy services. These supplementary information will further the
knowledge of the therapist on what the client has experienced. Thus, will determine
which type of activities the client will more likely respond positively to. Also, the
comprehensive results of the various occupational therapy assessments conducted such as
the Missouri Level of Care Survey, the AMPS, and the Activity Configuration will
validate the specific areas where the client needs intervention. Information regarding
friends and support group or lack thereof is helpful to establish a program that will help
the client relate with others and form healthy and positive relationships. All of the
additional information can be obtain through the records of the previous hospitals the
client has been admitted to. Setting up an appointment with the school counselor and the
instructors of the client in his elementary and secondary school will give some valuable
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SCO 214. 4212
Rachel Bianca Mallari
Case Study Analysis
Prof. Mary Beth Early
information.
Client will state one positive thing about himself in the beginning of the group
sessions 2 times a week by 3 weeks. This functional goal focuses on the client’s
intrapersonal skills. People who have Borderline Personality Disorder like John are
identified to have a “fluctuating sense of personal identity” (Early, pg. 145). Therefore,
by establishing John’s self- esteem he is also being aware of his self. Thus, will gradually
lead to create self-identity.
A well-organized milieu with structure and supervision will provide stress-free
environment for the client. Avoiding too much stimulation in the environment would also
be effective. The client will be placed in group activities. The therapist should avoid
frequent one on one contact with the client to avoid too much clinging and dependence.
One should firmly set limitations yet be passionate. Encourage the client to engage in
various activities. Praise the client for an accomplished task. Activities recommended for
John are as follows:
Games: Board Games, Friendship Quilt, Woulda Shoulda Coulda- to increase
communication skills and rephrase self defeating sentences to increase personal strength
and self-control.
Arts and Crafts: Ceramics- provides mixed emotions through the use of clay. This will
eradicate “coping mechanism of splitting of feelings into use of black-or-white, all-ornothing [and good or bad] thinking…” (Nace). Also, the object created will be used as a
form of projection of the clients indecisive state. Self-mutilation and aggression may also
be reduced with the use of ceramics through wedging.
Exercise: long walks, gym, and dancing- coping skills for boredom and depression.
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SCO 214. 4212
Rachel Bianca Mallari
Case Study Analysis
Prof. Mary Beth Early
The indicator if the goal has been met is if the client is able to have a positive
response when ask to describe himself to others. The client would also be confident to
state good things about himself. There should also be less feeling of remorse and selfmutilation. There should be evidence of improvement in communication skills. If the goal
was satisfactorily met, the individual is then ready for further goals and intervention.
John has poor and unstructured use of his leisure time. He spends most of his evenings
and weekend time watching t.v. Therefore, through limiting the hours of his leisure
activity or introducing a different activity, he will not only have a sense of leisure time
management but also be encourage to explore other activities that he may find enjoyable
and pleasurable.
Since the client desires to be a nursing assistant, he can be placed in a Program for
Assertive Community Treatment (PACT). However, this won’t guarantee that the client
will be a nursing assistant but it will help the client to “improve functioning in adult
social and employment roles” (qtd. in Early, pg. 171). In addition, the client can enhance
performance of work skills, work tolerance and work habits.
WORKS CITED
Early, Mary Beth. Mental Health Concepts and Techniques for the Occupational Therapy
Assistant. 3rd ed. Baltimore, Maryland: Lippincott Williams & Wilkins, 2000.
Nace, Barbara Amelia. “Mental Health Disorders : Personality Disorders”. The Merck
Manuals Online Medical Dictionary. 1 February,2003.
<http://www.merck.com/mmhe/sec07/ch105/ch105a.html#sec07-ch105-ch105a-
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SCO 214. 4212
Rachel Bianca Mallari
Case Study Analysis
Prof. Mary Beth Early
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