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General Psychosocial Treatment Plan
Occupation Based Practice
Client Initials: R. P.
Dg: Schizophenia, Depression,
Alcoholism
Accommodations:
Avoid crowds at first (make therapy individual- progress to
group); make sure client is taking medications, no
environmental supports for unwanted behaviors (ex.
Alcohol paraphernalia); speak softly and with simple
sentences; make sure environment is non-threatening, and
implement simple structured, short, familiar activities.
Goals:
1. In order to improve productivity, client will learn stress
management techniques in OT and report having used
them at least twice a week by discharge in 90 days.
2. In order to improve social participation, client will have
meaningful, personal interactions with a friend for at least
10 min 3x week by discharge in 90 days.
Student: Becca, Sarah, Hillary, Chris, Lauren
T., Morgan
Rationale:
(3) People with schizophrenia tend to become
stressed in multi-sensory environments. In the
early stages of treatment, avoid environments
that provide too much sensory stimulation.
(6) Clients also need to maintain their medical
regimen to avoid rehospitalization.
Rationale:
(8) According to Stein and Nikolic, stress can
be a major trigger for people with
schizophrenia, which can lead to relapse and
rehospitalization. Because clients with
schizophrenia tend to have increased levels of
stress, their ability to function independently
decreases tremendously.
According to the cognitive behavioral frame of
reference, environmental stressors can also
enhance irrational thinking and negative
thoughts, leading to paralysis of will and drive
to be productive. Therefore, incorporating
stress management techniques into therapy and
having the client determine ways to use them
during different situations can help the client be
able to generate adaptive responses to stressful
situations in order to function more
independently.
(4) According to Hooley, clients that are
diagnosed with schizophrenia show signs of
impaired social functioning including social
isolation and withdrawal. Clients with
schizophrenia demonstrate weaker verbal
(clarity, negotiation, persistence) and nonverbal skills (interests and affect) than persons
not diagnosed with schizophrenia. These
communication barriers contribute to irrational
thoughts and negative view of one’ self;
therefore, social skills training can facilitate
client to act on more rational thoughts.
Since the client demonstrates hyperstable
behavior, social skills training will probe her to
implement modified or new response modes in
order to establish a more stable behavior and
participate in social interactions. Improvement
in social skills would lead to greater social
functioning and increased acceptance by peers.
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Treatment Description:
1. Perform Breathing and Relaxation
Techniques
Therapy sessions will focus on informing
client when and how to use breathing and
relaxation techniques to reduce stress.
Client will be provided resources to expand
knowledge on available breathing and
relaxation techniques.
Client will be instructed to perform simple
diaphragmatic breathing exercises in a
quiet, peaceful room.
Yoga Poses
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Cat pose
Cobra Pose
Childs pose
Triangle
Tree
Pictures and explanation can be found at:
http://www.yogabloomington.com/Poses.
html
Sessions will facilitate client to explore the
effectiveness of the relaxation strategies
Questions to ask during treatment:
-When can you use diaphragmatic breathing?
-What time of day can you use yoga to
decrease your stress?
-What situations would you find these stress
reducing strategies most effective?
-What are the benefits of implementing
diaphragmatic breathing or yoga into your
daily routine?
-What are the costs of implementing
diaphragmatic breathing or yoga into your
daily routine?
-How can yoga direct you away from
irrational thoughts (delusions)?
2. Needleworking- to encourage
rhythmic, repetitive motion to
decrease stress.
Activity and instructions found on page 214 of
Crafts and Creative Media in Therapy, third edition
Carol Tubbs & Margaret Drake
Questions to ask during treatment:
-How has your stress level changed during
this activity?
-When would it be an appropriate time to use
this activity?
-Where can you use this activity?
Therapeutic
Considerations:
Adaptations:
-Perform activity in quiet,
peaceful setting
-If client is unable to
determine times within her
routine to perform
activities, therapist will
create visual chart with
scheduled times to
participate in relaxation
techniques during her
daily activities.
-If client is unable to
report how effective she
believes the techniques are
in reducing stress, have
client journal her thoughts
and emotional experiences
before, during, and after
performing stress
management techniques.
Rationale:
(1) The increased stress triggered by
schizophrenia can cause impaired cognitive
functioning and withdrawal from daily
activities. According to Chandratreya, yoga
has a unique ability to decrease stress and
improve cognitive functioning, making it an
appropriate treatment for a client with
schizophrenia. By learning the relaxation
techniques and applying them to different
situations, the client is better suited to
function independently.
This activity incorporates a variety of
frameworks under the cognitivist approach
including CBT and motivational
interviewing. The questions used during
treatment allow the client to weigh the
benefits and costs of implementing stress
reducing techniques and also test its
effectiveness in reducing irrational thoughts.
This also helps client to develop new
adaptive responses to stressful situations in
order to meet her desire to participate in
meaningful roles and routines which is a goal
of Occupational Adaptation.
-Provide client with stepby-step instructions as a
guide (reference) in case
she is confused
Adaptations:
-Start with simple
threading then move to
complex.
-Client may need a
schedule to perform
activity
-If she doesn’t like the
worksheet, have her
simply journal experiences
(7) According to Reynolds, engaging in a
task that requires intense concentration
provides distraction from worry and relief of
depressive thoughts and stress. This also
helps to enhance self-esteem, empowerment,
and control. Activities that require repetitive
motions allow the client to succeed because
it involves minimal learning of one
skill/movement that is repeated to perform
the activity. This repetition also helps to
decrease anxiety levels.
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-How could you use this activity to interact
with others?
Behavioral Activation Worksheet
This worksheet serves a record keeping
strategy to allow the client to report
depression, pleasure, and achievement
levels experienced before and after
performing needleworking activities.
-Provide client with stepby-step instructions as a
guide (reference) in case
she is confused
http://www.cci.health.wa.gov.au/docs/AC
FB003.pdf
3. Social Skills Training
Semi-scripted role play that addresses
conversational skills in different
environments and various situations
defined by the client.
-Social skills strategies and
conversational scenarios found at:
1.www.mirecc.va.gov/visn5/training/sst/s
st_clinicians_handbook.pdf
2.http://www.dhs.wisconsin.gov/mh_bcm
h/docs/confandtraining/2012/9-2712SkillTraining2SlidesPerPage.pdf
To address client’s irrational beliefs and
paranoia associated with social situations,
use the REBT Self Help Form to enhance
role play outcomes.
Questions to ask during activity:
-Think about a situation or conversation
where you felt overwhelmed. How could
you have used these skills to better handle
the situation?
-How will you use these skills to initiate a
conversation?
-How do you feel these skills will help
you form new friendships?
-What will be the most difficult part of
interacting with others?
-Acknowledge shy
feelings
-Provide client with
example by observing
others role play
-Engage person in
providing feedback
-Start with shortened
versions of role play
-Gradually increase the
number of steps or skills
involved in role play
-If unable to identify
irrational beliefs, provide
prompts or role reversal to
direct her identification.
-Use sentence stems to
help guide conversations
and allow client to express
feelings and structure
thoughts.
(2) Behavioral activation is a key technique
within CBT that facilitates the client to
explore affective and behavioral reactions to
psychotic symptoms; it also provides insight
into how activities affect thoughts and
emotions. Cognitivist instruction encourages
guided exploration of attitudes and emotions
in response to participation in one’s
environment; record keeping and journaling
are strategies within the cognitivist approach.
This behavioral activation form also provides
the client with a way to evaluate her relative
mastery by determining the effectiveness,
efficiency, and satisfaction to self that the
adaptive coping strategy of needlework
provides.
(5) According to the Schizophrenia Bulletin,
strengthening social skills results in
improved coping and competence for
individuals with cognitive deficits, as well as
protect against stress-induced relapse.
Structured social skills training helps to
improve interpersonal relationships and
overall quality of life.
The REBT Self Help Form will help identify
irrational and paranoid thoughts associated
with various social interactions. This CBT
approach helps to dispute irrational beliefs
and encourage client to act on more rational
beliefs. Semi-scripted role play within the
environment helps to implement these new
beliefs into pretend social situations all of
which are strategies within the cognitivist
approach. Social skills training provides
client with strategies to meet societal and
role expectations of being a friend, teacher,
and family member.
-Gradually expose client to
real social situations with
other clinic staff or clients
-As competence increases,
invite family members to
participate in role play
activities.
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Resources:
National Alliance on Mental Illness- www.NAMI.org
Hud’s public housing program at www.hud.gov
Cole, M. & Tufano, R. (2008). Applied theories in occupational therapy: A practical approach. Thorofare, NJ: Slack
Schell, B.A.B., Gillen, G., Scaffa, M. E. (2013). Willard and Spackman's occupational therapy (12th ed.).Philadelphia:
Lippincott, Williams, & Wilkins.
Behavioral activation worksheet: http://www.cci.health.wa.gov.au/docs/ACFB003.pdf
References:
1)Chandratreya, S. (2011). Yoga: An evidence-based therapy. Journal of Mid-Life Health, 2(1), 3-4.
2)Cuiipers, P., van Straten, A., Warmerdam, L. (2007). Behavioral activation treatments of depression: A meta
analysis. Clin Psychol Rev, 27(3), 318-326.
3)Dunn, W. (2001). The sensations of everyday life: Empirical, theoretical, and pragmatic considerations. American
Journal of Occupational Therapy, 55(6), 608-620.
4)Hooley, J. (2010). Social factors in schizophrenia. Current Directions in Psychological Science, 19(4), 238-242.
5)Kopelowicz, A., Liberman R., Zarate R. (2006). Recent advantages in social skills training for schizophrenia.
Schizophrenia Bulletin, 32(1), 12-13.
6)Laliberre-Rudman, D., Yu, B., Scott, E., Pajouhandeh, P. (2000). Exploration of the perceptions of persons with
schizophrenia regarding quality of life. American Journal of Occupational Therapy, 54(2), 137-147.
7)Reynolds, F. (2000). Managing depression through needlecraft creative activities: A qualitative study. The Arts in
Psychotherapy, 27(2), 107-114.
8)Stein, F., Nikolic, S., (1989). Teaching stress management techniques to a schizophrenic patient. American Journal
of Occupational Therapy, 43(3), 162-169.
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