Emma is 34 years old and lives with her son and daughter aged 11 and 8. Emma has experienced life-long difficulties regulating her emotions and was diagnosed with a Personality Disorder. There has been a significant increase in symptoms and episodes of self harm since her marriage ended two years previously. Emma does not work and is in receipt of Employment Support Allowance.
Reason For Referral
Emma was referred to occupational therapy by her Mental Health Nurse as she had difficulty structuring and occupying her time when alone.
Emma took her role as a mother very seriously and enjoyed looking after her children cooking them a balanced meal every evening and keeping a clean and tidy home. However when her children were visiting their father she was often at her most vulnerable struggling to structure her time and regulate her emotions. During these times she frequently self harmed and required hospital treatment.
Occupational Therapy Assessment
An initial Occupational Therapy Assessment was conducted drawing on a number of occupational therapy models and treatment strategies including the Model of Human Occupation and a more informal one to one interview.
This assessment identified that:-
- Emma most strongly identified with her role as a mother and struggled to identify with any other roles;
- When Emma was not in her parent role she struggled to identify, and see the purpose of engaging in, activities and would often drink alcohol as a way to alleviate her boredom;
- Emma had developed significant social anxiety and was unable to venture out in public places without engaging in several safety behaviours such listening to an MP3 Player at all times, going out at quiet times of day, always staying on a familiar route and visiting the same places.
Occupational Therapy Treatment Plan
Emma participated in an Occupational Therapy Programme consisting of 12 sessions over a 24 week period which focussed on:-
- Enabling her to develop some positive coping strategies to help her manage her emotions as an alternative to more harmful coping strategies such as self harm;
- Completing an interest checklist – identifying past interests and identifying activities she had considered but never tried;
- Formulating a skills/activities checklist to use when she is on her own;
- Developing a graded exposure plan to enable Emma to build on her skills and confidence in public places.
On completion of her Occupational Therapy Programme Emma was able to:-
- Increase the amount of activities she engaged in which were not directly related to caring for her children such as revisiting a previous interest in craft making, meeting up with friends for lunch and joining a local gym;
- Increase her range of coping strategies and reduce her levels of self harm (she spent a week at home alone whilst her children were on holiday without needing to self harm);
- Identify with a work role and a goal to return to meaningful employment as a result of which she enrolled on an NVQ course at the local college.