Signs of Unhealthy Boundaries

Today's handout is another one I found on Pinterest.  How will you incorporate it into your groups?

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Inside Outside Bags

This activity was submitted by the Activity Therapists at Provo Canyon Behavioral Hospital.

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You’ll Need: Magazines

                         Glue or Tape

                         Paper

                         Markers or Colored Pencils or Crayons

                         Brown Paper Bag for each participant

Patients should be instructed to decorate the outside of their bag with things that represent how other people see them and put things inside that represent how they really are on the inside. Patients can tear out of the magazines, so scissors are not needed!

Then, patients should share the outside and inside of their bags with the group.

Can process:

1.     The difference between who we really are and how we present ourselves.

2.     Why it can be difficult to share what is inside the bag, what are we afraid of?

3.     How can communicating who we are be important in relationships?

4.     What happens if we don’t communicate who we are?

Leisure Lists

Size of Group: 4-12

Equipment: Pencil, paper, timer, and leisure categories

FOCUS AREA: Benefits of Leisure

Description: Break the group into 2 to 3 groups. Begin the game of Leisure Lists. This game is reminiscent of "Scattegories."

A topic will be named and participants are given one minute to list as many things as possible. After each round, chose a group to read their list first. If another team has the same item on their list, that item is crossed off on everyone's list. If no one else has the same item, then the team gets one point. After team one has finished reading their list, the next team(s) read their list. The team with the most listed items wins the round.

Give the groups one minute to make each list.

1.  List your favorite leisure/recreation activities

2.  List positive benefits you obtain from participating in leisure you like

3.  List lessons you have learned from participating in leisure/recreation

4.  List places you can participate in leisure/recreation

5.  List Olympic Sports

6.  List things you take on a picnic

7.  List things related to football

8.  List names of dances

·         Begin discussion on favorite activities. What makes an activity enjoyable? Further discuss the positive benefits of preferred leisure.

·         (Optional): Relate the theory of Flow by Mihaly Csikszentmihalyi.

Following discussion, Complete the activity with feedback from participants on what choices they might make when feeling depressed, bored, etc. and tie it in with the benefits they listed earlier.

EXPECTED OUTCOME: Participants will better understand how engagement in preferred activities can positively affect their feelings, moods, and thoughts.

Csikszentmihalyi (1993: 178-9) defined eight dimensions of the flow experience:

The 8 dimensions
Clear goals and immediate feedback
Equilibrium between the level of challenge and personal skill
Merging of action and awareness
Focused concentration
Sense of potential control
Loss of self-consciousness
Time distortion
Autotelic or self-rewarding experience

The Rainbow Fish

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Read the book “The Rainbow Fish” by Marcus Pfister with the patients.  Discuss the moral of the story with the patients.  Why did the fish not want to share his special fins at the beginning?  What helped him change his mind?  What do the shiny fins represent? 

Activity:

Instruct patients to make a multi-colored fish.  You can either print off a template and have the patients color it with markers, or give them construction paper and make a mosaic out of it.  However, there are only as many colors as there are participants.  Each participant gets one color, and must share with the others in order for each person to be successful. 

Process:

Talk about how it is important to work together to accomplish a goal.  What was it like to ask for something you needed?  To help someone?  Why couldn’t you just have one color in your fish?  What does this represent?

What qualities or contributions can you make to this group?  To other groups in your life (ie family, religious groups, friends, coworkers, etc.)?

Have You Ever?

Size: 5+

Equipment: Chairs, or something to mark how many seats there are in the circle (one less than the number of participants).

Objective: Ice Breaker, energy burner, appropriate social interactions, keeping the topic appropriate, overcoming social anxiety/public speaking, communicating personal boundaries

Description:
Procedure: Arrange group into a large circle with one person in the middle. The person in the middle will prompt with the phrase Have you ever ? and then finish the phrase-- Example: Have you ever had a candy bar for breakfast?

Each person in the circle who has done what the person in the middle has said (ever had a candy bar for breakfast) will quickly exchange places with someone else that has also done it. (A person can’t trade places with the person immediately to their left or right). Whoever is left without a seat will finish the phrase the next
time.

The game has no real end so you can play 2 or 20 times, it’s up to you!

Process:
-why are boundaries important?
-how do you decide when something is or is not appropriate to say or do?
-recognize your typical place in a group setting--are you comfortable with that or would you like to change that?
-what can you do to respect others’ personal space?
-why do we set boundaries?
-how can we communicate our boundaries?
-how do you feel safe in a group setting?

Variation: Give each participant a role to play (ie. Passive, argumentative, bring up a taboo topic, talking too loud, talking too soft, demanding, ect.) and have them play a few rounds in these “inappropriate” roles-process what it was like, and then play again, encouraging appropriate social boundaries.

Submitted by Jessica Hohenberger

Positive Reframes

This week's Friday Handout is also from Pinterest.  I'm excited to use this in groups and help patients understand their positive traits, not just the negative side of things.

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Back to Back Drawings

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Partner patients up with a peer and have them sit back to back.  One peer describes to the other peer how to draw the picture they are looking at.  They may not tell the other person what the picture is.  Have the other peer draw the picture then look at the real picture. 

Have patients change roles and now have the person drawing last time be the explainer (using a different picture that before). Show them the real picture afterwards to compare.

Discussion Ideas

1.     What made the assignment challenging?  How is this similar to the challenges that arise in our everyday communication with others?

2.     What were the strengths/ weaknesses of your partner’s communication?

3.     What is your personal style of communication and how did that come through in the activity?

4.     What is one thing you could take from this activity to better improve your communication in your personal life?

Leisure and Feelings

Submitted by Joselyn Whetzel of UVA Medical Center / Adult Psychiatric

Size: 4-10

Equipment: papers, pens/pencils, chalkboard, small basket

Objective: To raise the awareness of leisure activities being effective as positive coping strategies.

Description: Pass out paper and pens and have each patient write down 2-3 leisure activities that they enjoy. Collect these papers in a basket and put aside.


Next, ask patients to brainstorm feelings or emotions they enjoy or like to feel (i.e. belonging, sense of adventure, love, happiness, sense of accomplishment, self- worth, etc.). List on chalkboard leaving space under each emotion.

After you have listed about 8 or so emotions/feelings... pull out the basket you have set aside. Pull out the papers and read each leisure activity and ask patients how it makes them feel (i.e. How does walking in the park make you feel? relaxed, peaceful). List the leisure activities on the board under the appropriate emotions/feelings.

Lastly, explain to patients that when we feel low or depressed we are able to get back in touch with these emotions/feelings that we like through the magic of leisure activities!!

Tell a Story

submitted by Anna Evans of Longwood University

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Equipment: Yarn of various colors and scissors

Objective: 1. To enhance socialization skills. 2. To share memories with others.

Description: Cut different colored yarn into varying lengths. Tie yarn together end to end, alternating the colors. Roll the yarn into a ball. Sit in a circle. Decide who will go first and hand the person the ball of yarn. As the person begins telling a story, he or she slowly unravels the ball of yarn. When the color changes, it is time to pass the ball of yarn to the next person so he or she can take over telling the story. Keep passing the ball of yarn around as the colors change, until the ball of yarn is completely unraveled. The last person ends the story. For a variation, make up a rule to follow when the color changes. For example, each time the color changes you need to change the setting or introduce another character in your story.

Bocce Ball

A while back our facility started a program called "Activity Nights."  Basically, we had a "fun" group with each unit where we would play games board games, do puzzles and word searches, go to the gym, etc.  One of the activities we did was Bocce Ball.

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Materials: 

Bocce Ball Kit

Procedure:

Divide the group into two teams and so each player gets 1 ball (if there is enough for 2 balls each then do that). Throw the white ball out anywhere on the court. The first player will throw one of their balls and try to get as close as they can to the white ball. Each person will throw one ball alternating teams (i.e. red team throws then blue team etc.) After everyone has thrown their ball, the ball that is closest to the white ball wins that round (if it is a blue ball, blue team gets a point and vice versa). The player who threw the winning ball gets the throw the white ball.  You can decide how many rounds you are going to play. 

Change

I loved this when I saw it on Pinterest!  I feel like almost everyone can relate to it, whether it be the patient or the therapist.  What is holding you back??

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Drawing in the Dark

Here's an art activity from the rec therapists at Provo Canyon Behavioral Hospital.

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2 or more players

Ages: 6 and up

Need pencils (or crayons) and paper

Go!

Begin by turning the lights out. An adult then starts telling a story.

The kids have to draw, in the dark, what the adult asks them to draw.

This is a lot of fun for the kids to do! Since they can't see, you can expect some pretty funny pieces of art to come about.

Example, an adult says, "There was once a rabbit named Randy. Draw Randy." The kids then draw a rabbit on their papers.

The story continues, "Randy had a friend named John, who was a horse. Draw John." The kids then draw a horse.

"Randy and John liked to play in the lake. Draw the lake." The kids draw a lake.

"They like playing with Tommy, a turtle, when they are at the lake. Draw Tommy". And the kids draw a turtle.

"The turtle had a friend named Buddy. Buddy was a bird". The kids then draw a bird.

"Buddy had a nice birdhouse that his family lived in". They draw the bird's house.

Try to keep the story to 5 or 10 minutes. It's not easy to draw in the dark!

After the story is finished, the lights are turned on. The kids show each other their drawings.

Get ready for a lot of laughs with this activity!

A rabbit may look like a snowman! A lake may look like a rock!

A turtle may look like a dinosaur!

Processing:

·Talk about the frustration of drawing in the dark; did their drawings turn out the way they expected? How can this relate to your life? Do things always turn out the way we plan? What coping skills can we use to overcome the frustration you may feel when things don’t turn out the way you plan? How can you get “more light” on your situation so you are not “drawing in the dark” or living unexpectedly?

Straw Blown Paintings

Here is an activity submitted by Heidi Bolster, CTRS.

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Materials:

·         Paper (preferably thicker paper for painting

·         Acrylic paint

·         Water mixed with acrylic paint to thin the paint for the straw-blowing portion of the activity

·         Paint brushes

·         Drinking straws

Description

·         Patients will paint a background using whatever creativity they like onto the paper until the whole page is painted

·         Patients will use straws to blow the “water thinned” paint across the background painting

·         Patients can create trees with this technique, or they can make spiders/monsters, etc. for a Halloween activity.

Processing questions:

·         How well were you able to control the paint when you were blowing it with the straw? Was it frustrating when it didn’t go the way you wanted? Were you able to create the image in your mind, or did it turn out different than expected? Was it frustrating, and how did you deal with those emotions?

·         Does this happen in life sometimes? (When things don’t go as planned?) How do you deal with this in your life? What are emotions you feel when things don’t go as planned? How do you deal with those emotions? How do you want to deal with those emotions? What can you do right now, while you are in the hospital, to help you manage your emotions and choices when life seems to go a different way than planned?

Got Rec

This is an activity that Brinda Green, CTRS found but was originally posted by Shari Burshytn, CTRS of the Children's Village.

Group Size: 2-20

Equipment:  Construction paper, pens, markers, colored pencils, glue, paint, etc.

Objective: Leisure education, teamwork, leisure skill development, increasing repertoire of leisure skills

Description:
1. Have patients brainstorm together about the benefits of recreation and leisure, and who can benefit from it

2. Break the group into smaller groups of 2-3 depending on the size of the group.

3. Have each group create a public service announcement exploring the benefits of recreation and leisure for THEM PERSONALLY  It can be a print ad or a commercial.

4.  Have the patients share their finished products with the entire group and have staff vote on the best public service announcement.  If possible, give the winning team a prize (i.e. candy).

Building Bridges

This is an activity submitted by the Activity Therapists at Provo Canyon Behavioral Hospital.

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Materials:
Newspaper or Magazines (LOTS!!)
Tape
Something heavy (i.e. textbook)

Tell patients that they need to build a bridge taht will hold the heavy object.  The specifications for the bridge are that it needs to be at least 6 inches tall and 10 inches long.

The rec therapist can add variations as needed, for example:
   -If a person is bossy, tell him he can't talk anymore
   -Give a time limit to create tension
   -Tell someone she has to say "banana" in between each word she says

Processing:
Talk about the experience.  What went well?  What was frustrating?  Consider the following questions:
   -How do you react to stress?  Is that healthy or unhealthy?
   -How do you react to success?  Failure?
   -How do you treat people under pressure?  Is there anything you need to change?
   -How can you diffuse a stressful situation?

For a large group, you can also make it into a competition.  Which team can build the tallest bridge that holds the book?  The most aesthetically pleasing bridge?  Etc.

How to Overcome Perfectionism

I feel like this is a topic that is relevant to many of my patients.  I found this on Pinterest, but it was originally posted here.

Colored Candy Go Round - Boundaries

The Colored Candy Go Round is one of my favorite activities.  It works really well for a low or high functioning group, and I've found that people are more likely to come to group if I bring candy! :)

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Materials
Skittles
Plastic Baggies

Description:
Distribute 10-15 candies to each member of the group. Have each member sort their candy by color with instructions NOT to eat them. Ask one member to pick a color and tell how many they have (i.e. two greens). Ask them to give two (or however many they have) responses to the following questions:

Red: state a word to describe yourself

Yellow: tell about a joyful experience in your life

Green: State a goal you want to make regarding boundaries with others

Orange: name a type of boundary

Purple: Give a compliment to someone in the group

After one person has answered a question have them choose the next person to answer the same question based on the number of candies that person has. The activity is complete when each person has answered all the questions. Candies can be eaten after each question is answered.

Processing Questions:

What did you learn?

Did anything surprise you?

How will you work toward making changes/ improvements?

You can also review any handouts you have on the subject at the end, and tie the game into the daily theme/topic.

This game is also easy to adapt to a variety of themes including the domino effect, getting to know you, etc.

Two Truths and A Lie

I like to use this game after we discuss communication or even as an ice breaker/getting to know you game.

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Materials:
Index Cards
Pens/pencils

Description:
Give each person an index card and a pen.  Instruct them to write down two truths and one lie about themselves on the card.  (Not necessarily in that order!)  I've found that by having the patients write down their three statements, they remember them better and it makes it harder to tell which one is the lie.

After everyone has written down their three statements, select one person to go first.  This person reads his three statements and the group tries to guess which ones are true and which one is false.  After the group guesses, have the person reveal whether or not the group was right.  Then select another player to go, and continue doing so until everyone has had a chance to read their statements.

After everyone has finished, I like to lead a discussion about communication   We talk about non-verbal communication, body language, tone of voice, eye contact, etc. and how that relates to how we communicate with one another.  It also helps us get to know each other and feel more comfortable as a group.

A Rainy Day

This is a fun art project submitted by Heidi Bolster, CTRS.

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Materials:

·         Paper with printout of people with umbrella

·         Painting (canvas) paper

·         Border colored paper (construction paper)

·         Paints (acrylic is best but you can use watercolor too)

·         Brushes

·         Water

·         Paper towels

·         Plates for each patient

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Description:

      1.       Talk with patients about times when they have had a negative (or rainy) day

a.       Ask patients how/if they were able to see the good in all the negative parts of the day

b.      Discuss with patients how one might be able to see the brighter side of life (being positive, etc)

2.       Instruct patients to begin rainy day activity:

a.       Show them an example, have them glue the small cut out of the people standing with the umbrella in the rain to the canvas paper

b.      Instruct patients to choose at least three colors to use to depict the rain in their painting

c.       Show patients how to do small strokes down on their paper in order to create raindrops, and instruct them to paint the rain drops all over the canvas except under the umbrella

d.      *Extra step if patients want: After patients are finished painting, allow them to pic a background color for their border and help them glue the background onto their painting.

3.       After the patients are finished congratulate them on the uniqueness of each of their paintings and discuss how these paintings will help them to remember to see the brighter side to life; even on the darkest and most rainy days.

Anger Management Art Activity

Here is another activity we frequently use at Provo Canyon Behavioral Hospital.  It's great for lower functioning groups!

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Materials:
Anger Management handout (if applicable)
Colored pencils, markers, crayons, etc.
Blank Paper

Description:
Give each patient a blank piece of paper.  Have them draw what anger looks like, feels like, etc. for them personally.  Afterwards, have patients share their drawings with the group.

On the back of the paper, have patients draw or write the answer to the following questions: 1). How have I dealt with anger in the past and 2). How I want to deal with anger in the future.

Discuss the patients responses.  Go over the anger management handout and talk about different coping skills patients can use to deal with anger.

S.M.A.R.T. Goals

We often discuss goal setting in my groups, and one of the things I like to stress is the concept of "SMART" goals.  I thought this was a cute handout on the topic!  Originally posted here.

Honor Collages

This is a great activity for dealing with grief and/or loss.  Submitted by Adrianna Markley, CTRS.

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Materials:
Any handouts you want to use about grief and loss (myths and facts, stages of grief, etc.)
Construction or white paper
Colored pencils or crayons
Glue
Scissors (Optional)
Magazines that can be cut up

Description:
Lead a discussion on grief and loss, incorporating the handouts

Have patients make a collage to honor a person/pet they have lost and shared with the group.  Emphasize that the loss does not necessarily mean death, it could be that a friend moved away, a close relationship that isn't close anymore, etc.

Processing questions:
-Why did you pick that person to honor?
-How have you dealt with that loss?
-What coping skills have you used? (Positive and/or negative)
     -Discuss coping skills and strategies
-How does it feel to honor the person you have lost?

Box of Chocolates

This activity was created by Heidi Bolster, CTRS.  It's a lot of fun!

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You Never Know What You’re Gonna get in a Box of Chocolates…

Materials:
-Cut up about 20 small strips of paper
-Something for patients to write with
-Candy (preferably chocolate)

Directions:
Talk about the different elements of communication (tone, verbal, no verbal, etc.).  Discuss why it is important to communicate appropriately and clearly with others Discuss emotions in relation to communication and talk about how difficult it can be to assume someone else’s emotion at times.

Hand out strips of paper and writing utensils to patients and have them write down and discuss different emotions on the strips of paper. Have patients put strips of paper in a bag.

Show the patients the written statement, “You Never Know What You’re Gonna get in a Box of Chocolates…”

Instruct patients to, one at a time, pick an emotion from the bag and act out the emotion while saying, “You Never Know What You’re Gonna get in a Box of Chocolates…”  Allow the other patients to try and guess the emotion; once the emotion is guessed, the person who guessed it correctly goes next This is similar to emotion charades.  After everyone has had a few turns discuss the ease or difficulty with which the patients could act/guess the emotion that was picked from the bag.  Talk about the importance of tone & body language in the absence of words.

Discuss how the difficulty of presenting/guessing the emotions relates to their current situation in treatment.  How can they be more clear and appropriate in communicating their feelings? How can this benefit them in the hospital and how can this benefit them after discharge?  Give the patients chocolate for participating and encourage them to make small goals to help them improve their communication skills.