Betty, our last client, suffers from a variety of psychological disorders. Her primary areas of concern are Attention Deficit Disorder (ADD) with hyperactivity, and major chronic depression. She has suffered physical, emotional, and sexual abuse. The resultant behavior observed is psychomotor agitation, impulsiveness, binge-eating, thought disorder and instability. She shows decreased occupational functioning as assessed by the Global Assessment Functioning (GAF) score. This is apparent in her inability to hold a steady job while currently relying on social assistance. Betty previously attempted suicide, and states that her main reason for living is her five year old daughter.

Adaptations are made to accommodate Bettyís psychological instabilities since she does not suffer from major physical impairments. Our primary focus areas are her productivity and leisure. We are assuming that upon engaging her interest in a leisure pursuit, her productivity levels will also improve. Initially, her daughter will have to be involved in the therapy process as Bettyís self-motivation is very poor.

1) Adaptations - Bettyís drawing/coloring environment should be in a large, comfortable, well-lit room with only the necessary art materials and supplies laid out. Pleasant warm colors rather than institutional colors such as gray should enhance the room.

Grading - Eventually, the room can be filled with non-art supplies such as plants, wall decorations, and possible even a stereo.

Therapeutic Benefits - We would like to first sustain Bettyís interest in the activity by reducing as much distracting stimuli as possible. If the room contains only the essentials relating to the activity, her focus will have to remain on the activity.

2) Adaptations - Using general themes and topics for the drawings will allow Betty to involve herself in the therapeutic activity, and leave time for her to adjust.

Grading - Over a long period of time, the incorporation of gradually more complex themes should be implemented. The themes should begin to touch upon issues such as her sexual abuse trauma and her abusive situation with her mother.

Therapeutic Benefits - The increasing complexity of the themes allows a safe emotional outlet for repressed or painful feelings. Betty can express herself in a nonthreatening and nonjudgmental environment which will be useful for self-healing and realization.

3) Adaptations - Initially, we would have Betty start and complete her projects within a time frame comfortable for her. She must be able to maintain her concentration on the activity within that time frame.

Grading - As she progresses in her ability to focus, the time frame can be increased. For example, we can start with a 10 minute project, then increase the time period by 5 minutes per month until she is able to concentrate and complete a drawing within 1 hour. Depending on her progress, the time frame can be gauged accordingly.

Therapeutic Benefits - By working within a time frame, Betty can focus her attentions to one activity or task. This will slowly increase her concentration capacity and train her thought distraction. To focus on an activity and complete it requires self-control and stability. This can eventually transfer to other areas of her life.

4) Adaptations - As Betty begins to build self-confidence and maintain some balance in her life, we can begin to isolate the activity from her daughter. This will become necessary as emotional themes become increasingly complex.

Grading - Increasing the complexity of the themes in conjunction with having Betty begin to work on her own will be a slow process. Perhaps Betty can continue to work with her daughter but not as frequently, and emotionally complex issues should exclude her daughter altogether.

Therapeutic Benefits - Independence in the activity will impact her self-esteem and give her a sense of accomplishment. Her productivity levels and job stability will also benefit as a result of the discipline with her own leisure pursuits.

Secondary Benefits: Bettyís psychomotor agitation and exaggerated self-expression may benefit from expression of painful emotions through drawing and coloring. Her impulsive behavior may be curbed to some degree, and her increasing independence can help with her dependency issues.