Betty has survived extensive emotional trauma in her life (physical abuse, mental abuse, rape). Rather than examining and dealing with her pain, anger, and frustration, she has swept many of her "undealt with" problems under the rug. She feels that she must "put aside the previous abuse and keep going". Additionally, she has employed the denial defence mechanism to cope with her episode of sexual assault. As a result, she has developed a mental illness. She has been diagnosed with a recurrent form of Major Depression. She has also developed some maladaptive personality traits such as impulsivity, instability of affect, and binge eating (symptoms associated with Borderline Personality traits). On a more emotional level, Betty often seeks reassurance, displays seductive behavior, and exaggerates self-expression (symptoms of Histrionic Personality disorder). Through occupational therapy, we feel that some of Betty's issues can be addressed. Of immediate concern are the issues of her depression, her lack of desire to live, and the absence of any personal leisure pursuits in her life. These are all very complex issues, but they all share a simple origin that is within Betty's locus of control to change. It is neglect in realizing, accepting and dealing with her feelings. These are the three skills we would like to focus on and develop, through our chosen activity, painting.

As painting allows for self-expression and revelation of emotional content, we feel that it has great therapeutic potential for Betty. We are assuming that talking about her problems and feelings does not go against any of Betty's cultural beliefs. Such a creative outlet will encourage her to become more introspective. Eventually, she will find it easier to really get in touch with the darker aspects of her life, and challenge the negative effects that they have had on her. Ultimately, her sense of self-esteem will improve, and she will build successful interpersonal relationships (currently, she has a past of dysfunctional relationships).

We will start Betty out painting still life images. She will paint simple, concrete objects (perhaps just shapes at first) in order to learn some basic skills, and build confidence in her abilities. She will be asked to briefly critique her work, in a dual attempt to build rapport with the therapist, and at the same time encourage her to become absorbed in, and concerned with herself and her project. Due to her attention-deficit/ hyperactivity disorder, we will start with short sessions (20 min. to 1/2 hr.) to avoid boredom, or loss of concentration.

As progress is made, Betty will be prompted to paint more from her imagination than still life, making the activity both more difficult and self-expressive. The therapist, while maintaining an environment of unconditional positive regard, will encourage Betty to "release" in her work, and continue to critique and explain as much of her painting as she feels comfortable with. With time, painting will be utilized as a projective technique. As Betty's interest and ability heighten, the duration of her painting time will also be increased. Gradually, she will become more in touch with the issues she has been covering, as she allows her anger and confusion to manifest itself in her artwork.

In the case that Betty feels reluctant to pursue this past-time without her daughter present (her existence currently revolves around her daughter), the therapy will include Betty's five-year old for the first few sessions, or until Betty feels comfortable enough to continue alone. Keeping in mind that Betty's daughter is also hyperactive, plenty of toys and activities (eg: finger painting) will be provided. Eventually, it is important that Betty become engaged in an activity by and for herself, so that a sense of purpose and self-worth can be achieved.

An additional (secondary) concern is Betty's arthritis. We have assumed her arthritis to be mild, and in her wrists and fingers. We will provide a brush with an adapted handle so that not too much fine motor movement is necessary on the days when the arthritis flares up. Her sessions, if necessary, will be scheduled during a time of day at which the condition is least aggravated (eg: mid-day).

As therapy comes to a close, and Betty approaches discharge, the occupational therapist will do a home visit to find an appropriate place in Betty's house for an easel. We would like her to continue with this individual hobby, so every attempt to promote ongoing involvement in it will be made. With time, a long-term goal may be to involve Betty in a painting group to enhance her ability to create healty interpersonal relationships.