major depression (recurrent); symptoms include: decreased self esteem, self worth, poor self image, and feelings of hopelessness and helplessness (which result in her believing that she does not have control over her life)
borderline personality traits: binge eating, impulsiveness, unstable affect
histronic personality: constant seeking of reassurance, desire to be center of attention, exaggerates self-expression
attention deficit / hyperactivity disorder, combined type: inattention in work and related tasks that lead to things being left unfinished
secondary deficit: arthritis fibrositis
Roles and Responsibilities
mother (5 year old daughter)
responsible for homemaking and child rearing tasks
client expressed interest in cooking (especially Indian dishes)
since daughter is sole reason for living, a primary goal in her life is to be able to take care of her daughter
expresses interest in re-connecting with her culture
interest in increasing social interactions
can concentrate for 20 minute time period
To enable her to function at a stable and optimal level in her daily roles and routines.
1) empower client to develop a sense of control in her life, which can be achieved by increasing her self esteem and self worth and developing effective coping strategies
2) deal with ADHD by gradually increasing the amount of concentration and attention needed in the activity
3) educate her on nutrition and the maintenance of health
4) develop interpersonal skills
use cooking utensils with built-up foam handles to avoid irritating vulnerable joints
- Prior to the first session, the OT and Betty may discuss the food to be prepared to ensure that she understands the instructions fully and the nutritional value of the dish. The therapist can discuss safety issues in the kitchen (example the fire extinguisher). A brief orientation of the kitchen, including locations of ingredients, appliances, etc. can also be done at this time
- Betty will prepare Indian vegetables and rice. The OT will be present during this activity to answer Betty's questions and to provide her with assistance as needed
- Procedure for recipe:
- wash and cut vegetables
- put rice in boiling water (use timer)
- sauté vegetables with spices
- take rice out of pot
- clean up
- She can write in a journal to explain how she felt during the activity (i.e. stressors, how effective she felt she was in her performance, and how she felt she could improve)
- she can write in the journal right after session or bring it home to complete at her leisure and as her feelings change in between sessions
- increase complexity of recipe (she can choose the recipe without the help of therapist)
- recipe requires more time, more ingredients, longer procedure, etc.
- Gradually decrease assistance from therapist - encourage Betty to problem solve rather than seeking answers and constant reassurrance from therapist
- work within a group of 8 - 10
- each person prepares an Indian dish; share the meal (allows for social interaction)
- work one on one with another person in preparing a meal
Coping and Self-esteem:
- Concentration and attention can be graded by increasing the length of time of the session and complexity of the recipe
Interpersonal Skills & Insight:
- The therapist will take note of the number of times the client asks for reassurance. If there is a decrease in the number of times, the therapist can assume that she is using her problem solving techniques and her self confidence and esteem have increased
- Betty's insight can be graded as she uses her journal and collaborates with the therapist in making competent decisions regarding advancement into the next level of therapy.
- Betty's interpersonal skills will be graded during her group sessions, as she develops the ability to express her emotions appropriately in the group (e.g. patience, tolerance, suppressing the need to be the center of attention).
- As she moves from the one on one sessions with the therapist to working within a group, she will be provided with more complex interpersonal experiences such as negotiation, division of labour and shared accomplishment.
- Client will be given as much control in the rate of therapeutic progression as possible. Her increased feelings of control will be demonstrated by the progression through the prediscussed levels of therapy.
Cognitive / Insight:
- Therapy sessions will be an excellent testing ground for Betty to gain insight into her negative and pessimistic perceptions. With each culinary success, these perceptions can be re-examined.
- Later, she can also compare her success to that of others in the group, thereby developing more realistic self-expectations.
- Through the use of journalling and choosing her own recipes, Betty can gain insight into her abilities and limitations.
- The process of doing an activity she enjoys and experiencing success will increase self-esteem and feelings of control. Furthermore, with the help of the therapist, the client can gain confidence and competence in her problem solving skills.
- Conducting an activity like cooking in a group can build a lacking social network in her life as well as allowing a safe place to develop her skills at working with others. Such skills can hopefully later be generalized to a work environment.